A Comprehensive Chronic Illness Treatment Paradigm that Makes Full Use of Group Visits

In this chapter, we discuss a comprehensive chronic disease treatment program—one that should work for managing virtually any chronic illness and takes full advantage of the multiple benefits that group visits offer. As will be seen, of all the group visit models, the DIGMA model has many specific advantages that make it singularly well suited to chronic disease and lifestyle management programs—although the other group visit models can also be applied in certain unique ways. For illustrative purposes, diabetes is used in this chapter as a specific application of the proposed chronic disease management paradigm. However, the reader should keep in mind that this is but a single example, and that this same paradigm could work equally well for any chronic illness treatment program (CHF, asthma, diabetes, hypertension, hyperlipidemia, stroke, Parkinson’s disease, etc., provided that there are sufficient patients with that diagnosis to fill the SMA groups).

Chronic conditions such as Type 2 diabetes and heart failure have become epidemic. This is not just a problem unique to the United States; it is a global problem. A contributing factor to the increase in many of the chronic conditions has been the epidemic of obesity. In the past 20 years, the rates of obesity have tripled in developing countries that have adopted a Western lifestyle involving decreased physical activity and overconsumption of inexpensive, high calorie foods. Today more than 1.1 billion adults and 1.7 billion children are overweight.¹ The impact of this problem has staggering numbers attached to it. In the US the combined costs for diabetes and heart failure exceed $200 billion per year.² Worldwide by 2030, there will be approximately 366 million people with Type 2 diabetes (Footnote 1). Our current models of providing care have not worked in addressing this problem. If we are to have a broad impact in reversing this trend we must find more effective ways in helping patients address the necessary health behavior changes. Group visits that help foster self-management support can have a substantial impact on the efficient use of resources necessary to reverse this trend. Not only can they impact the effects of conditions such as diabetes and heart failure, they have a broad applicability to a host of problems faced by an aging population.

Jim Nuovo, MD, personal communication, February 1, 2007