Patient Satisfaction with Patient Satisfaction with Shared Medical - PDF document

APNA 29th Annual Conference Session 4037: October 31, 2015 Patient Satisfaction with Patient Satisfaction with Shared Medical Shared Medical Disclosures: Disclosures: Appointments for Women Appointments for Women with Depression with Depression I lie about my weight I don’t lie about my age Jerilyn M. Hagan, JD, MSN, CNS The Cleveland Clinic My hair is its natural color Center for Behavioral Health and APRN/PA Manager I have no conflicts of interest Lilian Gonsalves, MD Clinical Professor Cleveland Clinic Lerner College of Medicine OBJECTIVES OBJECTIVES BACKGROUND BACKGROUND • Define a Shared Medical Appointment (SMA) • February, 2003-Meeting with Kaiser Permanente psychologist Dr. Edward Noffsinger (DIGMA) • Explain the characteristics of a successful SMA • October, 2003-SMAs for women with depression launched in the Center • List advantages of having SMAs for Behavioral Health • Identify opportunities for the APRN SMAs SMAs PREPARATION and DESIGN PREPARATION and DESIGN • Location • Implemented for the management of - Size of room chronic health conditions (Bronson and - Computer availability Maxwell, 2004) • Time - Length of Group • Increase patient satisfaction and quality - Time of day of life (Brenan et al., 2011) • Co-therapist • Schedulers • Little is known about the effectiveness in the treatment of mental health • Script/talking points disorders (Brenan et al., 2011) Hagan 1

APNA 29th Annual Conference Session 4037: October 31, 2015 PARTICPANTS PARTICPANTS “MARKETING” “MARKETING” • Referred by internist, OB/GYN or self • Letters were sent to current patients • Initially seen for complete psychiatric evaluation • Posters with group information were • SMA offered as an option for placed at the reception desk medication f/u • Women over the age of 18 • “Give it a try” • Number limited to 12 participants • Average: 8/group GROUP PROCESS GROUP PROCESS METHODOLOGY METHODOLOGY • APRN completes quick initial assessment including VS and pain • From January, 2014 through June, assessment 2014, the PSQ-18 was given • Standardized testing is completed by • Eligibility: Patients who had attended at the patient least one SMA - PHQ-9 • Eighty (80) patients completed and returned the questionnaire - GAD-7 • Satisfaction scores in the domains - EQ-5D pertinent to our patients were compiled - CSSRS • Confidentiality is stressed 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 Hagan 2

APNA 29th Annual Conference Session 4037: October 31, 2015 RESULTS: General RESULTS: General PSQ-18 Subscales PSQ-18 Subscales Satisfaction Satisfaction • General Satisfaction (3,17) • Technical Quality (2,4, 6, 14) • Interpersonal Manner (10,11) The medical care I have been receiving 85% is just about perfect • Communication (1,13) • Financial Aspects (5,7) • Time Spent with Provider (12, 15) • Accessibility & Convenience (8,9,16,18) I am dissatisfied with some things about 36% the medical care I receive 0% 20% 40% 60% 80% 100% RESULTS: Interpersonal RESULTS: Interpersonal RESULTS: Communication RESULTS: Communication Manner Manner I am able to get medical care whenever 70% I need it Doctors act too businesslike and 16% impersonal toward me Doctors sometime ignore what I tell 25% My doctors treat me in a highly friendly 95% them and courteous manner 0% 10% 20% 30% 40% 50% 60% 70% 0% 20% 40% 60% 80% 100% RESULTS: Time spent with RESULTS: Time spent with RESULTS: Accessibility & RESULTS: Accessibility & Doctor Doctor Convenience Convenience I have easy access to the medical 94% specialists I need Those who provide my medical care 19% sometimes hurry too much when they treat me I find it hard to get an appointment for 36% medica care right away Doctors usually spend plenty of time 80% I am able to get medical care 70% with me whenever I need it 0% 20% 40% 60% 80% 100% 0% 10%20%30%40%50%60%70%80% Hagan 3

APNA 29th Annual Conference Session 4037: October 31, 2015 THE FIRST YEAR… THE FIRST YEAR… WHAT WORKS? WHAT WORKS? • Initial 2 months-poor turn out • Good planning • Gradual and progressive growth • Fixed location with computer access - Better description of our experiences • Common diagnosis to new patients • Prompt start and end times - Word of mouth • Prescriptions and appointments given - Feeding the group of new patients at end (Attrition, change in insurance, • Learning and sharing with other moves, no need for f/u death) patients Opportunities/Roles for APRN Opportunities/Roles for APRN LESSONS LEARNED LESSONS LEARNED • Cap group participation • Our SMA is cost effective number at 12 • Moderate group • Patient education • High degree of patient • Exclude satisfaction 10 years later - Severe personality • Establish • Motivational disorders confidentiality interviewing • Majority of patients return - Psychosis, dementia, to the SMA for follow up deaf • Group rules • Create an • Spend 5-7 minutes with environment that first few patients to set/determine the tone nurtures team support 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 . Hagan 4