Shared medical appointments for patients with diabetes: glycemic reduction in high-risk patients.

PURPOSE: To assess the impact on glycemic control (A1c, %) in a primary care urban Veterans Affairs (VA) shared medical appointments (SMAs). DATA SOURCES: A retrospective pretest/posttest study included all patients who had attended ≥1 SMA from 4/06 to 12/10. A1cs 810 days pre- and postinitial SMA were obtained from 90-day time periods. A1c levels were averaged within patient in these 90-day intervals and data were aggregated based upon corresponding time intervals.
CONCLUSIONS: Of 1290 individuals seen in SMAs, 1288 (99.8%) had ≥1 A1c levels and 1170 (90.7%) individuals had ≥1 level collected both before and after attendance. The sample was predominantly (96%) male and middle aged or older (mean [±1 SD] age of 62.6 + 9.09 years) with a mean Diabetes Severity Index 3.01 (2.34). There were significant A1c reductions (∼1%) in A1c overall (n = 1170) and for patients with ≥1 measurement in the 180-day periods preceding and following their first SMA appointment (n = 815). Linear regression analysis showed a significant (p < .001) pre-SMA positive trend (r(2) = 0.90). IMPLICATIONS FOR PRACTICE: Limitations notwithstanding (single site and design lacking a control group), the large number of patients demonstrates SMA clinical effectiveness in improving A1c for high-risk patients with diabetes. ©2015 American Association of Nurse Practitioners.