Although it took time to develop, one of the most successful strategies in the AHRQ pilot project was having shared appointments, which were led by the health facilitator from the YMCA. It soon became clear that clinicians not only lacked the time to answer patient questions about the targeted community program, but also lacked the time to discuss prediabetes and obesity in depth. Working as a team, the practices and health facilitator developed the following system:
- The practice scheduler asked the patient to return to the practice for a follow-up appointment, at no charge, with the community health facilitator. (Note: It was helpful to provide the scheduler a script with key details; otherwise, patients often thought they were coming back to see their physician. It was also important to stress the "no charge" component.)
- Between four and six patients were scheduled to return at the same time on the same day.
- The health facilitator used an empty meeting room in the practice to conduct a shared appointment with the patients. The agenda included a discussion on prediabetes followed by details on the YMCA Diabetes Prevention Program, including information on cost, financial assistance, class structure, and other topics. Patients who were interested in enrolling could do so immediately. (It should be noted that this strategy only worked with practices that had access to a meeting room during the day.)
- The health facilitator reported that patients usually came with the "right mindset" to learn about prediabetes. "They seemed to think that if their doctor wanted them to come to this additional appointment with me, it must be important. We had no other competing demands except to talk about prediabetes and maybe obesity," she said.
- Most of the shared appointments lasted between 30 and 45 minutes. Except for scheduling and ushering the patients to the meeting place, the practice incurred no additional work.