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Group Care for Chronic Disease Management: A Review of the Clinical Effectiveness, Cost-effectiveness, and Guidelines

Published on: November 12, 2013
Project Number: RC0493-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Report in Brief

Context
Chronic diseases are, as their name implies, diseases that usually do not improve with time. Typically, diseases progression is slow and patients live with their illness for a long time. Examples of chronic disease include diabetes, heart disease, COPD, HIV, and hepatitis C.

Technology
Group care is an approach in which multiple patients are seen simultaneously in the same clinical setting. Care is provided by a multidisciplinary team comprised of, for example, a physician, specialists, a nurse, a dietitian, and an educator. Patients attending group care may remain constant, or may vary in the case of drop-in attendance. A shared medical appointment (SMA) is a type of group care.

Issue
Easy access to high-quality care and timely delivery of that care are essential if chronic disease is to be well- managed. As an alternative to one-on-one care by a clinician, could group care be a more efficient means to deliver care to those with chronic disease?

Methods
A limited literature search was conducted of key resources, and titles and abstracts of the retrieved publications were reviewed. Full-text publications were evaluated for final article selection according to predetermined selection criteria (population, intervention, comparator, outcomes, and study designs).

Results
The literature search identified 593 citations, with 2 additional articles identified from other sources. After screening the abstracts, 30 studies were deemed potentially relevant, with 8 meeting the criteria for inclusion in this review: 3 systematic reviews, 2 RCTs, 2 non-randomized studies, and 1 evidence-based guideline.

Key Messages

  • For patients with diabetes, group care improved, with solid evidence for glycemic control; and mixed evidence for blood pressure, quality of life, and BMI.
  • For patients with diabetes, no differences were seen in patient satisfaction, medication adherence, or lipid lowering.
  • For patients with hypertension, group care improved blood pressure and BMI.
  • Cost comparisons of group care to usual care were mixed, showing higher, lower, and non-significant differences in cost.

Question

  1. What is the comparative clinical effectiveness of group care vs. one-on-one care for chronic disease management?
  2. What is the cost-effectiveness of group care compared to one-on-one care for chronic disease management?
  3. What are the evidence-based guidelines for group care for chronic disease management?

Key Message

The available evidence shows that for adults with diabetes, better glycemic control is achieved with group care compared with usual care. One included study found that for adults with hypertension better control of blood pressure is achieved with group care compared with usual care. However, there are variations in the structure of group care, and details on usual were not consistently described. It was assumed that usual care is likely to involve a one-to-one care provider. No information on the effectiveness group care for COPD or HIV/AIDS, and no cost-effectiveness evaluations of group care models were identified. No evidence based guideline specifically on group care for chronic disease management was identified. One guideline on diabetes management recommended that diabetes education should be delivered in groups or individually, but did not recommend a preferred model.

Tags

group therapy, copd, cardiovascular diseases, chronic disease, diabetes mellitus, group processes, heart failure, hepatitis c, hiv, mental disorders, psychotherapy, group, pulmonary disease, infectious diseases, mental health, psychotherapy, group, pulmonary disease, chronic obstructive, cardiovascular, diabetes, group visit, group visits, group medical visit, group medical visits, group care, group therapies, Chronic, mental illness, Chronic Obstructive