With respect, asthma is a disease that
NEEDS periodic re-assessment, and has the potential for real DISEASE progression (with increase morbidity and mortality). And it's a disease that can go from controlled to uncontrol fairly quickly. People do DIE from asthma (both short term and long term). Hint - why is there a blackbox warning on advair/symbicort?
Having a patient who is frequently using albuterol (or refilling albuterol) is a concern that must be addressed (WHY is the patient frequently using albuterol?) Maintenance medications must also be tailored and adjusted base on disease severity and control.
To be honest, I can't think of a chronic disease state that a patient can self-maintain. Medications for hypertension all requires periodic monitoring - is HCTZ really the right drug? What if your patient has a history of hyponatremia, or gout, or sarcoid? Would patients know enough to not take HCTZ (if it is OTC) if they have that? What about ACE in an elderly gentleman with critical AS? Or history of acute renal failure from dehydration/UTI? Or beta-blockers in patients with heart failure (indicated but would you prefer letting physicians titrate beta-blockers, or would you like your patients to self-titrate?) I'm sure you can give CCBs without worry
Hyperlipidemia - which statins and how much? Any potential drug-drug interactions with the patient's other drugs? Who will monitor LFTs? And there is increasing evidence that link statins with IPF. Will patients really take a drug every single day (when asymptomatic)? When the patient comes to your office with diffuse muscle ache, will the patient tell you that they are on a statin (otc)?
We don't have patients periodically return just to collect co-pays. It's to re-assess how the patients are doing, if medications should be changed or discontinued, or escalate, and if indicated, periodic monitoring.