title: Group medical visits for low-income women with chronic disease: a feasibility study.
abstract: BACKGROUND
  Group medical visits (GMVs) have been proposed as a means of providing comprehensive primary care services to patients with chronic disease. We studied the feasibility of implementing a GMV model with low-income women in an innercity clinic setting.
  
  
  METHODS
  The intervention consisted of six GMV sessions cofacilitated by a physician/nurse practitioner team. Participants included 28 women with at least one chronic disease diagnosis (71% Latina). Thematic analysis of open-ended interviews assessed participants' experiences in the GMV. Patient charts and provider logs provided information on health service utilization patterns and provider productivity.
  
  
  RESULTS
  An average of 7 women attended each session, with 16 women attending three or more sessions. In open-ended interviews, the most commonly mentioned positive aspects of the GMV were personalized attention (77%), self-care education (69%), access to medication refills and examinations (69%), and advice from peers (62%). Negative aspects included insufficient personal attention (23%), logistical barriers (8%), and loss of confidentiality (4%). On average, patients required 20 minutes of physician time plus 21 minutes of nurse practitioner time per session. Medical record reviews revealed a significant decrease in urgent care visits (p < 0.05) during the 9 months of the intervention compared with a prior 9-month period.
  
  
  CONCLUSIONS
  In this innercity clinic setting, the GMV model was well tolerated by patients, did not alter provider productivity, and may have encouraged participants to avoid more expensive urgent care services. The results of this pilot study suggest that GMVs represent a cost-effective ambulatory care alternative that is acceptable to low-income women with chronic disease.
authors.affiliation: Department of Family and Community Medicine, University of California, San Francisco, California, USA. dm@drdaphne.com
authors.forename: Daphne
authors.initials: D
authors.lastname: Miller
authors.forename: Veronika
authors.initials: V
authors.lastname: Zantop
authors.forename: Hali
authors.initials: H
authors.lastname: Hammer
authors.forename: Shotsy
authors.initials: S
authors.lastname: Faust
authors.forename: Kevin
authors.initials: K
authors.lastname: Grumbach
mesh_terms: D002140:California / Q000453:epidemiology; D002908:Chronic Disease / Q000628:therapy*; D003153:Community Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006126:Group Processes; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D017146:Models, Organizational; D009819:Office Visits / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011203:Poverty; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012944:Social Support; D014932:Women's Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data