On-Demand Care Worse Than Scheduled Visits in Controlling Blood Pressure for People With Diabetes

Are adults with diabetes better able to manage their disease if they can schedule same- or next-day appointments to see their doctors rather than sticking to appointments made in advance? The conventional wisdom goes that if people with diabetes can more quickly get in to see their doctors whenever problems comes up, the sooner they can receive treatment for it. However, an Indiana University School of Medicine study of 4,060 adults with diabetes being treated at 12 clinics showed that open-ended scheduling produced no benefit and, when it came to blood pressure control, actually worsened patients’ conditions.

The study’s lead author, Dr. Usha Subramanian, an assistant professor of medicine, was surprised that open-schedule patients didn’t do as well with their blood pressure control. “Control of blood pressure is probably the single most important medical intervention to improve survival and reduce healthcare costs for those with diabetes,” she said. 

Tentatively, the researchers have concluded that open scheduling, because it does not require much planning by patients and has an element of spontaneity, can result in people with diabetes making fewer visits to their doctors than patients who have regularly scheduled appointments that they have written down and incorporated into their schedules. 

The Indiana study found that the rates of hospitalization and visits to emergency rooms due to complications of diabetes were the same for people using open scheduling as for those using traditional longer-term scheduling. 

The study was published in the March issue of the Journal of General Internal Medicine.

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