Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

1002 — Group Medical Visits to Improve Hypertension Chronic Disease Management

Goldstein MK (GRECC VA Palo Alto and Stanford) , Fenn C (GRECC VA Palo Alto), Olkin I (Stanford University), Bursick J (GRECC VA Palo Alto), Lorig K (Stanford University), Hoffman BB (VA Boston-West Roxbury and Harvard Medical School)

Objectives:
Group visits can enhance patients’ self-management of chronic disease. Our primary aim was to design and evaluate a model of group medical visits (GMVs) for VA primary care patients with hypertension to determine if GMVs improved blood pressure (BP) control. Secondary aims included assessing impact on patient medication adherence and satisfaction with care.

Methods:
We used a staircase study design of increasing numbers of primary care providers (PCPs) and their hypertensive patients enrolled at each of 3 Steps, with a formative evaluation guiding re-design of the model after Steps 1 and 2 and a summative evaluation after Step 3. At each Step, newly enrolled PCPs were randomly allocated in 2:1 ratio to hold GMVs or to serve as treatment-as-usual controls. Enrolled patients of GMV-PCPs were randomly allocated in 2:1 ratio to GMV-intervention (participate in GMVs) or GMV-control.

Results:
We enrolled 3 PCPs at Step 1; 4 at Step 2; and 9 at Step 3, totaling 16. We report here on 198 patients enrolled in Step 3: 101 GMV-intervention, 53 GMV-control, and 44 treatment-as-usual. Average age was 68.6 years. Analysis of change in BP control (at goal or not), and medication adherence (high or not), from baseline to endpoint showed that GMV patients were more likely to achieve or maintain BP control and high medication adherence. These findings are based on a 2x2x3 log-linear model that included the individual effects of study arm, and a 2-way interaction of baseline with endpoint, and that satisfied goodness-of-fit criteria. Overall patient satisfaction with overall care, at study endpoint, was high in all 3 study arms: 9.1, 9.3, 8.7 (scale 1-10) in, respectively, GMV-intervention, GMV-control, and treatment-as-usual. One-way ANOVA of the change scores (rating at endpoint less rating at baseline) for satisfaction was significant (F=3.58, p=0.03), with GMV-intervention significantly higher than treatment-as-usual by post-hoc analysis (Sheffe, p=0.031)

Implications:
Group medical visits contributed to BP control and medication adherence. Patient satisfaction with care was high in all groups but significantly higher in GMVs than in treatment-as-usual.

Impacts:
Group medical visits offer a viable option for primary care management of chronic disease.