The Effects of a Group Visit Program on Outcomes of Diabetes Care in an Urban Family Practice

摘要

Diabetes mellitus is a prevalent chronic health condition associated with significant morbidity and mortality. Those with diabetes must acquire self-efficacy in the tasks necessary for them to successfully manage their disease. In this study, a controlled pre- and post-design was used to determine the effect of an adult support and education group visit program embedded in an urban academic family medicine practice on weight and the achievement of treatment goals for hemoglobin A1C, low-density lipoprotein (LDL) blood concentration, and blood pressure (BP) several months after it was implemented. Participants in the program were matched to a comparison group based on age, gender, race/ethnicity, and zip code group, a surrogate marker for socioeconomic status. The distribution of demographic characteristics and co-morbidities was similar between the groups. Significant increases occurred in the proportion of participants achieving both an A1C concentration <7% (CMH=4.6613, p = 0.0309) while controlling for baseline AIC concentration, and a BP<140/90 mm Hg (CMH=5.61, p = 0.018) controlling for baseline BP compared to the comparison group. The hemoglobin A1C concentration declined in 76.9% of the participants in the group visit program compared to 54.3% in the comparison group (CMH=8.9911, p = 0.0027). The increase in the proportion of group visit participants achieving the target LDL concentrations did not achieve statistical significance. The proportion of participants who lost weight was similar to that in the comparison group. Early experience with the program was encouraging and suggested it may improve patients’ management of their diabetes mellitus in an urban, predominantly African American population.