Characteristics and Components of Medical Group Visits for Chronic Health Conditions: A Systematic Scoping Review

Important Nutritional Concepts and Recommendations at the Level of Medical School Education

PURPOSE OF REVIEW

The purpose of the review is to share experiential recommendations to improve nutrition education for medical students. The review examines the history and the current state of nutrition education in order to identify opportunities to strengthen medical provider nutrition knowledge. Methods currently in use by medical school educators are highlighted to promote wellness and prevent development of chronic disease. Lastly, strategies and resources are described to integrate fundamental nutrition concepts into medical school education.

RECENT FINDINGS

Several surveys reveal that most U.S. medical students and residents feel underprepared to address patient nutrition and lifestyle concerns. Innovative programs such as culinary medicine, hands-on cooking electives, and modules on motivational interviewing show promise in improving students' competence and confidence. There is a lack of guidance from nutrition experts on how to improve medical school education by incorporating nutrition. A growing number of experts agree that medical school curricula should include more comprehensive nutrition content to prepare future physicians for addressing chronic diseases. Structured learning modules, enrichment electives, real-world community involvement, and interdisciplinary approaches can enhance evidence-based dietary counseling skills in medical trainees.

Twenty-first century management of diabetes with shared telemedicine appointments

This commentary article discusses the benefits of utilizing telemedicine to conduct shared medical appointments for people with type 1 diabetes and type 2 diabetes. We conducted a literature review of articles about shared medical appointments or group medical visits in people with diabetes with associated clinical data. We identified 43 articles. Models of this approach to care have demonstrated positive outcomes in adults and children with type 1 diabetes. Shared telemedicine appointments also have the potential to improve diabetes self-management, reduce the treatment burden, and improve psychosocial outcomes in adults with type 2 diabetes. Ten key recommendations for implementation are presented to guide the development of shared telemedicine appointments for diabetes. These recommendations can improve care for diabetes.

Age Self Care-Resilience, a medical group visit program targeting pre-frailty: A mixed methods pilot clinical trial

BACKGROUND

Pre-frailty is highly prevalent and multimodal lifestyle interventions are effective for preventing transition to frailty. However, little is known about the potential for medical group visits (MGV) to prevent frailty progression.

OBJECTIVES

To assess the feasibility and acceptability of the MGV Age Self Care-Resilience.

DESIGN

Single-arm mixed methods pilot clinical trial.

SETTING

Virtual MGV delivered in an ambulatory setting at a U.S. academic medical center.

PARTICIPANTS

Community-dwelling older adults (n = 11; age 65+) with pre- to mild frailty.

INTERVENTION

Age Self Care-Resilience, an 8-week virtual MGV (90-minute sessions once per week) with sessions focused on physical activity, nutrition, social engagement, mind-body practice, and home environment modification.

MEASUREMENTS

Primary outcomes were feasibility of recruitment, attendance, satisfaction, and feasibility of study measurements, collected via quantitative and qualitative approaches. Exploratory outcomes included frailty, psychosocial health, and physical function.

RESULTS

A priori feasibility criteria were met for recruitment, with 15 (48 %) of those screened (31) meeting eligibility criteria, 11 (35 %) enrolling (mean age 74.5 yrs), and recruitment completed in less than one month. The nine participants who completed the study attended a mean of 7.2 of 8 sessions and completed 100 % of baseline and follow-up study measures; participants completed 58 % of the home practice log. Themes from participant interviews included: (1) mixed reactions to the recruitment term "pre-frailty;" (2) finding group participation as meaningful and empowering; and (3) perception that the program positively changed attitudes and lifestyle behaviors.

CONCLUSIONS

Age Self Care-Resilience is feasible and acceptable to pre- to mildly frail older adults. Next steps include evaluating the efficacy of Age Self Care-Resilience for preventing frailty progression with a fully powered randomized controlled trial.

Social Capital and Cultural Health Capital in Primary Care: The Case of Group Medical Visits

This article focuses on an empirical setting that upends the clinician-patient dyadic norm: group medical visits (GMVs), in which multiple patients gather in the same space for medical care, health education and peer support. Our grounded theory analysis draws on participant observation and interviews (N = 53) with patients and staff of GMVs at four safety-net healthcare organisations in the United States. We delineate (1) how group medical visits provide health-focused social networks that facilitate the mobilisation of social capital, (2) how the organisationally embedded relationships that comprise group visits are made possible through extended time that is part of the GMV field and (3) how clinicians have opportunities rarely found in other settings to learn from patients, using knowledge accrued from GMV networks to advance their own skills, thereby converting social capital into provider cultural health capital. GMVs provide a rich empirical site for understanding the ways in which organisational arrangements can shape opportunities for patients and clinicians to cultivate and mobilise social capital and cultural health capital, and in doing so, materially shift experiences of receiving and providing healthcare.

Implementing Food as Medicine During COVID-19: Produce Prescriptions and Integrative Group Medical Visits in Federally Qualified Health Centers

Background

Food as Medicine is a rapidly developing area of health care in the United States, aimed at concurrently addressing nutrition-sensitive chronic conditions and food and nutrition insecurity. Recipe4Health (R4H) is a Food as Medicine program with an integrative health equity focus. It provides prescriptions for locally grown produce ('Food Farmacy') with or without integrative group medical visits, alongside training for clinic staff.

Objectives

To describe the initial implementation of R4H in four Federally Qualified Health Centers in Northern California, using a convergent mixed-methods approach.

Methods

We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) implementation science framework to assess the first two years of R4H (2020-2022). We draw from 40 interviews (26 partner organization staff, 14 patients) and program data on reach and adoption. Qualitative data were analyzed using codebook thematic analysis.

Results

Reach: From January 2020 to August 2022, 3255 patients were referred to the program; 1997 of those referred (61%) enrolled in the Food Farmacy only (N = 1681) or Food Farmacy + integrative group medical visits (N = 316). Participating patients included a wide range of ages (mean age 41.4, [SD 20]; 18% < 18 years old) and racial and ethnic backgrounds (3% American Indian or Alaska Native, 6% Asian or Pacific Islander, 19% Black, 57% Hispanic/Latine, 7% white). 69% were female; 43% primarily spoke Spanish. Adoption: 84% of trained clinic staff referred two or more patients to R4H. Implementation: Elements of successful implementation included: (1) support from county government leadership, (2) centralized coordination of the multi-sector partnership, and (3) a flexible approach responsive to organizational and COVID-related shifts. R4H implementation informed statewide Medicaid policy changes. Maintenance: To date, all four clinics continue to participate in R4H.

Conclusion

Centralized implementation, training, and administration of Food as Medicine programs can strengthen community health centers' capacities to concurrently address chronic conditions and food insecurity. Multi-sector partnerships can support Food as Medicine program sustainability.

Self-Monitoring With Coping Skills and Lifestyle Education for Hypertension Control in Primary Care

Self-monitoring with support, lifestyle modifications, and emotion management improves blood pressure (BP). Patients with hypertension need continual support to modify behaviors, but time pressures limit lifestyle education in primary care settings. Using mixed methods, we aimed to study the feasibility and acceptability of an innovative 6-week program that combined self-monitoring with coping skills and lifestyle education for patients with uncontrolled hypertension. Patients with uncontrolled hypertension interested in lifestyle modifications before intensifying medications were enrolled from primary care clinics. Patients self-monitored emotions, behaviors, and BPs and received education from medical providers and mind-body therapists through shared medical appointments (SMAs) with an option of weekly printed materials. Over 6 months, 31 eligible participants completed the program with higher uptake (21/41) from physician referrals (74.2% women, 41.9% Black, median household income $100 000). Fourteen participants opted for weekly educational materials due to upcoming SMA sessions being fully booked or personal schedules. Pre- to post-intervention paired t-test showed improvement in systolic BP of 11.6 mmHg (95% CI, 6.6-16.6, p < 0.0001), and hypertension control rate improved by 36% (11/31) post-intervention. Higher baseline systolic BP was associated with higher BP reduction (p < 0.001). Thematic analysis showed the perceived benefit of self-awareness, education, and peer support, whereas time constraints were perceived as challenges. Self-monitoring with education on coping skills and lifestyle modification is feasible and improved BP and hypertension control across diverse primary care patients interested in lifestyle modifications; however, few low-income patients enrolled. Less burdensome and community-based interventions may improve participation in low-income patients.

Determinants of implementation for group medical visits for patients with chronic pain: a systematic review

BACKGROUND

Despite the critical need for comprehensive and effective chronic pain care, delivery of such care remains challenging. Group medical visits (GMVs) offer an innovative and efficient model for providing comprehensive care for patients with chronic pain. The purpose of this systematic review was to identify barriers and facilitators (determinants) to implementing GMVs for adult patients with chronic pain.

METHODS

The review included peer-reviewed studies reporting findings on implementation of GMVs for chronic pain, inclusive of all study designs. Pubmed, EMBASE, Web of Science, and Cochrane Library were searched. Studies of individual appointments or group therapy were excluded. The Mixed Methods Appraisal Tool was used to determine risk of bias. Data related to implementation determinants were extracted independently by two reviewers. Data synthesis was guided by the updated Consolidated Framework for Implementation Research.

RESULTS

Thirty-three articles reporting on 25 studies met criteria for inclusion and included qualitative observational (n = 8), randomized controlled trial (n = 6), quantitative non-randomized (n = 9), quantitative descriptive (n = 3), and mixed methods designs (n = 7). The studies included in this review included a total of 2364 participants. Quality ratings were mixed, with qualitative articles receiving the highest quality ratings. Common multi-level determinants included the relative advantage of GMVs for chronic pain over other available models, the capability and motivation of clinicians, the cost of GMVs to patients and the health system, the need and opportunity of patients, the availability of resources and relational connections supporting recruitment and referral to GMVs within the clinic setting, and financing and policies within the outer setting.

CONCLUSIONS

Multi-level factors determine the implementation of GMVs for chronic pain. Future research is needed to investigate these determinants more thoroughly and to develop and test implementation strategies addressing these determinants to promote the scale-up of GMVs for patients with chronic pain.

TRIAL REGISTRATION

This systematic review was registered with PROSPERO 2021 CRD42021231310 .

Race-Based Differences in the Response to a Mindfulness Based Integrative Medical Group Visit Intervention for Chronic Pain

Background

Chronic pain is one of the most common drivers of healthcare utilization and a marked domain for health disparities, as African American/Black populations experience high rates of chronic pain. Integrative Medical Group Visits (IMGV) combine mindfulness techniques, evidence-based integrative medicine, and medical group visits. In a parent randomized controlled trial, this approach was tested as an adjunct treatment in a diverse, medically underserved population with chronic pain and depression.

Objective

To determine race-based heterogeneity in the effects of a mindfulness based treatment for chronic pain.

Methods

This secondary analysis of the parent trial assessed heterogeneity of treatment effects along racialized identity in terms of primary patient-reported pain outcomes in a racially diverse sample suffering from chronic pain and depression. The analytic approach examined comorbidities and sociodemographics between racialized groups. RMANOVAs examined trajectories in pain outcomes (average pain, pain severity, and pain interference) over three timepoints (baseline, 9, and 21 weeks) between participants identifying as African American/Black (n = 90) vs White (n = 29) across both intervention and control conditions.

Results

At baseline, African American/Black participants had higher pain severity and had significantly different age, work status, and comorbidity profiles. RMANOVA models also identified significant race-based differences in the response to the parent IMGV intervention. There was reduced pain severity in African American/Black subjects in the IMGV condition from baseline to 9 weeks. This change was not observed in White participants over this time period. However, there was a reduction in pain severity in White participants over the subsequent interval from 9 to 21 week where IMGV had no significant effect in African American/Black subjects during this latter time period.

Conclusion

Interactions between pain and racialization require further investigation to understand how race-based heterogeneity in the response to integrative medicine treatments for chronic pain contribute to the broader landscape of health inequity.

Clinician Experiences With Integrative Group Medical Visits for Chronic Pain

Background

The well-being of healthcare teams is an important consideration when seeking to improve patient experience and quality of care. Prior studies have found that changes to working conditions are most effective in improving clinician well-being. Integrative Group Medical Visits (IGMVs) modify working conditions in ways that have potential to improve clinician experience.

Objective

The objective of this study was to understand healthcare teams' experiences with IGMVs.

Methods

In this qualitative study, interviews were conducted via Zoom and telephone with 21 clinicians, administrators, and staff from safety-net healthcare settings throughout the United States (U.S.) who have implemented IGMVs for patients with chronic pain. Interviews included questions about clinician experience, well-being, and satisfaction with the IGMV model. Interviews were recorded, transcribed, and coded using thematic content analysis by a team of trained qualitative researchers.

Results

The authors identified five themes describing how IGMV positively affected clinician well-being: organizational supports, human-centered engagement, collaboration with an interprofessional team, provision of guideline-concordant care, and enhanced meaning and purpose for the clinicians.

Conclusion

The current study was the first to use interviews from healthcare teams who have implemented IGMV to assess their experience. The themes identified warrant further investigation into IGMVs as a strategy to promote clinician well-being and mitigate aspects of burnout.

A descriptive exploration of younger and older adults' experiences of Integrative Medical Group Visits for Long COVID

Introduction

Long COVID disproportionately affects older adults. Individuals with Long COVID (LC) often experience symptoms that severely impact quality of life, and treatment approaches are still evolving. The Integrative Medical Group Visit (IMGV) model is an evidence-based approach that may be useful to treat patients with LC; however, there is limited evidence describing the experience and/or feasibility of using IMGV for LC treatment, especially among the older adult population. The purpose of this study is to describe older and younger adults' experiences of both having LC and participating in a virtually delivered IMGV for LC.

Methods

This is a secondary analysis of qualitative data from a parent study examining the experiences of participants in a virtually delivered IMGV for patients with LC. Patients participated in semi-structured interviews before and after 8 weekly IMGV sessions. Thematic analysis was used to analyze interview data.

Results

Overall, 21 pre-interviews and 17 post-interviews were collected. Thematic analysis of patient interviews by age group resulted in three themes that each contained similarities and differences between the younger and older adult participants. These themes included: (1) experiences of LC (2) feelings about the future (3) experiences of the pilot IMGV on LC.

Conclusion

This study provides critical context for clinicians who treat older adults with LC. Results support virtually delivered IMGVs as a potentially feasible option for both older and younger adults who want to apply an integrative approach to their LC treatment. Findings from this study will inform future research on IMGV for LC treatment.

Feasibility and efficacy of implementing group visits for women's health conditions: a systematic review

BACKGROUND

Shared medical appointments, also known as group visits, are a feasible and well-accepted approach for women receiving antenatal care, yet the feasibility and efficacy of this approach for female-specific reproductive conditions is uncertain.

OBJECTIVE

The aim of this systematic review was to (a) determine the feasibility of group visits in adults with any female-specific reproductive condition, and (b) identify whether delivering group care for these conditions impacts clinical outcomes.

METHOD

Six databases and two clinical trials registries were searched from inception through to 26 January 2022 for original research examining group medical visits or group consultation interventions for adults with female reproductive conditions or pathologic conditions specific to the female reproductive system.

RESULTS

The search yielded 2584 studies, of which four met the inclusion criteria. Included studies sampled women with breast cancer, chronic pelvic pain, polycystic ovary syndrome and gynaecological cancers. Studies reported high levels of patient satisfaction, with participants indicating their expectations had been met or exceeded. The impact of group visits on clinical outcomes was inconclusive however.

DISCUSSION/CONCLUSIONS

The studies in this review indicate delivery of female-specific healthcare via a group model maybe feasible and well-accepted. The review provides a solid basis for proposing larger and longer studies on group visits for female reproductive conditions.

TRIAL REGISTRATION

The review protocol was registered with PROSPERO (CRD42020196995).

Addressing food insecurity and chronic conditions in community health centres: protocol of a quasi-experimental evaluation of Recipe4Health

INTRODUCTION

Chronic conditions, such as diabetes, obesity, heart disease and depression, are highly prevalent and frequently co-occur with food insecurity in communities served by community health centres in the USA. Community health centres are increasingly implementing 'Food as Medicine' programmes to address the dual challenge of chronic conditions and food insecurity, yet they have been infrequently evaluated.

METHODS AND ANALYSIS

The goal of this quasi-experimental study was to evaluate the effectiveness of Recipe4Health, a 'Food as Medicine' programme. Recipe4Health includes two components: (1) a 'Food Farmacy' that includes 16 weekly deliveries of produce and (2) a 'Behavioural Pharmacy' which is a group medical visit. We will use mixed models to compare pre/post changes among participants who receive the Food Farmacy alone (n=250) and those who receive the Food Farmacy and Behavioural Pharmacy (n=140). The primary outcome, fruit and vegetable consumption, and secondary outcomes (eg, food security status, physical activity, depressive symptoms) will be collected via survey. We will also use electronic health record (EHR) data on laboratory values, prescriptions and healthcare usage. Propensity score matching will be used to compare Recipe4Health participants to a control group of patients in clinics where Recipe4Health has not been implemented for EHR-derived outcomes. Data from surveys, EHR, group visit attendance and produce delivery is linked with a common identifier (medical record number) and then deidentified for analysis with use of an assigned unique study ID. This study will provide important preliminary evidence on the effectiveness of primary care-based strategies to address food insecurity and chronic conditions.

ETHICS AND DISSEMINATION

This study was approved by the Stanford University Institutional Review Board (reference protocol ID 57239). Appropriate study result dissemination will be determined in partnership with the Community Advisory Board.

Group Medical Care: A Systematic Review of Health Service Performance

Group care models, in which patients with similar health conditions receive medical services in a shared appointment, have increasingly been adopted in a variety of health care settings. Applying the Triple Aim framework, we examined the potential of group medical care to optimize health system performance through improved patient experience, better health outcomes, and the reduced cost of health care. A systematic review of English language articles was conducted using the Cochrane Controlled Trials Register (CENTRAL), MEDLINE/PubMed, Scopus, and Embase. Studies based on data from randomized control trials (RCTs) conducted in the US and analyzed using an intent-to-treat approach to test the effect of group visits versus standard individual care on at least one Triple Aim domain were included. Thirty-one studies met the inclusion criteria. These studies focused on pregnancy (n = 9), diabetes (n = 15), and other chronic health conditions (n = 7). Compared with individual care, group visits have the potential to improve patient experience, health outcomes, and costs for a diversity of health conditions. Although findings varied between studies, no adverse effects were associated with group health care delivery in these randomized controlled trials. Group care models may contribute to quality improvements, better health outcomes, and lower costs for select health conditions.

Feasibility of Implementation Mapping for Integrative Medical Group Visits

Objectives: Implementation science is key to translating complementary and integrative health intervention research into practice as it can increase accessibility and affordability while maximizing patient health outcomes. The authors describe using implementation mapping to (1) identify barriers and facilitators impacting the implementation of an Integrative Medical Group Visit (IMGV) intervention in an outpatient setting with a high burden of patients with chronic pain and (2) select and develop implementation strategies utilizing theory and stakeholder input to address those barriers and facilitators. Design: The authors selected a packaged, evidence-based, integrative pain management intervention, the IMGV, to implement in an outpatient clinic with a high burden of patients with chronic pain. The authors used implementation mapping to identify implementation strategies for IMGV, considering theory and stakeholder input. Stakeholder interviews with clinic staff, faculty, and administrators (n = 15) were guided by the Consolidated Framework for Implementation Research. Results: Based on interview data, the authors identified administrators, physicians, nursing staff, and scheduling staff as key stakeholders involved in implementation. Barriers and facilitators focused on knowledge, buy-in, and operational procedures needed to successfully implement IMGV. The implementation team identified three cognitive influences on behavior that would impact performance: knowledge, outcome expectations, and self-efficacy; and three theoretical change methods: cue to participate, communication, and mobilization. Implementation strategies identified included identifying and preparing champions, participation in ongoing training, developing and distributing educational materials, and organizing clinician implementation team meetings. Conclusions: This study provides an example of the application of implementation mapping to identify theory-driven implementation strategies for IMGV. Implementation mapping is a feasible method that may be useful in providing a guiding structure for implementation teams as they employ implementation frameworks and select implementation strategies for integrative health interventions.

Patient outcomes and costs associated with functional medicine-based care in a shared versus individual setting for patients with chronic conditions: a retrospective cohort study

OBJECTIVE

To compare outcomes and costs associated with functional medicine-based care delivered in a shared medical appointment (SMA) to those delivered through individual appointments.

DESIGN

A retrospective cohort study was performed to assess outcomes and cost to deliver care to patients in SMAs and compared with Propensity Score (PS)-matched patients in individual appointments.

SETTING

A single-centre study performed at Cleveland Clinic Center for Functional Medicine.

PARTICIPANTS

A total of 9778 patients were assessed for eligibility and 7323 excluded. The sample included 2455 patients (226 SMAs and 2229 individual appointments) aged ≥18 years who participated in in-person SMAs or individual appointments between 1 March 2017 and 31 December 2019. Patients had a baseline Patient-Reported Outcome Measurement Information System (PROMIS) Global Physical Health (GPH) score and follow-up score at 3 months. Patients were PS-matched 1:1 with 213 per group based on age, sex, race, marital status, income, weight, body mass index, blood pressure (BP), PROMIS score and functional medicine diagnostic category.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was change in PROMIS GPH at 3 months. Secondary outcomes included change in PROMIS Global Mental Health (GMH), biometrics, and cost.

RESULTS

Among 213 PS-matched pairs, patients in SMAs exhibited greater improvements at 3 months in PROMIS GPH T-scores (mean difference 1.18 (95% CI 0.14 to 2.22), p=0.03) and PROMIS GMH T-scores (mean difference 1.78 (95% CI 0.66 to 2.89), p=0.002) than patients in individual appointments. SMA patients also experienced greater weight loss (kg) than patients in individual appointments (mean difference -1.4 (95% CI -2.15 to -0.64), p<0.001). Both groups experienced a 5.5 mm Hg improvement in systolic BP. SMAs were also less costly to deliver than individual appointments.

CONCLUSION

SMAs deliver functional medicine-based care that improves outcomes more than care delivered in individual appointments and is less costly to deliver.

Lifestyle Medicine Shared Medical Appointments

Chronic diseases pose many challenges to health care providers and the health care system from a human capital, logistic, and financial perspective. To overcome these challenges, efficient and effective health care delivery models that address multiple chronic conditions need to be leveraged. Shared medical appointments are one potential solution to address these issues. This article offers a brief history of group visits and shared medical appointments and reviews the available data regarding their outcomes. It describes the benefits of using lifestyle medicine as the primary therapeutic modality within a shared medical appointment to treat, reverse, and prevent chronic disease. Key considerations and action steps for the implementation of lifestyle medicine shared medical appointments (LMSMAs) are outlined and the potential delivery of these services via telehealth is explored.

Active Long-term Care Strategies in a Group Setting for Chronic Spine Pain in 3 United States Military Veterans: A Case Series

Objective

The purpose of this article is to describe the management of chronic spine pain in 3 United States military veterans who participated in extended courses of chiropractic care that focused on active care strategies in a group setting.

Clinical Features

A 68-year old male veteran (case 1) with a 90% service-connected disability rating presented with chronic neck and lower back pain. An 82-year old male veteran (case 2) with a 20% service-connected disability rating presented with chronic neck and upper back pain. A 66-year old male veteran (case 3) presented with a 10% service-connected disability with chronic episodic back and neck pain. Each veteran described a desire to maintain ongoing chiropractic treatments after completion of a course of chiropractic care in which maximal therapeutic gain had been determined. Patient-Reported Outcomes Measurement Information System (PROMIS) Patient Interference Short Form 6b (PPI), PROMIS Physical Function Short Form 10b (PPF), and Pain, Enjoyment, and General Activity (PEG) outcome measurement tools were used to track response to care.

Interventions and Outcome

Each veteran participated in an extended course of chiropractic visits consisting of group pain education, group cognitive behavioral strategies, group exercise, group mind-body self-regulation therapy, and optional individual manual therapy. Case 1 completed 8 extended chiropractic visits in 12 months and reported no change in PPI scores, improvement in PPF scores, and worsening PEG scores. Cases 2 and 3 completed 6 extended chiropractic visits each over a 12-month period and reported improvements in PPI, PPF, and PEG scores.

Conclusion

This article describes the responses of 3 veterans with chronic spine pain participating in long-term care using chiropractic visits in a group setting that focused on active care strategies. Our group-based, active care approach differs from those described in literature, which commonly focus on visits with a strong emphasis on manual therapy in 1-on-1 patient encounters.

Group Medical Visits and Clinician Wellbeing

There is strong evidence for clinical benefits of group medical visits (GMVs) (also known as shared medical appointments) for prenatal care, diabetes, chronic pain, and a wide range of other conditions. GMVs can increase access to integrative care while providing additional benefits including increased clinician-patient contact time, cost savings, and support with prevention and self-management of chronic conditions. During the COVID-19 pandemic, many clinical sites are experimenting with new models of care delivery including virtual GMVs using telehealth. Little research has focused on which clinicians offer this type of care, how the GMV approach affects the ways they practice, and their job satisfaction. Workplace-based interventions have been shown to decrease burnout in individual physicians. We argue that more research is needed to understand if GMVs should be considered among these workplace-based interventions, given their potential benefits to clinician wellbeing. GMVs can benefit clinician wellbeing in multiple ways, including: (1) Extended time with patients; (2) Increased ability to provide team-based care; (3) Understanding patients' social context and addressing social determinants of health. GMVs can be implemented in a variety of settings in many different ways depending on institutional context, patient needs and clinician preferences. We suggest that GMV programs with adequate institutional support may be beneficial for preventing burnout and improving retention among clinicians and health care teams more broadly, including in integrative health care. Just as group support benefits patients struggling with loneliness and social isolation, GMVs can help address these and other concerns in overwhelmed clinicians.

Applying a Medical Wellness Group Visit Model to a Community Setting Yielding Weight Loss and Improved Laboratory Results

PURPOSE

To determine the feasibility of applying a medical wellness group (WG) model to a community setting to improve cardiometabolic health.

DESIGN

This quasi-experiment was designed to compare individuals participating in the WG to participants in the control group who received general lectures on nutrition, physical activity, and sleep.

SETTING

A suburb north of Boston, Massachusetts.

PARTICIPANTS

Forty-five adults were in the WG and 10 in the control group.

INTERVENTION

Fourteen weekly 90-minute sessions, led by a physician and dietitian, focusing on nutrition, physical activity, and sleep, compared to controls receiving two 30-minute general wellness lectures provided within 3 months.

MEASURES

Pre- and postweight, waist circumference, hemoglobin A_1C (HbA_1c), and serum lipids; a survey measuring beliefs, attitudes, and intentions related to behavioral change.

ANALYSIS

T tests examined the mean change in biometric measurements. The Wilcoxon test was used to compare the ordinal questions in baseline and final survey results. The Mann-Whitney test was used to compare final survey results between groups.

RESULTS

The WG demonstrated desirable difference-in-difference between groups in weight (P < .001), waist circumference (P < .001), and total cholesterol (P = .03) compared to the control group. Mean change of HbA_1c and triglycerides was not different between groups. Survey results showed that attitudes, perceived behavioral control, and feeling supported about wellness behaviors significantly improved from baseline to final visit in the WG (P = .002; P = .019, P = .006, respectively), but not among controls.

CONCLUSION

Wellness groups are feasible and provide high levels of support and accountability that empower people to make behavioral changes to improve health.