Paper
Wednesday, July 21, 2004
This presentation is part of : Models for Improved Care
Shared Medical Appointments; A Model for Improved Diabetic Self Care
Maureen B. Boardman, MSN, FNP, Community Health Center, Community Health Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
Learning Objective #1: Evaluate the effectiveness of Shared Medical Appointments (SMA's) in improving diabetic self care
Learning Objective #2: Discuss the effectiveness of the SMA's in the treatment of diabetes and the potential of the SMA model to be used with other chronic disease populations
Objectives: To evaluate: 1) the effectiveness of Shared Medical Appointments (SMA’s) in improving diabetic self- care; 2) whether SMA’s would lead to lower HA1C’s, weight loss, decrease the cost of care and reduced longterm complications secondary to poor glycemic control; and 3) patient satisfaction with SMA’s conducted by an Advanced Practice Nurse (APN).

Design: A comprehensive review of the literature related to SMA’s and strategies to promote self-care was performed. A randomized sample of diabetics, cared for at a local community health center were sent a letter of invitation to participate in six weekly SMA’s. Patients were provided information about the dates, times and locations of the visits, topics of discussion, the name of the APN conducting the visits, and a phone number to call to register.

Methods: Six weekly 90 minute SMA’s were held. Visits explored a variety of topics including: a basic physiological overview of both Type I and Type II diabetes; eye, foot and skin care; diet; exercise; medications. A brief exam was also performed on each patient by the APN at each of the weekly visits. Patient satisfaction surveys were completed at the end of each visit.

Outcomes: Preliminary data suggest that SMA’s are an effective way to improve diabetic self-care. Patients reported not only an increased sense of knowledge regarding their diabetes, but also a high level of satisfaction with the SMA format. For patients that participated in the SMA's, preliminary data also shows an overall decline in HA1C’s three and six months following the completion of the program.

Implications: This project demonstrates the effectiveness of SMA's in improving health outcomes and decreasing costly complications related to diabetes. Furthermore, these findings will provide helpful insights regarding the effectiveness of the SMA's, and the potential of the SMA's model to be used with other chronic illnesses.

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Sigma Theta Tau International
July 21, 2004