Encounter Frequency and Serum Glucose Level, Blood Pressure, and Cholesterol Level Control in Patients With Diabetes Mellitus

Abstract

Background More frequent patient-provider encounters may lead to faster A1c, blood pressure and LDL control and improve outcomes but there are no guidelines for how frequently patients with diabetes should be seen. Methods This retrospective cohort study analyzed 26,496 patients with diabetes and elevated A1c, blood pressure, and/or LDL cholesterol treated by primary care physicians at two teaching hospitals between 1/1/2000 and 1/1/2009. Relationship between provider encounter (defined as a note in medical record) frequency and time to A1c, blood pressure and LDL control was assessed. Results Comparing patients who had encounters with their physicians between 1-2 weeks vs. 3-6 months, median time to A1c < 7.0% was 4.4 vs. 24.9 months (not on insulin) and 10.1 vs. 52.8 months (on insulin); median time to blood pressure < 130/85 mm Hg was 1.3 vs. 13.9 months; and median time to LDL < 100 mg/dL was 5.1 vs. 36.9 months, respectively (p < 0.0001 for all). In multivariable analysis, doubling the time between physician encounters led to a 35%, 17%, 87%, and 27% increase in median time to A1c (off and on insulin), blood pressure, and LDL targets, respectively (p < 0.0001 for all). Time to control decreased progressively as encounter frequency increased up to once every two weeks for most targets, consistent with pharmacodynamics of respective medication classes. Conclusions Biweekly primary care provider encounters are associated with fastest achievement of A1c, blood pressure, and LDL targets for patients with diabetes.

Hydroxyurea and Growth in Young Children With Sickle Cell Disease

“…We are not aware of any studies that have looked at the effects of frequent clinic visits and close central monitoring of growth parameters in individuals with chronic illness; however, frequent visits have been shown to have favorable effects on other health outcomes, such as improved HbA1c levels in individuals with type 2 diabetes and hypertension. [42][43][44] More frequent study visits (required for dosage titration in some subjects) were associated with better adherence to medications in BABY HUG. 45 …”

Variation in Nephrologist Visits to Patients on Hemodialysis across Dialysis Facilities and Geographic Locations

“…For instance, closer follow-up was associated with reduced rates of rehospitalization in patients recently hospitalized for chronic obstructive pulmonary disease exacerbations (22), whereas a multidisciplinary intervention, including more frequent provider visits, prevented rehospitalization in patients recently hospitalized for heart failure (23). Additionally, more frequent ambulatory visits were found to be beneficial in patients with uncontrolled diabetes (24). If a similar pattern holds true for patients on hemodialysis (i.e., sicker patients benefit from more frequent encounters with their provider), our finding that certain subsets of sicker or more vulnerable patients on hemodialysis (e.g., patients recently started or hospitalized) are not seen as frequently as more stable patients highlights a potential area for improved care in this population.…”

Association of Provider–Patient Visit Frequency and Patient Outcomes on Hemodialysis

“…[1][2][3] Patients with ESRD have a high rate of morbidity and mortality and account for a disproportionate share of healthcare dollars. 4 Based on two small observational studies that suggested an association between greater provider-patient interaction and improved patient survival, 5,6 increasing the frequency of provider visits with hemodialysis patients has received attention as a potentially useful intervention.…”