Moving America Forward

This Simple Idea Could Decrease Premature Births By a Third. So Why Aren’t We Doing It?

January 1, 2014
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This Simple Idea Could Decrease Premature Births By a Third. So Why Aren’t We Doing It?
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Group medical visits mean better results for patients. The problem is in getting doctors on board.

It’s a fairly simple practice that research shows could reduce the chance of premature birth by 33% (or by as much 41% in African American women, among whom preterm delivery is troublingly frequent), and it is more cost effective than conventional prenatal care. But it’s used in fewer than 100,000 American births each year. What is it? Group medical care.

Here’s how it works: instead of an individual mother-to-be meeting with a single doctor for a 15-minute visit, group care would allow, say, eight women (and their spouses or partners) to meet with a couple of doctors for two hours. So, rather than being hurried through a brief appointment, patients get to interact with their doctors over a more leisurely span of time, ask all the questions they want, and enjoy the added benefit of trading support and advice with the other patients in the group. As for the doctor, he or she gets to bill for the same eight patients over the same two hours, minus the rush.

The research suggests that group doctor’s visits improve patients’ health outcomes, health behaviors, knowledge of their condition and satisfaction with their medical care. (It works not just for pregnant women, but also for patients with chronic diseases like diabetes.) One randomized controlled study of 1,000 pregnant women found that group care reduced the risk of preterm birth by a third, compared with traditional prenatal care. That’s a big deal considering that 1 in 8 babies are born preterm in the U.S., the biggest cause of neonatal death. Premature birth also puts kids at higher risk for developmental and health problems later on.

So why aren’t all American patients signing up for group medical visits? Because they’re exceedingly hard to find; doctors don’t have much of an incentive, financially or otherwise, to adopt them. Perhaps the biggest hurdle is getting docs to upend the status quo — they’ve long gotten used to doing things the old way, and they’re comfortable with it. “As physicians we’re taught in a more autocratic style,” Edward Shahady, the medical director of the Diabetes Master Clinician program at the Florida Academy of Family Physicians, recently told the New York Times. “Group visits require another skill – facilitation skills. This is not commonly taught in medical schools. You have a 45-year-old family physician who’s reached the pinnacle of his profession, and you want him to get in an arena where he’s a novice.”

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