Centering Group Visits Help Cincinnati Grandmother Better Manage Diabetes

Colleen Kelley/UC Creative Services

By Cedric Ricks
cedric.ricks@uc.edu

Tonette Young felt she was careless with her diabetes.

The Cincinnati grandmother says her nurse practitioner suggested attending a centering group visit (CGV) at Hoxworth Center to better manage her condition. She got a chance to interact with other patients with diabetes and receive care from physicians and other healthcare providers.

“I saw the struggles they were going through and it just encouraged me that I could do better because everybody had different suggestions for tackling diabetes,” says Young. “I had trouble exercising and one doctor said I should try some simple chair exercises. I also found out about how stress plays a role in my diabetes.”

“One lady at the last meeting had just gotten out of the hospital and just seeing the struggles she had to go through made me want to reach out,” says Young. “There was a lot I wanted to speak with her about. There are people in my church and community who can help.”

Young, 59, was diagnosed with Type 2 diabetes two years ago. She takes insulin and tries to manage the condition through diet, exercise and the support the CGV model provides. CGVs connect patients dealing with diabetes with healthcare providers: physicians, nurses, dietitians and pharmacists during monthly two-hour sessions.

“These visits are a different type of medical appointment where care is delivered, but also patients can learn from and support each other in how to manage day-to-day situations with their condition,” explains Tiffiny Diers, MD, associate professor in the University of Cincinnati (UC) Department of Internal Medicine and UC Health physician.

Patients in group visits engage with each other and with healthcare providers through facilitated activities designed to build self-care skills and confidence in managing a shared condition. Depending on the type of condition, patients attend group visits with the same group of patients and providers for four to six months, allowing supportive relationships to develop, says Diers.

“It’s so much more than just a support group,” adds Jinda Bowerman, APRN, UC Health family nurse practitioner. “I like to think of it as medical care plus. People actually have the opportunity to meet with licensed medical providers one-on-one at every visit plus they get extended time with that provider and other patients in a relaxed atmosphere.”

Centering group visits at UC Health began with CenteringPregnancy and now are used in managing patients with diabetes, chronic pain, obesity, and in recovery from addiction. Each of these group visits operates in the Hoxworth Center on the UC Medical Center campus along with a new expansion to the UC Physicians Midtown office to include centering diabetes.

“Often people worry about the time commitment,” adds Bowerman. “The overall time footprint is actually not much larger than one-one-one visits—except instead of waiting in a lobby by yourself, your time is spent with direct access to people who can help encourage you and answer your questions regarding your health. We often have diabetic educators, pharmacists, registered dietitians, and other health professionals join us in the CGV.”

Diers says the CGV model has been well-received by her colleagues at UC Health.

“We are getting people from different parts of our healthcare system asking about centering and we now have the capacity to enroll patients seen anywhere in the UC Health system and to support practices interested in starting centering with new populations of patients. Group visits are medical care, and they are billed as such, but the establishment of a new group visit program requires a lot of change from a traditional system of individual care,” says Diers.

Diers says a grant of $68,279 from Anthem Blue Cross and Blue Shield Foundation has helped establish the CGV model for patients with diabetes in the Hoxworth Center and Midtown practices, as well as expand the Centering Healthy Lifestyles group visit program for weight management. The grant funds evaluation and data management, program materials, training, guest speakers and project management. The award was secured with assistance from the UC Foundation.

“One of the things I think we do well at UC Health is to incorporate a mind-body component into our centering group visits,” says Diers. “We usually start our groups with a short breathing exercise or opening meditation to bring us into the space and allow us to really focus on our time together. We might learn techniques like guided imagery as a way for managing chronic pain or mindful eating as a way to address weight management.”

Bowerman says the visits are also enjoyable for both patients and healthcare providers.

“By using games and interactive activities, people come away learning more about themselves and their health conditions,” says Bowerman. “During a two-hour CGV, I get to hear stories of patient experiences that I would never have had the opportunity or time to explore during a traditional 20-minute appointment.”

Young says the CGV model and her grandkids keep her grounded and remind her to stay focused on managing her diabetes. She has three adult children, 11 grandkids and two great grandchildren.

“They try to keep me on track,” says Young. “My 12-year-old grandson says ‘Grandma are you supposed to be eating that?’

Her response: “Well, maybe not.”

Diers adds that participants in the CGV model are also offered the chance to visit a teaching kitchen run by medical students through a collaboration with the UC Department of Nutrition Sciences in the College of Allied Health Sciences.

Patients can choose to come to the teaching kitchen once a month to learn healthy cooking techniques and to share a meal with students, providers and staff.

“The teaching kitchen has different cooking stations where small teams can prepare different dishes that we all then share together at a communal meal,” says Diers. “It is a good example of elements we emphasize in centering: shared learning and community-building around healthy behaviors enjoyed by patients and healthcare team members alike.”

To learn more about centering group visits, speak with your physician or call 513-584-0373.

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