title: Prolonging the return visit interval in primary care.
abstract: OBJECTIVE
  Extending the scheduled return visit interval has been suggested as one means to improve clinic access to the provider. However, prolonging the return visit interval may affect quality of care if prevention measures and chronic disease management receive less attention as clinic visits become less frequent. The purpose of this study was to determine whether a comprehensive education program could encourage providers to lengthen their return visit interval without compromising performance on key quality indicators.
  
  
  METHODS
  This was a prospective cohort study monitoring scheduling and performance data of primary care providers at the Milwaukee Veterans Affairs Medical Center. Following collection of baseline data (January through June 1999), providers were encouraged to lengthen the return visit interval while increasing reliance on nurses and other clinic staff for interim management of chronic disease. Provider-specific feedback of return visit interval and performance data was utilized to motivate behavioral change. Scheduling and clinical data were abstracted from random medical record audits performed at baseline and from July through December in the years 2000 and 2001.
  
  
  RESULTS
  Compared with the baseline period, the percent of patients scheduled > or =6 months was significantly increased among staff providers and medicine residents at 2 years (Staff providers: 31% vs. 62%, P <0.001; Medicine residents: 22 vs. 44%, P <0.001). Colorectal screening, pneumonia immunizations, and achievement of therapeutic goals for diabetes, hypertension, and lipid disorders significantly improved at 2 years compared with baseline measurements.
  
  
  CONCLUSIONS
  Educational interventions can successfully retrain providers to extend the return visit interval and reduce the scheduling of routine and perhaps unnecessary appointments. This can be accomplished without compromising important performance monitors for diabetes, lipid disorders, hypertension, and prevention.
authors.affiliation: Division of Primary Care (PC-00), Milwaukee Veterans Affairs Medical Center, 5000 National Avenue, Milwaukee, WI 53226, USA gordon.schechtman@med.va.gov
authors.forename: Gordon
authors.initials: G
authors.lastname: Schectman
authors.forename: Gary
authors.initials: G
authors.lastname: Barnas
authors.forename: Prakash
authors.initials: P
authors.lastname: Laud
authors.forename: Laura
authors.initials: L
authors.lastname: Cantwell
authors.forename: Monica
authors.initials: M
authors.lastname: Horton
authors.forename: Edwin J
authors.initials: EJ
authors.lastname: Zarling
mesh_terms: D002908:Chronic Disease / Q000628:therapy; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000517:prevention & control; D006266:Health Education; D006801:Humans; D006949:Hyperlipidemias / Q000517:prevention & control; D006973:Hypertension / Q000517:prevention & control; D008875:Middle Aged; D010561:Personnel Staffing and Scheduling; D011014:Pneumonia / Q000517:prevention & control; D011314:Preventive Health Services; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies