Abstract
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
(r2 = 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.