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Doctor's Interactive Group Medical Appointments

Improve Outcomes for Asthma Patients

by Myron Liebhaber, MD Allergist & Immunologist

Myron Liebhaber, MD

Doctor's Interactive Group Medical Appointments (DIGMAs), sometimes called Drop-In Group Medical Appointments, are shared medical visits that enable physicians to deliver high quality and innovative medical care to an increasing number of patients.

Sansum Clinic's asthma DIGMAs are designed to allow patients to interact with an allergist, a behaviorist and an asthma educator in a group setting. In the DIGMAs I lead, I address medical concerns, Robert Bannister, MFT, facilitates group discussion of psychosocial issues, and an asthma educator addresses specific questions regarding monitoring and equipment. Through this model I am able to evaluate asthmatic patients on a weekly basis and to provide patient education and disease self-management instruction without the limitation of a formal lecture.

DIGMAs typically last for 90 minutes and involve up to 10 patients. Family members are also encouraged to attend and it is not unusual to see two or three generations participating in a session.

Group medical appointments were born of two similar frustrations. (1) Patients felt that they didn't get to spend enough time with their physicians and (2) physicians felt that they didn't get enough time to spend with their patients. From these concerns, group appointments evolved.

In many ways, a DIGMA appointment is similar to a regular doctor's appointment. We review lab results; write, change or refill prescriptions; and answer questions. The ways in which DIGMAs are different offer some advantages.

Group visits allow patients to interact with one another in a mutually supportive environment where individual patient concerns are discussed as a group, leading to a dialog of experiences by other participants. Patients benefit from being able to hear how others with a similar condition are treated, such as whether they have similar side-effects to medications. The group often discusses issues encountered by one patient that applies to other patients in the group.

DIGMAs remove barriers to healthcare access and provide extra value by allowing patients to attend any scheduled session. DIGMAs are great for peace of mind because patients can be seen within the week even if they don't have an appointment, which is important for someone with a chronic illness who doesn't know how they will feel from week to week.

Patients are encouraged to join a DIGMA once they are diagnosed with asthma and have a treatment plan. DIGMAs provide easy access to spirometry (measuring of breathing), vaccines, prescription renewals, and healthcare advice as often as weekly, if necessary. Treatment goals include symptom and exacerbation prevention, the maintenance of pulmonary function, optimized activity levels, meeting expectations of satisfaction with asthma care and the provision of optimal pharmacotherapy.

DIGMAs focus on behavioral change. Participants have proven positive outcomes, including improved compliance with treatment, and significantly fewer emergency room visits and hospital admissions. Outcomes were measured in accordance with the National Heart, Lung, and Blood Institute (NHLBI) 2007 guidelines and were published as an abstract and a journal article, which showed that we met all the published outcomes criteria as an effective way of treating asthma.

Another benefit of this model is that the group format virtually eliminates the feeling of isolation that can be caused by this chronic condition. Patients with diseases like asthma can often feel isolated, as if they are the only people dealing with this issue. When people come to this group and realize they are not alone, they feel better. They build their own community and reduce the sense of loneliness that can contribute to the problem and sometimes even lead to depression. Some people are apprehensive at first, but once they attend the DIGMA, they love it. We have heard that even those who are not "group people" or "joiners" really enjoy the appointments.

Sansum Clinic is the first organization in Santa Barbara to introduce DIGMAs to our patients. Though many physicians throughout the country don't yet know about the model, we have been elevating the level of care for our patients using DIGMAs for years.

Abstract - American Academy of Allergy, Asthma and Immunology
Liebhaber, M.I., Banister, R.B., Raffetto, W., Dyer, Z.A., Gershenhorn, G.; Sansum Clinic, Santa Barbara, CA: Doctor Interactive Group Medical Appointments (DIGMA) For Patients with Asthma: A Four Year Outcome Study. Journal of Allergy/Clinical Immunology, Vol. 123, No, 2, PageS42, February 2009.

ISRN Allergy Journal
Liebhaber, M.I., Bannister, R., Raffetto, W., Dyer, Z.: Drop-In Group Medical Appointments for Patients with Asthma: A Four-Year Outcomes Study. ISRN Allergy. Vol. 2011, Article ID 178925, June 2011.

DIGMA is a targeted intervention that fulfills the treatment goals of asthma care, as described by the National Asthma Education and Prevention Program (NAEPP) Guidelines.


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