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A brief review of the evidence for Shared Medical Appointments (SMAs) and Medical Yarn Ups (MYUs)

SMA nomenclature and process

Shared Medical Appointments (SMAs) are also known in the medical literature as Group Consultations, Group Medical Appointments, and when applied to the care of Aboriginal and Torres Strait Islander people, Medical Yarn Ups (MYUs).

A typical SMA may take up to 90 minutes with 8-12 patients attending with similar concerns, managed and supported by a trained facilitator, in which the General Practitioner (GP) consults with each patient individually and consecutively,  according to the requirements of their scope of practice and the Health Insurance Regulations (2021).

The SMA process is predicated on a personal attendance, by a single medical practitioner, being provided to a single patient, on a single occasion – this is an important consideration if an Australian provider is intending to claim MBS item numbers.

The requirements of a consultation are met in a SMA as the GP evaluates the patient’s health-related issue/s; formulates a management plan in relation to the health issues; provides advice to the patient and/or their relatives (if authorised by the patient); provides appropriate preventive health care; and records the clinical detail of the service(s) provided to the patient.

The main difference that the SMA process offers is that other patients with similar concerns are listening and, when appropriate, are asked to contribute their knowledge and lived experience to a conversation that might follow the consultation.

Evidence for SMAs

There is a large and growing body of evidence showing that this difference in the consultation process is making significant improvements to: patient outcomes, practice efficiencies and cost effectiveness1 2 3 4 5 6 7; reduced waiting times5 7 8; reduced presentations to emergency departments and hospital admission rates2 8 9 10. The literature also strongly and consistently reports that SMAs improve patients’ knowledge and self-management competency3 11 12. SMA consultations are a rare example of a model that meets healthcare’s quintuple aim of better cost-effective care and outcomes, better education, high patient, and clinician satisfaction6 13 14 15 .

SMAs as a strategy in Closing the Gap

Shared Medical Appointments provide a model of care that is of great interest in Aboriginal Controlled Community Health Organisations (ACCHO’s) as it also offers improved accessibility while being culturally safe and responsive3 16 17 18. The  model has been named  Medical Yarn Up by the ACCHOS  and their clients using it. Medical Yarn Ups have been reported in the literature and through roundtable discussions facilitated by ASLM, to being an important strategy in closing the Gap16,18.

SMAs, current practice, and collaborations with Primary Health Networks

ASLM is currently working with a number of PHNS to develop SMAs as an adjunct to General Practice. The PHNs are engaging SMAs as a strategy to enhance primary care’s capacity to manage the rise in lifestyle-related chronic disease presentations and workforce issues.

ASLM has trained over 1200 clinicians in the last 5 years in the SMA process and conducted a number of trials showing its effectiveness and acceptance by patients and providers in practice3. ASLM has worked with UK and NZ health Services to help develop equivalent SMA processes that are now integrated into services in those countries5. The UK is now routinely using Group Consultation (SMAS) in over 1000 medical centres. Group Consultations, as SMAs are referred to in the UK, have been identified by the NHS as the most important strategy for reducing ~8 million patient waiting list in the aftermath of the Covid 19 pandemic19.

  1. Egger G, Binns A, Cole M, Stevens J , et al. Shared medical appointments – An adjunct for chronic disease management in Australia? Aust Fam Physician 2014;43(3):151–54.
  2. Edelman D, McDuffie JR, Oddone E, Gierisch JM, Nagi A, Williams JW Jr. Shared medical appointments for chronic medical conditions: A systematic review. Durham, NC: Evidencebased Synthesis Program (ESP) Center Durham Veterans Affairs Healthcare System, 2012
  3. Egger G, Stevens J, Egger S Volker N. 2019 ‘Programmed’ Shared Medical Appointments (pSMAs) for weight management in primary care: A proof of concept intervention study. Aust Journal of General Practice Vol 48, No 10, 681-688
  4. Wadsworth KH, Archibald TG, Payne AE, Cleary AK, Haney BL, Hoverman AS. Shared medical appointments and patient-centered experience: a mixed-methods systematic review. BMC Fam Pract. 2019 Jul 8;20(1):97. doi: 10.1186/s12875-019-0972-1. PMID: 31286876; PMCID: PMC6615093.
  5. Jones T, Darzi A, Egger G, Ickovics J, Noffsinger E, Ramdas K, Stevens J, Sumego M, Birrell F. PROCESS & SYSTEMS: A systems approach to embedding group consultations in the NHS. Future Healthc J. 2019 Feb;6(1):8-16
  6. Birrell F, Lawson R, Sumego M, Lewis J, Harden A, Taveira T, et al. Virtual group consultations offer continuity of care globally during Covid‐19. Lifestyle Medicine. 2020;1(2)
  7. Tang M,  Graham F,  O’Donnell A et al. Effectiveness of shared medical appointments delivered in primary care for improving health outcomes in patients with long-term conditions: a systematic review of randomised controlled trials. MedRxiv 2022.03.24.22272866
  8. Cunningham, S.D.; Sutherland, R.A.; Yee, C.W.; Thomas, J.L.; Monin, J.K.; Ickovics, J.R.; Lewis, J.B. Group Medical Care: A Systematic Review of Health Service Performance. Int. J. Environ. Res. Public Health
  9. Dwyer KM, Axtens MJ, Egger G, Stevens J. Re-imaging healthcare delivery in the era of COVID-19. Intern Med J. 2022 Nov;52(11):1998-2000. doi: 10.1111/imj.15931. PMID: 36114725; PMCID: PMC9538078.
  10. Kelly F, Liska C, Morash R, Hu J, Carroll SL, Shorr R, Dent S, Stacey D. Shared medical appointments for patients with a nondiabetic physical chronic illness: A systematic review. Chronic Illn. 2019 Mar;15(1):3-26. doi: 10.1177/1742395317731608. Epub 2017 Sep 19. PMID: 28927284.9.
  11. Harvey 2020  Shared Medical Appointments to Improve Self-Care Actions in the Adult Heart Failure Patient Paige E. Harvey University of Missouri-Kansas City Approved May 2020 by the faculty of UMKC in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice ©2020
  12. Ee C, de Courten B, Avard N, de Manincor M, Al-Dabbas MA, Hao J, McBride K, Dubois S, White RL, Fleming C, Egger G, Blair A, Stevens J, MacMillan F, Deed G, Grant S, Templeman K and Chang D (2020) Shared Medical Appointments and Mindfulness for Type 2 Diabetes—A Mixed-Methods Feasibility Study. Front. Endocrinol. 11:570777. doi: 10.3389/fendo.2020.570777
  13. Bartley KB, Haney R. Shared medical appointments: improving access, outcomes, and satisfaction for patients with chronic cardiac diseases. The Journal of Cardiovascular Nursing. 2010 Jan-Feb;25(1):13-19. DOI: 10.1097/jcn.0b013e3181b8e82e. PMID: 20134280.
  14. Stevens JA, Cole M-A, Binns A, Dixon J, Egger G. A user assessment of the potential for shared medical appointments in Australia. Aust Fam Physician 2014;43(11):804–07
  15. Marshall V, Jewett-Tennant J, Shell-Boyd J, Stevenson L, Hearns R, Gee J, Schaub K, LaForest S, Taveira TH, Cohen L, Parent M, Dev S, Barrette A, Oliver K, Wu WC, Ball SL. Healthcare providers experiences with shared medical appointments for heart failure. PLoS One. 2022 Feb 7;17(2):e0263498. doi: 10.1371/journal.pone.0263498. PMID: 35130320; PMCID: PMC8820643.
  16. Stevens J, Binns A, Dixon J, Morgan R, Egger G 2016 Shared Medical Appointments for Aboriginal and Torres Strait Islander Men.  Australian Family Physician vol 45 (6) 425-429.
  17. Stevens J, Morgan B, Firth W, Egger G. Shared Medical Appointments in Weight Management: A Culturally Responsive Process for Aboriginal Women. Translational Trial Results. American Journal of Lifestyle Medicine. May 2022. doi:10.1177/15598276221088246
  18. Stevens J, Morgan B, Firth W, Egger G. Shared Medical Appointments in Weight Management: A Culturally Responsive Process for Aboriginal Women. Translational Trial Results. American Journal of Lifestyle Medicine. May 2022. doi:10.1177/15598276221088246
  19. British Society of Lifestyle Medicine Address by Finance Dept Lead NHS  – report on Covid waiting lists- 22-23rd September 2022 Tottenham. 

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