Poster Presentation

Wednesday, July 11, 2007
9:00 AM - 9:45 AM

Wednesday, July 11, 2007
2:45 PM - 3:30 PM
This presentation is part of : Poster Presentation I
A New Paradigm of Care for Patients with Chronic Disease
Deborah A. Capone-Swearer, MSN1, Christine H. Peterson, MSN1, Kathryn L. Chicano, MSN2, and Susan E. Thompson, BSN1. (1) Patient/Nursing Care Services, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA, (2) Patient/Nursing Services, Veterans Affairs Medical Center, Philadelphia, PA, USA
Learning Objective #1: The learner will be able to examine evidence based research supporting a Shared Medical Appointment (SMA) model in Primary Care.
Learning Objective #2: The learner will be able to identify chronic disease conditions in which SMA may be developed and implemented to improve patient outcomes.

Diabetes is a serious chronic illness with multiple complications and premature mortality.  The World Health Organization (WHO) attributes 1.7% of total world mortality to diabetes. (1) WHO has called for “halting the …threat of chronic diseases” through patient education. (2) Low medical literacy impedes this goal. (3)
Diabetes afflicts 20.8 million (7% ) Americans. (4)
          The US Veterans Health Administration (VHA) reports one million (20%) veterans have diabetes. VHA is organized into 22 regions.  The Philadelphia, Pennsylvania VA, ranks first in its region, for diabetes burden with 18,243 diabetics! (5)
Shared Medical Appointments (SMA) may hold the key to improve care of patients with chronic disease. SMA create “an optimal learning environment as interaction is exchanged between staff and patients”. (6) They allow providers and staff to deliver intensive education as well as to conduct an individual medical encounters in a group setting. (6,7,8, 9) SMA are holistic and address psychosocial and behavioral aspects of illness. Patients learn from experience and wisdom of peers.
Using the SMA paradigm of care, diabetic patients have demonstrated higher satisfaction, acceptance, loss of the “woe is me” mentality, improved quality of life and disease self-management. (10,11,12,13,) Some SMA research suggests that this model may be cost effective in preventing longterm diabetes complications. (14,15) 
            Nurse practitioners and educators at the Philadelphia VA want to“ enable people to improve, maintain, … and to cope with health problems…” (16) We believe the mission of Sigma Theta Tau “to enhance the health of all people”. (17)
Therefore, we have examined evidence, shifted resources, organized a multidisciplinary team and embarked on a nurse driven pilot project of SMA for diabetics with HbA1C between 7.5% -9.99%. Information on patient  satisfaction, knowledge and clinical process indicators (HbA1C, lipids, blood pressure and BMI) will be analyzed and reported.