Evidence from the first Shared Medical Appointments (SMAs) randomised controlled trial in India
SMAs increase the satisfaction, knowledge, and medication compliance of patients with glaucoma
Bibliographic Data
| ID | 19594682 |
|---|---|
| Authors | Nazlı Sönmez (0000-0003-2793-1561, European School of Management and Technology, corresponding author), Kavitha Srinivasan (0000-0002-9796-6981, Aravind Eye Hospital, corresponding author), Rengaraj Venkatesh (0000-0001-7741-324X, Aravind Eye Hospital, corresponding author), Ryan W Buell (0000-0002-6779-8593, Harvard University, corresponding author), Kamalini Ramdas (0000-0002-5047-5333, London Business School, corresponding author) |
| Editors | Madhukar Pai (0000-0003-3667-4536) |
| Year | 2023 |
| Volume | 3 |
| Issue | 7 |
| Pages | e0001648 |
| Publication date | 2023-07-20 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | PLOS Global Public Health (JOURNAL) |
| Journal identifiers | ISSN: 2767-3375 • E-ISSN: 2767-3375 |
| Publisher | Public Library of Science (PLoS) (PUBLISHER) |
| DOI | 10.1371/journal.pgph.0001648 |
| PMID | 37471312 |
| OpenAlex | W4384925986 |
| Language | EN |
| Citations received | 1 |
| References cited | 26 |
In Shared Medical Appointments (SMAs), patients with similar conditions meet the physician together and each receives one-on-one attention. SMAs can improve outcomes and physician productivity. Yet privacy concerns have stymied adoption. In physician-deprived nations, patients’ utility from improved access may outweigh their disutility from loss of privacy. Ours is to our knowledge the first SMA trial for any disease, in India, where doctors are scarce. In a 1,000-patient, single-site, randomized controlled trial at Aravind Eye Hospital, Pondicherry, we compared SMAs and one-on-one appointments, over four successive visits, for patients with glaucoma. We examined patients’ satisfaction, knowledge, intention-to-follow-up, follow-up rates, and medication compliance rates (primary outcomes) using intention-to-treat analysis. Of 1,034 patients invited between July 12, 2016 –July 19, 2018, 1,000 (96.7%) consented to participate, and were randomly assigned to either SMAs ( N SMA = 500) or one-on-one appointments ( N 1-1 = 500). Patients who received SMAs showed higher satisfaction ( Mean SMA = 4.955 (SD 0.241), Mean 1-1 = 4.920 (SD 0.326); difference in means 0.035; 95% CI, 0.017–0.054, p = 0.0002) and knowledge ( Mean SMA = 3.416 (SD 1.340), Mean 1-1 = 3.267 (SD 1.492); difference in means 0.149; 95% CI, 0.057–0.241, p = 0.002) than patients who received one-on-one appointments. Across conditions, there was no difference in patients’ intention-to-follow-up ( Mean SMA = 4.989 (SD 0.118), Mean 1-1 = 4.986 (SD 0.149); difference in means 0.003; 95% CI, -0.006–0.012, p = 0.481) and actual follow-up rates ( Mean SMA = 87.5% (SD 0.372), Mean 1-1 = 88.7% (SD 0.338); difference in means -0.012; 95% CI, -0.039–0.015, p = 0.377). Patients who received SMAs exhibited higher medication compliance rates ( Mean SMA = 97.0% (SD 0.180), Mean 1-1 = 94.9% (SD 0.238); difference in means 0.020; 95% CI, 0.004–0.036, p = 0.013). SMAs improved satisfaction, learning, and medication compliance, without compromising follow-up rates or measured clinical outcomes. Peer interruptions were negatively correlated with patient satisfaction in early-trial SMAs and positively correlated with patient satisfaction in later-trial SMAs. Trial registration : The trial was registered with Clinical Trials Registry of India ( https://ctri.nic.in/ ) with reference no. REF/2016/11/012659 and registration no. CTRI/2018/02/011998
Family medicine · Glaucoma · Patient satisfaction · Physical therapy · Randomized controlled trial · Significant difference · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Patient Satisfaction in Healthcare · Psychology · Internal Medicine · Ophthalmology · Pediatrics · Surgery
| Citations per year | 0.5 |
|---|---|
| Citation span | 2024 - 2024 (1) |
| Highly cited | No |