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      Implementation and Evaluation of Shared Medical Appointments for Type 2 Diabetes at a Free, Student-Run Clinic in Alamance County, North Carolina

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          Abstract

          Introduction

          Type 2 diabetes is a significant problem among uninsured patients. Shared medical appointments (SMA) have been shown to improve outcomes in type 2 diabetes. We hypothesized that the SMA model could be adapted for a non-profit clinic in North Carolina that serves uninsured patients with diabetes that have incomes at/below 150% of the federal poverty line.

          Research Design and Methods

          We implemented and sustained a patient-driven, student-led SMA model that incorporated the monthly rotations of students, physician assistant, and undergraduate students as well as pharmacy residents and an endocrinologist who collectively provide diabetes care at the free clinic. SMA groups are ‘open’ cohorts and include 4–12 patients scheduled for the monthly clinic. Teams of transdisciplinary trainees work together to perform triage, medication reconciliation, brief history, and physical exam, after which patients participate in the SMA. The endocrinologist evaluates SMA patients individually during and after the visit.

          Results

          Between November 2015 and January 2017, we enrolled 29 patients in SMA. There was high variability in HbA1c at baseline. Among eight type 2 diabetes patients seen in endocrine clinic and with complete data one year before and after SMA implementation, the mean (SD) HbA1c before SMA was 9.7% ± 1.7% (83±7 mmol/ mol); mean HbA1c after SMA was 9.2% ± 1.8% (77 ± 8mmol/mol). The median HbA1c before SMA was 9.5% (80 mmol/mol); median HbA1c after SMA was 8.9% (74 mmol/mol). Overall, 6/8 patients showed decreased HbA1c after SMA although there was variability between individuals in response of glycemic control to SMA. SMA increased clinic efficiency and offered an opportunity to integrate transdisciplinary trainees. Trainees gain experience with novel models of care and the complexities of the patient experience of diabetes.

          Conclusions

          We hope this observation encourages others to implement such programs to enhance the evidence-base for SMA to address health disparities and increase the quality of free diabetes care.

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          Author and article information

          Journal
          101719040
          47218
          J Med Educ Train
          Journal of medical education and training
          19 June 2018
          2018
          19 July 2018
          : 2
          : 1
          : 032
          Affiliations
          [1 ]University of North Carolina at Chapel Hill, Gillings School of Public Health, Department of Nutrition, Chapel Hill, NC, USA
          [2 ]University of North Carolina School of Medicine, Chapel Hill, NC, USA
          [3 ]University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, USA
          [4 ]Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
          Author notes
          [* ]Co-first author. Corresponding author: Anna R. Kahkoska, anna_kahkoska@ 123456med.unc.edu
          Article
          PMC6053275 PMC6053275 6053275 nihpa975921
          6053275
          30035272
          86744194-483d-4c62-9f08-572e66a7cecf
          History
          Categories
          Article

          Type 2 diabetes,Shared medical appointments,Interdisciplinary,Free clinic

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