EVALUATING VIRTUAL GROUP VISITS FOR DIABETES CARE DURING THE COVID-19 PANDEMIC

ABSTRACT

BACKGROUND: One strategy to aid patients in managing their diabetes is group visits (GVs) that include group education and individual medical visits with a provider. Though in-person GVs have been shown to benefit patients, few studies have evaluated virtual diabetes GVs. METHODS: In this single-arm trial, adult patients with A1c ≥ 8% from six community health centers were recruited to participate in monthly virtual GVs for 6 months. Patients completed surveys about diabetes self-care, support, distress, and the group visit concept before and after they participated in GVs. Health center staff trained to lead the GVs completed surveys pre and post virtual GVs. Linear mixed effects models were used to adjust cohort-based association and model the survey data over time for the time trend effect. RESULTS: Forty-five patients enrolled in the study and thirty-eight patients completed the baseline survey. The average age was 55 (range of 36-83) and 65% of enrollees were female. 63% were black/African American, 32% were white/Caucasian, and 8% were Hispanic/Latino. Thirty-four patients attended one or more GVs and twenty-one patients completed the post GV survey. Overall satisfaction with the virtual GVs was high with 18/20 (90%) of participants being very satisfied and 20/21 (95%) saying they would attend GVs in the future. Most participants agreed that GVs helped improve diabetes self-management skills (78%), motivated them to achieve health goals (89%), and introduced them to others living with diabetes (78%). Barriers to participation were the timing of the GVs and access to a computer, tablet, phone, and internet. Patients had an increase in their diabetes knowledge (mean (SD) 3.2/ 5 (0.9) to 3.6/5 (0.7), p= 0.02) and diabetes support (3.5/5 (0.64) to 4.1/5 (0.7), p <0.001) as well as decreased diabetes distress (2.9/6 (1.5) to 1.2/6 (0.5), p=0.03) from baseline to 6 months. Thirty-five staff enrolled in the study and seventeen completed a post GV survey. Most staff agreed that GVs provided patients with social support and more frequent contact with medical providers. Staff largely agreed that virtual GVs increased opportunity for teamwork and collaboration (94%), care coordination (82%), and understanding of patients (94%). However, only 5/17 (29%) and 3/17 (18%) staff members agreed that virtual GVs increased provider productivity or led to higher reimbursement, respectively. Staff cited other priorities at the health center, difficulty recruiting patients, and concerns about access to technology as the biggest barriers to implementing virtual GVs. CONCLUSIONS: Virtual GVs show promise as evidenced by high patient satisfaction and improvements in support, distress, and diabetes knowledge in patients. Staff also perceived virtual GV benefits to patients, staff, and health centers despite concerns about logistics such as productivity, reimbursement, and the health center's ability to continue visits virtually.