Implementing shared medical appointments across multiple patient aligned care teams: the role of coordinated care in the improvement of type 2 diabetes outcomes

Service or Program: The type 2 diabetes mellitus Shared Medical Appointment (SMA) service started at the Central Alabama Veterans Healthcare System (CAVHCS) was created to allow widespread adoption throughout the system. The model includes a monthly SMA run by an interdisciplinary team of providers, including clinical pharmacists. Patients with HbA1c greater than 9% are identified and recruited for the program via telephone. The SMA is split into two hour-long segments. The first hour involves facilitated discussion, with topics at each appointment based on group interest. The second hour focuses on patient-centered goal-setting. Medications are adjusted in the group setting by the clinical pharmacist and primary care provider. Telephone follow-up is done two weeks later, during which the pharmacist reviews goals, glucose monitoring, medication adherence, and adverse events. Patients graduate from the SMA when they achieve their HbA1c goal.

Justification/Documentation: The time required to manage a patient with diabetes, along with its increasing prevalence, makes access to quality care a challenge. This system-wide model employs an interdisciplinary team to provide well-rounded patient care, with pharmacists playing a large role in patient education, medication adjustment, and follow-up. The SMA model also provides patients with a strong social support system from peers in the group.

Transferability: The SMA program is spread via a series of local conferences which defines the standardized procedures and team roles. Interested providers are invited to view an existing SMA via video conference. Overall, twelve patient aligned care teams at four CAVHCS sites have successfully adopted the SMA model presented.

Impact: Median baseline HbA1C in 186 SMA participants was 10%, which was decreased by a median of 0.85% across all patients. The greatest benefit was seen in patients attending six or more SMAs, with a median HbA1C reduction of 1.2%.