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Living Whole with Diabetes through Shared Medical Group at Erie VAMC

Erie VAMC Whole Health Diabetes Shared Medical Group Interdisciplinary Team
Dr. Tyler Mautino, Chief of Optometry; Dr. Clifton Barretta, DPM, Podiatrist; Dr. Muryam Khan, Optometrist; Denise Ott, LPN, PACT Honor; Yi Seul Kim, PharmD; Libby Towns, CRNP, PACT Honor; Darren Allen, LCSW, VA Calm Mindfulness Facilitator; Rocky Escajadillo, PT, DPT, Whole Health Program Manager; Mari Johnson, MSN, HPDP; Deborah Kuntz, RD, LDN, Clinical Nutrition Manager.

Erie VAMC empowered Veterans with diabetes to “Live Whole” by offering a Whole Health (WH) Shared Medical Group (SMG) over a 7-month period. The interdisciplinary team used the VA Whole Health model and delivered shared medical appointments for those with diabetes.

Libby Towns, CRNP, provider for Patient Aligned Care Team (PACT) Honor, led the team to optimize Veteran outcomes and improve provider satisfaction. The interdisciplinary team consisted of a PACT provider, a PACT LPN, a HPDP, a PT, a social worker, a dietician, an optometrist, and a podiatrist.

The team offered a hybrid program of 2 in-person groups and 5 virtual groups which met monthly over a period of 7 months. PACT Honor team reviewed a panel of Veterans and contacted those with diabetes whose A1C results were elevated, newly diagnosed, or who showed an interest in participating in SMG group. Initially, 7 Veterans enrolled; 5 of the 7 Veterans completed the 6-month program.

Creativity was necessary in planning for the groups to maintain safety for staff and Veterans due to COVID-19. The content of the program was quickly adapted to assure there was follow up and outreach to the participants between the group sessions. All participants completed a Personal Health Inventory and Personal Health Plan including a Specific, Measurable, Action-Oriented, Realistic, and Timed (SMART) goal within the first month. Goals ranged from portion control, taking medications, eating habits – eat 2 meals/day, engaging in life, and getting back to fishing. Sessions 1, 3, 6, and 7 were structured to have a check-in regarding status of goals and concerns, vital signs, waist circumference, weight, mindful moment, exercise experience, educational topic presented by an in-field expert, and nutrition. Topics focused on understanding diabetes, Whole Health introduction, reviewing medications, nutrition, healthy teaching kitchen, exercise and movement therapy, sick day care, will power, mindful eating, stress during the holidays, mindfulness, diabetic neuropathy, and eye and foot care.

After program completion, a Veteran commented, "it was as if he was taking us on his diabetes journey." All agreed there was a connection and felt empowered, reinforcing that it takes a team to address living healthy and whole with diabetes. Living healthy with diabetes impacts all aspects of life, both mentally and physically. Similarly, treatment of exercise, diet, and social connections has a significant impact on psycho-emotional health and well-being. 

This was a small group trial of lifestyle intervention using a holistic approach that yielded an average reduction of 1.2 in hemoglobin A1C, reduction in weight of 8.5 pounds, and reduction of up to 2 inches in waist circumference. The results demonstrate the importance of lifestyle intervention and the Whole Health approach positively impacting and improving health and sense of well-being, even during a pandemic.

Story contributed by: Mari Johnson, RN