Patients Lose More Weight in Shared Medical Appointments

Patients participating in shared medical appointments (SMAs) led by a multidisciplinary team lost significantly more weight from baseline than patients who had individual medical appointments, according to a new study published in Obesity Science and Practice.

“Our current approach to obesity is rarely successful,” says Bartolome Burguera, MD, PhD, Chairman of Cleveland Clinic’s Endocrinology & Metabolism Institute and senior author on the paper. “We may ask our patients to eat less and exercise more, but that is clearly not enough. As a result, we tend to treat the consequences of obesity (such as hypertension and diabetes), which we know we can treat with medications, rather than obesity itself. Obesity is a chronic disease that requires chronic treatment in its own right.”

Shared medical appointments versus standard of care

In this retrospective study, researchers scrutinized the medical records of matched patient pairs who were diagnosed with obesity: 301 were enrolled in SMAs and 301 were managed with individual medical appointments. Patients in the SMA group first met individually with an obesity specialist, and then with a registered dietician after selecting a nutrition plan to follow (i.e., Mediterranean, protein-sparing modified fast or meal replacement). After these initial visits, patients attended monthly SMAs in groups of 8–10 patients. The 90-minute SMAs focused on nutrition, exercise, appetite control with consideration of AOMs, sleep quality and stress management. The primary outcome of study was weight loss from baseline. Secondary outcomes included the use of antiobesity medication (AOM) for at least 90 days, the number of SMA visits and the duration of SMA enrollment.

Shared medical appointments increase face time and patient satisfaction

A SMA is a group medical visit in which several patients with a similar clinical diagnosis, such as obesity, see a multidisciplinary team of healthcare providers. Typically, 5–10 patients have consultations with providers during a 60- to 90-minute appointment. Part of the session is dedicated to education on the patients’ common medical condition with the goal of improving self-management, but most of the time is spent addressing individual patient concerns.

Each patient takes a turn consulting with a provider, as in a traditional medical appointment, but in a group setting. This allows others in the group to observe and learn from their peers’ experiences. During this consultation, the patient’s concerns are addressed, medications are managed, necessary tests are ordered, and a treatment plan is made. Additional specialty referrals may occur for sleep studies, stress testing, and stress management with psychology professionals. Patients can continue to receive follow-up care through SMAs at predetermined times, instead of traditional individual medical appointments.

Research indicates there are several benefits of shared medical appointments, including:

• Increased face time and access
• Improved patient outcomes
• Increased patient and provider satisfaction
• Decreased costs

“SMAs allow providers to increase their productivity by seeing more patients in a given time frame, thus allowing for a more appropriate amount of time to specifically address obesity management. Further, patients have more time with the provider(s) leading the SMAs. Coordinated SMA programs may also allow patients to access more tools that can aid in chronic weight management, as evidenced by the higher percentage of FDA-approved anti-obesity medications utilization in the SMA group as compared to standard of care,” Dr. Burguera states.

In the one-year study, average weight loss was 5.2% in the SMA group compared with 1.8% in the non-SMA group. “Our study showed that this aggressive lifestyle intervention, in the context of SMAs, resulted in significant weight loss,” Dr. Burguera says. “We still need to get a better idea of the role that AOMs play in helping people to lose weight and maintain weight loss, which would hopefully be useful in addressing whether insurance companies should cover them as they do other medications for other chronic conditions, such as diabetes or hypertension.”