This is a quantitative research that was developed to help provide self-management support for patients diagnosed with diabetes. The purpose of the research was to find out if the implementation of group visits was effective in improving diabetes self-management outcomes (Katherine, 2011).
This research topic is significant taking into account the fact that the prevalence of diabetes has dramatically risen over the recent past (Davis et al., 2008). The management of diabetes calls for a focus on the interaction between dietary changes, exercise, and medication management (Peek et al., 2007). To enhance on the patients outcomes, it is recommended that patients learn self-management strategies. However, the aspect of self- management has not been adequately addressed within the primary care setting, thus, the study focuses on this aspect (Davis et al., 2008; Chen et al., 2009).
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The focus of the study was on patients in an academic health centre. The survey was carried out on adult patients with diabetes, who were recruited through a referral from the primary care provider. A review of the health centre diabetes registry was done to identify potential patients. The target of the study was patients with glycosylated haemoglobin (A1c) of 8% or greater (Katherine, 2011).
A study to provide group visits for patients was developed, including family and internal medicine. Brochures were also developed and distributed tot primary health care clinics. A bulleting board was placed in the lobby of the health centre to create direct marketing to potential participants regarding the study. The group visits required that nursing practitioners conduct a one-on-one encounter, while a registered nurse takes the role of a facilitator, as the student nurse records essential signs as well as other patient information. The group visits occurred over 32 months with a total of 197 visits representing 51 patients. Tools used for project evaluation were a participant satisfaction survey and a primary care provider satisfaction survey. The primary care provider satisfaction tool included a 6-item survey developed to assess the health care provider interaction and satisfaction with the group visit process.
The results of the study showed improved clinical outcomes associated with monitoring and documentation of diabetes measures, high patient provider satisfaction, and self-management behaviours (Katherine, 2011). In addition, the study found out that adherence to specific diabetes care guideline metrics trended higher in individuals who attended 3 or more group visits compared with individuals at baseline. These results are significant because they support the research question. Besides, this is consistent with other studies of group visits and reflects the long-term nature of these quality measures (Davis et al., 2008; Chen et al., 2009). Patient survey results demonstrated high satisfaction with the group visit study. According to the author, the results revealed that 100% of respondents indicated they would definitely or probably recommend group visits to their family and friends (Katherine, 2011).
The research design contained some strengths and limitations. One of the strengths is that the survey was conducted for over 32 months, thus, concrete results could be obtained since there was enough time to conduct the surveys. In addition, a one-on-one interaction with the patients enhanced the accuracy levels. However, the small group size, there was not enough statistical power to determine significance between groups. The study basically depended on the referrals from the primary care providers to obtain the study participants. It is noted that the concept of group visit had been discussed and supported by all potential referring primary care providers, but only a few of the providers referred patients, thus a few participants were used for the study (Katherine, 2011). Furthermore, the attempts that had been made to directly market the study through brochures bad bulletin boards yielded few participants, since they failed to create interest to sustain the number of patients required to be self-sustaining over time. In addition, it was also noted that most of the group visits were conducted with the primary care providers offering services to their own panel of patients, which is very effective with full-time providers who have large panels of patients, but makes it hard to obtain the number of patients required for adequate reimbursement for those who are part of a team of providers with smaller case loads (Katherine, 2011). Therefore, the study encountered sustainability challenge, as it could not constantly recruit and support enough individuals to be cost effective, and the program was discontinued after 2 years of providing group visit due to financial challenges.
This study contains veracious implications for the students’ personal nursing practice. The study demonstrated improved patient outcomes associated with patient satisfaction and documentation of quality care metrics through the group visit model (Katherine, 2011). Nurses are in a good position to offer self-management strategies for behaviour change through their knowledge of chronic health care conditions and patient education (Chen et al., 2009). However, it is worth noting that financial sustainability was a challenge. Therefore, nurses establishing group visit programs should address matters of continued recruitment and maintenance in order to attain success. To attain sustainability, the service has to contain an adequate number of patients within the clinical setting and be reimbursable (Katherine, 2011). Financial sustainability can also be attained through acquiring a certified diabetes educator who would meet the criteria for an accredited program, in order to increase reimbursement. New reimbursement systems could also be developed that focus on medical homes and patient-centred care, in order to create opportunities to come up with other methods for proving self-management strategies (Katherine, 2011). For instance, the use of virtual social networking through secure web portals, and on the other hand, the patient-centred medical home focuses on activated informed patient working with a prepared provider team as the best situation to improve chronic care outcomes.
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