Care of the patient with poorly controlled type 2 diabetes in a shared medical appointment: A DNP project

Background: Diabetes is a chronic illness that affects a large proportion of the population nationally, state-wide, and in the region of the practice project. The financial burden of diabetes on our nation's health system, our economy, and individual patients is significant. Optimal control of blood sugar occurs in only a small percentage of those with type 2 diabetes. An intervention is needed that is safe, efficient, patient-centered, and cost-effective. A shared medical appointment for diabetics has the potential to meet these needs and improve patient outcomes.;Methods: The project is a randomized controlled trial comparing outcomes of patients with poorly controlled type 2 diabetes who receive care in a shared medical appointment (intervention) to outcomes of patients who receive care in a traditional provider/patient office visit (control). Inclusion criteria included a diagnosis of type 2 diabetes, age > 18 years, and hemoglobin A1C ≥ 7.5 percent within three months of the start of the project. The project time period of study was 3 months. Outcome measures included post-project hemoglobin A1C, completion of three ADA recommended standards of care, patient satisfaction, and a practice revenue analysis of the intervention compared to the control group.;Results: No statistically significant findings were produced for any of the outcome measures between the two groups. The average post-project A1C for the intervention group decreased 0.8% while the control group average increased 0.66%. Percentages for completion of the three ADA standards were higher in the intervention group for each standard. The two groups were equally satisfied with the care they received. The practice had a net gain of ;Interpretation: The decrease in A1C for the intervention group, though not statistically significant, is clinically significant. For every 1% reduction in A1C, diabetes microvascular complications decrease 37% and the risk of any diabetes-related complication or death is reduced by 21% (Bayer Health Care, LLC, 2009). The intervention group was smaller than the control group. After adjusting for costs of the intervention, the group produced a net gain compared to the control group. Larger shared medical appointment groups will produce greater revenue.