Effects of Shared Medical Appointments for Diabetic Patients in Taiwan
Condition: Diabetes Mellitus
Study type: Interventional

Summary: 
      This quasi-experimental study is done to investigate the effect of Shared Medical
      Appointments (SMA) program for the diabetic patients in Taiwan. The relevant corresponding
      effects were determined via the generalized estimating equation (GEE) model.
    

Detailed description: 
      Study design and participants A quasi-experimental pre-posttest control group design, with
      purposive sampling, was used to recruit participants from the Endocrinology department of a
      hospital in southern Taiwan from Jan to Dec in 2019. The inclusion criteria were (i) being at
      least 20 years old at the time of recruitment (ii) having no cognitive impairment and severe
      complications, (iii) being able to express opinions in either Mandarin or Taiwanese, and (iv)
      having a diagnosis of diabetes. To ensure participants' anonymity, all questionnaires were
      marked with an encryption code to facilitate data analysis, but with no personal identifiers.

      Sample size calculation Sample size calculation for this analysis of repeated measures to
      detect an effect size of 0.4 at 80% power and a 0.05 significance level indicated that a
      sample size of 56 patients is needed (according to G- POWER 3.1 analytical software, Franz
      Faul, Universitat Kiel, Germany). A sample of at least 68 participants for both groups
      combined was required on the basis of these parameters, allowing for a 20% attrition rate.

      Intervention Because continued participation was essential for this study, the participants
      were divided into the experiment or control group in accordance with the personal
      willingness. The control group received routine health education lasting for about 30 minutes
      per medical visit, which consisted of consultation about disease symptoms, related
      treatments, and self-care skills. They would receive health education instruction leaflets
      for reference purposes if necessary.

      The experiment group received four shared medical appointments (SMP) -based group education
      sessions (7-10 participants, 1.5 hours each) for four consecutive weeks in addition to
      routine health education at a private room in the outpatient unit. One registered nurse who
      received SMP facilitator training, from the Taiwanese Association of Diabetic Educators,
      served as the class facilitator. SMP sessions were conducted using several colored maps
      covering different topics, which included "healthy diet and exercises", "relevant treatment
      towards diabetic medications", " self-monitoring of blood glucose," and "treatment on
      hypoglycemia and hyperglycemia" . This procedure served to create mutual imagery to be shared
      with participants. In addition to using these colored maps, the facilitator further offered
      participants self-designed conversation cards and asked them to share individual glycemic
      control experiences based on the questions shown on the cards.

      Outcome measures The primary outcomes were composed of two self-development tools, namely
      diabetic self-management questionnaire (DSMQ) as well as diabetic self-care questionnaire
      (DSCQ).

      On the other hand, the consideration of covariates contained additional items addressing
      demographic and disease characteristics were developed based on clinical experience and
      literature review, and were collected at study entry via patient interviews and medical
      records. Demographic data included sex, age, marital status, education level, religion,
      household status, monthly income, and certain lifestyle factors, such as smoking, exercise
      habits, and presence of sleep disturbances. Smoking status was recorded as "non-smoker" or
      "current or ex-smoker." Those who exercised regularly (i.e., weekly) were classified as
      having "exercise habits." Sleep disturbances were defined as waking up at night more than
      twice without external factors during the week before the interview. Disease characteristics
      included the presence of chronic disease (i.e., stroke, hypertension, heart disease, renal
      disease, or cancer), medication regimen, and duration of diabetes.
    

Intervention name(s): Shared Medical Appointments
Intervention type(s): Other
Intervention description(s): SMA is a subset of such clinics and are defined by groups of patients meeting over time for comprehensive care for a defining chronic condition or health care state, which involved both a person trained or skilled in delivering patient education or facilitating patient interaction.
Other intervention name(s): Standard care
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Diabete Mellitus; Taiwan; effect