Effectiveness of Prediabetes Nutrition Shared Medical Appointments

Cole, Renee E.; Boyer, K.; Spanbauer, S.M.; Sprague, D.; Bingham, Mona

doi:10.1177/0145721713484812

Cited by 23 publications

(82 citation statements)

References 30 publications

(45 reference statements)

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“…80% of eligible patients) this still means that alternative provision, by which we would typically mean an individual consultation plus some type of information provision, is still being required by one in every five patients. A recent trial found an enrolment percentage of only 31% 64 -and this was with the prospect of 50% of the patients receiving usual care. Alternatively, if group clinics are mandatory as the only type of provision, this would yield a significantly large proportion of patients who would be being treated either inappropriately (e.g.…”

Section: Acceptability and Sustainabilitymentioning

confidence: 96%

“…many-to-many interaction) was reported in 14 studies. 63,64,66,68,70,71,[73][74][75][76][77]82,85,86 Eleven studies explicitly reported health education/information presentation(s) by individual clinicians, 57,60,65,[66][67][68]70,71,[73][74][75]79 with one for health education/information presentation(s) by multiple clinicians 63 and two for health education/information via booklet, leaflet or video. 70,80 Seven studies reported medication review and four describe completion of prescriptions.…”

Section: Intervention Componentsmentioning

confidence: 99%

“…The quality of included RCTs was assessed using questions relevant for RCTs and from these responses a Cochrane risk of bias was determined for each study (Table 17). Of the 22 trials, nine studies (11 papers) [60][61][62][63][65][66][67][68][69][70]73 were categorised as having a low risk of bias, 10 studies (11 papers) were categorised as having a high risk of bias 20,[57][58][59]64,71,74,75,[79][80][81][82][83][84][85][86][87] and three studies (four papers) were categorised as unclear. 72,[76][77][78] The large number of studies with a high risk of bias means that any conclusions based on these trials should be treated with caution.…”

Section: Narrative Summary Of Study Qualitymentioning

confidence: 99%

“…20,31,57,59,64,71,74,75,79,80,82,85,86 One of the studies with a high risk of bias was a pilot study 57,58 with small sample sizes, no blinding, patient selection bias and short-term follow-up. Five of the studies with a high risk of bias 48,71,80,81,83 had patients with different baseline characteristics.…”

Section: Narrative Summary Of Study Qualitymentioning

confidence: 99%

“…By far the majority of the trials (11 out of 22 trials) studied a population with type 2 diabetes. 57,60,63,64,72,[74][75][76][77]80,83 A further four trials studied a mixed type 1 and type 2 diabetes population, 20 a type 1 diabetes-only population 70,85 and a population with type 2 diabetes and hypertension. 66,67,69 A further group of studies examined the effects of group clinics in populations with a variety of cardiac problems (heart disease/hypertension 71,73 and hypertension/heart failure 31 ).…”

Section: Study Analyses: Condition-specific Clinical Outcomesmentioning

confidence: 99%

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What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions? A systematic review

Cantrell

Preston

Chambers

et al. 2015

Health Serv Deliv Res

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BackgroundGroup clinics are a form of delivering specialist-led care in groups rather than in individual consultations.ObjectiveTo examine the evidence for the use of group clinics for patients with chronic health conditions.DesignA systematic review of evidence from randomised controlled trials (RCTs) supplemented by qualitative studies, cost studies and UK initiatives.Data sourcesWe searched MEDLINE, EMBASE, The Cochrane Library, Web of Science and Cumulative Index to Nursing and Allied Health Literature from 1999 to 2014. Systematic reviews and RCTs were eligible for inclusion. Additional searches were performed to identify qualitative studies, studies reporting costs and evidence specific to UK settings.Review methodsData were extracted for all included systematic reviews, RCTs and qualitative studies using a standardised form. Quality assessment was performed for systematic reviews, RCTs and qualitative studies. UK studies were included regardless of the quality or level of reporting. Tabulation of the extracted data informed a narrative synthesis. We did not attempt to synthesise quantitative data through formal meta-analysis. However, given the predominance of studies of group clinics for diabetes, using common biomedical outcomes, this subset was subject to quantitative analysis.ResultsThirteen systematic reviews and 22 RCT studies met the inclusion criteria. These were supplemented by 12 qualitative papers (10 studies), four surveys and eight papers examining costs. Thirteen papers reported on 12 UK initiatives. With 82 papers covering 69 different studies, this constituted the most comprehensive coverage of the evidence base to date. Disease-specific outcomes – the large majority of RCTs examined group clinic approaches to diabetes. Other conditions included hypertension/heart failure and neuromuscular conditions. The most commonly measured outcomes for diabetes were glycated haemoglobin A1c(HbA1c), blood pressure and cholesterol. Group clinic approaches improved HbA1cand improved systolic blood pressure but did not improve low-density lipoprotein cholesterol. A significant effect was found for disease-specific quality of life in a few studies. No other outcome measure showed a consistent effect in favour of group clinics. Recent RCTs largely confirm previous findings. Health services outcomes – the evidence on costs and feasibility was equivocal. No rigorous evaluation of group clinics has been conducted in a UK setting. A good-quality qualitative study from the UK highlighted factors such as the physical space and a flexible appointment system as being important to patients. The views and attitudes of those who dislike group clinic provision are poorly represented. Little attention has been directed at the needs of people from ethnic minorities. The review team identified significant weaknesses in the included research. Potential selection bias limits the generalisability of the results. Many patients who could potentially be included do not consent to the group approach. Attendance is often interpreted liberally.LimitationsThis telescoped review, conducted within half the time period of a conventional systematic review, sought breadth in covering feasibility, appropriateness and meaningfulness in addition to effectiveness and cost-effectiveness and utilised several rapid-review methods. It focused on the contribution of recently published evidence from RCTs to the existing evidence base. It did not reanalyse trials covered in previous reviews. Following rapid review methods, we did not perform independent double data extraction and quality assessment.ConclusionsAlthough there is consistent and promising evidence for an effect of group clinics for some biomedical measures, this effect does not extend across all outcomes. Much of the evidence was derived from the USA. It is important to engage with UK stakeholders to identify NHS considerations relating to the implementation of group clinic approaches.Future workThe review team identified three research priorities: (1) more UK-centred evaluations using rigorous research designs and economic models with robust components; (2) clearer delineation of individual components within different models of group clinic delivery; and (3) clarification of the circumstances under which group clinics present an appropriate alternative to an individual consultation.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Acceptability and Sustainabilitymentioning

confidence: 96%

Section: Intervention Componentsmentioning

confidence: 99%

Section: Narrative Summary Of Study Qualitymentioning

confidence: 99%

Section: Narrative Summary Of Study Qualitymentioning

confidence: 99%

Section: Study Analyses: Condition-specific Clinical Outcomesmentioning

confidence: 99%

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What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions? A systematic review

Cantrell

Preston

Chambers

et al. 2015

Health Serv Deliv Res

View full text Add to dashboard Cite

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Program for Reducing Obesity (PRO): An institutional review of an insurance‐based weight loss program utilizing shared medical appointments

Wei

Lei

Shieh

et al. 2021

Obesity Science & Practice

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Background: Based on CDC estimates in the United States, the prevalence of obesity was 42.4% in 2017-2018, and the annual cost of obesity was $147 billion in 2008. Yet studies estimate that only 20-40% of adults with obesity received counseling from their primary care providers. Recent studies using shared medical appointments (SMA), where patients are seen by a multidisciplinary team, have shown promising results in obesity management. We developed an insurance-based weight loss program incorporating SMA, called the Program for Reducing Obesity (PRO), and report our findings here. Methods: Enrollment began in January 2019 at the UCLA Health Thousand Oaks clinic. Patients age ≥18 years with BMI ≥30 kg/m 2 were eligible by referral to PRO, a program consisting of individual visits and SMAs with an obesity medicine board certified endocrinologist and registered dietitian. Primary outcomes were change in weight after 3, 6, and 12 months. Secondary outcomes included proportion that achieved ≥5% weight loss, change in percent body fat, HbA1c, HDL, triglycerides, and blood pressure.Results: 102 patients (mean age 59.7 years, 72% women, mean weight 103.6 kg, mean BMI 36.6 kg/m 2 ) have been analyzed, with 91 patients completing at least 12 months of the program. Patients achieved significant weight loss: 3.0%, 5.0%, and 7.8% of their baseline weight after 3, 6, and 12 months respectively. 52% of patients lost ≥5% of their baseline weight after 12 months. Patients had significant reductions in body fat: 2.1%, 7.4%, and 6.7% of their baseline (all p ≤ 0.01) after 3, 6, and 12 months respectively. Improvements were also seen in HbA1c (p ≤ 0.01), triglycerides (p ≤ 0.04), and systolic blood pressure (p ≤ 0.07) after 12 months although not all results achieved statistical significance. Conclusion:Our institutional review of PRO, an insurance-based obesity program utilizing SMA, demonstrates a successful approach to promoting weight loss in a community-based setting.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Group medical consultations in the follow-up of breast cancer: a randomized feasibility study

et al. 2015

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Effectiveness of Prediabetes Nutrition Shared Medical Appointments

Cited by 23 publications

References 30 publications

What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions? A systematic review

What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions? A systematic review

Program for Reducing Obesity (PRO): An institutional review of an insurance‐based weight loss program utilizing shared medical appointments

Group medical consultations in the follow-up of breast cancer: a randomized feasibility study

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