Impact of group medical visits on patient engagement and quality of life.

BACKGROUND: Group medical visits (GMV) effectively improve patient care and outcomes through interactive education, increased patient contact, and facilitated social support. This quality improvement research examined if patient activation and quality of life correlate with weight, blood pressure (BP), and hemoglobin A1c (A1C) through GMV interventions. METHODS: Participants were enrolled in GMV Lighten Up for weight management or GMV Diabetes. At pre- and post-intervention, patients completed the Patient Activation Measure (PAM) and the health-related quality of life measure, the SF-12; and were assessed for weight, blood pressure (BP), and hemoglobin A1c (A1C). RESULTS: Weight and PAM scores significantly improved regardless of group. For patients in GMV Diabetes, A1C significantly decreased. GMV Lighten Up participants had statistically significant declines in diastolic BP. Both groups improved patient activation, but statistically significantly so only in GMV Diabetes participants. SF-12 scores did not statistically significantly improve. There were no predictors of A1C and PAM score change for the Diabetes GMV. However, age, SBP and SF-12 scores predicted PAM score changes in GMV Lighten up participants. CONCLUSIONS: Participants in this study showed overall improvement in biomarkers and patient activation. Thus, GMV continue to be a viable method for healthcare delivery.

High-dose tramadol conversion to buprenorphine-naloxone.

Buprenorphine-naloxone is a combination medication of an opioid partial agonist and opioid antagonist that is proven to be effective in outpatient management of opioid use disorder (OUD). Tramadol is a centrally acting analgesic. This commonly used pain medication inhibits serotonin and noradrenaline reuptake by acting as a selective agonist on opioid µ receptors. Transition and tapering high-dose tramadol to buprenorphine-naloxone is not well described in the literature. We report a case of a patient who was taking 1,000-1,250 mg of tramadol daily upon presentation to the clinic. She was originally prescribed 150 mg daily with escalation in dose and frequency over a 10-year period. The patient was converted to bupren-orphine-naloxone and has been successful in treatment of OUD for 1 year.

Utility of the group medical visit model for medication-assisted therapy.

OBJECTIVE: To describe a group medical visit (GMV) model to facilitate medication assisted therapy. DESIGN: Retrospective cohort analysis. PARTICIPANTS: Adult patients over 18 years of age desiring to receive medication assisted therapy (MAT). METHODS: We describe the MAT GMV model including the clinical flow and group facilitation processes. The key elements for documentation and the medical portion of the visit are discussed. Using descriptive methods, we report the characteristics of our patient population entailing demographics, co-occurring mental health diagnosis, and medication use. RESULTS: A total of 32 patients have participated in our MAT GMV over the past 2 years with nine active patients. Age range of participants is 20-65, with about half of them between 31 and 54; race and ethnicity have been primarily White (87 percent) with equal distribution of male and female patients. Most patients had one or more co-occurring mental health disorder. The majority of patients had a prescription of buprenorphine-naloxone 8-2 mg twice a day (62 percent). Many of our patients had repeated co-occurring illegal substance use on urine testing resulting in program dismissal. CONCLUSIONS: MAT GMV is a straightforward and innovative way to deliver care to patients affected by opioid use disorder who are in a maintenance state. One of the biggest obstacles to successful participation in this program is repeated co-occurring illegal substance use. When remission is achieved via MAT GMV, provider efficiency is also increased and patients accomplish a sense of wellbeing via therapy, self-management, and medication assistance.

Launching a Medication-Assisted Treatment in an Outpatient Office-Based Practice.

Background: Opioid use and overdose are escalating in the United States. Primary care providers are in a strategic position to assess patients for medication-assisted treatment (MAT). Objectives: To describe the implementation of MAT in an integrated primary care residency clinic and assess provider comfort levels with evaluating patients for high-risk opioid use, conduct crucial conversations about MAT treatment options and referral to MAT for evaluation and treatment. Methods: As part of a Primary Care Training and Enhancement grant through Health Resources and Services Administration, we used an implementation process to allow for optimal clinic flow. The process included assessment of patient populations, identifying a provider champion, organizing multidisciplinary team, engaging a practice facilitator, designing clinic model and infrastructure, creating the electronic health record order sets along with provider and staff training. Providers responded to brief questions to evaluate comfort levels in 3 domains: identifying high-risk opioid use, conducting crucial conversations about treatment options and referral to MAT for evaluation and treatment. Discussion: Incorporating MAT within an integrated primary care clinic and residency program with waiver training for residents was a successful and innovative program. The availability of MAT provided a solution for patients that could benefit from this type of treatment. MAT presence gave providers the opportunity to refer these patients for treatment that had not previously been as accessible. Conclusion: An integrated primary care practice with an embedded MAT can be successful with an organized structure to optimize clinic flow.

Group Medical Visits: experiences with patient and resident implementation.

Objective: Patients with diabetes must navigate multiple components of care to self-manage their disease. Group Medical Visits (GMVs) are a forum for patients to see a provider as well as actively participate in education and care management with other patients with diabetes. The objective is to describe GMV implementation and resident involvement in a primary care setting.Methods: We adapted and implemented a GMV model into a primary care practice with a residency program. Residents attend GMV sessions that provide a continuity experience in addition to their regular clinic schedules. A cohort of patients enroll in a series of eight GMVs occurring over of 4 months. Each patient and resident complete surveys evaluating the visits.Results: There have been 14 GMV groups totaling 70 participants. GMV groups (N = 67) mean A1C for reduction was 0.53 ± 1.60 from baseline to 3- to 6-month post-GMV follow-up. Resident and patient feedback show an overall positive experience.Conclusion: The GMV model offers patients the setting to interact and exchange experiences with each other as well as to receive feedback from providers and the health-care team.  The incorporation of the GMV program into residency training provides a continuity group care experience and an alternative practice model.