Promises and Perils of Group Clinics for Young People Living With Diabetes: A Realist Review

Abstract

Group clinics are becoming popular as a new care model in diabetes care. This evidence synthesis, using realist review methodology, examined the role of group clinics in meeting the complex needs of young people living with diabetes. Following Realist And Meta-narrative Evidence Synthesis-Evolving Standards (RAMESES) quality standards, we conducted a systematic search across 10 databases. A total of 131 articles met inclusion criteria and were analyzed to develop theoretically informed explanations of how and why group clinics could work (or not) for young people with diabetes. Models of group-based care in the literature varied significantly and incorporated different degrees of clinical and educational content. Our analysis identified four overarching principles that can be applied in different contexts to drive sustained engagement of young people in group clinics: 1) emphasizing self-management as practical knowledge; 2) developing a sense of affinity between patients; 3) providing safe, developmentally appropriate care; and 4) balancing group and individual needs. Implementation of group clinics was not always straightforward; numerous adjustments to operational and clinical processes were required to establish and deliver high-quality care. Group clinics for young people with diabetes offer the potential to complement individualized care but are not a panacea and may generate as well as solve problems.The global rise in diabetes prevalence is expected to have serious consequences across health care systems. It is estimated that by 2045, health care expenditure on diabetes will reach 776 billion U.S. dollars (1). In the U.K., the cost of diabetes care is expected to account for 17% of the total health resource expenditure in 2035/2036 (2). A large proportion of these costs relates to managing diabetes complications, such as retinopathy, neuropathy, diabetic foot, and cardiovascular disease, which lead to reduced quality of life and premature mortality (1). Alternative approaches to care provision are necessary to stem what has been described as a "titanic struggle" against the burgeoning personal and systemic impact of diabetes (3).Group clinics (also known as shared medical appointments) involve delivery of care provided to groups of individuals at the same time rather than one-to-one interactions with health professionals (4,5). They have been proposed as a way to address rising health care costs and diminishing resources, with the potential to improve efficiency and provide opportunities for peer support and social learning (6). Group clinics can be delivered in a variety of formats and have been targeted to different patient populations (4,5).In diabetes, experimental studies of group-based care for adults have shown improvements in glycemic control, problem-solving ability, quality of life, and reduced time commitment for clinicians, compared with standard one-to-one

Implementing video group consultations in general practice during COVID-19: a qualitative study

“… 32 , 33 , 35 , 36 Instead of a single standardised format, the literature proposes common organising principles for successful delivery of VGCs (and technology-supported care in general), including attention to the role of patients as active co-production partners, and reconfiguration of care delivery so that VGCs provide added value. 13 , 37 …”

“…2 , 8 – 12 Combining clinical care with elements of group education and peer support, group consultations have been delivered in a variety of formats for patients with long-term conditions or shared health concerns. 8 , 13 …”

“…It has also been suggested that face-to-face group consultations can contribute to patient-centred care and job satisfaction for healthcare staff, 12 , 20 but local implementation can be challenging. 13 , 19…”

Implementation and delivery of group consultations for young people with diabetes in socioeconomically deprived, ethnically diverse settings

“…Novel approaches, such as group consultations (or ‘shared medical appointments’), have been employed to address current shortcomings in diabetes care delivery [ 16 – 21 ]. Group consultations bring together clinical experience and patient expertise to provide an alternative means of service provision, where small groups of patients attend jointly for their clinical consultations and at the same time have the opportunity to share with peers [ 22 ]. Extending beyond patient education, self-management, and peer support programmes (long established in diabetes care), it has been suggested that group consultations contribute towards improvement of clinical and patient-reported outcomes [ 21 , 23 ].…”

Beneficial effects on body weight of group vs individual care in adults with type 1 diabetes on advanced technologies

“…The role of group visits in adult patients with T1D has not been defined. A recent analysis 10 assessing whether—based on the group care models existing in the literature—group visits may or may not work for young patients with diabetes, identified four general principles that can be applied in different contexts to support the involvement in group visits: (a) emphasize self‐management as practical knowledge, (b) develop a sense of affinity between patients, (c) provide safe and adequate care, and (d) balance individual and group needs. The few reports available on group visits in patients with T1DM mainly regard adolescents/young people, 11 , 12 with no data in adults with T1DM using pump and innovative technologies.…”