The inner workings of a DIGMA
Here’s what you can expect
The drop-in group medical appointment (DIGMA) usually follows the scenario below, according to Edward B. Noffsinger, PhD, a Santa Cruz, CA, psychologist who developed the model while he was with Kaiser Permanente Medical Center in San Jose, CA:
When patients arrive, they are seen by a medical assistant who takes vital signs, pulls the medical chart, and looks for medical services and preventive tests that are due, such as a mammogram or a retinal check for diabetics. The assistant assembles any referral forms needed, fills them out as much as possible, and attaches them to the chart. The physician finishes completing the form during the meeting and discusses the importance of following through with the patients.
The physician and a behavioral health professional, usually a psychologist or social worker, attend the entire session. The behaviorist usually opens the meeting with a discussion of how DIGMAs work and their benefit to patients. The physician talks to each patient, making notes on the chart, dealing with the referrals, and delivering appropriate care.
The physician uses a custom-designed pro gress note that is largely preprinted in check-off form so the amount of required handwriting is minimal.
If a patient requests a private discussion or needs a brief private physical examination, the physician steps out at the end of the meeting and examines the patient while the behavioral health person runs the group and focuses on any psychosocial issues that interest the group. If a patient needs a more extensive examination, the physician schedules a private appointment.
"A DIGMA is like an individual appointment in the sense that it is an extended medical appointment with the patient’s own doctor that focuses on medical issues that patients bring in with them," says Noffsinger.
Patients can get access to a DIGMA in three ways: by invitation from their physician, by a phone call from a scheduler who calls patients from the physician’s waiting list, or by simply dropping in when they have a question or medical need. Although drop-ins are welcome, patients should be urged to call a day in advance so their medical records can be pulled, Noffsinger advises.
Most physicians that Noffsinger has dealt with say their practice is so diverse that they want to break their DIGMAs down into categories.
Here’s an example of how family practitioners may arrange their DIGMAs to cover all their patients in a month:
• week one: cardiopulmonary patients;
• week two: weight management patients and diabetics;
• week three: chronic pain patients, including headaches, fibromyalgia, and arthritis.
A drawback to having groups during the day is that some patients are reluctant to take time off work and visit the doctor for an hour and a half at a time, says Lynn A. Dowdell, MD, an endocrinologist with Kaiser Permanente Medical Center in San Jose.
However, the groups were popular with retired people who had the time, she notes.
"And for a lot of people, an hour-and-a-half group session was preferable to waiting a month or more for an appointment," she adds.
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