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Impact of Collaborative Shared Medical Appointments on Diabetes Outcomes in a Family Medicine Clinic

Hartzler, Melody L., Shenk, McKenzie, Williams, Julie, Schoen, James, Dunn, Thomas, Anderson, Douglas
TheDiabetes educator 2018 v.44 no.4 pp. 361-372
aspirin, diabetes, distress, glycemic effect, guidelines, hemoglobin, literacy, low density lipoprotein cholesterol, medicine, patients, pneumonia, surveys, systolic blood pressure, vaccines
The purpose of this study is to evaluate the impact of a collaborative diabetes shared medical appointment on patient outcomes in an urban family medicine practice. Fifty-nine patients were enrolled to participate in multiple shared medical appointments (SMAs) over 12 months. Baseline data included hemoglobin (A1C), lipids, systolic blood pressure (SBP), weight, adherence to American Diabetes Association (ADA) guidelines, and surveys, including the Problem Areas in Diabetes (PAID-2) scale and the Spoken Knowledge in Low Literacy in Diabetes Scale (SKILLD). A1C and SBP were evaluated at each visit. Lipid control was assessed at baseline and at 6 and 12 months. Adherence to ADA guidelines, SKILLD and PAID-2 survey scores, and number of antihyperglycemic and antihypertensive medications were also evaluated at 12 months. Thirty-eight patients completed the study. Compared with baseline, A1C and low-density lipoprotein cholesterol (LDL-C) levels decreased significantly over 12 months (P < .001 and P = .004, respectively). More patients became compliant with the ADA guidelines throughout the course of the study. Specifically, more patients achieved the LDL-C goal of ≤100 mg/dL (2.59 mmol/L; P < .001), were prescribed appropriate antihypertensive medications (P < .001) and aspirin (P < .001), and received the pneumonia vaccine (P < .001). PAID-2 and SKILLD survey scores also significantly improved over the course of the study (P ≤ .001 and P = .003, respectively). Short-term interdisciplinary SMAs decreased A1C and LDL-C, improved patient adherence to ADA guidelines, improved emotional distress related to diabetes, and increased knowledge of diabetes.