Diabetes Mellitus
Conditions
Keywords
Shared Medical Appointments, Diabetes, Education
Brief summary
While medical training has increasingly included chronic care management, quality care necessitates education approaches that go farther. In April 2005, the Louis Stokes Cleveland Veterans Affairs Medical Center (VAMC) implemented a weekly Diabetes Shared Medical Appointment (SMA). SMAs offer an important opportunity to improve chronic care and a unique setting for training physicians. In order to equip physicians with needed resources to manage chronic care, the ways in which SMA experiences are processed and integrated into learning about interdisciplinary approaches and expanding trainees' understanding of chronic care issues need to be examined.
Detailed description
: Most physicians receive training in and about an acute care-oriented health care system that cannot adequately address the challenges of chronic care management. While medical training has increasingly included chronic care management, quality care necessitates education approaches that go farther. In April 2005, the Louis Stokes Cleveland VAMC implemented a weekly Diabetes Shared Medical Appointment (SMA). Results indicate that SMAs are sustained and, as such, SMAs offer an important opportunity to improve chronic care and a unique setting for training physicians. SMAs offer the potential to provide training in crucial skills that have to date remained less amendable to traditional educational practices. In order to equip physicians with resources to effectively and efficiently manage chronic care, the ways in which SMA experiences are processed and integrated into learning about interdisciplinary approaches and expanding trainees' understanding of chronic care issues need to be examined. Without addressing this gap, it is not possible to develop a comprehensive care model that links education and patient outcomes for chronic conditions, such as diabetes. Building on previous pilot work, we continued to address evaluating and validating instruments. The proposed pilot project included using a think-aloud protocol to evaluate and validate new items and scales assessing interdisciplinary team and chronic care/diabetes beliefs, and evaluating and adjusting direct observation coding tools for chronic condition care.
Interventions
BEHAVIORALShared Medical Appointments
Participated in shared appointments for patients as part of interprofessional team providing care for diabetes
Sponsors
VA Office of Research and Development
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
Medical Students: Inclusion: All medical students participating in diabetes Shared Medical Appointment sessions or other training experiences during the course of the study.
Exclusion criteria
medical students who have participated in SMAs for patients with diabetes at the Cleveland VAMC in the past.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Confidence in Ability to Perform Teamwork | Pre-intervention and Post-Intervention at 1 month | A three item scale was used to assess confidence in ability to convey logic of recommendations to other providers, explain one's distinctive perspective, and be accountable to patients for a decision made by a colleague from another discipline. The responses for each item ranged from 'not at all confident' (0) to 'very confident' (4), with higher values indicating more confidence. The total scale ranged from 0 to 16 with higher being more confident. Difference scores were analyzed (post-pre) with positive and higher values indicating more favorable change. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Professionals' Attitudes About Diabetes | Pre-intervention and Post-intervention at 1 month | The University of Michigan's Research and Training Center's Diabetes Attitude Scale was used. There are 33 items and the response format is a 5 point Likert Scale ranging from 'strongly disagree'(1) to 'strongly agree'(5). A higher score means more positive attitudes toward diabetes and its treatment (e.g., psychosocial impact of diabetes; value of tight glucose control).The total score is computed by summing individual items and ranges from 0 to 165. Post-pre total scores were used with positive and higher values indicating greater favorable change. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| SMA Participants Medical Students who were assigned to observe Shared Medical Appointments (SMA). | 14 |
| Comparison Medical students who do not experience Shared Medical Appointments. | 19 |
| Total | 33 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Incomplete data | 2 | 4 |
| Overall Study | Lost to Follow-up | 0 | 2 |
Baseline characteristics
| Characteristic | SMA Participants | Comparison | Total |
|---|---|---|---|
| Age, Categorical <=18 years | NA Participants | NA Participants | NA Participants |
| Age, Categorical >=65 years | NA Participants | NA Participants | NA Participants |
| Age, Categorical Between 18 and 65 years | NA Participants | NA Participants | NA Participants |
| Region of Enrollment United States | 14 participants | 19 participants | 33 participants |
| Sex/Gender, Customized Not collected | NA participants | NA participants | NA participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 14 | 0 / 19 |
| serious Total, serious adverse events | 0 / 14 | 0 / 19 |
Outcome results
Primary
Change in Confidence in Ability to Perform Teamwork
A three item scale was used to assess confidence in ability to convey logic of recommendations to other providers, explain one's distinctive perspective, and be accountable to patients for a decision made by a colleague from another discipline. The responses for each item ranged from 'not at all confident' (0) to 'very confident' (4), with higher values indicating more confidence. The total scale ranged from 0 to 16 with higher being more confident. Difference scores were analyzed (post-pre) with positive and higher values indicating more favorable change.
Time frame: Pre-intervention and Post-Intervention at 1 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SMA Participants | Change in Confidence in Ability to Perform Teamwork | 1.40 units of a scale | Standard Deviation 0.65 |
| Comparison | Change in Confidence in Ability to Perform Teamwork | -0.12 units of a scale | Standard Deviation 0.6 |
p-value: 0.04t-test, 2 sided
Secondary
Change in Professionals' Attitudes About Diabetes
The University of Michigan's Research and Training Center's Diabetes Attitude Scale was used. There are 33 items and the response format is a 5 point Likert Scale ranging from 'strongly disagree'(1) to 'strongly agree'(5). A higher score means more positive attitudes toward diabetes and its treatment (e.g., psychosocial impact of diabetes; value of tight glucose control).The total score is computed by summing individual items and ranges from 0 to 165. Post-pre total scores were used with positive and higher values indicating greater favorable change.
Time frame: Pre-intervention and Post-intervention at 1 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SMA Participants | Change in Professionals' Attitudes About Diabetes | 0.88 units on a scale | Standard Deviation 1.51 |
| Comparison | Change in Professionals' Attitudes About Diabetes | -1.12 units on a scale | Standard Deviation 2.85 |
p-value: 0.04t-test, 2 sided