Characteristics of Asthma Visits to Physician Offices in the United States: 2012-2015 National Ambulatory Medical Care Survey.

Objective-This report describes asthma visits to offices of nonfederally employed U.S. physicians. Methods-Asthma visits are defined by the first-listed diagnosis from National Ambulatory Medical Care Survey data. Asthma visit rates among the general population and among persons with asthma (at-risk rates) were estimated. Trends from 2001 through 2016 were assessed. Asthma visit characteristics were assessed for the period 2012-2015 (the diagnostic coding system was changed to the International Classification of Diseases, 10th Revision, Clinical Modification in 2016). The consistency of visit characteristics with national asthma guidelines was also assessed. Results-From 2001 through 2016, population-based asthma visit rates declined from 40.2 to 30.7 visits per 1,000 persons, and at-risk visit rates from 55.5 to 36.7 visits per 100 persons with asthma. During 2012-2015, there was an annual average of 10.2 million asthma visits: 63.5% were by non-Hispanic white persons, 53.8% by female patients, and 32.5% by children under age 15 years. Population and at-risk visit rates were similar across sex and racial and ethnic groups. Children aged 0-4 years had the highest at-risk asthma visit rate. Primary care physicians saw 60.0% of asthma visits. Asthma severity was documented in 34.5% of visits, asthma control in 40.9%, spirometry in 14.9%, and peak flow in 3.3%. Asthma education was provided in 21.4% of asthma visits and asthma action plans in 9.9%. Bronchodilators were the most commonly mentioned medication class (24.9%). A quick-acting relief medication was the most frequently mentioned (albuterol, 16.9%), followed by asthma-control medications (montelukast, 4.7%; fluticasone-salmeterol, 3.7%; and prednisone, 2.7%). Conclusions-Asthma physician office visit rates declined from 2001 through 2016. During 2012-2015, primary care providers saw nearly two-thirds of asthma visits. Physician adherence to documenting asthma severity or control and providing patient education appeared low. Quick-acting relief medication was the most frequently prescribed medication.

Ambulatory medical care utilization estimates for 2007.

OBJECTIVES: This report presents statistics on ambulatory care visits to physician offices, hospital outpatient departments (OPDs), and hospital emergency departments (EDs) in the United States in 2007. Ambulatory medical care utilization is described in terms of patient, provider, and visit characteristics. METHODS: Data from the 2007 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey were combined to produce annual estimates of ambulatory medical care utilization. RESULTS: Patients in the United States made an estimated 1.2 billion visits to physician offices and hospital OPDs and EDs, a rate of 405.0 visits per 100 persons annually. This was not significantly different than the rate of 381.9 visits per 100 persons in 2006, neither were significant differences found in overall visit rates by age, sex, or geographic region. Visit distribution by ambulatory care setting differed by poverty level in the patient's ZIP Code of residence, with higher proportions of visits to hospital OPDs and EDs as poverty levels increased. Between 1997 and 2007, the age-adjusted visit rate increased by 11 percent, fueled mainly by a 29 percent increase in the visit rate to medical specialty offices. Nonillness and noninjury conditions, such as general and prenatal exams, accounted for the largest percentage of ambulatory care diagnoses in 2007, about 19 per 100 visits. Seven of 10 ambulatory care visits had at least one medication provided, prescribed, or continued in 2007, for a total of 2.7 billion drugs overall. These were not significantly different than 2006 figures. Analgesics were the most common therapeutic category, accounting for 13.1 drugs per 100 drugs reported, and were most often utilized at primary care and ED visits. The number of viral vaccines that were ordered or provided increased by 79 percent, from 33.2 million occurrences in 2006 to 59.3 million in 2007; significant increases were also noted for anticonvulsants and antiemetics.

National Ambulatory Medical Care Survey: 2007 summary.

OBJECTIVES: 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. METHODS: 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. RESULTS: 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.

Polypharmacy in nursing home residents in the United States: results of the 2004 National Nursing Home Survey.

BACKGROUND: Despite the need for and benefits of medications, polypharmacy (defined here as concurrent use of > or =9 medications) in nursing home residents is a concern. As the number of medications taken increases, so does the risk for adverse events. Monitoring polypharmacy in this population is important and can improve the quality of nursing home care. OBJECTIVES: The aims of this article were to estimate the use of polypharmacy in residents of nursing homes in the United States, to examine the associations between select resident and facility characteristics and polypharmacy, and to determine the leading therapeutic subclasses included in the polypharmacy received by these nursing home residents. METHODS: This was a retrospective, cross-sectional study of a nationally representative sample of US nursing home residents in 2004; the outcome was use of polypharmacy. The 2004 National Nursing Home Survey was used to collect medication data and other resident and facility information. Resident characteristics included age, sex, race, primary payment source, number of comorbidities, number of activities of daily living (ADLs) for which the resident required assistance, and length of stay (LOS) since admission. Facility characteristics included ownership and size (number of beds). RESULTS: Of 13,507 nursing home residents who received care, 13,403 had valid responses for all 9 independent variables in the analyses. The prevalence of polypharmacy among nursing home residents in 2004 was approximately 40%. A multiple regression model controlling for resident and facility factors revealed that the odds of receiving polypharmacy were higher for residents who were female (odds ratio [OR] = 1.10; 95% CI, 1.00-1.20), were white, had Medicaid as a primary payer, had >3 comorbidities (OR = 1.57-5.18; 95% CI, 1.36-6.15), needed assistance with < or =4 ADLs, had an LOS since admission of 3 to <6 months (OR = 1.25; 95% CI, 1.04-1.50), and received care in a small, not- for-profit facility (data not shown for reference levels [OR = 1.00]). The most frequently reported medications for residents who received polypharmacy included gastrointestinal agents (laxatives, 47.5%; agents for acid/peptic disorders, 43.3%), drugs that affect the central nervous system (antidepressants, 46.3%; antipsychotics or antimanics, 25.9%), and pain relievers (nonnarcotic analgesics, 43.6%; antipyretics, 41.2%; antiarthritics, 31.2%). CONCLUSIONS: Despite awareness of polypharmacy and its potential consequences in older patients, results of our analysis suggest that polypharmacy remains widespread in US nursing homes. Although complex medication regimens are often necessary for nursing home residents, monitoring polypharmacy and its consequences may improve the quality of nursing home care and reduce unnecessary health care spending related to adverse events.

National Ambulatory Medical Care Survey: 2006 summary.

OBJECTIVES: 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. METHODS: The data presented in this report were collected in the 2006 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. RESULTS: During 2006, an estimated 902 million visits were made to physician offices in the United States, an overall rate of 306.6 visits per 100 persons. In over one-quarter of office visits, electronic medical records were utilized by physicians, while at 85.5 percent of visits, claims were submitted electronically. Since 1996, the percentage of visits by adults 18 years and over with chronic diabetes increased 40%, and during the same time period, visits increased for chronic hypertension (28%), and depression (27%). Among visits by females, a Pap test was ordered or provided more frequently than a human papilloma virus DNA test (5.6 versus 0.6 percent). Private insurance visits were more likely to include liquid-based Pap tests (6.3 percent) compared with visits using conventional or unspecified tests (3.7 percent), whereas visits utilizing Medicaid and other sources of payment were equally likely to provide conventional or unspecified, and liquid-based Pap tests. Medication therapy was reported at 636.7 million office visits, accounting for 70.6 percent of all office visits. In 2006, there were about 1.9 billion drugs mentioned, resulting in an overall 210.3 drug mentions per 100 visits. Visits to primary care physicians at community health centers were more likely to document health education compared with office-based practices, whereas diagnostic or screening services, drug mentions, and any nonmedication treatment occurred at approximately the same proportion of visits for primary care providers in both type of settings.

Ambulatory medical care utilization estimates for 2006.

OBJECTIVES: This report presents statistics on ambulatory care visits to physician offices, hospital outpatient departments (OPDs), and hospital emergency departments (EDs) in the United States in 2006. Ambulatory medical care utilization is described in terms of patient, practice, facility, and visit characteristics. METHODS: Data from the 2006 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) were combined to produce annual estimates of ambulatory medical care utilization. RESULTS: Patients in the United States made an estimated 1.1 billion visits to physician offices and hospital OPDs and EDs, a rate of 381.9 visits per 100 persons annually. The overall visit rate was not significantly different for white and black persons. However, black persons had higher visit rates than white persons to hospital OPDs and EDs and lower visit rates to office-based surgical and medical specialists. Visit distribution by ambulatory care setting differed by poverty level in the patient's ZIP Code of residence, with higher proportions of visits to hospital OPDs and EDs as poverty levels increased. Between 1996 and 2006, visit rates to medical specialty offices climbed overall by 29 percent, with a significant increase noted for white patients but not black patients. The rate of OPD visits jumped from 25.4 visits per 100 persons in 1996 to 34.7 in 2006, whereas ED visits during the same period increased from 34.1 to 40.5 per 100 persons. About 18.3 percent of all ambulatory care visits in 2006 were for nonillness or noninjury conditions, such as routine checkups and pregnancy exams. Seven in ten ambulatory care visits had at least one medication provided, prescribed, or continued in 2006, for a total of 2.6 billion drugs overall. Analgesics were the most common therapeutic category, accounting for 13.6 drugs per 100 drugs prescribed, and they were most often utilized at primary care and ED visits. The percentage of visits at which medication was prescribed increased significantly in most settings between 1996 and 2006.

Ambulatory medical care utilization estimates for 2005.

OBJECTIVE: This report presents statistics on ambulatory care visits to physician offices, hospital outpatient departments (OPDs), and hospital emergency departments (EDs) in the United States in 2005. Ambulatory medical care utilization is described in terms of patient, practice, facility, and visit characteristics. METHODS: Data from the 2005 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) were combined to produce averaged annual estimates of ambulatory medical care utilization. RESULTS: Patients in the United States made an estimated 1.2 billion visits to physician offices and hospital OPDs and EDs, a rate of 4.0 visits per person annually. Between 1995 and 2005, population visit rates increased by about 20% in primary care offices, surgical care offices, and OPDs; 37% in medical specialty offices; and 7% in EDs. The aging of the population has contributed to increased volume of visits because older patients have higher visit rates. Visits by patients 40-59 years of age represented about 28.5 percent in 2005, compared with 23.9 percent in 1995. Black persons had higher visit rates than white persons to hospital OPDs and EDs, but lower visit rates to office-based primary care and to surgical and medical specialists. In the ED, the visit rate for patients with no insurance was about twice that of those with private insurance; whereas for all types of office-based care, the visit rates were higher for privately insured persons than for uninsured persons. About 29.4 percent of all ambulatory care visits were for chronic diseases and 25.2 percent were for preventive care, including checkups, prenatal care, and postsurgical care. The leading treatment provided at ambulatory care visits was medicinal with 71.3 percent of all visits having one or more medications prescribed, up by 10% since 1995 when encounters with drug therapy represented 64.9 percent of all visits. In 2005, 2.4 billion medications were prescribed or administered at these visits.

National Ambulatory Medical Care Survey: 2005 summary.

OBJECTIVES: 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. METHODS: The data presented in this report were collected in the 2005 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 doctor visits. RESULTS: During 2005, an estimated 963.6 million visits were made to physician offices in the United States, an overall rate of 331.0 visits per 100 persons. In one-quarter of office visits, electronic medical records were utilized by physicians, while at 83.9 percent of visits, claims were submitted electronically. As the baby boomer generation aged, there was a shift in utilization, as the majority of visits in 1995 were by patients 25-44 years of age compared with 2005, when most visits were by patients 45-64 years of age. In 2005, 52.7 percent of office visits were made by patients with at least one chronic condition. Hypertension was the most frequent condition (22.8 percent), followed by arthritis (14.3 percent), hyperlipidemia (13.5 percent), and diabetes (9.8 percent). Medication therapy was reported at 679.2 million office visits, accounting for 70.5 percent of all office visits. In 2005, there were about 2.0 billion drugs prescribed, resulting in an overall rate of 210.7 drugs per 100 visits. Drugs with amoxicillin were more likely to be new prescriptions (85.4 percent), while ibuprofen and acetaminophen were just as likely to be a new or continued drug. The overall mean time spent with a physician, excluding psychiatrists, has not changed since 1995; however, visits with a duration of 6-10 minutes decreased by 28% from 1995, while visits lasting 16-30 minutes increased by 20%.