Take steps to ensure group visits are successful

Start with chronic patient groups

When deciding whether a group appointment would be beneficial, first identify the population you want to address, keeping in mind that chronic conditions respond best to group care, advises Andrew Bertagnolli, PhD. Bertagnolli is project manager for group appointments and chronic pain at regional health education for Kaiser Permanente Northern California in Oakland. Conditions that require a high degree of patient involvement in disease management are also good candidates for group visits, such as diabetes and asthma.

Next, determine the goals for the group and what you wish to accomplish. For example, for a diabetes group, the goals might be to increase knowledge and education, improve clinical management, and reinforce behavioral life change skills.

Once goals are set, it’s time to decide what clinical interventions you want to offer. It may be appropriate to offer nutrition counseling or medication counseling and adjustment. The goals and interventions will help determine who best can meet those needs.

To determine whether the group would work best as a closed membership or drop-in, review the condition. Is there a need for ready access? Is the level of subjective distress when symptoms are out of control high or low? If it is low, you may not get the participation in a drop-in group that would make it worthwhile and a closed group might be best.

"Once you have decided on the population you want to target, your goals, the interventions you want to provide, staffing decisions, and group structure, it’s time to consider logistics," says Bertagnolli. Does your facility have a large enough room available for the group visits? It’s important to have clerical support as well, someone to contact people and introduce them to the concept of group appointments, schedule patients for the group appointments, pull charts, and make sure educational materials are stocked in the room.

Finally, you’ll need to determine how to measure whether you are meeting your goals. For example, to determine if patients were learning to manage their asthma, Bertagnolli checked computer data at Kaiser to see how many prescriptions for preventative medications group participants had filled vs. rescue medications. "A lot of people were overutilizing their rescue medications and not really taking their preventative, so I wanted to switch that around and I saw that happening," he says.