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Fam Pract Manag. 2019;26(3):32


To improve efficiency and clarify visit expectations, we have started creating an annual visit plan with each patient. We explain that each medication a patient takes and each related condition should be evaluated at least once a year, and sometimes more. In mapping out visits, we group together chronic illnesses, preventive care exams, and so on. Each annual visit plan reflects the individual patient's needs and the physician's style, but here's an example:


  • Hypertension, diabetes, and hyperlipidemia: once every six months with labs

  • Asthma and allergies: once a year

  • Physical exam: as needed, but at least once every two years

  • Annual wellness visit (for Medicare patients): once a year

  • Insomnia, gastroesophageal reflux disease, and gout: once a year

We tell patients that this plan assumes their conditions are stable and well-controlled and that, if they develop any additional complaints or new needs, they should schedule a separate appointment.

Physicians typically do this kind of planning internally, but we have rarely made it transparent for the patient and our staff. We give the patient a copy of this plan and put an alert on the chart so the patient knows what to expect at visits and team members can help schedule visits ahead of time. This planning saves the clinician from having to think through these issues at each visit. It also helps with certain types of scheduling. For instance, we can suggest the asthma visit be scheduled in October so the patient can receive a flu vaccine at the same time.


One of our family medicine clinics recently completed a project to improve the rate of pneumonia vaccination among its patient panel. The practice has approximately 1,500 eligible patients, and even with all the attention physicians and staff give to patients seen in the office, its pneumonia vaccination rate had plateaued at 83 percent. Over a six-month period, the practice's five clinicians and staff used the electronic health record (EHR) to identify patients who still had not received a pneumonia vaccine, paying special attention to patients who had recently turned 65 years old. Nursing staff contacted these patients by phone, notifying them of their status and asking if they wanted a pneumonia vaccination. Approximately 30 percent of the contacted patients requested and received the recommended vaccine, helping the office improve its pneumonia vaccination rate to 89 percent, which it has maintained.

This project demonstrates the use of the EHR and patient out-reach to close care gaps and the importance of engaging nursing staff in these efforts.


Constantly having to log into computers and websites can feel inefficient and frustrating. However, this redundant task can be an opportunity to increase your mindfulness at work. Try changing your passwords to include mindfulness mantras that speak to you, such as “gratitude,” “breathe,” “smile,” or “lovingkindness.”

To meet the requirements of a strong password, be sure to include some uppercase characters, special symbols, and numbers. Once you've changed your passwords, you can take a brief moment each time you log in to be mindful and reset your energy and focus. I have been doing this for years, and my log-in moments no longer feel like a burden.


Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Submit a pearl (250 words or less) to FPM at

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