***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective : To compare the effect of individual educational visits versus group visits using academic detailing to discuss prescribing of highly anticholinergic antidepressants in elderly people . Design : R and omised controlled trial with three arms ( individual visits , group visits , and a control arm ) . Setting : Southwest Netherl and s. Participants : 190 general practitioners and 37 pharmacists organised in 21 peer review groups were studied using a data base covering all prescriptions to people covered by national health insurance in the area ( about 240 000 ) . Intervention : All general practitioners and pharmacists in both intervention arms were offered two educational visits . For physicians in groups r and omised to the individual visit arm , 43 of 70 general practitioners participated ; in the group visit intervention arm , five of seven groups ( 41 of 52 general practitioners ) participated . Main outcome measures : Numbers of elderly people ( 60 years ) with new prescriptions of highly anticholinergic antidepressants and less anticholinergic antidepressants . Results : An intention to treat analysis found a 26 % reduction in the rate of starting highly anticholinergic antidepressants in elderly people ( 95 % confidence interval —4 % to 48 % ) in the individual intervention arm and 45 % ( 8 % to 67 % ) in the group intervention arm . The use of less anticholinergic antidepressants increased by 40 % ( 6 % to 83 % ) in the individual intervention arm and 29 % ( —7 % to 79 % ) in the group intervention arm . Conclusions : Both the individual and the group visits decreased the use of highly anticholinergic antidepressants and increased the use of less anticholinergic antidepressant in elderly people . These approaches are practical means to improve prescribing by continuing medical education Background —This trial tested the effects of multidisciplinary group clinic appointments on the primary outcome of time to first heart failure ( HF ) rehospitalization or death . Methods and Results —HF patients ( n=198 ) were r and omly assigned to st and ard care or st and ard care plus multidisciplinary group clinics .  The group intervention consisted of 4 weekly clinic appointments and 1 booster clinic at month 6 , where multidisciplinary professionals engaged patients in HF self-management skills . Data were collected prospect ively for 12 months beginning after completion of the first 4 group clinic appointments ( 2 months post r and omization ) . The intervention was associated with greater adherence to recommended vasodilators ( P=0.04 ) . The primary outcome ( first HF-related hospitalization or death ) was experienced by 22 ( 24 % ) in the intervention group and 30 ( 28 % ) in st and ard care . The total HF-related hospitalizations , including repeat hospitalizations after the first time , were 28 in the intervention group and 45 among those receiving st and ard care . The effects of treatment on rehospitalization varied significantly over time . From 2 to 7 months post r and omization , there was a significantly longer hospitalization-free time in the intervention group ( Cox proportional hazard ratio=0.45 ( 95 % confidence interval , 0.21–0.98 ; P=0.04 ) . No significant difference between groups was found from month 8 to 12 ( hazard ratio=1.7 ; 95 % confidence interval , 0.7–4.1 ) . Conclusions —Multidisciplinary group clinic appointments were associated with greater adherence to selected HF medications and longer hospitalization-free survival during the time that the intervention was underway . Larger studies will be needed to confirm the benefits seen in this trial and identify methods to sustain these benefits . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : NCT00439842 Background : Over the past decade , group medical visits have become more prevalent . Group medical visits may have some advantages in treating chronic illnesses such as chronic pain as they can be more patient centered . The empowerment model is a novel approach used to provide support , education , and healthy activities guided by participants . Objective : To evaluate the early stages of a chronic pain group medical visit program based on the empowerment model . Methods : This prospect i ve cohort study recruited 60 female participants to participate between October 2004 and May 2005 . All enrolled participants completed the SF-36 question naire , which was administered at baseline and again after 6 months of participation . Data from chart review included age , race , weight , height , chronic illness , chronic pain diagnosis , and degree of participation . Chronic pain diagnoses included back pain , osteoarthritis , fibromyalgia , rheumatoid/inflammatory arthritis , and other/unknown . Results : Forty-two participants were enrolled in the program for 6 months . Their average Charleson Comorbidity Index score was 3.1 ( SD=1.5 ) . Statistically significant changes ( P<.05 ) were seen in the following SF-36 categories : Role-Physical , Bodily Pain , General Health , Social Function , and Mental Health . All factors trended toward improvement , with the largest improvements seen in Role-Physical and Role-Emotional . Conclusion : Participants in the chronic pain group medical visit program had a high degree of comorbidity and poor health related quality of life in regards to functioning . There was improvement in many domains of health-related quality of life Purpose Group medical consultations ( GMCs ) provide individual medical visits conducted within a group of four to eight peer patients . This study evaluated the feasibility and efficacy of GMCs in the follow-up of breast cancer . Methods In this r and omized controlled trial , 38 patients participated in a single GMC ( intervention group ) , while the control group ( n = 31 ) received individual outpatient visits .  Feasibility is measured in terms of acceptability , dem and , practicability and costs , integration and implementation , and efficacy . Between-group differences on the efficacy outcomes distress ( SCL-90 ) and empowerment ( CEQ ) , 1 week and 3 months after the visit , were analyzed using ANCOVAs . Results GMCs scored high on most areas of feasibility . Patients in GMCs and individual visits were equally satisfied . Patients and professionals reported more discussed themes in GMCs , despite no between-group differences on information needs prior to the visit . Sixty-nine percent of GMC patients experienced peer support . Costs for GMCs were higher compared to individual visits . However , involving a clinical nurse specialist ( CNS ) instead of a medical specialist reduced costs to the level of individual CNS care . Efficacy outcomes ( distress and empowerment ) were equal in both groups . Conclusion GMCs in this study were feasible . Further optimization of GMCs in future (cost-)effectiveness trials is possible by increasing the frequency of GMCs , stating criteria for the type of professionals , number of patients involved , and time limits . Implication s for Cancer SurvivorsBCS may benefit from GMCs by receiving more information and additional peer support . GMCs cover all aspects of follow-up and may be a good alternative for individual follow-up Background : Group patient visits are medical appointments shared among patients with a common medical condition . This care delivery method has demonstrated benefits for individuals with chronic conditions but has not been evaluated for Parkinson disease ( PD ) . Methods : We conducted a 12-month , r and omized trial of group patient visits vs usual ( one-on-one ) care for patients with PD . Visits were led by one of 3 study physicians , included patients and caregivers , and lasted approximately 90 minutes . Those receiving group visits had 4 sessions over 12 months . The primary outcome measure was feasibility as measured by the ability to recruit participants and by the proportion of participants who completed the study . The primary efficacy outcome was quality of life as measured by the PD Question naire-39 . Results : Thirty patients and 27 caregivers enrolled in the study . Thirteen of the 15 patients r and omized to group patient visits and 14 of the 15 r and omized to usual care completed the study . Quality of life measured 12 months after baseline between the 2 groups was not different ( 25.9 points for group patient visits vs 26.0 points for usual care ; p = 0.99 ) . Conclusions : Group patient visits may be a feasible means of providing care to individuals with PD and may offer an alternative or complementary method of care delivery for some patients and physicians . Classification of evidence : This study provides Class II evidence that group patient visits did not improve quality of life for individuals with PD over a 1-year period CONTEXT Emergency department utilization by chronically ill older adults may be an important sentinel event signifying a breakdown in care coordination . A primary care group visit ( i.e. , several patients meeting together with the provider at the same time ) may reduce fragmentation of care and subsequent emergency department utilization . OBJECTIVE To determine whether primary care group visits reduce emergency department utilization in chronically ill older adults . DESIGN R and omized trial conducted over a 2-year period . SETTING Group-model HMO in Denver , Colorado . PATIENTS 295 older adults ( > or = 60 years of age ) with frequent utilization of outpatient services and one or more chronic illnesses . INTERVENTION Monthly group visits ( generally 8 to 12 patients ) with a primary care physician , nurse , and pharmacist held in 19 physician practice s. Visits emphasized self-management of chronic illness , peer support , and regular contact with the primary care team . MEASURES Emergency department visits , hospitalizations , and primary care visits . RESULTS On average , patients in the intervention group attended 10.6 group visits during the 2-year study period . These patients averaged fewer emergency department visits ( 0.65 vs. 1.08 visits ; P = 0.005 ) and were less likely to have any emergency department visits ( 34.9 % vs. 52.4 % ; P = 0.003 ) than controls . These differences remained statistically significant after controlling for demographic factors , comorbid conditions , functional status , and prior utilization . Adjusted mean difference in visits was -0.42 visits ( 95 % CI , -0.13 to -0.72 ) , and adjusted RR for any emergency department visit was 0.64 ( CI , 0.44 to 0.86 ) . CONCLUSION Monthly group visits reduce emergency department utilization for chronically ill older adults Background : Primary care providers ( PCPs ) in safety net setting s face barriers to optimizing care for patients with diabetes . We conducted this study to assess PCPs ' perspectives on the effectiveness of two language -concordant diabetes self-management support programs . Methods : One year postintervention , we surveyed PCPs whose patients with diabetes participated in a three-arm multiclinic r and omized controlled trial comparing usual care ( UC ) , weekly automated telephone self-management ( ATSM ) support with nurse care management  ,  and monthly group medical visits ( GMVs ) . We compared PCP perspectives on patient activation to create and achieve goals , quality of care , and barriers to care using regression models accounting for within-PCP clustering . Results : Of 113 eligible PCPs caring for 330 enrolled patients , 87 PCPs ( 77 % ) responded to surveys about 245 ( 74 % ) enrolled patients . Intervention patients were more likely to be perceived by PCPs as activated to create and achieve goals for chronic care when compared with UC patients ( st and ardized effect size , ATSM vs UC , + 0.41 , p = 0.01 ; GMV vs UC , + 0.31 , p = 0.05 ) . Primary care providers rated quality of care as higher for patients exposed to ATSM compared to UC ( odds ratio 3.6 , p < 0.01 ) . Compared with GMV patients , ATSM patients were more likely to be perceived by PCPs as overcoming barriers related to limited English proficiency ( 82 % ATSM vs 44 % GMV , p = 0.01 ) and managing medications ( 80 % ATSM vs 53 % GMV , p = 0.01 ) . Conclusions : Primary care providers perceived that patients receiving ATSM support had overcome barriers , participated more actively , and received higher quality diabetes care . These views of clinician stakeholders lend additional evidence for the potential to upscale ATSM more broadly to support PCPs in their care of diverse , multi-linguistic population Objective : To assess whether shared medical appointments ( SMAs ) for neuromuscular patients represent a way of using clinicians ' time efficiently without compromising quality of care for patients . Methods : Patients with a chronic neuromuscular disease ( NMD ) ( n = 272 ) were r and omly allocated to either an SMA or a regular individual annual appointment and followed up for a period of 6 months . Data on re source utilization and quality of life ( EQ-5D ) were collected prospect ively , using a health care perspective . Incremental costs and changes in quality -adjusted life-years ( QALYs ) were computed using a probabilistic decision model . Factors critical to the incremental cost-effectiveness of SMAs were explored in sensitivity analyses . Results : No substantial differences between SMAs and individual visits in terms of costs per QALY were found ( incremental cost-effectiveness ratio € −960.00 ; 95 % confidence interval € −34,600.00 , € + 36,800.00 ) . Sensitivity analyses showed that the cost-effectiveness ratio was particularly sensitive to SMA group size and proportion of patients seeing their treating neurologist . Conclusions : Cost-effectiveness  of SMAs did not show a significant difference vs that of individual appointments based on data from our r and omized controlled trial . On the other h and , we were able to show that a minimum of 6 patients per SMA and 7 
    Output:
    
Compared to usual care , no negative effects on patient quality of life , knowledge and satisfaction were reported .
Discussion Few rigorous studies evaluated the use of shared medical appointments for chronic illnesses .
Overall , there appears to be no patient harms .