Private Primary Care Practices Research Articles

Case report: Treatment of non-medical tetrahydrocannabinol toxicosis with transmucosal cannabidiol-infused dissolving sheets in six dogs

Increased cases of canine tetrahydrocannabinol (THC) toxicosis have been reported in North America in recent years. Cases are often evaluated on an emergency basis and treatment has relied upon supportive care which can be costly and prohibitive for some pet owners. The purpose of this report is to describe the clinical findings and outcomes in dogs with non-medical, presumptive THC toxicosis treated by administration of a cannibidiol (CBD)-infused transmucosal dissolving sheet. Medical records of six cases of non-medical, presumptive THC toxicosis from a private primary care practice and a private after-hours emergency practice were reviewed and summarized. Five of six cases were treated exclusively with transmucosal CBD (0.4–2.6 mg/kg); one case also received injectable anti-emetic therapy. Lethargy and ataxia noticeably improved and all additional clinical signs resolved within 45 min of treatment in five of six cases. No further follow-up measures for THC toxicosis were required in any case; one case required additional follow-up for presumably unrelated gastrointestinal distress. This is the first report of treatment of canine THC toxicosis by administration of CBD. The use of transmucosal CBD-infused dissolving sheets resulted in expedient resolution of clinical signs in a minimally invasive manner that is accessible to both clients and veterinary practitioners.

Assessing the impact of a payor-funded embedded clinical pharmacist on patient and provider satisfaction in a private primary care practice.

With expanding roles of clinic-embedded pharmacists comes the need to identify routes for optimization, soliciting and addressing feedback, and justifying the position(s) to the employing institution. Studies have demonstrated the benefit of integrating pharmacists into healthcare teams, but these opportunities remain largely limited to major health systems due to a lack of billing avenues for and familiarity with the services pharmacists can provide. With funding from and partnership with a third-party payor, a pharmacist was incorporated into a private physician-owned clinic to be a resource to the providers and provide comprehensive medication management to patients. Patient and provider experiences were assessed by survey and interview, respectively, utilizing both Likert-scale and free-response questions. The responses were coded, analyzed, and aggregated into themes. The demographic and Likert-scale responses were analyzed using descriptive statistics. Patients reported a high level of satisfaction with the pharmacist's service, indicating that they felt more comfortable managing their medications and that they would recommend the pharmacist to a family member or friend. Provider satisfaction was also high, with providers stating that they found the recommendations by the pharmacist helpful, that the recommendations improved cardiovascular risk factors in their patients with diabetes, and that, overall, they were satisfied with the care provided by the pharmacist. The primary concern from the providers was a lack of understanding regarding how best to reach and utilize the service. Overall, an embedded clinical pharmacist providing comprehensive medication management at a private primary care clinic had a positive impact on both provider and patient satisfaction.

The use of routine data from primary care practices in Germany to analyze the impact of the outbreak of SARS-CoV-2 on the utilization of primary care services for patients with type 2 diabetes mellitus

BackgroundRoutinely collected health data from ambulatory care providers offer a wide range of research opportunities. However, the access is often (e.g., technically) hindered, particularly in Germany. In the following, we describe the development of an infrastructure for the analysis of pseudonymized routine data extracted from primary care practices in Germany. Further, we analyze the impact of the outbreak of SARS-CoV-2 on the utilization of primary care services for patients with type 2 diabetes mellitus (DM type 2).MethodsIn this retrospective cohort study, routine data were extracted from nine private primary care practices before and since the outbreak of SARS-CoV-2 in Germany. The sample consisted of patients who were treated between 2016 and 2022 in one of the participating practices. The effects of the outbreak on the frequency of practice visits and the disease course of DM type 2 patients were analyzed by means of bivariate and multivariate analyses.ResultsThe developed infrastructure offers an analysis of routine data from outpatient care within 24 h. In total, routine data of 30,734 patients could be processed for the analyses with 4182 (13.6%) patients having a diagnosed DM type 2 and 59.0% of these patients were enrolled in a disease management program (DMP). In the multivariate analysis, there was a significant negative effect of the SARS-CoV-2 outbreak on utilization of outpatient services of patients with DM type 2 disease. This decrease was less pronounced among DMP patients. The glycated haemoglobin level (HbA1c) has not changed significantly.ConclusionsThe study showed that the analysis of routine data from outpatient care in Germany is possible in a timely manner using a special developed electronic health record system and corresponding software. The significantly negative effect of the SARS-CoV-2 outbreak on utilization of outpatient services of patients with DM type 2 disease was less pronounced among DMP patients. Two years after the start of the Covid pandemic a significantly worsened course of illness cannot be observed. However, it must be taken into account that the observation period for clinically relevant outcomes is still relatively short.

1655. Factors Associated with Acceptance of Telehealth-based Antimicrobial Stewardship Program Recommendations in a Community Hospital Health System

Abstract Background Telehealth-based antimicrobial stewardship programs (TeleASPs) have led to reduced broad-spectrum antimicrobial utilization. Data on factors associated with acceptance of stewardship recommendations are limited. Methods A TeleASP, facilitated by remote infectious disease physicians and local pharmacists, was implemented in 2 community hospitals from February 2018 through July 2020. Variables potentially affecting acceptance of TeleASP recommendations were tracked. Odds ratios of acceptance were determined utilizing multiple logistic regression. Results During the 30 month period, 4863 (91.2%) of the total 5333 recommendations were accepted. Hospitalist and Critical Care Medicine services had significantly higher odds of acceptance in univariable analysis, while General Surgery, Private Practice Primary Care Physician, Pulmonology, and Urology had lower odds of acceptance. Only Critical Care Medicine remained significant on multivariable analysis (OR 3.23, 95%CI 1.4–7.5). Other factors associated with a higher odds of acceptance in multivariable analysis were recommendations for antimicrobial dose/frequency adjustment (OR 2.63, 95%CI 1.6–4.3) and order for labs/tests (OR 3.30, 95%CI 2.1–5.2), while recommendations for antimicrobial de-escalation (OR 0.75, 95%CI 0.60–0.95) and antimicrobial discontinuation (OR 0.57, 95%CI 0.42–0.76) were associated with lower odds of acceptance. Female physicians were more likely to accept recommendations compared to males (93.1% vs 90.3% acceptance, OR 1.65; 95%CI 1.3–2.2). Compared to physicians with less than 3 years of experience, who had the highest acceptance rate (96.3%), physicians with 21 or more years of experience had the lowest (87.1%, OR 0.26; 95%CI 0.15–0.45). Conclusion TeleASP recommendations were accepted at a high rate. Acceptance rates were higher among female physicians, and recommendations to stop or de-escalate antimicrobials led to lower acceptance. Recommendations made to the most experienced physicians were the least accepted, which may be an important factor for stewardship programs to consider in education and intervention efforts. Disclosures Thomas L. Walsh, MD, Accelerate Diagnostics: Honoraria.

Exploring differences between public and private providers in primary care: findings from a large Swedish region.

This study contributes to the sparse literature on differences between public and private primary care practices (PCCs). The purpose was to explore if differences in performance and characteristics between public and PCCs persist over time in a welfare market with patient choice and provider competition, where public and private providers operate under similar conditions. The analysis is based on data from a national patient survey and administrative registries in a large Swedish region, covering PCC observations in 2010 and 2019, i.e., the year after and 10 years after introducing choice and competition in the region. The findings suggest that differences across owner types tend to decrease over time in welfare markets. Differences in patients' experiences, PCC size, patient mix and the division of labour have decreased or disappeared between 2010 and 2019. There were small but significant differences in process measures of quality in 2019; public PCCs complied better with prescription guidelines. While the results demonstrate a convergence between public and private PCCs in regards to their characteristics and performance, differences in patients' experiences in regards to socioeconomic conditions persisted. Such unwarranted variation calls for continued attention from policy makers and further research about causes.

Evaluation of the Appropriate Use of Coronary Computed Tomography Angiography: A Retrospective, Single-Center Analysis.

Purpose: We assessed the application of appropriate use criteria of coronary computed tomography angiography (CCTA) in comparison to invasive coronary angiography results and revascularization rates in patients with coronary artery disease (CAD). Methods: 1305 patients referred to invasive coronary angiography (ICA) after CCTA were evaluated retrospectively. The primary indication for CCTA was assessed according to the consensus for intermediate-risk (15–85% pre-test probability) into appropriate (A), inappropriate (I), and uncertain while referring to published guidelines. Patients’ risk factors, angina, and heart failure symptoms (Canadian Cardiovascular Society classification (CCSC), New York Heart Association (NYHA); clinical data; and ICA results were gathered. Results: Of 1305 patients referred to CCTA prior to ICA, 496 (38.0%) were appropriate, 766 (56.9%) inappropriate, and 43 (3.3%) uncertain. Of 766 patients with inappropriate CCTA referrals, 370 (48.3%) were classified as “inappropriately low” (<15% pre-test probability) and 396 (51.7%) as “inappropriately high” (>85%) in regard to the recommended CCTA utilization. Sub-analysis of the adherence to the appropriate use criteria did not differ between the source of the referring physicians (intramural tertiary, private practice primary care, or external secondary care hospitals). Obstructive CAD with subsequent revascularization rates (total of 39.2%) did not differ significantly between the appropriate (38.3%), inappropriate (41.0%), or uncertain (23.3%) groups (p = 0.068). Conclusion: The total coronary revascularization rate after CCTA was 39.2% and not different among low, intermediate, and pre-test probability groups. These findings support the role of CCTA as an excellent gatekeeper in patients with suspected obstructive CAD even beyond pre-test probability calculation models.

Project Five Wishes: promoting advance directives in primary care.

Despite the widely known and well-established benefits of advance care planning, it is estimated that 15-30% of American adults have completed advance directives (ADs). Evidence suggests that the best place for advance care planning (ACP) is in primary care, but many barriers to this practice exist. Providers in a Northern Arizona private practice primary care clinic expressed frustration with their current ability and standard of care regarding ADs. Only 0.8% of their established adult patients had ADs. Project Five Wishes was a 16-week trial designed to increase the number of ADs recorded at a Northern Arizona primary practice. The secondary purpose was to increase primary care provider knowledge, comfort, confidence, perceived importance, and frequency of discussions about ADs with patients. Interventions used in this project aimed to eliminate common barriers to ACP through a 30-minute presentation for providers and by integrating a user-friendly AD form into the office workflow. The number of ADs recorded increased by 25.4%. There were no statistically significant changes in the providers' reported knowledge, comfort, confidence, perceived importance, and frequency of discussions regarding ADs. The feasibly reproducible process used in Project Five Wishes was successful at increasing the number of patients with ADs in this 16-week trial and could lead to improvement in this area for other clinics as well.

To What Does The Finger Point?

This case challenge describes a 75-year-old white male patient who presented to a private primary care practice with a 1-month history of right third digit numbness, tenderness, and discoloration despite there being no history of injury to the digit.

Response to survey directed to patient portal members differs by age, race, and healthcare utilization

Health care systems are increasingly utilizing electronic medical record—associated patient portals to facilitate communication with patients and between providers and their patients. These patient portals are growing in recognition as potentially valuable research tools. While there is much information about the response rates and demographics of internet-based surveys as well as the demographics of patients who are portal members, not much is known about the response rate of internet-based surveys directed to a group of patient portal members or the demographics of which portal members respond to internet-based surveys issued within that specific population. The objective of these analyses was to determine the demographics of patient portal users who respond to an internet-based survey request. We hypothesized that respondents would more likely be: (1) older (65+), (2) European American, (3) married, (4) female, (5) college educated, (6) have higher medical care utilization, (7) have more comorbidities, and (8) have a private practice primary care physician (as opposed to a salaried group practice primary care physician). We found that our respondents tended to be older, of European geographic ancestry, and more frequent users of healthcare. While patient portal members are an easily identifiable and contactable group that are potentially valuable participants for research, it is important to understand that respondents to surveys solicited from this sampling frame may not be entirely representative. It will be important to develop strategies to more fully engage populations that represent the target population in order to increase overall and subgroup response rates.

Do primary care physicians use the 5As in counselling obese patients? A qualitative study

Background: Obesity is a global public health problem. A systematic review showed that intensive behavioural counselling is effective in weight management amongst patients with obesity, but little is known if primary care physicians (PCPs) are involved in delivering such counselling. Studies revealed that patients had weight reduction if they were counselled by PCPs who used the 5As (Ask, Assess, Advise, Agree and Assist) method, but PCPs varied in their use of this tool. We aimed to explore the local PCP modalities of obesity counselling and if their approaches and methods corresponded to the 5As tool. Methods: Qualitative data were obtained from interviews with 50 PCPs from public and private primary care practices during six focus group discussions and seven in-depth interviews. The interviews were audio-recorded, transcribed, audited and analysed iteratively based on the grounded theory. Emergent themes were first externally validated, and then finalized after rounds of deliberations amongst the investigators. Results: PCPs varied in their approach in obesity counselling, focusing predominantly on “Ask”, “Assess” and “Advise” in the 5As tool. “Asking” was indirect and “Assessment” rarely covered the effects of obesity on psychosocial functioning. Dietary and lifestyle modifications were the main foci in “Advise”. “Agree” was least performed. Polyclinic doctors tended to “Assist” patients with referral to other healthcare workers for further weight management, but few deliberately “Arrange” to review progress in weight management, citing barriers. Conclusion: PCPs varied in their method of obesity counselling, pending on context and setting of their practices. In contrast to “Ask’, “Assess” and “Advise”, the use of “Agree” and “Arrange” was uncommon.

Evaluation of a Curriculum in an Internal Medicine Residency and Patient- Centered Medical Home Rotation

Introduction: The Patient-Centered Medical Home (PCMH) model aims to transform primary care by delivering high-quality, safe, comprehensive, patient-centered, and accessible care. Few evaluations of PCMH curricula for internal medicine residency programs have been published. The objective of this study was to develop and implement a PCMH curriculum, a new PCMH rotation, and to redesign the resident ambulatory care clinic and private primary care practices of the residency program. Effects were evaluated by examining: 1) residents’ attitudes towards primary care and PCMH, 2) residents’ skills in communicating and managing care and 3) patients’ assessments of practice accessibility. Methods: From 2010-2015, we implemented a multi-modal program combining practice redesign, a lecture series, a one-month PCMH rotation, clinical activities, a quality improvement project, and self-reflection at an academic community hospital, a Federally Qualified Health Center (FQHC) and faculty practice offices to internal medic ne residents. Evaluations were conducted through resident self-assessment, patient assessment of practice accessibility, and objective structured clinical examinations. Results: Twelve residents [41% (12/29)] completed all components of the curriculum. After the rotation, residents thought their PCMH skills improved in 13 components of PCMH (all domains: p<0.02). Residents’ attitudes towards primary care and PCMH did not improve from 2010 to 2012 [response rate: 38% (11/29) and 44% (13/29), respectively]. Patient ratings improved, mostly in practice accessibility (p<0.001) and test notification (p=0.01). Conclusion: By engaging in the PCMH curriculum and practice redesign, residents showed improvement in PCMH skills across all domains, and patients demonstrated increased satisfaction with the practice. This curriculum in PCMH can be utilized as a useful model for other internal medicine programs.

Communicating with mismatch and tension: treatment provision experiences of primary care doctors treating patients with overactive bladder in Hong Kong.

BackgroundOveractive bladder (OAB) is a common chronic bladder dysfunction worldwide. As the first contact point of health care, primary health care providers are often consulted by patients seeking initial consultation for OAB. The relatively short history of the existence of OAB in medicine and low public awareness of OAB in Hong Kong, however, often serve as a challenge to primary health care providers in treating patients with OAB. The experiences of patients and health care providers are often influenced by the interaction between these two groups, hence both health care providers and patients are key determinants of the entire treatment experience, and the perspectives of health care providers should not be overlooked. However, patient experiences have been the main focus of related studies, few of which have examined the treatment provision experiences and perspectives of health care providers. This research gap is notable considering that the satisfaction and morale of health care providers can influence treatment outcome.MethodsThis study adopted a qualitative research approach by conducting semistructured individual interviews with 30 private practice primary care doctors in Hong Kong between November 2013 and May 2014.ResultsLacking confidence in treating OAB patients, encountering mismatch with patients in treatment expectations and communication style, and feeling embarrassed when communicating with OAB patients were the experiences reported by the sampled doctors.ConclusionThe sampled doctors’ treatment provision experiences revealed a general lack of knowledge about OAB among primary care doctors in Hong Kong. Furthermore, the negative stereotype of and lack of trust in private practice doctors created tension between the doctors and patients. This lack of mutual trust was particularly unfavourable for the doctors to provide long-term treatment and support to patients with OAB. The embedded distrust of private practice doctors also affected the prescribing behaviour of the doctors, who prescribed medication only to satisfy patient demands, which may lead to antibiotic abuse and resistance. Finally, the expectations of doctor professionalism and behaviour in Chinese cultures and the cultural perceptions of urinary diseases caused challenging treatment provision experiences for the sampled doctors.

Asthma education: different viewpoints elicited by qualitative and quantitative methods

Objective: This project began as a qualitative examination of how asthma education provided by health professionals could be improved. Unexpected qualitative findings regarding the use of Asthma Action Plans and the importance of insurance reimbursement for asthma education prompted further quantitative examination.Methods: Qualitative individual interviews were conducted with primary care physicians in private practice who routinely provide initial diagnoses of asthma and focus groups were conducted with other clinicians in private primary care practices who routinely provide asthma education. Using the DocStyles quantitative tool two questions regarding Asthma Action Plans and insurance reimbursement were asked of a representative sample of physicians and other clinicians.Results: The utility of Asthma Action Plans was questioned in the 2012 qualitative study. Qualitative findings also raised questions regarding whether reimbursement is the barrier to asthma education for patients performed by medical professionals it is thought to be. 2013 quantitative findings show that the majority of clinicians see Asthma Action Plans as useful. The question of whether reimbursement is a barrier to providing asthma education to patients was not resolved by the quantitative data.Conclusions: The majority of clinicians see Asthma Action Plans as a useful tool for patient education. Clinicians had less clear opinions on whether the lack of defined reimbursement codes acted as a barrier to asthma education. The study also provided useful audience data for design of new asthma educational tools developed by CDC.

Primary care at Swiss universities--current state and perspective.

BackgroundThere is increasing evidence that a strong primary care is a cornerstone of an efficient health care system. But Switzerland is facing a shortage of primary care physicians (PCPs). This pushed the Federal Council of Switzerland to introduce a multifaceted political programme to strengthen the position of primary care, including its academic role. The aim of this paper is to provide a comprehensive overview of the situation of academic primary care at the five Swiss universities by the end of year 2012.ResultsAlthough primary care teaching activities have a long tradition at the five Swiss universities with activities starting in the beginning of the 1980ies; the academic institutes of primary care were only established in recent years (2005 – 2009). Only one of them has an established chair. Human and financial resources vary substantially. At all universities a broad variety of courses and lectures are offered, including teaching in private primary care practices with 1331 PCPs involved. Regarding research, differences among the institutes are tremendous, mainly caused by entirely different human resources and skills.ConclusionSo far, the activities of the existing institutes at the Swiss Universities are mainly focused on teaching. However, for a complete academic institutionalization as well as an increased acceptance and attractiveness, more research activities are needed. In addition to an adequate basic funding of research positions, competitive research grants have to be created to establish a specialty-specific research culture.

Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures

The 2010 Affordable Care Act relies on Federally Qualified Health Centers (FQHCs) and FQHC look-alikes (look-alikes) to provide care for newly insured patients, but ties increased funding to demonstrated quality and efficiency. To compare FQHC and look-alike physician performance with private practice primary care physicians (PCPs) on ambulatory care quality measures. The study was a cross-sectional analysis of visits in the 2006-2008 National Ambulatory Medical Care Survey. Performance of FQHCs and look-alikes on 18 quality measures was compared with private practice PCPs. Data analysis was completed in 2011. Compared to private practice PCPs, FQHCs and look-alikes performed better on six measures (p<0.05); worse on diet counseling in at-risk adolescents (26% vs 36%, p=0.05); and no differently on 11 measures. Higher performance occurred in ACE inhibitors use for congestive heart failure (51% vs 37%, p=0.004); aspirin use in coronary artery disease (CAD; 57% vs 44%, p=0.004); β-blocker use for CAD (59% vs 47%, p=0.01); no use of benzodiazepines in depression (91% vs 84%, p=0.008); blood pressure screening (90% vs 86%, p<0.001); and screening electrocardiogram (EKG) avoidance in low-risk patients (99% vs 93%, p<0.001). Adjusting for patient characteristics yielded similar results, except that private practice PCPs no longer performed better on any measures. FQHCs and look-alikes demonstrated equal or better performance than private practice PCPs on select quality measures despite serving patients who have more chronic disease and socioeconomic complexity. These findings can provide policymakers with some reassurance as to the quality of chronic disease and preventive care at Federally Qualified Health Centers and look-alikes, as they plan to use these health centers to serve 20 million newly insured individuals.

Detecting and measuring deprivation in primary care: development, reliability and validity of a self-reported questionnaire: the DiPCare-Q

ObjectivesAdvances in biopsychosocial science have underlined the importance of taking social history and life course perspective into consideration in primary care. For both clinical and research purposes, this study aims...

Challenges in Recruiting Minority-Serving Private Practice Primary Care Physicians to a Quality Improvement Project

The objectives of this study were the following: (1) describe one organization's experience with recruiting minority-serving private practice primary care physicians to an ambulatory quality improvement (QI) project; (2) compare and contrast physicians who agreed to participate with those who declined; and (3) list incentives and barriers to participation. The authors identified eligible physicians by analyzing Medicare Part B claims data, a publicly available physician database, and office staff responses to telephone inquiries. The recruitment team had difficulty identifying, contacting, and recruiting eligible physicians. Solo practitioners and physicians who had lower scores on certain quality measures were more likely to participate. Barriers to participation were similar in all practices and included concerns about extra work, difficulty of change, and impact on office work flow. Commonly used incentives were offered but were not universally embraced. Additional work is required to refine the process of physician recruitment and to find more compelling incentives for QI.

Impact of comorbidity on the individual's choice of primary health care provider

Objective. This study examined whether age, gender, and comorbidity were of importance for an individual's choice of listing with either a public or a private primary health care (PHC) practice. Design and setting. The study was a register-based closed cohort study in one private and one public PHC practice in Blekinge County in southern Sweden. Subjects. A cohort (12 696 individuals) was studied comprising all those listed with the public or private PHC practice on 1 October 2005 who were also listed with the public PHC practice on 1 October 2004. Main outcome measures. The listing/re-listing behaviour of the population in this cohort was studied at two points in time, 1 October 2005 and 1 October 2006, with respect to age, gender, and comorbidity level as measured by the ACG Case-Mix system. Results. Individuals listed with the public practice both on 1 October 2005 and one year later were significantly older, were more often females, and had a higher comorbidity level than individuals listed with the private practice. Individuals with a higher comorbidity level were more likely to re-list or to stay listed with the public practice. Conclusions. This study shows that the probability of choosing a public instead of private PHC provider increased with higher age and comorbidity level of the individuals. It is suggested that using a measure of comorbidity can help us understand more about the chronically ill individual's choice of health care provider. This would be of importance when health care policy-makers decide on reimbursement system or organization of PHC.

Autism Spectrum Disorder Screening in Primary Care

One in 110 children in the United States has autism spectrum disorder (ASD). Early identification and early intervention have been shown to improve outcomes for children with ASD. Although recommended, routine ASD screening at 18 and 24 months of age has not been widely adopted in practice. This quality improvement study examined whether a private primary care practice could overcome screening barriers and implement the recommended universal ASD screening practice using the Modified Checklist for Autism in Toddlers™. Guided by the Diffusion of Innovations evidence-based conceptual model, a practice change using the Modified Checklist for Autism in Toddlers™ was developed. A retrospective chart review of 99 subjects was done to evaluate screening fidelity and cost. An overall screening fidelity of 91% was achieved over a 7-month period. The cost of screening to the practice averaged $22.78 per month. This was offset by an average of $38.76 of revenue per month. These findings suggest that low-cost universal screening can be implemented in primary care when addressed from an organizational perspective.

Group Visits in Diabetes Care

This review appraised research evidence on the effectiveness of group visits for persons with diabetes. The group visit approach included both education and medical management of the patient, and this review focuses on the implications for the certified diabetes educator (CDE) as part of the group visit provider team. A search of a comprehensive list of databases produced 395 articles related to group visits, group education, and primary care of patients with diabetes. Using specific inclusion criteria, 12 articles were included in the review. Four review articles examined a total of 75 studies, and 8 additional original research articles analyzed outcomes related to group visits in the care of patients with diabetes. Current models for diabetes focused group visits that incorporate both group education and a health provider office visit in lieu of the traditional brief office visit failed to demonstrate consistent statistical improvement in A1C, BP, or lipids. There is evidence that group visits may reduce costs, some physiological outcomes may be improved, and patient and clinician satisfaction may be enhanced. The diabetes focused group visit model needs further testing by health care teams in a variety of settings including private primary care and rural practices.