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Shared Medical Appointments for Pulmonary Hypertension

Franck Rahaghi

V. Chastain

Rosanna Benavides

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Conference: 2010 International PHA Conference and Scientific Sessions

Release Date: 06.24.2010

Presentation Type: Abstracts

Rahaghi F, Chastain V, Benavides R. 
Department of Pulmonary Diseases, Cleveland Clinic Florida, Weston, FL, USA

BACKGROUNDA shared medical appointment (SMA) 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. SMA’s improve the quality of patient care through regular visits, thereby decreasing the number of office, emergency room and specialty care clinic visits.

METHODSWe adapted the SMA model to Pulmonary Hypertension (PH), a rare pulmonary disease. The SMA team included a PH specialist, a PH nurse, and one research fellow. Two months before the first meeting; we secured the administration support, drafted the necessary documents and, established the team roles, agenda, census goal and enrolment strategy. Eight to ten PH patients and a family member were invited during office visits and by phone calls. Attendance was verified and encouraged by phone calls and informational letters that were sent. The day of the meeting, vital signs were taken and signed HIPAA waiver consents were collected. The meeting started with a 30-minute presentation on various PH topics. The physician then called each patient for an individual visit and a focused examination in front of the group. The physician directed the visit allowing group questions and interaction. The meeting ended in a casual non-directed support group style lunch session, were the team worked on fostering intergroup communication and sharing of experiences.

RESULTSSeven separate SMAs were conducted in the Pulmonary Hypertension Clinic at Cleveland Clinic Florida between March and October 2009. A Total of 53 patients participated with a mean age of 65 years, the majority of whom were women (74%). Of the total, 84% of patients stated they would attend a future SMA. The care provided was rated excellent to very good by 98% of the patients. Ninety-two percent stated they improved their understanding of the disease and treatment options, 96% think social interaction with other patients was facilitated, 65% rated the emotional support excellent and 59% acknowledged a preference for the group visit over the private visit. Twenty five percent of patients stated that they were very likely to seek a change in treatment modality based on conversation with other patients in the SMA. The majority of our patients expressed no concerns with privacy either before or after the meeting, 76% and 88% respectively. Only 6% of patients declare having “definitive” concerns about their privacy prior the SMA; all of which downgraded to have “somewhat” privacy concerns after the visit.

CONCLUSIONSThe SMA was well received by our PH patients. Privacy concerns were not a significant detractor. This model allows PH patients to increase understanding of their disease process, while integrating peer support, promoting social interaction and addressing the patient emotional needs. Other (rare) pulmonary diseases may benefit from this model.