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Shared medical appointments for neuromuscular patients at the RUNMC
17 November 2010

Drs. FM Seesing, Dr. GD Drost, Prof. GJ van der Wilt, Prof. BGM van Engelen


As of January 2006, the department of neurology at the RUNMC has started offering shared medical appointments or group visits for patients with neuromuscular diseases during a pilot project. This novel approach of delivering outpatient care is now being compared with usual care during a randomized clinical trial with 300 patients and partners . Focus of research is on health outcomes and costs.


Most neuromuscular diseases are chronic progressive diseases necessitating periodic specialized care. Because of the progressive nature of the disease, existing symptoms aggravate over time and/or new symptoms develop over time, requiring adjustment of management, and can raise new questions on the part of the patient and his or her partner. Currently, these patients attend the out-patient clinic at regular intervals (usually annually), where they are seen in one-to-one patient- physician encounters. It is difficult, however, to fulfill the complex needs of neuromuscular patients in these brief, problem-focused out-patient visits which leave little time for the patient's psychosocial needs, patient education, and patient empowerment. The possible advantages of a shared medical appointment could be an answer to these questions.  

What is a shared medical appointment?

During a shared medical appointment a number of 6-10 patients and their partners are seen simultaneously by a physician and a specialized nurse or psychologist.  Shared medical appointments are a series of one on one doctor- patient contacts, in presence of a group fellow patients.  This group visit takes  1,5 – 2 hours and substitutes the annual control visit the patients pay to the neurology department. The same items the neurologist attends to in a one on one appointment are attended to during the group medical appointment.  The physician has more time to give information to the patient and patients and partners can ask questions to- and learn from their fellow patients. Group visits seem to facilitate for support patients and partners experience from other patients during the appointment.  Also group visits could contribute to the idea of the patient as an expert in managing his own disease.


•       Randomized controlled trial comparing the effect of shared medical appointments with regular one-to-one appointments

•       Intervention group: one shared medical appointment with 6-8 patients & partners, a neurologist and a groupmentor

•       Control group: one individual control visit with neurologist

•       Questionnaires measuring:
         Quality of life (EQ5D, SF36 and INQoL)
         Social support
         Service utilization
         Experience of care 

•       Measurements: at baseline, 1 week, 3 months and 6 months after intervention

Results expected in 2012

Photograph: Jan Wille, CBO, Netherlands

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