Shared medical appointments for Innu patients with well-controlled diabetes in a Northern First Nation Community.

INTRODUCTION: The prevalence of diabetes and its complications in the Innu community of Sheshatshiu is high. We wanted to determine if shared medical appointments (SMAs) could provide culturally appropriate, effective treatment to Innu patients with relatively well-controlled diabetes, as an alternative to standard, 'one-on-one' care. METHODS: We conducted a mixed-method study including a randomised controlled trial comparing standard care versus SMAs for patients aged 18-65 years with haemoglobin A1C (HbA1C) of ≤7.5%, followed by a qualitative study using semi-structured interviews with patients who attended SMAs. RESULTS: Among 23 patients, 13 received the intervention. There were no significant differences of HbA1C level or HbA1C percentage of change between intervention and control groups at baseline, 6 months or 12 months. There were no statistical differences between standard care and SMA groups, concerning mortality or the need for haemodialysis. The qualitative analysis found that patients generally enjoyed the SMA model and the peer support and learning benefits of the SMAs. Patients did not believe that the SMA model was more or less culturally appropriate than standard care, but the majority said they felt that the SMAs were good for the community and could be a good venue for incorporating Innu healthy-lifestyle knowledge into medical diabetes care. CONCLUSIONS: SMAs may be an efficient way to manage well-controlled diabetic patients in the Innu community of Sheshatshiu and to provide peer support and opportunities for learning and incorporating community-specific knowledge into care.

Résumé Introduction: La prévalence du diabète et de ses complications est élevée dans la communauté innu de Sheshatshiu. Nous voulions déterminer si, plutôt que la norme de soins personnalisés, les rendez-vous médicaux partagés pourraient dispenser un traitement efficace et culturellement approprié aux patients innu dont le diabète est relativement bien maîtrisé. Méthodologie: Nous avons réalisé une étude à méthodologies mixtes, soit une étude avec répartition aléatoire et contrôlée pour comparer la norme de soins aux rendez-vous médicaux partagés auprès de patients de 18 à 65 ans dont le taux d'HbA1C était inférieur ou égal à 7,5 %, suivie d'une étude qualitative ayant eu recours à des entrevues semi-structurées auprès de patients s'étant présentés à des rendez-vous médicaux partagés. Résultats: Treize patients sur 23 ont reçu l'intervention. On n'a observé aucune différence significative du taux d'HbA1C ou du pourcentage de variation du taux d'HbA1C entre les groupes intervention et témoin, au départ, et à 6 ou 12 mois. On n'a observé aucune différence statistique entre les groupes norme de soins et rendez-vous médicaux partagés en ce qui concerne la mortalité ou le besoin d'hémodialyse. L'analyse qualitative a indiqué qu'en général, les patients appréciaient le modèle des rendez-vous médicaux partagés ainsi que le soutien par les pairs et l'apprentissage qu'ils en tiraient. Les patients ne croyaient pas que le modèle des rendez-vous médicaux partagés était plus ni moins approprié que la norme de soins sur le plan culturel, mais la majorité était d'avis que les rendez-vous médicaux partagés étaient favorables pour la communauté, et seraient l'occasion d'incorporer les connaissances sur le mode de vie sain innu dans les soins médicaux du diabète. Conclusions: Les rendez-vous médicaux partagés seraient une façon efficace de prendre en charge les patients dont le diabète est maîtrisé de la communauté innu de Sheshatshiu, et de fournir un soutien par les pairs, et l'occasion d'apprendre et d'incorporer dans les soins les connaissances sur la communauté. Mots-clés: Soins du diabète, rendez-vous médicaux partagés, communauté des Premières Nations, santé autochtone.

Adapting Diabetes Shared Medical Appointments to Fit Context for Practice-Based Research (PBR).

INTRODUCTION: Complex behavioral interventions such as diabetes shared medical appointments (SMAs) should be tested in pragmatic trials. Partnerships between dissemination and implementation scientists and practice-based research networks can support adaptation and implementation to ensure such interventions fit the context. This article describes adaptations to and implementation of the Targeted Training in Illness Management (TTIM) intervention to fit the primary care diabetes context. METHODS: The Invested in Diabetes pragmatic trial engaged 22 practice-based research network practices to compare 2 models of diabetes SMAs, based on TTIM. We used surveys, interviews, and observation to assess practice contextual factors, such as practice size, location, payer mix, change and work culture, motivation to participate, and clinical and administrative capacity. The enhanced Replicating Effective Programs framework was used to guide adaptations to TTIM and implementation in participating practices. RESULTS: Practices varied in size and patient demographics. All practices had integrated behavioral health, but limited health educators or prescribing providers. Adaptations to SMA delivery accommodated the need for flexibility in personnel and reduced scheduling burden. Adaptations to TTIM content were designed to fit general primary care diabetes and Spanish-speaking patients. CONCLUSION: Enhanced Replicating Effective Programs is a useful process framework for adaptation, implementation, and testing of diabetes SMAs in primary care. Adapting intervention content, delivery, and training to fit context can help ensure pragmatic trials have both internal and external validity. Attention to intervention fit to context can support continued practice engagement in research and sustainability of evidence-based interventions.

Implementing group visits for opioid use disorder: A case series.

Background: Group-based models of Office-Based Opioid Treatment with buprenorphine-naloxone (B/N) are increasingly being implemented in clinical practice to increase access to care and provide additional therapeutic benefits. While previous studies reported these Group-Based Opioid Treatment (GBOT) models are feasible for providers and acceptable to patients, there has been no literature to help providers with the more practical aspects of how to create and maintain GBOT in different outpatient settings. Case series: We present 4 cases of GBOT implementation across a large academic health care system, highlighting various potential approaches for providers who seek to implement GBOT and demonstrate "success" based on feasibility and sustainability of these models. For each case, we describe the pros and cons and detail the personnel and resources involved, patient mix and group format, workflow logistics, monitoring and management, and sustainability components. Discussion: The implementation details illustrate that there is no one-size-fits-all approach, although feasibility is commonly supported by a team-based, patient-centered medical home. This approach includes the capacity for referral to higher levels of mental health and addiction support services and is bolstered by ongoing provider communication and shared resources across the health system. Future research identifying the core and malleable components to implementation, their evidence base, and how they might be influenced by site-specific resources, culture, and other contextual factors can help providers better understand how to implement a GBOT model in their unique clinical environment.

Programmed shared medical appointments for weight management in primary care: An exploratory study in translational research.

BACKGROUND AND OBJECTIVES: Programmed shared medical appointments (pSMAs) are an extension of shared medical appointments (SMAs) for managing chronic diseases. Acceptance and outcomes of a trial for weight management are reported here. METHOD: Six programmed sessions in weight management were carried out in seven NSW primary healthcare centres. RESULTS: Seventy-seven per cent of 216 participants (64 male, 102 female) completed at least four of six pSMAs over 16-18 weeks ('adherers'). Eighty-five per cent of adherers approved of pSMAs, and 73% said they would prefer these over a standard clinical consult. Providers also rated the process highly. Overall mean weight loss over 12 months was 3.2% (95% confidence interval [CI]: 2.2, 4.3; P <0.001). For adherers, mean weight loss was 4.3% for males (95% CI: 2.6, 6.1; P <0.001) and 4.2% for females (95% CI: 2.7, 5.7; P <0.001), with 46% of males and 35% of females maintaining clinically significant losses (>5%) after 12 months. pSMAs were calculated to be four times more cost effective and up to seven times more time effective than 1:1 consultations for weight loss. DISCUSSION: pSMAs are a popular, cost and time-effective adjunct to standard clinical management.

Establishing a Group Educational Session for Hyperacusis Patients.

Purpose Audiologists should be treating hyperacusis patients. However, it can be difficult to know where to begin because treatment protocols and evidence-based treatment studies are lacking. A good place to start in any tinnitus and hyperacusis clinic is to incorporate a group educational session. Method Here, we outline our approach to establishing a hyperacusis group educational session that includes specific aspects of getting to know each patient to best meet their needs, understanding the problems associated with hyperacusis, explaining the auditory system and the relationship of hyperacusis to hearing loss and tinnitus, describing the influence of hyperacusis on daily life, and introducing treatment options. Subjective responses from 11 adults with hyperacusis, who participated in a recent clinical group education session, were discussed to illustrate examples from actual patients. Conclusions Due to the devastating nature of hyperacusis, patients need to be reassured that they are not alone and that they can rely on audiologists to provide support and guidance. A group approach can facilitate the therapeutic process by connecting patients with others who are also affected by hyperacusis, and by educating patients and significant others on hyperacusis and its treatment options. Supplemental Material https://doi.org/10.23641/asha.8121197.

Successful Implementation of a Shared Medical Appointment Model for Hepatitis C Treatment at a Community Health Center.

Highly efficacious direct acting antiviral (DAA) therapy for treatment of Hepatitis C Virus (HCV) infection is largely inaccessible to communities facing a shortage of available specialist providers. Though less demanding than previous interferon regimens, DAA therapy requires patients to adhere to 8-12 weeks of daily treatment, which can be challenging for some patient populations. Duffy Health Center, located on Cape Cod, Massachusetts, provides integrated medical, mental health and case management services to people who are homeless or at risk for homelessness. The goal of this manuscript is to evaluate the outcomes of treatment of HCV infection with a shared medical appointment (SMA) model. The primary outcome was sustained virologic response (SVR-12), or HCV RNA ≤ 15 IU/mL at 12 weeks post-treatment. There were 102 patients recruited, with a total of 104 treatments administered. Over three-fourths of patients who attended one SMA visit (78 of 102) continued in SMA for the duration of treatment. Of these patients opting for SMA, 99% (77 of 78) completed the full treatment course, and 91% (71 of 78) of SMA patients achieved SVR-12. DAA therapy provided by non-specialist providers using the SMA model yielded comparable response rates to those achieved by specialist providers, and has the potential to substantially increase access to HCV treatment for patient populations within high-risk communities.