1. Session # C1B
Improving Patients’ Physical and Mental Wellbeing: A Shared Medical Appointment Targeting Type 2 Diabetes
Ruth Nutting, MA, LCMFT ~ Coordinator of Behavioral Health/Teaching Associate ~ University of Kansas School of Medicine at Via Christi Family Medicine Residency, Wichita, Kansas
Kristen Cook, PharmD, BCPS ~ Assistant Professor Pharmacy Practice/PCMH Clinical Pharmacist ~ University of Nebraska Medical Center & Nebraska Medicine
Omaha, Nebraska
Please insert the assigned session number (track letter, period number), i.e., A2a
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List EACH PRESENTER who will ATTEND the CFHA Conference to make this presentation.
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CFHA 18th Annual Conference
October 13-15, 2016  Charlotte, NC U.S.A.
Collaborative Family Healthcare Association 12th Annual Conference

2. Faculty Disclosure
The presenters of this session have NOT had any relevant financial relationships during the past 12 months.
You must include ONE of the statements above for this session.
CFHA requires that your presentation be FREE FROM COMMERCIAL BIAS. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts CANNOT contain any advertising or product‐group message.
The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest. Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidence‐based) methods generally accepted by the medical community.
Collaborative Family Healthcare Association 12th Annual Conference

3. Learning Objectives At the conclusion of this session, the participant will be able to:
Recognize the prevalence and implications of Type 2 Diabetes
Discuss patient perception, satisfaction, and improvements in health related outcomes stemming from participation in a SMA for patients with Type 2 Diabetes
Understand how to implement a SMA within an integrated care setting
Include the behavioral learning objectives you identified for this session
Collaborative Family Healthcare Association 12th Annual Conference

4. Bibliography / Reference
Ali, M.K., Bullard, K. M., Saaddine, J. B., Cowie, C. C., Imperatore, G., Gregg, E. W. (2013). Achievement of goals in U. S. diabetes care, New England Journal of Medicine, 368(17),
Centers for Disease Control and Prevention. (2014). National diabetes statistics report: Estimates of diabetes and its burden in the United States. Retrieved from
Heron, M. (2015). Deaths. Leading causes for National Vital Statistics Report, 64(10), 1-94.
Housden, L., Wong, S. T., Dawes, M. (2013). Effectiveness of group medical visits for improving diabetes care: A systematic review and meta-analysis. Canadian Medical Association Journal, 185(13),
Ritholz, M.D., Beverly, E. A., Brooks, K.M., Abrahamson, M.J., & Weinger, K. (2014). Barriers and facilitators to self-care communication during medical appointments in the United States for adults with type 2 diabetes. Chronic Illness, 10(4),
Continuing education approval now requires that each presentation include five references within the last 5 years.
Please list at least FIVE (5) references for this presentation that are no older than 5 years.
Without these references, your session may NOT be approved for CE credit.
Collaborative Family Healthcare Association 12th Annual Conference

5. Learning Assessment A learning assessment is required for CE credit.
A question and answer period will be conducted at the end of this presentation.
Please incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation.
This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements.
Collaborative Family Healthcare Association 12th Annual Conference

6. Prevalence & Implications
1 in 3 Americans will have DM by 2050 (CDC, 2014)
86 million US have prediabetes
8 milllion undiagnosed patients
Over 29 million Americans diagnosed with diabetes mellitus.
Ranked in top ten causes of death
Suboptimal treatment
Limited time
Lack of interprofessional team
Patient reluctance to disclose self-care behaviors
Lack of diabetes education
You can begin your own slides here. Feel free to use your own background on this and subsequent slides.
Collaborative Family Healthcare Association 12th Annual Conference

7. SMA Model Educational Introduction Rotation Concluding Summary
Interprofessional Team:
Resident Physician
Pharmacist
Behavioral Health Specialist
Social Worker
Clinical Diabetes Educator
LPN
Educational Introduction
Rotation
Concluding Summary

8. Study Design Participants Mixed Methods 24 (17 female and 7 male)
12 –African American, 12-non-Hispanic white adults
Average age 56
16% un-insured, 44% insured, and 40% Medicaid/Medicare
Mixed Methods
Quantitative Analysis
PHQ-9
Diabetes Lifestyle Survey
Full Circle Diabetes Program
A1C and other biometric screenings analyzed
Qualitative Analysis
4 Focus Groups
15 participants
Semi-structured interview
Six open-ended questions investigating participant’s perceptions of SMA’s

9. Quantitative Findings

10. Quantitative Findings

11. Quantitative Findings Group Retention

12. Patient Perception & Satisfaction
Themes Found:
Prior barriers
“In my case, I just didn’t want to deal with it.”
Reduced barriers
“I can come in here every three months, I know I need to keep my blood sugars at such and such a level for three months and I'll check and say, ‘oh good, I made it’. Ok, so I do the same thing for the next three months. That helps—baby steps.”
Improved adherence to treatment regimens
“I think that I'm realizing that I need to get a better balance of myself because I might do good with diet but not check my sugars, or take my insulin but not exercise. So, balancing myself...”
Increased self-care
“I’ve learned to say ‘no’, and set boundaries.”

13. Patient Perception & Satisfaction
Themes Found:
Increased psychosocial wellbeing
“I think a theme that we all find with each SMA group is that when you are staying on top of what you want to do, you’re feeling confident, and you’re feeling good”.
Supported through team approach
“I like that team approach where you can just sit down and don’t have to make four or five different appointments. I think that’s the most beneficial, but it all helps”.
Sustained learned behaviors
“I know for myself I think I need it[SMA’s]because that's the support we have, in our group, not necessarily at home, but in our group”.
“I think I could do it. It's still helpful to have it around, but if you cancelled them I’d be fine”.
Valued Experience
“When you get in a group like this and everybody starts talking about things that have happened to them, it makes it different….Not that we don’t appreciate the doctors and nurses, we do. They are what keeps us alive. But, it just hits and registers better. It supports everything they're telling you, but in a different way”.

14. Participating Providers
Design Your Own SMA!
Process
Health Care Concern
Participating Providers
Outcome Measures

15. Conclusions
The interprofessional SMA model provides patients a new way to engage and empower themselves to take an active role in managing their diabetes.
Enthusiasm for our model was found with group retention at 86%. Significantly improved diabetes control was also shown with hemoglobin A1c reduction from % to 7.9%.
Qualitative analyses showed that patients felt the SMA model increased accountability, minimized barriers to care, and encouraged empowerment through the group dynamics and shared experience.

16. Ruth Nutting, MA, LCMFT
Coordinator of Behavioral Health
Teaching Associate
The University of Kansas School of Medicine at
Via Christi Family Medicine Residency
Kristen Cook, Pharm D, BCPS
Assistant Professor Pharmacy Practice
PCMH Clinical Pharmacist
University of Nebraska Medical Center
Nebraska Medicine

17. Session Evaluation
Please complete and return the evaluation form before leaving this session. Thank you!
This should be the last slide of your presentation
Collaborative Family Healthcare Association 12th Annual Conference