Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.
Section of General Internal Medicine, University of Chicago, Chicago, Illinois, USA.
J Eval Clin Pract. 2023 Feb;29(1):146-157. doi: 10.1111/jep.13746. Epub 2022 Aug 15.
RATIONALE, AIMS AND OBJECTIVES: To examine factors related to recruitment of eligible patients and retention of enrolled patients in diabetes group visits (GVs).
As part of a cluster randomized trial, 272 eligible patients were contacted and 75 patients were eventually enrolled in GVs at six community health centers (CHC). Fisher's exact tests and χ tests were used to compare enrolled and nonenrolled patients by patient recruitment method, gender and preferred language. Linear mixed models were used to evaluate characteristics associated with GV attendance such as diabetes self-empowerment and diabetes-associated distress. Content analysis was used to analyse patients' open-ended survey responses, and template analysis was used to analyse CHC staff interviews.
In terms of recruitment and enrollment analysis, patients who received in-person contact only and both phone and in-person contact comprised a greater fraction of the enrolled than unenrolled group, while those who received phone only and both phone and mail comprised a smaller fraction of the enrolled than unenrolled group (p = 0.004). In terms of retention analysis, 70 of the 75 enrolled patients attended at least one GV (93%). The average number of GVs was 3.2 out of 6 visits. Higher GV attendance was associated with lower baseline diabetes empowerment (p = 0.03). Patients' most common self-reported motivating factors to attend GVs were to learn more about diabetes, gain improved blood glucose control and find support from peers.
In-person recruitment for GVs at CHCs was more effective than recruitment by telephone/mail. Patients who felt less empowered to manage their diabetes were most motivated to attend GVs. These findings could help clinicians implement targeted recruitment of patient populations who are more likely to attend diabetes GVs and tailor self-management education interventions to their patient populations, particularly for underserved patients who face disparate clinical outcomes.
探讨与糖尿病小组访视（GV）合格患者招募和入组患者保留相关的因素。
作为一项集群随机试验的一部分，联系了 272 名合格患者，最终有 75 名患者在 6 家社区卫生中心（CHC）入组 GV。采用 Fisher 确切检验和 χ 检验比较了按患者招募方法、性别和首选语言进行的入组和未入组患者。采用线性混合模型评估了与 GV 就诊相关的特征，如糖尿病自我效能和糖尿病相关困扰。采用内容分析法分析患者的开放式调查回复，采用模板分析法分析 CHC 工作人员访谈。
在招募和入组分析方面，仅接受过面对面接触和同时接受过电话和面对面接触的患者中，入组患者的比例大于未入组患者，而仅接受过电话和同时接受过电话和邮件的患者中，入组患者的比例小于未入组患者（p=0.004）。在保留分析方面，75 名入组患者中有 70 名至少参加了一次 GV（93%）。平均参加了 6 次访视中的 3.2 次。更高的 GV 出勤率与基线糖尿病效能感较低相关（p=0.03）。患者参加 GV 的最常见自我报告的动机因素是了解更多关于糖尿病的知识、改善血糖控制和从同龄人那里获得支持。
CHC 的 GV 面对面招募比电话/邮件招募更有效。那些自我管理糖尿病能力较低的患者最有动力参加 GV。这些发现可以帮助临床医生针对更有可能参加糖尿病 GV 的患者群体实施有针对性的招募，并根据患者群体调整自我管理教育干预措施，特别是针对面临不同临床结局的服务不足的患者。
