Delivering Lifestyle Interventions for Chronic Disease Care Sustainably and at Scale through Virtual Shared Medical Appointments in Primary Care.

摘要

Behavior changes related to nutrition, physical activity, sleep, alcohol, and smoking are critical for the prevention and management of many chronic diseases, but interventions to implement these behavior changes are operationally and financially challenging to scale in primary care. In an effort to provide broad access to programming that supports such behavior changes for primary care patients, the Massachusetts General Hospital Division of General Internal Medicine developed the Healthy Lifestyle Program, which includes reimbursable virtual shared medical appointment (SMA) programming with health and wellness coaching. The virtual SMAs, also known as group medical visits, launched in 2020 using a secure video platform and initially focused on evidence-based behavior changes to treat chronic diseases such as hypertension and diabetes. The program continued to grow while addressing hurdles in establishing the medical-legal, documentation, and billing requirements for virtual SMAs; sustaining program growth by increasing revenue; building reliable referral and recruitment streams; and expanding offerings to cover more conditions and Spanish-speaking patients. To track the utilization and progress of the program, electronic medical record data were used to measure participation in virtual SMAs and determine predictors of program attrition. In addition, blood pressure (BP) measurements were used to assess clinical outcomes among patients who participated in the hypertension series compared with propensity score-matched controls. Between March 2020 and October 2024, 1679 unique primary care patients attended at least one virtual SMA. Among a cohort of 400 patients referred specifically to the hypertension virtual SMA series, including 200 who attended a virtual SMA and 200 matched control patients who did not schedule a visit, there was a strong trend toward improved BP - without any increase in medications - among virtual SMA participants versus controls (adjusted odds ratio, 1.55; 95% confidence interval [CI], 0.94 to 2.58; P=0.086). In a subgroup analysis of the 87% of the study population whose baseline BP was higher than 130/80 mmHg (n=348, 174 in each group), the intervention group had an 8.7 mmHg decrease in systolic BP compared with a 3.9 mmHg decrease among controls (adjusted difference in systolic BP change, -4.7 mmHg; 95% CI, -8.8 to -0.76; P=0.019). In this subgroup, 33% of those who attended at least one virtual SMA achieved BP control to less than 130/80 mmHg compared with 16% of patients in the control group (95% CI, 7.0 to 27.0). The authors believe that virtual SMAs offer the potential to increase access to reimbursable behavior change interventions in primary care and, as a result, improve chronic disease outcomes.