Re: Evaluation of an Ongoing Diabetes Group Medical Visit in a Family Medicine Practice


Correspondence

Re: Evaluation of an Ongoing Diabetes Group
Medical Visit in a Family Medicine Practice

To the Editor: We want to share our experience with a
similar patient demographic using diabetes shared med-
ical appointments (SMAs). The report, by Cunningham
et al.1, describes a series of four 2-hour sessions. One
hour is dedicated to a traditional one-on-one medical
appointment with additional time for goal setting, while
hour two is group diabetes self-management education.
These are two different components, not an SMA.

The traditional one-on-one medical visit does not
work for the care of chronic medical conditions, as
exemplified by the low number of people with diabetes
meeting goals for HbA1c, blood pressure, and lipids.
Our group has previously described a multidisciplinary
SMA model that incorporates medical care (directed
by an endocrinologist), patient support, and interactive
group education with improved access to care and
lower HbA1c levels.2 The value of an SMA lies in
patient education, empowerment, and engagement.
The tagline for every SMA should be, “What happens
in the group is good for everyone in the group.” Over
time, patients build relationships with staff and other
patients that would be challenging to develop in a
limited number of sessions.

We appreciate the work our colleagues across the
Delaware River have done to improve the care of patients
with diabetes. We would encourage them to continue
their work while changing the model to promote more
sharing of patient experiences.

We call for changes on a national level to develop
SMA best practices to aid in further evaluation of this
innovative care model, develop a national working
group to share SMA models and experiences across
disease states, and for medical associations to designate
time at national conferences to new models of care
delivery.

Valerie S. Ganetsky, PharmD, BCPS, Associate
Professor of Clinical Pharmacy, University of the

Sciences, Philadelphia College of Pharmacy, Research
Fellow, University of Pennsylvania Perelman School of

Medicine; Steven Kaufman, MD, Associate Professor
of Medicine, Cooper Medical School of Rowan

University., Medical Director, Urban Health Institute,
Division Head, Endocrinology and Metabolism

References
1. Cunningham, AT, Delgado, DJ, Jackson, JD et al. Evalua-

tion of an Ongoing Diabetes Group Medical Visit in a
Family Medicine Practice. J Am Board Fam Med. 2018;31:
279 – 85.

2. Ganetsky, V, Adams, R, Coolman, T, Brenner, J, Kaufman,
S. Specialty diabetes group medical visits improve access to
care and clinical outcomes at lower cost in an underserved

patient population. Diabetes 2016 Jun;65(Supplement 1):
2308-Pub;582.

doi: 10.3122/jabfm.2018.05.180113

The above letter was referred to the author of the article
in question, who offers the following reply.

Response: Re: Evaluation of an Ongoing
Diabetes Group Medical Visit in a Family
Medicine Practice

To the Editor: We thank Steven Kaufman, MD; and
Valerie S. Ganetsky, PharmD, BCPS and for their re-
sponse to our article1 evaluating a diabetes group medical
visit (GMV) and for sharing their experience implement-
ing a diabetes shared medical appointment (SMA). We
applaud their implementation of an ongoing diabetes
SMA.

As the authors illustrate, the terminology for these
types of group visits (GMV vs SMA) varies. However, the
terms are ultimately interchangeable; both refer to group
visits that incorporate medical care and group self-man-
agement education.2,3 While our program has a different
structure than that of Drs. Kaufman and Ganetsky, we do
want to clarify that our participants have opportunities to
interact and support 1 another during the diabetes self-
management education component of our GMV. In fact,
an earlier study of our diabetes GMV, consisting of
interviews with former participants, showed that a sub-
stantial proportion of participants found that the pro-
gram offered peer support and important opportunities
to learn about diabetes self-management from their
peers.4

In addition, we agree with the authors’ call for na-
tional best practices for group visits, a national working
group, and national conferences focused on group visits
and other care delivery innovations. While diabetes
group visits hold promise as a patient-centered approach
to chronic disease management, more research is needed
to identify the optimal group visit size, frequency, struc-
ture, and payment mechanisms5 that will make these
visits effective and sustainable in primary care practices.

Amy T. Cunningham, PhD, MPH
Department of Family and Community Medicine,

Thomas Jefferson University, Philadelphia, PA

To see this article online, please go to: http://jabfm.org/content/
31/5/828.full.

References
1. Cunningham AT, Delgado DJ, Jackson JD, et al. Evaluation

of an ongoing diabetes group medical visit in a family
medicine practice. The Journal of the American Board of
Family Medicine. 2018;31:279 – 81.

828 JABFM September–October 2018 Vol. 31 No. 5 http://www.jabfm.org

co
p
yrig

h
t.

 o
n

 5
 A

p
ril 2

0
2
1

 b
y g

u
e
st. P

ro
te

cte
d
 b

y
h
ttp

://w
w

w
.ja

b
fm

.o
rg

/
J A

m
 B

o
a

rd
 F

a
m

 M
e

d
: first p

u
b

lish
e

d
 a

s 1
0

.3
1

2
2

/ja
b

fm
.2

0
1
8
.0

5
.1

8
0
1
1
3
 o

n
 1

0
 S

e
p
te

m
b
e
r 2

0
1
8
. D

o
w

n
lo

a
d
e
d
 fro

m
 

http://jabfm.org/content/31/5/828.full
http://jabfm.org/content/31/5/828.full
http://www.jabfm.org/