Morrison Fritha, Shubina Maria, Turchin Alexander
Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA 02115, USA.
Arch Intern Med. 2011 Sep 26;171(17):1542-50. doi: 10.1001/archinternmed.2011.400.
More frequent patient-provider encounters may lead to faster control of hemoglobin A1c level, blood pressure (BP), and low-density lipoprotein (LDL) cholesterol (LDL-C) level (hereafter referred to as hemoglobin A1c, BP, and LDL-C) and improve outcomes, but no guidelines exist for how frequently patients with diabetes mellitus (DM) should be seen.
This retrospective cohort study analyzed 26,496 patients with diabetes and elevated hemoglobin A1c, 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 A1c, BP, and LDL-C control was assessed.
Comparing patients who had encounters with their physicians between 1 to 2 weeks vs 3 to 6 months, median time to hemoglobin A1c 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 A1c (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.
Primary care provider encounters every 2 weeks are associated with fastest achievement of hemoglobin A1c, BP, and LDL-C targets for patients with diabetes mellitus.
患者与医疗服务提供者更频繁的接触可能会使糖化血红蛋白水平、血压（BP）和低密度脂蛋白（LDL）胆固醇水平（以下简称糖化血红蛋白、血压和LDL-C）得到更快控制，并改善治疗结果，但目前尚无关于糖尿病（DM）患者应多久就诊一次的指南。
这项回顾性队列研究分析了2000年1月1日至2009年1月1日期间在两家教学医院由初级保健医生治疗的26496例糖化血红蛋白、血压和/或LDL-C升高的糖尿病患者。评估了医疗服务提供者接触（定义为病历中的记录）频率与糖化血红蛋白、血压和LDL-C控制时间之间的关系。
将每1至2周与医生接触一次的患者与每3至6个月与医生接触一次的患者进行比较，糖化血红蛋白低于7.0%的中位时间在未接受胰岛素治疗的患者中分别为4.4个月和24.9个月，在接受胰岛素治疗的患者中分别为10.1个月和52.8个月；血压低于130/85 mmHg的中位时间分别为1.3个月和13.9个月；LDL-C低于100 mg/dL的中位时间分别为5.1个月和32.8个月（所有P值均<0.001）。在多变量分析中，医生接触时间加倍会导致糖化血红蛋白（未接受[35%]和接受[17%]胰岛素）、血压（87%）和LDL-C（27%）达到目标的中位时间增加（所有P值均<0.001）。对于大多数目标，随着接触频率增加至每2周一次，控制时间逐渐缩短，这与各药物类别的药效动力学一致。
对于糖尿病患者，每2周与初级保健提供者接触一次与最快达到糖化血红蛋白、血压和LDL-C目标相关。
