A win-win consultation
Since childhood, we learned our 1, 2, 3’s through to our A, B, C’s in a classroom setting, engaging with our peers and listening to our teachers. Fast forward to adulthood, and it appears a similar technique via Shared Medical Appointments may be the answer to our chronic disease epidemic.
Chronic diseases, such as high blood pressure, diabetes, depression, arthritis, and cancers are growing rapidly. Professor of Lifestyle Medicine at Southern Cross University, Garry Egger suggests “About 70 to 75% of all diseases these days are chronic diseases and they are related to lifestyle, and chronic diseases are going up and up and up.”1 Furthermore, these chronic diseases, many of which are preventable, are the leading cause of illness, disability and death in Australia, accounting for 90% of all deaths in 2011.2
Despite the significant health burden of chronic diseases, many Australians lack knowledge about the management of these conditions. A survey3 of over 2,000 Australian adults indicated that less than half of the participants were aware that most people should consume two serves of fruits and five serves of vegetables daily. Over a third of participants were unaware of the beneficial effects of omega-3 fatty acids on the prevention of heart disease.
Doctors and other health professionals should be educating patients on lifestyle interventions such as a nutritious diet, regular physical activity and stress management techniques for the management of chronic diseases. However, the traditional model of care involving six to ten minute one-on-one consultations with a doctor provides inadequate time for a thorough medical examination, note taking and prescription writing, let alone quality education around chronic conditions and time for patient’s questions to be answered.
Professor Egger highlights, “Just as the six minute one-on-one medical consultation lacks educational input, the educational group lacks medical input. What’s needed is a middle road.”4
The solution?
Shared Medical Appointments (SMAs) have been employed in the United States since the 1990s as an adjunct to traditional consultations to help address this issue. SMAs are defined as “a series of individual office visits sequentially attending to each patient’s unique medical needs individually, but in a supportive group setting where all can listen, interact and learn.”5
They typically involve 10-12 patients at a time, along with their medical practitioner and a trained facilitator (generally a practice nurse or allied health professional). Consultations run for 60-90 minutes, which provides greater time for education and questions to facilitate lifestyle modifications.
Patients reported having more time to ask questions, learn from others and receive peer support during these SMAs.
“I got so much out of this because I heard answers to questions that I always forget to ask the doctor.” – Patient 1
“I got the opportunity to tell the young ones about what had happened to me and I look forward to thinking more about that for next time.” – Patient 2
Health providers have improved their practice after realising the need to communicate in simpler ‘patient-friendly’ terms.
“One of the things I realised out of doing these SMAs is that we [doctors] assume medical literacy. We think we adjust our language to meet the knowledge of the patients, but obviously we don’t do it as well as we think – people in these groups still didn’t know the difference between fat, carbohydrate and protein. I assumed they would … So I’ve been telling them things they have no hope of understanding! I’ve already changed that in my practice…” – GP, New South Wales
Other benefits reported include a reduction in repetition of information, increased efficiencies, and the opportunity to work in a multi-disciplinary team.
SMAs in Australia
SMAs have been successfully conducted in Australia since 2014.
Despite initial reservations about incorporating SMAs into practice, both health-care providers and patients have reported great satisfaction from these group consultations. Both doctors and patients have reported feeling more ‘relaxed’ during the consultation, and patients have felt comfortable sharing intimate medical details from sexual health to bowel habits. Confidentiality concerns are addressed by signing a Confidentiality Agreement prior to the consultation and engaging in a pre-consultation briefing with the facilitator.
Given the doctor still addresses each patient’s concerns individually, but with the added benefit of peer support and education for others, health-care providers have been able to successfully bill patients on Medicare.
How do I find out more?
The Australasian Society of Lifestyle Medicine conducts one day face-to-face Shared Medical Appointment training sessions. Click here to find out more.
And remember, SMAs may not be for everyone, but they may be the perfect adjunct to tackling the chronic disease epidemic.
- Lifestyle Medicine [radio programme]. The Health Report: Radio National; 2009 February 2. Available from: http://www.abc.net.au/radionational/programs/healthreport/lifestyle-medicine/3181214
- 2 Chronic disease – Australia’s biggest health challenge [Internet]. Canberra: Australian Institute of Health and Welfare; 2014 [cited 2017 May 14]. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129547726
- Deakin University, Centre for Physical Activity and Nutrition Research. Food Knowledge Survey 2011: Preliminary Report [Internet]. Available from: https://www.deakin.edu.au/__data/assets/pdf_file/0020/307028/food-knowledge-survey-report.pdf
- Egger G. How shared medical appointments could improve chronic disease treatment [Internet]. Radio National; 2014 [cited 2017 May 14]. Available from: http://www.abc.net.au/radionational/programs/ockhamsrazor/5951658
- Noffsinger E. The ABCs of Group Visits An implementation manual for your practice. New York: Springer-Verlag; 2012.
This article was written for the Australasian Society of Lifestyle Medicine (ASLM) by Shivaun Conn, Dr Kate Marsh, Dr Flavia Fayet-Moore, and Dr Cameron McDonald (Accredited Practising Dietitians and members of the ASLM Board).
