Medical Group Visits can take many forms
Most Tuesday mornings the CIPC faculty gather to discuss their projects: developing a new online course, presenting a paper, structuring a research study, or applying for a grant. The list varies each week and the conversations are rich and entertaining. CIPC has recently added Dr. Paula Gardiner to our faculty and the Tuesday meetings have become even richer.
Associate Professor of Family Medicine and Community Health, Paula Gardiner, MD, MPH comes to UMass from Boston University Medical School where she was Assistant Director for the Program for Integrative Medicine and Health Care Disparities at Boston Medical Center. Her current research is focused on the adaptive role of an Integrative Medicine Group Visit (IMGV) combining mindfulness-based stress reduction and a medical group visit to support health behavior change and reducing pain and stress. Dr. Gardner is leading the implementation of this medical group visit model nationally and provides training on medical group visits around the United States.
Dr. Paula Gardiner
Paula’s research interests dovetail well with the Center’s projects.
Last May Paula joined Dr. Jeffrey Geller in presenting a workshop on Group Medical Visits here at the Medical School, hosted by CIPC. They spent two days introducing their audience (drawn from clinicians from throughout New England) to the strategies and techniques of GMV. We hope that Paula will be able to repeat and perhaps expand this offering in the Spring of 2019.
What are Integrative Medical Group Visits?
IMGV combines: 1) a medical group visit and 2) the principles of Mindfulness-Based Stress Reduction (MBSR) and 3) a self-management “toolkit” of Evidenced Based Integrative Medicine (EBIM) techniques.
Seeing patients and families as a group is not new to behavioral health professionals, but it is a more novel approach when the issue being addressed is medical rather than behavioral or a combination of both. In IMGV, clinicians use a facilitative leadership style and patients are empowered to monitor their own vitals, pain, mood, and stress levels; the group honors each member’s contribution. Mindfulness-Based Stress Reduction (MBSR) figures prominently. Self-massage, acupressure, and integrative nutrition, as well as meditation, are introduced and encouraged. There are patient education discussions on relevant health topics, but there are also opportunities for socializing and community building within the groups.
Background on Medical Group Visits, Mindfulness-Based Stress Reduction, and Integrative Medicine Techniques for Chronic Pain
Medical group visits (MGV) are used for an increasing number of chronic illnesses, including symptom management and health issues, and current literature reveals that MGV can improve patient health status indicators such as quality of life, satisfaction, trust in their physician, coordination of care, and more culturally competent care.
Groups range from 4-20 patients with one to two facilitators and meet at regular intervals – anywhere from weekly to every month from 1-3 hours. The clinician’s assessment/management is sometimes conducted in the group setting in an adjacent private examining space, and clinicians charge for the visit using the established patient reimbursement codes.
But the type of MGV that Paula conducts and teaches adds evidence-based integrative medicine. Integrative medicine considers the patient’s mind, body, and spirit as factors influencing health and uses a combination of conventional and complementary modalities. Rigorous studies using IM techniques, such as massage and acupuncture, have demonstrated significant health improvements in chronic pain patients.
Recent research demonstrates that lifestyle factors such as diet, exercise, mind-body therapies, and sleep play significant roles in pain and chronic conditions. MBSR is a promising Mind-Body group intervention. It consists of 8 weekly classes taught by a trained instructor and one silent retreat day. The major techniques used are sitting and walking meditation, body scans, and mindful yoga. A recent systematic review identified 21 randomized controlled trials of MBSR; eleven of these studies showed improvement in mental health measures compared to wait-list or standard care controls, as well as improved pain scores and mental health status for patients with chronic pain. Patients with two or more co-morbid conditions had the greatest improvement in pain.
