Group medical visits: Enhancing chronic illness care

Issue: BCMJ, Vol. 50, No. 6, July, August 2008, page(s) 297 GPSC
Liza Kallstrom

An “impressive tool for change” is how Dr Judy Dercksen des­cribes group visits—one of four modules offered by the General Practice Services Committee’s Practice Support Program (PSP). 

The Quesnel GP, who practised in South Africa until 5 years ago, first learned about group visits at an Institute for Healthcare Improvement (IHI) conference in the US. She was immediately taken with the approach, which puts chronic disease patients together for medical visits—and in the process improves access to medical appointments, uses resources more efficiently, helps motivate behavior change, and ultimately improves outcomes.

“The vast majority of my diabetes patients—some of whom have been very resistant—have made noticeable changes in their lifestyle,” says Dr Dercksen.

Who can participate?
A group medical visit includes several patients with the same or similar chronic conditions who meet with a health care team that consists of two or more of the physician, medical office assistant, nurse, dietitian, or specialist. Candidates for group visits are patients with chronic illness or particular problems (e.g., diabetes, blood pressure management) who need regular monitoring, patients in a specific age group (e.g., frail elderly), and patients who might benefit from a  support structure. 

Group visits allow patients to learn from providers as well as from other patients. There’s more time to address psychosocial issues, which in turn helps patients put their illness into perspective and boosts their confidence in their self-management abilities.

Enderby GP Dr Allison Rankin says group visits would work in any practice with complex or elderly patients, or those with comorbidities. “Let’s face it—these days, that’s most practices,” she says. 

Dr Rankin also learned about group visits at an IHI conference, and is now a GP champion on Interior Health’s PSP team. In that role, she will mentor her colleagues participating in the group visit module.

Group visits: Coming soon
PSP group visit modules will soon be available in all health authorities. The sessions will enable practices to identify the group visit model that will work best in that practice, identify patient populations, plan, conduct, and evaluate group visits, and identify patient issues and outcomes.

“There is no set recipe for group visits—my team has tried a few different ways,” says Dr Rankin. Her most recent sessions—with chronic pain patients—have been extremely successful. She has just completed her fifth session and the group is at the point of exchanging contact information with each other, sharing resources, and arranging for other participating health professionals for upcoming sessions. 

“I was at the point where I thought I couldn’t help my pain patients,” says Dr Rankin. “But when you put them together in a group and they can support each other as well as get the medical attention they need, things really turn around.”
Medical care is always part of the visit, says Dr Rankin. “Patient evaluations, necessary lab tests or physical exams, and updating of charts and flow sheets still happen,” she says.  “It just takes place in a more relaxed setting, which reduces anxiety and leads to better and broader education.”

The GPSC, a BCMA/Ministry of Health joint committee, administers approximately $100 million annually through the Full Service Family  Practice Incentive Program, which is designed to support improvements in primary care. These include:
• Complex care
• Facility and community case conferencing
• Prevention
• Chronic disease management
• Community Based Mental Health Initiative
• Family Physicians for BC (FPs4BC)
• Maternity Care for BC (MC4BC)

Through the Practice Support Program, GPSC offers training modules in ad­vanced access, group medical visits, managing patients with chronic diseases, and patient self-management. 

For more information on the GPSC, visit www.bcma.org and for PSP, visit www.practicesupport.bc.ca.

—Liza Kallstrom
Lead, Change Management and Practice Support 

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