This document describes a project that implemented group visits to improve diabetes care for 28 low-income Latino patients. The group visits occurred monthly for 2 hours and included checking vitals, immunizations, foot exams, interactive discussions on patient-selected topics, private time with physicians if needed, and a light healthy dinner. Key outcomes measured included A1c, blood pressure, weight, LDL, eye exams, and diabetes knowledge. While A1c and LDL did not show statistically significant improvements possibly due to the short duration, eye exams and diabetes knowledge did significantly increase. The group visit model showed potential to effectively deliver diabetes care and self-management support to underserved populations, but requires a dedicated clinical team and addressing social barriers like transportation.

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Group Visits: an effective model of diabetes self-management
for low-income Latino patients
Marie-Andrine Constant, MD, MPH
Thanks to: Heidi Behforouz, MD; Kiame Mahaniah, MD (Kraft Advisors); Peabody Family Health Center;
North Shore Community Action Program; Cindy Zavala and Laura Rojas (medical assistants); Cynthia Guillen (SCO); Jeff Geller, MD
(GLFHC); Dariana Reyes (nutritionist at GLFHC) , Alison Madden, LCSW
Abstract
Anticipated Outcomes
Methods
Peabody staff preparing healthy
wraps before group visits
Conclusions
Scroll down to learn more
about the project.
Diabetes costs increased by 41% in 2012. US Hispanics
are almost 2 times more likely to have diabetes than
non-Hispanic whites (12.8% vs 7.6%). Diabetic group
visits (DGVs) often lead to statistically significant
improvement in A1c and other quality measures;
however, underserved communities face unique
challenges that may prevent them from reaping the
same benefits.
We sought to improve the quality of diabetes care for 28
low-income Latino patients living in the Peabody area,
using group visits as a self-empowerment tool. We
measured several diabetes-related measures before,
during, and after the 9-month intervention. The project
also emphasized building broad collaboration within
and outside of the organization.
 Improve A1c, blood pressure, weight, LDL;
 Ensure yearly eye exam, foot exam, pneumovax;
 Improve patients’ diabetes knowledge
 Improve team’s clinical skills
 Setting: Local non-profit (NSCAP)
 Participants: 28 Latino patients from NSCHI
(Peabody) with diabetes mellitus, type 2,
controlled and uncontrolled
 Intervention: Monthly diabetic group visits lasting
2 hours
 Topics: Patient-selected
 Facilitators: 1 physician, 1-2 medical assistants,
guests experts
 Team Training in Motivational interviewing, Foot
exam, Effective communication with patients.
•Both A1c and LDL improved – results were not
however statistically significant. This may be
due in part to the short duration of the
project.
•Percentage of Eye exams, pneumovax
administered, and monofilament testing
doubled.
•Weight and Blood pressure neither worsened
nor improved.
•Patients’s knowledge on diabetes significantly
improved.22
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18
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15
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25
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# of patients
# of visits
Attendance

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Group Visits: an effective model of diabetes self-management
for low-income Latino patients
Marie-Andrine Constant, MD, MPH
Thanks to: Heidi Behforouz, MD; Kiame Mahaniah, MD (Kraft Advisors); Peabody Family Health Center;
North Shore Community Action Program; Cindy Zavala and Laura Rojas (medical assistants); Cynthia Guillen (SCO); Jeff Geller, MD
(GLFHC); Dariana Reyes (nutritionist at GLFHC) , Alison Madden, LCSW
Format of Group visits
Paired t:
A1c baseline, A1C Q2
Clinical Implications
for FQHCs
References
 Diabetes group visits constitute a viable way of
delivering diabetes care for low-income Latino
patients. Some patients will require supplemental
one-on-one diabetes teaching.
 To be effective, DGVs require a dedicated team of
a minimum of two clinical staff.
 Medical Assistants can be trained to perform
effective foot exam and to educate patients using
motivational interviewing.
 To recruit and maintain participants, reminder
phone calls, and transportation options are
crucial.
 Peer-to-peer modeling and support can be an
effective tool for behavior changes.
 Patient care could greatly improve if FQHCs and
community organizations jointly plan and
implement diabetes management programs.
 FQHCs would ensure the success of their internal
chronic disease management programs by
creating working teams of clinicians, diabetes
educators, nurses, medical assistants, mental
health professionals, and community health
workers.
American Diabetes Association. Standards of Medical Care in Diabetes – 2015. Diabetes Care. January 2015 vol. 38
Anderson, D., and J. Christison-Lagay. "Diabetes Self-Management in a Community Health Center: Improving Health Behaviors and Clinical Outcomes for Underserved
Patients." Clinical Diabetes 26.1 (2008): 22-27. Print.
Burke, R. E., and E. T. O'grady. "Group Visits Hold Great Potential For Improving Diabetes Care And Outcomes, But Best Practices Must Be Developed." Health Affairs 31.1
(2012): 103-09. Print.
Geller, Jeffrey S., Ariela Orkaby, and G. Dean Cleghorn. "Impact of a Group Medical Visit Program on Latino Health-Related Quality of Life." EXPLORE: The Journal of Science
and Healing 7.2 (2011): 94-99. Print.
Huang, Elbert S., Qi Zhang, Sydney E. S. Brown, Melinda L. Drum, David O. Meltzer, and Marshall H. Chin. "The Cost-Effectiveness of Improving Diabetes Care in U.S.
Federally Qualified Community Health Centers." Health Services Research 42.6p1 (2007): 2174-193. Print.
Piatt, G. A. "Translating the Chronic Care Model Into the Community: Results from a Randomized Controlled Trial of a Multifaceted Diabetes Care Intervention." Diabetes
Care 29.4 (2006): 811-17. Print.
Stellefson, Michael, Krishna Dipnarine, and Christine Stopka. "The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review."
Preventing Chronic Disease 10 (2013): n. pag. Print.
a) Checking-in and vital signs; immunizations and foot exams
b) NSCAP presentation
c) Interactive discussion on topics selected by patients
d) Private time with physician if needed; medical assistant’s
help to order labs and set future appointments and/or
referrals
e) Light dinner with nutrition exchange
f) Wrapping up and cleaning
0
50
100
150
200
250
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Participants
Trend in systolic BP
remains unchanged
BP systolic Baseline 2nd Quarter Systolic