Shared Medical Appointments for Dizziness and Imbalance

By Julie Honaker, PhD, and Amy Johnson, CNP

Symptoms of dizziness – including vertigo and imbalance – are estimated to affect upwards of 20 percent of adults per year, with an increase in prevalence with advanced age (Neuhauser, 2016). These symptoms are commonly linked to inner ear vestibular disorders, including Benign Paroxysmal Positional Vertigo (BPPV), vestibular migraine and Meniere’s disease. However, there are numerous other causes that must be ruled out, including medication effects and cardiovascular, neurological and even psychological disorders. Even healthy individuals may report symptoms of imbalance, which can be secondary to the aging process.

It stands to reason that dizziness is one of the most common causes for doctor visits and hospital admissions. Patients with these symptoms have significant activity restrictions and reduced quality of life. The restriction of physical activity then leads to decreased physical conditioning and balance skills and can increase the likelihood of future falls. To stop this vicious cycle and reduce falling risk, early evaluation and management of patients with dizziness and imbalance are essential.

Often the complexities of dizziness are difficult to determine at individual medical provider appointments due to the multifaceted reasons and potential causes. Access to one-on-one appointments with specialists also presents a challenge. Patients with chronic disease (including dizziness) benefit from additional education and encouragement to remain healthy and break the cycle restricting activities and participation. For these reasons, the use of a shared medical appointment (SMA) may provide a more efficient solution to standard care by having patients with similar symptoms and disorders benefit from a longer appointment session with multiple providers and group education (Coates et al. 2017; Bartley, 2010).

What are Shared Medical Appointments?

Shared medical appointments are not a new concept, and have been in existence since the late 1990s (Bartley, 2010). This type of appointment is unique in that it provides simultaneous one-on-one patient encounters in a group setting. An SMA is now offered to all prospective new patients to the Cleveland Clinic Head & Neck Institute who report symptoms of dizziness and imbalance.

Patients with interest in a group setting are most favorable for this type of appointment. Patients may be of any age, gender or background – with acute or chronic illness. The appointment team includes:

• Four to five patients and any loved ones
• A medical provider (certified nurse practitioner) for private otology medical examination and system review
• A facilitator (vestibular audiologist) for comprehensive case history, patient education and vestibular screening
• A medical assistant to check vital signs, review medications and retrieve outside records
• A student extern to help with appointment flow and note taking

While this is a group appointment, each patient is addressed individually during case history and system review, and receives a private otology examination away from the group setting.

What Are the Benefits?

This model can improve patient access, with shorter wait times and coordination of appointments (Kaider-Person et al, 2006). SMAs are cost effective and can also increase physician productivity (Seesing, 2015). Patients feel empowered to communicate information and motivated to follow the plan of care (Coates et al. 2017). Overall, patients who have participated in the Cleveland Clinic Dizziness SMA found it to be valuable and appreciated learning that they are not alone with symptoms of dizziness and imbalance.

We have found that this model truly represents a team-based approach to the management and care of patients with dizziness and imbalance complaints, and it is our hope that it will continue to improve healthcare delivery for better patient satisfaction and engagement, reduced wait times and improved quality of life for patients (Ramdas & Darzi, 2016).

Dr. Honaker is Director of Vestibular and Balance Disorders Laboratories at Cleveland Clinic; she can be reached at honakej@ccf.org. Amy Johnson, CNP, is a certified nurse practitioner in the Head & Neck Institute.

References

Bartley, K.B., & Haney, R. (2010). Shared medical appointments. Improving access, outcomes and satisfaction for patients with chronic cardiac disease. J Cardiovasc Nurs, 25(1), 13-19. doi: 10.1097/JCN.0b013e3181b8e82e.

Coates, J., Gething, F., & Johnson, M.I. (2017). Shared medical appointments for managing pain in primary care settings? Pain Manag, 7(4), 223-227. doi: 10.2217/pmt-2017-0016.

Kaider-Person, O., Swartz, E.W., Lefkowitz, M., Rosenthal, R. (2006) Shared medical appointments: new concept for high-volume follow-up for bariatric patients. Surg Obes Relat Dis, 2, 509-512.

Neuhauser, H.K. (2016). Chapter 5 – the epidemiology of dizziness and vertigo. Handbook of Clinical Neurology, 137, 67-82. Doi: 10.1016/B978-0-444-63437-5.00005-4.

Ramdas, K., & Darzi, A. (2016). Adopting innovations in care delivery – the case of shared medical appointments. N Engl J Med, 376(12), 1105-1107. doi: 10.1056/NEJMp1612803.

Seesing, FM, Groenewould, HJ, Drost, G., van Engelen, B.G., & van der Wilt, G.J. (2015) Cost-effectiveness of shared medical appointments for neuromuscular patients. Neurology, 85(7), 619-625. doi: 10.1212/WNL.0000000000001857.