Group Visits: Promoting Adherence to Diabetes Guidelines
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Current diabetes management guidelines offer blueprints for providers, yet type 2 diabetes control is often poor in disadvantaged populations. The group visit is a new treatment modality originating in managed care for efficient service delivery to patients with chronic health problems. Group visits offer promise for delivering care to diabetic patients, as visits are lengthier and can be more frequent, more organized, and more educational.
To evaluate the effect of group visits on clinical outcomes, concordance with 10 American Diabetes Association (ADA) guidelines [American Diabetes Association, Diabetes Care, 28:S4–36, 2004] and 3 United States Preventive Services Task Force (USPSTF) cancer screens [U.S. Preventive Services Task Force, http://www.ahrq.gov/clinic/uspstf/resource.htm, 2003].
RESEARCH DESIGN AND METHODS
A 12-month randomized controlled trial of 186 diabetic patients comparing care in group visits with care in the traditional patient–physician dyad. Clinical outcomes (HbA1c, blood pressure [BP], lipid profiles) were assessed at 6 and 12 months and quality of care measures (adherence to 10 ADA guidelines and 3 USPSTF cancer screens) at 12 months.
At both measurement points, HbA1c, BP, and lipid levels did not differ significantly for patients attending group visits versus those in usual care. At 12 months, however, patients receiving care in group visits exhibited greater concordance with ADA process-of-care indicators (p < .0001) and higher screening rates for cancers of the breast (80 vs. 68%, p = .006) and cervix (80 vs 68%, p = .019).
Group visits can improve the quality of care for diabetic patients, but modifications to the content and style of group visits may be necessary to achieve improved clinical outcomes.
KEY WORDSgroup visits guideline concordance type 2 diabetes control
Acknowledgement of Financial and/or Other Support
This project was supported by grant number 5 P01 HS10871 from the Agency for Healthcare Research and Quality, a grant from The Robert Wood Johnson Foundation, Princeton, New Jersey, and 1R21NS043569 from National Institutes of Health/NINDS.
Conflict of Interest
Dr. Magruder, and Mr. Yeager reported receiving a $7,500 grant from Pfizer.
Drs. Clancy, Magruder and Mr. Yeager received a $107,445 grant from Eli Lilly in 2005–2006. Dr. Magruder was the principal investigator.
The other authors reported no conflicts of interest.
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