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Encounter Frequ..

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One of the components of ensuring proper management of complex disease states is the relationship with the health care provider. Disease states, such as diabetes, require monitoring of drug therapy, complications, and disease progression and attainment of evidence-based therapeutic goals known to result in reduced morbidity and mortality.1 There are many factors that play a role in determining the frequency of patient visits to their provider for management. Some of these factors include: practice type, education and financial status of patient, race, and disease state.2 These factors and frequency of visits could become barriers to a patient reaching and maintaining target goals for their disease state(s). Numerous studies have demonstrated that patients who visit their physician more often have better treatment outcomes.2 Unfortunately many guidelines offer little guidance for how frequent patient visits should be when the disease state is uncontrolled.3,4

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Morrison and colleagues conducted a retrospective cohort study in 26,496 patients with diabetes and elevated hemoglobin A1C (A1C), blood pressure (BP) and/or LDL cholesterol (LDL) to determine the relationship between encounter frequency and time to reach therapeutic goals. Patients included in the study were at least 18 years of age, diagnosed with diabetes or had an A1C > 7%, and had at least 1 instance of A1C, BP or LDL higher than the treatment goal. Actual treatment goals for the study were predetermined at an A1C < 7%, BP < 130/85mmHg, and LDL < 100mg/dL. Monitoring for each category began when the patient was outside of the specified target and stopped when the goal was met.3

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The results demonstrated that patients with more frequent physician visits reached their target treatment goal sooner and that a frequency of every 2 weeks led to the fastest achievement of control. This held true for each of the three categories. For diabetic patients not on insulin, encounters at 1-2 week intervals led to a median time to goal of 4.4 months compared to 24.9 months for a 3-6 month encounter interval; for diabetics on insulin, a 1-2 wk interval led to a median time to goal of 10.1 months and 3-6 month interval of 52.8 months. Blood pressure time to goal for 1-2 week and 3-6 month intervals was 1.3 and 13.9 months, respectively. Hyperlipidemia was 5.1 and 32.8 months at the 1-2 week and 3-6 month intervals, respectively (p<0.001 for all categories). When all treatment groups are combined, the median time to goal for 1-2 week intervals and 3-6 month intervals was 1.5 and 36.9 months, respectively. The authors concluded that as the time between encounter frequency increased, the proportion of patients who never reached goal increased as well.3

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Overall, this study found that as the interval between practitioner visits decrease, the time to treatment goal decreases. The study has various limitations. It was a retrospective study, so the nature of the visits and what occurred at the visit is unknown. Other evaluations have shown that more frequent visits result in better medication adherence which could also result in attainment of goals.3 Medication adherence cannot be dismissed as a potential confounder, as well as patients may have received more education at visits. The study also did not evaluate other innovative approaches to care, such as group visits, telephone follow-ups or use of mid-level providers.1,3 With healthcare reform, pay-for-performance and the increased need for primary care providers, it will be difficult for physicians to follow patients at 2 week ...

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