Veteran Thomas Henry, Dr. Vivian Hayashi and Dr. Jade Yang
“I’m doing great,” said one patient as she entered the weekly Diabetes Shared Medical Appointment. Dr. Marisa Wallace, a Diabetes Nurse Practitioner, responded, “Isn’t it amazing how much difference a change in medication can make?” Later, Dr. Wallace explained that this short conversation was meaningful because it was a shared decision involving both patient and clinician to change a medication that resulted in the patient now noticing a dramatic difference to her overall quality of life. Enthusiastic about this approach, Dr. Wallace said, “Encouraging joint decision making in management of diabetes care is one important way in which this shared medical appointment is helping our patients.”
Veteran Daryl Woods was among about ten patients with diabetes who participated in a recent joint appointment. He was surprised when the small bag of cashews he brought-in for a snack at the session became the opening point of a discussion. But there it was, with other patients expressing their views about whether nuts were good or bad for your health. Nurse Practitioner Marisa Wallace jumped right in and said that while you have to worry about fat and calories, cashews are low in sugar as are some other nuts such as walnuts and almonds and can make for a good snack. So, in general, nuts are a great snack for patients with diabetes since they don’t raise the blood sugar much, but we have to be cautious we’re not adding too many calories into the diet. And, overall portion control is something everyone must keep in mind.
The Shared Medical Appointments (SMAs) are an innovative, interactive approach to healthcare that brings patients with common needs together with one or more healthcare providers. The Diabetes SMA at the Manhattan campus is led by an interdisciplinary team that includes nursing, pharmacy, medicine, nutrition, and psychology.
The priority is responding to what patients want to know about improving the management of their diabetes, explained Dr. Wallace. In addition to dietary issues, an ongoing matter of great concern is medications. “Patients want to know about medications and how to manage them.” said Dr. Vivian Hayashi, a Primary Care Physician who helped to create the program and has been key in guiding its development since 2009.
On one recent Tuesday morning, Pharmacist Jade Yang joined Dr. Wallace in discussing new medications that patients hear about on television. “Many patients have approached me recently with curiosity about new medicines that hit the market, recently commenting on a few new commercials they have seen promoting some of the newer diabetes medications,” said Dr. Wallace. One new, vigorously promoted medication is very expensive but not necessarily more effective nor has a long proven safety profile compared to some of the older antihyperglycemic oral agents.
In addition to a pharmacist, physician and specialist Diabetes nurse practitioner, the interdisciplinary team includes a Certified Diabetes Educator, a Registered Dietitian and behavioral health psychologists. Following the group session, patients meet one-on-one with Dr. Hayashi, Dr. Wallace, Dr. Yang or with other specialists so that they can consult privately in greater depth about their target blood sugar and about adjusting their diabetes medications.