Table 3.

Views and experiences of practitioners and staff

Themes	Subthemes	Exemplar codes	Exemplar quotes and data
Advantages and benefits	Comprehensive patient-led care	Multidisciplinary care, patient-led, increase patient understanding, increase practitioner understanding	‘…one person’s worried about hyperglycemia and another person’s worried about nocturia, and another person’s worried about their vision you get information that can be both preventative and curative all in the same visit’. NP25
	Peer support and accountability	Normalise condition, offer support, share experiences, encourage accountability, increase motivation	‘The biggest part is just that they [the patients] get to kind of feed off of each other and they talk about what works and what doesn’t… I think that the fact that they can help teach each other is most important’. Dietician23
	Efficiency and lower cost	More efficient, less repetition, improved access, costs	[The SMAs] kind of a win all around because when you increase your productivity you increase access for patients, your waiting times go down…we’re better able to meet evidence-based guidelines because there’s a team taking care of patients rather than a single provider’. Provider 131
Barriers and challenges to adoption and implementation	Patient resistance and suitability	Accustomed to 1:1 appointment, not for all patients, attached to physician, confidentiality	‘Definitely the top barrier will be convincing the patients to show up. We invite an average of 10 people and we usually have between 4 and 7 who come and continue to show up. I think patient buy-in is definitely a barrier’. Primary care physician28
	Role adjustment and uncertainties	Colleague resistance, self-efficacy/new skills, power relationships, managing peer interaction	‘I’ve got to tell you, it’s a hard sell with physicians. Even now, I don’t have a champion for the diabetes SMA. They see it as extra work. They don’t see the added value. It troubles me a lot that it’s so hard to get the docs involved’. Nurse28
	Administrative and resource challenges	Coordinating schedules, patient reminders, funding and billing, lack of space/rooms, staff shortage, busy staff	Author interpretation: NPs described how physical space, administrative time, and buy-in were major barriers to the diffusion of Group Medical Visits. Many NPs described the challenges of lacking regular office space or having limited administrative time, which required them to engage in clinical organization during personal or unpaid time.25
Implementation success and sustainability	Skilled facilitator	Facilitator—important, group management	Author interpretation: The role of the facilitator was thought to be crucial to the successful operation of the group, and selection and training for the facilitator was seen as crucial to success.21
	Tailored to patient groups	Patient background, disease stage	‘…critical that we (the video-SMA providers) were sensitive and expressed a value for diversity; that we were conscious of the dynamics inherent to the participant’s cultures especially in the group interaction and demonstrated that we (the video-SMA providers) had knowledge regarding these differences and were willing to adapt our service delivery’. Provider26
	Leadership, teamwork and communication	Leadership, teamwork, communication, collegiality	‘It cannot be one person because the key word is ‘sustainability.’ If that person ever leaves or something ever happens, everything falls apart’. Administrator18 ‘I think speaking to the importance of research and teamwork, getting people together for the betterment of patient care and the collegial approach to doing the kind of thing that brings people from different disciplines together, particularly nursing and the primary care providers. I think that’s where we’ve got to wear that cap to get the right people engaging and working together’. Administrator and primary care physician23

NP, nurse practitioner.