The following is a summary of “Delivering diabetes shared medical appointments in primary care: early and mid-program adaptations and implications for successful implementation,” published in the February 2023 issue of Primary Care by Nederveld, et al.
Patients with type 2 diabetes often benefit from self-management education since it teaches them how to take responsibility for their condition. However, some primary care settings may find it challenging to adopt shared medical appointments (SMAs), which have been shown to boost patients’ confidence in their ability to take charge of their care. To help other practices interested in integrating SMAs, it may be useful to understand how practices modify processes and delivery of SMAs for patients with type 2 diabetes. The Invested in Diabetes study aimed to assess 2 primary care delivery approaches for diabetes SMAs by conducting a pragmatic cluster-randomized comparative efficacy trial. Researchers used the FRAME as a framework for a multi-method analysis of the practices’ implementation history, considering deliberate and accidental changes. Interviews, field notes, and recordings of check-ins with practice facilitators were all used to compile the data.
The results revealed multiple conclusions: While most modifications and adaptations were fidelity-consistent, supporting the core components of the intervention conditions as designed, some were not; Adaptations were viewed as necessary to help SMAs meet patient and practice needs and overcome implementation challenges and content changes in the sessions were often planned and enacted to address the contextual circumstances such as patient better needs. The Invested in Diabetes study found that many SMAs for patients with type 2 diabetes had some form of modification to their implementation method, content, or delivery.
Identifying the need for practice-based adjustments before implementation may increase fit and success with SMAs; however, care must be taken to ensure that changes do not dilute the intervention’s efficacy. Practices can determine what changes will be necessary for their success before they’re put into place, but it’s more probable that they’ll evolve through time. In the Invested in Diabetes study, adjustments were prevalent. Learning about the obstacles other practices have had while implementing SMAs can help them adjust their implementation strategies.
Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-023-02006-8
