Horton, Edward S, MD
The impact of group medical visits on diabetes related outcomes in latino patients with type 2 diabetes
General Research Subject: Type 2 Diabetes
Focus: Complications, Complications\ Macrovascular-Atherosclerotic CVD and Human Diabetes, Health Care Delivery/Economics, Psychosocial Behavioral Medicine
Type of Grant: Clinical Scholars Award
Project Start Date: July 1, 2012
Project End Date: June 30, 2013
Latinos/Hispanics represent the largest racial/ethnic minority in the country and suffer from high rates of type 2 diabetes and its complications. There are often multiple medical, psychological, social and cultural challenges that limit the ability to improve self-care behaviors in this group. Group Medical Visits (GMV) are a viable possibility to improve patient-health care provider interaction, improve self-management behaviors, patient satisfaction, access to care, disease specific outcomes and reduce health care costs in the management of chronic diseases. GMV are structured medical appointments that include 8 to 10 patients and last approximately 90 minutes.
We propose a one-year clinical trial in Latino patients with type 2 diabetes to evaluate the impact of GMV on diabetes control and other diabetes related outcomes such as self-care behaviors, diabetes knowledge, patient and provider satisfaction, diabetes related emotional distress, depression, blood pressure, anthropometrics, smoking, lipids, attendance to appointments, emergency room visits, hospitalizations, health care costs and some tests to assess patients' circulation in comparison to the standard model of care represented by individual appointments with health care providers. A total of 64 patients will be included in the study and will be divided into those that attend the group appointments and those that receive standard care (individual appointments). All visits in the study will be conducted in Spanish by the health care team in the Latino Diabetes Initiative at the Joslin Diabetes Center. The student will participate in all steps of the development, implementation and analysis of data in this clinical research study.
Mentor: Edward Horton, MD Student: Felix Chinea
What area of diabetes research does your project cover? What role will this particular project play in preventing, treating and/or curing diabetes?
This research study focuses on comparing an innovative group medical visit model with the standard model of individual appointments with the diabetes care provider, diabetes educator and psychologist at a specialized center. In the group medical visit, 6 to 10 patients gather at the same time for a medical appointment and interact with the health care provider in a group setting allowing a unique experience of learning from each other and more opportunities for interaction with the health care team. This model has been shown to help health care providers spend more effective time with patients with chronic diseases and has translated into some clinical benefits in patients with asthma, arthritis and other chronic conditions.
There are already some studies in the field of diabetes but none in the Latino population. Due to particular social and cultural issues in this population, group activities have been very well received and seem promising to improve diabetes related outcomes. This research study will allow us to identify whether a group medical visit model that allows a more engaging and effective interaction with patients with type 2 diabetes translates into improvements in clinical outcomes, such as diabetes control, adherence to treatment recommendations, clinical measures such as blood pressure and lipid control, weight and some tests that reflect vascular function.
If a person with diabetes were to ask you how your project will help them in the future, how would you respond?
This project may help us identify a clinical care model that can represent an effective alternative to the traditional individual appointments that patients with type 2 diabetes usually have with their health care team. This model may provide a unique beneficial environment to address regular medical issues related to diabetes care as well as to provide diabetes education, better motivate patients and improve adherence to treatment recommendations.
Why is it important for you, personally, to become involved in diabetes research? What role will this award play in your research efforts?
We believe that the current model of diabetes care, based on patients attending individual appointments with health care providers has not helped many patients to improve diabetes management due to the limited interaction with the provider and the difficulty in implementing social and culturally oriented strategies with Latino patients with diabetes.
In the Latino Diabetes Initiative at Joslin Diabetes Center, we have developed multiple socially and culturally oriented programs and activities to improve the lives of Latinos with diabetes and at risk of the disease. We are convinced that taking into consideration social and cultural issues into the development and implementation of treatment plans is a must for any practitioner. This research study is important in that it extends our research efforts to better understand strategies that can help this vulnerable population improve diabetes related outcomes.
In what direction do you see the future of diabetes research going?
While we find a cure for the disease, research strategies are expanding in not only identifying better treatment options for the patient with diabetes, but better and more effective strategies to help patients implement treatment recommendations. Very few patients with type 2 diabetes have achieved good control of the disease despite the availability of numerous treatment options for the disease. This indicates a real problem in modifying patients’ lifestyle resulting in a healthier meal plan and regular physical activity as well as properly adhering to their treatment plans. Multiple biological, social and cultural factors influence patients’ decisions on a day to day basis. A better understanding on how common medical, social and cultural barriers can become opportunities to improve diabetes care, particularly in those at the highest risk for the disease and complications will continue to be a very important area of research for many years to come.
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