Fischer Kimberly L, Christman Matthew S
Naval Medical Center San Diego, San Diego, California.
Urol Pract. 2015 Mar;2(2):55-59. doi: 10.1016/j.urpr.2014.09.008. Epub 2014 Dec 22.
Physicians are increasingly challenged to balance quality health care with fewer resources and limited time. To help achieve this balance, shared medical appointments have been described. We improved clinic-wide access to care by creating a shared medical appointment for minor penile complaints and anomalies.
We implemented a shared medical appointment in April 2013. We developed an intake form to efficiently gather patient history, and a standardized presentation to discuss diagnosis, treatment options, risks and benefits. Outcomes assessed included access to care time, the rate at which patients were seen within a target of 28 days, the number of appointments scheduled and patient complaints. To control for provider availability we evaluated the number of vacation days and operating room cases for the sole pediatric urologist. Data were analyzed using the Mann-Whitney U test.
The periods of November 2012 to March 2013 and May 2013 to September 2013 were evaluated. There was a statistically significant improvement in median (IQR) access to care, with a decrease from 26.6 days (26.4, 29.4) before to 20 days (17.1, 24.3) after implementation of the shared medical appointment (p=0.0163). The goal access to care standard was met with a median (IQR) of 81.4% (56.7, 82.8) after the shared medical appointment compared to 44.3% (25.0, 46.9) before the shared appointment (p=0.0283). After implementation of the shared medical appointment, more appointments were scheduled per month at 161 (156, 165) vs 128 (120, 130; p=0.1172).
We successfully implemented a shared medical appointment and significantly improved our clinic productivity. This program allowed us to improve access to care by almost 1 week and to increase the overall volume of patients seen monthly.
