Shared Medical Appointments for Registered Nurse Facilitators
Published on the 17 July 2019
Published on the 17 July 2019
Shared medical appointments (SMA) have emerged as a new way for healthcare professionals to see clients in medical settings.
Typically, it involves seeing a group of around ten people – wherein each participant is consecutively and individually treated by at least one healthcare professional (e.g. dietitian, registered nurse) (Kirsh et al. 2017).
There is usually a ‘facilitator’ (e.g. a registered nurse) present, who will have undergone specialised training and/or accreditation to guide participants, as well as provide treatment throughout the session(s).
An SMA can be thought of as both an individual consultation and as a group peer support session (Australasian Association of Lifestyle Medicine 2019).
A review by Edelman et al. (2015 p. 99) finds that SMAs are an ‘increasingly used system-redesign strategy for improving access to and quality of chronic illness care’.
SMA interventions were also found by this review to effectively ‘improve biophysical outcomes among patients with diabetes’. The study also recognised that SMAs resulted in better blood pressure and HbAIc for participants (Edelman et al. 2015).
Similarly, another systematic review from 2015 by Watts et al. (p. 450) found that ‘primary care Veterans Affairs (VA) SMAs significantly improved AIc results for clients with diabetes’.
A more recent review (Kelly et al. 2017) investigated SMAs for non-diabetic ‘physical chronic illness’ and found that there were nil adverse outcomes in terms of ‘patient harms’. Kelly et al. (2015) states that one of the studies saw a reduced number of hospital admissions for patients who participated in shared medical appointments as opposed to individual appointments.
Above findings implores questions such as, ‘why aren’t we offering more SMAs?’, ‘why aren’t there more government-funded SMAs in community health facilities and/or hospitals?’ and, ‘why isn’t there a specific Medicare item number for registered nurses, medical officers and/or other health professionals to run SMAs?’.
The following are potential barriers to the implementation of SMAs as identified by Egger et al. (2014):
(Egger et al. 2014)
Edelman’s et al. (2015) study was unable to determine the specific reason(s) for the success of SMAs. However, a more recent study by Kirsh et al. (2017) highlights potential reasons for their success:
(Kirsh et al. 2017)
Further known advantages of shared medical appointments include: reduced healthcare costs; improved clinical outcomes; first-hand knowledge sharing; improved uptake of health knowledge by patients; new and creative problem-solving by providers; improved health among patients with chronic conditions; more time during the visit; healthcare staff bonding and enhanced collegiality; and an overall improvement in social dynamics (Kirsh et al. 2017; Edelman et al. 2015).
(Edelman et al. 2015; Kelly et al. 2017; Kirsh et al. 2017; Watts et al. 2015)
There is sufficient research to suggest that shared medical appointments have a promising role to play in modern health and patient care.
If the SMA model can overcome its primary barriers of funding, stigma and transparency issues, SMAs could be successfully integrated into the healthcare system – thus creating new roles for registered nurses and offering patients previously under-researched health benefits.
(Correct answers below.)
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Madeline Gilkes focused the research project for her master's of healthcare leadership on health coaching for long-term weight loss in obese adults. Madeline is also a qualified weight management practitioner and Registered Nurse. Her vision is to prevent lifestyle diseases, obesogenic environments, dementia, and metabolic syndrome. She has a master of healthcare leadership, a graduate certificate in aged care, and a bachelor of nursing. Madeline works as an academic and has spent the past years in the role of clinical facilitator and clinical nurse specialist (gerontology & education). She is due to complete her Graduate Certificate in Adult and Vocational Education at CSU before November 2018.