FRI0638 A novel group clinic model for new patients enhances patient activation
Authors: T. Jones, A. Morbi, M. Grove, F. Birrell
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background:</h3> Group clinics are a widely used, key alternative care model in USA (as shared medical appointments and other labels), especially in centres of excellence like the Cleveland Clinic. They are increasingly seen as 'a transformative innovation'<sup>1</sup> and recognised as an effective solution to the universal healthcare challenges: increasing demand and limited resource<sup>2</sup>. We have extensive experience of follow up group clinics for inflammatory arthritis patients since 2008 with a co-designed model integrating patient and team views<sup>3</sup>. Qualitative research showed robust themes associated with successful delivery: Efficiency, Empathy, Education, Engagement and Empowerment. 'Patient activation' describes the knowledge, skills and confidence a person has in managing their own healthcare, but there is no published data in group clinics. A group model has also never been used for seeing new patients in secondary care, so this is an original application of an established care model. <h3>Objectives:</h3> To show feasibility for new patients seen in a group setting and assess patient experience, including activation. <h3>Methods:</h3> A mixed methods pilot study. New patients awaiting Rheumatology appointments were invited to pilots at one of two hospitals: 1) with experience of group clinics 2) without. Patients agreeing to attend knew this was a new application of an established innovation with an option to stay for a focus group or be interviewed by telephone afterwards. Sessions were videoed for educational purposes and qualitative interviews were conducted under existing research approvals with relevant consents for both. Numerical data included Patient Activation Measure before/after the two-hour clinic, EQ-5D and a standard feedback tool. Qualitative data was analysed using nVivo and compared to previously identified themes. <h3>Results:</h3> 19 patients were seen in two two-hour clinics (mean 13 mins/patient vs. 30 mins/patient usual care), including complex patients with multiple diagnoses. 69 patients were phoned, of whom 16 did not answer, 20 declined, 6 failed to attend, 3 declined to see a Rheumatologist at all, 2 were deemed not suitable and 3 already had an appointment. Feedback was very positive: median 10 (IQR 8–10) across all domains, so was consistent with usual clinics and follow up group clinics. Free text positive comments far outweighing the negative. EQ-5D showed a highly impacted group (mean global health index 54 vs. UK age norm 77). Patient Activation Measure showed significant improvement over each two-hour session: (54–63 &amp; 67–74; p&lt;0.03). Qualitative analysis mapped to previous themes will be summarised at the meeting. <h3>Conclusions:</h3> It is feasible and effective to see new patients in a group setting with an experienced team. New patients group clinics have a powerful effect in empowering patients and may become an important option for hard to manage patients especially where resources are limited. <h3>References</h3> 1. Ramdas K, Darzi A. Adopting innovations in care delivery – the case of shared medical appointments. N Engl J Med2017;376;12. 2. Hayhoe B, Verma A, Kumar S. Shared Medical Appointments: A promising response to escalating demand for healthcare. BMJ2017;358:j4034. 3. Birrell F, et al. Patients Say Yes to Group Clinics. BMJ2017;358:j4034/rr-5. <h3>Acknowledgements:</h3> Patients and team involved in this innovation. <h3>Disclosure of Interest:</h3> None declared