Effectiveness of group medical visits for improving diabetes care: a systematic review and meta-analysis

Abstract

Research CMAJBackground: Group medical visits, whereby health care professionals meet with groups of patients who have the same disease, have been introduced in primary care as a way to meet the increasing demand for health care delivery to patients with chronic diseases. We performed a systematic review and metaanalysis of the evidence on the effectiveness of such visits for patients with diabetes. Methods:We conducted a systematic review of all relevant studies published from 1947 to February 2012 identified in a search of electronic databases and grey literature. We included randomized controlled trials (RCTs) and observational studies published in English that included patients aged 16-80 years with type 1 or 2 diabetes and that had group medical visits as the intervention. These studies were assessed for methodologic quality.We included data only from the RCTs in the meta-analysis. Results:Of the 94 studies identified, we selected 26 that met our inclusion criteria, 13 of which were RCTs. Group medical visits had a positive effect on clinical and patient-reported outcomes, with significant reductions in glycated hemoglobin (HbA 1c reduction −0.46%, 95% confidence interval −0.80% to −0.31%). We were unable to assess the effect of group medical visits on processes of care because of an insufficient number of RCTs that reported on this outcome.Interpretation: Group medical visits for pa tients with diabetes were found to be effective in terms of reducing HbA 1c . The results of our metaanalysis suggest that wider implementation of group medical visits for patients with diabetes will have a positive effect on patient outcomes. Abstract

What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions? A systematic review

“…However, this report 67 originated from the Edelman trial 69 and would not be eligible for inclusion alongside the original report because of the risk of double counting. So, neither the meta-analysis by Edelman et al 18 nor that by Housden et al 53 is sensitive to the inclusion of the newly retrieved study.…”

“…A further seven reviews 47,49,51,[53][54][55]87 focused on one specific condition [in all bar one instance this condition was diabetes, with the exception being the review by Slyer and Ferrara 54 (heart failure)]. Two of the remaining reviews 42,50 were broadly coterminous with our own review, focusing on chronic disease in adults (however, we also included children and adolescents).…”

“…42,47,51 A further five reviews had a scope for the intervention that was broader than group clinics: for four of these reviews [48][49][50]54 this focus was labelled 'group visits' and for the remaining review 52 this was 'group care'. Two reviews 18,55 focused on SMAs and two reviews targeted GMVs; 53,57 both of these labels were considered coterminous with our own. The Cochrane review by Rolfe et al covered a heterogeneous mix of interventions for improving patient trust, one intervention of which was a group clinic approach.…”

“…In a review of 26 studies including 13 RCTs, Housden et al 53 reported a positive effect for GMAs on clinical and patient-reported outcomes, with significant reductions in HbA 1c . However, the team were unable to assess the effect of GMVs on processes of care because of an insufficient number of RCTs reporting this outcome.…”

“…The triallists found no such HbA 1c difference between group medical clinic and usual care patients using no insulin (p = 0.65) or basal insulin only (p = 0.71). 57 The same outcome measure was examined by Housden et al, 53 who included 10 studies in a meta-analysis, 20,59,69,75,77,81,[84][85][86]92 seven of which are included in our review. They reported a significant effect of group clinics on HbA 1c .…”