| Edelman et al. (2014)55 | (2921 in RCTs; 326 in OS) | Haemoglobin: SMAs improved HbA1c (Δ = −0.55 percentage points, 95% CI −0.11 to −0.99 percentage points); HbA1c result had significant heterogeneity among studies, likely to be secondary to heterogeneity among included SMA interventions
BP: SMAs improved systolic BP (Δ = −5.2 mmHg, 95% CI −3.0 to −7.4 mmHg)
Cholesterol: SMAs did not improve LDL cholesterol (Δ = −6.6 mg/dl, 95% CI 2.8 to −16.1 mg/dl) | Non-biophysical outcomes, including economic outcomes, were reported too infrequently to meta-analyse or to draw conclusions from |
| Rolfe et al. (2014)56 | 11,063 patients | None | Trials showing small but statistically significant increase in trust included a trial of group visits for new inductees into a health maintenance organisation and a trial of group visits for diabetic patients. However, trust was not affected in subsequent larger trial of group visits for uninsured people with diabetes. There was no evidence of harm from any of the studies |
| CADTH (2013)52 | Not stated | Glycaemic control: better glycaemic control achieved for group care vs. usual care
BP: one included study found that for adults with hypertension better control of BP is achieved with group care vs. usual care
There was no information on the effectiveness of group care for COPD or HIV/AIDS | No cost-effectiveness evaluations of group care models were identified. No evidence-based guideline specifically on group care for chronic disease management was identified. One guideline on diabetes management recommended that diabetes education should be delivered in groups or individually, but did not recommend a preferred model |
| Housden et al. (2013)53 | 2240 patients | HbA1c: there were clear benefits of GMVs for HbA1c levels, which are consistent post-intervention and change from baseline effect sizes. The most significant effect is change from baseline results
BP: there was some evidence for post-intervention, and change from baseline, systolic BP improvement at 9–12 months’ interval and change from baseline improvement at 4 years
Cholesterol: there was no evidence that GMVs improve LDL cholesterol values | None reported |
| Slyer and Ferrara (2013)54 | 108 participants (52 in RCT) | Two studies: one RCT (52 participants) and one cohort study (56 participants) | The review examined knowledge, quality of life, self-care and readmissions
Knowledge: the RCT reported statistically significant improvement in heart failure knowledge at 8 weeks, compared with control, which was not maintained at 16 weeks
Quality of life and self-care: there were no statistically significant differences in self-care and health-related quality of life between groups at 8 and 16 weeks
Readmissions: no trial data |
| Edelman et al. (2012)18 | 4157 patients | 10 out of 13 RCTs evaluating outcomes for patients with diabetes examined type 2 diabetes only and one examined type 1 only. Two examined a mixed patient population
HbA1c: studies enrolled patients with poor glucose control (thresholds varied from HbA1c 6.5% to > 9%); a minority required elevated BP or lipids. All studies reported effects on average HbA1c at the end of intervention. SMAs associated with lower HbA1c vs. usual care at 4 to 48 months’ follow-up (mean difference = −0.55, 95% CI −0.99 to −0.11). Effects varied significantly across studies; this was not explained by study quality
Cholesterol: eight studies reported effects on either total or LDL cholesterol, showing small but statistically non-significant treatment effects that varied across studies
BP: five studies reported effects on systolic BP, showing consistent and statistically significant effect (mean difference = −5.2, 95% CI −7.40 to −3.05) | Two trials described effects on patient experience. Neither showed greater satisfaction for SMAs vs. usual care
Quality of life: five studies reported large improvements in health-related quality of life (SMD = −0.84; 95% CI −1.64 to −0.03). Effects were greater for disease-specific measures. Findings from OS were generally consistent with RCTs
Admissions/ED visits: effects of SMAs on hospital admissions and ED visits were explored in five studies on patients with diabetes. In three out of the five studies admission rates were lower with SMAs. The result was statistically significant in only one study. Two studies found that ED visits decreased significantly with SMAs
Costs: four studies reported effects on total costs. Results were mixed. In one, total costs significantly higher; in another, total costs were significantly lower; in the third, results did not differ significantly; and the fourth was conducted in Europe
Health-care utilisation: two RCTs and one OS evaluated effects of SMAs on older adults with high health-care service utilisation rates. All studies reported positive effects on patient experience for SMAs vs. usual care. Both trials reported no difference vs. usual care for overall health status and functional status. Biophysical outcomes were not reported
Hospital admissions/ED visits: three studies (two RCTs and one OS) showed fewer hospital admissions in SMA groups. Both trials reported statistically significant decrease in ED visits for SMAs vs. usual care. Total costs were lower for SMA group in each study but varied substantially across studies. They did not reach statistical significance for any study |
| Steinsbekk et al. (2012)51 | 2833 participants | 4 out of 10 participants were male, baseline age = 60 years, BMI 31.6 kg/m2, HbA1c 8.23%, diabetes duration 8 years. 82% used medication
HbA1c reduced at 6 months (0.44 % points; p = 0.0006, 13 studies, 1883 participants), 12 months (0.46 % points; p = 0.001, 11 studies, 1503 participants) and 2 years (0.87 % points; p < 0.00001, three studies, 397 participants)
Blood glucose: fasting blood glucose levels reduced at 12 months (1.26 mmol/l; p < 0.00001, five studies, 690 participants) but not at 6 months | Knowledge: diabetes knowledge improved at 6 months (SMD 0.83; p = 0.00001, six studies, 768 participants), 12 months (SMD 0.85; p < 0.00001, five studies, 955 participants) and 2 years (SMD 1.59; p = 0.03, two studies, 355 participants)
Self-management: self-management skills improved at 6 months (SMD 0.55; p = 0.01, four studies, 534 participants). Improvement for empowerment/self-efficacy (SMD 0.28; p = 0.01, two studies, 326 participants) after 6 months
Quality of life: no conclusion could be drawn due to high heterogeneity
Other outcomes: significant improvements in patient satisfaction and body weight at 12 months for IG. No differences between groups in mortality rate, BMI, BP and lipid profile |
| Burke et al. (2011)87,88 | 2240 patients | HbA1c: clear benefits of GMVs for patients’ HbA1c levels which are consistent in the post-intervention and change from baseline effect sizes. Most significant effect is with change from baseline results
BP: evidence suggests post-intervention and change from baseline systolic BP improvement at 9- to 12-month interval and change from baseline improvement at the 4-year time frame
Cholesterol: no evidence that group visits improve LDL cholesterol values of GMV participants | No details |
| Riley and Marshall (2010)49 | Not stated | HbA1c, BP, lipids: diabetes-focused group visits that incorporate group education and a health provider office visit vs. traditional brief office visit failed to demonstrate consistent statistical improvement in HbA1C, BP or lipids | Other outcomes: group visits may reduce costs, some physiological outcomes may be improved, and patient and clinician satisfaction may be enhanced |
| Jaber et al. (2006)48 | Not stated | None | Although heterogeneity renders assessment of group visit model problematic, there are sufficient data to support the effectiveness of group visits in improving patient and physician satisfaction, quality of care and quality of life, and in decreasing ED and specialist visits
Future research may benefit, however, from abandoning old nomenclatures and clearly defining structure, processes of care, content of visits and appropriate outcome measures |
| Deakin et al. (2005)47 | 1532 participants | Haemoglobin: results favour group-based diabetes education programmes for reduced HbA1c at 4–6 months (1.4%, 95% CI 0.8% to 1.9%; p < 0.00001), at 12–14 months (0.8%, 95% CI 0.7% to 1.0%; p < 0.00001) and 2 years (1.0%, 95% CI 0.5% to 1.4%; p < 0.00001)
Blood glucose levels: reduced fasting blood glucose levels at 12 months (1.2 mmol/l, 95% CI 0.7 to 1.6 mmol/l; p < 0.00001)
BP: reduced systolic BP at 4–6 months (5 mmHg, 95% CI 1 to 10 mmHg; p = 0.01) | Reduced body weight at 12–14 months (1.6 kg, 95% CI 0.3 to 3.0 kg; p = 0.02); improved diabetes knowledge at 12–14 months (SMD 1.0, 95% CI 0.7 to 1.2; p < 0.00001)
Reduced need for diabetes medication (odds ratio 11.8, 95% CI 5.2 to 26.9; p < 0.00001; RD = 0.2; NNT = 5). For every five patients attending a group-based education programme, one patient would reduce diabetes medication |
