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Editorials |

Shared Medical Appointments: Challenges and Opportunities

Andrea Sikon, MD; and David L. Bronson, MD
[+] Article and Author Information

From Cleveland Clinic Foundation, Cleveland, OH 44195.


Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1000.

Requests for Single Reprints: David L. Bronson, MD, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.

Current Author Addresses: Drs. Sikon and Bronson: Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.


Ann Intern Med. 2010;152(11):745-746. doi:10.7326/0003-4819-152-11-201006010-00012
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A perfect storm is placing increased stress on our health care system. The forces involved include the aging of the baby boomer population, the growing obesity epidemic, scientific advances in treatment options, and the anticipated growth in insured patients due to recent health care reforms. These factors will substantially increase the number of patients who present for care of multiple chronic diseases, with an associated increase in medical expenditures. At the same time, the number of medical school graduates who enter and sustain careers in general internal medicine and family medicine in the United States are at historically low levels. This rapidly approaching access and affordability crisis creates an urgent need for innovations in health care delivery. It is therefore not surprising that many studies have been recently published outlining new models of practice design, including shared medical appointments (also called group visits), an innovative alternative to the traditional patientphysician encounter.

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Satisfaction with SMA
Posted on June 24, 2010
Christine Peterson
Philadelphia VA
Conflict of Interest: None Declared

Drs. Sikon and Bronson wrote of their resource intensive SMA diabetes clinic at the Cleveland VA .

We have been conducting SMA at the Philadelphia VA for more than 3 years.

Our model differs in that it is very patient centric and not resource rich.

Patients are referred by their PCP for a 3 hour session, the first of which is used for VS and serial mini H and PE. The next 2 hours are spent discussing each person's self care management issues using a white board to display lab values, weights and BP. Another board is used to display individual FBS values, dietary patterns etc under discussion. Patients are requested to come back on an as needed basis. Some may need to be back in one week and others need Q 3 mo coaching to sustain their effort. We have found that individualization of visits and Q3 mo return is key to improving glycemic control. All participants sign an agreement of confidentiality every time they attend and all receive written instructions when they leave. Every week we try to have a guest from one of the following: optometry, podiatry, behavioral health, renal or vascular disciplines for a 15 minute discussion about complications. This is accomplished with a CRNP/CDE provider and RN/CDE and RN. Our results have been consistent with others, and our patients and clinicians report great satisfaction.

Conflict of Interest:

None declared

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