As the epidemic of diabetes continues to grow, it’s becoming increasingly important for healthcare providers to find effective strategies to minimize microvascular and macrovascular complications associated with the disease. Unfortunately, many patients with diabetes do not have these disease components under control.
Intriguing New Data
In the Archives of Internal Medicine, my colleagues and I had a study published in which we retrospectively analyzed more than 26,000 patients with diabetes and hyperglycemia, hypertension, and/or hyperlipidemia who received care in primary care settings. We wanted to determine if diabetes control was improved with a greater frequency of patient encounters. A strong association between encounter frequency and A1C, blood pressure (BP), and LDL cholesterol control in patients with diabetes was observed (Table 1).
Doubling the time between physician encounters was also found to increase median time to A1C, BP, and LDL cholesterol targets. More frequent opportunities for medication intensification are likely an important factor in our findings (Table 2). They may also likely improve medication adherence and increase opportunities for providers to offer lifestyle coaching or other education that can further enhance diabetes control.
Potential for Great Benefits
Considering that more frequent encounters in patients with diabetes would increase the demands on healthcare resources, increasing the frequency of encounters may require innovative approaches to delivering care. For example, medical homes may help coordinate the care of patients. In addition, some interactions could be accomplished through group visits, telephone, fax, email, or internet communications. Midlevel providers can also alleviate physician workloads without negatively affecting patient outcomes.
Until guidelines provide more data or recommendations on how frequently patients with diabetes should be seen by their physicians, efforts should be made to see these individuals as often as possible, especially in cases for which diabetes is severely uncontrolled. Once diabetes is under control, the frequency of encounters may be decreased to alleviate strains on healthcare resources.
Readings & Resources (click to view)
Morrison F, Shubina M, Turchin A. Encounter frequency and serum glucose level, blood pressure, and cholesterol level control in patients with diabetes mellitus. Arch Intern Med. 2011;171:1542-1550. Available at: http://archinte.ama-assn.org/cgi/content/full/171/17/1542.
Turchin A, Goldberg SI, Shubina M, et al. Encounter frequency and blood pressure in hypertensive patients with diabetes mellitus. Hypertension. 2010;56:68-74.
Patel NC, Crismon ML, Miller AL, Johnsrud MT. Drug adherence: effects of decreased visit frequency on adherence to clozapine therapy. Pharmacotherapy. 2005;25:1242-1247.
Guthmann R, Davis N, Brown M, Elizondo J. Visit frequency and hypertension. JClin Hypertens (Greenwich). 2005;7:327-332.
Wick A, Koller MT. Views of patients and physicians on follow-up visits: results from a cross-sectional study in Swiss primary care. Swiss Med Wkly. 2005;135:139-144.
Østbye T, Yarnall KS, Krause KM, et al. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med. 2005;3:209-214.