Diabetes Group Visits: Integrated Medical Care and Behavioral Support to Improve Diabetes Care and Outcomes from a Primary Care Perspective

Eisenstat, Stephanie A.; Ulman, Kathleen Hubbs; Siegel, Allison L; Carlson, Karen J.

doi:10.1007/s11892-012-0349-5

Cited by 33 publications

(30 citation statements)

References 84 publications

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“…The Project Dulce model is perhaps the longest standing example of a feasible cost-effective partnership between the community and the health system, as it has been implemented in community health centres in San Diego County for more than 15 years 36. Furthermore, shared medical care models, where diabetic patients attend medical visits in a group, have also been shown to effect clinically significant improvements and to not be subject to financial barriers from the current US provider reimbursement system 37. The fragmentation of the US healthcare system also seems to not pose an insurmountable hurdle for implementing new care delivery systems engaging the community.…”

Section: Discussionmentioning

confidence: 99%

Effect of social networks intervention in type 2 diabetes: a partial randomised study

Shaya

Chirikov

Howard

et al. 2013

J Epidemiol Community Health

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Section: Discussionmentioning

confidence: 99%

Effect of social networks intervention in type 2 diabetes: a partial randomised study

Shaya

Chirikov

Howard

et al. 2013

J Epidemiol Community Health

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Section: Introductionmentioning

confidence: 99%

“…11,12 GMVs, also called shared medical appointments, engage patients in health promotion and disease management. [13][14][15][16][17][18] care, and self-efficacy, as well as decreased health care utilization.19 Key GMV strengths include increased patient satisfaction, support for behavior change, and patient engagement. 16,18 Given how GMVs support patient engagement through group interaction, we developed the first advance care planning group visit, the "Conversation Group Medical Visit."…”

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confidence: 99%

“…11,12 GMVs, also called shared medical appointments, engage patients in health promotion and disease management. [13][14][15][16][17][18] Older adults enrolled in chronic disease management GMVs showed improved health status, satisfaction with care, and self-efficacy, as well as decreased health care utilization. 19 Key GMV strengths include increased patient satisfaction, support for behavior change, and patient engagement.…”

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confidence: 99%

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Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations

et al. 2016

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PURPOSE Primary care needs new models to facilitate advance care planning conversations. These conversations focus on preferences regarding serious illness and may involve patients, decision makers, and health care providers. We describe the feasibility of the first primary care-based group visit model focused on advance care planning. METHODSWe conducted a pilot demonstration of an advance care planning group visit in a geriatrics clinic. Patients were aged at least 65 years. Groups of patients met in 2 sessions of 2 hours each facilitated by a geriatrician and a social worker. Activities included considering personal values, discussing advance care planning, choosing surrogate decision-makers, and completing advance directives. We used the RE-AIM framework to evaluate the project. RESULTSTen of 11 clinicians referred patients for participation. Of 80 patients approached, 32 participated in 5 group visit cohorts (a 40% participation rate) and 27 participated in both sessions (an 84% retention rate). Mean age was 79 years; 59% of participants were female and 72% white. Most evaluated the group visit as better than usual clinic visits for discussing advance care planning. Patients reported increases in detailed advance care planning conversations after participating (19% to 41%, P = .02). Qualitative analysis found that older adults were willing to share personal values and challenges related to advance care planning and that they initiated discussions about a broad range of relevant topics.CONCLUSION A group visit to facilitate discussions about advance care planning and increase patient engagement is feasible. This model warrants further evaluation for effectiveness in improving advance care planning outcomes for patients, clinicians, and the system. 2016;14:125-132. doi: 10.1370/afm.1906. Ann Fam Med INTRODUCTIOND espite the benefits of advance care planning for patients, primary care clinicians face barriers to effective counseling on the issue, including their limited time and a lack of clinic-based support. [1][2][3][4] The Dying in America report 5 emphasized the need to integrate advance care planning into clinical care, and the Centers for Medicare and Medicaid Services recently approved reimbursement for counseling on advance care planning. 6 Advance care planning is an ongoing process that involves multiple conversations among individuals, family members, and health care professionals. 1,7 Studies show that many US decedents had not discussed preferences for end-of-life care with someone close to them, completed a living will, or established a durable power of attorney for health care. 8,9 Primary care clinics are uniquely positioned to implement new models that engage patients in advance care planning. 10 The American Academy of Family Physicians recognizes group medical visits (GMVs) as a strategic approach within the patient-centered medical home. 11,12 GMVs, also called shared medical appointments, engage patients in health promotion and disease management. [13][14][15][16][17][18] care, a...

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“…23–25 Key strengths of group visits include high-quality education and supportive discussions, patient and provider satisfaction, and improved patient self-efficacy. 26–28 Although ACP counseling has traditionally occurred in 1-on-1 patient–provider interactions, support from peers in the group visit setting creates a group dynamic that may promote patient engagement in ACP by improving knowledge, supporting values-based discussions, and promoting decision making about future medical care. In the United States and Canada, support for group visits in primary care is increasing 29,30 and may represent a practical opportunity to implement ACP discussions.…”

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confidence: 99%

A Group Visit Initiative Improves Advance Care Planning Documentation among Older Adults in Primary Care

et al. 2017

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Introduction Group visits for advance care planning (ACP) may help patients document preferences for decision makers and future care. We assessed the impact of a primary care-based ACP group visit (ACP-GV) intervention on older adults’ ACP documentation and why patients participated. Methods Older adults (>65 years) in primary care participated in a 2-session ACP-GV intervention that promotes group dynamics, peer-based learning, and goal setting. Charts were reviewed at baseline, 3 months, and 12 months for documentation of decision makers and ACP forms. We described patients’ reasons for participating through analysis of transcripts. Results 118 patients (mean age 76 years; 62% female and 82% white) participated in 16 ACP-GV cohorts. From baseline to 3-month follow-up, documentation of decision maker preferences increased from 39% to 81%, and was 89% at 12-month follow-up. Patients with completed ACP forms increased from 20% to 57% at 3 months, and was 67% at 12 months. Reasons for participating included recognizing the importance of ACP, curiosity, participation recommended by primary care provider, desire to talk with family/friends, and desire to complete advance directives. Conclusions This ACP-GV intervention increased ACP documentation among patients with diverse reasons for participating. This is a patient-centered approach to ACP in primary care.

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Diabetes Group Visits: Integrated Medical Care and Behavioral Support to Improve Diabetes Care and Outcomes from a Primary Care Perspective

Cited by 33 publications

References 84 publications

Effect of social networks intervention in type 2 diabetes: a partial randomised study

Effect of social networks intervention in type 2 diabetes: a partial randomised study

Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations

A Group Visit Initiative Improves Advance Care Planning Documentation among Older Adults in Primary Care

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