Chronic care clinics for diabetes in primary care - A system-wide randomized trial

OBJECTIVE - To evaluate the impact of primary care group visits (chronic ca re clinics) on the process and outcome of care for diabetic patients. RESEARCH DESIGN AND METHODS - We evaluated the intervention in primary care practices randomized to intervention and control groups in a large-staff m odel health maintenance organization (HMO). Patients included diabetic pati ents greater than or equal to 30);ears of age in each participating primary care practice, selected at random from an automated diabetes registry. Pri mary care practices were randomized within clinics to either a chronic care clinic (intervention) group or a usual care (control) group. The intervent ion group conducted periodic one-halt day chronic care clinics for groups o f similar to 8 diabetic patients in their respective doctor's practice. Chr onic care clinics consisted of standardized assessments; visits with the pr imary care physician, nurse, and clinical pharmacist; and a group education /peer support meeting. We collected self-report questionnaires from patient s and data from administrative systems. The questionnaires were mailed, and telephoned interviews were conducted tor nonrespondents, at baseline and a t 12 and 24 months, we queried the process of care received. the satisfacti on with care, and the health status of each patient. Serum cholesterol and HbA(1c) levels and health care use and cost data was collected from HMO adm inistration systems. RESULTS - In an intention-to-treat analysis at 24 months, the intervention group had received significantly more recommended preventive procedures and helpful patient education. Of five primary health status indicators examin ed, two (SF-36 general health and bed disability days) were significantly b etter in the intervention group. Compared with control patients, interventi on patients had slightly more primary care visits, but significantly fewer specialty and emergency room visits. Among intervention participants, we fo und consistently positive associations between the number of chronic care c linics attended and a number of outcomes, including patient satisfaction an d HbA(1c) levels. CONCLUSIONS - Periodic primary care sessions organized to meet the complex needs of diabetic patients improved the process of diabetes care and were a ssociated with better outcomes.