Group visits: promoting adherence to diabetes guidelines.
BACKGROUND
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.


OBJECTIVE
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].


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.


RESULTS
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).


CONCLUSIONS
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.
Clancy
Dawn E
DE
Department of Medicine, Medical University of South Carolina, Charleston, SC 250591, USA. clancyd@musc.edu
Huang
Peng
P
Okonofua
Eni
E
Yeager
Derik
D
Magruder
Kathryn Marley
KM
D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006770:Hospitals, Group Practice / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods / Q000639:trends