PMPM statistical data is difficult to evaluate because of the well-known high variability in the cost of providing care to high-risk patients. No statistically significant differences were noted in total PMPM expenses between the groups in our study. The Cooperative Health Care Clinic Study20 supports the idea that group visit interventions may reduce health care expenses while improving clinical outcomes. That study in Colorado was conducted using seniors with multiple medical problems and noted reduced PMPM expenses, as well as enhanced patient satisfaction, improved immunization rates, and reduced hospital admission rates.
Limitations
A limitation of this and many lifestyle intervention studies that are taught on the group level is that we cannot distinguish between the direct benefits of the lifestyle interventions and the indirect benefits of meeting within a group. A group visit itself is an intervention that may provide clinical benefits. These attributes include group support and improved adherence to lifestyle changes. More studies are needed to clarify the direct benefits of combining cohorts of patients with specific illnesses with the same intervention taught on an individual and a group visit level.
Additional limitations to our study are that the dietary results were self-reported and that all study participants would be expected to show a healthy participant effect. Although the control group did show a reduction in lipid profiles during our study, that group noted only a 3% decrease in total fat intake, no change in saturated fat intake, and a reduction in their vegetable, fruit, and legume intake. Thus, no significant dietary improvements were noted in the control group.
Conclusions
Patients with known CAD who are already being treated with lipid-lowering medication are willing to make dietary changes that are taught during group visits. More than 50% of inadequately controlled patients with known CAD who were offered our program were willing to enroll, and we achieved significant improvements in these patients in increased fruit and vegetable intake, legume intake, and in changing the type of fat use for cooking. In larger studies these improvements may prove to be associated with reductions in total health care expenses and in clinical events. Further studies are needed to test this type of group visit program with other patient populations in larger clinical settings.
Related Resources
- American Diabetes Association www.diabetes.org
- American Heart Association www.americanheart.org
Acknowledgments
This study was funded by the South Region Executive Committee at Group Health Cooperative of Puget Sound. The patient data registry was provided by Group Health’s Heart Care Team. Patient recruitment and sample size calculations were provided by Group Health’s Center for Health Studies. Fred Hutchinson’s Cancer Research Center provided food frequency questionnaires and performed the associated data analysis. The Geriatric Research Team at Morton Plant Mease Health Care in Clearwater, Florida, performed the remaining statistical data analysis.