This is a really interesting idea, but I too am having a hard time wrapping my head around how this would work in psychiatry.
From my experience in primary care, there is a growing model of doing "group medical visits" for a cohort of patients with a single disease or group of diseases. This works best when the cohort is carefully chosen. Off the top of my head, some of the conditions I have seen/heard of being managed in group visits includes diabetes, HTN, erectile dysfunction (yup!), obesity/weight loss, and (more generically) metabolic syndrome. In one case I heard about a specific cohort of "adolescents with poorly controlled type 1 diabetes" which certainly are a special population of their own. I would imagine this model could also be applied to rheum disease (eg, RA?) or maybe even chronic pain management. The unifying theme in all of these conditions is that there is a substantial component of lifestyle and psychosocial issues in successfully managing the illness, in addition to taking meds. Also, management of these conditions is greatly enhanced by good patient education, and you end up giving a similar education/counseling spiel to many pts with the condition. (For example, I know that my diet counseling for type 2 DM is probably 80% similar for the vast majority of my pts).
The way such group visits usually work is something along these general lines: A physician or physician group identifies pts in their practice with the target condition, who are willing to participate in the group visit model. The size of the group has to be manageable (ie, maybe 8 pts). Length of the group visit is perhaps 2 hrs. There is actually a group component and an individual component. It seems to work best if there are 2 clinicians, one to run most of the group, and one to pull pts out to do their individual portion of the visit. In the group, issues are addressed that are common to many pts with the disease, and pts can learn from each other. For example, in a diabetes group, the group session may address diet choices/nutrition education, medication adherence, self-monitoring skills, exercise, etc. The group is led/facilitated by a clinician, but encourages pts to share information and strategies and challenges with each other as well. Meanwhile, a second clinician pulls out one pt at a time from the group and reviews their individual data (eg, A1c, BP, med list, glucometer log, weight, etc) and makes adjustments to their meds or whatever. That's also a time when the pt can mention any individual concerns he/she doesn't want to bring up in the group. Finally, at the end of the group visit, all the pts leave with their new prescriptions, etc. Often these group visits are done as a series with the same cohort, so that there is an opportunity to build rapport within the group and also to be able to focus each session in the series on a different main topic area. According to the literature, the benefit to patients appears to be that they end up getting a lot more educational counseling time than they normally would during a 15-min individual visit, and they learn from peers about strategies to manage their illness.
Thinking about this model from primary care, I can see how it might be effectively translated to psychiatry for suboxone management. I wonder whether it could also be utilized for moderate depression, anxiety disorders, or PTSD. I absolutely agree that the nature of psychiatry is different from primary care. There is much more of a nuanced art to psychopharm and individual responses, side effects, etc, compared with diabetes meds for example. Maybe the model of pulling out each individual for 15 min would not work because the individual needs more private time than that--but I do not see pts for much longer than that in my outpatient med-check visits anyway. But psychiatric illnesses share something in common with DM/HTN/obesity/pain/etc, which is that the lifestyle and self-management component is a HUGE part of successfully managing the illness. And just like my diabetic patients, many of my depressed or anxious patients have common issues with adherence, self-management skills, healthy routines, exercise, sleep, etc. These issues could probably be addressed effectively in a group-visit model, while the specifics of each person's medication regimen could be done during their individual pull-out portion. And anyone who is too acute or is having major issues requiring big change in treatment plan, would not be appropriate for the group setting and should be scheduled in traditional individual appointment format instead.
I am interested to hear other thoughts on this.
