Miller Daphne, Zantop Veronika, Hammer Hali, Faust Shotsy, Grumbach Kevin
Department of Family and Community Medicine, University of California, San Francisco, California, USA.
J Womens Health (Larchmt). 2004 Mar;13(2):217-25. doi: 10.1089/154099904322966209.
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.
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.
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.
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.
小组医疗就诊（GMV）已被提议作为向慢性病患者提供全面初级保健服务的一种方式。我们研究了在市中心诊所环境中对低收入女性实施GMV模式的可行性。
干预措施包括由医生/执业护士团队共同主持的六次GMV课程。参与者包括28名患有至少一种慢性病诊断的女性（71%为拉丁裔）。对开放式访谈进行主题分析，以评估参与者在GMV中的体验。患者病历和提供者日志提供了关于卫生服务利用模式和提供者生产力的信息。
每次课程平均有7名女性参加，16名女性参加了三次或更多次课程。在开放式访谈中，GMV最常被提及的积极方面是个性化关注（77%）、自我护理教育（69%）、获得药物续方和检查（69%）以及同伴建议（62%）。消极方面包括个人关注不足（23%）、后勤障碍（8%）和保密性丧失（4%）。平均而言，患者每次课程需要医生20分钟时间加上执业护士21分钟时间。病历审查显示，与之前的9个月期间相比，在干预的9个月期间急诊就诊显著减少（p<0.05）。
在这个市中心诊所环境中，GMV模式患者耐受性良好，未改变提供者生产力，并且可能鼓励参与者避免使用更昂贵的急诊服务。这项试点研究的结果表明，GMV是一种具有成本效益的门诊护理替代方案，对于患有慢性病的低收入女性来说是可以接受的。
