Elsevier

Journal of Pediatric Health Care

Volume 26, Issue 1, January–February 2012, Pages 37-44
Journal of Pediatric Health Care

Article
Shared Medical Appointments: Facilitating Care for Children With Asthma and Their Caregivers

https://doi.org/10.1016/j.pedhc.2010.06.007Get rights and content

Abstract

As important members of the health care team, patients and caregivers must be empowered to recognize their asthma status and to act accordingly. Education about asthma, complications, and successful management of asthma provide the best way to empower children and their caregivers. A Shared Medical Appointment (SMA) is a unique health care delivery approach that integrates disease management and patient education. The SMA described here is a 90-minute group appointment for four to nine patients who share a diagnosis of asthma, bronchospasm, or wheeze and their caregivers. The appointment includes a brief individual examination, health education delivered to the group, and the opportunity for interaction between group members. Because a supporting theoretic framework is not identified in the original design proposals for the SMA model or in the literature on its use, for the purposes of this project, Social Cognitive Theory is identified as the theoretical framework that best explains and reinforces the benefits of the SMA. The theoretic framework is important to direct the development and continued success of this treatment model. This project report describes the first nurse practitioner-led SMA as a tool for improving quality of care and service for children with asthma and their caregivers.

Section snippets

Background and Literature Review

The effective treatment of pediatric asthma strains the resources of primary care settings. The efforts of health care providers to control asthma are clearly inadequate. A review of the literature confirms that the number and severity of asthma cases in children is increasing (American Academy of Allergy, Asthma and Immunology, 2008, American Lung Association, 2007, Centers for Disease Control and Prevention & National Institutes of Health, 2006). In addition, asthma is a growing problem for

Theoretical Framework

It has long been established that the concepts of (a) parental participation in children's health care, (b) partnership and collaboration between the health care team and parents in decision making, (c) family-friendly environments that normalize as much as possible family functioning within the health care setting, and (d) care of family members as well as of children is critical to the successful management of asthma (Bursch, Schwankovsky, Gilbert, & Zeiger, 1999; Franck & Callery, 2004).

Shared Medical Appointment Program Setting

The SMA program was introduced to Harvard Vanguard Medical Associates (HVMA) in December 2007. HVMA is a non-profit, multispecialty medical group practice that provides care to more than 450,000 adult and pediatric patients at more than 20 offices across eastern Massachusetts.

HVMA physicians, challenged to adopt a new model of care, implemented the first adult SMA in January 2008 in the Internal Medicine Department to provide the physicians with tools to solve access, service, and quality of

Results

Eighteen-year-old patients and caregivers of patients younger than 18 years responded to questions about their level of satisfaction with several aspects of the SMA. Frequency distributions were run to examine the satisfaction items. Responses measuring satisfaction can be found in Table 2, Table 3, Table 4. The survey was voluntary, and 30 of the 39 caregiver/patient dyads, including one of two 18-year-old patients, returned the survey.

A 5-point Likert-type scale (“poor,” “fair,” “good,” “very

Conclusion

Although managing any chronic illness is time consuming, studies have shown that incorporating illness concerns in well visits may improve chronic illness management (Looman, O'Conner-Von, & Lindeke, 2008). However, obstacles cited by physicians that affect delivery of care are the same as those identified by NPs in primary care (Van Leuven & Prion, 2007). By improving access to regular visits for patients with asthma, the SMA provides opportunities for introducing and anticipating illness

Constance L. Wall-Haas, Pediatric Nurse Practitioner, Harvard Vanguard Medical Associates, Chelmsford, MA.

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    Constance L. Wall-Haas, Pediatric Nurse Practitioner, Harvard Vanguard Medical Associates, Chelmsford, MA.

    Pamela Kulbok, Associate Professor of Nursing, University of Virginia School of Nursing, Charlottesville, VA.

    John Kirchgessner, Assistant Professor of Nursing, University of Virginia School of Nursing, Charlottesville, VA.

    Virginia Rovnyak, Senior Scientist, University of Virginia School of Nursing, Charlottesville, VA.

    Conflicts of interest: None to report.

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