1Department of Family Medicine and Boston Medical Center, Boston, MA.
2Department of Internal Medicine, Boston Medical Center, Boston, MA.
J Altern Complement Med. 2019 Jul;25(7):683-698. doi: 10.1089/acm.2018.0524. Epub 2019 Apr 4.
Chronic health conditions are a major challenge to the health care system. Medical Group Visits (MGVs) are a valuable health care delivery model used in a variety of medical settings and patient populations. We conducted a systematic scoping review of MGV research literature for chronic health conditions to summarize the characteristics and individual components of MGVs in the United States of America and Canada. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review methodology and searched five databases using nine widely used MGV-related terms. We included studies conducted in the United States and Canada, whose participants were >18 years old and attended an MGV conducted in a medical setting by a billable health care provider. We excluded groups related to diabetes, pregnancy, and cancer. Of 3777 studies identified, we found 55 eligible studies of which 9 are randomized controlled trials and 46 are observational studies. The majority of studies were conducted in academic medical centers, were observational in design, and recruited patients using physician referrals. The three most frequently studied groups include a combination of several chronic conditions ( = 12), chronic pain conditions ( = 10), and cardiovascular disease ( = 9). Curriculum components included didactics ( = 55), experiential activities ( = 27), and socializing components ( = 12). Didactic areas include (1) medical topics such as symptoms management ( = 27) of which 14 included pain management, and (2) lifestyle/educational component ( = 33) that comprised of talks on nutrition ( = 29), exercise ( = 20), stress ( = 16), and sleep ( = 10). The top integrative medicine (IM) modalities ( = 13) included: mindfulness techniques ( = 8), meditation ( = 6), and yoga ( = 5). Substantial heterogeneity was observed in the recruitment, implementation, curriculum components, and outcomes reported. The MGV is a model of patient-centered care that has captured the attention of researchers. IM modalities are well represented in the curriculum components of MGVs. Further investigation into the components identified by this study, may help in better targeting of group interventions to patients and contexts, where it is most likely to be effective.
慢性健康状况是医疗保健系统面临的主要挑战。医疗小组访视（MGV）是一种在各种医疗环境和患者群体中使用的有价值的医疗保健提供模式。我们对 MGV 研究文献进行了系统的范围综述，以总结美国和加拿大慢性健康状况下 MGV 的特征和各个组成部分。我们遵循系统评价和荟萃分析范围综述的首选报告项目方法，并使用九个广泛使用的 MGV 相关术语在五个数据库中进行了搜索。我们纳入了在美国和加拿大进行的研究，其参与者年龄大于 18 岁，并参加了由计费医疗保健提供者在医疗环境中进行的 MGV。我们排除了与糖尿病、妊娠和癌症有关的群体。在确定的 3777 项研究中，我们发现了 55 项符合条件的研究，其中 9 项为随机对照试验，46 项为观察性研究。大多数研究在学术医疗中心进行，设计为观察性，并通过医生推荐招募患者。研究最多的三个群体包括几种慢性疾病的组合（ = 12）、慢性疼痛疾病（ = 10）和心血管疾病（ = 9）。课程组成部分包括教学（ = 55）、体验活动（ = 27）和社交成分（ = 12）。教学领域包括（1）医学主题，如症状管理（ = 27），其中 14 项包括疼痛管理，以及（2）生活方式/教育组成部分（ = 33），包括关于营养（ = 29）、运动（ = 20）、压力（ = 16）和睡眠（ = 10）的讲座。顶级整合医学（IM）模式（ = 13）包括：正念技术（ = 8）、冥想（ = 6）和瑜伽（ = 5）。在报告的招募、实施、课程组成部分和结果方面观察到了很大的异质性。MGV 是一种以患者为中心的护理模式，引起了研究人员的关注。IM 模式在 MGV 的课程组成部分中得到了很好的体现。对本研究确定的组成部分进行进一步研究，可能有助于更好地针对患者和最有可能有效的环境确定小组干预措施。
