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

Housden, Laura; Wong, Sabrina T.

doi:10.1007/s11892-016-0817-4

Cited by 33 publications

(26 citation statements)

References 67 publications

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“…More work is needed to examine the use of NP‐led GMVs in other Canadian provinces and jurisdictions. While this study examines the interprofessional processes that can unfold within a GMV, other work has shown that GMVs can positively affect clinical outcomes such as HbA1C and blood pressure, for patients with diabetes . Although some studies have examined GMVs for heart disease, chronic obstructive pulmonary disease (COPD), dementia and mental illness, much of the current work has focused on GMVs for diabetes.…”

Section: Discussionmentioning

confidence: 99%

Attending to power differentials: How NP‐led group medical visits can influence the management of chronic conditions

Housden

Browne

Wong

et al. 2017

Health Expectations

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ObjectiveIn Canada, primary care reform has encouraged innovations, including nurse practitioners (NPs) and group medical visits (GMVs). NP‐led GMVs provide an opportunity to examine barriers and enablers to implementing this innovation in primary care.DesignAn instrumental case study design (n=3): two cases where NPs were using GMVs and one case where NPs were not using GMVs, was completed. In‐depth interviews with patients and providers (N=24) and 10 hours of direct observation were completed. Interpretive descriptive methods were used to analyse data.Results/FindingsTwo main themes were identified: (i) acquisition of knowledge and (ii) GMVs help shift relationships between patients and health‐care providers. Participants discussed how patients and providers learn from one another to facilitate self‐management of chronic conditions. They also discussed how the GMV shifts inherent power differentials between providers and between patients and providers.DiscussionNP‐led GMVs are a method of care delivery that harness NPs’ professional agency through increased leadership and interprofessional collaboration. GMVs also facilitate an environment that is patient‐centred and interprofessional, providing patients with increased confidence to manage their chronic conditions. The GMV provides the opportunity to meet both team‐based and patient‐centred health‐care objectives and may disrupt inherent power differentials that exist in primary care.

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Section: Discussionmentioning

confidence: 99%

Attending to power differentials: How NP‐led group medical visits can influence the management of chronic conditions

Housden

Browne

Wong

et al. 2017

Health Expectations

Self Cite

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“…Our study is limited by time and a moderate sample size that is majority female, although most diabetes group visit investigations are less than a year, have high attrition, and are minority male. 6,[10][11][12] Results are also limited to Spanishspeaking individuals at a nonprofit clinic. Though multifaceted interventions limit deciphering the most efficacious variable, these strategies have been found valuable for the complicated nature of diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…6 Group visits or shared medical appointments are a cost-effective intervention, comprising of education, integrated primary care (e.g., medication reconciliation), and goal development. [9][10][11] Most group visits are led by physicians or other health professionals 12 and, though bilingual providers add value in relating to the patient population, they are in short supply. 13 Integrating CHWs into group visits has showed value in overcoming cultural and language barriers.…”

Section: Introductionmentioning

confidence: 99%

A Telehealth-supported, Integrated care with CHWs, and MEdication-access (TIME) Program for Diabetes Improves HbA1c: a Randomized Clinical Trial

et al. 2020

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BACKGROUND: Many individuals with diabetes live in low-or middle-income settings. Glycemic control is challenging, particularly in resource-limited areas that face numerous healthcare barriers. OBJECTIVE: To compare HbA1c outcomes for individuals randomized to TIME, a Telehealth-supported, Integrated care with CHWs (Community Health Workers), and MEdication-access program (intervention) versus usual care (wait-list control). DESIGN: Randomized clinical trial. PARTICIPANTS: Low-income Latino(a) adults with type 2 diabetes. INTERVENTIONS: TIME consisted of (1) CHW-participant telehealth communication via mobile health (mHealth) for 12 months, (2) CHW-led monthly group visits for 6 months, and (3) weekly CHW-physician diabetes training and support via telehealth (video conferencing). MAIN MEASURES: Investigators compared TIME versus control participant baseline to month 6 changes of HbA1c (primary outcome), blood pressure, body mass index (BMI), weight, and adherence to seven American Diabetes Association (ADA) standards of care. CHW assistance in identifying barriers to healthcare in the intervention group were measured at the end of mHealth communication (12 months). KEY RESULTS: A total of 89 individuals participated. TIME individuals compared to control participants had significant HbA1c decreases (9.02 to 7.59% (− 1.43%) vs. 8.71 to 8.26% (− 0.45%), respectively, p = 0.002), blood pressure changes (systolic: − 6.89 mmHg vs. 0.03 mmHg, p = 0.023; diastolic: − 3.36 mmHg vs. 0.2 mmHg, respectively, p = 0.046), and ADA guideline adherence (p < 0.001) from baseline to month 6. At month 6, more TIME than control participants achieved > 0.50% HbA1c reductions (88.57% vs. 43.75%, p < 0.001). BMI and weight changes were not significant between groups. Many (54.6%) TIME participants experienced > 1 barrier to care, of whom 91.7% had medication issues. CHWs identified the majority (87.5%) of barriers. CONCLUSIONS: TIME participants resulted in improved outcomes including HbA1c. CHWs are uniquely positioned to identify barriers to care particularly related to medications that may have gone unrecognized otherwise. Larger trials are needed to determine the scalability and sustainability of the intervention.

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“…This is notable given that these and other chronic conditions disproportionately affect low-income individuals, and health care disparities exacerbate this higher prevalence. There is a strong research base for diabetes GMVs, 11,40 and integrative care may provide additional benefits to patients with diabetes. All authors of this article have ongoing qualitative and mixed-methods projects examining group-based integrative care for chronic pain.…”

Section: Discussionmentioning

confidence: 99%

Integrative Group Medical Visits: A National Scoping Survey of Safety-Net Clinics

2019

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Purpose: Integrative group medical visits (IGMVs) aim to increase access to complementary and integrative health care, which is particularly relevant for low-income people. We sought to describe IGMV programs in US safety-net clinics through a survey of providers.Methods: An online and paper survey was conducted to collect data on the use of complementary health approaches and characteristics of IGMV programs. We recruited a purposive sample of safety-net clinicians via national meetings and listservs.Results: Fifty-seven clinicians reported on group medical visits. Forty percent worked in federally qualified health centers, 57% in safety-net or teaching hospitals, 23% in other settings such as free clinics. Thirty-seven respondents in 11 states provided care in IGMVs, most commonly for chronic pain and diabetes. Nutrition (70%), mindfulness/meditation/breathing (59%), and tai chi/yoga/other movement practices (51%) were the most common treatment approaches in IGMVs.Conclusion: Safety-net institutions in 11 states offered IGMVs to treat a range of chronic conditions. IGMVs are an innovative model to improve access to non-pharmacologic approaches to chronic illness care and health promotion. They may advance health equity by serving patients negatively impacted by health and health care disparities.

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

Cited by 33 publications

References 67 publications

Attending to power differentials: How NP‐led group medical visits can influence the management of chronic conditions

Attending to power differentials: How NP‐led group medical visits can influence the management of chronic conditions

A Telehealth-supported, Integrated care with CHWs, and MEdication-access (TIME) Program for Diabetes Improves HbA1c: a Randomized Clinical Trial

Integrative Group Medical Visits: A National Scoping Survey of Safety-Net Clinics

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