April 2019

In This Issue: Improving Care for Veterans with Diabetes
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Peer Support to Enhance Diabetes Shared Medical Appointments

Feature Article

Efficacy trials have found that Shared Medical Appointments (SMAs) group sessions in the VA healthcare system increase access to care and improve patients’ self-management, clinical, and Veteran-centered outcomes during and immediately after completion. Less is known about the effectiveness of SMAs as implemented on a large scale in different VA health systems – or about the extent to which gains achieved through SMAs are maintained over time and, if not, what additional scalable approaches can best maintain improvements. One potentially scalable approach is telephone-based peer support in which fellow Veterans provide support to each other. Because peers share similar characteristics, this approach is intrinsically culturally sensitive. Moreover, because most contacts are over the telephone, it is accessible to vulnerable patients who face obstacles to accessing clinic-based care.

This ongoing HSR&D study (2016-2020) will evaluate the implementation of diabetes SMAs in five VA health systems, with some patient cohorts also being offered a program found in a recent VA randomized, controlled trial to significantly improve VA patients' diabetes-specific social support, insulin starts, and glycemic control compared to usual nurse care management. The program uses periodic group sessions in conjunction with calls between paired patients with diabetes to promote more effective care management as well as peer-to-peer (P2P) communication among diabetes patients who both have poor glycemic control and are working on similar care goals. Participants are matched with another Veteran of similar age and facing similar self-management challenges. "Peer buddies" are encouraged to talk by phone at least weekly to provide mutual support and share their progress on meeting self-management goals.

Findings: No findings to report at this time.

Impact: This study will provide important information on the comparative effectiveness and barriers faced when shared medical appointments and peer-to-peer strategies are implemented as part of existing clinical processes.

Principal Investigator: M.E. Michele Heisler, MD, MPA is part of HSR&D’s Center for Clinical Management Research (CCMR) in Ann Arbor, MI.

View project abstract.