Follow-up Visits: Stay on Track
GIP Priority Message: Schedule Follow-up Visits
Patients who have asthma should be scheduled for planned follow-up visits at periodic intervals in order to assess their asthma control and modify treatment if needed.
Monitor asthma control at follow-up visits
Asthma is highly variable. It can change over time, vary by season or situation, and differ from person to person. Because response to asthma therapy also can vary, periodic monitoring of asthma control through clinical visits is essential to “step up” therapy (increase the dose, number of medications, and frequency) as necessary; or, “step down” (decrease) therapy when possible to the minimum medication necessary to maintain control.
Furthermore, the interval between follow-up visits may vary based on the level or duration of asthma control as well as the level of treatment required. The frequency of monitoring is a matter of clinical judgment. It will vary depending on several factors, including the level of asthma control. In general, patient visits should be scheduled at 2- to 6-week intervals while initiating therapy or stepping up therapy to achieve control; at 1- to 6-month intervals after asthma control is achieved in order to monitor if asthma control is maintained; and at 3-month intervals if a step-down in therapy is anticipated.
Patients being discharged from the emergency department should be referred for a follow-up asthma care appointment within 1 to 4 weeks. Timely follow-up care is essential to avoid relapse.
Communicate the importance of routine asthma “check-ups”
Patients and their families, clinicians, health care administrators, and policymakers may lack knowledge and appreciation about the importance and benefit of periodic clinical follow-up of people who have asthma. Contributing factors include the complexity of the message related to routine “check-ups” for asthma, even when the patient is feeling fine; the lack of belief in the benefits of preventive care; and the tendency to visit the doctor only during an asthma attack. A message that focuses on mutually agreed-upon goals for therapy, objective measures of control, and the benefits of well-controlled asthma would be a motivational cue to patients for keeping their appointments.