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Educational group visits for the management of chronic health conditions: a systematic review [with consumer summary] |
Quinones AR, Richardson J, Freeman M, Fu R, O'Neil ME, Motu'apuaka M, Kansagara D |
Patient Education and Counseling 2014 Apr;95(1):3-29 |
systematic review |
OBJECTIVE: Review the effectiveness of group visits (appointments of multiple patients) on quality of life, function, self-efficacy, utilization, and biophysical outcomes in randomized controlled trials of patients with chronic conditions. METHODS: We searched Medline, Cochrane, CINAHL, and PsycINFO to January 2013 for English-language trials of educational group visits led by non-prescribing facilitators (eg, peer educators). RESULTS: We report on 80 arthritis/falls (n = 22), asthma/COPD (n = 10), CHF/hypertension (n = 12), diabetes (n = 29), multiple conditions (n = 4), and pain (n = 4) studies. We found moderate evidence of improved short-term self-efficacy in patients with arthritis (10 studies) and diabetes (10 studies). We found no consistent evidence of improved quality of life; however a moderately strong body of evidence suggests peer-led community-based programs might improve quality of life and utilization in patients with multiple chronic conditions. Meta-analyses found short- (14 studies; mean change HbA1c -0.27, CI -0.44 to 0.11) and long-term (10 studies; mean change HbA1c -0.23, CI -0.44 to -0.02) glycemic improvement. CONCLUSIONS: Group visits may improve self-efficacy and glycemic control. There was little consistent evidence of improved quality of life, functional status, or utilization. PRACTICE IMPLICATIONS: Group visits represent a reasonable alternative for educating patients with chronic illness, though varied participation/retention suggests they should not be the sole alternative. A brief summary and a critical assessment of this review may be available at DARE |