प्राथमिक देखभाल में गुणवत्ता खुला एक्सेस

अमूर्त

Quality improvement in chronic care delivery for patients with arterial hypertension through Group Medical Visits: Patient acceptance and attendance in the German pilot project

Benedikt Simon

Background: To improve the quality of chronic care delivered and to effectively manage their panel of chronically ill patients is a challenge for many family physicians, which have historically focused on acute care. A high quality intervention for chronically ill patients are group medical visits (GMV), where physicians see a group of patients with a common (chronic) condition simultaneously in a supportive setting. GMV typically include both, educative group work fostering the exchange of coping strategies between patients as well as elements of the individual one-on-one visit like the taking of history and vital sign collection. In North America and several European countries GMV as care innovations, have for the most part been introduced with the backing of larger care organizations. In Germany, primary care in group settings is unknown and larger care organizations, which could drive innovations like GMV, are not present.

Aims: The pilot project was conducted in order to assess the transferability and implementability of GMV, following the model of chronic health care clinics (CHCC), into the German health care system.

Method: The findings presented here, stem from a RCT conducted at two rural physician practices to assess the effectiveness of GMV against standard one-on-one visits. After assessing the willingness of patients to attend GMV, 48 patients were included in the study at both practices. At each practice half of the patients were randomized into a control group, while the other half was split in into two intervention groups of twelve patients that met every second month for a GMV. It is the actual attendance of these intervention groups that are described analyzed here.

Results: GMV were successfully implemented by both physicians. With a positive response rate of 81.9%, patients’ willingness to attend GMV exceeded the willingness to attend measured in previous studies. Actual attendance was on and above target-census of ten patients per GMV, in three out of four patient groups, only in one patient group the census consistently fell short. On average, 9.8 patients attended each GMV, equaling an attendance rate of 81.6%.

Conclusion: Our pilot study indicates that it is generally possible to establish GMC in ordinary primary care practices, without the backing of a larger health care organization. According to the willingness to attend and actual attendance rates of the small sample in this study, GMV following the CHCC model appear to be a feasible and acceptable model of primary care for chronically ill patients in Germany.