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Group education visits, are they working for you?

Dec 21, 2010
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.

7 comments

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  1. Feb 27, 2012

    Our organization is building a new delivery model for chronic disease education for diabetes. The outpatient phase is active and is showing much buy-in from our collaborating partners and patients. Our patients stay with us and are engaged. We are really excited about peers perception. We want to hear back from you. Here is the basic model: Diabetes Education Live and On-Line by Take Better Care of Yourself The program has three goals: 1) To show that current internet technology can be used deliver accredited diabetes education effectively, to a population of patients with diabetes, a chronic disease. Access 24hrs a day 7 days a week. 2) To show that a population of inpatients with diabetes in hospitals can initiate this program prior to discharge and this would effectively reduce hospital costs. 3) To show that a population of ambulatory patients with diabetes will take advantage of this technology for any of the following reasons: the educational content is the same, it's more convenient, access to low cost of diabetes supplies, don't have to get out in the weather, can get the education in privacy and other reasons yet to be determined. The program has three objectives: 1) Acquire repeat referrals from physicians and community health professionals in the TBCOY Grant area for on line accredited diabetes self education and management. The goal for repeat referrals is 20 sources in 12 months. A repeat referral is more than 5 patients from one source. 2) For 50% of patients starting the program with a physician prescription to attend 7 out of 7 on line classes for diabetes education classes. 3) For 30% of patients starting the program with a physician prescription to enroll in the texting adherence program and for 20% to report the specific action they took to the text. The program has three outcomes for patients that have completed all 7 on line diabetes classes: 1) Get a free glucose meter and low cost diabetes supplies. 2) State by memory the AADE 7 self care behaviors of diabetes management. They must test out they understand the behaviors. 3) They will know how to use the glucose meter and know what to do to keep their sugars in control.
  2. Dec 30, 2010

    Hello Carla and Happy New Year. We have been offering diabetes group classes since 2009. For me, it was quite a shift but it is working well. The RDs and myself continue to see people on 1:1 basis if they decline class but we usually have 8-10 at class. The classes run from 9-11 AM on Thursdays for 4 weeks. We struggled with a time but decided it is important and you can't get an MRI in the evening or see your doc in the evening. not sure if this is right or wrong but that was our approach. If people have to miss a class, we call and remind them for the next session. The people seem apprehensive at first but once they get to know one another, it goes well BUT we have seen drop outs too, especially for the fourth class, which is on reducing risks and foot care. Nobody misses class 2 and 3 on food. huh? we are considering moving the content around to see if that helps. The RD and myself have done them so much, we don't need much prep time and it does save a lot of time overall. Good LuckCarla. Ida
  3. Dec 28, 2010

    We have found that group classes are very productive and interesting for the patients and staff. We offer three classes and each is 3 hours long. We prefer that people start with number one but all the classes are structured so that people can enter at any point, this helps if schedules change or in case of illness. We have a morning series that runs 9am-12noon and two afternoon series that run either 1pm-4pm or 2pm-5pm. Patients have the choice of attending sessions back to back (all in one week) or spreading them out once weekly or even monthly if schedules are tight. Almost everyone completes the series. One of my biggest fears when we started groups was how to keep track of who had come to all the classes but that has not been a problem at all, most people complete the series as scheduled. At one time we tried weekend and evening classes and found attendance in those was worse so we quickly switched back to the week day only schedule. The best part of group classes has been seeing how people support each other and really bond during the sessions.
  4. Dec 26, 2010

    There are so many barriers found by the patient that make them unable to attend diabetes classes or educational sessions. Time, days of the week, place,et seemed to be unconvenient for the patients and families. I have tried different approaches to overcome those barriers, however it appears that very little things work. We began in our practice almost a year ago, diabetes group medical visits. It has been really an excellent way to deliver diabetes care in conjuction with diabetes educaction. Patients are really engaged with their care and you can see that the patient is really the leader of the group. DGV's produces very good patient satisfaction, patients and families think and experience that the medical staf are more able to spent extratime with them and resolve their inquires and concerns. I really recommend for the diabetes educators to consider DGV's as a new and fresh way to deliver Diabetes care and diabetes education. Now, the retention rate improves but there is still people who despite of being very interested in continuing attending the group they did not attend all the planned sessions. DGVs take lots of time for planning and implementation. Howerver, it is a rewarding challennge that is worthy to take for the patient and the educator.
  5. Dec 23, 2010

    We offer five Type2 Diabetes class sessions a week that rotate, so we have at least one Class One starting each week. We also have a GDM class every Wednesday afternoon from 2-4:00. About 60% of our diabetes education is done in a group now. Most of our individual appointments are for clients on insulin, refresher, on non-English speaking. Our Type2 classes are held on Thursday and Friday mornings from 8:30 to 10:30, Monday and Thursday afternoons from 1:30 to 3:30 and Tuesday afternoon from 3:30 to 5:30. We offer four two-hour classes (+ half an hour at Class One to teach SMBG if needed) and then a follow-up class (or 1:1) about 4-6 weeks later. Our completion rate for the past two quarters is 86%, although not all of them come back for the final follow-up. I think the key for completion is good screening (done by scheduling staff) and making the classes meaningful and relevant. We do not offer an incentive for completion but have considered it and think it would be a good idea. I thought about having a raffle and they earn one entry for every class they come or for everytime they bring food & BG records.
  6. Dec 21, 2010

    I, too, am in favor of individual sessions, for a variety of reasons. However, we do continue to offer group classes, with the caveat that we also encourage an individual session in addition, as needed. Saturdays are our best attended classes: a whole day, 6 hour class. We are affiliated with a hospital, so we offer a free lunch at the cafeteria. (1/2 hour). The RD CDE begins the session and, after lunch, the RN CDE covers the rest. We use the Conversation Maps; it really keeps people engaged!
  7. Dec 21, 2010

    As a part of a newly accredited program I don't have a lot of statistics to share. We have been offering group classes for a year. We made a conscious decision to have 1 class 6 1/2 hours long. We weighed the pros and cons of having several classes. Since we were reaching out to the working class we supposed that a person could more easily take 1 day off from work than a few hours on several days. That didn't actually hold as true in our circumstances. Most of our classes were attended by persons who didn't work. Our best attended days were Saturdays. The most we have had in a class has been 7 and it was on a Saturday. We have had an average of 3 at most of the classes in addition to a few caregivers that attended too. We plan to continue a few Saturday classes next year in addition to a few 1 1/2 and 2 hour serial classes in the afternoon and evening along with the continuation of the all day class. I will be interested in following this blog to find what others have experienced and the plans for the future.

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