domingo, 23 de octubre de 2011

Encounter frequency and serum glucose level,... [Arch Intern Med. 2011] - PubMed - NCBI

Study of Diabetes Patients’ Electronic Medical Records Shows Frequent Encounters with Doctors Leads to Better Care and Outcomes
Having more physician/patient encounters may lead to quicker control of type 2 diabetes measurements and improve outcomes, according to an AHRQ-funded study. The article “Encounter Frequency and Serum Glucose Level, Blood Pressure, and Cholesterol Level Control in Patients With Diabetes Mellitus,” published in the September 26 issue of the Archives of Internal Medicine, compared the electronic medical records (EMRs) of 26,496 patients who had encounters with their primary care physicians over 1 to 2 weeks versus 3 to 6 months. Defined by the study authors as “any note made in the EMR,” doctor-patient encounters included face-to-face interactions, as well as remote communication between doctor and patient, such as those taking place by telephone. More physician contact improved disease management across the board. The authors caution, however, that increasing patient encounters with providers could increase demand on health care resources. Select to access the abstract on PubMed.®
Encounter frequency and serum glucose level,... [Arch Intern Med. 2011] - PubMed - NCBI

Arch Intern Med. 2011 Sep 26;171(17):1542-50.

Encounter frequency and serum glucose level, blood pressure, and cholesterol level control in patients with diabetes mellitus.

Morrison F, Shubina M, Turchin A.

Source

Division of Endocrinology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA 02115. aturchin@partners.org .

Abstract

BACKGROUND:

More frequent patient-provider encounters may lead to faster control of hemoglobin A(1c) level, blood pressure (BP), and low-density lipoprotein (LDL) cholesterol (LDL-C) level (hereafter referred to as hemoglobin A(1c), BP, and LDL-C) and improve outcomes, but no guidelines exist for how frequently patients with diabetes mellitus (DM) should be seen.

METHODS:

This retrospective cohort study analyzed 26 496 patients with diabetes and elevated hemoglobin A(1c), BP, and/or LDL-C treated by primary care physicians at 2 teaching hospitals between January 1, 2000, and January 1, 2009. The relationship between provider encounter (defined as a note in the medical record) frequency and time to hemoglobin A(1c), BP, and LDL-C control was assessed.

RESULTS:

Comparing patients who had encounters with their physicians between 1 to 2 weeks vs 3 to 6 months, median time to hemoglobin A(1c) less than 7.0% was 4.4 vs 24.9 months (not receiving insulin) and 10.1 vs 52.8 months (receiving insulin); median time to BP lower than 130/85 mm Hg was 1.3 vs 13.9 months; and median time to LDL-C less than 100 mg/dL was 5.1 vs 32.8 months, respectively (P < .001 for all). In multivariable analysis, doubling the time between physician encounters led to an increase in median time to hemoglobin A(1c) (not receiving [35%] and receiving [17%] insulin), BP (87%), and LDL-C (27%) targets (P < .001 for all). Time to control decreased progressively as encounter frequency increased up to once every 2 weeks for most targets, consistent with the pharmacodynamics of the respective medication classes.

CONCLUSIONS:

Primary care provider encounters every 2 weeks are associated with fastest achievement of hemoglobin A(1c), BP, and LDL-C targets for patients with diabetes mellitus.