I have long been an advocate of individual counseling for patients with diabetes. Each person has their own social and economic history that influences lifestyle decisions, but also has their own unique diabetes needs and medical treatment strategies. But as belts are tightening across the country, I must rethink the cost efficiency of seeing all my patients on an individual basis. In addition, we are presently in the process of accreditation, and I realize, group visits must be offered as part of the package.
As I review the literature, groups have been consistently effective in helping patients to reduce weight (short term). The great outcome data from the Diabetes Prevention Programs across the country demonstrate that lifestyle education can be taught and applied successfully by those taught in the group setting.
The biggest challenge in my review, and after talking with many of my peers, is the attrition rate. A recent study out of Britain (Gucciardi et al, 2008) reported that there was a 44% drop out rate. They followed up with an open-ended question survey to determine the reasons for the drop-out rate. Working (full time or part time), being over 65 years of age, and having a primary care physician or fewer diabetes symptoms were contributing factors. Other studies support a higher retention after careful screening (Parra-Medina et al, 2004) reported a retention rate of 81.5%, but that still appears high.
It’s not that I have never attempted classes. But even at the beginning, finding a good time seems to be a barrier to retaining patients. Offering them at night seems to conflict with other priorities (family dinners, meetings, exhaustion after work), having them during the day is challenging with work schedules and early morning times seem to conflict with getting kids off to school, or being too tired to roll out of bed. So I could use your help!
I would appreciate your input on how you structure your classes and how successful you are at retaining class members for the duration of the class sessions. What time of the day do you schedule classes? What is the duration of each class session and how many sessions do you hold? Do you have an incentive program built in for those who stay for the whole duration (other than they will learn a lot more!) Do you offer a “make up class” online or in your clinic?
As we head into the New Year, it appears we will need to be even more mindful of the costs of doing business. Group education and group medical visits may the direction we need to focus, and learning how to remove barriers to retain patients will be an even more important topic of conversation.
Happy New Year! I wish you days of joy and a sense of accomplishment in the year ahead.