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An Improved Approach to Follow-up Care for Urologic Patients: Drop in Group Appointments (DIGMA)?

Sophie G Fletcher, Dana L Overstreet*, Sean J Clark, William D Steers
University of Virginia, Charlottesville, VA

Introduction:
Drop in group appointments (DIGMA) have never been studied in a surgical subspecialty setting. We hypothesized that urologists could improve: 1) efficiency by seeing 6-14 patients in one appointment, 2) patients' access to appointments; and 3) patient satisfaction with 90 minutes of didactic and discussion.
Methods:
Voluntary DIGMA appointments were made based on sex, not diagnosis. A 90-minute group teaching session was followed by private 2-5 minute exams, and further testing when indicated. Confidential satisfaction surveys were compared with surveys from patients seen in traditional individual appointments (solo). A controlled trial was not attempted because of the voluntary basis for scheduling.
Results:
From 9-03 to 8-04, 299 patients attended DIGMAs. Most diagnoses were: incontinence, ED, BPH, neurogenic bladder, and chronic discomfort syndromes. 177 surveys were returned in the DIGMA group/110 in the solo group. Satisfaction scores were high in both groups. 82% of DIGMA patients considered the time they had to wait for an appointment was “excellent” or “very good" (79% solo). Satisfaction with the overall visit/care received was 95% (92% solo). 94% of DIGMA patients felt that time with the urologist, and the explanations/teaching received was “excellent” or “very good” (89% solo). Wait times for appointments dropped 2.2 weeks despite a 2.7% increase in total patient volume.
Conclusions:
DIGMAs can be implemented successfully in a urologic practice despite the sensitive nature of topics discussed. The shared appointment offers the physician an innovative way to follow patients with chronic urologic conditions.

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