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BACKGROUND/RATIONALE:
Diabetes is a common, morbid and expensive disease among veterans. Achieving adequate glycemic control and blood pressure control can reduce the devastating complications of diabetes. Because the majority of patients do not achieve adequate control of blood sugar and blood pressure, innovative strategies to improve control are needed.One strategy with great potential for veterans receiving VA care is the group clinic. Group clinics have been developed over the last 5-10 years, and have been shown to improve clinical outcomes and reduce outpatient utilization in geriatric settings. Group medical clinics involve a cohort of 8-20 patients who have 1-2 hour group visits. These clinics are distinguished from traditional group education visits for diabetes by the fact that these visits involve one physician and one or more additional health care professionals, usually a nurse practitioner and/or a pharmacist, and are designed to make management changes for a number of people with the same disease in a short period of time. The effect of group medical clinics on blood sugar, blood pressure, and the cost of diabetes care, is unknown.
OBJECTIVE(S):
Our primary objectives in this project are to determine the effectiveness and cost-effectiveness of a group visit intervention in improving rates of control of diabetes and high blood pressure in patints with both illnesses.
METHODS:
We are performing a multi-site, randomized, controlled trial of group medical visits for diabetes management. Patients will be patients in primary care at the Durham or Richmond VAMC’s who have inadequate control of both their blood sugar and their blood pressure. We will exclude patients with life-limiting illness. Patients randomized to the control arm will receive usual primary care. Patients randomized to the intervention arm will be assigned to attend a group medical clinic every two months for one year. In the clinic, a primary care physician, with the assistance of a nurse and a pharmacist, will measure blood pressure and hemoglobin A1c (a measure of blood sugar control) at the point of care, and then make all necessary medical changes for patients with diabetes. The primary outcomes will be proportion of patients in adequate blood sugar control, and proportion of patients in adequate blood pressure control. Additional outcomes will be adequate control of serum cholesterol, diabetes-specific quality of life, and health services utilization. Formative evaluation will be undertaken to determine the mechanism of the intervention and to prepare for more successful dissemination if the intervention is effective. Formal cost analysis will be performed and, if the intervention is effective, cost-effectiveness analysis will be undertaken. All outcomes will be measured at baseline, and 6 and 12 months after the beginning of the intervention.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
Diabetes is possibly the most burdensome chronic disease to VHA, with 18% of patients in VHA having diabetes and a larger percentage of visits and costs associated with the disease. Improvements in diabetes care would result in a significant improvement in the health of veterans, and any cost savings would be of importance to VHA as well. Group visits are in wide use throughout VHA and, indeed, the USA in a number of settings. A well-conducted trial showing either effectiveness or ineffectiveness of this strategy will have a major impact on the use of these group visits.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Prevention, Quality of Care
Keywords:
Diabetes, Outpatient, Primary care
MeSH Terms:
none
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