Group Clinic Evaluation of Diabetes Related Measures of Control in Veterans with Poorly Controlled Type 2 Diabetes

Purpose: Group medical clinics within the Patient Centered Medical Home (PCMH) model allow patients to support one another while also receiving focused care from multiple providers on specific disease states. At the Alvin C. York (ACY) campus of the Veterans Health Administration (VHA) Tennessee Valley Healthcare System, a diabetes group clinic is held weekly as part of the newly-implemented PCMH model. These clinics are conducted by a team that includes a clinical pharmacist (CDE/BC-ADM), a registered dietician (CDE), and a registered nurse (CDE).  This study evaluated the effectiveness of diabetes group clinic attendance on glucose control and other diabetes-related measures of control by comparing lab results at inclusion and after six months of attendance.

Methods: This was a retrospective, single center study.  Records of all patients who were enrolled in the diabetes group clinic between January 1, 2009 and June 30, 2011 were evaluated.  The primary objective was to assess the change from baseline in hemoglobin A1c after 6 months of diabetes group clinic attendance.  Secondary objectives were to assess the changes in blood pressure (BP) and lipid panel results as well as the number of patients meeting individual American Diabetes Association (ADA) treatment goals and VHA performance measures. 

Results:

Forty-nine patients met inclusion criteria.  Statistically significant changes were observed in A1c and systolic BP (p=0.003 and 0.016, respectively).  There were also significant improvements in the number of patients meeting ADA goals for A1c and SBP (p=0.0057 and 0.0012, respectively) and VA performance measure for SBP (p=0.0051).

Conclusions:

Six months of group clinic attendance improved A1c and systolic BP in this veteran population. These results indicate that group clinic visits are an effective tool to help patients improve control of cardiovascular risk factors.