Promises and perils of group clinics for young people living with diabetes: a realist review

Abstract

Group clinics are becoming popular as a new care model in diabetes care. This evidence synthesis, using realist review methodology, examined the role of group clinics in meeting the complex needs of young people living with diabetes. Following RAMESES (Realist And Meta-narrative Evidence Synthesis) quality standards, we conducted a systematic search across 10 databases. 131 articles met inclusion criteria and were analysed to develop theoretically-informed explanations of how and why group clinics could work (or not) for young people with diabetes.

Models of group-based care in the literature varied significantly and incorporated different degrees of clinical and educational content. Our analysis identified four over-arching principles that can be applied in different contexts to drive sustained engagement of young people in group clinics principles: [a] emphasising self-management as practical knowledge; [b] developing a sense of affinity between patients; [c] providing safe, developmentally-appropriate care; and [d] balancing group and individual needs. Implementation of group clinics was not always straightforward; numerous adjustments to operational and clinical processes were required to establish and deliver high-quality care.

Group clinics for young people with diabetes offer potential to complement individualised care but are not a panacea and may generate as well as solve problems.