Team Clinic: An Innovative Group Care Model for Youth With Type 1 Diabetes—Engaging Patients and Meeting Educational Needs

Abstract

The purpose of this pilot was to implement an innovative group care model, “Team Clinic”, for adolescents with type 1 diabetes and assess patient and provider perspectives. Ninety-one intervention patients and 87 controls were enrolled. Ninety-six percent of intervention adolescents endorsed increased support and perceived connecting with peers as important. The medical providers and staff also provided positive feedback stating Team Clinic allowed more creativity in education and higher quality of care. Team Clinic may be a promising model to engage adolescents and incorporate education and support into clinic visits in a format valued by patients and providers.

Home Telemedicine (CoYoT1 Clinic): A Novel Approach to Improve Psychosocial Outcomes in Young Adults With Diabetes

“…Another SMA model for adolescents, "Team Clinic," successfully improved appointment attendance, exposed patients to more educational materials, and increased both satisfaction and efficiency of care delivery compared to traditional clinic visits. [55][56][57] Team Clinic demonstrated success as an intervention for middle school and high school students; however, attending Team Clinic was a challenge for YAs (unpublished data).…”

Importance of Patient–Provider Communication to Adherence in Adolescents with Type 1 Diabetes

“…Providers have recently explored the use of group visits or shared medical appointments (appointments with multiple patients seen together) as a way to avoid repeating the same information to individual patients and increase direct point of care between the provider and patient [ 34 ]. With conditions such as T1D, many families are experiencing similar challenges, and a group setting may allow adolescents and caregivers to share strategies to overcome those challenges [ 35 ]. Thus, group appointments may have the indirect benefit of forming a support system for families of youth with T1D.…”

Adapting home telehealth group appointment model (CoYoT1 clinic) for a low SES, publicly insured, minority young adult population with type 1 diabetes

“…If the CoYoT1 Care intervention is successful in YA with diabetes, the telehealth and/or collaborative care model will be modified for patients and families in other age groups. For example, the Team Clinic model focuses on inperson, group appointments for middle and high school patients and families [16,39]. Adapting the Team Clinic model, which serves adolescents and their families, for telehealth would be an ideal next step for this line of research.…”

“…CHLA serves nearly 2000 patients with T1D (including 568 patients ages [16][17][18][19][20][21][22][23][24][25]; many often struggle to adhere to best care practices. Approximately 70% receive public insurance or have no insurance, and 85% have ethnic minority status documented in the electronic medical record.…”

“…Shared medical appointments (SMA, or group appointments) have proven effective at increasing engagement among adolescent and YA patients [15]. Recently, we evaluated "Team Clinic," our group appointment model for 13-to-18-year-old patients with T1D [16,17], and found that both patients and providers reported high levels of satisfaction, and patients also experienced increased self-management behaviors, visit frequency, and social support. Building on this success, coupled with previous research demonstrating the potential for telemedicine to increase access to medical care [15,[18][19][20][21][22][23], we designed CoYoT1 Clinic (Colorado Young Adults with Type 1 Diabetes; pronounced "coyote") to provide routine diabetes care for YA with T1D using a telehealth group appointment model, delivering developmentally-appropriate clinical care to patients at home or another preferred location via web-based video conferencing [24].…”