Clinical effectiveness of shared medical appointments

Introduction: The Shared Medical Appointment (SMA) is considered an efficient alternative to conventional one-on-one appointments. During an SMA, 90-minute primary care appointments are conducted in a group setting among 8 to 17 patients. Although studies indicate high levels of patient and provider satisfaction with SMAs, few studies have examined their clinical outcomes. We investigated the clinical effectiveness of SMAs.

Methods: Medical records of patients (N=63) with type 2 diabetes who attended at least two SMAs in the Parkland Community Oriented Primary Care clinics were reviewed. Clinical parameters pertaining to glycemic control, presence of co-morbid conditions, adherence to preventive guidelines, and presence of complications were recorded before and after SMA attendance.

Results: Analysis revealed no change in the level of glycemic control or co-morbid conditions following SMA attendance. Adherence to preventive guidelines improved in regard to influenza vaccinations (31% before vs. 53% after SMA, P=0.018). The number of complications declined; of these, the decrease in cardiovascular disease events was statistically significant (2.20 vs 1.88, P=0.014). LDL levels improved in unmarried patients and females but worsened in married patients and males after SMA attendance (-9.9 mg/dl for unmarried vs. +12.5 for married, P = 0.115); (-4.1mg/dl for females vs. +9.6 for males, P=0.357).

Conclusions: Although many of the clinical outcomes improved following SMA attendance, the overall patient improvement was similar to or slightly better than that prior to SMA attendance. In addition, unmarried and female patients may benefit more from the social interaction during SMAs than married and male patients.