[Editor’s note: this video from author Dan Heath, a Senior Fellow at Duke University’s CASE center, is similar in subject matter and essence, so we’ve added it here for your viewing pleasure! -Tom Peterson]
By Les Gura
For three years in two rural areas of North Carolina—where educating people about chronic illness can be just as crucial as treating it—a novel program has brought diabetes patients together in one setting to learn about nutrition, medication management and mental health at the same time.
The Shared Medical Appointments monthly group support program is being offered by Wake Forest Baptist Health to diabetes patients in North Wilkesboro and in Mount Airy.
After her clinical residency with the U.S. Veterans Administration, Candace Dixon, a Clinical Pharmacist Practitioner for Wake Forest Baptist, began the program in North Wilkesboro. Currently, two monthly support groups are held at her primary practice site, Internal Medicine – Wilkes.
“It’s really about emotional support,” Dixon said. “I know what diabetics should do, but I don’t have diabetes. I don’t know how it feels to have the physical pain of checking blood sugars every day and monitoring carbohydrate intake. But everybody around that table knows. It’s much more powerful to hear someone who has had success.”
In addition to learning about medications and nutrition, the psychological aspect of coping with a chronic disease is an important part of the program. In a group session held before the holiday season, Dixon said, the focus was on coping with the high emotions frequently experienced at that time of year that often lead to poor eating habits.
Chad Brown, president of Wilkes Medical Center and Davie Medical Center for Wake Forest Baptist, said the Shared Medical Appointments program speaks to an important goal.
“I think it’s one of those turning points in population health because this is about what we can do outside the four walls of the traditional hospital from a wellness perspective,” he said. “It aligns perfectly within that framework and it’s exciting to see that.”
The program has had notable results in its first two years.
At the end of fiscal year 2018, the first year of the program, 72 percent of patients achieved an A1C (a common blood test used to diagnose and monitor type 1 and type 2 diabetes) goal of less than 8 percent. Of those, 27 percent had an A1C less than 7 percent. This was a notable improvement from 33 percent and 13 percent at baseline. In addition, blood pressure and cholesterol levels improved by 18 percent and 36 percent, respectively. Hospitalizations were reduced by 62 percent and primary care physician visits for complications of diabetes were reduced by 100 percent.
At the end of fiscal year 2019, 50 percent of patients achieved an A1C goal of less than 8 percent, and 23 percent reached an A1C less than 7 percent. Similarly, blood pressure and cholesterol levels improved by 38 percent and 42 percent, respectively. Finally, hospitalizations in the second year of the program were reduced by 60 percent and primary care visits for diabetes related complications were reduced by 55 percent.
But people in the Shared Medical Appointments program hardly need numbers to know that the group support is working.
At a recent monthly meeting, several diabetes patients gathered for more than an hour after their blood sugar, blood pressure and other vitals were taken. In an informal setting around a conference table, they munched on cheese cubes and crackers provided by the practice, shared successes and challenges they faced through recent weeks, and listened to each other’s thoughts. They did so with humor and compassion.
“I’ve had diabetes for 20 years,” one patient told the group. “I’m still learning about the foods and how they affect me. The thing I learned most recently is the important of water. I have a daughter, a runner, who gets on us all the time about drinking water and exercising.”
After another patient noted that he sometimes has a slip and goes off his intent to have no more than 60 grams of carbohydrates for meal, he is quickly consoled by fellow patients and the support team from Wake Forest Baptist, which is comprised of a nutritionist, a pharmacist and a clinical mental health counselor.
“We don’t ever say you can’t have something,” Genelle Hix, a registered dietitian and certified diabetes educator, told the patient. “It’s all about moderation. That’s the key word. You can eat basically anything, but it’s watching those serving sizes.”
At one point, Robert Willis, a licensed marital and family therapist with CareNet Counseling who moderated the session, led the patients in a discussion about the hardest foods they have had to give up. Patients identified potatoes, cake, sweets and more.
“It’s important to recognize that some foods operate in our bodies kind of like an addiction,” he said. “One mindful thing you can do is focus on chewing; the other thing you can do to slow yourself is to put your fork down between bites.”
Alex Fleury, a pharmacist who attended the session, suggested that changing a habit doesn’t take as long as might be imagined. He asked the patients to consider that if they changed their habits for four weeks, the body gets used to a new routine.
Afterward, the patients shared why they enjoy coming to the group sessions.
“It helps us see what other people do for their medications and diabetes,” one said. “It gives us a lot of insight in what we aren’t doing and what we need to do.”
“We’ve got all kinds of people in here to talk about medications and other issues,” another patient said. “If we were just seeing one doctor every six months, we wouldn’t get all this information. I think it’s a great thing.”