Integration of Personalized Health Planning and Shared Medical Appointments for Patients with Type 2 Diabetes Mellitus

Abstract

resident Obama's Precision Medicine Initiative has refocused national attention on the ability of genomics and other emerging technologies to provide a better understanding of the relationship between genetics, environment, lifestyles, and the development of disease 1. This initiative was heralded as a "bold new research effort to revolutionize how to improve health and treat disease" 2. Yet, in 2000 the sequencing of the human genome was also anticipated to lead to new ways to personalize medicine and to prevent, diagnose, and cure disease. While there have been major advances in diagnosing and treating disease, the goals for personalized medicine to improve health and prevent disease have not yet been achieved 3-5. Despite the benefits of more targeted disease treatments, the real promise of personalized/precision medicine lies in its ability to prevent disease and improve health as, in addition to the human cost, our nation spends almost 80% of its unaffordable health care expenses on treating complex, chronic diseases which are preventable. Research in precision medicine will certainly provide new capabilities to improve health and minimize disease, but to actually do so, the approach to the practice of medicine must change so it is prepared to use them. The Limitations of Reductionism in Medicine Medical care today is derivative of concepts developed over a century ago when science began to be applied to the practice of medicine and identified the causes of many, particularly infectious, diseases. The logical assumption arose that diseases have a root cause and the role of the physician became to "find it and fix it." This concept led to a paradigm of care based on the capability of the physician to identify the disease underlying the patient's chief clinical complaint and, when possible, eliminate the cause. With improving technologies and clinical experience, this reductionist approach to care has improved and resulted in wondrous cures and treatments for many diseases. However, the concept of treating disease by removing its root cause is overly simplistic in dealing with the increasingly common chronic multifactorial diseases that develop over long periods of time. Complex chronic diseases such as obesity, type II diabetes, and cardiovascular disease are but a few examples of many conditions which account for a vast proportion of our nation's health and medical expenses. As medical practice continues to be reactive to the patient's chief complaint rather than also being proactive, care is not designed to effectively adopt new technologies to improve health or predict and prevent disease. To do this, a new approach to care is needed; one that utilizes the best of what works in the current system but is based on what we know about the evolution of disease.

A Qualitative Evaluation of Patient Experiences With Group Medical and Individual Education Appointments for Type 2 Diabetes Management in Saskatchewan, Canada

“…Some participants have also mentioned that the GMAs increased their personal accountability to attend their appointments. A similar finding was reported in another qualitative study 23 of GMAs in the United States. In addition, Thompson-Lastad 24 reported that staff involved with group medical appointments felt that patient interactions with other patients was the most important aspect of these appointments; they also reported that patients could support one another in ways that health providers could not.…”

“…20 Although GMAs have shown benefits, understanding patient experiences with these types of appointments is essential to help to refine this emerging approach to care for people with type 2 diabetes. Although a few studies to date have captured qualitative patient experiences and perspectives with this method for managing type 2 diabetes, 7,21,23,24 these type of data are scarce. To our knowledge, no studies have examined naturalistic patient experiences and perspectives of GMAs for type 2 diabetes in a rural Saskatchewan context.…”

Barriers and facilitators to implementation of shared medical appointments in primary care for the management of long-term conditions: a systematic review and synthesis of qualitative studies

“…Quality of the included studies was generally high; most papers met the majority of the CASP checklist criteria (online supplemental file 2). Weaknesses commonly related to lack of information about participant recruitment [16][17][18][19][20][21][22] and researcher reflexivity, which was missing in all but two studies. 23 24 Figure 1 Flow diagram of review search.…”

“…16 18 19 21 24 25 27-31 Fewer studies captured the views of healthcare managers, programme/research coordinators and administrators. 18 21 23 28-31 The SMAs varied in terms of content, duration, numbers of attendees and frequency of sessions. The majority of studies focused on single-condition SMAs (n=12); three reported on both single-condition and mixed-condition SMAs 29 31 32 ; two reported on mixed-condition SMAs only 27 33 ; and one gave no details.…”

“…If that person ever leaves or something ever happens, everything falls apart'. Administrator 18 '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'.…”