March 2002 • Volume 8 • Number 3 |
 FP resident Casey Dutton-Triplett, M.D., addresses patient Emily Cunningham's concerns during her exam after a group visit. |
Poverty. Drug use. Depression. Physical abuse. STDs. Mix any of these conditions with teen pregnancy, and you have a recipe for disaster. The patients coming to Providence St. Peter Family Practice Residency Program are no exception to the risk.
What is exceptional about these patients of the Olympia, Wash., residency program is the method for their treatment: group visits. The sessions bring together eight to 10 pregnant teens and any friends or family members who wish to accompany them. The group visits were organized 11 years ago when physicians at the practice became frustrated in their efforts to care for teen-age mothers whose psychosocial problems are inadequately addressed by traditional care, says FP Devin Sawyer, M.D.
PRACTICE 2010 CONCEPT
This may seem like a futuristic way of practicing medicine, but it doesn't have to be. The AAFP promotes group visits through Practice 2010, a quality initiative to help FPs accelerate change in their office practices. In the group sessions, several patients receive an educational message and then can discuss their unique concerns during a one-on-one exam. The process allows physicians to make effective use of their time.
In Olympia, every two weeks teen-age patients -- sometimes as young as 13 -- come in for a group session that begins with an interactive lesson on a salient topic such as nutrition, usually delivered by a third-year family practice resident. The patients then have an examination and may also be seen by a nutritionist or social worker.
"This is a fun way of practicing medicine," says Sawyer, who precepts three third-year residents who report back to him on their patients' status at the end of each session.
Many of the patients are enthusiastic about the sessions as well. "I'm learning new stuff all the time," says Julie Murray, 18. "It's helped me open up, and I've made some friends." Is she scared? "A little bit," she says. "A new baby is going to pop out, and I'm going to have to take care of it."
But if the staff at Providence St. Peter can help it, patients such as Murray will be better prepared.
IT STARTS WITH EDUCATION
One recent session began with social worker Suzanne Woodsum-Reed discussing child-proofing a home, a topic probably given little thought by teen-agers who might have come from broken homes or dropped out of school.
In fact, some don't know where they'll be living when their baby is born. And many of the pregnancies are complicated by physical or sexual abuse.
Although some might think the situation is hopeless, Sawyer says the prospect of having a child forces some of the teens to get their lives together.
The teens are quick to accept snacks such as muffins, yogurt, milk and juice, provided by the clinic to help increase awareness of good nutrition and to give the patients incentive to come in.
The clinic also encourages compliance by keeping a running appointment on Tuesday afternoons for the visits.
"It's really fun," said Rebecca Keen, 19, "and it's so much easier because you don't have to set the appointment -- the appointment's already made."
Another benefit apparent at a recent session was that of peer interaction. Two new mothers -- now veterans of the program -- returned with their newborns in tow to tell their friends what to expect from labor, night feedings and sleep schedules.
 New parents return to the group with their infants: At left is April Kelly; at right are David and Lisa Sanford. |
"Twenty-seven hours of labor!" new mother Lisa Sanford told the group.
Her husband, David, offered tips for potential labor coaches: "During the labor, get involved. I was holding her leg up and was right there, and it was really cool."
OTHER GROUPS, OTHER PATIENTS
Sawyer's practice also provides well-child care in group visits, sometimes transitioning mothers from the adolescent maternity care program. The patient benefit is twofold, says Sawyer: The inexperienced mothers receive additional peer support from more seasoned mothers, and the visits facilitate parent-to-parent learning.
Sawyer says they've learned along the way how to best structure the well-child visits. For instance, it's best not to take vital signs during the sessions -- unless you don't mind a room full of crying infants. A resident physician facilitates the teaching session, and each patient has a brief one-on-one interaction with the primary care physician. Immunizations are given at the end of the visit.
Sawyer's practice also treats patients with diabetes in group visits. Again, a resident physician delivers a teaching session based on the needs expressed by the group. Initially Sawyer said he was concerned about residents' ability to lead the sessions, but his worries were put to rest by the creative approaches they took. In one session, the diabetes group visited a supermarket and selected groceries so the physicians could educate patients on interpreting food labels.
In the teen mothers' group, the residents organized a game of "Baby Jeopardy" for eager participants who earned prizes by correctly supplying the questions.
In the end, the success of the group visit program is measured by its ability to educate patients. Therein lies the beauty, Sawyer says: "The seasoned patients model the behaviors" the physicians try to teach. "This is why the group visit works."
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.