However, a recent randomized controlled trial determined 6 months to be too short an interval to reflect accurate therapy-induced changes in blood pressure. For example, patients being medically managed for hypertension are typically seen every 6 months. Determining the appropriate intervals and modeling their impact are important. Some guidelines attempted to recommend specific followup intervals, but the vast majority were not evidence based. Eight studies recommended specific follow-up times ( 7-15). Abstracts of these studies were reviewed, and guidelines with recommendations for follow-up interval timing were included. 5 These 5 conditions accounted for approximately $281 billion in healthcare expenditures in 2010. (1) Are these follow- up visits and their timing determined scientifically or by convenience and habit? (2) Is there an evidence base to support physicians’ practice patterns? (3) If there is evidence to support physicians’ practice patterns, are physicians adhering to those guidelines? If not, scheduling habits may be unnecessarily contributing to the problems f limited access, excessive utilization, and excessive costs, without improvement in healthcare outcomes.įollowing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for performing a systematic review, we used the PubMed database to search for studies discussing evidence-based guidelines for follow-up intervals for the top 5 chronic conditions accounting for the greatest number of outpatient visits in 2010 (mental disorders, back problems, arthritis, chronic obstructive pulmonary disease/asthma, hypertension). The remaining 42% were for the evaluation of a new problem or an exacerbation of a chronic condition. According to the National Health Statistics Report for 2009, there were nearly 1 billion office visits in 2009, 30% of which were for routine follow-up of a chronic problem and an additional 26% of which were for preventive care or follow-up of an acute condition. Where might there be more room for patients in this system? Notably, a substantial portion of outpatient office visits are follow-up visits. 2 This problem is confounded by increasing patient demand in an aging population and slow growth in physician supply, which lags behind other countries on a per capita basis, and is further exacerbated by economic disparities. 1 Several specialties face a shortage of providers, and geographic inequities also exist in almost all areas. Similarly, 19% of patients in the United States waited 6 or more days for an appointment compared with only 2% of patients in Switzerland. 1 Moreover, the study showed that only 57% of patients were able to access a same-day or next-day appointment when they were sick or needed care, compared with top-ranking Switzerland, where 93% of patients described being able to secure an appointment under these conditions. A 2010 Commonwealth Fund study of 11 industrialized countries found waiting times were longer in the United States than in all the other countries except Canada, Norway, and Sweden. Perhaps surprisingly, Americans face long wait times compared with other industrialized nations. Public concern regarding access to care combined with increasing pressure to curtail healthcare costs has prompted physicians to think critically about how best to manage chronic disease.
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