Improving Outcomes Using Collaborative Group Clinics to Empower Older Patients
Condition: Diabetes; Hypertension
MeSH terms: Hypertension
Study type: Interventional

Summary: 
      The purpose of this study is to determine if group clinics help older veterans change
      behaviors with the goal of improving diabetes outcomes.
    

Detailed description: 
      Among persons aged 55-84 years, over 65% have one to three common medical conditions (e.g.,
      hypertension, diabetes, arthritis, stroke, heart disease, etc.). Fortunately, large
      randomized clinical trials have demonstrated the effectiveness of treatment and prevention
      strategies for many chronic conditions (e.g., dietary modification and medications for
      hypertension, intensive glucose monitoring with diet and medication regimens for diabetes,
      etc.). Despite the significant findings from numerous clinical trials, most older persons
      continue to suffer from uncontrolled hypertension, hyperglycemia, and other predictors of
      poor health outcomes. Non-compliance with clinical guidelines by providers (i.e. clinical
      inertia) and non-adherence to doctors' recommendations are typically blamed for these
      unacceptably poor outcomes. For older adults with several conditions, the processes of
      patient-clinician collaboration are not well understood. Goal-setting behaviors may improve
      health care by linking desired outcomes (i.e., reduce risk of heart attacks) to the goals of
      care (i.e., salt restriction for hypertension control). Furthermore, the process of
      goal-setting may be more effective if patients internalize the importance of a particular
      goal and prioritize that goal among multiple clinical problems (i.e., hypertension care for
      patients with diabetes.

      Effective methods of implementing collaborative goals and training patients to negotiate
      shared goals and goal-directed behaviors with their clinicians have been developed for
      diabetes control. The effectiveness of these methods may be enhanced through the use of
      clinics that enroll small groups of subjects with rapid follow-up for several weeks. Group
      clinics have demonstrated improved outcomes for common chronic conditions. Evidence
      demonstrating the synergistic benefit of efficient group clinics and collaborative
      goal-setting is limited. However, an approach combining these methodologies may provide an
      improved method of rapidly controlling multiple chronic conditions and maintaining control of
      those chronic conditions over a prolonged time period.

      To address the gap in the implementation of effective and efficient medical care, we will
      develop and test a model of collaborative group clinics that empowers older patients to adopt
      goal-setting behaviors, increases communication with their health care provider, and improves
      their diabetes-related outcomes. The objectives are to use a collaborative group clinic to:
      1) Improve diabetes process of care outcomes over a 3 month time period; 2) Significantly
      improve the maintenance of diabetes process of care improvements over a 12 month time period;
      and 3) Significantly improve use of self-management behaviors for diabetes care.
    

Intervention name(s): Improving outcomes using group clinics for older patients; Standard of Care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Collaborative group clinics to empower older patients to adopt goal-setting behaviors with their health care providers and improve their diabetes-related outcomes.; Standard of care for diabetes patients
Other intervention name(s): Diabetes Group Clinic; Goal-setting Clinic; Diabetes usual care
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Group clinics; Goal setting; Diabetes; Hypertension; Age 50+