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Pulmonary Hypertension: Shared Medical Appointment (SMA)

Rosanna Benavides

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Conference: 2009 PH Resource Network Symposium

Release Date: 09.24.2009

Presentation Type: Abstracts

Rosanna Benavides, LPN
Cleveland Clinic Florida, Weston, FL

PURPOSEShared medical appointments (SMAs) have been used in other chronic illnesses as a model to provide patients the opportunity to spend more time with their caregivers and to enhance patient education. We propose to introduce the concept of SMA to Pulmonary Hypertension.

BACKGROUNDA shared medical appointment is a model of care which involves multiple patients being seen as a group. In this interactive setting, although the physician answers each patient's questions, the patients actually inspire each other to learn about their own health issues by adding personal experiences and engaging in conversations with other patients who have similar issues. SMAs incorporate all the components of individual appointments, including one-on-one medical evaluations, but allow more time for patient education. Data indicates that SMAs improve the quality of patient care through regular visits, thereby decreasing the number of office, emergency room and specialty care clinic visits.

METHODOLOGYThe goal was to have a wide variability in patients, including co-morbidities and therapy modalities. The 3-hour SMA was limited to 8-10 patients. Approximately 1-2 weeks before the visit, a phone call was made to each patient, once again describing the SMA and verifying attendance. In addition, SMA descriptive letters and current list of medications (to be updated by the patient) were mailed. The majority of patients had a spouse or other family members present during their visit. The SMA team included a PAH specialist, a PAH nurse, a nurse educator and two research fellows. As patients arrived the day of the meeting, vital signs were taken and signed consents were collected. The meeting started with a 30-minute presentation on PAH, including diagnosis, treatment modalities and lifestyle modifications. Following the presentation, the physician called each patient to the front for his or her individual appointment. The physician directed the interactive visit allowing group questions and fostering intergroup communication and discussion. Afterwards, a question-and-answer session was facilitated in a relaxed manner, followed by a group lunch. The meeting was finalized with a satisfaction survey.

FINDINGSTo date, 3 separate SMA's have been conducted at the Pulmonary Hypertension Clinic at Cleveland Clinic Florida. Of the total (n=19), 89.5% of patients stated they would attend a future SMA. The care provided was rated excellent by 94.8% and very good by 5.3%. 84% of the patients improved their understanding of the disease and treatment options, 89.5% think social interaction with other patients was facilitated, and 94.7% stated the SMA either met or exceeded their expectations compared to a regular office visit. After the visit, 83.3% of the patients expressed no confidentiality issues.

IMPLICATIONSThe SMA model allows PAH patients to spend considerable amounts of time with their care providers and promotes patient understanding of their disease process while integrating peer support and addressing the patient psychosocial needs.