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03-06-2010 | Cardiology | Article

Group medical clinics improve BP but not HbA1c in hypertensive diabetics

Abstract

Free abstract

MedWire News: Group medical clinics help to reduce blood pressure (BP) in patients with Type 2 diabetes and hypertension when compared with usual care, report researchers.

However, they found that reductions in HbA1c were not significantly different between the two groups.

David Edelman (Durham Veterans Affairs Medical Center, North Carolina, USA) and colleagues say that many medical practices lack resources to train individual patients with chronic diseases such as diabetes to participate actively in their own care.

They suggest that a more efficient alternative could be for such patients to attend group visits with other individuals with the same condition to receive training on optimum disease management.

Edelman and team recruited 239 patients with poorly controlled hypertension (systolic/diastolic BP above 140/90 mmHg) and Type 2 diabetes (HbA1c of 7.5% or above) to take part in a study comparing group medical clinic treatment with usual care.

The group clinics included 7–8 patients and a care team comprising a general internist physician, pharmacist, and a nurse or other qualified diabetes educator. The groups met every 2 months for just over 1 year (7 visits in total over 12.8 months).

Patients were randomly assigned to group care in addition to usual care (n=133) or usual care alone (n=106).

The mean systolic/diastolic BP and HbA1c values at baseline were 152.9/84.4 mmHg and 9.2%, respectively.

By study completion, the mean systolic BP had decreased by 13.7 mmHg in the group care patients compared with a decrease of 6.4 mmHg in the usual care group, a statistically significant difference. Diastolic BP was also reduced to a greater extent in the group care than usual care patients, but the difference was not statistically significant.

However, the mean reduction in HbA1c was not significantly different between the two groups, at 0.8% in the group care and 0.5% in the usual care group.

“Group visits are feasible and can improve outcomes for some, but not all, chronic diseases,” say the authors.

They add that the reduction in systolic BP seen in the group care patients could hold promise for “reducing cardiovascular morbidity and mortality among patients with diabetes.”

Edelman et al conclude in the Annals of Internal Medicine: “If found to be cost-effective and efficient, group medical clinics could be implemented in a wide range of settings and become important in the remodeling of long-term care in the United States.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Helen Albert

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