Patient Satisfaction with Patient Satisfaction with Shared Medical - - PDF document

APNA 29th Annual Conference Session 4037: October 31, 2015 Hagan 1

Patient Satisfaction with Shared Medical Appointments for Women with Depression Patient Satisfaction with Shared Medical Appointments for Women with Depression

Jerilyn M. Hagan, JD, MSN, CNS The Cleveland Clinic Center for Behavioral Health APRN/PA Manager

Lilian Gonsalves, MD Clinical Professor Cleveland Clinic Lerner College of Medicine

Disclosures: Disclosures:

I lie about my weight I don’t lie about my age My hair is its natural color and I have no conflicts of interest

OBJECTIVES OBJECTIVES

• Define a Shared Medical Appointment

(SMA)

• Explain the characteristics of a

successful SMA

• List advantages of having SMAs
• Identify opportunities for the APRN

BACKGROUND BACKGROUND

• February, 2003-Meeting with Kaiser

Permanente psychologist Dr. Edward Noffsinger (DIGMA)

• October, 2003-SMAs for women with

depression launched in the Center for Behavioral Health

SMAs SMAs

• Implemented for the management of

chronic health conditions (Bronson and Maxwell, 2004)

• Increase patient satisfaction and quality
• f life (Brenan et al., 2011)
• Little is known about the effectiveness

in the treatment of mental health disorders (Brenan et al., 2011)

PREPARATION and DESIGN PREPARATION and DESIGN

• Location
• Size of room
• Computer availability
• Time
• Length of Group
• Time of day
• Co-therapist
• Schedulers
• Script/talking points

APNA 29th Annual Conference Session 4037: October 31, 2015 Hagan 2

PARTICPANTS PARTICPANTS

• Referred by internist, OB/GYN or self
• Initially seen for complete psychiatric

evaluation

• SMA offered as an option for

medication f/u

• Women over the age of 18
• Number limited to 12 participants
• Average: 8/group

“MARKETING” “MARKETING”

• Letters were sent to current patients
• Posters with group information were

placed at the reception desk

• “Give it a try”

GROUP PROCESS GROUP PROCESS

• APRN completes quick initial

assessment including VS and pain assessment

• Standardized testing is completed by

the patient

• PHQ-9
• GAD-7
• EQ-5D
• CSSRS
• Confidentiality is stressed

METHODOLOGY METHODOLOGY

• From January, 2014 through June,

2014, the PSQ-18 was given

• Eligibility: Patients who had attended at

least one SMA

• Eighty (80) patients completed and

returned the questionnaire

• Satisfaction scores in the domains

pertinent to our patients were compiled

PSQ-18 PSQ-18

• Patient-administered instrument
• Highly correlated with full-length 50-item

Patient Satisfaction Questionnaire-III (PSQ-III)

• 18 items answered on 1-5 scale
• Scored on 7 subscales
• Unique domains of satisfaction
• Average of 2-4 items each

Marshal GN and Hays RD. The Patient Satisfaction Questionnaire Short-Form (PSQ-18). RAND. 1994

APNA 29th Annual Conference Session 4037: October 31, 2015 Hagan 3

PSQ-18 Subscales PSQ-18 Subscales

• General Satisfaction (3,17)
• Technical Quality (2,4, 6, 14)
• Interpersonal Manner (10,11)
• Communication (1,13)
• Financial Aspects (5,7)
• Time Spent with Provider (12, 15)
• Accessibility & Convenience (8,9,16,18)

RESULTS: General Satisfaction RESULTS: General Satisfaction

0% 20% 40% 60% 80% 100% I am dissatisfied with some things about the medical care I receive The medical care I have been receiving is just about perfect 36% 85%

RESULTS: Interpersonal Manner RESULTS: Interpersonal Manner

0% 20% 40% 60% 80% 100% My doctors treat me in a highly friendly and courteous manner Doctors act too businesslike and impersonal toward me 95% 16%

RESULTS: Communication RESULTS: Communication

0% 10% 20% 30% 40% 50% 60% 70% Doctors sometime ignore what I tell them I am able to get medical care whenever I need it 25% 70%

RESULTS: Time spent with Doctor RESULTS: Time spent with Doctor

0% 10%20%30%40%50%60%70%80% Doctors usually spend plenty of time with me Those who provide my medical care sometimes hurry too much when they treat me 80% 19%

RESULTS: Accessibility & Convenience RESULTS: Accessibility & Convenience

0% 20% 40% 60% 80% 100% I am able to get medical care whenever I need it I find it hard to get an appointment for medica care right away I have easy access to the medical specialists I need 70% 36% 94%

APNA 29th Annual Conference Session 4037: October 31, 2015 Hagan 4

THE FIRST YEAR… THE FIRST YEAR…

• Initial 2 months-poor turn out
• Gradual and progressive growth
• Better description of our experiences

to new patients

• Word of mouth
• Feeding the group of new patients

(Attrition, change in insurance, moves, no need for f/u death)

WHAT WORKS? WHAT WORKS?

• Good planning
• Fixed location with computer access
• Common diagnosis
• Prompt start and end times
• Prescriptions and appointments given

at end

• Learning and sharing with other

patients

Opportunities/Roles for APRN Opportunities/Roles for APRN

• Moderate group
• Establish

confidentiality

• Group rules
• Patient education
• Motivational

interviewing

• Create an

environment that nurtures team support

LESSONS LEARNED LESSONS LEARNED

• Cap group participation

number at 12

• Exclude
• Severe personality

disorders

• Psychosis, dementia,

deaf

• Spend 5-7 minutes with

first few patients to set/determine the tone

• Our SMA is cost effective
• High degree of patient

satisfaction 10 years later

• Majority of patients return

to the SMA for follow up BIBLIOGRAPHY BIBLIOGRAPHY

• Brennan J, Hwang D, Phelps K. Group visits and chronic disease management in

adults: A review. Am J Lifestyle Med. 2011; 69-84.

• Bronson DL, Maxwell R. Shared medical appointments: increasing patient access

without increasing physician hours. Cleveland Clin J Med. 2004;369-377.

• Kish SR, Watts S, Pascuzzi K, O’Day M, Davidson D, Strauss G, Kern E, Aron D.

Shared medical appointments based on the chronic care model: A quality improvement project to address the challenges of patients with diabetes with high cardiovascular risk. Quality Safety in Health Care. 2007; 349-353.

• Heyworth L, Rosenblum R, Burgess J, Baker E, Meterko M, Prescott D, Neuwirth Z,

Simon S. Influence of shared medical appointments on patient satisfaction: A retrospective 3-year study. Annals of Family Medicine. 2014; 324-330.

• Marshal GN, Hays RD. The patient health questionnaire short-form (PSQ-18). RAND.

1994

• Watts S, Gee J, O’Day M, Schaub K, Lawrence R, Aron D, Kirsh S. Nurse practitioner-

led multidisciplinary teams to improve chronic illness care: The unique strengths of nurse practitioners applied to shared medical appointment/group visits. Journal of the American Academy of Nurse Practioners. 2009;167-172.