A brief review of the evidence for Shared Medical Appointments (SMAs) and Medical Yarn Ups (MYUs)

SMA nomenclature and process

Shared Medical Appointments (SMAs) are also known in the medical literature as Group Consultations, Group Medical Appointments, and when applied to the care of Aboriginal and Torres Strait Islander people, Medical Yarn Ups (MYUs).

A typical SMA may take up to 90 minutes with 8-12 patients attending with similar concerns, managed and supported by a trained facilitator, in which the General Practitioner (GP) consults with each patient individually and consecutively,  according to the requirements of their scope of practice and the Health Insurance Regulations (2021).

The SMA process is predicated on a personal attendance, by a single medical practitioner, being provided to a single patient, on a single occasion – this is an important consideration if an Australian provider is intending to claim MBS item numbers.

The requirements of a consultation are met in a SMA as the GP evaluates the patient’s health-related issue/s; formulates a management plan in relation to the health issues; provides advice to the patient and/or their relatives (if authorised by the patient); provides appropriate preventive health care; and records the clinical detail of the service(s) provided to the patient.

The main difference that the SMA process offers is that other patients with similar concerns are listening and, when appropriate, are asked to contribute their knowledge and lived experience to a conversation that might follow the consultation.

Evidence for SMAs

There is a large and growing body of evidence showing that this difference in the consultation process is making significant improvements to: patient outcomes, practice efficiencies and cost effectiveness^{1 2 3 4 5 6 7}; reduced waiting times^{5 7 8}; reduced presentations to emergency departments and hospital admission rates^{2 8 9 10}. The literature also strongly and consistently reports that SMAs improve patients’ knowledge and self-management competency^{3 11 12}. SMA consultations are a rare example of a model that meets healthcare’s quintuple aim of better cost-effective care and outcomes, better education, high patient, and clinician satisfaction^{6 13 14 15} .

SMAs as a strategy in Closing the Gap

Shared Medical Appointments provide a model of care that is of great interest in Aboriginal Controlled Community Health Organisations (ACCHO’s) as it also offers improved accessibility while being culturally safe and responsive^{3 16 17 18}. The  model has been named  Medical Yarn Up by the ACCHOS  and their clients using it. Medical Yarn Ups have been reported in the literature and through roundtable discussions facilitated by ASLM, to being an important strategy in closing the Gap^16,18.

SMAs, current practice, and collaborations with Primary Health Networks

ASLM is currently working with a number of PHNS to develop SMAs as an adjunct to General Practice. The PHNs are engaging SMAs as a strategy to enhance primary care’s capacity to manage the rise in lifestyle-related chronic disease presentations and workforce issues.

ASLM has trained over 1200 clinicians in the last 5 years in the SMA process and conducted a number of trials showing its effectiveness and acceptance by patients and providers in practice³. ASLM has worked with UK and NZ health Services to help develop equivalent SMA processes that are now integrated into services in those countries⁵. The UK is now routinely using Group Consultation (SMAS) in over 1000 medical centres. Group Consultations, as SMAs are referred to in the UK, have been identified by the NHS as the most important strategy for reducing ~8 million patient waiting list in the aftermath of the Covid 19 pandemic¹⁹.