The Relationship of Frequency of Follow-Up Visits to Asthma Outcomes in Patients with Moderate Persistent Asthma

Abstract

Background. Although regular follow-up is recommended for patients with asthma, the optimal frequency of such follow-up has not been defined. The purpose of this study was to evaluate the relationship of the interval between routine physician visits to asthma outcomes in patients with moderate persistent asthma. Methods. The study population was a volunteer sample of subjects aged 18 years or older with moderate persistent asthma requiring at least moderate doses of inhaled corticosteroids who were followed for at least 6 months by one of two allergists in a large staff model HMO. Subjects were randomized to one of three groups: 1) monthly physician visits, 2) semi-annual physician visits, and 3) semiannual physician visits and monthly nurse phone calls. All subjects were advised to call their physician for questions or increased symptoms. The primary outcome variable was total asthma quality of life measured at baseline, 6 months and 12 months. Other outcome variables included specific asthma quality of life domains, spirometry, global asthma rating, satisfaction with treatment rating, and asthma resource and medication utilization during the one year of follow-up. Results. The final cohort included 29 patients per group. There were no significant differences between groups in baseline demographics, smoking history, spirometry, asthma quality of life, global rating, or satisfaction with treatment rating. As per the protocol, patients in the monthly physician visit group made significantly more routine visits during the study than other patients (P<.0001), but there were no other significant differences between groups in any of the other outcome variables at 6 months, 12 months, or during the year of the study. Conclusion. Patients with the characteristics of those in this study do not need routine follow-up visits more often than every 6 months. Further studies will be necessary to determine optimal follow-up intervals for patients with other degrees of asthma severity and for those followed in other settings.