Like other complex chronic diseases, diabetes is difficult to manage effectively in one-to-one visits in the office setting, said Edward Shahady, MD, Clinical Professor of Family Medicine at the University of Miami and Director of the Diabetes Master Clinician Program of the Florida Academy of Family Physicians. In the United States, only 7% of patients have reached the American Diabetes Association goals of a hemoglobin A1c value of 7% or less, low-density lipoprotein (LDL) cholesterol level of 100 mg/dL or less, and a blood pressure of 130/80 mm Hg or less.
Group visits can empower patients to better self-manage their diabetes. Physicians are encouraged to invite their high-risk patients (those who are not at goal for hemoglobin A1c, LDL cholesterol, or blood pressure) to participate. Group visits are usually 2 hours long; the first hour is conducted by a medical assistant or nurse, and the second hour is led by the physician.
Each patient is given a “report card” that details information such as hemoglobin A1c, LDL cholesterol, and blood pressure levels. Patients have the option of sharing this information with the other group members, said Dr Shahady. “Most love to show each other their report cards.”
The group visit is a safe environment that allows patients to share solutions to common problems. “Physicians have a false belief that telling changes behavior," said Dr Shahady. "Emotion fuels change, not lectures. The group visit allows patients to share their emotions about their disease.”
Further details about group visits—including how to code and charge for the visits and sample patient privacy statements—are available on the Web site of the Florida Academy of Family Physicians.
More information about overcoming barriers to diabetes care can be found in Dr Shahady’s article “Diabetes Management: An Approach That Improves Outcomes and Reduces Costs” (CONSULTANT, April 1, 2008).