Shared Medical Appointments and Mindfulness for Type 2 Diabetes-A Mixed-Methods Feasibility Study.

Introduction: Type 2 diabetes (T2DM) is a major health concern with significant personal and healthcare system costs. There is growing interest in using shared medical appointments (SMAs) for management of T2DM. We hypothesize that adding mindfulness to SMAs may be beneficial. This study aimed to assess the feasibility and acceptability of SMAs with mindfulness for T2DM within primary care in Australia. Materials and Methods: We conducted a single-blind randomized controlled feasibility study of SMAs within primary care for people with T2DM living in Western Sydney, Australia. People with T2DM, age 21 years and over, with HbA1c > 6.5% or fasting glucose >7.00 mmol/L within the past 3 months were eligible to enroll. The intervention group attended six 2-h programmed SMAs (pSMAs) which were held fortnightly. pSMAs included a structured education program and mindfulness component. The control group received usual care from their healthcare providers. We collected quantitative and qualitative data on acceptability as well as glycemic control (glycated hemoglobin and continuous glucose monitoring), lipids, anthropometric measures, blood pressure, self-reported psychological outcomes, quality of life, diet, and physical activity using an ActiGraph accelerometer. Results: Over a 2-month period, we enrolled 18 participants (10 females, 8 males) with a mean age of 58 years (standard deviation 9.8). We had 94.4% retention. All participants in the intervention group completed at least four pSMAs. Participants reported that attending pSMAs had been a positive experience that allowed them to accept their diagnosis and empowered them to make changes, which led to beneficial effects including weight loss and better glycemic control. Four pSMA participants found the mindfulness component helpful while two did not. All of the seven participants who contributed to qualitative evaluation reported improved psychosocial wellbeing and found the group setting beneficial. There was a significant difference in total cholesterol levels at 12 weeks between groups (3.86 mmol/L in intervention group vs. 4.15 mmol/L in the control group; p = 0.025) as well as pain intensity levels as measured by the PROMIS-29 (2.11 vs. 2.38; p = 0.034). Conclusion: pSMAs are feasible and acceptable to people with T2DM and may result in clinical improvement. A follow-up fully-powered randomized controlled trial is warranted. Clinical Trial Registration: Australia and New Zealand Clinical Trial Registry, identifier ACTRN12619000892112.

Shared Medical Appointments: An Innovative Model to Reduce Health Disparities Among Latinxs With Type-2 Diabetes.

In the United States, diabetes is epidemic. A study of Latinxs with diabetes evaluated a behavioral shared medical appointment (SMA) intervention. This quasi-experimental study included nonrandomized matched control group participants receiving usual care. The nonprobability convenience sample consisted of 90 participants (SMA = 30; control = 60) receiving primary care at an FQHC (Federally Qualified Health Center) clinic. At 6 months, the percentage of participants achieving target A1C goals was greater in the intervention group (59%) than in the control group (31%; χ2 = 4.462, p ≤ .05). In a multiple regression model, the SMA intervention group, compared to the control group had an A1C decline at 3 months of 0.55% (b = - 0.55, t = - 1.48, p=.14) and an A1C decline at 6 months of 0.83% (b= - 0.83, t= - 2.25, p = .03). Therefore, the results showed 3- and 6-month declines that were greater in the SMA group than in the control group. Underserved, underinsured Latinxs in the ALDEA program achieved significant A1C reductions; the program succeeded in empowering Latino patients and improving glycemic control.

Implementation of a Shared Medical Appointment as a Holistic Approach to CHF Management.

Congestive heart failure is a costly chronic disease within the United States. The purpose of this study was to examine the effect of a holistic shared medical appointment (SMA) approach to congestive heart failure. Findings suggest the SMA approach improves depression, quality of life (QOL), and health-promoting behaviors. This study implemented congestive heart failure self-management education in primary care using a holistic multidisciplinary approach with SMA to provide evidence-based interventions to improve depression, QOL, and health promotion outcomes. Patients participating in the holistic multidisciplinary SMA experienced improvement in depression, QOL, and health promotion behaviors. A comparison of the means between preintervention and postintervention showed an overall reduction in systolic blood pressure, weight, depression scores, QOL scores, and several indicators of health promotion lifestyle.