Can Group Visits Improve Outcomes of Veterans With Diabetes
Condition: Diabetes; Hypertension
MeSH terms: Hypertension; Diabetes Mellitus
Intervention: Diabetes Group Management Visits
Intervention description: Patients meet in groups and receive education about diabetes, reinforcing each other with their own experiences. Each patient also gets medication management by a physician and pharmacist.
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Enrollment: 239.0
Sex: All
Healthy volunteers: No
Keywords: Diabetes; Hypertension; Randomized controlled trials; cost-effectiveness; health services

Summary:

      Background: 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. Objectives: 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
      patients with both illnesses.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Primary care at one of two participating sites,

          -  HbA1c >= 7.5%, Systolic BP > 140 OR Diastolic BP > 90 on 2 consecutive measurements

        Exclusion Criteria:

        -Primary care provider excludes patient from study, -Patient states that primary care is
        shared with non-VA primary care provider, -New enrollment in endocrine clinic within the
        last 6 months, -Patient is reluctant to participate in group visit for any reason, -Reduced
        life expectancy, as determined by any of the following: -New York Heart Association Class
        IV congestive heart failure, -Lung disease requiring supplemental oxygen, -End-stage renal
        disease on dialysis, -Current malignancy with any evidence of disease or currently
        undergoing chemotherapy or radiation therapy, -Cirrhosis of the liver, or -AIDS (HIV
        disease does not exclude a patient in the absence of an AIDS diagnosis), -Five or more
        errors on Short Portable Mental Status Questionnaire, Psychotic illness with
        hospitalization within three years prior to enrollment