Group Medical Education Visits

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Group Medical Education Visits

• Presentation by
• Jeanine Wilson

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My Family Medicine Rotation Clinton Family
Health Center

• Four full-time providers
• 8000 patients
• Inner city practice, mostly Hispanic
• High rate of Medicaid and uninsured

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What is a group visit?

• Group medical visits give 8-12 willing patients
  more access to their provider by meeting for a
  90 minute shared visit

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Group Medical Education Visits

• Appropriate for any type of chronic medical
  condition
• Diabetes
• Asthma
• Chronic Pain
• CHF
• Depression
• Cancer
• Orthopedic Procedures

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Why they do group visits

• Education, education, education which in turn
• Increases compliance with meds
• Decreases hospital visits
• Increases patients health
• Increases pt knowledge which leads to empowerment

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What they incorporate

• Education
• Social concerns
• Psychological concerns
• 15 minute office visit

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How they work

• Pts are invited by their provider
• Groups meet 1x per month for 1.5 - 2 hrs
• Each visit covers a pertinent topic related to
  disease
• Individual progress is discussed
• Each group has time for questions and answers

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Who is involved

• 8-12 pts per group
• Their provider
• Their nurse
• A secretary or medical assistant

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Group Office Visit
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The Facts

• 20.8 million people in US have diabetes (7 of
  population)1
• 1.5 million new cases were diagnosed in 20051
• Diabetes is the 6th leading cause of death due to
  its many complications
• 1. U.S. Department of Health and Human Services,
  Centers for Disease Control and Prevention, 2005.
  

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Groups increase patient and provider satisfaction

• Improved sense of trust in physician (p 0.2)2
• If given the choice, pts preferred group visits
  over individual office visits3
• Pts had much higher level of satisfaction4
• 2. Clancy DE, Brown SB, Magruder KM, Huang P.
  Group visits in medically and economically
  disadvantaged patients with type 2 diabetes and
  their relationships to clinical outcomes. Top
  Health Inf Manage. 2003248-14.
• 3. Trento M, Passera P, Bajardi M, et al.
  Lifestyle intervention by group care prevents
  deterioration of type II diabetes A 4-year
  randomized controlled clinical trial.
  Diabetologia. 2002451231-1239.
• 4. Sadur C, Moline N, Costa M, et al. Diabetes
  management in a health maintenance organization
  Efficacy of care management using cluster visits.
  Diabetes Care. 1999222011-2017.

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Groups increase compliance with ADA standards of
care

• Standards include
• HbA1C levels
• Lipid Profiles
• Urine for microalbumin
• Appropriate use of an Ace-I or ARB
• Use of a statin
• Daily aspirin use
• Annual foot exam
• Annual eye exam
• Immunizations against Strep
• and Influenza

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Groups increase compliance with ADA standards of
care

• Pts in groups showed significant concordance
  (plt.001)5
• 76 reached 9/10 standards, control group 235
• Statistically significant improvement in
  standards (plt.001)2
• 5. Clancy DE, Cope DW, Magruder KM, Huang P,
  Wolfman TE. Evaluating concordance to american
  diabetes association standards of care for type 2
  diabetes through group visits in an uninsured or
  inadequately insured patient population. Diabetes
  Care. 2003262032-2036.

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Group visits decrease hospitalization

• Hospital (p .04) and outpatient (p lt .01)
  utilization significantly lower for intervention
  patients4
• ER visits among the intervention group were 33
  lower and had fewer hospital admissions than the
  comparison group (p lt .05)6
• 6. Balamurugan A, Ohsfeldt R, Hughes T, Phillips
  M. Diabetes self-management education program for
  medicaid recipients A continuous quality
  improvement process. Diabetes Educ.
  200632893-900.

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ED visits per 1000 members per year7
7. Sutton, James B., RPA-C. Putting it all
together Team building, open access, and planned
care in one change package. Clinton Family
Health Center, Rochester NY2006.
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Group visits increase knowledge

• A 2-year follow-up study showed that knowledge of
  diabetes improved in the intervention group8
• A 5-year study showed that knowledge kept
  increasing (p lt.001) for pts in groups compared
  to control, whose knowledge tended to gradually
  decrease (p lt .005)9
• 8. Trento M, Passera P, Tomalino M, et al. Group
  visits improve metabolic control in type 2
  diabetes A 2-year follow-up. Diabetes Care.
  200124995-1000.
• 9. Trento M, Passera P, Borgo E, et al. A 5-year
  randomized controlled study of learning, problem
  solving ability, and quality of life
  modifications in people with type 2 diabetes
  managed by group care. Diabetes Care.
  200427670-675.

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Group visits decrease or stabilize HbA1C

• Every percentage point drop in HbA1C levels (8.0
  to 7.0 for example) reduces the risk of
  microvascular complications by 40.1
• In a study involving 180 diabetics HbA1C levels
  declined by 1.3 in the intervention subjects
  versus 0.2 in the control subjects (p lt .0001).4
• In a two-year follow-up, HbA1C levels had
  remained stable in the group patients but had
  worsened in control patients (p lt .002).8

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To Summarize

• The components of individual medical visits are
  included in group visits
• There is a focus on updating immunizations and
  routine health maintenance
• A broader range of prevention information can be
  covered
• Greater attention is put on psychosocial needs

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• Preparation is needed before implementing groups
• The patients provider and nurse are present at
  each meeting
• The help and support of other patients is a part
  of the health care experience
• The patients are invited to bring a family member
  or friend for support
• For insurance purposes the visit is billed the
  same as a level 3 office visit

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Additional Information

• Group Visit Starter Kit
• http//www.improvingchroniccare.org/improvement/do
  cs/startkit.doc
• Interesting news report http//www.13wham.com/medi
  acenter/default.aspx?videoId178200_at_video.wokr13.c
  om