If healthcare providers could wave a magic wand and cast a spell banishing the impact of stress on their patient populations, it would have a tremendous impact on primary care. “It’s estimated that around 80 to 90 percent of primary care visits have something to do with stress, either directly or indirectly,” said Lisa Grant, DO, clinical associate professor, General Internal Medicine and UW Health director for the Center for Wellness at The American Center.

While it may not be a magic wand, this month marks the one-year anniversary of an important tool that UW Health providers and patients can use to combat the medical manifestations of stress: group medical visits that blend physician care, wellness, and a sense of community among a group of patients living with similar diagnoses.

“Group medical visits feel like a class because a cohort of patients meet together for several weeks for education or training around a particular healthcare issue that they all share,” said Dr. Grant. But unlike fee-based retail classes on topics such as yoga or meditation, group medical visits are not open to everyone; they are aimed at patients with specific diagnoses.

“If you want to attend a group medical visit in the learning kitchen at The American Center because you want to get general information about healthy eating but you don’t have any risk factors for cardiovascular disease [such as obesity, diabetes, or a diagnosed cardiovascular condition], we can’t accept you—although we could recommend a fee-based retail class,” explained Dr. Grant.

The distinction lies in the fact that group medical visits are within a medical context. Each patient receives a brief examination at every visit, and visits are documented as part of their medical record. “I communicate with their providers to tell them that their patient joined the group medical visit, as well as how many sessions they attended, the goals they achieved, and whether I identified anything that might require a follow-up,” said Dr. Grant.

Importantly, the visits are typically covered by insurance plans, including Medicare. “We have not had any problems with coverage,” said Dr. Grant. Patients can either be referred by a practitioner, or they can self-refer.

Group medical visits are designed for public health priorities that echo the “triple aim” of improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care. “We started the (wellness clinical service line) by targeting three patient populations in particular: people who have risk factors for cardiovascular disease, people who have chronic pain, and people who have chronic stress,” said Dr. Grant.

Group medical visit offerings include sessions was season on the following topics (not all classes are offered every season):

• Relaxation and stress reduction in which patients receive didactic instruction on physiological responses to stress and how to counteract these responses through evidence-based techniques such as meditation, breathing practices, guided imagery, and muscle relaxation.
• Water-based movement (not an exercise class) called Healing Waters in which patients struggling with chronic pain practice gentle motions linked to breathing practices. The sessions, which were developed by a physical therapist with expertise in pain management, are designed to gradually improve flexibility, strength, and stamina.
• Healthy eating and cooking habits, in which patients learn the principles of Mediterranean and anti-inflammatory eating plans, cooking from wholesome ingredients, as well as mindful eating and food preparation. Sessions meet in the learning kitchen at The American Center and include direction from a professional chef.
• Cooking for Heart Health in which patients explore the health benefits of the Mediterranean diet with a cardiologist, with hands-on practical cooking skills that can be implemented at home.

To view sessions offered in fall 2018, click here.

“Wellness clinical services support and complement the great care we’re already providing at UW Health,” said Dr. Grant. Many patients want to deepen their own skill and understanding of topics that they can use to improve their own health, and standard one-on-one ambulatory visits leave little time to explore such tactics in depth. “These group visits are a great additional service we can offer to patients.”

The visits are part of a wellness service line that was developed as an outcome of a UW Health task force that assessed best practices in wellness care within academic medical centers throughout the nation. In addition to benefitting patients, they also provide unique opportunities for medical students, residents, fellows, and allied health trainees interested in learning about integrative medicine. And although the program is still at an early stage, Dr. Grant hopes that it will provide opportunities for scholarly collaboration for health services research and clinical research.

“We are still clearly in our infancy and are taking care to provide high-quality, evidence-informed services. Now that we've piloted them, the next step is to look at outcomes,” said Dr. Grant. These analyses include the use of validated tools to assess stress scale before and after participation in the group medical visits.

“Ultimately, we want wellness services to extend the boundaries of good clinical care.”

Resources:

• Center for Wellness and Group Medical Visits at The American Center
• Video: Approach to Care at the Center for Wellness

Photo credit: Clint Thayer/Department of Medicine