ABSTRACT
Rationale. To evaluate the effectiveness of group medical appointments (GMAs) for patients with type 2 diabetes. Objective. To compare A1C levels of patients participating in GMAs to those of patients who received usual primary care. Design and methods. This study was a retrospective electronic chart review comparing GMA care for 52 male patients to usual primary care for 52 male patients. Demographic (age, marital status, and ethnicity/race) and health-related (height, weight, BMI, duration of diabetes, use of alcohol and tobacco, and A1C) variables were analyzed. Results. A greater proportion of GMA patients (50%) versus usual primary care patients (19.2%) reached target A1C goals (P = 0.001). GMA participants also had a significantly faster rate of decline in A1C over time compared to usual primary care patients (P < 0.001). Conclusion. This study demonstrated that the concept of medical management delivered in a group approach had a positive effect on glycemic control in patients with type 2 diabetes. GMAs were found to be an effective approach to achieving patient-centered goals for improving the glycemic control of patients with type 2 diabetes.
ABSTRACT
BACKGROUND: Second-generation atypical antipsychotics improve the outcome of patients with schizophrenia, although studies of their cost efficacy in comparison to first-generation conventional antipsychotics have yielded mixed results. OBJECTIVES: This study examines the cost effectiveness outcome of olanzapine treatment in veterans with schizophrenia (n 5 22) or schizoaffective disorder (n 5 4). METHODS: Health-care utilization and costs associated with prospective olanzapine treatment were compared with those of retrospective first-generation neuroleptic treatment in a mirror-image design. RESULTS: The analysis of variance with repeated measures for the Positive and Negative Syndrome Scale (PANSS; n 5 22) showed a significant main effect of olanzapine treatment (p , .025), and the effect was of medium-to-large size (h2 5 .13). The PANSS-positive subscale (p , .005) and the PANSS general subscale (p , .005) significantly decreased, but the PANSS negative subscale did not change. The quality of life survey (n 5 21) significantly increased (p , .025), and the effect size was large (h2 5 .14). For VA outpatient and inpatient care, study patients incurred an average cost difference of 2$1,289 (NS) and 2$6,682 (NS), respectively. Combining inpatient and outpatient VA care, patients incurred an annual difference of 2$7,971 per patient (NS). These numerically lower costs were due, in part, to a slower growth rate in outpatient encounters (p 5 .013), lower overall cost per outpatient encounter (p 5 .008), and a lower overall inpatient encounter rate (p 5 .005). CONCLUSIONS: Olanzapine treatment resulted in improvements in positive and general psychiatric symptoms, as well as quality of life. Negative symptoms did not change significantly. Though not statistically significant, the postbaseline health-care costs and utilization declined.
