Original Research

Experiences of Veterans With Diabetes From Shared Medical Appointments

Fed Pract. 2015 May;32(5):40-45

References

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Another veteran had what the group felt was the optimal experience: “The nurse told me I was diabetic...sat there for 45 minutes and just talked to me about it. It was the fact that she sat and talked with me and covered all the questions I had. That was the best thing bar none.”

Veterans expressed frustration with the time delay between the diagnosis and availability of clinical support and education: “When I first got the diagnosis, there was 4 or 5 weeks until the class. I’m thinking, what they should have done as soon as they sent that letter with the A_1c, they should have sent me a packet saying, here’s what you can do NOW. Boom!”

Interventions

The chance to meet with other veterans with diabetes was something many participants said was helpful and provided a specific benefit that health care providers on their own could not give. One participant stated, “Classes make you feel more normal, when you sit with these people whose experiences you share.” Another stated, “When people have had a problem, get together and say how they’ve overcome it, I wanna hear about it.” The veterans agreed that someone who has specialty training in diabetes, not just in peer-to-peer support groups, should lead the education or support groups.

When the veterans were asked whether they thought that a veteran-led group would be beneficial, one veteran stated, “A support group must have a facilitator that has skills and resources.” Another stated, “You need at least one person to give you direction.”

One veteran explained that having weekly classes and hearing the same information several times helped information to “stick.” Another veteran, while expressing frustration about the lack of education he received on diet, stated, “What we eat directly affects us…classes like this are the greatest thing that ever happened. They give us more support than the doctors ever do.” One veteran described how having his weekly morning SMA class to look forward to was a strong motivation to pay attention to all the things that matter to his diabetes throughout the week. Another veteran emphasized the SMA as being important, because “being members of the military, you still have the civilians and they are them and we are us. ... With no family members, this [SMA] has made a big difference.”

Provider Relationship

Veterans expressed that having a positive provider relationship was an important element in diabetes self-management. The lack of time available for diabetes management in standard primary care encounters was cited as a barrier. One veteran stated, “[Providers] diagnose you with a blood test and [push you] out the door!” One veteran observed, “I think they need to turn you over to a nurse practitioner. You’re better off with someone like that who actually has time to talk to you instead of leaving you with someone who just gives you a prescription.”

The quality of the interaction mattered, and veterans felt that providers’ actions during the appointment could negatively affect the experience. One veteran summed up the groups’ feelings regarding their interactions with providers by saying, “[It is] key for our care providers to treat us like people. We should be able to ask them to get off of the computer and talk to us for a bit!” Other participants nodded in agreement, and one veteran remarked that he had a provider who had diabetes and “that was great.” The veterans also appreciated positive reinforcement from the primary care team. One participant remarked, “It’s nice to get the letter from my primary care provider with a little note saying you’re doing better.”

Resources

Participants had many suggestions regarding additional resources that they would like the VA to offer to help them self-manage diabetes. Many suggestions related to having greater access to resources for weight management through exercise or healthful eating. One participant stated, “An exercise facility…I think that’s key, and not just for diabetics.” Another participant noted, “In the VA, we have places to eat. Have you seen the food they give us to eat? Fatty, carbs, fried food.” However, many veterans were unclear about what resources the VA did offer, not knowing about certain resources such as diabetic shoes. When asked to prioritize what resources are most useful, given a scarcity, most participants insisted that a wide range of resources needed to be offered, because different people have different needs. One participant summed it up: “You can’t do away with primary care, you can’t do away with education, you can’t do away with pharmacy...[and] face-to-face makes all the difference in the world.”