What are Cleveland Clinic's shared medical visits and how can they benefit patients with chronic conditions like diabetes or heart disease?

Shared Medical Appointments for Chronic Disease Management

Shared medical appointments (SMAs) are group-based healthcare visits where multiple patients with similar chronic conditions meet together with their provider for individual examinations followed by group education and peer support, offering a valid and effective alternative to traditional one-on-one clinic visits for managing conditions like diabetes and heart disease. 1, 2

What Are Shared Medical Appointments?

SMAs represent a healthcare delivery model where patients with the same chronic condition are seen together in a group setting, combining individual medical assessment with collective education and peer interaction. 2 The format typically includes:

• Individual brief examinations by the provider while other patients wait in the group setting 3
• Group education sessions led by the healthcare provider focusing on disease management 2
• Peer-to-peer interaction allowing patients to share successes and struggles with others facing similar challenges 2
• Extended visit times compared to traditional appointments, allowing more comprehensive education 1

Clinical Effectiveness for Chronic Conditions

Diabetes Management

The Cleveland Clinic's ESCALAIT program (Enrichment Services and Care for Adolescents Living with Autoimmune Insulin Dependent Type 1 Diabetes) demonstrates that SMAs produce comparable clinical outcomes to traditional visits. 3 In a study of 80 adolescent patients with type 1 diabetes compared to 516 controls:

• HbA1c improvements were statistically similar between SMA and traditional clinic patients over approximately one year 3
• While SMA patients showed slightly less HbA1c improvement, the difference was not clinically significant 3
• Increased access to care and peer support provided substantial additional benefits beyond glycemic control alone 3

Cardiovascular Disease

For patients with chronic cardiac diseases, SMAs have demonstrated measurable improvements in multiple domains. 2 The model is particularly well-suited for heart disease management, which consumes substantial healthcare resources related to hospital admissions and acute exacerbations. 2

Key Benefits Across Chronic Conditions

For Patients

• Improved access to care by allowing providers to see more patients efficiently 2, 3
• Enhanced patient satisfaction through extended time with providers and peer interaction 4
• Better quality of life and patient perception of care quality 4
• Increased patient trust in their healthcare team 4
• Peer support and shared learning from others managing the same condition 2

For Healthcare Systems

• Improved provider productivity by concentrating education efforts 2
• More efficient use of provider time for repetitive disease management education 2
• Reduced burden on demanding provider schedules 2

Integration with Evidence-Based Chronic Disease Management

SMAs align perfectly with current guideline recommendations for chronic disease management. The format naturally incorporates:

• Patient self-management education, which improves psychological, clinical, and lifestyle outcomes 5, 6
• Shared decision-making by eliciting patient priorities and encouraging open-ended questions 5
• "Know your numbers" education covering BMI, A1C, blood pressure, lipid profiles, and other key parameters 5, 6
• Lifestyle intervention reinforcement including physical activity, sleep, and dietary modifications 6
• Medication reconciliation to address treatment adherence issues 5, 6

Practical Implementation Considerations

Patient Selection

• Target patients with the same chronic condition (diabetes, heart failure, hypertension, etc.) 2
• Consider adolescents and adults who can benefit from peer interaction 3
• Screen for patients willing to participate in group settings 2

Visit Structure

• Schedule approximately 3-month intervals between visits, similar to traditional chronic disease follow-up 3
• Allocate extended time blocks to accommodate both individual assessments and group education 1
• Maintain confidentiality while conducting brief individual examinations in the group setting 3

Educational Content

The group education component should address guideline-recommended topics systematically:

• Disease recognition as a chronic condition requiring ongoing management 5
• Risk factor monitoring and interpretation of key health parameters 5, 6
• Treatment options including lifestyle, pharmacologic, and procedural interventions 5
• Medication management with emphasis on adherence and side effect recognition 5
• Lifestyle modifications with specific, actionable recommendations 6

Important caveat: Do not attempt to cover all educational topics in a single session; provide education at every visit with repetition and reinforcement, avoiding judgmental language. 5

Telehealth Adaptation

SMAs can be effectively delivered via telehealth platforms, allowing providers to reach multiple patients simultaneously while maintaining the benefits of group interaction and education. 5, 1

Evidence Quality and Limitations

The evidence base for SMAs includes 13 quantitative controlled trials, 11 qualitative studies, and 2 mixed-methods studies, though no singular gold standard model exists. 4 Three consistent formats have emerged:

• Cooperative health care clinic model 4
• Standard shared medical appointment/group visit format 4
• Specialized models (e.g., CenteringPregnancy for prenatal care) 4

Critical consideration: While SMAs demonstrate improvements in patient satisfaction, trust, and quality of life measures, standardization of patient satisfaction metrics and clinical outcome measures remains needed for optimal refinement of this delivery model. 4

Role in Multidisciplinary Care

SMAs complement rather than replace comprehensive chronic disease management. They should be integrated with:

• Referrals to disease-specific specialists (e.g., diabetes care and education specialists) when available 6
• Medication reconciliation at each visit to optimize adherence 6
• Coordination with other healthcare team members including nurses, pharmacists, and allied health providers 7
• Community resource linkage to address social determinants of health 5