An evaluation of the Doctor Interactive Group Medical Appointment : assessing changes in health behaviors attributed to an integrated healthcare model



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This dissertation investigated the effect of a Doctor Interactive Group Medical Appointment (DIGMA), a unique multidisciplinary medical treatment modality, upon the health behavior of hypertensive patients at the Veterans Health Administration Outpatient Clinic (VA-OPC) in Austin, Texas. Health behavior modification, differences in stress perceptions, blood pressure changes due to the intervention and differences in coping strategies were assessed. Integrated healthcare utilizes a multidisciplinary approach in considering physiological and psychological aspects of health, promoting patients to act on their own behalf in managing health. Increased healthcare costs, decreased patient satisfaction of care received and practitioner satisfaction in care provided currently afflict primary healthcare. Earlier, a “drop-in” shared medical appointment aimed to improve continuity of care, and increase patient and physician satisfaction by allowing patients better access to physicians without taxing more resources. Contrasting the “drop-in” model, this study examined the efficacy of a multi-session DIGMA. Functioning as an adjunct to hypertensive management, participants attended 5 sessions, including one introduction meeting, three consecutive weekly group sessions and an individual telephone session occurring one week following the intervention. The study utilized a pretest/posttest design, with participants acting as their own controls. Self-report measures and blood pressure readings were administered prior to the onset, and again at termination of the DIGMA program. Analyses of variance and hierarchical regression models helped reveal any significant changes in health behaviors, perceptions of stress, and coping styles related to hypertension among 58 participants occurring over time for 7 distinct cohorts participating in the DIGMA. Findings revealed significant differences in both systolic and diastolic blood pressure readings between pre and post intervention. Significant changes in health promoting behaviors among participants who successfully completed all components of the program were also detected. In addition, adaptive coping strategies were found to significantly impact components of health behaviors. Qualitative information supports the quantitative data in determining whether the agent of change is the group process itself, the information imparted in the group, or some other variable. Findings reveal the dynamic of the group, as well as the modality in which information was conveyed positively influenced health behavior changes. Results, implications, and limitations of the study as well as future directions are discussed.