Comparative Effectiveness Study Shows Improvements Using Patient-Aligned Group Clinics for Diabetes Care
Self-management skills are an essential means of reducing morbidity and health services use among older individuals with diabetes and comorbid conditions; however, the delivery of effective self-management education and support can be difficult in traditional primary care. This study evaluated the comparative effectiveness of two group self-management interventions for glycemic control among 87 Veterans with treated but uncontrolled diabetes. “Empowering Patients in Care” (EPIC) was a clinician-led, patient-centered group clinic consisting of four one-hour sessions on setting self-management action plans (e.g., diet, exercise, medications) and communicating about progress with action plans; each session included 10 minutes of 1:1 interaction with the study clinician. The comparison intervention consisted of 2 two-hour group education sessions with a diabetes educator and dietician, followed by an additional visit with the primary care provider. The effectiveness of both groups was compared using HbA1c levels and diabetes self-efficacy (i.e., confidence to perform self-care) immediately after the three-month interventions and at one-year follow-up. All participants received usual primary care post-intervention until the one-year follow-up. Study participants were recruited between 8/07 and 3/08; and all were receiving routine primary care at one VAMC.
- Veterans who participated in the primary care-based EPIC intervention had significantly greater improvements in HbA1c levels immediately following the active intervention; these differences remained at one-year follow-up. Thus, primary care-based diabetes group clinics that include patient-aligned approaches to goal-setting (e.g., action plan) for medication management, and diet and exercise changes can significantly improve HbA1c levels.
- Diabetes self-efficacy measures improved immediately after the intervention in both groups, but were significantly higher in the EPIC intervention group. Self-efficacy was associated with individual changes in HbA1c levels.
- At 1 year, differences in HbA1c levels between groups remained the same (i.e., there was no return to baseline, but also no further improvements). Self-efficacy levels dropped in both groups at 1 year; but the drop in the EPIC intervention participants was less than the diabetes education participants, resulting in modest (non-significant) differences between the groups at one year.
- This study was limited to older Veterans and was a relatively small sample.
- The duration of the EPIC intervention sessions exceeded the length of instruction in the traditional group; however, with the exception of content on goal setting and formulating action plans, the EPIC group received the same or less content about diabetes education than the traditional group.
This study was partly supported through HSR&D’s Houston Center for Quality of Care and Utilization Studies (HCQCUS). Drs. Naik and Petersen are part of HCQCUS.
Naik A, Palmer N, Petersen N, et al. Comparative Effectiveness of Goal-Setting in Diabetes Group Clinics: Randomized Clinical Trial. Archives of Internal Medicine March 14, 2011;171(5):453-59.