On-Demand Care for Diabetics May Not Help

Diabetic adults using same-day medical scheduling to manage their care fared no better and, in some aspects, saw their condition worsen, compared with those who

Diabetic adults using same-day medical scheduling to manage their care fared no better and, in some aspects, saw their condition worsen, compared with those who made their doctors’ appointments in advance as usual, a new study finds.

With on-demand, or open-access, scheduling, doctors’ offices give patients a general time period when they should come in for a follow-up, and the patients can then book their appointment on the day they want it or the day before. Some studies have linked open-access scheduling to more satisfied patients.

But the new study, by researchers at the Indiana University School of Medicine, found that such a system does not appear to benefit people with a chronic disease such as diabetes. It involved 4,060 adult diabetics and 12 clinics, half using open-access scheduling and half following usual in-advance scheduling of appointments.

Dr. Usha Subramanian, an assistant professor of medicine, said in a news release that, “We were surprised and concerned to find that, with open-access scheduling, patients did less well with their blood pressure,” the study’s first author. “Control of blood pressure is probably the single most important medical intervention to improve survival and reduce health-care costs for those with diabetes.”

The study reported that the rate of hospitalization or visits to hospital emergency departments were the same for people who visited clinics using open-access scheduling and those who went to places with traditional scheduling practices.

“It appears that timely follow-up for chronic disease management may be compromised if patients are required to remember and schedule their appointment at a suggested interval as opposed to putting a previously scheduled appointment on the calendar and remembering to get to the doctor’s office,” Subramanian said.

Journal of General Internal Medicine, March 2009