TITLE:
Diabetes group medical visits and outcomes of care in low-income, rural, uninsured persons
AUTHORS:
Jennifer A. Mallow, Laurie A. Theeke, Tara Whetsel, Emily R. Barnes
KEYWORDS:
Diabetes; Group Visits; Uninsured; Rural
JOURNAL NAME:
Open Journal of Nursing,
Vol.3 No.3,
July
19,
2013
ABSTRACT:
Purpose: The purpose
of this study was to test the effectiveness of Diabetes Group Medical Visits
(DGMVs) verses usual care in a sample of low-income
patients with diabetes receiving care at a rural free clinic. Methods: Data
were collected through chart review, using direct data entry into Microsoft
Access. Participants were included if they met the inclusion criteria: 1) age ≥ 18 years; 2) diagnosis of diabetes; 3) uninsured and
received care between May 2007 and August
2009. Fifty-three participants attended DGMVs and were compared to 58
participants who received usual care. Results: The personal characteristics and
biophysical measures of this population differed from previously studied Group
Visit populations. The majority of patients were female (73.9%), white
(95.5%), younger than 50 (53.2%), driving long distances to receive care (mean
miles = 21, SD 20.4) and had a high school education or less (95.4%). Participants
were severely obese (mean BMI = 37.6, SD 28.48) and had 5 co-morbid conditions other than diabetes (mean = 5.5, SD
2.1). Those attending DGMVs had higher baseline A1C, depression scores, BMIs, and more pain than usual
care. There was a statistically significant decrease in systolic pressure
from time one to time two in patients who attended DGMVs t(52) = 2.18, (p = 0.03). There was no significant impact on
outcomes of patients who received usual care. However, it is important to
note that the majority of patients attended three or fewer DGMVs visits in
one year. Conclusion: Group visits may not be enough to improve outcomes in
this population. Previous studies suggest that improvements are seen in those
who attend more frequently. Hence, the lack of improvement in biophysical outcomes
may be due to low attendance. The limited impact of this traditional style
intervention in relation to low attendance argues the need to test alternative
interventions to reach this population.