Department of Family & Preventive Medicine, UC San Diego, 9500 Gilman Dr, MC0807, La Jolla, CA 92093-0807 USA.
Transl Behav Med. 2012 Dec;2(4):535-42. doi: 10.1007/s13142-012-0150-7.
Essential to the implementation of a patient-centered medical home is use of evidence-based interventions by a well-coordinated team of providers in a cost-effective manner. Group Medical Visits (GMVs), designed to increase self-management behaviors in patients with chronic illness, have shown inconsistently to be efficacious. Despite the modest results reported thus far in the literature, GMVs have been promoted by the American Academy of Family Physicians as an important component in the patient-centered medical home. This paper describes the challenges of translating GMVs into clinical practice when research support is not available. A review of 5+ years experience in conducting GMVs in clinical practice, including the numerous barriers, is presented through a "three-world view" model utilized by collaborative care leaders. This review is followed by a comparison of variables extracted from patients' electronic health records of those who participated in GMVs to similar patients who did not participate in GMVs. Results suggest that outcomes often reported in efficacy trials are not easily obtained in real clinical practice. Overcoming the operational and financial obstacles to offering GMVs is necessary before they can be promoted as essential elements in a patient-centered medical home.
以经济有效的方式，由协调良好的医疗团队提供循证干预措施，是实施以患者为中心的医疗之家的基础。设计用于增加慢性病患者自我管理行为的小组医疗访问（GMV），其疗效不一致。尽管迄今为止在文献中报告的结果并不理想，但 GMV 已被美国家庭医生学会推广为以患者为中心的医疗之家的重要组成部分。本文描述了当研究支持不可用时，将 GMV 转化为临床实践所面临的挑战。通过协作护理领导者使用的“三重视角”模型，介绍了在临床实践中开展 GMV 5 年以上的经验，包括许多障碍。接下来，将对参加 GMV 的患者的电子健康记录中的变量与未参加 GMV 的类似患者的变量进行比较。结果表明，在真实的临床实践中，往往难以获得疗效试验中经常报告的结果。在将 GMV 作为以患者为中心的医疗之家的基本要素进行推广之前，必须克服提供 GMV 的运营和财务障碍。
