Page 358 - Encyclopedia of Nursing Research

NuRSe-LeD GROuP CLINIC vISITS n 325

Henry, 1997; Houck, Kilo, & Scott, 2003; Jaber 2008; Watts et al., 2009). In a current trial,
et al., 2006). Further, the Centers for Disease findings demonstrated that HF group clinic
Control and Prevention has included this visits were provided at less cost than the N
model in its collaborative effort to improve allowable reimbursement from the Centers
diabetes care in federally funded health cen- for Medicare & Medicaid Services for one
ters (Bodenheimer, 2003). group education visit (Smith, 2006). In addi-
Despite the support by these and other tion, all of the HF group clinics were eval-
organizations for the use of group clinic vis- uated highly and attended regularly by
its, few clinical trials describing patient out- patients and caregivers. Additional observa-
comes of group clinic processes exist (Lapp, tion data showed reduced depression, exten-
2002; Musley, Sokoloff, & Hawes, 2000). sive patient problem solving, and supportive
Wagner et al. examined primary care group exchanges with multidisciplinary profes-
visits for patients with diabetes (Glasgow sionals (Bowden, Piamjariyakul, & Smith,
et al., 2002; Wagner et al., 2001). Compared 2008). Content analysis of all group clinic
with traditional single-patient clinic vis- discussions identified the following predom-
its, group visit participants reported better inant topics for problem solving of common
diabetes education, improved overall health HF self-management issues: low-salt diet, HF
status, fewer emergency center and spe- medications, monitoring of weight, report-
cialty physician visits, and lower costs of ing of symptoms, and depressed moods. All
care, and they received more preventive care national clinical guideline information for HF
services with greater screening for diabetic self-management by the American College of
neuropathy. Cardiology and American Heart Association
In a Kaiser Permanente study, 294 elders was discussed (Jessup et al., 2009). At the
with chronic illness were randomized to group clinic visits, patients readily shared
usual care or monthly group visits led by the emotions and talked with health care pro-
patient’s primary care physician (Scott et al., fessionals about their mood and financial
2004). Group clinic visit participants, com- concerns. Patients’ interactions and emo-
pared with traditional clinic visit patients, tional and social support of one another in
experienced significantly fewer hospital group discussions were observed across all
admissions and emergency center visits and sessions. The inclusion of an advanced prac-
reported higher satisfaction with their phy- tice mental health nurse as an integral part of
sician and greater quality of life. In another the multidisciplinary health care team in the
study of poorly controlled type 2 diabetes group clinics allowed for differential assess-
patients, group clinic visit patients (vs. usual ments of fatigue and insomnia, grief and
care patients) had clinically significant reduc- situational depression, as well as anger and
tions in total cholesterol/HDL ratios (>32%), regret reactions that might have otherwise
HbA1c (>30%), and health care costs (>7%) been inadvertently mislabeled as depres-
(Scott et al., 2004). Individual clinic appoint- sion. Patients were more likely to disclose
ments use more physician time and result in mental health illnesses, private family issues,
significantly poorer patient adherence to pre- and illicit substance use to the mental health
scribed regimens, less problem solving, fewer nurse. These topics were left unreported to
resource recommendations, and no group or investigators in the clinical trial self-report
community support when compared with study questionnaires (Bowden et al., 2011).
group appointments (Terry, 2000). Postintervention evaluation data
Nurse-led group clinic visits can be pro- revealed patients’ (n = 251) consistent, long-
vided at low cost, even in clinical settings term use of effective step-by-step prob-
providing intense HF management, such as lem-solving algorithms resulted in greater
nurse-run HF specialty clinics (Smith, 2006, collaboration with health care professionals