Patients receive all their interventions in one place

Three-hour group visit improves adherence to plan

Monthly diabetes group visits, where patients receive all their recommended tests and examinations in one place, are an effective and cost-efficient way to help diabetics keep their disease under control, but they take a lot of organization, says Donna Zazworsky, RN, MS, CCM, FAAN, manager of network diabetes care, faith community nursing and telemedicine for Carondelet Health Network in Tucson, AZ.

At St. Elizabeth Health Center, the primary care providers refer their patients for the group visits. The group visits are on the same day each month so the physicians know when it will be and can refer their patients.

A different group of patients attends the clinic for the group visits each month and receives all the services and laboratory tests in two to three hours.

The team compiles a list of patients eligible for group visits and notifies the providers to make sure they can be on hand when their patients arrive.

"It's a lot of work up front. We work off the telephone list from our registry and health plan registries and send letters out to eligible patients. In some cases, we have to get prior authorization from the health plan for the patient to attend," she says.

On the day of the group visit, the team designates one person to handle traffic flow.

When the patients first come in, the laboratory staff come down and draw the blood. Then the patients use the patient flow sheets to track their visits to all the stations.

Roughly half of the patients who come to the clinic attend a group class, while the others are receiving their eye and foot checks and provider visits. Then the other group repeats the process.

After the group meeting is over, the promotoras, or community health advisor show a seven-minute video on the basics of diabetes and talk to the group about self-management, says Sr. Janet Sue Smith, ACS, RN, MAPS, director of community outreach, St. Elizabeth Health Center.

A contract is passed off that sets out self-management goals and helps patients identify their needs and set goals to address them.

The promotoras call the patients a week later to check on their progress in meeting their goal and work with them on any problems or issues. They continue calling regularly until the problem is solved, Smith says.

The cost for the group visit is about $600 for three hours or $50 to $60 a patient. Patients pay between $10 and $20 each, depending on their income. The rest of the cost is provided by grants and donations.

The aim of the Diabetes Day clinics is to help patients adhere to their treatment plan and receive the recommended tests and procedures by having it all in one place and to eliminate barriers to care, Zazworksy says.

For instance, when St. Elizabeth Health Center began its chronic care model for diabetes, the team analyzed the patient records and found that although a sizeable percentage of patients failed to receive hemoglobin A1c tests each year, it wasn't because the doctors weren't prescribing the tests.

"The patients weren't getting the tests because they couldn't afford the cost. We obtained a machine so we can analyze the blood right here in the clinic at a cost of just $6.50 to the patients," she says.

The team tackled other barriers to receiving care.

For instance, the uninsured have high no-show rates, which improve if they receive calls three days before the appointment as well as a reminder call the day before.

Even with discounts the clinic provides, the cost of care and self-management can be prohibitive, Zazworsky points out.

When the promotoras make the reminder calls, they ask if there will be a problem with payment and can waive the fees. If the patient is having problems finding a ride, they can help with transportation.

"When you're living in chaos, health care is not a priority. Our outreach workers problem solve with the patients to resolve issues the day before the appointments," she says.