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Primary Care

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Physician preference plays a large role in scheduling patient return visits

Patient health status does not necessarily determine how physicians time followup visits, which can range from 1 week to over 1 year. Instead, a recent study supported by the Agency for Health Care Policy and Research (HS07350) indicates that revisit intervals are consistently long for some physicians and consistently short for others. Even after accounting for important patient characteristics and regardless of whether the visit was routine or required a change in management, physicians' mean revisit intervals in this study varied five-fold.

The most common revisit intervals were 12 and 16 weeks. Patients rated in fair or poor health had an average revisit interval of 7 weeks, while patients in excellent or good health had an average interval of 13 weeks. Fair or poor mental health was associated with a 4-week shorter revisit interval, as was fair or poor medical stability. The revisit interval for nonroutine visits was about 9 weeks shorter than for routine visits. Similarly, the interval for visits when there was a change in management was about 9 weeks shorter than for visits without such a change.

Physicians tend to schedule return visits sooner for sicker patients and also when there is a change in management of a patient's condition—for example, starting or changing medication or the ordering of a diagnostic test. Yet some physicians always tend to schedule shorter followup intervals, and others tend to schedule longer followup visit intervals within that range, explains John H. Wasson, M.D., of Dartmouth Medical School. The researchers surveyed 11 primary care physicians in the Dartmouth Primary Care Cooperative Research Network at the end of visits with 164 patients with hypertension, angina, diabetes, or musculoskeletal pain.

For more details see, "Setting the revisit interval in primary care," by Lisa M. Schwartz, M.D., M.S., Steven Woloshin, M.D., M.S., Dr. Wasson, and others, in the April 1999 Journal of General Internal Medicine 14, pp. 230-235.

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