The key elements that drove the development of the SMA groups is that diabetes is a national problem that has reach epidemic proportions, along with hypertension (Kirsh et al., 2007, p. 11). When these chronic disease are out of control, this puts patients at risk for renal failure. According to Kirsh (2007), its management complexity threatens to overwhelm the acute care systems and challenge the resources of current and future individual primary care provider (p.9). Chronic care management needs approaches that educates, sensitize, support, and help nurture an activated patient and prepare proactive health care team (Kirsh et al., 2007, p.11). Shared medical appointments (SMA’s) constitutes a promising improvement strategy to help address