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Shared medical appointments for patients with diabetes mellitus: a systematic review.

Publication ,  Journal Article
Edelman, D; Gierisch, JM; McDuffie, JR; Oddone, E; Williams, JW
Published in: J Gen Intern Med
January 2015

OBJECTIVES: Shared medical appointments (SMAs) are an increasingly used system-redesign strategy for improving access to and quality of chronic illness care. We conducted a systematic review of the existing literature on SMA interventions for patients with diabetes in order to understand their impact on outcomes. DATA SOURCES: MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science from January 1996 through April 2012. PubMed search updated June 2013. STUDY SELECTION: English-language peer-reviewed publications of randomized controlled trials (RCTs), nonrandomized cluster controlled trials, controlled before-and-after studies, or interrupted time-series designs conducted among adult patients with diabetes. Two independent reviewers used prespecified criteria to screen titles and abstracts for full text review. STUDY APPRAISAL AND SYNTHESIS METHODS: Two different reviewers abstracted data and rated study quality and strength of evidence. When possible, we used random-effects models to synthesize the effects quantitatively, reporting by a weighted difference of the means when the same scale was used across studies, and a standardized mean difference when the scales differed. We measured heterogeneity in study effects using Forest Plots, Cochran's Q, and I(2), and explored heterogeneity by using subgroup analyses for categorical variables and meta-regression analyses for continuous or discrete variables. Outcomes not suitable to meta-analysis were summarized qualitatively. RESULTS: Twenty-five articles representing 17 unique studies compared SMA interventions with usual care. Among patients with diabetes, SMAs improved hemoglobin A1c (∆ = -0.55 percentage points [95 % CI, -0.11 to -0.99]); improved systolic blood pressure (∆ = -5.2 mmHg [95 % CI, -3.0 to -7.4]); and did not improve LDL cholesterol (∆ = -6.6 mg/dl [95 % CI, 2.8 to -16.1]). Nonbiophysical outcomes, including economic outcomes, were reported too infrequently to meta-analyze, or to draw conclusions from. The A1c result had significant heterogeneity among studies, likely secondary to the heterogeneity among included SMA interventions. LIMITATION: Heterogeneity among the components of diabetes SMAs leads to uncertainty about what makes a particular SMA successful. CONCLUSION: SMA interventions improve biophysical outcomes among patients with diabetes. There was inadequate literature to determine SMA effects on patient experience, utilization, and costs.

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Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

January 2015

Volume

30

Issue

1

Start / End Page

99 / 106

Location

United States

Related Subject Headings

  • Primary Health Care
  • Patient Satisfaction
  • Outcome Assessment, Health Care
  • Organizational Innovation
  • Humans
  • Health Care Costs
  • Glycated Hemoglobin
  • General & Internal Medicine
  • Diabetes Mellitus
  • Blood Pressure
 

Citation

APA
Chicago
ICMJE
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Edelman, D., Gierisch, J. M., McDuffie, J. R., Oddone, E., & Williams, J. W. (2015). Shared medical appointments for patients with diabetes mellitus: a systematic review. J Gen Intern Med, 30(1), 99–106. https://doi.org/10.1007/s11606-014-2978-7
Edelman, David, Jennifer M. Gierisch, Jennifer R. McDuffie, Eugene Oddone, and John W. Williams. “Shared medical appointments for patients with diabetes mellitus: a systematic review.J Gen Intern Med 30, no. 1 (January 2015): 99–106. https://doi.org/10.1007/s11606-014-2978-7.
Edelman D, Gierisch JM, McDuffie JR, Oddone E, Williams JW. Shared medical appointments for patients with diabetes mellitus: a systematic review. J Gen Intern Med. 2015 Jan;30(1):99–106.
Edelman, David, et al. “Shared medical appointments for patients with diabetes mellitus: a systematic review.J Gen Intern Med, vol. 30, no. 1, Jan. 2015, pp. 99–106. Pubmed, doi:10.1007/s11606-014-2978-7.
Edelman D, Gierisch JM, McDuffie JR, Oddone E, Williams JW. Shared medical appointments for patients with diabetes mellitus: a systematic review. J Gen Intern Med. 2015 Jan;30(1):99–106.
Journal cover image

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

January 2015

Volume

30

Issue

1

Start / End Page

99 / 106

Location

United States

Related Subject Headings

  • Primary Health Care
  • Patient Satisfaction
  • Outcome Assessment, Health Care
  • Organizational Innovation
  • Humans
  • Health Care Costs
  • Glycated Hemoglobin
  • General & Internal Medicine
  • Diabetes Mellitus
  • Blood Pressure