Group visits improved diabetes patients??

U.S. Veterans with uncontrolled diabetes and hypertension who attended a group medical clinic had better blood pressure control for up to one year compared with those who received usual care, according to new study findings.

The randomized, controlled trial assessed the effectiveness of group medial visits (GMCs) compared with usual care. Researchers assessed 239 primary care patients at the Veterans Affairs Medical Centers in Durham, N.C., and Richmond, Va. All patients had poorly controlled diabetes (HbA1c level ???7.5%) and hypertension (systolic BP >140 mm Hg or diastolic BP >90 mm Hg).

Patients were randomly assigned to a GMC or usual care group, with patients in the usual care group receiving typical primary care. Each GMC included seven to eight patients and a care team that consisted of a primary care physician, pharmacist and nurse or certified diabetes educator. Groups met every two months for a total of seven visits during one year.

Benefits of group visits

At the end of the study, mean systolic BP improved by 13.7 mm Hg in the GMC group vs. 6.4 mm Hg in the usual care group, from a mean 152.9 mm Hg at baseline (P=.011).

Twenty-two percent of patients in the GMC group achieved BP control at the end of the study compared with 12% in the usual care group (OR=2; 95% CI, 1-4.2).

Patients who attended GMCs also experienced a 0.8% improvement in HbA1c vs. a 0.5% improvement for those who received usual care, from a mean HbA1c of 9.2% at baseline (P=.159).

Researchers further observed a 1.6-point improvement in perceived competence scores among those who attended GMCs compared with usual care.

More than half of the patients in the GMC group reported no falls or lightheadedness compared with 37% of the usual care group (P=.006). In addition, GMCs were also associated with fewer emergency care visits (0.4 vs. 1.3 visits per year; P

<.001) and primary care visits (5.3 vs. 6.3 visits per year; P=.010). Twenty-three patients (17%) were hospitalized 32 times in the GMC group vs. 23 patients (22%) hospitalized 39 times in the usual care group (OR=0.8; 95% CI, 0.4-1.4).

The estimated cost of conducting each group visits was $504, with a per patient cost of $63. The annual per patient cost was estimated to be $441 if patients attended all seven sessions. These values were calculated using 2009 dollars.

???If found to be cost-effective and efficient, GMCs would be implemented in a wide-range of settings and become important in the remodeling of long-term care in the United States,??? the researchers concluded.

Edelman D. Ann Intern Med. 2010;152:689-696.