Diabetes group visits: Integrated medical care and behavioral support to improve diabetes care and outcomes from a primary care perspective

Current Diabetes Reports

Volumn 13, Issue 2, 2013, Pages 177-187

  Eisenstat, Stephanie A ^a,b   Ulman, Kathleen ^a,b   Siegel, Allison L ^c   Carlson, Karen ^a,b  

^a HARVARD MEDICAL SCHOOL   (United States)

^b MASSACHUSETTS GENERAL HOSPITAL   (United States)

^c The John D Stoeckle Center for Primary Care Innovation   (United States)

Author keywords

Behavioral change; Behavioral support; Diabetes; Group visits; Medical care; Self management; Shared medical appointments

Indexed keywords

HEMOGLOBIN A1C;

BEHAVIOR CHANGE; CLINICAL DECISION MAKING; CLINICAL EFFECTIVENESS; CLINICAL OBSERVATION; COST EFFECTIVENESS ANALYSIS; DIABETES EDUCATION; DIABETES MELLITUS; HEALTH CARE ACCESS; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE PERSONNEL; HEALTH INSURANCE; HEALTH PROGRAM; HIGH RISK POPULATION; HUMAN; INTEGRATED HEALTH CARE SYSTEM; OUTCOMES RESEARCH; PATIENT EDUCATION; PATIENT REFERRAL; PATIENT SATISFACTION; PERSONALIZED MEDICINE; PRIMARY HEALTH CARE; QUALITY OF LIFE; RANDOMIZED CONTROLLED TRIAL (TOPIC); REIMBURSEMENT; RELAXATION TRAINING; RESOURCE ALLOCATION; REVIEW; SELF CARE; STUDY DESIGN;

EID: 84878633606     PISSN: 15344827     EISSN: 15390829     Source Type: Journal    
DOI: 10.1007/s11892-012-0349-5     Document Type: Review

References (128)

1. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States. 2011. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2011.
2. Kochanek KD, Murphy SL, Minino AM, et al. Deaths: final data for 2009. National Vital Statistics Report; 60(3). Hyattsville: National Center for Health Statistics; 2011.
3. Glasgow RE, Ruggiero L, Eakin E, et al. Quality of life and associated characteristics in a large national sample of adults with diabetes. Diabetes Care. 1997;20(4):562-7.
4. Fisher L, Mullan J, Arean P, et al. Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care. 2010;33(1):23-8.
5. Anderson RJ, Freedland KE, Clouse RE, et al. The prevalence of comorbid depression in adults with diabetes: A meta analysis. Diabetes Care. 2001;24(6):1069-78.
6. Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of depressive symptoms on adherence, function and costs. Arch Intern Med. 2000;160(21):3278-85.
7. Lustman PJ, Anderson RJ, Freedland KE, et al. Depression and poor glycemic control: A meta-Analytic review of the literature. Diabetes Care. 2000;23:934-42.
8. Rubin R, Peyrot R. Psychological issues and treatments for people with diabetes. J Clin Psychol. 2001;57(4):457-78.
9. Egede LE, Zheng D, Simpson L. Comorbid depression is associated with increase health care use and expenditures in individuals with diabetes. Diabetes Care. 2002;25(3):464-70.
10. Lin E, Katon W, Von Korff M, et al. Relationship of depression and diabetes self care, medication adherence and preventive care. Diabetes Care. 2004;27(9):2154-60.
11. Ludman EJ, Katon W, Russo J, et al. Depression and diabetes symptoms burden. Gen Hosp Psychiatry. 2004;26:430-6.
12. McKellar JD, Humphreys K, Piette JD. Depression increases diabetes symptoms by complicating patients' self care adherence. Diabetes Educ. 2004;30:485-92.
13. Simon G, Katon W, Lin E. Diabetes complications and depression as predictors of health care costs. Gen Hosp Psychiatry. 2005;27:344-51.
14. Golden SH, Lazo M, Carnethon M, et al. Examining a bidirectional association between depressive symptoms and diabetes. JAMA. 2008;299:2751-9.
15. Kurtz SMS. Adherence to diabetes regimens: empirical status and clinical applications. Diabetes Educ. 1990;16:50-6.
16. Ciechanowski PS, Katon WJ, Russo JE, et al. The relationship between depressive symptoms to symptom reporting, self care and glucose control in diabetes. Gen Hosp Psychiatry. 2003;25(4):246-52.
17. Gonzalez JS, Safren SA, Cagliero E, et al. Depression, self care and medication adherence in type 2 diabetes. Relationship across the full range of symptom severity. Diabetes Care. 2007;30(9):2222-7.
18. Gonzalez JS, Peyrot M, McCarl LA, et al. Depression and diabetes treatment. Nonadherence: A meta-Analysis. Diabetes Care. 2008;31(12):2398-403.
19. Funnell MM, Anderson RM. Empowerment and self management of diabetes. Clin Diabetes. 2004;22:123-7.
20. Glasgow RE, Fisher EB, Anderson BJ, et al. Behavioral science in diabetes. Contributions and opportunities. Diabetes Care. 1999;22:832-43.
21. The State of Healthcare Quality. Annual Report., Available at: http://web.ncqa.org/tabid/543/Default.aspx. Accessed August 31, 2012
22. Holman H, Lorig K. Patients as partners in managing chronic disease. Partnership is a prerequisite for effective and efficient health care. BMJ. 2000;320:526-7.
23. HealthyPeople.gov. Health people 2020: goals and objectives-diabetes. Washington DC: Dept Health and Human Services, 2011. http://healthypeople.gov/ 2020/topicsobjectives2020/overview.aspx?topicid=8
24. American Diabetes Association. Standards of Medical Care 2012. http://care.diabetesjournals.org
25. Norris SL, Engelgau MM, Narayan KM. Effectiveness of self management training in type 2 diabetes: A systematic review of randomized controlled trials. Diabetes Care. 2001;2493:561-87.
26. Chodosh J, Morton SC, Mojica W, et al. Meta-Analysis: chronic disease self-management programs for older adults. Ann Intern Med. 2005;143:427-38.
27. Deakin T, McShane CE, Cade JE, et al. Group based training for self management strategies in people with type 2 diabetes. Cochrane Database Syst Rev 2005; CD003417.
28. Trento M, Gamba S, Gentile L, et al. Rethink organizations to improve education and outcomes (ROMEO). A multicenter randomized trial of lifestyle intervention by group care to manage type 2 diabetes. Diabetes Care. 2010;33(4):745-7. This 4-year multicenter Italian randomized trial of lifestyle intervention using the group visit model to manage type 2 diabetes demonstrated improvement in standard diabetes health measurements (i.e., HgbA1c, cholesterol and blood pressure) and health behaviors, quality of life, and knowledge of diabetes.
29. Funnell MM, Anderson RM. Changing office practice and health care systems to facilitate diabetes self-management. Diabetes Care. 2003;3:127-33.
30. Pratt JH. The efficient treatment of pulmonary TB among poor with special reference to the class method. The Association, 1908.
31. MacKensie KR. The class method of treating consumption in the homes of the poor. In Classic in Group Psychotherapy. NY: Guildford Press, 1992. p. 25.
32. Wagner EH. Diversifying the options for interacting with patients. Qual Saf Healthcare. 2007;16:322-3.
33. Scott J, Robertson B. Kaiser Colorado's cooperative health care clinic: A group approach to patient care. Manag Care Q. 1996;4(3):41-5.
34. Scott J, Gade G, McKenzie M, et al. Coopertive health care clinics: A group approach to individual care. Geriatrics. 1998;53(5):68-81.
35. Scott J, Conner D, Venohr I, et al. Effectiveness of group outpatient visit model for chronically ill older health maintenance organization members: A 2 year randomized trial of the cooperative health care clinic. J Am Geriatr Soc. 2004;52(9):1463-70.
36. Noffsinger EB, Scott JC. Understanding today's group-visit models. Permanente J. 2000;48(2):48-56.
37. Noffsinger E. Physicals shared medical appointments: A revolutionary access solution. Group Pract J. 2002; 1-9.
38. Noffsinger E. Group visits for efficient, high- quality chronic disease management. Group Pract J. 2008;57(2):23-40.
39. Noffsinger E. Running group visits in your practice. NY: Springer; 2009.
40. Jaber R, Braksmajer A, Trilling JS. Group visits: A qualitative review of current research. J Am Board Fam Med. 2006;19(3):276-90.
41. Beck A, Scott J, Williams P, et al. A randomized trial of group outpatient visits for chronically ill older HMO members: the Cooperative Health Care Clinic. J Am Geriatr Soc. 1997;45(5):543-9.
42. Sadur CN, Moline N, Costa M, et al. Diabetes management in a health maintenance organization. Efficacy of care management using cluster visits. Diabetes Care. 1999;22(12):2011-7.
43. Masley S, Sokoloff J, Hawes C. Planning group visits for high risk patients. Fam Pract Med. 2000;7(6):33-7. Available at: http://www.aafp.org/fpm/ 20000600/33plan.html.
44. Masley S, Phillips S, Copeland JR. Group office visits change dietary habits of patients with coronary artery disease. J Fam Pract. 2001;50:235-9.
45. Trento M, Passera P, Tomalino M, et al. Group visits improve metabolic control in type 2 diabetes: A 2-year follow-up. Diabetes Care. 2001;24(6):995-1000.
46. Trento M, Passera P, Bajardi M, et al. Lifestyle intervention by group care prevents deterioration of type II diabetes: A 4-year randomized controlled clinical trial. Diabetologia. 2002;45(9):1231-9.
47. Trento M, Passera P, Borgo E, et al. A 5 year randomized controlled study of learning, problem solving ability and quality of life modifications in people with type 2 diabetes managed by group care. Diabetes Care. 2004;27(3):670-5.
48. Trento M, Passera P, Borgo E, et al. A 3 year prospective randomized controlled clinical trial of group care in type 1 diabetes. Nutr Metab Cardiovasc Dis. 2005;15(4):293-301.
49. Coleman EA, Eilertsen TB, Kramer AM, et al. Reducing emergency visits in older adults with chronic illness- A randomized, controlled trial of group visits. Eff Clin Pract. 2001;4(2):49-57.
50. Howard B. Group appointments-just what the doctor ordered. Minn Med. 2002;85(6):59.
51. Ickovics JR, Kershaw TS, et al. Group prenatal care and preterm birth weight: results from a matched cohort study at public clinics. Obstet Gynecol. 2003;102:1051-7.
52. Houck S, Kilo C, Scott J. Improving patient care: group visits 101. Fam Pract Manag 2003:1-3.
53. Clancy DE, Cope DW, Magruder KM, Huang P, Wolfman TE. Evaluating concordance to American Diabetes Association standards of care for type 2 diabetes through group visits in an uninsured or inadequately insured patient population. Diabetes Care. 2003;26(7):2032-6.
54. Clancy DE, Huang P, Okonofua E, et al. Group visits: promoting adherence to diabetes guidelines. J Gen Intern Med. 2007;22(5):620-4.
55. Blumenfeld A, Tischio M. Center of excellence for headache care: group model at Kaiser Permanente. Headache. 2003;43(5):431-40.
56. Sanchez I. Implementation of a diabetes self management education program in primary care for adults using shared medical appointments. Diabetes Educ. 2011;37(4):381-91. This quality improvement project in primary care setting evaluated diabetes self-management education based on the chronic care model using shared medical appointments. They found improvement in diabetes outcomes consistent with other studies in the literature, increased revenue, improvement in disease management, and increased patient and provider satisfaction.
57. Bronson D, Maxwell R. Shared medical appointments: increasing patient access without increasing physician hours. Cleve Clin J Med. 2004;71(5):369-77.
58. Thacker H, Maxwell R, Saporito J, et al. Shared medical appointments: facilitating interdisciplinary care for midlife women. J Women's Health. 2005;14:867-70.
59. Bray P, Thompson D, Wynn JD, et al. Confronting disparities in diabetes care: the clinical effectiveness of redesigning care management for minority patients in rural primary care practices. J Rural Health. 2005;21(4):317-21.
60. Culhane-Pera K, Peterson KA, Crain AL, et al. Group visits for Hmong adults with type 2 diabetes mellitus: A pre-post analysis. J Health Care Poor Underserved. 2005;16(2):315-27.
61. Meehan KR, Hill JM, et al. Group medical appointments: organization and implementation in the bone marrow transplantation clinic. Support Cancer Ther. 2006;3(2):84-90.
62. Gaynor CH, Vincent C, Safranek S. Group medical visits for the management of chronic pain. American Family Physician 2007:76(1): https://www.aafp.org/ afp/20071201/fpin.html
63. Kirsh S, Watts S, et al. Shared medical appointments based on the chronic care model: A quality improvement project to address the challenges of patients with diabetes with high cardiovascular risk. Qual Saf Health Care. 2007;16(5):349-53.
64. Kirsh SR, Lawrence RH, Aron DC. Tailoring an intervention to the context and system redesign related to the intervention: A case study of implementing shared medical appointments for diabetes. Implement Sci. 2008;3:34.
65. De Vries B, Darling-Fisher C, Thomas AC, Belanger-Shugart EB. Implementation and outcomes of group medical appointments in an outpatient specialty care clinic. J Am Acad Nurse Pract. 2008;20:163-16.
66. Yehle KS, Sands LP, et al. The effect of shared medical visits on knowledge and self-care in patients with heart failure: A pilot study. Heart Lung. 2009;38(1):25-33.
67. Shojania K, Ratlaff M. Group visits for rheumatoid arthritis: A pilot study. Clin Rheumatol. 2010;29(6):625-8.
68. Sikon A, Bronson D. Shared medical appointment: challenges and opportunities. Ann Intern Med. 2010;152(11):745-6.
69. Taviera TH, Friedmann PD, et al. Pharmacist-led group medical appointment model in type 2 diabetes. Diabetes Educ. 2010;36(1):109-17.
70. Levine MD, Ross TR, et al. Implementing group medical visits for older adults at group health cooperative. J Am Geriatr Soc. 2010;58(1):168-72.
71. Bartley KB, Haney R. Shared medical appointments: improving access, outcomes, and satisfaction for patients with chronic cardiac disease. J Cardiovasc Nurs. 2010;25(1):13-9.
72. Palaniappan LP, Muzaffar AL, et al. Shared medical appointments: promoting weight loss in a clinical setting. J Am Board Fam Med. 2011;24(3):326-8.
73. Dorsey ER, Deuel LM, Beck CA, et al. Group patient visits for Parkinson disease: A randomized feasibility trial. Neurology. 2011;76(18):1542-7.
74. Greer D, Hill DC. Implementing an evidence-based metabolic syndrome prevention and treatment program utilizing group visits. J Am Acad Nurse Pract. 2011;23:76-83.
75. Geller JS, Orkaby A, Cleghorn GD. Impact of a group medical visit program on Latino health-related quality of life. Explore (NY). 2011;7(2):94-9.
76. Wall-Haas CL, Kulbok P, Kirchgessner J, et al. Shared medical appointments: facilitating care for children with asthma and their caregivers. J Pediatr Health Care. 2012;26(1):37-44.
77. Wagner E, Grothaus L, Sandhu N, et al. Chronic care clinics for diabetes in primary care. A system wide randomized trial. Diabetes Care. 2001;24:695-700.
78. Clancy DE, Cope DW, Magruder KM, et al. Evaluating group visits in an uninsured or inadequately insured patient population with uncontrolled type 2 diabetes. Diabetes Educ. 2003;29(2):292-302.
79. Kulzer B, Hernanns N, Reinecker H, et al. Effects of self management training in type 2 diabetes: A randomized prospective trial. Diabet Med. 2007;24(4):415-23.
80. Coleman EA, Grothaus LC, Sandhu N, Wagner EH. Chronic care clinics: A randomized controlled trial of a new model of primary care for frail older adults. J Am Geriatr Soc. 1999;47(7):775-83.
81. Clancy DS, Dismuke CE, Magruder KM, et al. Do diabetes group visits lead to lower medical care charges? Am J Manag Care. 2008;14:39-44.
82. Eisenstat S, Siegel AL, Carlson K, Ulman K. Putting group visits into practice. A practical overview to preparation, implementation and maintenance of group visits at MGH. Internal Handbook. Boston: John D Stoeckle Center for Primary Care Innovation, January 2012. http://www.massgeneral.org/ stoecklecenter/assets/pdf/group-visit-guide.pdf
83. Wenger E, McDermott R, Snyder W. Cultivating communities of practice. Boston: Harvard BusinessReview Press; 2002.
84. Groopman J. The anatomy of hope: how people prevail in the face of illness. New York: Random House Trade Paperbacks; 2005.
85. Kleinberg J. Restoring hope through post-trauma groups. Group. 2007;31(4):293-308.
86. Ulman, K. The many layers of hope in group psychotherapy. Anne and Ramon Alonso Presidential Plenary Address. Annual Meeting of the American Group Psychotherapy Association: New York City, March 9, 2012. https://www. hungrymindrecordings.com/ProductListing.aspx?Id-Category=166 (DVD No.: AGPA12-FRI)
87. Yalom I, Leszcz M. The theory and practice of group psychotherapy. 5th ed. New York: Basic Books; 2005.
88. Peyrot M, Rubin R. Behavioral and psychological interventions in diabetes. A conceptual review. Diabetes Care. 2007;30(10):2433-40.
89. Goodman B. Group therapy for medically ill patients. In: Halperin DA, editor. Group psychodynamics: new paradigms and new perspectives. Chicago: YearBook Medical; 1989. p. 107.
90. Goldstein D, Fransve LM. Group psychotherapy for chronic illness: clinical applications of selected empirical studies. Int J Group Psychother. 2009;59:577-83.
91. Leszcz M. Introduction to special issue on group psychotherapy for the medically ill. Int J Group Psychother. 1998;48:137-42.
92. Ulman K. Group psychotherapy with the medically ill. In: Kaplan HI, Saddock BJ, editors. Comprehensive group psychotherapy. III ed. Baltimore: Williams and Wilkins; 1993. p. 459-70.
93. Ulman K. An integrative model of stress management groups for women. Int J Group Psychother. 2000;50(3):341-36.
94. Ulman K. Treatment. In: Schein LA, Bernard HS, Spit HI, Muskin PR, editors. Psychological treatment for medical conditions. New York: Brunner-Routledge; 2003.
95. Edelman D, McDuffie J, Oddone E, et al. Shared medical appointments for chronic medical conditions. Evidence based synthesis program. Washington DC: Department of Veterans Affairs; 2012. This recent systematic review uses rigorous methodology to evaluate the effectiveness of group visits, focusing on studies in diabetic and older adult populations.
96. Riley SB, Marshall ES. Group visits in diabetes care: A systematic review. Diabetes Edu. 2010;36(6):936-44.
97. Burke RE, Ferrara SA, Fuller A, et al. The effectiveness of group medical visits on type 2 diabetes mellitus (DM2) specific outcomes in adults: A systematic review. Joanna Briggs Institute. 2011;9(23):833-85.
98. Burke R, OGrady E. Group visits hold great potential for improving diabetes care and outcomes, but best practices must be developed. Heal Aff. 2012;31(1):103-9.
99. Simmons C, Kapustin JF. Diabetes group visits: An alternative to managing chronic disease outcomes. J Nurs Pract. 2011;7(8):671-9.
100. Naik AD, Palmer N, Petersen NJ, et al. Comparative effectiveness of goal setting in diabetes mellitus group clinics: randomized clinical trial. Arch Intern Med. 2011;171(5):453-9.
101. American Heart Assocation. Heart Disease and Stroke Statistics-2007 Update. http://www.americanheart.org/downloadable/heart/1166711577754HS- StatsInsideText.pdf
102. Wexler DJ, Grant RW, Meigs JB, et al. Sex disparities in treatment of cardiac risk factors in patients with type 2 diabetes. Diabetes Care. 2005;28:514-20.
103. Slomski AJ. What a behavioral specialist could add to your practice. Med Econ. 2000;77(11):149-71.
104. Prochaska J, Norcross J, DiClemente C. Changing for good: A revolutionary six stage program for overcoming bad habits and moving your life positively forward. NY: Harper Collins Publishers Press; 1994.
105. Funnell MM, Nwankwo R, Gillard ML, et al. Implementing an empowerment based diabetes self management education program. Diabetes Educator. 2005;31(1):53-61.
106. Funnell M, Brown T, Childs B, et al. National standards for diabetes self-management education. Diabetes Care. 2010;33(S1):S89-96.
107. Rice B. Mind-body interventions. Diabetes Spectr. 2001;14(4):213-7.
108. Astin JA, Shapiro SL, Eisenberg DM, Forys KL. Mind-body medicine: state of the science, implications for practice. J Am Board Fam Med. 2003;2003:16,131-147.
109. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-13.
110. Kroenke K, Spitzer RL, Williams JB. The Patient health questionnaire-2: validity of a two item depression screener. Med Care. 2003;41:1284-94.
111. Anderson D, Horton C. Integrating depression care with diabetes care in real-world settings: lessons from the Robert Wood Johnson Foundation Diabetes Initiative. Diabetes Spectr. 2007;20:10-6.
112. Beck ET, Guth D, Steer RA, et al. Screening for major depression disorders in medical inpatients with the Beck Depression inventory for primary care. Behav Res Thera. 1997;35:785-91.
113. Polansky W. Understanding and assessing diabetes-specific quality of life. Diabetes Spectr. 2000;13:36-49.
114. Polansky WH, Fisher L, Earles J, et al. Assessing psychological distress in diabetes. Development of diabetes distress scale. Diabetes Care. 2005;28(3):626-31.
115. Jacobson A, DeGroot M, Samson J. The evaluation of two measures of quality of life in patients with type 1 and type 2 diabetes. Diabetes Care. 1994;17(4):267-74.
116. Anderson RJ, Funnell M, Fitzgerald J. The diabetes empowerment scale. A measure of psychosocial self-efficacy. Diabetes Care. 2000;23(6):739-43.
117. Weinger K, Welch G, et al. Measuring diabetes self-care. A psychometric analysis of the Self-care Inventory-revised with adults. Diabetes Care. 2005;28(6):1346-52.
118. Hibbard JH, Mahoney ER, Stockard J, et al. Development and testing of a short form of the patient activation measure. Health Serv Res. 2005;40(6):1918-30.
119. Blais M, Lenderking W, Baer L, et al. Development and initial validation of a brief mental health outcome measure. J Personal Assess. 1999;73(3):359-73.
120. Lorig KR, Sobel DS, Ritter PL, et al. Effect of a self-management program for patients with chronic disease. Eff Clin Pract. 2001;4:256-62.
121. Thompson E. The power of group visits. Improved quality of care, increased productivity entice physicians to see up to 15 patients at a time. Mod Healthc. 2000;30(23):54. 56,62.
122. Gutman J (Ed) Group visits can lift revenues, efficiency, quality for docs with many kinds of patients. Physician Compens Rep 2004;5(10):1-4
123. Bowers J. Shared visits improve access, productivity and satisfaction. ACP Internist 2009; October: 1-4.
124. Watts S, Gee J, O'Day ME, et al. Nurse practitioner-led multidisciplinary teams to improve chronic illness care: the unique strengths of nurse practitioners applied to shared medical appointment/group visits. J Am Acad Nurse Pract. 2009;21:167-72.
125. American Academy of Family Practitioners. Coding for Group visits, 2010. www.aafp.org
126. BlueCross BlueShield of North Carolina. Corporate Medical Policy. http://www.bcbsnc.com/content/services/medical-policy/updates/ medical-policy-updates-2011-01-04.htm
127. American Medical Association. CPT Coding, Medical Billing and Insurance. https://www.ama-Assn.org/ama/pub/physician-resources/solutions-managing-your- practice/coding-billing-insurance/cpt.page
128. Stange KS, Nutting PA, Miller WL, et al. Defining and measuring the patient-centered medical home. J Gen Intern Med. 2010;25(6):601-12.