Implementing Group Visits: Are They Effective to Improve Diabetes Self-Management Outcomes?

Dontje, Katherine; Forrest, Kathy M.

doi:10.1016/j.nurpra.2010.09.014

Cited by 11 publications

(9 citation statements)

References 13 publications

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“…In our synthesis of findings from all 26 studies, we noted reports on aspects of patients' engagement in their health care, including positive outcomes in the domain of selfcare, 2 1 , 2 5 physical activity, 3 9 the setting and achievement of measurable goals, 21,34,39 patient knowledge, 24,31,32,41,44 self-efficacy 23,25 and selfmanagement. 24,26,34,36,40,44 …”

Section: Other Outcomesmentioning

confidence: 99%

Effectiveness of group medical visits for improving diabetes care: a systematic review and meta-analysis

Housden

Wong

Dawes

2013

CMAJ

121

132

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Research CMAJBackground: Group medical visits, whereby health care professionals meet with groups of patients who have the same disease, have been introduced in primary care as a way to meet the increasing demand for health care delivery to patients with chronic diseases. We performed a systematic review and metaanalysis of the evidence on the effectiveness of such visits for patients with diabetes. Methods:We conducted a systematic review of all relevant studies published from 1947 to February 2012 identified in a search of electronic databases and grey literature. We included randomized controlled trials (RCTs) and observational studies published in English that included patients aged 16-80 years with type 1 or 2 diabetes and that had group medical visits as the intervention. These studies were assessed for methodologic quality.We included data only from the RCTs in the meta-analysis. Results:Of the 94 studies identified, we selected 26 that met our inclusion criteria, 13 of which were RCTs. Group medical visits had a positive effect on clinical and patient-reported outcomes, with significant reductions in glycated hemoglobin (HbA 1c reduction −0.46%, 95% confidence interval −0.80% to −0.31%). We were unable to assess the effect of group medical visits on processes of care because of an insufficient number of RCTs that reported on this outcome.Interpretation: Group medical visits for pa tients with diabetes were found to be effective in terms of reducing HbA 1c . The results of our metaanalysis suggest that wider implementation of group medical visits for patients with diabetes will have a positive effect on patient outcomes. Abstract

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Section: Other Outcomesmentioning

confidence: 99%

Effectiveness of group medical visits for improving diabetes care: a systematic review and meta-analysis

Housden

Wong

Dawes

2013

CMAJ

121

132

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“…Although the participation numbers were small, the project data is consistent with previous research regarding the success of using group visits with diabetes patients (Dontje & Forrest, 2011). The use of group-based intervention seemed instrumental in helping to decrease participants' A1C levels and improve self-care management skills by enhancing their knowledge.…”

Section: Discussionsupporting

confidence: 78%

“…The majority of research conducted regarding group visits has been performed with a diabetic population . According to Dontje and Forrest, (2011) and Gucciardi et al (2013), group based interventions have provided effective diabetes self-management education and have helped to reduce A1C levels while providing patients with the opportunity to interact with each other and address health concerns collectively. Housden, Wong, and Dawes (2013) conducted a systematic review from 1947 to February 2012 consisting of randomized controlled trials (RCTs), and observational studies of patients aged 16-80 years old with type 1 or 2 diabetes who experienced healthcare management using group medical visits.…”

Section: Summary Of the Evidencementioning

confidence: 99%

Transitional Care of Adult Patients with Diabetes Following Hospitalizations

Tobin¹

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Purpose: The purpose of this evidence-based practice project was to incorporate a diabetes transitional care program using group visits to improve self-care management behaviors and glycemic control in diabetic patients at a southern California hospital. Background: Diabetes is a challenging healthcare problem associated with significant mortality and morbidity issues. In 2012, 29.1 million people, or 9.3% of the U.S. population, were diagnosed with diabetes, and 28.9 million of those patients were 20 years of age and older. Today, diabetes is of epidemic proportion worldwide, and a projection of 5.4% of the adult population will have diabetes by 2025. The growing incidence of diabetes can be attributed to an increase in obesity, lack of exercise, diet high in processed sugars, and overall lack of diabetes self-care. Research consistently supports transitional care as an effective evidence-based solution for enhancing the overall management of patients with diabetes as reflected in improved self-management and glycemic control. At the project facility, there was no formalized transitional care program for diabetes patients. Practice Change Process: Patients 18 years of age and older, who were hospitalized and had an A1C > 7.5% were selected to participate in the transitional diabetes care program. Following discharge from the hospital, the patients were seen within a 14-day period. Selected participants joined in a 90-minute multidisciplinary group visit to discuss evidence-based care regarding diabetes management. Patients were educated based on the American Association of Diabetes Education (AADE)-7 Self-Care Behaviors during their stay in the hospital. The Diabetes Knowledge Questionnaire was administered pre and post practice change in order to measure the patient's knowledge regarding diabetes self-care management. Results: This evidence-based project had 3 participants who attended the group visits and completed the pre and post intervention. The overall knowledge scores improved from a mean of 72% to 87%, a 15% improvement, while the mean A1C levels were reduced from 9.2% to 7.1%, a 1.9% decrease. Conclusions: Transitional care provides a multi-faceted approach to evidence-based diabetic self-care management. Patients were empowered with self-care knowledge and management skills promoting improved diabetes self-care behaviors and glycemic control. Advanced practice registered nurses (APRNs) possess the knowledge and skills to assume leadership roles in the development and implementation of transitional care programs for diabetic patients.

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“…West Virginia is in the only state that is entirely in Appalachia [18]. Although this study did not collect data on culture, all of the participants of this study live in West Virginia.…”

Section: Discussionmentioning

confidence: 99%

Diabetes group medical visits and outcomes of care in low-income, rural, uninsured persons

Mallow¹,

Theeke²,

Whetsel³

et al. 2013

OJN

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Purpose The purpose of this study was to test the effectiveness of Diabetes Group Medical Visits (DGMVs) verses usual care in a sample of low-income patients with diabetes receiving care at a rural free clinic. Methods Data were collected through chart review, using direct data entry into Microsoft Access. Participants were included if they met the inclusion criteria: 1) age ≥ 18 years; 2) diagnosis of diabetes; 3) uninsured and received care between May 2007 and August 2009. Fifty-three participants attended DGMVs and were compared to 58 participants who received usual care. Results The personal characteristics and biophysical measures of this population differed from previously studied Group Visit populations. The majority of patients were female (73.9%), white (95.5%), younger than 50 (53.2%), driving long distances to receive care (mean miles = 21, SD 20.4) and had a high school education or less (95.4%). Participants were severely obese (mean BMI = 37.6, SD 28.48) and had 5 co-morbid conditions other than diabetes (mean = 5.5, SD 2.1). Those attending DGMVs had higher baseline A1C, depression scores, BMIs, and more pain than usual care. There was a statistically significant decrease in systolic pressure from time one to time two in patients who attended DGMVs t(52) = 2.18, (p = 0.03). There was no significant impact on outcomes of patients who received usual care. However, it is important to note that the majority of patients attended three or fewer DGMVs visits in one year. Conclusion Group visits may not be enough to improve outcomes in this population. Previous studies suggest that improvements are seen in those who attend more frequently. Hence, the lack of improvement in biophysical outcomes may be due to low attendance. The limited impact of this traditional style intervention in relation to low attendance argues the need to test alternative interventions to reach this population.

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Implementing Group Visits: Are They Effective to Improve Diabetes Self-Management Outcomes?

Cited by 11 publications

References 13 publications

Effectiveness of group medical visits for improving diabetes care: a systematic review and meta-analysis

Effectiveness of group medical visits for improving diabetes care: a systematic review and meta-analysis

Transitional Care of Adult Patients with Diabetes Following Hospitalizations

Diabetes group medical visits and outcomes of care in low-income, rural, uninsured persons

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