Sustaining Diabetes Shared Medical Appointments After a Pragmatic Trial

Area of Science:

• Primary Care
• Health Services Research
• Diabetes Management

Background:

• Diabetes Shared Medical Appointments (SMAs) offer diabetes self-management education and support (DSMES) in primary care settings.
• Sustaining SMAs after initial implementation presents significant challenges for primary care practices.

Purpose of the Study:

• To understand factors influencing the sustainability of diabetes SMAs from the perspective of primary care practice members.
• To identify barriers and facilitators for long-term implementation of SMAs following a pragmatic trial.

Main Methods:

• A qualitative study involving 79 interviews with members of 20 primary care practices that participated in the Invested in Diabetes pragmatic trial.
• Analysis employed a grounded theory hermeneutic editing approach to explore experiences and perspectives on SMA sustainability.

Main Results:

• SMAs were perceived as valuable, yet sustainability plans were inconsistent across practices.
• Key themes for sustainability included practical operational factors (some unsupported by current payment models), the need for relevance and efficiency, and the incentive of improved quality measures.

Conclusions:

• Primary care teams are motivated to provide diabetes SMAs, but sustainability is hindered by current healthcare reimbursement structures.
• Policy changes, healthcare payment innovation, and novel reimbursement models are crucial for enhancing the sustainability of SMAs and improving patient outcomes.