Abstract
BackgroundDiabetes shared medical appointments (SMAs) and reciprocal peer support programs have been found in efficacy trials to help adults with diabetes improve their self-management and achieve short-term gains in clinical and patient-centered outcomes. In order to translate this evidence to system-level interventions, there is a need for large-scale, pragmatic trials that examine the effectiveness, implementation, and costs of SMAs and reciprocal peer support across diverse settings.MethodsThe Shared Health Appointments and Reciprocal Enhanced Support (SHARES) study is a multisite, cluster randomized trial that is evaluating the effectiveness and implementation of SMAs with and without an additional reciprocal Peer-to-Peer (P2P) support program, when compared to usual care. The P2P program comprises periodic peer support group sessions and telephone contact between SMA participant pairs to promote more effective diabetes self-management. We will examine outcomes across three different treatment groups: (1) SMAs, (2) SMAs plus P2P, and (3) usual care. We will collect and analyze data over a 2.5-year implementation period at five geographically diverse Veterans Affairs (VA) health systems. The primary outcome is the relative change in hemoglobin A1c over time. Secondary outcomes are changes in systolic blood pressure, antihypertensive medication use, statin use, and insulin initiation over the study period. The unit of analysis is the individual, adjusted by the individual’s SMA group (the cluster). We will use mixed methods to rigorously evaluate processes and costs of implementing these programs in each of the clinic settings.DiscussionWe hypothesize that patients will experience improved outcomes immediately following participation in SMAs and that augmenting SMAs with reciprocal peer support will help to maintain these gains over time. The results of this study will be among the first to examine the effects of diabetes SMAs alone and in conjunction with P2P in a range of real-life clinical settings. In addition, the study will provide important information on contextual factors associated with successful program implementation.Trial registrationClinicalTrials.gov, ID: NCT02132676. Registered on 21 August 2013.
Highlights
Diabetes shared medical appointments (SMAs) and reciprocal peer support programs have been found in efficacy trials to help adults with diabetes improve their self-management and achieve short-term gains in clinical and patient-centered outcomes
Several recent meta-analyses of randomized controlled trials (RCTs) of diabetes Shared medical appointment (SMA) have found that SMAs are more effective than usual care in improving hemoglobin A1c levels and systolic blood pressure (SBP) [5,6,7]
Rationale for undergoing the trial For diabetic patients, effective diabetes SM is a key determinant of diabetes outcomes
Summary
Diabetes shared medical appointments (SMAs) and reciprocal peer support programs have been found in efficacy trials to help adults with diabetes improve their self-management and achieve short-term gains in clinical and patient-centered outcomes. Most studies of SMAs to date have examined outcomes during, and immediately after, participation in SMAs. There is growing evidence that many patients do not succeed in maintaining SM and clinical improvements achieved through short-term programs [8,9,10,11]. Maintaining achieved gains may be especially difficult for patients who lack sustained social support Both receiving and providing social support is associated with improved SM and clinical outcomes [12,13,14,15]. With increasing resource and staff constraints, novel approaches are needed to help patients sustain SM improvements that do not rely exclusively on face-toface or professionally led programs
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