***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : The need to provide high quality prenatal care services , which take account of women ’s views and specifically address their need for information , support and communication , has been advocated and group prenatal care , had been suggested as one of the ways to achieve this objective . The purpose of this study was to examine the impact of group versus individual prenatal care on satisfaction and prenatal care use . Methods : This was a cluster-r and omized controlled trial with the health center as the r and omization unit that conducted in 2007 . Satisfaction was measured through a st and ardized question naire , and the Kotelchuck Adequacy of Prenatal Care Utilization Index was used to measure prenatal care utilization . Results : We recruited 678 women ( group prenatal care , ( N= 344 ) and individual prenatal care , ( N=334 ) in the study . Women in group prenatal care model were more satisfied than women in individual prenatal care model in all areas evaluated , including information , communication , co-ordination and quality of care . Group care women were significantly more likely to have adequate prenatal care than individual care women were ( OR=1.35 95 % CI=1.26–1.44 ) . Conclusions : Group prenatal care was associated with a significant improvement in client satisfaction and prenatal care utilization . This model of care has implication s for the planning and provision of prenatal services within public health system , which is moving toward a better quality health care , and increasing use of services OBJECTIVE To study time course changes in knowledge , problem solving ability , and quality of life in patients with type 2 diabetes managed by group compared with individual care and education . RESEARCH DESIGN AND METHODS We conducted a 5-year r and omized controlled clinical trial of continuing systemic education delivered by group versus individual diabetes care in a hospital-based secondary care diabetes unit . There were 120 patients with non-insulin-treated type 2 diabetes enrolled and r and omly allocated to group or individual care . Eight did not start and 28 did not complete the study . The main outcome measures were knowledge of diabetes , problem solving ability , quality of life , HbA1c , BMI , and HDL cholesterol . RESULTS Knowledge of diabetes and problem solving ability improved from year 1 with group care and worsened among control subjects ( P<0.001 for both ) . Quality of life improved from year 2 with group care but worsened with individual care ( P<0.001 ) . HbA1c level progressively increased over 5 years among control subjects ( + 1.7 % , 95 % CI 1.1 - 2.2 ) but not group care patients ( + 0.1 % , -0.5 to 0.4 ) , in whom BMI decreased ( -1.4 , -2.0 to -0.7 ) and HDL cholesterol increased ( + 0.14 mmol/l , 0.07 - 0.22 ) . CONCLUSIONS Adults with type 2 diabetes can acquire specific knowledge and conscious behaviors if exposed to educational procedures and setting s tailored to their needs . Traditional one-to-one care , although delivered according to optimized criteria , is associated with progressive deterioration of knowledge , problem solving ability , and quality of life . Better cognitive and psychosocial results are associated with more favorable clinical outcomes PURPOSE this study was conducted to evaluate the feasibility and acceptability of a managed-care approach ( group visits ) on delivering care to uninsured or inadequately insured patients with type 2 diabetes . METHODS One hundred twenty patients with uncontrolled type 2 diabetes were r and omly assigned to receive care in group visits or usual care for 6 months . At baseline , 3 months , and 6 months , the feasibility and acceptability of this model of healthcare delivery were assessed through the patients ' responses to the Primary Care Assessment Tool and the Trust in Physician Scale . Attendance records were kept for each group . RESULTS Patients who received care in group visits showed an improved sense of trust in their physician compared with patients who continued to receive usual care . There was a tendency for patients in groups to report better coordination of their care , better community orientation , and more culturally competent care . Patient attendance at the groups also indicated good acceptance of this form of healthcare delivery . CONCLUSIONS Group visits were feasible and acceptable to these uninsured and inadequately insured patients with uncontrolled type 2 diabetes and fostered an improved sense of trust in their physician PURPOSE The purpose of the study was to evaluate perceptions of care delivered through group visits to disadvantaged patients with type 2 diabetes . METHODS One hundred eighty-six patients with uncontrolled type 2 diabetes were r and omly assigned to receive care in group visits or usual care for 12 months . Their perceptions of the care they received were measured at baseline and 6 and 12 months by the  Primary Care Assessment Tool ( PCAT ) , the Diabetes-Specific Locus of Control ( DLC ) survey , and the Trust in Physician Scale ( TPS ) .  RESULTS Compared to patients in usual care , group visit patients ' PCAT scores were higher in the domains of ongoing care ( P = .001 ) , community orientation ( P < .0001 ) , and cultural competence ( P = .022 ) . In addition , group patients had higher scores for the Powerful-Other Health Professional subscale of the DLC survey ( P = .010 ) . CONCLUSIONS Patients assigned to group visits had generally more positive perceptions about their care in the areas of ongoing care , community orientation of care , and cultural competence of care than did those in usual care . The perception that one 's health professional is powerful , however , has been associated with a reluctance of patients to make medication changes on their own in previous studies . These findings suggest the need for modification in the way that group visits are conducted to empower and activate patients while still delivering continuous , culturally competent , and community-oriented care OBJECTIVE We investigated the perceptions of diabetes care and diabetes in patients followed long-term by group or usual care .  RESEARCH DESIGN AND METHODS Three open questions were administered to 120 patients ( 43 with T1DM and 77 with T2DM ) who had been r and omized at least 2 years before to be followed by group care and 121 ( 41 T1DM and 80 T2DM ) who had always been on usual care .  The responses were analyzed by propositional analysis , by identifying the focal nuclei , i.e. , the terms around which all sentences are organized , and then other predicates , according to their hierarchical relationship to the nuclear proposition . Specific communicative units were arbitrarily classified into three categories : attitudes , empowerment , and locus of control . RESULTS Patients on group care  showed more positive attitudes , higher sense of empowerment , and more internal locus of control than those on usual care . In addition , they expressed a wider and more articulated range of concepts associated with the care received and made less use of medical terminology ( P < 0.001 , all ) . Higher HbA1c was associated with negative attitudes ( P = 0.025 ) and negative empowerment ( P = 0.055 ) . CONCLUSIONS Group treatment reinforces communication and peer identification and may achieve its clinical results by promoting awareness , self-efficacy , positive attitudes toward diabetes and the setting of care , an internal locus of control , and , ultimately , empowerment in the patients OBJECTIVES To compare the effectiveness of Cooperative Health Care Clinic ( ( CHCC ) group outpatient model for chronically ill , older health maintenance organization ( HMO ) patients ) with usual care .  DESIGN Two-year , r and omized , controlled trial conducted with recruitment from February 1995 through July of 1996 . SETTING Nonprofit group model HMO . PARTICIPANTS Two hundred ninety-four adults ( 145 intervention and 149 usual care ) , aged 60 and older ( mean age 74.1 ) with 11 or more outpatient visits in the prior 18 months , one or more self-reported chronic conditions , and expressed interest in participating in a group clinic . INTERVENTION Monthly group meetings held by patients ' primary care physicians . MEASUREMENT Differences in clinic visits , inpatient admissions , emergency room visits , hospital outpatient services , professional services , home health , and skilled nursing facility admissions ; measures of patient satisfaction , quality of life , self-efficacy , and activities of daily living ( ADLs ) . RESULTS Outpatient , pharmacy services , home health , and skilled nursing facility use did not differ between groups , but CHCC patients had fewer hospital admissions ( P=.012 ) , emergency visits ( P=.008 ) , and professional services ( P=.005 ) . CHCC patients ' costs were $ 41.80 per member per month less than those of control patients . CHCC patients reported higher satisfaction with their primary care physician ( P=.022 ) , better quality of life ( P=.002 ) , and greater self-efficacy ( P=.03 ) . Health status and ADLs did not differ between groups . CONCLUSION The CHCC model result ed in fewer hospitalizations and emergency visits , increased patient satisfaction , and self-efficacy , but no effect on outpatient use , health , or functional status BACKGROUND AND AIMS We showed that continuing education can be embedded into routine diabetes care by seeing patients in small groups rather than individually . Group care was cost-effective in improving quality of life , knowledge of diabetes , health behaviours and clinical outcomes in people with type 2 diabetes . The aim of this study was to verify if group care can also be applied to type 1 diabetes . METHODS AND RESULTS R and omized , controlled clinical trial comparing 31 patients managed by group care with 31 managed by traditional one-to-one care .  A syllabus was built and later remodulated with the patients in a series of focus-group meetings . The primary end-point was changes in quality of life . Secondary end-points were : knowledge of diabetes , health behaviours , HbA1c and circulating lipids . Differential costs to the Italian National Health System and to the patients were also calculated . After 3 years , quality of life improved among patients on group care , along with knowledge and health behaviours ( p<0.001 , all ) . Knowledge added its effects to those of group care by independently influencing behaviours ( p=0.004 ) while quality of life changed independently of either ( p<0.001 ) . Among controls , quality of life worsened ( p<0.001 ) whereas knowledge and behaviours remained unchanged . HDL cholesterol increased among patients on group care ( p=0.027 ) and total cholesterol decreased in the controls ( p<0.05 ) . HbA1c decreased , though not significantly , in both . Direct costs for group and one-to-one care were Euros 933.19 and Euros 697.10 per patient , respectively , giving a cost-effectiveness ratio of Euros 19.42 spent per point gained in the quality of life scale . CONCLUSIONS Group care is applicable and also cost-effective in type 1 diabetes . It improves quality of life , knowledge and behaviours . Future programme adjustments should strive to impact more on metabolic control Background . Hypertension is becoming a main health problem worldwide , but there is little evidence as to how care for hypertensive patients should be organized and delivered in the community to help improve blood pressure control .  Group visit ( GV ) as a new care-delivering model has been shown to be less costly and have quality that is equal to or of better quality than usual care . The present study was conducted to evaluate the effectiveness of GVs for Chinese hypertensive patients compared with usual care . Methods . A r and omized , controlled trial was conducted , and a total of 1024 patients participated in the study . The patients in the GV groups received health care services in group format . The outcomes on blood pressure , treatment compliance , and self-efficacy were measured at baseline and at 6 months follow-up . Results . The average diastolic blood pressure decrease in the GV groups ( 1.5 mm Hg ) was more than that in the control groups ( 0.4 mm Hg ) significantly . In the GV groups , compliance with medicine , physical activities , and diet increased to 14.7 % , 9.7 % , and 10.1 % , respectively , which is more significant than that in the control groups ( 2.0 % , 1.6 % , and 8.0 % ) ; self-reported health and self-efficacy also improved significantly . Conclusion . The results suggest that the GV model is an acceptable and effective model for managing Chinese hypertensive patients in primary health care centers , and it could be a complement to the traditional individual office visit OBJECTIVE The aim of this study was to compare women 's satisfaction with  group based antenatal care  and st and ard care . DESIGN A r and omised control trial where midwives were r and omized to perform either GBAC or st and ard care . Women were invited to evaluate the two models of care . Data was collected by two question naires , in early pregnancy and six months after birth . Crude and adjusted odds ratios with a 95 % confidence interval were calculated by model of care . SETTING S Twelve antenatal clinics in Sweden between September 2008 and December 2010 . PARTICIPANTS Women in various part of Sweden ( n=700 ) . FINDINGS In total , 8:16 variables in GBAC versus 9:16 in st and ard care were reported as deficient . Women in GBAC reported significantly less deficiencies with information about labour/birth OR 0.16 ( 0.10 - 0.27 ) , breastfeeding OR 0.58 ( 0.37 - 0.90 ) and time following birth OR 0.61 ( 0.40 - 0.94 ) . Engagement from the midwives OR 0.44 ( 0.25 - 0.78 ) and being taken seriously OR 0.55 ( 0.31 - 0.98 ) were also 
    Output:
    
Accepting and implementing this nontraditional approach by both patients and clinicians can yield measurable improvements in patient trust , patient perception of quality of care and quality of life , and relevant biophysical measurements of clinical parameters .