Shared Medical Appointments for Registered Nurse Facilitators

What are Shared Medical Appointments?

Shared medical appointments (SMA) have emerged as a new way for healthcare professionals to see clients in medical settings.

Typically, they involve one or more healthcare practitioners seeing a group of patients concurrently (Kirsh et al. 2017).

There is usually a designated ‘facilitator’ (e.g. nurse) present, who explains the session, answers questions and manages the process (Egger et al. 2014).

An SMA can be thought of as both an individual consultation and a group peer support session (Australasian Association of Lifestyle Medicine 2022).

What are the Benefits of Shared Medical Appointments?

A review by Edelman et al. (2015) found that SMAs were an ‘increasingly used system-redesign strategy for improving access to and quality of chronic illness care’.

SMA interventions were also found by this review to effectively ‘improve biophysical outcomes among patients with diabetes’. The study also recognised that SMAs resulted in better blood pressure and haemoglobin A1c (HbA1c) for participants (Edelman et al. 2015).

Similarly, another systematic review from 2015 found that ‘primary care Veterans Affairs (VA) SMAs significantly improved A1c results for clients with diabetes’ (Watts et al. 2015).

A more recent review (Kelly et al. 2017) investigated SMAs for non-diabetic ‘physical chronic illness’ and found there were nil adverse outcomes in terms of ‘patient harms’. Kelly et al. (2015) stated that one of the studies saw a reduced number of hospital admissions for patients who participated in SMAs as opposed to individual appointments.

Why Aren’t Shared Medical Appointments More Popular?

The above findings implore questions such as, ‘why aren’t we offering more SMAs?’, ‘why aren’t there more government-funded SMAs in community health facilities and/or hospitals?’ and, ‘why isn’t there a specific Medicare item number for registered nurses, medical officers and/or other health professionals to run SMAs?’.

The following are potential barriers to the implementation of SMAs as identified by Egger et al. (2014):

• Privacy and confidentiality concerns – there would be a need for those involved to sign a confidentiality agreement before each session commences
• People may not want to share their experiences and data with peers
• A facilitator would need to be educated and trained to effectively and efficiently deliver the session(s) in a way that meets requirements
• Nurses may specialise in this field and therefore practices would have to pay them accordingly
• Clients need to be educated about SMAs before giving informed consent to take part in the session
• A facility must be adequately organised to host the session, as well as complete documentation, follow-up care/referrals, billing, private examinations and more
• Cost-efficiency as well as time-efficiency must be achieved
• Lack of awareness of the existence of SMAs
• Poor marketing and uptake of SMAs
• Resistance to change.

How do Shared Medical Appointments Achieve Success?

A study by Edelman et al. (2015) was unable to determine the specific reason(s) for the success of SMAs. However, a more recent study by Kirsh et al. (2017) highlights potential reasons for their success:

• A reduced feeling of isolation in patients and an improvement in the confidence of individuals in managing their conditions
• Self-management learning as a result of listening to experiences of group members
• Well-coping participants may inspire other group members
• ‘Equitable relationships’ between all participants and healthcare professionals
• Enhanced rapport and appreciation between health professionals, which may improve efficiency in care delivery
• Better insights for health professionals regarding fulfilment of their clients’ needs
• More time within the healthcare environment may result in an improved sense of support for clients
• More robust knowledge in terms of health professional ‘expertise’ in addition to peers sharing their lived experiences
• Trust in the health professional(s) may be improved by allowing the clients to observe the interactions between the health worker and other clients/group members.
• Improved time-management and scheduling for healthcare workers.

Further known advantages of shared medical appointments include: reduced healthcare costs; improved clinical outcomes; first-hand knowledge sharing; improved uptake of health knowledge by patients; new and creative problem-solving by providers; improved health among patients with chronic conditions; more time during the visit; healthcare staff bonding and enhanced collegiality; and an overall improvement in social dynamics (Kirsh et al. 2017; Edelman et al. 2015).

Ideas on How to Help Nurses Deliver Shared Medical Appointments:

• Medicare provider numbers for registered nurses (with appropriate specialisation qualifications/experience)
• Medicare item numbers for SMAs
• Increased access to facilitator training, education and accreditation
• Widespread awareness campaigns aimed at potential clients (e.g. people with chronic diseases), carers, health professionals and organisations/providers
• More high-quality studies (e.g. RCTs) into nurse-led SMAs (e.g. cost-efficiency, reductions in hospitalisations, improvements in vital signs, etc.)
• Government funding, scholarships and grants to enable appropriate nurse specialists to run SMA programs and/or set up independent nurse clinics within their scope of practice
• Increased industry/regulatory body/professional network awareness and support of nurse-led SMAs.

(Edelman et al. 2015; Kelly et al. 2017; Kirsh et al. 2017; Watts et al. 2015)

Conclusion

There is sufficient research to suggest that SMAs have a promising role to play in modern health and patient care.

If the SMA model can overcome its primary barriers of funding, stigma and transparency issues, SMAs could be successfully integrated into the healthcare system – thus creating new roles for registered nurses and offering patients previously under-researched health benefits.