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Background
Despite the critical need for comprehensive and effective chronic pain care, delivery of such care remains challenging. Group medical visits (GMVs) offer an innovative and efficient model for providing comprehensive care for patients with chronic pain. The purpose of this systematic review was to identify barriers and facilitators (deter...
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Background
The use of data in decision making and planning in primary health care settings is critical for improving efficiency and health outcomes for patients and communities. Implementation research can be used to fully understand the effects, context, challenges, and facilitators of data use, as well as how to scale up data use interventions. H...
Citations
... In this setting, patients benefit from peer learning, social support, and clinician access. [11][12][13] Moreover, this type of clinical encounter is covered by most insurers. Many benefits have been linked to the group medical visit model, including improved patient and provider satisfaction. ...
Background
Chronic low back pain is globally prevalent and associated with significant impairment in quality of life. Furthermore, people from historically marginalized communities are less likely to receive treatment, contributing to health inequities. Group mindfulness-based interventions improve pain and function, and virtual delivery has been demonstrated to be feasible. Little is known about how participants experience the virtual delivery of mindfulness-based interventions, especially participants from historically marginalized communities.
Objective
This study explored participant perspectives of a virtual mindfulness-based group medical visit for people with chronic low back pain.
Methods
Participants were recruited from the intervention arm of OPTIMUM, a study of virtual medical group visits using an adapted Mindfulness-Based Stress Reduction program for chronic low back pain. Semi-structured exit interviews were examined, and reflexive thematic analysis was used to compose key themes.
Results
Interviews from 59 participants (mean 56 years, 69.5% women; 45.8% Black or African American) were examined. Two major themes were derived from analysis. The first theme was ‘effects of the external environment,’ ie, the physical location from which the participant engaged with the session. The subthemes were comfort, social demands in the home setting, and sharing personal spaces. The second theme was ‘navigating the virtual platform.’ Subthemes were ease, struggle, and levels of support.
Conclusion
Patient experiences varied substantially during the virtual mindfulness-based group medical visit intervention and this variation was influenced by social determinants of health. The key themes bring attention to the effects of the external environment and the technology itself on participation for people from historically marginalized communities. Basic tenets of mindfulness, such as present state awareness and equanimit y, can provide a structure within which to navigate virtual participation amid home environments. Future studies are needed to explore differences in virtual and in-person mindfulness programs and to adapt virtual mindfulness programs.
Clinicaltrials.gov ID number
NCT04129450.
... A more recent systematic review by Roth et al (2024) highlights the importance of referral networks for GMV recruitment within the clinical environment. 34 Furthermore, Roth et al. (2023) also state that poor referral networks and providers' limited knowledge of integrative services serve as significant barriers to patients accessing integrative pain care. 35 Our HoW study outlines novel methods of recruitment through the use of Appetizer events out in the community in addition to clinical referral networks. ...
... These proposed methods serve the dual purpose of extending GMV recruitment capacity while simultaneously spreading real-time access to integrative care modalities and knowledge to community members. Roth et al (2024) also describe transportation as a significant barrier to accessing in-person groups. The current study aimed to address this barrier by implementing a system for offering and coordinating Lyft rides to and from GMVs for patients needing transportation. ...
Background
Chronic pain is a global problem affecting approximately 20% of adults. The prevalence of opioid use for chronic pain has contributed to a widespread crisis of addiction and inadequately managed pain. Though national and international guidelines recommend nonpharmacological, integrative, multi-modal therapies for chronic pain, numerous systemic barriers limit access to these services for those with the highest need and fewest resources.
Objective
This paper describes the development and testing of an innovative “Heals on Wheels” (HoW) community engagement and Group Medical Visit (GMV) program for underserved communities experiencing chronic pain in Hennepin County, Minnesota.
Methods
The HoW program’s curriculum was collaboratively adapted from pre-existing Hennepin Health care GMV programs for chronic pain. Free community-based “Appetizer” workshops were developed alongside an 8-week “Full Meal” GMV program titled Easing Pain Holistically (EPH). Three pain-affinity variations of EPH were created (the “Body”, “Head”, and “Heart”) and delivered to 6 cohorts (2 cohorts of each variation). Feasibility was measured by attendance, demographics, and insurance provider information. To evaluate program acceptability, thematic analysis of patients post-GMV weekly progress sheets was performed.
Results
The curriculum for the HoW program included experiential training and education in evidence-based integrative pain management strategies. Fourteen community appetizer workshops (n = 142) were offered in partnership with organizations representing underserved populations. Fifty-five patients completed EPH from 2022 to 2024 with the greatest number of patients in the Heart (n = 23), followed by the Body (n = 19), and the Head (n = 13). Feasibility for the GMV program was demonstrated with average attendance across 6 cohorts at 75.1%. Thematic analysis of qualitative data revealed themes highlighting appreciation for group connection (“sharing”) and the EPH program content.
Conclusion
The HoW program shows promise as a feasible and acceptable model of community outreach and engagement to improve access to evidence-based integrative pain care.
... 19 Group medical visits are a rapidly expanding model of care delivery that many see as an important model for addressing health care inequities. [20][21][22] Group visits have been implemented in primary care settings, particularly FQHCs, 23 to provide care for diabetes, prenatal care, and chronic pain, among other conditions. Group medical visits bring multiple patients into the same physical or virtual space with one or more clinicians for billable medical care, peer support, and health education. ...
... 23,24 Telehealth IGMVs were uncommon before the COVID pandemic but have been growing rapidly, with many organizations continuing to offer virtual IGMVs. 25,26 Clinical research on IGMVs has demonstrated a wide variety of benefits for chronic conditions, 21,24,27 and qualitative evidence consistently points to their promise for reducing social isolation and loneliness. [28][29][30] Recipe4Health (R4H), a Food as Medicine initiative, addresses food insecurity and nutrition-sensitive chronic conditions among patients in FQHCs in Alameda County, CA (see Figure 1). ...
... Each of these has a body of encouraging health outcomes research, 2,42-44 and a growing body of research on implementation and sustainability in safety-net settings. 16,17,21,[45][46][47] Our findings demonstrate that Rec-ipe4Health uses many of the best practices for produce prescription programs that have been identified in prior literature, 17,48 including (1) integration into health care organizations (screening for food insecurity, electronic health record integration, and staff training in food as medicine); (2) expanding access via home delivery; (3) multi-sector collaboration, including with small farms and health care payors. Additionally, R4H has broad eligibility criteria for patient participation (including chronic conditions as well as food insecurity), allows people in many clinical roles to 'prescribe' participation in telehealth or in-person visits, and offers IGMVs in two languages. ...
Background
Food as Medicine is a rapidly developing area of health care in the United States, aimed at concurrently addressing nutrition-sensitive chronic conditions and food and nutrition insecurity. Recipe4Health (R4H) is a Food as Medicine program with an integrative health equity focus. It provides prescriptions for locally grown produce (‘Food Farmacy’) with or without integrative group medical visits, alongside training for clinic staff.
Objectives
To describe the initial implementation of R4H in four Federally Qualified Health Centers in Northern California, using a convergent mixed-methods approach.
Methods
We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) implementation science framework to assess the first two years of R4H (2020-2022). We draw from 40 interviews (26 partner organization staff, 14 patients) and program data on reach and adoption. Qualitative data were analyzed using codebook thematic analysis.
Results
Reach: From January 2020 to August 2022, 3255 patients were referred to the program; 1997 of those referred (61%) enrolled in the Food Farmacy only ( N = 1681) or Food Farmacy + integrative group medical visits ( N = 316). Participating patients included a wide range of ages (mean age 41.4, [SD 20]; 18% < 18 years old) and racial and ethnic backgrounds (3% American Indian or Alaska Native, 6% Asian or Pacific Islander, 19% Black, 57% Hispanic/Latine, 7% white). 69% were female; 43% primarily spoke Spanish. Adoption: 84% of trained clinic staff referred two or more patients to R4H. Implementation: Elements of successful implementation included: (1) support from county government leadership, (2) centralized coordination of the multi-sector partnership, and (3) a flexible approach responsive to organizational and COVID-related shifts. R4H implementation informed statewide Medicaid policy changes. Maintenance: To date, all four clinics continue to participate in R4H.
Conclusion
Centralized implementation, training, and administration of Food as Medicine programs can strengthen community health centers’ capacities to concurrently address chronic conditions and food insecurity. Multi-sector partnerships can support Food as Medicine program sustainability.
... 11 GMVs were defined in a recent systematic review as multiple patients receiving care concurrently in the same room or telehealth session, a licensed clinician billing and documenting the visit, and patient interaction occurring. 12 According to a systematic and scoping review of 55 studies on GMVs, session durations were on average 90 minutes and frequency of the sessions varied depending on the medical condition, from 1 to 10 sessions. 13 Group visits were facilitated by one to two health professionals, had common defining themes such as a shared medical condition, didactic components like medical topics and lifestyle modifications, and most included experiential learning or activities. ...
Background
The well-being of healthcare teams is an important consideration when seeking to improve patient experience and quality of care. Prior studies have found that changes to working conditions are most effective in improving clinician well-being. Integrative Group Medical Visits (IGMVs) modify working conditions in ways that have potential to improve clinician experience.
Objective
The objective of this study was to understand healthcare teams’ experiences with IGMVs.
Methods
In this qualitative study, interviews were conducted via Zoom and telephone with 21 clinicians, administrators, and staff from safety-net healthcare settings throughout the United States (U.S.) who have implemented IGMVs for patients with chronic pain. Interviews included questions about clinician experience, well-being, and satisfaction with the IGMV model. Interviews were recorded, transcribed, and coded using thematic content analysis by a team of trained qualitative researchers.
Results
The authors identified five themes describing how IGMV positively affected clinician well-being: organizational supports, human-centered engagement, collaboration with an interprofessional team, provision of guideline-concordant care, and enhanced meaning and purpose for the clinicians.
Conclusion
The current study was the first to use interviews from healthcare teams who have implemented IGMV to assess their experience. The themes identified warrant further investigation into IGMVs as a strategy to promote clinician well-being and mitigate aspects of burnout.
