Group Medical Visit Conference 2021

Poor lifestyle choices are the root causes of major risk factors for cardiovascular disease, including hypertension, hyperlipidemia and type 2 diabetes. Although well-established chronic disease management guidelines uniformly call for lifestyle change as first-line therapy, there is a gap between recommended self-care practices and their implementation. To bridge that gap, implement recommendations, and to improve accessibility in healthcare, we developed a program to promote optimal health through lifestyle modifications covered by most third-party payers.

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Many safety-net clinics are spearheading GMV clinical innovation but unable to conduct research on their programs. Existing research does not reflect the diversity of safety-net GMV programs.  This interactive workshop for researchers and clinical staff will introduce frameworks and  methods for GMV research. Expanding collaboration between researchers and clinical staff will allow for better understanding of how GMVs may benefit patients and staff.  

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Cambridge Health Alliance, a safety-net healthcare system north of Boston, was embarking on a process to standardize operations to support Primary Care Group Medical Visits (GMVs) when the COVID pandemic began.Instead of abandoning the effort, CHA rapidly pivoted to adapting existing GMVs to telehealth (T-GMVs). Once we identified the staffing resources and technological protocols necessary, we created a Business Plan to increase the number and type of T-GMVs offered.In this presentation, we will share lessons learned during our expansion process so that other institutions can rapidly expand their own T-GMV program on a population scale.

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Joint session to discuss practical ways to implement integrative and functional medicine-based shared medical appointments (SMAs) at academic medical centers, review available evidence for care models, and explore how implementation of SMAs in academic medical centers improvess acces and patient satisfaction.  The facilitators and barriers to delievering these care models within the SMA setting will also be identified. 

Description of Individual Presentations:

"A Closer Look into Functioning For Life®: A Functional Medicine-Based Shared Medical Appointment Program to Address Chronic Conditions" -  Michelle Beidelschies, PhD

Shared medical appointments (SMAs) offer a promising solution to mitigate the impact of chronic disease. To improve access, efficiency and chronic disease management, a functional medicine-based SMA called Functioning For Life® (FFL) was developed. This 10-week SMA program focuses on nutrition and lifestyle to address chronic disease. It is associated with improved patient-reported and biometric outcomes, and can be delivered at a lower cost compared to individual appointments. This presentation will explore the operational implementation and outcomes associated with FFL.

"Shared Medical Visits at an Integrative Medicine Practice in an Academic Center" - Michelle Loy, MD, FAAP

At the Integrative Health and Well Being Center or Weill Cornell Medicine/New York Presbyterian Hospital, a number of shared medical appointments (SMA)/group visits are offered. I run the Lifestyle Change SMA, Oncology SMA, Prenatal SMA, and Yoga Oncology SMA. In addition, we also have SMA’s that cover chronic pain, gut health, anxiety, meditation/mindfulness, and meditation retreats. These SMA are a way to introduce and educate patients on the various integrative services we provide (physician consultation, medical acupuncture, nutrition consultation, psychotherapy, mind-body instruction, massage therapy, TCM & Ayurvedic medicine, medical yoga, pastoral care/spiritual support/narrative medicine). Patients enjoy the access to physicians and group support and physicians are able to see multiple patients at a time and bill for the visits. All of the SMAs have been converted to an on-line format successfully. Practical obstacles will be covered as well as future thoughts concerning SMAs.

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Practice-based research networks can support research, innovation, and practice interventions that can reduce racial/ethnic and socioeconomic inequities in preventive care utilization. We know from our research studying innovative models of pediatric clinical care such as the CenteringParenting model of group well child-care, effective group care models already exist that provide families with tools and social support to buffer children from adversity, ameliorate the effect of ACEs, and prevent poor life course outcomes to improve health equity.

The CenteringParenting Research Network (CPRN) is a national practice-based research network with 10 member sites and launched in January 2020 with the explicit goals to 1) work across pediatric clinical sites to promote collaboration among researchers, clinicians, patients, and community members; 2) facilitate practice-based research; and 3) increase the use of shared assessment measures and protocols. To date, the CPRN has engaged in a 10-month co-design process with a leadership and steering committee to identify priorities and develop the operational infrastructure. The CPRN is a research initiative of the CRADLE (Childhood Research to Advance Developmental-Health Learning and Equity) Research Lab, the research and evaluation arm of the Vital Village Networks organization at Boston Medical Center. Vital Village Networks develops community-based strategies to promote child wellbeing and advance health and educational equity through research, data sharing, and collective action. Developing networks such as the CPRN and cross-sector collaborations where community residents co-lead and co-design is a central strategy of our work.

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The pandemic required rapid shifts to virtual group services, but virtual groups already had a significant evidence base. The Center for Mind-Body Medicine (CMBM) successfully introduced online small-groups for mind-body skills training in 2019, laying the groundwork for a dramatic expansion of virtual services in 2020.  This presentation will discuss the nature and impact of this program, and will review best practices and lessons learned for virtual groups, especially mind-body group models.

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Town Halls focusing on key issues such as policy, reimbursement, and implementation

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Dietary factors are a significant risk factor for morbidity and mortality in the US.  Pre-pandemic, Shared Medical Appointments (SMAs) offered a unique opportunity to teach Nutrition and Culinary skills to patients.  Many groups across the country developed various models including Teaching Kitchens to increase access to these important life skills.  The act of demonstrating how simple, healthy, appealing, delicious dishes can be prepared is fodder for patients to prepare these meals at home for themselves and their families.In our necessary transition to Virtual care in 2020, we have taken our amassed knowledge and skills and transitioned to Virtual Group Visits from our kitchens.  For this poster presentation, we share tips and photos of how to harness Technology from our Kitchens to continue to reach our patients.   We have learned that the Virtual world offers advantages for Culinary instruction, and in the future, we envision a Hybrid model of virtual and in-person Nutrition and Culinary Medicine education for patients.

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This video is a story illustration that represents low-income adult patients with an anxiety diagnosis from a retrospective quantitative comparative analysis study of two groups that occured over the course of a year in a health system that conducted integrative behavioral health in primary care (IBH-PC). The first group participated in integrative group medical visits (IGMV) as an option for realizing their mental health care in addition to usual IBH-PC services while the other group were managed by their primary care provider and had access to usual care IBH-PC services only.  Non-emergent ED utilization, BZD use and anxiety symptom severity were all measured before and after a one year time frame for both types of groups and statistical analysis to compare their outcomes. The characters represented give a snapshot of the results of the study.  The study also created a framework for looking at these groups in the context of the US healthcare system and quadruple aim priorities. 

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As transmission rates of COVID-19 decline across the United States, a new wave of illness and dysfunction is  coming to the forefront. Post-acute sequelae of COVID (PASC) refers to a wide collection of signs and  symptoms experienced by patients with a history of COVID-19 infection.

Patients with PASC have varied symptomatology; however, common complaints include fatigue, cognitive  impairment (often called “brain fog”), shortness of breath, and headache. Sleep disturbances, decreased  physical activity, anxiety and depression are common. Early estimates are that up to a third of patients who  have been diagnosed with COVID-19 experience some PASC symptoms. Therefore, effective therapies and clinical strategies for managing this population are needed.

Our first aim is to better understand the symptoms and progression of symptoms of patients with Post-Acute  Sequelae of COVID (PASC). Our second aim is to adapt IMGV to meet the needs of PASC patients. Our third  aim is to assess the feasibility of IMGV in this patient population.

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This poster presentation will summarize our experience transitioning from in-person Group Medical Visits (GMVs) at a Family Medicine residency program to virtual GMVs in 2020.  We will discuss the structure of our Prevention and Wellness GMVs offered for patients to address chronic health issues (including metabolic syndrome, obesity, chronic lung and heart disease, diabetes, and mental health issues) through lifestyle changes.  Our model has consistently changed based on experience with the patient population we work with. With our model, the GMVs are billed to insurance and considered a medical visit to address a specific diagnosis. They focus on components of lifestyle medicine including mindfulness, sleep/relaxation, nutrition, physical activity, and general mental health. The Prevention and Wellness GMV providers initially included a family physician/integrative medicine faculty and a behavioral health faculty/clinical social worker, and we will describe our transition to a more health-coaching model for the groups and making the virtual groups accessible to a wide variety of our patient population. We had to completely restructure our offerings to a virtual platform and curriculum. The platform and curriculum continue to evolve with each group and have included exploring lifestyle apps and remote patient monitoring. The challenges, successes and upcoming opportunities for these components will be discussed. The GMVs started in 2015 and ran successfully as in-person visits until 12/2019 enrolling patients from our Family Medicine clinics based in Portland and Falmouth, ME. The number and types of referrals for patients have doubled since 2018. The poster will describe the numbers of referrals and the different specialty practices generating referrals. In addition, patient recruitment and retention into the GMVs can be challenging and we will summarize how this has been affected by the transition to virtual groups and include plans for expansion of groups into our broader MaineHealth system by aligning with organization goals, advocacy and education. Lastly, we will focus on how we have incorporated medical trainees into the GMVs teaching residents and fellows in our Family Medicine residency along with our Integrative and Preventative Medicine fellowships.

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RECORDED

Naturopathic service utilization is high, particularly among women and those with chronic conditions and menstrual disorders. Despite this, there remain some barriers (e.g. financial and social) to accessing naturopathic services in the broader population. Shared medical appointments (SMAs) (also known as integrative group medical visits (IGMVs) where integrative medicine is included in the care) are a medical model of care developed to mitigate such barriers and improve patient outcomes. SMAs appear to be a promising approach to managing chronic disease and may be a suitable model for naturopaths seeking to improve service accessibility and patient outcomes. Further research is needed to determine the suitability of the model within the scope of naturopathic medicine.The aim of this research is to co-design, and examine the feasibility of, a novel approach (SMA model) to delivering naturopathic care to people with a chronic reproductive condition (endometriosis) that is not currently well managed with conventional medical services alone. The proposed study uses a mixed methods design and comprises three phases: (i) a co-design phase where the intervention will be developed collaboratively with participants, (ii) a pilot feasibility trial of group naturopathic consultations for persons living with endometriosis, and (iii) an intervention evaluation. The research will provide new insights into the feasibility of delivering group-based naturopathy services to people living with endometriosis. The findings will support further research to test the clinical and economic effectiveness of the model, as well as application of the model to other chronic conditions.

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Medical students need interactions with patients throughout their training to gain critical clinical skills. During the first year of the COVID-19 pandemic, opportunities for medical students to have clinical experiences dwindled. Although previous students have explored traditional clinical settings, the opportunity for medical students to learn within the context of a virtual group medical visit has not been examined. The aim of this project is to explore the role of medical students in a virtual space within the group medical visit. To contribute to the growth of future virtual medical group visits, details regarding the development of the student intern role are reported. A literature review on the benefits of virtual visits is included. A first-year medical student’s reflections on her intern position in the University of North Carolina Physical Medical & Rehabilitation Department’s Integrative Medical Group Visits are presented. Emerging themes from reflective writing include difficulties of being an online student and the process of finding opportunities to meaningfully contribute to patient care, the effect of chronic pain on patients’ lives, the benefits of mindfulness practice, the unique role osteopathic physicians can play in the treatment of pain, and the benefits of reflective writing in graduate medical education. Through this presentation, providers can get a better understanding of how a medical student intern can contribute to a group medical visit. Chronic pain patients can also learn helpful information from medical students throughout the sessions. Although this reports only one medical student’s experience, it demonstrates how medical students can grow greatly from being a student intern and how it contributes to their professional development.

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The Integrated Medication Assisted Treatment (IMAT) Program works with individuals with opioid use disorder (OUD) referred by their primary care provider.  Individuals first meet with a licensed clinical social worker (LCSW) for an intake assessment to determine if they meet criteria for OUD and what level of care is recommended. If accepted into the program, the individual meets with the addiction medicine physician and starts on buprenorphine/naloxone.  Following these individual visits, participants are treated in a group model.  Our group medical visits are interprofessional and are co-led by the LCSW, physician and our peer support specialist.  Our peer is a person in long-term recovery who provides the perspective of someone with the shared life experience of the group members.Prior to the COVID epidemic, our weekly group visits lasted 90 minutes and were in person.  We transitioned to a virtual format in March 2000 and have been holding our groups for 60 minutes utilizing Zoom.   The transition to virtual visits has had some advantages.  These include:  increased access due to the elimination of transportation and childcare barriers and reduction in the amount of time individuals need to be away from work. We have also noted that those with anxiety have felt more comfortable sharing information from the safety of their own home.  We were able to gain access to smart phones to provide to individuals who did not have the capability of using Zoom.  The disadvantage we have noticed the most is the challenge for group members who had not met prior to COVID to feel connected to and known by the other group members.At the beginning of our virtual group, ground rules and confidentiality are addressed. The individuals are asked to ensure they are in a private space.  Patients then check in about how they are doing overall, if they have been having cravings or use of illicit substances, then are asked a question related to the group topic.  Because our groups are co-led by both behavioral health and medical providers, topics span both domains related to use disorder.In terms of billing, the LCSW bills a 90853 for each group member. Each member has an Individualized Treatment Plan and a SOAP note is completed after each group.  The physician writes a separate note and typically bills a 99213, based on level of complexity.Group visits will continue in this program through COVID-19 and beyond. They will remain on Zoom until conditions change to allow us to meet in person safely. There has been discussion around doing a hybrid model where some individuals will be in person and some will remain on Zoom depending on comfort level.  Remaining flexible and meeting individuals where they are in their stage of recovery have been important lessons for all of us to learn during these challenging times.

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Little is known about the relationship between adverse childhood experiences (ACEs) and obesity among adults in the United States. Objectives: To examine whether ACE scores are associated with obesity in patients enrolling in the SLIM Program, a lifestyle medicine program delivered as shared medical appointments (SMAs) virtually at UC San Diego Health. Methods: We conducted a cross-sectional analysis of baseline data of patients enrolled in the SLIM program. ACE scores were measured using the 10-point ACE questionnaire by Kaiser Permanente. Sociodemographic characteristics were self-reported and acquired from medical records. Anthropometric measures were assessed prior to the start of the program using standard clinical protocols, and body fat was assessed using bioimpedance. We assessed the association between obesity and ACE scores through unadjusted linear regression models. We analyzed predicting factors of obesity using multivariable linear regression models. Results: Patients (n=52) were majority White (67%), Non-Hispanic (79%) females (77%), aged 54 (13) years. The mean weight was 108.6 (25.88) kg, BMI 39.02 (7.71) kg/m2, body fat percentage of 47.23 (8.11), and waist circumference of 121.79 (16.89) cm. Most patients (67%) had low ACE scores (between 0 and 3) and 23% had medium scores (4-6 points). We excluded five patients with incomplete data in the regression models. In the unadjusted and fully adjusted linear regression models, ACE score did not predict baseline weight, BMI, % body fat, or waist circumference. In our sample baseline weight predictors were White race and sex (being Male), BMI predictors were White race, % body fat predictors were Mixed/Other race and sex (being Male), and waist circumference predictors were Non-Hispanic ethnicity and White race (p<0.05).   Conclusions: In this sample of patients attending a lifestyle medicine program for weight management, ACE score was not a significant predictor for obesity measures. Our sample was limited in size, and the association of ACEs and obesity should be further investigated. KEYWORDSAdverse childhood experiences (ACEs), body mass index (BMI), comorbidities, group visits, obesity, lifestyle medicine, shared medical appointments (SMAs), sociodemographics, virtual

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In 2017, MedStar Health launched Fresh and Savory, a Culinary and Lifestyle Medicine Teaching Kitchen (TK) program, which proved to be feasible in the format of a Shared Medical Appointment (SMA). In response to the COVID-19 pandemic, MedStar Health transitioned the in-person TK to a novel virtual model, while maintaining the same curriculum and SMA structure. The virtual program, called Fresh and Savory @ Home, utilized the Zoom platform and consisted of 2 hour weekly meetings over 8 weeks. Each meeting was structured with a 45-50-minute lecture on the lifestyle medicine topic of the week, a 10-15 minute cooking demonstration, and 1 hour of small groups (breakout rooms) with cooking and further discussion. Providers switched between breakout rooms to provide individualized, SMA-based patient care. At the end of the 8 weeks, a focus group was held to gather quantitative and qualitative data for overall satisfaction and quality of education in the course. Out of 39 program participants, 11 joined in the focus group. Feedback was positive, as participants generally felt that presentations and cooking activities on the virtual platform were effective. They also perceived improved accessibility and noted that they felt a strong sense of community in a time of otherwise feeling isolated. Compared to in-person, the associated expenses of the virtual program were minimal, as the program was only accountable for the food costs of the cooking demo. Based on overwhelmingly positive participant feedback, the ability to scale the program to more providers and patients, and the significant reduction in costs, MedStar Health will continue to offer this virtual option to patients in the future.

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Patients with advanced cancer face significant physical and emotional distress, complex medical decisions, and the threat of their own mortality. Palliative care implemented early in the disease trajectory improves quality of life (QOL), reduces physical symptoms and depression, improves care satisfaction, reduces hospital costs, and even improves mortality in some cancers. Psycho-oncology improves QOL, distress, and the management of physical symptoms using non-pharmacological, mind-body interventions. Integrative therapies are on the rise and have been utilized for symptom management and improve QOL for patients with cancer. While these supportive care services improve patient outcomes and health care utilization, there is limited access to them at cancer centers nationally. Group medical visits (GMVs), which combine medical care, health education, and peer support, have been offered in a number of clinical settings, and have been shown to improve patients’ access to care, increase patient empowerment, and improve health outcomes. Additionally, in this time of COVID-19, telehealth is increasingly utilized and is improving access to care for many patient populations. However, to our knowledge, GMVs have not been studied in those with advanced cancer. Therefore, the aim of this study was to develop a 4-session integrative palliative care and psycho-oncology GMV using telehealth among patients with advanced cancer. After review of the literature and consultation with an expert team, the GMVs were designed to address the following issues in the 4 sessions: fatigue/sleep difficulties, pain, emotional distress, and advanced care planning. Each session has a group component, co-led by a psychologist and palliative care physician, in addition to individual consultations with the physician. Content was developed with the input of the expert team and using evidence-based practices. Initially, in order to get feedback and refine the intervention, we recruited 7 participants (3 males, 4 females; age range 37-73 with various stage III or IV cancer diagnoses) and elicited written feedback after each session, as well as conducted post-intervention interviews with each participant. All participants provided overwhelmingly positive feedback. They particularly enjoyed the telehealth group format, as it increased accessibility to services and allowed participants to learn from one another. In fact, participants requested more interaction time with each other, and while many found 4 sessions to be sufficient, some wanted more sessions. Participants highlighted additional positive attributes about the GMVs as well as provided constructive feedback. Participant feedback will be used to refine the intervention, with the goal of offering this intervention to 3 additional cohorts.  These cohorts will be used to examine the acceptability and feasibility and assess preliminary data on patient-reported outcomes. We hope to demonstrate that GMVs are acceptable and feasible and can provide immediate patient benefit by increasing access to palliative care and psycho-oncology, decreasing symptom burden, and connecting patients to other supportive care services. We also hope to demonstrate that the GMVs are a sustainable model of patient care. Long-term, we hope to integrate this model into routine medical care at UCSF so that all patients with advanced cancer can benefit from early access to palliative care and psycho-oncology.

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In this presentation we will discuss a lifestyle group visit model serving an underserved, primarily ethnic minority population at Boston Medical Center. The longitudinal, 6-week, wellness-based group visit, Stronger Together, which focused on an integrative approach to chronic pain, was built on a platform of positive psychology, with love as a foundational concept to be explored and utilized as a tool for sustained lifestyle change and personal transformation. The overall group visit design and share unpublished, quality improvement data, collected from a small sample of participants that begins to capture the impact of the group visit experience on the lives and health of the participants will also be discussed. Our experience with this group visit model supports the positive impact that a focus on self-love and self-empowerment can have in catalyzing and sustaining transformation towards better health.

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Frequently, champions for group medical visits get tired and disheartened after trying to single-handedly create a GMV program. Lacking institutional support and community partners, designing and implementing GMV’s can be a heavy lift! The good news is that you don’t have to reinvent the wheel, and you don’t have to do it alone!

This interactive session focuses on:

1. FUN: Interactive techniques for creating lively, vulnerable, and supportive group cultures in both virtual and in-person contexts. 2. FULL: How to design and run full, and thus financially sustainable, transdiagnostic groups. 3. EASY: How to engage community partners to make your GMV’s fun, engaging, and easy.

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Opioid use disorder (OUD) has been deemed a public health emergency across the U.S.  Before March 2020 when the COVID-19 pandemic began, our health system provided in-person group-based opioid treatment (GBOT) as the standard of care to treat OUD, coupling pharmacological treatment with peer support and behavioral counseling.  When COVID emerged, we were forced to move all our patient care to individual telehealth visits.  After adjusting to new technology and workflows, both providers and patients desired renewing the group-based care delivery model, through telehealth-GBOT (t-GBOT). 

In this presentation, we describe our implementation strategy and lessons learned along the way in making the transition to t-GBOT through 6 iterative PDSA cycles. Preliminary data will be discussed with the themes highlighting important focus areas for health systems to consider when making a transition to telehealth groups.

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Joint Session that will focues on identifying the common characteristics of Lifestyle Medicine treatent in a shared medical appointment (SMA) format, recognizing facilitators an dbarriers in the implementation of  such SMAs in diverse settings, and define the resources necessary to hosts similar programs.

Descriptions of Individual Presentations:

(1) "The Supervised Lifestyle Integrative Medicine (SLIM) Program: Implementing an Innovative Service for Patients with Obesity" - Deepa Sannidhi, MD

In obesity management, shared medical appointments (SMAs) empower patients to take control of health and behavior. It also encourages community support through peer interaction and increases patients’ trust in a variety of healthcare professionals. Clinicians and researchers at UCSD embarked on a novel pilot project to evaluate the acceptability, feasibility, and preliminary clinical efficacy of a virtual SMA program focused on lifestyle and behavioral treatment of obesity in conjunction with traditional clinical-based obesity treatment. Attendees will learn about the role of intensive lifestyle therapy in the obesity treatment, how shared medical appointments can be leveraged to provide intensive lifestyle treatment, and about common pitfalls and challenges that may be encountered in the implementation of lifestyle medicine group visits in the academic medical center setting. The SLIM program was created in partnership with the UCSD Weight Management Clinic, Integrative Medicine Center, and the Center of Excellence in Integrative Health.

(2) Using Cooking Matters Programming as a Group Visit to Improve Health Outcomes in a Primary Care Setting - Rachel Moyer & Holly Russell, MD, MS

The quality of food consumed is an important risk factor for chronic diseases, but patients experience many barriers to consuming healthy food.  Cooking Matters is a nation-wide program which teaches individuals how to make healthy choices and cook healthy, budget-friendly meals.  In an effort to provide patients with the skills needed to follow a healthier diet and improve health outcomes, Highland Family Medicine in Rochester, NY and Foodlink have partnered to bring Cooking Matters into a primary care setting.  This session will discuss program implementation and the impact of Cooking Matters in a primary care setting.

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The synergistic combination of the group medical appointment format with the convenience of telemedicine was utilized to address the growing mental health needs of a national network of functional medicine patients during the COVID era.  We educate patients on brain biochemistry, the connection between a healthy functioning microbiome to neurotransmitter supplies to the brain, and common clinical symptoms associated with low neurotransmitter levels. 

Network providers are trained on identification of ideal patient candidates and program details.  The patient completes a neurotransmitter deficiency questionnaire that generates the suspected amino acid replacement options.  Zoom group visits are held every 2 weeks for local practices’ operational ease.  We use Calendly for patients to self-schedule their one individual coach visit.  This personalized assessment is followed by an automatic email drip campaign that guides them through the next 3 group medical appointments (i.e. 1 with provider and 2 with trained health coaches).  Patients from various time zones gather, learn, and share to improve the self-efficacy it takes to implement and fine-tune the newly prescribed supplement regimen. The question-and-answer phase answers questions that may have not been answered until much later when the mistakes or confusion had already occurred. 

We found that shifting from the original 4 individual visit format (i.e. 2 provider and 2 health coach) to 4 visit (1 individual followed by 3 group) created a shorter time to initial symptom reduction, less dosing errors, and improved patient compliance. 

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Two Part Session

(1)MiMedico Group Visits: Planning and Implementation of Group Visits Among Latinx Adolescents

Presented by: Ray Mendez, MD; Kryztal Pena; Erika Meraz

Group visits historically have been used to manage chronic diseases and have been viewed as a promising approach, given that it allows providers to provide better quality care and quality of life. However, considering it is a newly established approach there are many existing gaps in the literature. Group visits lack minority participants and are rarely used to address other issues like depression or obesity. Group visits managed by MiMedico Clinic target Latinx patients in the area. We also have various group visits established at our clinic that address anxiety/depression, obesity among adolescents, and education on the COVID vaccine. This presentation will discuss the planning and implementation of the Group Visits managed by MiMedico Clinic.

(2) Adapting Diabetes Group Medical Visits in an Urban Family Medicine Residency Program Serving Low-income Primary Care Patients during the COVID-19 Pandemic

presented by Bonnie Kwok

The objective of this field report is to describe adaptations made to a diabetes GMV involving family medicine residents in an urban, low-income primary care setting due to the COVID-19 pandemic when shelter-in-place (SIP) began in Contra Costa County on March 16, 2020. This report highlights October 2019 – March 2020 (5 months prior to SIP) and May 2020 – October 2020 (5 months after the start of SIP). Next steps include seeking Internal Review Board approval to conduct a formal study and evaluate clinical outcomes.

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Working together for our future... creating next steps. 

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