Shared medical appointments could have impact on prediabetes 'epidemic'
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Patients with prediabetes who participated in shared medical appointments lost more weight and experienced greater reductions in HbA1C and BP levels than their counterparts who received usual care, a retrospective cohort study showed.
“We have an epidemic on our hands,” Aphrodite Papadakis, MD, a clinician in the family medicine department at Cleveland Clinic, told Healio Primary Care. “The epidemic is the rise in prediabetes and the fact that three-quarters of folks with prediabetes can progress to diabetes.”
Shared medical appointments (SMAs) are “group visits that combine a medical visit with education and discussion around a common condition,” Papadakis and colleagues wrote in Annals of Family Medicine.
A guide on the American Academy of Family Physicians’ website provides several templates health care practitioners can use to recruit patients for these types of appointments and states that “although HIPAA doesn’t prevent patients from voluntarily discussing personal health information, it’s probably a good idea to have patients sign a confidentiality form and HIPAA disclosure form prior to the group medical visit.” Cleveland Clinic’s website said these types of appointments are covered by most insurance plans.
In their study, Papadakis and colleagues analyzed the clinical effect SMAs had on 68 nonpregnant adults with HbA1c levels of 5.7% to 6.4% in the 90 days before their first visit and who received a prescription for weight loss or a previous diabetes diagnosis. Their results were compared with those of 135 adults with similar demographics and medical and smoking histories — except that patients in the SMA cohort had more prescriptions for statins (8.7% vs. 2.9%, P = .006) and metformin (2.9% vs. 0.25%, P < .001).
“Pre-COVID-19, having a meeting space that could comfortably seat eight to 12 individuals and allow for a private area adjacent to conduct any private physical examination would be ideal” for SMAs, Papadakis said. “Since COVID-19, we have been conducting these group appointments virtually.”
In the study, the SMA group had 90-minute appointments with eight to 10 patients who were guided by a family physician and diabetes educator, and 10 to 15 minutes of individualized discussions between patients and the clinicians. Test results related to diabetes were discussed with the group and personal goals were set for each patient.
The researchers reported that, based on a review of patients’ electronic medical records after 24 months, the SMA cohort lost more weight (2.88 kg vs. 1.29 kg, P = .003) and experienced greater reductions in HbA1c levels (–0.87% vs. +0.87%, P = .001) and systolic BP (–4.35 mmHg vs. +0.52 mmHg, P = .044).
Physicians, support staff and patients will “obtain a great sense of satisfaction” with the SMA model, according to Papadakis.
“I would encourage a physician who is hesitant to try an SMA to shadow a colleague who has an SMA already in place. A physician who sees or has passion for a particular diagnosis [and the patients] will gain a lot out of the experience,” she said in the interview. “The group dynamic is interesting and stimulating. Ancillary staff members get to play a greater role in interacting with patients as well. Also, physicians can see more patients than they would in the same period of time in one-on‐one [appointments].”
References:
American Academy of Family Physicians. A guide to group visits for chronic conditions affected by overweight and obesity. Available at: https://www.aafp.org/dam/AAFP/documents/patient_care/fitness/GroupVisitAIM.pdf. Accessed June 23, 2021.
Cleveland Clinic. Shared Medical Appointments. https://my.clevelandclinic.org/departments/wellness/integrative/shared-medical-appointments. Accessed June 23, 2021.
Papadakis A, et al. Ann Fam Med. 2021;doi:10.1370/afm.2647.
Perspective
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SMAs have gained interest in recent years, but their true value is still questionable, given the scarcity of studies on them. This retrospective cohort study evaluated the effectiveness of SMAs in pre-diabetic patients. The study found that the patients who participated in SMAs had greater weight loss, better control of HbA1C and systolic blood pressure than the control group.
However, the study had some limitations in being a retrospective study, and it was not multi-centered research.
Patients need to understand the medical conditions that they have and their long-term consequences. Providing this kind of education, motivation and teachings on lifestyle modifications is necessary. SMAs/group visits can fulfill these unmet needs of the patients with a common clinical condition. A multidisciplinary approach from a health care team composed of a physician, dietician, health educator, behaviorist, and others can prove beneficial in attaining the desired goal and improve patient outcomes.
SMAs can be expanded further to cover other chronic medical conditions such as full-blown diabetes mellitus, hypertension, obesity, chronic kidney disease and chronic alcoholism, and they can help in managing these conditions better. These types of appointments have the potential to reduce the nation’s burden of cardiovascular diseases, one of the leading causes of mortality in the United States.
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