Can Group Medical Clinics Improve Lipid Management in Diabetes?

Crowley, Matthew J; Melnyk, S. Dee; Ostroff, Jared L.; Fredrickson, Sonja K.; Jeffreys, Amy S.; Edelman, David

doi:10.1016/j.amjmed.2013.09.027

Cited by 9 publications

(18 citation statements)

References 22 publications

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“…Indeed, even different reports of the same study portrayed different depictions of the same intervention. Notwithstanding these reporting limitations, we found that some element of socialisation was included in 15 of the studies 57,[60][61][62]65,66,[68][69][70]73,74,76,77,79,81 and group discussion (i.e. many-to-many interaction) was reported in 14 studies.…”

Section: Intervention Componentsmentioning

confidence: 99%

“…many-to-many interaction) was reported in 14 studies. 63,64,66,68,70,71,[73][74][75][76][77]82,85,86 Eleven studies explicitly reported health education/information presentation(s) by individual clinicians, 57,60,65,[66][67][68]70,71,[73][74][75]79 with one for health education/information presentation(s) by multiple clinicians 63 and two for health education/information via booklet, leaflet or video. 70,80 Seven studies reported medication review and four describe completion of prescriptions.…”

Section: Intervention Componentsmentioning

confidence: 99%

“…70,80 Seven studies reported medication review and four describe completion of prescriptions. 60,63,66,71,75,80,81 Six studies reported individual consultation within the group session 60,65,76,77,84,86 , with five describing individual consultation immediately following the group session for all patients 58,59,68,69,82 and three for individual consultation immediately following the group session for selected patients. 73,74,83 Six studies reported routine medical checks being performed by multiple clinicians 57,65,66,74,79,86 and six reported these checks being made by individual clinicians, 60,63,67,73,77,82 while only two studies reported routine medical checks being conducted by the patient.…”

Section: Intervention Componentsmentioning

confidence: 99%

“…The quality of included RCTs was assessed using questions relevant for RCTs and from these responses a Cochrane risk of bias was determined for each study (Table 17). Of the 22 trials, nine studies (11 papers) [60][61][62][63][65][66][67][68][69][70]73 were categorised as having a low risk of bias, 10 studies (11 papers) were categorised as having a high risk of bias 20,[57][58][59]64,71,74,75,[79][80][81][82][83][84][85][86][87] and three studies (four papers) were categorised as unclear. 72,[76][77][78] The large number of studies with a high risk of bias means that any conclusions based on these trials should be treated with caution.…”

Section: Narrative Summary Of Study Qualitymentioning

confidence: 99%

“…Two of the studies 70,79 did have a 24-month follow-up. The 11 studies assigned a low risk of bias 60,61,63,[65][66][67][68][69][70]73,78 were generally large, well-conducted trials.…”

Section: Narrative Summary Of Study Qualitymentioning

confidence: 99%

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What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions? A systematic review

Cantrell

Preston

Chambers

et al. 2015

Health Serv Deliv Res

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BackgroundGroup clinics are a form of delivering specialist-led care in groups rather than in individual consultations.ObjectiveTo examine the evidence for the use of group clinics for patients with chronic health conditions.DesignA systematic review of evidence from randomised controlled trials (RCTs) supplemented by qualitative studies, cost studies and UK initiatives.Data sourcesWe searched MEDLINE, EMBASE, The Cochrane Library, Web of Science and Cumulative Index to Nursing and Allied Health Literature from 1999 to 2014. Systematic reviews and RCTs were eligible for inclusion. Additional searches were performed to identify qualitative studies, studies reporting costs and evidence specific to UK settings.Review methodsData were extracted for all included systematic reviews, RCTs and qualitative studies using a standardised form. Quality assessment was performed for systematic reviews, RCTs and qualitative studies. UK studies were included regardless of the quality or level of reporting. Tabulation of the extracted data informed a narrative synthesis. We did not attempt to synthesise quantitative data through formal meta-analysis. However, given the predominance of studies of group clinics for diabetes, using common biomedical outcomes, this subset was subject to quantitative analysis.ResultsThirteen systematic reviews and 22 RCT studies met the inclusion criteria. These were supplemented by 12 qualitative papers (10 studies), four surveys and eight papers examining costs. Thirteen papers reported on 12 UK initiatives. With 82 papers covering 69 different studies, this constituted the most comprehensive coverage of the evidence base to date. Disease-specific outcomes – the large majority of RCTs examined group clinic approaches to diabetes. Other conditions included hypertension/heart failure and neuromuscular conditions. The most commonly measured outcomes for diabetes were glycated haemoglobin A1c(HbA1c), blood pressure and cholesterol. Group clinic approaches improved HbA1cand improved systolic blood pressure but did not improve low-density lipoprotein cholesterol. A significant effect was found for disease-specific quality of life in a few studies. No other outcome measure showed a consistent effect in favour of group clinics. Recent RCTs largely confirm previous findings. Health services outcomes – the evidence on costs and feasibility was equivocal. No rigorous evaluation of group clinics has been conducted in a UK setting. A good-quality qualitative study from the UK highlighted factors such as the physical space and a flexible appointment system as being important to patients. The views and attitudes of those who dislike group clinic provision are poorly represented. Little attention has been directed at the needs of people from ethnic minorities. The review team identified significant weaknesses in the included research. Potential selection bias limits the generalisability of the results. Many patients who could potentially be included do not consent to the group approach. Attendance is often interpreted liberally.LimitationsThis telescoped review, conducted within half the time period of a conventional systematic review, sought breadth in covering feasibility, appropriateness and meaningfulness in addition to effectiveness and cost-effectiveness and utilised several rapid-review methods. It focused on the contribution of recently published evidence from RCTs to the existing evidence base. It did not reanalyse trials covered in previous reviews. Following rapid review methods, we did not perform independent double data extraction and quality assessment.ConclusionsAlthough there is consistent and promising evidence for an effect of group clinics for some biomedical measures, this effect does not extend across all outcomes. Much of the evidence was derived from the USA. It is important to engage with UK stakeholders to identify NHS considerations relating to the implementation of group clinic approaches.Future workThe review team identified three research priorities: (1) more UK-centred evaluations using rigorous research designs and economic models with robust components; (2) clearer delineation of individual components within different models of group clinic delivery; and (3) clarification of the circumstances under which group clinics present an appropriate alternative to an individual consultation.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Intervention Componentsmentioning

confidence: 99%

Section: Intervention Componentsmentioning

confidence: 99%

Section: Intervention Componentsmentioning

confidence: 99%

Section: Narrative Summary Of Study Qualitymentioning

confidence: 99%

“…Two of the studies 70,79 did have a 24-month follow-up. The 11 studies assigned a low risk of bias 60,61,63,[65][66][67][68][69][70]73,78 were generally large, well-conducted trials.…”

Section: Narrative Summary Of Study Qualitymentioning

confidence: 99%

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What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions? A systematic review

Cantrell

Preston

Chambers

et al. 2015

Health Serv Deliv Res

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Using Group Medical Visits With Those Who Have Diabetes: Examining the Evidence

Housden

Wong

2016

Curr Diab Rep

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The number of people with diabetes is expected to rise to over 592 million by the year 2035. Past work provides evidence that the conventional method of primary care delivery may not meet many patients' needs. An alternative to the conventional one-on-one appointment is care offered to a group of patients through group medical visits (GMVs). Group medical visits for diabetes have a positive impact on physiologic and self-care outcomes including improved HbA1c, blood pressure control and self-management skills. Less work has examined the impacts of GMVs on systems of care; however, evidence suggests improved primary and secondary prevention strategies and the potential for GMVs to decrease emergency room visits and hospitalizations. Additional work is needed to examine the effect of GMVs on patient reported quality of life, functional health status and cost-savings. Further work is also needed on which patients GMVs work best for and patient barriers to attending GMVs.

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