Shared Medical Appointments for Registered Nurse Facilitators
Published: 16 July 2019
Published: 16 July 2019
Shared medical appointments (SMA) have emerged as a new way for healthcare professionals to see clients in medical settings.
Typically, they involve one or more healthcare practitioners seeing a group of patients concurrently (Kirsh et al. 2017).
There is usually a designated ‘facilitator’ (e.g. nurse) present, who explains the session, answers questions and manages the process (Egger et al. 2014).
An SMA can be thought of as both an individual consultation and a group peer support session (Australasian Association of Lifestyle Medicine 2022).
A review by Edelman et al. (2015) found that SMAs were 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 haemoglobin A1c (HbA1c) for participants (Edelman et al. 2015).
Similarly, another systematic review from 2015 found that ‘primary care Veterans Affairs (VA) SMAs significantly improved A1c results for clients with diabetes’ (Watts et al. 2015).
A more recent review (Kelly et al. 2017) investigated SMAs for non-diabetic ‘physical chronic illness’ and found there were nil adverse outcomes in terms of ‘patient harms’. Kelly et al. (2015) stated that one of the studies saw a reduced number of hospital admissions for patients who participated in SMAs as opposed to individual appointments.
The above findings implore 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):
A study by Edelman et al. (2015) 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:
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 SMAs 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.
Question 1 of 3
True or false: Privacy and confidentiality concerns are a barrier to the implementation of SMAs in Australia.