Shared medical appointments may have influence on prediabetes ‘epidemic’

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Papadakis does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

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A retrospective cohort study showed that prediabetes patients who attended joint medical appointments lost more weight and had greater reductions in HbA1C and BP levels than their counterparts who received standard care.

“We have an epidemic in hand” Aphrodite Papadakis, MD, a clinician in the family medicine division of Cleveland Clinic told Healio Primary Care. “The epidemic is the rise in prediabetes and the fact that three-quarters of people with prediabetes can progress to diabetes.”

Joint doctor’s appointments (SMAs) are “group visits that combine a doctor’s visit with education and discussion about a common illness,” wrote Papadakis and colleagues in the Annals of Family Medicine.

A guide on the American Academy of Family Physicians website provides a variety of templates clinicians can use to recruit patients for these types of appointments, stating that “HIPAA does not prevent patients from voluntarily discussing personal health information, but it does is a good idea ”. that patients sign a confidentiality form and a HIPAA disclosure form prior to the medical group visit. ”The Cleveland Clinic website states that these types of appointments are covered by most insurance plans.

In their study, Papadakis and colleagues analyzed the clinical effects of SMA in 68 non-pregnant adults with HbA1c levels of 5.7% to 6.4% in the 90 days prior to their first visit who had a prescription for weight loss or had a history of diabetes. Diagnosis received. Their results were compared with those of 135 adults with similar demographics and medical histories – except that patients in the SMA cohort had more statins (8.7% vs. 2.9%, p = 0.006) and metformin (2.9 % vs. 0.25%, P <0.001)).

“Before COVID-19, it would be ideal for SMAs to have a meeting room that comfortably seats eight to 12 people and has a private area next door for private physical exams,” Papadakis said. “We have been holding these group meetings virtually since COVID-19.”

In the study, the SMA group had 90-minute appointments with eight to 10 patients, led by a family doctor and diabetes advisor, and 10 to 15 minutes of individual discussions between patients and clinicians. The 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, the SMA cohort lost more weight (2.88 kg vs. 1.29 kg, p = 0.003) and greater reductions in HbA1c levels after 24 months ( -0.87% vs + 0.87%, P = 0.001) and systolic blood pressure (-4.35 mmHg vs +0.52 mmHg, P = 0.044).

Doctors, nurses and patients will, according to Papadakis, “gain a great sense of satisfaction” with the SMA model.

“I would encourage a doctor who is hesitant to try an SMA to accompany a colleague who already has an SMA. A doctor who sees or has a passion for a particular diagnosis [and the patients] will draw a lot from the experience, ”she said in the interview. “The group dynamics are interesting and stimulating. Support staff can also play a bigger role in dealing with patients. In addition, doctors can see more patients in one-on-one conversation than in the same period of time [appointments]. “

References:

American Academy of General Practitioners. A guide to group visits for chronic conditions involving overweight and obesity. Available at: https://www.aafp.org/dam/AAFP/documents/patient_care/fitness/GroupVisitAIM.pdf. Accessed June 23, 2021.

Cleveland Clinic. Joint doctor’s 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.

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Shivaraj Nagalli, MD, FACP)

Shivaraj Nagalli, MD, FACP

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 examined the effectiveness of SMAs in prediabetic 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 because it was a retrospective study and not a multicenter research.

Patients need to understand their illnesses and their long-term consequences. It is necessary to provide this type of education, motivation, and instruction on lifestyle changes. SMAs / group visits can meet these unmet needs of patients with a common clinical condition. A multidisciplinary approach by a health team composed of a doctor, nutritionist, health educator, behaviorist, and others can prove useful in achieving the desired goal and improving patient outcomes.

SMAs can be extended to other chronic conditions such as full blown diabetes mellitus, high blood pressure, obesity, chronic kidney disease, and chronic alcoholism, and they can help better manage these conditions. These types of appointments have the potential to reduce the country’s exposure to cardiovascular disease, a leading killer in the United States.

Shivaraj Nagalli, MD, FACP

Hospitalist, Shelby Baptist Medical Center

Alabaster, Alabama

Disclosure: Nagalli does not report any relevant financial information.

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