I didn’t even think this was a big question until I read an article in the AJMC (American Journal of Managed Care). I just assumed that there were clear guidelines (evidence-based) that would say a diabetic should see a physician every X months, a hypertensive every Y months, etc. Of course, every patient is different and their situation unique, but I thought there would be a starting point.
According to the article and the meta-analysis they did, the evidence doesn’t exist. If that’s true (which I believe), then this could be a significant factor in overutilization.
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. The remaining 42% were for the evaluation of a new problem or an exacerbation of a chronic condition.
In their example, they model that moving hypertension follow-ups from 6 months to 9 months would save $1.5B a year in healthcare costs.
The same scientific rigor that guides therapeutic decision making should be used to optimize chronic disease management. Rational choice of follow-up intervals is a crucial step in adjusting current utilization patterns to maximize the quality of patient care while minimizing unnecessary costs.