Palay Josh, Bolton James M, Sareen Jitender, Hensel Jennifer M
Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.
Front Health Serv. 2023 Jun 26;3:1127725. doi: 10.3389/frhs.2023.1127725. eCollection 2023.
Group medical visits (GMVs) have strong evidence of acceptability and effectiveness in the management of chronic medical diseases. Adaptation of GMVs for psychiatric care has potential to increase access, decrease stigma and save costs. Despite promise, this model has not been widely adopted.
A novel GMV pilot was implemented for psychiatric care post-crisis among patients with primary mood or anxiety disorders who required medication management. Participants filled out PHQ-9 and GAD-7 scales at each visit in order to track their progress. After discharge, charts were reviewed for demographics, medication changes and symptom changes. Patient characteristics were compared between those who attended and those who didn't. Changes in total PHQ-9 and GAD-7 scores among attendees were assessed with paired -tests.
Forty-eight patients were enrolled between October 2017 and the end of December 2018, 41 of whom consented to participate. Of those, 10 did not attend, 8 attended but did not complete, and 23 completed. Baseline PHQ-9 and GAD-7 scores did not differ significantly between groups. Significant and meaningful reductions in PHQ-9 and GAD-7 scores from baseline to last visit attended occurred among those who attended at least 1 visit (decrease of 5.13 and 5.26 points, respectively).
This GMV pilot demonstrated feasibility of the model as well as positive outcomes for patients recruited in a post-crisis setting. This model has the potential to increase access to psychiatric care in the face of limited resources, however the failure of the pilot to sustain highlights challenges to be addressed in future pivots.
小组医疗就诊（GMV）在慢性疾病管理方面具有很强的可接受性和有效性证据。将GMV应用于精神科护理有可能增加就医机会、减少耻辱感并节省成本。尽管有前景，但该模式尚未得到广泛采用。
针对需要药物管理的原发性情绪或焦虑症患者，在危机后实施了一项新型GMV试点项目用于精神科护理。参与者在每次就诊时填写PHQ-9和GAD-7量表，以跟踪他们的进展。出院后，审查病历以了解人口统计学信息、药物变化和症状变化。比较参加者和未参加者的患者特征。使用配对t检验评估参加者中PHQ-9和GAD-7总分的变化。
2017年10月至2018年12月底共招募了48名患者，其中41名同意参与。其中，10名未参加，8名参加但未完成，23名完成。各组之间的基线PHQ-9和GAD-7得分无显著差异。至少参加过1次就诊的患者从基线到最后一次就诊时，PHQ-9和GAD-7得分有显著且有意义的降低（分别降低5.13分和5.26分）。
该GMV试点项目证明了该模式的可行性以及对危机后环境中招募的患者的积极结果。面对资源有限的情况，该模式有可能增加精神科护理的可及性，然而试点项目未能持续开展凸显了未来转型中需要解决的挑战。
