Shared Medical Visits for Spanish-speaking Patients With Type 2 Diabetes
Condition: Diabetes Mellitus Type 2
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 2
Study type: Interventional

Summary: 
      The investigators seek to apply a shared medical visit model and interdisciplinary approach
      to Spanish-speaking patients. The investigators will evaluate the patient's hemoglobin A1c as
      a marker of glycemic control and evaluate their mood with PHQ screening tools. The
      investigators seek to improve diabetes care for this group of underserved patients. Potential
      participants will be selected from the UNMC diabetes registry. Eligibility criteria includes
      adult patients over the age of eighteen years old with Type 2 diabetes, HgbA1c greater than
      8%, whose preferred language is Spanish. Exclusion criteria include pregnancy, residency at a
      nursing home or other facility, substance abuse, and physician recommendation that study is
      not appropriate for the patient.
    

Detailed description: 
      Type 2 diabetes is an expanding epidemic, which is particularly pervasive in the Hispanic
      community. In 2014, the CDC reported that 21.9 million adults have been diagnosed with
      diabetes, a number which has nearly quadrupled since 1980.

      Diabetes is a particularly challenging chronic disease due to the need for self-management.
      This research study plans to explore how shared medical visits with Spanish-speaking patients
      with diabetes can improve their control of diabetes, develop self-management behaviors, and
      enhance overall perspective of having a chronic disease.

      The investigators will model this project after an ongoing with English speakers and they
      have demonstrated improvements in hemoglobin A1c levels and quality of life, and will now
      apply this model to Spanish-speaking patients.

      Eligibility and exclusion criteria are detailed in the brief summary. Eligible participants
      will be recruited for the study through use of phone call in Spanish, letter writing in
      Spanish, word of mouth, and direct referral from their providers throughout UNMC. Once the
      list of potential subjects is compiled, those patients will be contacted and the details of
      the study will be explained in Spanish. All the participating staff in the study speak
      Spanish. The participants, at any time, can withdraw from the study.

      Participants will receive education in diabetes health and lifestyle education. This will be
      a quantitative study using pre- and post-intervention measures to evaluate the outcomes of
      HgbA1c levels, scores on the validated 2-item and 9-item Patient Health Questionnaires (PHQ-2
      and PHQ-9), and questionnaire which measures improvements in self-management behaviors.

      Researchers will to follow-up with the participants in the week following the visit to
      discuss lab results. At the end of the study, researcher will send a detailed letter to the
      patient's primary care provider regarding progress and management in shared medical visits.
    

Intervention name(s): Shared Medical Visit
Intervention type(s): Behavioral
Intervention description(s): The Shared Medical Visits are a replacement for standard diabetic visits with PCP, and will occur completely in Spanish, the patients' preferred primary language. An interdisciplinary group including behavioral health, social work, pharmacy, MD, and diabetic educator will be involved in the visit. The focal point of the meeting is a 30 minute session in which all members are seated around a large table in the Midtown SMV area and each patient's blood sugars, labs, and medications are discussed in front of the entire group. Pertinent labs and vaccines are drawn/administered.
Other intervention name(s): SMV
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Shared Medical Visits; Spanish-speaking