Increasing Patient Compliance in People with Diabetes Through Nurse Practitioner-Led Group Medical Visits

Abstract

Purpose: The purpose of this quality improvement project was to implement and evaluate the effect of an evidenced-based group medical visit (GMV) model for diabetes self-management education/support. Background: Type 2 diabetes mellitus is a costly disease that correlates significantly to mortality and morbidity. According to the American Diabetes Association (ADA; 2018), 1.5 million people nationally are diagnosed each year, over 30 million Americans (about 1 in 10) have diabetes, and 90% to 95% of these have type 2 diabetes. Economic costs and repercussions related to diabetes in the US are prohibitive: $237 billion in direct medical costs and $90 billion in reduced on-the-job productivity (ADA, 2018). Locally, approximately 241,120 people in New Mexico have type 2 diabetes, an estimated 59,000 of these people have diabetes but do not know it, and 603,000 people in New Mexico have been diagnosed with prediabetes (ADA, 2019). Method: Participants involved were adult patients (18 years and older) at a local outpatient clinic, with hemoglobin A1C (HbA1C) greater than 8%, who are taking oral medication or insulin. The investigator posted flyers in waiting and exam rooms and sent invitational and disclosure letters via mail to patients who agreed to participate. Pre- and post-test surveys via Qualtrics were administered to GMV patient participants in order to measure perceived knowledge, attitude and behavior changes, and the effectiveness of the GMV educational interventions after implementation. Stata software, Microsoft Excel, and Google sheets were utilized to perform all data analysis. Results: The project was implemented at FFHC over a six-week timeframe, with each visit lasting approximately 90 minutes. Upon completion of the project, participants improved by showing statistically significant changes in the behavior change and self-care recommendation variables and voiced great satisfaction with the GMV project. Conclusions: It has been established through this project that the GMV is one of the most pertinent approaches to supporting long-lasting self-management strategies and health behavior changes in T2DM for patients within this clinic. Future studies will be done at the same site to show sustainability and efficacy and will involve measures such as HBA1C.