title: Overcoming challenges to adoption of shared medical appointments.
abstract: Although research has shown many benefits of Shared Medical Appointments (SMAs) or group visits, uptake by physicians has been quite limited. The objective of this study was to explore the facilitators and barriers to implementing SMAs in a large multispecialty medical group. This was a comparative analysis of SMAs at 3 geographically distinct, semiautonomous divisions of the medical group based on qualitative themes identified in audio recorded key informant interviews with medical and administrative staff (n=12) involved with the implementation of SMAs. Data were collected by conducting key informant interviews focusing on the SMA implementation process, including motivations, history, barriers, and facilitators. Uptake at the 3 divisions was predicated by differing motivations, facilitators, and barriers. Divisions 1 and 2 allocated necessary resources including management support, a physician champion, expert consults, and support staff. These divisions also overcame physician reluctance and financial sustainability challenges. Despite early interest, Division 3 did not devote the time or resources to overcome initial resistance. Without the impetus of management mandate or a champion's enthusiasm, early attempts of SMA implementation faltered and were abandoned. In these cases, a physician champion, management support, and financial sustainability were judged to be the primary enablers of successful implementations of SMAs. Without these enablers and other contributing factors, implementing SMAs was challenging.
authors.affiliation: 1 Essential Anthropology , San Jose, California.
authors.forename: Mary Honodel
authors.initials: MH
authors.lastname: McCuistion
authors.forename: Cheryl D
authors.initials: CD
authors.lastname: Stults
authors.forename: Daniel
authors.initials: D
authors.lastname: Dohan
authors.forename: Dominick L
authors.initials: DL
authors.lastname: Frosch
authors.forename: Dorothy Y
authors.initials: DY
authors.lastname: Hung
authors.forename: Ming
authors.initials: M
authors.lastname: Tai-Seale
mesh_terms: D001071:Appointments and Schedules; D002140:California; D016208:Databases, Factual; D005260:Female; D006123:Group Practice / Q000458:organization & administration*; D006284:Health Plan Implementation; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D020380:Needs Assessment; D009819:Office Visits / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration*; D011787:Quality of Health Care; D014850:Waiting Lists