The most significant effect observed is with the change from baseline results .
Some evidence suggests post-intervention and change from baseline systolic blood pressure improvement at the nine to twelve month interval and change from baseline improvement at the 4 year timeframe .
There is no evidence that group visits improve LDL cholesterol values of the group visit participants .
IMPLICATION S FOR PRACTICE The evidence suggests that the most powerful model of Group medical visits ( GMV ) is when a clinician prescriber is present during or immediately after GMV sessions for medication reconciliation or individual patient needs .
BACKGROUND The prevalence of diabetes mellitus is ubiquitous .
Complications and costs of diabetes are rising and are depleting limited re sources .
It is imperative for healthcare professionals and patients alike to confront this chronic condition by exploring new interventions .
An innovative health care delivery model has emerged in the last 25 years in the form of the group medical visit .
Group medical visits can range from of six to twenty patients scheduled together with time allotted for individual care as well as in the group setting .
Shared medical appointments based on the chronic care model: a quality improvement project to address the challenges of patients with diabetes with high cardiovascular risk
Objective : The epidemic proportions and management complexity of diabetes have prompted efforts to improve clinic throughput and efficiency . One method of system re design based on the chronic care model is the Shared Medical Appointment ( SMA ) in which groups of patients ( 8–20 ) are seen by a multi-disciplinary team in a 1–2 h appointment . Evaluation of the impact of SMAs on quality of care has been limited . The purpose of this quality improvement project was to improve intermediate outcome measures for diabetes ( A1c , SBP , LDL-cholesterol ) focusing on those patients at highest cardiovascular risk . Setting : Primary care clinic at a tertiary care academic medical center . Subjects : Patients with diabetes with one or more of the following : A1c > 9 % , SBP blood pressure > 160 mm Hg and LDL-c > 130 mg/dl were targeted for potential participation ; other patients were referred by their primary care providers . Patients participated in at least one  SMA from 4/05 to 9/05 . Study design : Quasi-experimental with concurrent , but non-r and omised controls ( patients who participated in SMAs from 5/06 through 8/06 ; a retrospective period of observation prior to their SMA participation was used ) . Intervention : SMA system re design Analytical methods : Paired and independent t tests , χ2 tests and Fisher Exact tests . Results : Each group had up to 8 patients . Patients participated in 1–7 visits . At the initial visit , 83.3 % had A1c levels > 9 % , 30.6 % had LDL-cholesterol levels > 130 mg/dl , and 34.1 % had SBP ⩾160 mm Hg . Levels of A1c , LDL-c and SBP all fell significantly postintervention with a mean ( 95 % CI ) decrease of A1c 1.4 ( 0.8 , 2.1 ) ( p<0.001 ) , LDL-c 14.8 ( 2.3 , 27.4 ) ( p = 0.022 ) and SBP 16.0 ( 9.7 , 22.3 ) ( p<0.001 ) . There were no significant differences at baseline between control and intervention groups in terms of age , baseline intermediate outcomes , or medication use . The reductions in A1c in % and SBP were greater in the intervention group relative to the control group : 1.44 vs –0.30 ( p = 0.002 ) for A1c and 14.83 vs 2.54 mm Hg ( p = 0.04 ) for SBP . LDL-c reduction was also greater in the intervention group , 16.0 vs 5.37 mg/dl , but the difference was not statistically significant ( p = 0.29 ) . Conclusions : We were able to initiate a programme of group visits in which participants achieved benefits in terms of cardiovascular risk reduction . Some barriers needed to be addressed , and the operations of SMAs evolved over time . Shared medical appointments for diabetes constitute a practical system re design that may help to improve quality of care
The most significant effect observed is with the change from baseline results .
Some evidence suggests post-intervention and change from baseline systolic blood pressure improvement at the nine to twelve month interval and change from baseline improvement at the 4 year timeframe .
There is no evidence that group visits improve LDL cholesterol values of the group visit participants .
IMPLICATION S FOR PRACTICE The evidence suggests that the most powerful model of Group medical visits ( GMV ) is when a clinician prescriber is present during or immediately after GMV sessions for medication reconciliation or individual patient needs .
BACKGROUND The prevalence of diabetes mellitus is ubiquitous .
Complications and costs of diabetes are rising and are depleting limited re sources .
It is imperative for healthcare professionals and patients alike to confront this chronic condition by exploring new interventions .
An innovative health care delivery model has emerged in the last 25 years in the form of the group medical visit .
Group medical visits can range from of six to twenty patients scheduled together with time allotted for individual care as well as in the group setting .