Purpose: The purpose of this study is to gain understanding on factors identified by primary care practice members as impacting sustainability of diabetes Shared Medical Appointments (SMAs) after participating in a pragmatic trial that included sustainability planning. SMAs provide diabetes self-management education and support (DSMES) in primary care, though sustainability can be challenging.
Methods: The Invested in Diabetes study was a pragmatic comparative effectiveness trial of 2 approaches to providing SMAs for adults with type 2 diabetes. Qualitative interviews at the study end explored primary care practices' experiences with SMAs and perspectives on sustainability, analyzed using a grounded theory hermeneutic editing approach.
Results: Seventy-nine interviews were conducted in 20 participating practices. One primary finding and 3 themes on factors necessary for sustainment emerged: finding: SMAs were seen as valuable, but sustainment plans were inconsistent; theme 1) Sustainability hinges on practical factors, some not supported in current health care payment models; theme 2) Relevance and efficiency are important: future diabetes SMAs anticipated adaptations or revisions; and theme 3) Improvement in reportable practice quality measures would be an incentive to continue SMAs.
Discussion: Diabetes SMAs were perceived as beneficial, but difficult to sustain. We found that primary care teams want to provide SMAs and that changes in how primary care practices are reimbursed could support implementation and sustainment of DSMES approaches such as SMAs, leading to improved patient outcomes.
Conclusion: There is urgent need for explicit attention to policy change, health care payment innovation, and novel reimbursement models to enhance sustainability of diabetes SMAs.
Keywords: Education of Patients; Grounded Theory; Hermeneutics; Practice-based Research; Pragmatic Trials; Self Care; Self Management; Shared Medical Appointments; Type 2 Diabetes.
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