Group Doctor Visits

About fifteen people chat around the lunch table at Families First Seacoast Community Health Center.

Most of them are seniors, most of them are women, and all of them have diabetes.

[bring up sounds…I worry more about the A1C more than I do about the daily count. I want to know what that average is…]

They exchange medical notes and compare eating strategies:

Which grocery stores carry low-carb pitas, which fast food restaurants serve frozen yogurt.

For Shirley Corley casual sessions like these have helped dissolve the fear of living with a chronic disease.

Corley: I’m not so scared. I’m not the only one. They’re all out there, they all got the same problems. They’re scared of hurting their feet because if you get an infection and can’t control it you can lose a foot or a leg and that’s what happened in my family so that’s why I’m more terrified of it.

Corley found out about her type two diabetes a little over a year ago.

And just about every other month since then she has come to Families First for check-ups.

But hers are not just fifteen minutes with a nurse.

They are a two-hour combination of support group, medical visit, and seminar.

The medical check-up is private, and afterwards Corley returns to hear a nutritionist catalog the evils of cholesterol.

[sounds lecture]

A nurse follows up with information about cholesterol medication.

The month, attendance has swelled to over twenty patients—the most Families First has attracted to a group meeting.

Jane Cummings, a nurse who runs the program, is pleased.

Obviously, it’s an efficient system: twenty patients are educated with one schpeel.

She sees other benefits as well.

Cummings: Clearly the patients that see us often and especially the patients that come to group do better than patients that we don’t see and don’t come to group.

And this makes the group system cost effective.

Cummings adds that patients who attend group visits are more likely to follow the advice they learn there, and end up needing less medical attention.

Cummings has not put any number to possible cost savings, but Arne Beck at Kaiser Permanente in Colorado has.

He followed two groups of chronically ill patients over two years: those who went to monthly group doctor visits and those who stayed on a conventional one on one schedule.

He found no differences in health outcomes, but that doesn’t mean there weren’t advantages.

Beck: We found that the group visit patients had fewer hospital admissions and emergency room visits and that their costs overall were about 42 dollars per member per month less than control patients.

That’s about a ten to twenty percent decrease in their health care costs.

Those savings have made group visits more common nationwide.

Even so, they still remain relatively rare.

Elgert: Medical profession in general is fairly traditional and it tends to embrace change slowly.

Stephen Elgert is a doctor at Concord’s Capital Region Family Health Center.

He has taken the rare step of requiring all his residents to deliver a group visit.

Elgert: They’ve been very enthusiastic. I think there’s always a little bit of trepidation when they first go in there and they walk into the actual meeting but in general they’ve embraced it and done very well with it.

Elgert says doctors like the group system because they have more time to discuss topics they can’t typically fit in to a fifteen minute meeting.

But he says that even if group visits were more common, they could never replace individual visits.

For one, not all insurance covers group visits.

And some patients prefer to keep their health private.

Helen Taft, executive director of Families First Seacoast, says group visits also require a shift in the use of space and staff.

Taft: We understand that for prevention you are investing up front but the pay off in the long term is a lot more. And in fact in this instance it’s really on the health care system, not necessarily on Families First.

For nurse Jane Cummings, it pays off when she gets to give patient Shirley Corley another bill of good health.

Most of the time her blood sugars are in the normal range, which is great. And her blood sugar right now is a hundred, which is excellent.

SOQ