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Research ArticleOriginal Research

Influence of Shared Medical Appointments on Patient Satisfaction: A Retrospective 3-Year Study

Leonie Heyworth, Ronen Rozenblum, James F. Burgess, Errol Baker, Mark Meterko, Debra Prescott, Zeev Neuwirth and Steven R. Simon
The Annals of Family Medicine July 2014, 12 (4) 324-330; DOI: https://doi.org/10.1370/afm.1660
Leonie Heyworth
1Veterans Administration Boston Healthcare System, Jamaica Plain, Massachusetts
2Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
MD, MPH
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  • For correspondence: lheyworth@gmail.com
Ronen Rozenblum
2Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
PhD, MPH
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James F. Burgess Jr
1Veterans Administration Boston Healthcare System, Jamaica Plain, Massachusetts
PhD
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Errol Baker
1Veterans Administration Boston Healthcare System, Jamaica Plain, Massachusetts
PhD
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Mark Meterko
1Veterans Administration Boston Healthcare System, Jamaica Plain, Massachusetts
PhD
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Debra Prescott
3Harvard Vanguard Medical Associates, Newton, Massachusetts
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Zeev Neuwirth
4Carolinas Healthcare, Charlotte, North Carolina
MD, SM
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Steven R. Simon
1Veterans Administration Boston Healthcare System, Jamaica Plain, Massachusetts
2Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
MD, MPH
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  • Figure 1
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    Figure 1

    Trends in satisfaction with SMA care, 2008–2010, according to previous experience with this model.

    SMA=shared medical appointment

Tables

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    • View popup
    Table 1

    Baseline Characteristics Before and After Propensity Matching for Usual Care and SMA Patients

    Before Propensity MatchingAfter Propensity Matching
    CharacteristicUsual Care, % (n=34,619)SMA, % (n=981)P ValueUsual Care, % (n=921)SMA, % (n=921)P Value
    Age, y
    <6522,608 (65)490 (50)<.001471 (51)454 (49).4
    ≥6512,011 (35)491 (50)450 (49)467 (51)
    Sex
    Male12,347 (36)558 (57)<.001508 (55)526 (57).4
    Female22,272 (64)423 (43)413 (45)395 (43)
    Race/ethnicity
    White, non-Hispanic27,556 (84)882 (91)<.001823 (89)835 (91).4
    Other5,212 (16)91 (9)98 (11)86 (9)
    Insurance status
    Private22,409 (65)527 (54)<.001514 (56)491 (53).3
    Medicare/Medicaid12,161 (35)453 (46)406 (44)430 (47)
    Health care use
    Internal medicine visits
     ≥5 in prior 12 mo22,006 (64)769 (78)<.001728 (79)728 (79)1.0
     ≤4 in prior 12 mo12,613 (36)212 (22)193 (21)193 (21)
    Urgent care visits
     ≥2 in prior 12 mo15,241 (44)538 (55)<.001487 (53)503 (55).5
     ≤1 in prior 12 mo19,378 (56)443 (45)434 (47)418 (45)
    Chronic conditions
    Hypertension13,502 (39)606 (62)<.001573 (62)585 (64).5
    Cardiovascular disease3,003 (8)147 (15)<.001125 (14)144 (16).2
    Diabetes4,215 (12)248 (25)<.001206 (22)233 (25).1
    Tobacco use12,302 (42)409 (50)<.001407 (52)382 (50).4
    Number of medications
    ≥617,836 (52)620 (63)<.001573 (62)586 (64).5
    ≤516,783 (48)361 (37)348 (38)335 (36)
    • SMA=shared medical appointment.

    • View popup
    Table 2

    Satisfaction With Care for Propensity-Matched Patients in SMAs Relative to Those in Usual Care Visits

    Visit Experience ItemAdjusted OR (95% CI)P Value
    Enhanced access to care
     Ability to get desired appointment1.49 (1.21–1.92)<.001
     Convenience of office hours1.22 (1.02–1.45).03
     Promptness in returning calls1.06 (0.91–1.81).44
     Wait for laboratory tests1.49 (1.21–1.92).03
    Coordination of care
     Speed of registration0.94 (0.73–1.22).66
     Wait for clinician in examination room1.13 (0.91–1.40).28
     Clinician information from specialist physicians0.86 (0.73–1.01).07
     Clinician had information to diagnose/treat0.85 (0.70–1.04).11
    Personal physician communication
     Clinician explanation of problem/condition0.60 (0.50–0.73)<.001
     Information clinician gave about medication0.64 (0.54–0.77)<.001
     Time clinician spent with patient0.52 (0.50–1.60)<.001
     Concern expressed by clinician0.58 (0.50–0.70)<.001
    Team-based care
     Friendliness/courtesy of nurse/assistant1.27 (0.97–1.65).08
     Concern nurse/assistant showed for problem1.13 (0.96–1.34).15
    Whole-person orientation of care
     Sensitivity to patients’ needs1.34 (1.08–1.65).01
     Concern for patients’ privacy1.14 (0.97–1.35).12
     Patient’s confidence in clinician1.13 (0.91–1.38).27
    Overall impressions
     Overall satisfaction with care provided in visit1.26 (1.05–1.52).01
     Recommend clinician0.93 (0.75–1.16).54
    • OR=odds ratio; SMA=shared medical appointment.

    • Note: Odds of rating the item as “very good.” Results are propensity score matched to account for differences in variables that are related to SMA participation. See Methods for details.

    • View popup
    Table 3

    Satisfaction With and Perceptions of the Clinician Among SMA Patients According to Previous Experience

    Visit Experience ItemAdjusted OR (95% CI)P Value
    Overall satisfaction with care provided in visit1.86 (1.39–2.48)<.001
    Clinician explanation of problem/condition1.58 (1.17–2.14).003
    Information clinician gave about medication1.54 (1.16–2.03).003
    Time clinician spent with patient1.58 (1.17–2.12).002
    Concern expressed by clinician1.63 (1.19–2.25).003
    • OR=odds ratio; SMA=shared medical appointment.

    • Note: Odds of rating the item as “very good,” comparing patients with prior SMA experience (n = 569) with patients in their first SMA (n = 352).

Additional Files

  • Figures
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  • In Brief

    The Influence of Shared Medical Appointments on Patient Satisfaction: A Retrospective 3-Year Study.

    Leonie Heyworth , and colleagues

    Background In shared medical appointments (SMAs), multiple patients are seen as a group by a health care team for follow-up care or management of chronic conditions. SMAs represent an innovation that could improve access, cost, disease management outcomes, and patient-centeredness in primary care. This study examines satisfaction and patient-centered care experiences among patients attending SMAs compared with usual care appointments.

    What This Study Found In a large multispecialty group practice, patients attending group appointments report greater overall satisfaction compared with those attending individual primary care office visits. SMA patients are more likely to rate their overall satisfaction with care as "very good" and rate their visits as more accessible and more sensitive to their needs. Usual care patients consistently report higher levels of satisfaction with their relationship with their clinician, including time spent and communication during the encounter, compared with SMA peers.

    Implications

    • In an understaffed primary care system facing growing numbers of eligible patients, SMAs may accommodate a greater number of patients in a timely fashion.
    • The authors call for additional research to examine satisfaction with group visits over time and identify strategies to enhance patient-clinician communication within shared medical appointments.
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The Annals of Family Medicine: 12 (4)
The Annals of Family Medicine: 12 (4)
Vol. 12, Issue 4
July/August 2014
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Influence of Shared Medical Appointments on Patient Satisfaction: A Retrospective 3-Year Study
Leonie Heyworth, Ronen Rozenblum, James F. Burgess, Errol Baker, Mark Meterko, Debra Prescott, Zeev Neuwirth, Steven R. Simon
The Annals of Family Medicine Jul 2014, 12 (4) 324-330; DOI: 10.1370/afm.1660

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Influence of Shared Medical Appointments on Patient Satisfaction: A Retrospective 3-Year Study
Leonie Heyworth, Ronen Rozenblum, James F. Burgess, Errol Baker, Mark Meterko, Debra Prescott, Zeev Neuwirth, Steven R. Simon
The Annals of Family Medicine Jul 2014, 12 (4) 324-330; DOI: 10.1370/afm.1660
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  • patient satisfaction
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