Total United States health care costs could be lowered by billions of dollars per year if evidence-based guidelines for follow-up patient visits are established, according to the authors of a commentary in the January issue of the American Journal of Managed Care.
In addition, new standards for follow-up visits would improve access and maximize the quality of the visits without compromising or restricting care, wrote Emilia Javorsky of the University of Massachusetts and her associates.
"Scheduling habits may be unnecessarily contributing to the problems of limited access, excessive utilization, and excessive costs, without improvement in health care outcomes," the authors wrote. "The same scientific rigor that guides therapeutic decision making should be used to optimize chronic disease management."
They searched the PubMed database for studies discussing evidence-based guidelines for follow-up intervals for the Top 5 chronic conditions – mental disorders, back problems, arthritis, chronic obstructive pulmonary disease/asthma, and hypertension – in 2010. Out of 330 studies, only 8 recommended evidence-based follow-up intervals.
To illustrate the point, Ms. Javorsky and her associates crunched the numbers for follow-up treatment of hypertension, with patient visits typically occurring every 6 months. Hypertension management accounted for $47.4 billion in 2008, with $13.0 billion coming from outpatient visits. If follow-up visits were extended from 6 to 7 months, the authors argued, there would be a 15% decrease in the number of visits in 1 year, with cost savings predicted to be nearly $682 million/year.
In addition, many patients with hypertension could see even more effective care with new standards, as recent studies have suggested that more time is needed to reflect accurate therapy-induced changes in blood pressure.
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