Introducing Group Visits

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Introducing Group Visits
Change Management Topic
Practice Support Program
www.practicesupport.bc.ca
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Introduction

• Group visits make efficient use of resources,
  improve access, and use a group process to help
  motivate behaviour change and improve outcomes.
• A group visit provides the opportunity for
  multiple activities. Staff can evaluate patients,
  perform exams and tests, and update patient
  charts and flow sheets.
• Group visits can also include education sessions
  on specific topics. Sessions are held by the
  physician or a specialist, such as a dietician,
  mental health worker or diabetic nurse.

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Introducing Group Visits
Group visits are very helpful for both the
practice and the patients. Were starting to use
group visits to promote patient self-management,
action planning, and personal health files. Group
visits are a great tool that can integrate many
different health interventions at once. Shari
Pereira, LPN (Dr. Johan Bothas office, Kitimat)
Masset diabetes group clinic
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Benefits for patients

• Learn about their illness from providers and
  other patients
• Share their experience
• Gain support from the group
• Better access to physicians and the medical team
• Opportunity to ask questions they might not ask
  in solo visit

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Benefits for patients continued

• More time for psychosocial issues
• Put their own illness experience into perspective
  
• Improve their long-term health
• Gain confidence in their ability to self-manage
  their conditions

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Benefits for physicians and their staff

• More efficiently manage patient care and
  follow-up (much less repetition of the same
  information)
• Reduce patient hospitalizations and emergency
  room visits.
• Spend more time with patients in a relaxed
  setting
• Educate patients about their illness

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Benefits for physicians and their staff
continued

• Reduce patient anxiety
• Increase patient participation in ongoing care
• Provide systematic follow-up
• Increase professional satisfaction
• Ease practice load by reducing number of
  individual appointments

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Objectives

• After completing this module, clinical practices
  will be able to
• Identify the needs they want to address through
  group visits and the outcomes they would like to
  achieve
• Identify the model of group visit that will work
  best for their practice
• Dr. Shirley Sze, Kamloops, with her group
• visit team, a diabetic nurse educator (left)
• dietitian (right).

• For any type of chronic disease, the group
  visit model is very beneficial for patients. They
  get far more education and care than I can
  deliver in my checkups with them, and they get it
  in a familiar and comfortable settingtheir
  family doctors office.
• Dr. Sze

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Objectives continued

• After completing this module, clinical practices
  will be able to
• Identify a patient population for a group
  visit
• Plan a group visit
• Conduct an effective group visit
• Evaluate and improve how their group visits
  are going

Dr. Philip White (centre), Kelowna,
with nurse educator and specialist
This type of intervention with patient
participation is making complex care fun and
interesting for the patients and care team. Dr.
White
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Group Visit Models
Model 1 Cooperative Health Care Clinic (CHCC)

Model 2 Drop-in Group Medical Appointments
(DIGMAs)
Model 3 Physicals Shared Medical Appointments
(SMAs)
Group visits allow patients to become fellow
travelers with their disease. They realize they
are not alone, and their feelings of hopelessness
and isolation vanish. Dr. Walker
Dr. Mark Walker and his MOA Shelly Funnel
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How to.

• Assess which patient needs can be addressed in a
  group visit
• Plan the group visit
• Identify individual patients that will benefit
  from group visits
• Invite the patients
• Conduct the group visit
• Measure progress

Group visits are great forums if patients have
clear minds and good hearing. They are a good
way for patients to become educated and better
self managers. Dr. George Wray,
Saanichton
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How to.

• Complete the self-evaluation sheet
• Share your results with your team, colleagues,
  the Ministry of Health, and your health authority
  
• Rerun the cycle to refine it
• Plan more group visits
• Sustain the group visit system
• Consider other strategies

• Overall, we are pleased with the positive
  outcomes experienced in our group sessions, as
  well as the evaluation and goal-setting forms. A
  restructuring of the forms after our first group
  session made it more functional.
• Dr. White,
  Kelowna

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Impact of group visits on my practice

• Conducting group visits makes the medical
  teams job easier and more satisfying. Your
  income from the visits might not be as much as
  you earn in a regular day, but the benefit is
  that you know information has been transmitted to
  the patients.
• Now, when we ask for things from patients, they
  understand, and theyre more motivated. It
  translates to better patient self-management.
• Dr. Shirley Sze, Kamloops

Dr. Sze (bottom centre) and her team, Kamloops
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Impact of group visits on my practice
continued

• Patients stated that they felt better after
  group visits because they discovered other people
  with chronic disease had the same feelings and
  concerns they did. Patients also enjoyed the
  education part of the groups, especially getting
  more answers to their questions than they could
  in an office visit.

Dr. George Wray, Victoria
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What impact do Group Visits have on
billing?

• Office visit fees
• As long as the GV contains all the elements of an
  office visit
• Complex Care Fee, Option 2
• After the first visit, some followup can be via
  phone, group visit, or email
• Also see the Business Case
• Minimal start up costs, and some efficiencies
• Group Visits module participation
• Talk to your Practice Support Team about whats
  involved and how you can be compensated to learn
  and test changes in your practice

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Summary

Group visits are so beneficial we will continue
after the collaborative and expand to other
chronic diseases. Dr. White
Group visit at Dr. Philip Whites practice in
Kelowna
Contact your Practice Support Team