TY - JOUR
AU - B. M. Kwan
AU - L. M. Dickinson
AU - J. Dailey-Vail
AU - R. E. Glasgow
AU - R. M. Gritz
AU - D. Gurfinkel
AU - C. M. Hester
AU - J. S. Holtrop
AU - P. Hosokawa
AU - A. Lanigan
AU - D. E. Nease Jr.
AU - A. Nederveld
AU - P. Phimphasone-Brady
AU - N. D. Ritchie
AU - M. Sajatovic
AU - R. Wearner
AU - A. Begum
AU - M. Carter
AU - T. Carrigan
AU - B. Clay
AU - D. Downey
AU - R. Koren
AU - S. A. Trujillo
AU - J. A. Waxmonsky
A1 - 
AB - BACKGROUND: Diabetes self-management education and support can be effectively and efficiently delivered in primary care in the form of shared medical appointments (SMAs). Comparative effectiveness of SMA delivery features such as topic choice, multi-disciplinary care teams, and peer mentor involvement is not known. OBJECTIVE: To compare effects of standardized and patient-driven models of diabetes SMAs on patient-level diabetes outcomes. DESIGN: Pragmatic cluster randomized trial. PARTICIPANTS: A total of 1060 adults with type 2 diabetes in 22 primary care practices. INTERVENTIONS: Practice personnel delivered the 6-session Targeted Training in Illness Management (TTIM) curriculum using either standardized (set content delivered by a health educator) or patient-driven SMAs (patient-selected topic order delivered by health educators, behavioral health providers [BHPs], and peer mentors). MAIN MEASURES: Outcomes included self-reported diabetes distress and diabetes self-care behaviors from baseline and follow-up surveys (assessed at 1st and final SMA session), and HbA1c, BMI, and blood pressure from electronic health records. Analyses used descriptive statistics, linear regression, and linear mixed models. KEY RESULTS: Both standardized and patient-driven SMAs effectively improved diabetes distress, self-care behaviors, BMI (- 0.29 on average), and HbA1c (- 0.45% (mmol/mol) on average, 8.3 to 7.8%). Controlling for covariates, there was a small, significant effect of condition on overall diabetes distress in favor of standardized SMAs (F(1,841) = 4.3, p = .04), attributable to significant effects of condition on emotion and regimen distress subscales. There was a small, significant effect of condition on diastolic blood pressure in favor of standardized SMAs (F(1,5199) = 4.50, p = .03). There were no other differences between conditions. CONCLUSIONS: Both SMA models using the TTIM curriculum yielded significant improvement in diabetes distress, self-care, and HbA1c. Patient-driven diabetes SMAs involving BHPs and peer mentors and topic selection did not lead to better clinical or patient-reported outcomes than standardized diabetes SMAs facilitated by a health educator following a set topic order. NIH TRIAL REGISTRY NUMBER: NCT03590041.
AD - Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA. bethany.kwan@cuanschutz.edu.; Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. bethany.kwan@cuanschutz.edu.; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA. bethany.kwan@cuanschutz.edu.; Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.; Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.; University of Colorado College of Nursing, Aurora, CO, USA.; Division of Health Care Policy & Research, University of Colorado School of Medicine, Aurora, CO, USA.; American Academy of Family Physicians National Research Network, Leawood, KS, USA.; Office of Research, Denver Health & Hospital Authority, Denver, CO, USA.; Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA.; Departments of Psychiatry and Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.; Invested in Diabetes Patient Partners, Aurora, CO, USA.
AN - 38943014
BT - J Gen Intern Med
C5 - Education & Workforce
CP - 15
DA - Nov
DO - 10.1007/s11606-024-08868-7
DP - NLM
ET - 20240628
IS - 15
JF - J Gen Intern Med
LA - eng
N2 - BACKGROUND: Diabetes self-management education and support can be effectively and efficiently delivered in primary care in the form of shared medical appointments (SMAs). Comparative effectiveness of SMA delivery features such as topic choice, multi-disciplinary care teams, and peer mentor involvement is not known. OBJECTIVE: To compare effects of standardized and patient-driven models of diabetes SMAs on patient-level diabetes outcomes. DESIGN: Pragmatic cluster randomized trial. PARTICIPANTS: A total of 1060 adults with type 2 diabetes in 22 primary care practices. INTERVENTIONS: Practice personnel delivered the 6-session Targeted Training in Illness Management (TTIM) curriculum using either standardized (set content delivered by a health educator) or patient-driven SMAs (patient-selected topic order delivered by health educators, behavioral health providers [BHPs], and peer mentors). MAIN MEASURES: Outcomes included self-reported diabetes distress and diabetes self-care behaviors from baseline and follow-up surveys (assessed at 1st and final SMA session), and HbA1c, BMI, and blood pressure from electronic health records. Analyses used descriptive statistics, linear regression, and linear mixed models. KEY RESULTS: Both standardized and patient-driven SMAs effectively improved diabetes distress, self-care behaviors, BMI (- 0.29 on average), and HbA1c (- 0.45% (mmol/mol) on average, 8.3 to 7.8%). Controlling for covariates, there was a small, significant effect of condition on overall diabetes distress in favor of standardized SMAs (F(1,841) = 4.3, p = .04), attributable to significant effects of condition on emotion and regimen distress subscales. There was a small, significant effect of condition on diastolic blood pressure in favor of standardized SMAs (F(1,5199) = 4.50, p = .03). There were no other differences between conditions. CONCLUSIONS: Both SMA models using the TTIM curriculum yielded significant improvement in diabetes distress, self-care, and HbA1c. Patient-driven diabetes SMAs involving BHPs and peer mentors and topic selection did not lead to better clinical or patient-reported outcomes than standardized diabetes SMAs facilitated by a health educator following a set topic order. NIH TRIAL REGISTRY NUMBER: NCT03590041.
PY - 2024
SN - 0884-8734 (Print); 0884-8734
SP - 2970
EP - 2979+
ST - Comparative Effectiveness of Patient-Driven versus Standardized Diabetes Shared Medical Appointments: A Pragmatic Cluster Randomized Trial
T1 - Comparative Effectiveness of Patient-Driven versus Standardized Diabetes Shared Medical Appointments: A Pragmatic Cluster Randomized Trial
T2 - J Gen Intern Med
TI - Comparative Effectiveness of Patient-Driven versus Standardized Diabetes Shared Medical Appointments: A Pragmatic Cluster Randomized Trial
U1 - Education & Workforce
U3 - 10.1007/s11606-024-08868-7
VL - 39
VO - 0884-8734 (Print); 0884-8734
Y1 - 2024
ER -