Diabetes care: could group clinics be better than individual consultations?
Results from a recent systematic review suggest that group clinics are effective in improving blood sugar levels, blood pressure and quality of life in diabetes patients. However there was no evidence that group clinics are better than individual appointments for other diabetes outcomes or in other chronic conditions.
The study searched a number of databases and 13 systematic reviews and 22 randomised controlled studies met the inclusion criteria. Additional searches identified a large number of qualitative papers and surveys which constituted the most comprehensive coverage of the evidence base to date with 13 papers reporting on 12 UK initiatives.
Although there is consistent and promising evidence for an effect of group clinics for some biomedical measures, this effect does not extend across all outcomes. For example, group clinic approaches improved HbA1c (by 21% [95% CI 21.8% to 20.2%] compared with usual care)and systolic blood pressure but did not improve low-density lipoprotein cholesterol. A significant effect was found for disease-specific quality of life in a few studies. No other outcome measure showed a consistent effect in favour of group clinics. A good-quality qualitative study from the UK highlighted factors such as the physical space and a flexible appointment system as being important to patients.
Despite some positive evidence for group clinics, much of the available evidence is from the USA and as yet, no rigorous evaluation of group clinics has been conducted in the UK. In 2014 the Royal College of General Practitioners produced a guide to implementing group clinics which was broadly supportive of the idea.
Further studies are required to assess the value of group clinics, particularly for the UK health setting, but this first analysis suggests potential benefits in delivering supportive care that may span across primary and secondary care.
Booth A, Cantrell A, Preston L et al. What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions? A systematic review. Health Services and Delivery Research 2016;3 (46).