Shared medical appointments for patients with diabetes: Glycemic reduction in high-risk patients

Watts, Sharon A.; Strauss, Gerald; Pascuzzi, Kristina; O'Day, Mary Ellen; Young, Kevin; Aron, David C.; Kirsh, Susan

doi:10.1002/2327-6924.12200

Cited by 26 publications

(24 citation statements)

References 17 publications

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“…Originally developed by Caballero (6), SMAs are defined as: “… consecutive individual medical visits carried out in a supportive group setting of similar patients where all can listen, interact, and learn .” SMAs are group or cluster medical consultations (7), carried out sequentially, where approximately 8–15 patients with the same chronic condition are seen by a physician and an interdisciplinary team of health-care professionals over a 60- to 120-min time period (8). This allows physicians to deliver the same level of care to multiple patients at the same time, thereby maximizing available resources (6).…”

Section: Introductionmentioning

confidence: 99%

Shared Medical Appointments May Be Effective for Improving Clinical and Behavioral Outcomes in Type 2 Diabetes: A Narrative Review

et al. 2017

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Type 2 diabetes mellitus (T2DM) is a complex chronic disease affecting over 400 million people worldwide. Managing T2DM and its associated complications in individual patient consultations poses substantial challenges to physicians due to limited time and resources and lack of access to multidisciplinary teams. Shared medical appointments (SMAs) are consecutive medical consultations provided by a physician in a group setting, where integrated medical care and patient education are delivered in a single session. SMAs allow physicians to deliver the same level of care to multiple patients at the same time, thereby maximizing available resources. However, the effectiveness and practicality of SMAs in the management of T2DM remains unknown. This narrative review summarizes current and emerging evidence regarding the effectiveness of SMAs in improving clinical outcomes in patients with T2DM, as well as whether SMAs are associated with reduced costs and improved diabetes-related behavioral and lifestyle changes. An extensive literature search was conducted on major electronic databases including PubMed and Google Scholar using keywords, including SMAs, group visits, and T2DM to identify all studies of SMAs in patients with T2DM. Studies in type 1 diabetes or mixed or unspecified populations were excluded, as well as studies where SMAs did not involve a physician since these do not meet the classical definition of a SMA. Nineteen studies were identified and are included in this review. Overall, current evidence suggests that SMAs delivered regularly over time may be effective in improving glycemic outcomes, diabetes knowledge, and some diabetes-related behaviors. However, the main limitation of existing studies was the paucity of comparisons with standard care which limits the ability to draw conclusions regarding whether SMAs are superior to standard care in T2DM management. Moreover, the small number of studies and substantial heterogeneity in study designs, populations, and interventions creates difficulties in establishing the practicality and efficiency of SMAs in the clinical care setting. We conclude that there remains a need for larger studies to identify populations who may or may not benefit from the SMA model of care and to clarify the potential benefits and barriers to implementing SMAs into routine diabetes care.

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Section: Introductionmentioning

confidence: 99%

Shared Medical Appointments May Be Effective for Improving Clinical and Behavioral Outcomes in Type 2 Diabetes: A Narrative Review

et al. 2017

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“…Veterans have reported satisfaction and increased well‐being with SMA management for health issues such as smoking cessation, weight management, and diabetes (Cohen, Hartley, Mavi, Vest, & Wilson, ). SMA diabetes management programs utilizing NPs within the VA have documented successful improvements in glycemic control as measured by a reduction in hemoglobin A1c (HbA1c; Tokuda et al., ; Watts et al., ). Watts et al.…”

Section: Vha Interprofessional Team‐based Care and Population Health mentioning

confidence: 99%

Improving the care of veterans

Hobson¹,

Curtis²

2017

Journal of the American Association of Nurse Practitioners

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Background and purpose Improving healthcare delivery for U.S. veterans is a national priority. The Veterans Health Administration (VHA) employs a variety of team‐based, population health strategies to address critical issues in veterans’ health including the effective management of chronic disease. Nurse practitioners (NPs) are integral members of the VHA patient care team with a substantial role to play in the organization and delivery of healthcare services for veterans. This report explores the contributions of NPs in team‐based, population health strategies within the VHA. Methods This review of the literature examines peer‐reviewed articles published between 2006 and 2017 to explore the contributions of NPs in team‐based, population health strategies within the VHA. Search words include veterans, VHA, NPs, population health, panel management, and chronic disease. Conclusions NPs are vital members of the VHA primary care team; however, there is a dearth of available evidence reflecting the unique contribution of NPs within VHA team‐based, population health management strategies. Implications for practice The VHA adoption of full practice authority for NP practice provides NPs with an expanded capacity to lead improvements in veterans’ health. Future research is needed to fully understand the unique role of the NP in the delivery of population health management strategies for veterans.

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“…Studies have shown that shared medical appointments (SMAs) improve glycemic control in diabetic patients . An SMA is defined as “a model of care which involves multiple patients being seen as a group.” The structure of the SMA looks different in each study but generally combines a standard medical appointment with education and peer to peer discussion to improve self‐management of a chronic disease . Shared appointments have proven to increase knowledge of medical conditions as well as improve self‐care .…”

Section: Introductionmentioning

confidence: 99%

Novel, culturally sensitive, shared medical appointment model for Hispanic pediatric type 1 diabetes patients

Pascual¹,

Pyle²,

Nieto³

et al. 2019

Pediatr Diabetes

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Background/Objective Latino patients with type 1 diabetes (T1D) face cultural and language barriers leading to poor outcomes. Shared medical appointments (SMAs) are recognized as effective models of care. Our aim is to develop a culturally sensitive, cost effective SMA program for Latino T1D. Subjects Spanish speaking Latinos 1 to 20 years with T1D (n = 88) and their families. Methods Routine care alternating with SMAs that included group education was provided. Teens, ages >11 received the SMA separate from parents. Younger children were seen together. Hemoglobin A1c (HbA1c), behavioral questionnaires, and use of diabetes technology were measured at baseline and every 3 to 6 months. Results 57.7% of children and 77.27% of teens completed the 2 years of the Program. There was a significant association between age and change in HbA1c from baseline to year 1 (P = .001) and baseline to year 2 (P = <.0001). For participants <12 years, there was a significant improvement in HbA1c from baseline to year 1 (P = .0146) and from year 1 to year 2 (P = .0069). Participants ≥12 years, had an increase in HbA1c from year 1 to year 2 (P = .0082). Technology use increased significantly from baseline to year 2 for participants <12 years of age (19%‐60%, P = .0455) and for participants who were ≥12 years of age (10%‐23%, P = .0027). Participants reported a 98% satisfaction rate. Conclusions The culturally sensitive SMA proved to be an appreciated, feasible, and effective alternative to care for Latinos with T1D.

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Shared medical appointments for patients with diabetes: Glycemic reduction in high-risk patients

Cited by 26 publications

References 17 publications

Shared Medical Appointments May Be Effective for Improving Clinical and Behavioral Outcomes in Type 2 Diabetes: A Narrative Review

Shared Medical Appointments May Be Effective for Improving Clinical and Behavioral Outcomes in Type 2 Diabetes: A Narrative Review

Improving the care of veterans

Novel, culturally sensitive, shared medical appointment model for Hispanic pediatric type 1 diabetes patients

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