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Shared appointment model shows clinical potential for fibromyalgia.

Fibromyalgia patients who participated in shared medical appointments staffed by an interdisciplinary team at a rural academic medical center reported high satisfaction with the new care model, according to Nicole M. Orzechowski, DO, and her colleagues in the department of rheumatology at Dart-mouth-Hitchcock Medical Center, Lebanon, N.H.

The study of 67 referred patients, who were evaluated during a 1-year period with the shared medical appointment (SMA) model, revealed in postsession surveys that not only did all patients agree that the care model would assist in managing their condition, but 95% also thought that the peer-to-peer interaction was "extremely helpful."

Dr. Orzechowski and her co-authors wrote that they developed the SMA care model in response to an increased demand in rheumatologic consultation, as well as staffing constraints.

In the study, which Dr. Orzechowski reported at the annual meeting of the American College of Rheumatology in Washington, she and her associates noted that the 2.5-hour visits conducted by a rheumatologist, two nurse practitioners, a chaplain, and a secretary led to "clinical efficiency in assessing multiple new patients in a defined period of time," improved wait times for fibromyalgia patients from 3 months to 1 month, and also freed up new patient consultation slots for other conditions. The investigators estimated that the SMA has generated an additional 113 work relative value units since its inception.

Prior to the SMA, each patient received a medical history questionnaire in the mail, and the investigators informed primary care physicians about the SMA and its format and asked them to perform specific labs if they had not been done already. Besides individual exams for confirming the diagnosis, measuring vital signs, and reconciling medications, the SMA consisted of a facilitated discussion by a trained chaplain, followed by a short presentation by the clinician (with time for discussion and questions), and then concluded with the chaplain's demonstration of mindfulness techniques for managing chronic pain.

In the future, the investigators said that they hope to enhance and optimize the visit, expand its use, address referring provider satisfaction, and examine postvisit resource utilization.

None of the authors had disclosures to report.


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Author:Evans, Jeff
Publication:Family Practice News
Date:Dec 1, 2016
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