Setting the revisit interval in primary care

OBJECTIVE: Although longitudinal care constitutes the bulk of primary care, physicians receive little guidance on the fundamental question of how to t ime follow-up visits. We sought to identify important predictors of the rev isit interval and to describe the variability in how physicians set these i ntervals when caring for patients with common medical conditions. DESIGN: Cross-sectional survey of physicians performed at the end of office visits for consecutive patients with hypertension, angina, diabetes, or mu sculoskeletal pain. PARTICIPANTS/SETTING: One hundred sixty-four patients under the care of 11 primary care physicians in the Dartmouth Primary Care Cooperative Research Network. MEASUREMENTS: The main outcome measures were the variability in mean revisi t intervals across physicians and the proportion of explained variance by p otential determinants of revisit intervals. We assessed the relation betwee n the revisit interval (dependent variable) and three groups of independent variables, patient characteristics (e.g., age, physician perception of pat ient health), identification of individual physician, and physician charact erization of the visit (e.g;, routine visit, visit requiring a change in ma nagement, or visit occurring on a "hectic" day), using multiple regression that accounted for the natural grouping of patients within physician. MAIN RESULTS: Revisit intervals ranged from 1 week to over 1 year. The most common intervals were 12 and 16 weeks, Physicians' perception of fair-poor health status and visits involving a change in management were most strong ly related to shorter revisit intervals. In multivariate analyses, patient characteristics explained about 18% of the variance in revisit intervals, a nd adding identification of the individual provider doubled the explained v ariance to about 40%. Physician characterization of the visit increased exp lained variance to 57%. The average revisit interval adjusted for patient c haracteristics for each of the 11 physicians varied from 4 to 20 weeks. Alt hough all physicians lengthened revisit intervals for routine visits and sh ortened them when changing management, the relative ranking of mean revisit intervals for each physician changed Little for different visit characteri zations-so physicians were consistently long and others were consistently s hort. CONCLUSION: Physicians vary widely in their recommendations for office revi sits. Patient factors accounted for only a small part of this variation. Al though physicians responded to visits in predictable ways, each physician a ppeared to have a unique set point for the length of the revisits interval.