Cherry Donald K, Burt Catharine W, Woodwell David A
Adv Data. 2003 Aug 11(337):1-44.
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. Results highlighting new items on continuity of care are presented. They include whether the visit was the first or a followup for a problem, number of visits to this provider in the past 12 months for established patients, and whether other physicians shared care for the patient's problem. The report also highlights estimates of practice characteristics for office-based physicians.
The data presented in this report were collected from the 2001 National Ambulatory Medical Care Survey (NAMCS). NAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization by various types of providers. NAMCS is a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates. Selected trends from the 1992 and 1997 NAMCS are also presented.
During 2001, an estimated 880.5 million visits were made to physician offices in the United States, an overall rate of 314.4 visits per 100 persons. From 1992 through 2001, the visit rate for persons 45 years of age and over increased by 17%, from 407.3 to 478.2 visits per 100 persons. The mean age of patients at each office visit has steadily increased from 1992 through 2001 as has the mean number of diagnoses rendered and the overall drug mention rate. The visit rate to physician offices in metropolitan statistical areas (MSAs) (338.3 visits per 100 persons) was significantly larger than the rate in non-MSAs (218.0 visits per 100 persons). Females had a higher visit rate compared with males, and white persons had a higher rate than black or African-American persons. Half of all office visits were to the patient's primary care physician (PCP). Of the visits to physicians other than the patient's PCP, about one-third (32.6 percent) were referrals. About 1 in 10 office visits were made by new patients (11.8 percent), down 20% since 1992. More than one physician shared the care for the patient's condition at about one-fifth of the office visits. Of all visits made to offices in 2001, 58.8 percent listed private insurance as the primary expected source of payment, followed by Medicare (21.8 percent) and Medicaid and/or State Children's Health Insurance Program (7.2 percent). For preventive care visits, the female visit rate was over 75% higher than the rate for males (67.1 versus 37.7 visits per 100 persons). Essential hypertension, arthropathies, acute upper respiratory infection, and diabetes mellitus were the leading illness-related primary diagnoses. There were an estimated 99.8 million injury-related visits in 2001, or 35.6 visits per 100 persons. Diagnostic and screening services were ordered or provided at 82.8 percent of visits, therapeutic and preventive services were ordered or provided at 41.4 percent of visits, and medications were prescribed or provided at 61.9 percent of visits. On average, 2.4 medications were ordered or provided at each office visit with any mention of a medication. The leading therapeutic class for drugs mentioned at office visits included cardiovascular-renal drugs (14.7 percent of mentions) and pain-relieving drugs (12.1 percent of mentions). A physician was seen at a majority of visits (95.8 percent), and a registered or licensed practical nurse was seen at 31.3 percent of visits. From 1992 through 2001, changes were observed in the leading diagnoses, therapeutic drug classes, and drug mentions. Physician estimates revealed that primary care physicians were twice as likely as specialists to make home visits during an average week of work; when they conducted them, they made twice as many (6 versus 2-3 visits per week) as specialists. Approximately 3 in 10 physicians reported not accepting new capitated, privately insured patients, whereas only 6.8 percent did not accept noncapitated, privately insured patients.
本报告描述了美国门诊患者到医生办公室就诊的情况。报告展示了有关医生执业、患者及就诊的特定特征的统计数据。呈现了突出医疗连续性新内容的结果。这些内容包括此次就诊是某个问题的首次就诊还是后续就诊、已确诊患者在过去12个月内到该医疗服务提供者处就诊的次数，以及是否有其他医生参与了该患者问题的治疗。本报告还突出了对门诊医生执业特征的估计。
本报告中的数据来自2001年全国门诊医疗调查（NAMCS）。NAMCS是国家医疗保健调查门诊医疗部分的一部分，该调查衡量各类医疗服务提供者的医疗服务利用情况。NAMCS是对美国门诊医生就诊情况的全国概率抽样调查。样本数据经过加权处理以得出年度全国估计数。还呈现了1992年和1997年NAMCS的部分趋势。
2001年期间，美国门诊患者到医生办公室就诊的估计次数为8.805亿次，总体就诊率为每100人314.4次。1992年至2001年期间，45岁及以上人群的就诊率上升了17%，从每100人407.3次增至478.2次。从1992年至2001年，每次门诊患者的平均年龄稳步上升，每次就诊做出的诊断平均数量以及总体药物提及率也呈上升趋势。大都市统计区（MSA）的门诊医生就诊率（每100人就诊338.3次）显著高于非大都市统计区（每100人就诊218.0次）。女性的就诊率高于男性，白人的就诊率高于黑人或非裔美国人。所有门诊就诊中有一半是患者前往其初级保健医生（PCP）处。在患者前往非其初级保健医生处就诊中，约三分之一（32.6%）是转诊。约十分之一的门诊就诊是新患者（11.8%），自1992年以来下降了20%。在约五分之一的门诊就诊中，不止一名医生共同参与了患者病情的治疗。在2001年所有到办公室的就诊中，58.8%将私人保险列为主要预期支付来源，其次是医疗保险（21.8%）以及医疗补助和/或州儿童健康保险计划（7.2%）。对于预防性保健就诊，女性就诊率比男性高出75%以上（每100人分别为67.1次和37.7次）。原发性高血压、关节病、急性上呼吸道感染和糖尿病是与疾病相关的主要首要诊断。2001年估计有9980万次与损伤相关的就诊，即每100人中有35.6次就诊。在82.8%的就诊中开具或提供了诊断和筛查服务，在41.4%的就诊中开具或提供了治疗和预防性服务，在61.9%的就诊中开具或提供了药物。平均而言，每次提及药物的门诊就诊开具或提供2.
