Games as a Unique Teaching Strategy Used in Diabetes Shared Medical Appointments

Shared Medical Appointments SMAs are clinical encounters in which a population of patients receives diabetes care in a group setting. SMAs differ from diabetes education or support groups because in addition to patient education, counseling, and clinical support, there is also a medical component that may include a physical exam, medication adjustment, or other medical interventions.2 Because of this, SMAs must involve an advance practice provider or physician and include an interprofessional team approach.3 The theory behind group models such as SMAs is the ability to combine a patient’s own efficacy in managing medical issues as a part of their own health care team with the patient’s own support community.4 Studies looking at the effectiveness of SMAs on clinical outcomes in diabetes management have been inconsistent due to the variability in SMA interventions in diabetes management such as clinical and educational strategies.3,5 Despite this, there is research that has shown that SMAs in diabetes management improve health outcomes (eg, A1C, blood pressure), improve health-related quality of life, improve self-management activities (eg, home blood glucose monitoring, medication adherence, diabetes knowledge, self-efficacy), and improve patient satisfaction.4 SMAs are guided by the theory of adult learning. Adults learn by sharing lived experiences. A group setting can enhance the effects of diabetes self-management as it allows the opportunity for patients to come together for support to cope with the physical, social, and psychological effects of diabetes.4 SMAs allow patients to learn and interact with their peers and the health care team as a group.6 Here we describe one such program. DISH: Diabetes Information and Support for Your Health In 2009, the Department of Family and Community Medicine at Thomas Jefferson University in Philadelphia began the diabetes SMA program Diabetes Information and Support for your Health, also known as DISH. The family medicine practice is a Level 3 Patient-Centered Medical Home that is a large, academic, urban-based practice site with approximately 35 000 patients. SMAs are comprised of an interprofessional team including attending and resident physicians, a nurse practitioner, a clinical psychologist, clinical pharmacists, diabetes educators, medical assistants, and health professional students (medical, pharmacy, public health, and nursing). The program is a working collaboration between the health care team and participating patients to help empower them to manage their diabetes. DISH sessions are attended by people with diabetes who are newly diagnosed or have never attended a diabetes management class, those struggling with diabetes management, those diagnosed with prediabetes, those who want diabetes information and support, and family and friends of participants wanting to learn more to support the individual. Components of DISH include: