How Often Are Your Follow Up Appointments?
I had a regular clinic visit, recently. It was a combined appointment to discuss a specific matter with my doctor. I have been involved in a clinical trial so my follow up appointments have been happening a research center and very often. Soon, I will be returning to the clinic stream. I need to buff up on my survival of the clinic visit. In general, I come in prepared with my list of questions, concerns or points I would like to discuss.
In this particular visit, we were discussing why a particular medication may cause an odd blood result. It led to a lesson on cytokines and the realization that researchers just don't quite know why some things happen. My physician ordered a bunch of diagnostics for my next visit, the usual spirometry induced sputum and repeat Methacholine Challenge to see if I have hand any improvements in bronchial hyper-responsiveness. I was to follow up in 6 weeks in the clinic.
This had me taking an informal poll amongst my asthma friends, how often are your follow appointments. It is important to know that this is not based on any scientific data. The responses I received were all over the map, some people had follow-ups, every 3-4 months, others at 6 months and a couple were yearly. I wanted to find out more about the guidelines recommended and if there was any relationship to severity.
Important things to consider for time frames in asthma follow up:
- Asthma is highly varaiable
- Intervals between follow ups visits may be based on the level and duration of asthma control
- Frequency of monitoring is a matter of clinical judgement
- The proposed time frame the NIH is patient visits should be scheduled at 2- to 6-week intervals while initiating therapy or stepping up therapy to achieve control; at 1- to 6-month intervals after asthma control is achieved, in order to monitor if asthma control is maintained; and at 3-month intervals if a step-down in therapy is anticipated1
If I relate this information back to my informal poll, I could see a bit of a correlation between where the people I survey aligned with their current asthma status. It is important to note that even when the patient is feeling fine; the lack of belief in the benefits of preventive care and the tendency to visit the doctor only during an asthma attack can be misleading. It is important that both physicians and patients communicate and discuss mutually agreed-upon goals for therapy.
Objective measures of control and the benefits of well-controlled asthma would be a motivational cue to patients for keeping their appointments.1 I found some data that looked at observational studies which reported a decrease in ED visits, hospitalizations or both when patients were managed by specialists. patients also reported fewer symptoms, less rescue medication use, improved quality of life and higher satisfaction with their asthma care.2
Follow up visits should include addressing asthma care and patients educational, environmental, pharmacologic, and psychosocial factors. Patient self care plays an important role in appointments. Presumably, patient self-assessment and provider supervision must be ongoing to achieve maximal and persistent benefits.
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