National Ambulatory Medical Care Survey: 2007 summary.
ABSTRACT This report describes ambulatory care visits made to physician offices in the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit.
The data presented in this report were collected in the 2007 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits to nonfederal office-based physicians in the United States. Sample data are weighted to produce annual national estimates of physician visits.
During 2007, an estimated 994.3 million visits were made to physician offices in the United States, an overall rate of 335.6 visits per 100 persons. About one-third of office visits, 34.9 percent, were made to practices with all or partial electronic medical records systems, while 85.1 percent of the visits were made to practices with all or partial electronic submission of claims. From 1997 to 2007, the percentage of visits to physicians who were solo practitioners decreased 21 percent. During the same period, visits to physicians who were part of a group practice with 6-10 physicians increased 46 percent. There were an estimated 106.5 million injury- or poisoning-related office visits in 2007, representing 10.7 percent of all visits. Medications were ordered, supplied, or administered at 727.7 million office visits, accounting for 73.2 percent of all office visits. In 2007, about 2.3 billion drugs were ordered, supplied, or administered, resulting in an average of 226.3 drug mentions per 100 visits.
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ABSTRACT: Escalating rates of prescription opioid use and abuse have occurred in the context of efforts to improve the treatment of nonmalignant pain. The aim of the study was to characterize the diagnosis and management of nonmalignant pain in ambulatory, office-based settings in the United States between 2000 and 2010. Serial cross-sectional and multivariate regression analyses of the National Ambulatory Medical Care Survey (NAMCS), a nationally representative audit of office-based physician visits, were conducted. (1) Annual visit volume among adults with primary pain symptom or diagnosis; (2) receipt of any pain treatment; and (3) receipt of prescription opioid or nonopioid pharmacologic therapy in visits for new musculoskeletal pain. Primary symptoms or diagnoses of pain consistently represented one-fifth of visits, varying little from 2000 to 2010. Among all pain visits, opioid prescribing nearly doubled from 11.3% to 19.6%, whereas nonopioid analgesic prescribing remained unchanged (26%-29% of visits). One-half of new musculoskeletal pain visits resulted in pharmacologic treatment, although the prescribing of nonopioid pharmacotherapies decreased from 38% of visits (2000) to 29% of visits (2010). After adjusting for potentially confounding covariates, few patient, physician, or practice characteristics were associated with a prescription opioid rather than a nonopioid analgesic for new musculoskeletal pain, and increases in opioid prescribing generally occurred nonselectively over time. Increased opioid prescribing has not been accompanied by similar increases in nonopioid analgesics or the proportion of ambulatory pain patients receiving pharmacologic treatment. Clinical alternatives to prescription opioids may be underutilized as a means of treating ambulatory nonmalignant pain.Medical care 10/2013; 51(10):870-878. · 3.24 Impact Factor
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ABSTRACT: Arthritis affects 20 % of the adult US population and is associated with comorbid depression. Depression screening guidelines have been endorsed for high-risk groups, including persons with arthritis, in the hopes that screening will increase recognition and use of appropriate interventions. To examine national rates of depression and depression screening for patients with arthritis between 2006 and 2010. We used nationally representative cross-sections of ambulatory visits in the United States from the National Ambulatory Medical Care Survey from 2006 to 2010, which included 18,507 visits with a diagnosis of arthritis. When weighted to the US population, this total represents approximately 644 million visits. Visits where arthritis was listed among diagnoses. Outcomes were survey-weighted estimates of depression and prevalence of depression screening among patients with arthritis across patient and physician characteristics. Of the 644,419,374 visits with arthritis listed, 83,574,127 (13 %) were associated with a comorbid diagnosis of depression. The odds ratio for comorbid depression with arthritis was 1.42 (95 % CI 1.3, 1.5). Depression screening occurred at 3,835,000 (1 %) visits associated with arthritis. When examining the rates of depression screening between ambulatory visits with and without arthritis listed, there was no difference in depression screening rates; both were approximately 1 %. There was no difference in screening rates by provider type. Compared to visits with other common, chronic conditions, the prevalence of depression at arthritis visits was high (13 per 100 visits), although the prevalence of depression screening at arthritis visits was low (0.68 per 100 visits). Despite the high prevalence of depression with arthritis, screening for depression was performed at few arthritis visits, representing missed opportunities to detect a common, serious comorbidity. Improved depression screening by providers would identify affected patients, and may lead to appropriate interventions such as mental health referrals and/or treatment with anti-depressants.Journal of General Internal Medicine 07/2013; · 3.28 Impact Factor
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ABSTRACT: Objectives Many factors may influence choice of care setting for treatment of acute infections. The authors evaluated a national sample of U.S. outpatient clinic and emergency department (ED) visits for three common infections (urinary tract infection [UTI], skin and soft tissue infection [SSTI], and upper respiratory infection [URI]), comparing setting, demographics, and care. Methods This was a retrospective analysis of 2006–2010 data from the National Hospital Ambulatory Care Survey (NHAMCS) and National Ambulatory Care Survey (NAMCS). Patients age ≥ 18 years with primary diagnoses of UTI, URI, and SSTI were the visits of interest. Demographics, tests, and prescriptions were compared, divided by ED versus outpatient setting using bivariate statistics. ResultsBetween 2006 and 2010, there were an estimated 40.9 million ambulatory visits for UTI, 168.3 million visits for URI, and 34.8 million visits for SSTI; 24% of UTI, 11% of URI, and 33% of SSTI visits were seen in EDs. Across all groups, ED patients were more commonly younger and black and had Medicaid or no insurance. ED patients had more blood tests (54% vs. 22% for UTI, 21% vs. 14% for URI, and 25% vs. 20% for SSTI) and imaging studies (31% vs. 9% for UTI, 27% vs. 8% for URI, and 16% vs. 5% for SSTI). Pain medications were more frequently used in the ED; over one-fifth of UTI and SSTI visits included narcotics. In both settings, greater than 50% of URI visits received antibiotics; more than 40% of UTI ED visits included broad-spectrum fluoroquinolones. Conclusions Emergency departments treated a considerable proportion of U.S. ambulatory infections from 2006 to 2010. Patient factors, including the presence of acute pain and access to care, appear to influence choice of care setting. Observed antibiotic use in both settings suggests a need for optimizing antibiotic use. Resumen ObjetivosMuchos factores pueden influir en la elección del lugar de atención y tratamiento de las infecciones agudas. Se evaluó una muestra nacional de las visitas a servicios de urgencias (SU) y clínicas ambulatorias en EEUU por tres infecciones comunes (infección del tracto urinario, infección de piel y partes blandas, e infección de vías respiratorias altas), y se compararon el escenario, los aspectos demográficos y la atención. MetodologíaSe trata de un análisis retrospectivo de los datos de la National Hospital Ambulatory Care Survey y la National Ambulatory Care Survey desde 2006 a 2010. Las visitas de interés fueron los pacientes de 18 años o más con un diagnóstico principal de infección del tracto urinario (ITU), de vía respiratoria alta (IRA), y de piel y partes blandas (IPPB). Se compararon los datos demográficos, diagnósticos y terapéuticos, y se dividieron en función del escenario, ambulatorio frente SU. Se analizó mediante estadística bivariada. ResultadosEntre 2006 y 2010, hubo 40,9 millones de visitas ambulatorias por ITU, 168,3 millones de visitas por IRA y 34,8 millones de visitas por IPPB: el 24% de las ITU, el 11% de las IRA y el 33% de las IPPB se vieron en los SU. Entre los grupos, los pacientes del SU fueron más frecuentemente afroamericanos, más jóvenes y no tenían seguro o estaban asegurados por Medicaid. A los pacientes del SU se les hizo más analíticas de sangre (54% vs. 22% para las ITU, 21% vs. 14% para las IRA, y 25% vs. 20% para las IPPB) y estudios de imagen (31% vs. 9% para las ITU, 27% vs. 8% para las IRA, y 16% vs. 5% para las IPPB). Los analgésicos fueron más frecuentemente utilizados en el SU; y por encima de una quinta parte de las visitas por ITU y IPPB recibieron opiáceos. En ambos escenarios, más del 50% de las visitas por IRA recibieron antibióticos; y más del 40% de las visitas a urgencias por ITU incluyeron fluorquinolonas de amplio espectro. ConclusionesLos SU trataron un considerable porcentaje de las infecciones ambulatorias en EEUU desde 2006 a 2010. Los factores del paciente, incluyendo la presencia de dolor agudo y el acceso a la atención, parecen influir en la elección del lugar de atención. El uso de antibióticos observado en ambos escenarios sugiere la necesidad de optimizar la prescripción antibiótica.Academic Emergency Medicine 01/2014; 21(1). · 1.76 Impact Factor