A patient recently looked around a conference room full of other patients and their health care providers and shared how this group had helped her open up and feel supported about her health concerns: “Y’all know us. It’s kind of like family here.”
The Vanderbilt Interdisciplinary Care Program (VICP) at Vanderbilt University Medical Center is studying how the use of shared medical appointments — when patients with common needs meet together with several health care providers — might impact loneliness, as well as other factors such as depression, substance abuse and utilization of emergency care.
Shared medical appointments are a care delivery model growing in use in United States. The appointments concentrate on patient education, resource sharing and disease management and are interactive so patients can share their successes and concerns with others with similar challenges and with their medical team.
The appointments are less formal than a clinical office visit, with more time for conversations. Studies have demonstrated that group appointments can improve patient access, enhance outcomes and improve patient satisfaction.
The VICP, piloted in 2016 under the name Vanderbilt Familiar Faces, cares for patients characterized as high needs due to hospital readmission risk or medical complexity. A team of VICP health care specialists provide primary and urgent care for these patients in a dedicated clinic at the Medical Center. Inpatient care is also provided in a designated unit if hospital admission is needed.
“A goal of this research is to better describe baseline loneliness in this population and their associated health outcomes,” said Francis Balucan, MD, MBA, VICP medical director. “In addition, we want to understand the longitudinal effects of a support group intervention, with the use of group medical visits, on emotional well-being and loneliness.”
Even before the pandemic created forced isolation, the VICP team had noticed that a recurring element of their patients’ narratives was a feeling of loneliness.
While some VICP patients live alone or without family or loved ones nearby, the issue of isolation is deeper for this patient population, said Christy Claiborne, LCSW.
“I would say even some of our patients who have good family support, if their family members are fairly healthy and don’t have these chronic illnesses, they still can feel very alone despite having that support available to them.”
Past research has shown loneliness is a significant, independent risk factor for poor health behaviors, physical problems and psychiatric disorders, and that isolation contributes to worsening depression, increased health care utilization and increased mortality.
“I’m convinced that many times when patients come to the clinic with acute physical needs, those are driven by that underlying note of loneliness, because once they see our clinic nurse or they see Christy, their demeanor changes,” said Jane Wildeman, MSN, RN, VICP program coordinator.
An initial group of 15 patients are enrolled in the shared medical appointments, and 15 patients are in a control group. The VICP received a grant from the National Institute on Aging to support their work, though study participants represent a wide range of ages and diverse medical histories.
At the 90-minute, shared medical appointments, participants have their vitals and weight recorded. Then they complete forms to share current medical and social needs. The participants also share goals they’ve been working on, successes and challenges. Then a health care practitioner leads a topical conversation.
In a recent shared medical appointment, Kevin Liu, MD, a Hospice and Palliative Medicine clinical fellow, talked about the importance of completing an advance directive to guide medical decisions should an individual become seriously ill or unable to communicate their wishes. He fielded questions from the group, and the care team listened to patients’ ideas on how clinicians could improve these types of conversations.
Nashville resident Ellen Nelson, 54, has chronic medical issues that in the past led to continual emergency room visits.
She credits the VICP for helping stabilize her health and said participating in shared medical appointments has positively impacted her well-being.
“Any kind of group communication is beneficial, because you just are reminded of how alike we all are,” Nelson said. “And it’s interesting to hear other people’s perceptions, no matter how different their problem is, and to see that there are some neat solutions that we all could benefit from.
“When you have chronic health issues, you isolate because you don’t want to bother or bore family and friends with your problems. You feel you are just your illness. Stepping into this group communication with people in similar situations is quite liberating, educational and sometimes even fun.”
Billy Henderson, 63, has what he calls a “complicated medical history,” with past substance use disorder, poorly controlled diabetes, chronic lymphocytic leukemia and chronic pancreatitis bringing him to the hospital as often as three times a month. Just over two years ago, he was enrolled in VICP, and he said the difference has been remarkable.
“Vanderbilt saved my life — I get emotional every time I say that,” Henderson said. “My health is a lot more stable. And I look forward to the group meetings because I can input pertinent information, or I can gain some insight. The main thing that has been very enlightening is that I’m not alone.”
The study concludes in June, and if it shows shared medical appointments lead to improved health, including less loneliness, the goal is to make the appointments a monthly occurrence and to open them to all VICP patients.
The research is funded by grant number P30AG066619 from the National Institute of Aging, Center for Healthy Aging Behaviors and Longitudinal Investigations.