1Osher Center for Integrative Medicine, UC San Francisco, San Francisco, CA.
2Divisions of Hematology/Oncology UC San Francisco Department of Internal Medicine, San Francisco, CA.
J Altern Complement Med. 2019 Jul;25(7):733-739. doi: 10.1089/acm.2019.0073.
This article describes the implementation of a group medical visit (GMV) model to increase access to integrative oncology (IO) care. The most challenging and critical time to access high-quality IO care is while patients are receiving conventional cancer therapy. Often demand for individual IO clinic consultations precludes this from occurring. A three-session GMV program was designed to alleviate barriers to receiving integrative care during active cancer treatment. A consolidated framework was used for implementation research and focused ethnography methods to describe the IO GMV implementation process. Data sources included patient evaluations, participant observation, and brief provider and patient interviews. A pilot program was created to assess the feasibility and acceptability of implementing IO GMVs at a comprehensive cancer center. Each three-session GMV consisted of a didactic session, followed by individual visits with the integrative oncologist. The setting, intervention, and implementation process of the IO GMV program were described. Thirty-two patients participated in the first five cohorts of the program. Twenty-two were women; 24 were White. The median age of participants was 52. Patient evaluations demonstrate high levels of satisfaction with the program with all scored aspects rated >4.0 on a five-point Likert scale. For the medical center, group visits are a financially viable alternative to individual IO visits; revenue from group visits exceeded the revenue potential of 6 h of individual visits by an average of 38%. GMVs are a feasible and promising model for increasing access to IO. Patients in active cancer treatment were able to participate in the program. Future research and implementation efforts could examine health outcomes over time after participation in GMVs, as well as the feasibility of using this model with more diverse patient populations.
本文描述了实施小组就诊(GMV)模式以增加获得综合肿瘤学(IO)治疗的机会。在接受常规癌症治疗时,患者获得高质量 IO 治疗的最具挑战性和最关键的时期。通常,个人 IO 诊所咨询的需求使得这无法实现。设计了一个三阶段 GMV 计划,以缓解在积极接受癌症治疗时接受综合护理的障碍。使用综合框架进行实施研究,并采用聚焦民族志方法来描述 IO GMV 实施过程。数据来源包括患者评估、参与者观察以及对医生和患者的简短访谈。创建了一个试点计划,以评估在综合癌症中心实施 IO GMV 的可行性和可接受性。每次三阶段 GMV 都包括一个教学会议,然后是与综合肿瘤医生的个人访问。描述了 IO GMV 计划的设置、干预措施和实施过程。该计划的前五个队列中有 32 名患者参加。其中 22 名为女性;24 名为白人。参与者的平均年龄为 52 岁。患者评估表明对该计划的满意度很高,所有评分方面均在 5 分制的 4.0 分以上。对于医疗中心来说,小组就诊是个体 IO 就诊的一种经济可行的替代方式;小组就诊的收入平均比个体就诊的收入高出 6 小时的收入潜力 38%。GMV 是增加 IO 治疗机会的可行且有前途的模式。正在接受癌症治疗的患者能够参加该计划。未来的研究和实施工作可以检查 GMV 参与后随时间推移的健康结果,以及使用该模型治疗更多不同患者人群的可行性。