Acceptance of shared medical appointments (SMAs) for patients with diabetes and their gradual clinical implementation may lead to a new and more comprehensive approach to chronic disease management.

An analysis published in the N.C. Medical Journal surveys the limited, early use of SMAs and highlights the need for further research to determine best practices to increase effectiveness, says lead author Connor Drake, MPA, a PhD candidate at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill.

The model is not yet common, but Duke endocrinologist Susan E. Spratt, MD, who was also an author, says the idea has a foothold at in diabetes and weight control care. Spratt predicts SMAs will expand because of satisfaction she sees among patients and providers.

Endocrinology clinics practices have offered group diabetes education sessions for years, Spratt notes. “But the idea of a shared medical appointment is distinctive,” Spratt says. “The shared model involves a provider, but that may be a physician or a nurse practitioner as well as a pharmacist and a facilitator.”

Drake described the study as the first to examine SMA characteristics, delivery, and prevalence in clinical settings. The study found that SMAs for diabetes patients were offered in 10 clinics in 5 of the 12 health systems in North Carolina with “considerable heterogeneity” across the sites. Of the 12 health systems contacted, 10 responded for an 83% response rate. Eight were private and not-for-profit. Three were academic medical centers; 1 was operated by the Veterans Health Administration. The small size and the geographic clustering limit the analysis, the authors noted.

Key findings from the study:

• The success of SMAs in clinical practice will be based on patients’ and clinicians’ benefit.
• Leadership support and team-based care are key factors in growth.
• Nurses and pharmacists are closely involved in N.C. sites studied.
• Pharmacists are uniquely positioned to serve the clinics because of need for medical adherence and titration.

Providers see the shared sessions as productive and valuable, Spratt says, and believe the SMAs will be improve and grow. “Can you make it work?” Spratt asks. “Can you identify the right staff, the right space?”

Spratt says the clinics may be more effective in as a primary care offering to avoid patient co-payments for specialist care.  “As we move to more value-based care, we have to look into more of these opportunities,” Spratt says. “This is one way to do it.”

A successful weight counselling project at the Duke Diet and Fitness Center was directed by William S. Yancy, Jr, MD, MHS, center director and research associate at the Durham VA Medical Center. Patients with difficult-to-control diabetes who participated in weight management counseling during group medical visits experienced benefits beyond reduced-sugar levels.