Shared Medical Appointments for Registered Nurse Facilitators
Published: 17 July 2019
Published: 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.)
Ausmed’s Editorial team is committed to providing high-quality and thoroughly researched content to our readers, free of any commercial bias or conflict of interest. All articles are developed in consultation with healthcare professionals and peer reviewed where necessary, undergoing a yearly review to ensure all healthcare information is kept up to date. See Educator Profile
Madeline Gilkes, CNS, RN, is a <a href="https://www.lifestylemedicine.org.au/fellows" target="_blank">Fellow of the Australasian Society of Lifestyle Medicine</a>. She focussed her master of healthcare leadership research project on health coaching for long-term weight loss in obese adults. In recent years, Madeline has found a passion for preventative nursing, transitioning from leadership roles (CNS Gerontology & Education, Clinical Facilitator) in hospital settings to primary healthcare nursing. Madeline’s vision is to implement lifestyle medicine to prevent and treat chronic conditions. She is planning to complete a PhD in health education, and currently works mostly in the role of Head of Nursing. Madeline’s philosophy focuses on using humanistic management, adult learning theories/evidence and self-efficacy theories and interventions to promote positive learning environments. In addition to her master of healthcare leadership, Madeline has a graduate certificate in adult and vocational education, graduate certificate of aged care nursing, and a bachelor of nursing. Madeline is currently nearing completion of a graduate certificate of diabetes education and management. See Educator Profile