Educational group visits for the management of chronic health conditions: a systematic review.
OBJECTIVE
Review the effectiveness of group visits (appointments of multiple patients) on quality of life, function, self-efficacy, utilization, and biophysical outcomes in randomized controlled trials of patients with chronic conditions.


METHODS
We searched MEDLINE(®), Cochrane, CINAHL, and PsycINFO to January 2013 for English-language trials of educational group visits led by non-prescribing facilitators (e.g., peer educators).


RESULTS
We report on 80 arthritis/falls (n=22), asthma/COPD (n=10), CHF/hypertension (n=12), diabetes (n=29), multiple conditions (n=4), and pain (n=4) studies. We found moderate evidence of improved short-term self-efficacy in patients with arthritis (10 studies) and diabetes (10 studies). We found no consistent evidence of improved quality of life; however a moderately strong body of evidence suggests peer-led community-based programs might improve quality of life and utilization in patients with multiple chronic conditions. Meta-analyses found short- (14 studies; mean change HbA1c=-0.27, CI=-0.44, 0.11) and long-term (10 studies; mean change HbA1c=-0.23, CI=-0.44, -0.02) glycemic improvement.


CONCLUSIONS
Group visits may improve self-efficacy and glycemic control. There was little consistent evidence of improved quality of life, functional status, or utilization.


CONCLUSIONS
Group visits represent a reasonable alternative for educating patients with chronic illness, though varied participation/retention suggests they should not be the sole alternative.
Portland VA Medical Center, Health Services Research & Development, Portland, USA; Oregon Health & Science University, Public Health & Preventive Medicine, Portland, USA. Electronic address: quinones@ohsu.edu.
Ana R
AR
Quiñones
Portland VA Medical Center, Health Services Research & Development, Portland, USA.
Jeannette
J
Richardson
Portland VA Medical Center, Health Services Research & Development, Portland, USA.
Michele
M
Freeman
Portland VA Medical Center, Health Services Research & Development, Portland, USA; Oregon Health & Science University, Public Health & Preventive Medicine, Portland, USA.
Rochelle
R
Fu
Portland VA Medical Center, Health Services Research & Development, Portland, USA; Oregon Health & Science University, Psychiatry, Portland, USA.
Maya E
ME
O'Neil
Portland VA Medical Center, Health Services Research & Development, Portland, USA.
Makalapua
M
Motu'apuaka
Portland VA Medical Center, Health Services Research & Development, Portland, USA; General Internal Medicine, Oregon Health & Science University, Portland, USA.
Devan
D
Kansagara
D002908:Chronic Disease / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation; D010379:Peer Group; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012648:Self Care; D020377:Self Efficacy; D012657:Self-Help Groups
Chronic disease; Chronic disease self-management; Group visits; Health education