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Friday, June 20, 2014

Can Group Medical Visits Improve Quality of Life Outcomes for Neuromuscular Patients?

by Mark Moran

Shared medical appointments for patients with chronic neuromuscular disorders — during which a physician sees multiple patients simultaneously, combining individualized medical patient care with peer-support and education on self-management — appear to result in better self-reported health-related quality of life outcomes.

So a team of Dutch investigators reported from a randomized controlled trial comparing group visits with individual one-on-one visits at the Radboud University Medical Centre in the Netherlands. The study was published in the June 18 online issue of Neurology.

 “We started offering shared medical appointments in 2008 and the enthusiasm of patients, partners, and clinicians motivated us to evaluate scientifically whether attending a shared medical appointment would be more effective than an individual outpatient appointment,” said Femke Marie Seesing, MSc, the lead author of the study. “The quality of life of patients who attended a shared medical appointment improved on the subscales of general health and social functioning compared with patients who attended an individual appointment.”

Seesing noted that the neurologist actually spent less time per patient in the shared medical appointment group, but patients and their partners received a 90-minute to two-hour appointment, which enabled them to receive more information about living with their disease.

The study provides evidence that group visits can improve aspects of quality-of-life for patients with a chronic neuromuscular disorder and could offer an alternative to individual appointments, improving both effectiveness and efficiency, she said.



In the study, 272 patients and 149 partners were randomized to shared visits or 20- to 30-minute individual medical appointments. Patients were identified through the Computer Registry of All Myopathies and Polyneuropathies, a Dutch neuromuscular database.

During the group visit, one or two neurologists saw five to eight patients with the same diagnosis and their partners simultaneously, addressing the same topics that are commonly covered during an individual appointment. A group mentor was on hand to help the neurologist facilitate the group process by fostering interaction between patients and partners and by managing time.

Among their findings, the investigators reported that patients who participated in shared visits were more than three times as likely to report improvements in the primary outcome of health-related quality of life as measured by the Short Form Health Survey (SF-36).

In secondary outcomes, patients who participated in group visits showed higher values for quality of life as measured by the Individualized Neuromuscular Quality of Life questionnaire fatigue scale relative to the control group. But they also reported they were less satisfied with the appointment than those who had individual appointments; and the social support scores were 1.1 points higher in the individual appointment group.

Seesing and colleagues suggest in their paper that the lower satisfaction scores in the group visit may be related to the fact that patients had only one shared visit; previous studies have looked at the effect of multiple shared visits. “…Attending multiple successive SMAs gives participants the opportunity to build a relationship with peers and to acquaint themselves with the new care model over time,” they wrote. 

In comments to Neurology Today, she noted that maintaining a group size large enough to generate interactions between patients is critical. Although the “no-show” rate for group is not different from that for individual appointments, Seesing advised clinicians to “overbook” the shared appointments.

See the full story, including a discussion of other group patient care models, in the July 3 issue of Neurology Today. For more stories on innovative care models for neurology, visit