Managed care organizations have begun using group visits to doctors by patients with the same disease as one way to improve efficiency and control health care costs. This approach improved the diabetes care of uninsured and inadequately insured diabetes patients, according to a pilot study supported in part by the Agency for Healthcare Research and Quality (HS10871). Since group visits last longer than the typical primary care visit, they offer the provider more time to address diabetes-specific issues. Also, seeing the doctor on a monthly basis gives patients more opportunities to ask questions.
Researchers from the Medical University of South Carolina randomly assigned 120 uninsured or inadequately insured patients with uncontrolled type 2 diabetes to receive their care in group visits (59 patients) or usual care (individual visits, 61 patients) for 6 months. After 6 months, they examined the patients' medical charts to evaluate how many of the 10 standards of care recommended by the American Diabetes Association (ADA) were followed: up-to-date HbA1c (blood-sugar) levels and lipid profiles, urinalysis to test for microalbumin, appropriate use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers, use of lipid-lowering agents where indicated, daily aspirin use, annual foot examinations (to detect circulation problems and prevent wound infections), annual referral for retinal examinations (to detect diabetic retinopathy), and pneumonia and influenza immunizations.
Three-quarters (76 percent) of patients who received care in group visits were up to date on at least nine of these ten items, compared with 23 percent of control patients. Also, 86 percent of patients in group visits had at least eight of the ten indicators, compared with 47 percent of control patients. There were no significant differences seen in diabetes or lipid control, but this was probably due to the small sample size and short duration of the pilot study, note the researchers.
See "Evaluating concordance to American Diabetes Association standards of care for type 2 diabetes through group visits in an uninsured or inadequately insured patient population," by Dawn E. Clancy, M.D., Dennis W. Cope, M.D., Kathryn Marley Magruder, M.P.H., Ph.D., and others, in the July 2003 Diabetes Care 26(7), pp. 2032-2036.