Innovations in Interdisciplinary Diabetes Management: When Better Isn't Good Enough

Physical and psychological functioning in veterans with diabetes: Disease-related versus service-related effects.

“…VHA chronic care protocols, such as the SMA and PACT, may serve as delivery models for such approaches, not only for their holistic attention to psychological and self-care needs in addition to medical needs, but also for efficient service delivery. For example, the SMA protocol encompasses care provided by multidisciplinary teams of diabetes specialists, including nutritionists, nurses, and psychologists (Buckley et al, 2014). In addition to addressing behavioral issues, such as overcoming psychological barriers to change, the SMA protocol covers self-care strategies (e.g., on foot checks or portion sizes) to promote empowerment and prevent complications that could result in disease progression (e.g., foot ulceration that impedes walking exercise, leading to weight gain) or additional distress.…”

“…SMA services are provided in a group format that serves multiple patients (eight to 12 in the Phoenix VHA) while promoting peer support and feedback (Buckley et al, 2014; Kirsh et al, 2007). Supporting this peer-based approach, one meta-analysis of 47 group-delivered self-management education interventions found improvements in hemoglobin A1c, weight management, triglycerides, and diabetes knowledge compared with usual or individual care (Odgers-Jewell et al, 2017).…”

“…Second, the Veterans Health Administration (VHA) introduced several disease-management initiatives for chronic conditions, intended to improve veterans’ health using holistic, multidisciplinary approaches and peer support. Examples include the patient aligned care team (PACT), a medical home model (Velezmoro, 2018); the shared medical appointment (SMA) protocol, based on the Wagner chronic care model (Buckley et al, 2014; Kirsh et al, 2007); and the comprehensive, multicomponent VHA MOVE! weight management program (Chan & Raffa, 2017).…”

Association of Cardiovascular Disease and Military Veteran Status With Impairments in Physical and Psychological Functioning: Retrospective Cross-Sectional Analysis of US National Survey Data

“…15 Additionally, among those with diabetes, veterans had equivalent or slightly better functioning, defined using standard measures and diagnostic criteria, than did nonveterans. 15 The authors of that study noted that the multidisciplinary team-based care models used by the Veterans Health Administration (VHA) for diabetes and obesity, which include extensive peer-to-peer support and holistic care management, [22][23][24] might explain their findings. 15 Whether veterans with heart disease have similarly positive functional measures compared with their nonveteran counterparts is unknown.…”

Sustainability of Clinical Benefits Gained During a Multidisciplinary Diabetes Shared Medical Appointment After Patients Return to Usual Care

“…Patients enrolled were 18–75 years of age, with a diagnosis of type 2 diabetes, and an A1C >9% (75 mmol/mol) who were taking insulin and seen by the endocrinology clinic or a diabetes nurse educator at least once. A retrospective chart review of the HIDM clinic, which excluded patients who were followed by a non-VA endocrinology clinic, were enrolled in an alternative diabetes research study, or had inadequate records was performed; it confirmed statistically significant reductions in outcome measures (A1C, diastolic blood pressure, percentage of patients meeting blood pressure goals, and number of patients on aspirin therapy) after four visits (14). Although the HIDM clinic was beneficial in achieving clinical outcomes, the resources used (clinician involvement and time) were significant enough for the team to examine other models of care.…”