Date of Graduation

2012

Document Type

Dissertation/Thesis

Abstract

Background: Diabetes is a chronic disease that has potential complications if left unmanaged that can lead to financial burden for all those who are involved along with life altering health impacts. Complications can be reduced with proper management of this chronic disease. Selfmanagement of diabetes has been linked to improved outcomes and therefore, decreased complications. Improvements of self-management of those patients with diabetes often require health care providers to look at unique approaches to the delivery of care. The use of group medical visit is one such approach that has been studied and linked to improvements of selfmanagement. However, there is a gap in the literature on the use of group medical visits in the Appalachian culture. Objectives: To evaluate the use of group medical visits with patients who have Type 2 diabetes on self-management, glycemic control and reported self-efficacy along with satisfaction with the use of this method of providing care. Methods: This pilot project was conducted at a Federally Qualified Health Care Center in the central part of West Virginia. Inclusion criteria for the study were: 1) . 18 years of age, 2) diagnosis of Type 2 diabetes, 3) a patient receiving care at the clinic, 4) willingness to participate in the study. After obtaining IRB approval from West Virginia University, patients were randomly selected to be either in the control group or the experimental group. The control group consisted of "usual care", this is where the participants have a scheduled 20 minute appointment with their provider to go over treatment plan and make adjustments accordingly. The experimental group consists of those participants who will be attending the group medical visits sessions. The participants are expected to attend both of the sessions. The two sessions provided discussion in regards to nutritional therapy. Participants were asked to complete a survey that l assessed self-management and self-efficacy pre-intervention and post-intervention. Participants in the experimental group were asked to complete a satisfaction survey after the second session to evaluate satisfaction with the use of this method of care. There were a total of 22 participants in the control group and 21 participants in the experimental group. Originally there were 30 participants in the experimental group and 9 participants dropped out after the first session with an attrition rate of 33% in the experimental group. Consequently, these responses will not be evaluated in this project. Information from each of the two groups was entered in to the Statistical Package of Social Science (SPSS) version 20 for analysis of the data. Nonparametric test were conducted on the data using the Kruskal-Wallis Test, Kolmogorov Smirnov Test, and Median Test. Results: This pilot project demonstrated that there were no identified differences between the control group and the experimental group in the pre-intervention evaluation of self-management and self-efficacy. However, the post-intervention comparison could not be conducted due to lack of return of the post-intervention surveys in the control group. Glycemic control was not able to be evaluated due to the participants not bringing in blood glucose logs for review. In the experimental group there was improvement noted in self-management of the participants regarding dietary modifications, blood sugar testing, foot care, and smoking. The participants also showed improvements of self-efficacy in regards to ability to control their diabetes, judge changes in blood sugar in relation to symptoms, correlation with blood sugar readings and exercise, and judging when blood glucose were high or low. Participants reported satisfaction with the use of group medical visits and stated that they would attend another session if available. The use of group medical visits does offer a feasible approach to improvement of selfmanagement and self-efficacy of patients with Type 2 diabetes. However, modifications to the project may help to provide for greater sample size and ability to assess glycemic control along with further comparison of pre-intervention and post-intervention between the control and experimental groups. Discussion: This pilot project identified that there were improvement in self-management skills related to the nutritional management of diabetes, the focus of the group medical visit sessions. Patients in this select population were receptive and reported satisfaction with the use of group medical visits as an alternative approach to care. Additional research with other populations and specific outcome measures would be beneficial to further expand on this different approach to care for those individuals with diabetes.

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