Twice yearly doc visits for hypertension exemplify excessive care

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 - High blood pressure, hypertension

Twice-yearly doctor visits to manage hypertension may be too frequent an interval that is not supported by scientific evidence and also not cost-effective, according to an analysis published in the January issue of The American Journal of Managed Care.

In a commentary, Emilia Javorsky, MPH, of the University of Massachusetts in Boston, and colleagues used hypertension management as an example of patient care patterns that may warrant a closer look. They asked whether follow-up visits and their timing are based on scientific evidence or physician habit; whether there is evidence to support physicians’ patterns; and if there are evidence-based guidelines, whether physicians adhere to them.

“If not, scheduling habits may be unnecessarily contributing to the problems of limited access, excessive utilization, and excessive costs, without improvement in healthcare outcomes,” they wrote.

The authors reviewed 330 studies that reviewed evidence-based guidelines for the timing of follow-up visits for the five chronic conditions that made up for the most outpatient visits in 2010: mental disorders, back conditions, arthritis, chronic obstructive pulmonary disease/asthma and hypertension.

They noted that one recent trial found six months between visits for hypertension was too little time to accurately determine the effectiveness of therapy. Lengthening the follow-up interval could save money and lead to more accurate assessment of blood pressure and better therapeutic management.

Javorsky et al also noted that outpatient visits for hypertension cost more than $13 billion. If the follow-up interval were extended by one month, that would be a 15 percent decrease in the number of visits in a year and a savings of about $682 million.

They argued that physicians should support research into developing evidence-based follow-up guidelines for common chronic conditions. “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,” they wrote.