Shared medical appointments improve psychosocial outcomes in young diabetes
medwireNews: Shared medical appointments (SMA) may help adolescents with type 1 diabetes to reduce family conflict and improve their depressive symptoms, show data presented at the 79th ADA Scientific Sessions in San Francisco, California, USA.
The study included 86 middle school students (mean age 12 years, 51% female, 74% White) with a diabetes duration of at least 1 year who were randomly assigned to undergo treatment through the Team Clinic SMA model (n=44) or via usual care (n=42) for 1 year.
Jennifer Raymond, from Children’s Hospital Los Angeles in California, USA, explained that the model, which is provided by a multidisciplinary team, allows the patients to have time alone with their care provider, as well as interactions with other similar aged patients. Family members also attend a group session where they are given advice on problem-solving, support, and communication.
At baseline, adolescents in the Team Clinic and usual care groups had similar levels of both family conflict and depressive symptoms. After 1 year, Raymond and co-investigators found that Team Clinic participants attended significantly more visits than patients in usual care (115 vs 102) and were more likely to attend all four study visits (66 vs 33%), which is the number recommended to meet ADA Standards of Clinical Care.
These differences in clinic attendance corresponded to differences in psychosocial outcomes between the patients in Team Clinic and those receiving usual care, she said.
Specifically, patients in the Team Clinic group experienced a substantial decrease in family conflict, as measured by the Diabetes Family Conflict Scale (DFCS), during the course of the study whereas those in the control group reported an increase. This meant that at 1 year, the difference in DFCS between the two groups was statistically significant, at a score of 4 versus 11.
Raymond said she believed the significant reduction in family conflict was due to multiple factors. Firstly, “both the family and the patients were able to be with other patients and families to normalize and to understand that they are not alone.”
In addition, the “focus on communication and how the parent is going to work with the child” may have helped, along with the motivational interviewing components of the intervention.
The researchers also observed significant differences between the two groups at 1 year in the emotional problems, negative mood, low self-esteem, functional problems, and ineffectiveness subscales of the Children’s Depression Inventory. These were typically caused by increases over time in the usual care group compared with relative stability or slight decreases in the Team Clinic group.
Raymond concluded that “Team Clinic may be one way to address educational, clinical, and psychosocial needs of adolescents with type 1 diabetes.”
She cautioned, however, that the study participants were primarily White with private health insurance and a medium-to-high socioeconomic status, and the findings may therefore not apply to other sociodemographic groups.
By Laura Cowen
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