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From: Kathleen Cochran <[log in to unmask]>
Date: 4 May 2011 10:15
Subject: Fw: Exploring Group Checkups for Diabetes, Parkinson's (NYT 5/2/11)
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Exploring Group Checkups for Diabetes, Parkinson's

By THE ASSOCIATED PRESS
Published: May 2, 2011 at 4:22 PM ET
*WASHINGTON *(AP) — Wait a minute, Doc. You want me to share my appointment
with 10 other patients?

Group appointments aren't just for psychotherapy anymore. Put
diabetes<http://health.nytimes.com/health/guides/disease/diabetes/overview.html?inline=nyt-classifier>
, high blood pressure<http://health.nytimes.com/health/guides/disease/hypertension/overview.html?inline=nyt-classifier>
and
maybe even Parkinson's
disease<http://health.nytimes.com/health/guides/disease/parkinsons-disease/overview.html?inline=nyt-classifier>
on
the list.

Shared checkups aim to help patients who are battling certain chronic
diseases, and they're far from the typical 15-minute office visit. They're
stretched over 90 minutes or even two hours, offering more time to quiz the
doctor about concerns, learn about managing the disease — and get tips from
fellow patients.

What's in it for the doctor? A neurologist found he learned more about how
his Parkinson's patients were faring by watching them interact with others
than when he had them one-on-one.

"I can see if you're getting worse over the course of the visit, your
ability to eat, to walk, to converse and to think," says Dr. Ray Dorsey, who
led a pilot study of group checkups for Parkinson's patients at the
University of Rochester Medical Center.

"This is a new way of delivering health care," adds Dorsey, now at Johns
Hopkins University<http://topics.nytimes.com/top/reference/timestopics/organizations/j/johns_hopkins_university/index.html?inline=nyt-org>.
"People are thirsting for better ways."

It's a small but slowly growing trend that promises to get more attention
with the tight supply of primary care physicians, who find it hard to
squeeze in time to teach their patients how to deal with complex chronic
illnesses like diabetes. An American Academy of Family Physicians survey
found more doctors trying the group approach — about 10 percent of its
active members in 2009, up from fewer than 6 percent in 2005.

Peer pressure among patients helps, says family physician Dr. George Whiddon
of Quincy, Fla. He has about 40 diabetic patients divided into groups for
shared checkups at Tallahassee Memorial Family Medicine Quincy, and he wants
to add more.

One woman with uncontrolled diabetes for years confessed to fellow patients
that she'd ignored Whiddon's "eat better, take your meds" advice for too
long.

"Now I only have one toe left. I should have listened," Whiddon recalls her
saying. "That had more impact than anything I said all day."

Group appointments don't replace the patient's annual in-depth physical. But
many people with chronic illnesses, especially if they're not
well-controlled, are supposed to have additional follow-up visits about
every three months — an opportunity for shared checkups that stress patient
education.

But how well do these group visits work? Evidence is mixed. An Italian study
published last year found that diabetics who took part in them lowered their
blood sugar, blood
pressure<http://health.nytimes.com/health/guides/test/blood-pressure/overview.html?inline=nyt-classifier>
 and cholesterol<http://health.nytimes.com/health/guides/nutrition/cholesterol/overview.html?inline=nyt-classifier>
more
than similar patients who got regular individual office visits.

A separate study at two Veterans Affairs Medical Centers, in North Carolina
and Virginia, tracked people with poorly controlled diabetes and blood
pressure and also concluded shared appointments can improve care for some
people. Those in group visits significantly improved their blood pressure
and needed less emergency care, but there was no difference in diabetes
improvement between patients who had shared checkups or regular ones.

Parkinson's marks the newest attempt. Dorsey recruited 30 Parkinson's
patients and assigned half of them to 90-minute group checkups, and the rest
to regular private visits that lasted a generous half-hour. During group
visits, everyone got a few minutes for private discussion with the doctor.
Then Dorsey gave an educational talk about a Parkinson's topic the patients
had previously requested — from the newest research, to why symptoms vary so
widely, to how patients cope at work — and took group questions.

Medically, both sets of patients fared equally well during the year-long
study, showing that group visits are a feasible to offer, Dorsey reported
last week in the journal Neurology.

What the study couldn't measure, Dorsey says, was how he watched patients'
interactions for subtle signs that they needed
prescriptions<http://health.nytimes.com/health/guides/specialtopic/getting-a-prescription-filled/overview.html?inline=nyt-classifier>
adjusted,
things like cognitive problems or if medications wore off too quickly. One
meeting even devoted 45 minutes to the pros and cons of implanted brain
stimulators to curb tremors.

"Many heads are better than one. They think of questions you wouldn't
normally think of by yourself," says Jim Euken, a retired judge and
Parkinson's patient from Belmont, NY. He began exercising on a bicycle after
one of Dorsey's group visits discussed research showing some patients still
can bike when they can barely walk, for unknown reasons.

Euken joined some fellow study participants who petitioned the hospital,
unsuccessfully, to continue group visits when the study ended: "It's not
that I don't get good care. I do. But I still think I learned more and I
think the process was better doing it in a group format."

More research is needed to determine which patients fare better with group
visits, plus they take a lot of doctor preparation, cautions study co-author
Dr. Kevin Biglan of the University of
Rochester<http://topics.nytimes.com/top/reference/timestopics/organizations/u/university_of_rochester/index.html?inline=nyt-org>
.

Medicare<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicare/index.html?inline=nyt-classifier>
will
reimburse the doctor for each patient in a shared checkup with proper
documentation that the visit includes certain elements, says Florida's
Whiddon. For his office, that means breaking even, as long as at least six
people show up for his two-hour diabetes groups.

___

EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The
Associated Press in Washington.

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