Jetty Anuradha, Ezran Marie, Huffstetler Alison N, Jabbarpour Yalda
Robert Graham Center, Washington, DC, USA.
Thomas Jefferson University, Philadelphia, PA, USA.
J Prim Care Community Health. 2025 Jan-Dec;16:21501319251321618. doi: 10.1177/21501319251321618.
Primary care is the backbone of the United States healthcare system, yet it continues to be underfunded and inaccessible to many. Previous studies explored primary care visit patterns until 2016, leaving gaps in our understanding of how recent factors like state Medicaid expansions, the Coronavirus Disease 2019 (COVID-19) pandemic, and population growth have influenced these patterns. Hence, the objective of the current study was to analyze the trends in primary care visits provided by outpatient clinicians over time and by visit type and contextualize study findings within the changing healthcare landscape.
The Medical Expenditure Panel Survey data (2010-2021) were used to examine trends in the total number and share of ambulatory, preventive, acute, and chronic care visits and investigate sociodemographic factors associated with a given clinician visit. The outcome variable was the clinician type: Primary Care Physicians (PCPs), Internal Medicine (IM) subspecialists, and Nurse Practitioners or Physician Assistants or Registered Nurses (NP/PA/RNs). Explanatory variables included gender, age, race/ethnicity, education, region of respondent's residence, income-to-poverty ratio, insurance coverage, number of chronic conditions, and survey year. Univariate, bivariate, and multinomial logistic regression analyses were performed.
The visits led by PCPs and IM subspecialists declined by 43% and 23% between 2010 and 2021, respectively. However, visits led by NP/PA/RNs increased by 98%. From 2010 to 2021, the proportion of preventive care visits provided by PCPs, IMs, and NP/PA/RNs increased by 25%, 7%, and 4%, respectively. PCPs provided fewer acute and chronic care visits in 2021 than in 2010. Regression analyses illustrated that relative to Non-Hispanic White patients, non-White patients had a higher likelihood of seeing PCPs. Patients reporting 1 chronic condition were more likely to obtain care from an IM or NP/PA/RN than a PCP. In contrast, those with 2 or more chronic conditions had a greater propensity to see PCP than NP/PA/RN.
Despite a growing need for primary care services, the decrease in visits to PCPs is concerning and requires further examination. The declining trends in acute and chronic care visits raise questions as to whether primary care, in its current form, can continue to provide its essential attributes and services.
初级保健是美国医疗保健系统的支柱，但它仍然资金不足，许多人难以获得。以往的研究探讨了2016年之前的初级保健就诊模式，在我们对州医疗补助扩大、2019年冠状病毒病（COVID-19）大流行和人口增长等近期因素如何影响这些模式的理解上留下了空白。因此，本研究的目的是分析门诊临床医生提供的初级保健就诊随时间和就诊类型的趋势，并将研究结果置于不断变化的医疗环境中进行背景分析。
使用医疗支出面板调查数据（2010 - 2021年）来检查门诊、预防、急性和慢性护理就诊的总数和比例趋势，并调查与特定临床医生就诊相关的社会人口学因素。结果变量是临床医生类型：初级保健医生（PCP）、内科（IM）专科医生以及执业护士或医师助理或注册护士（NP/PA/RN）。解释变量包括性别、年龄、种族/民族、教育程度、受访者居住地区、收入贫困比、保险覆盖范围、慢性病数量和调查年份。进行了单变量、双变量和多项逻辑回归分析。
2010年至2021年间，由初级保健医生和内科专科医生主导的就诊分别下降了43%和23%。然而，由执业护士/医师助理/注册护士主导的就诊增加了98%。2010年至2021年，初级保健医生、内科医生以及执业护士/医师助理/注册护士提供的预防性护理就诊比例分别增加了25%、7%和4%。2021年初级保健医生提供的急性和慢性护理就诊比2010年减少。回归分析表明，与非西班牙裔白人患者相比，非白人患者看初级保健医生的可能性更高。报告患有1种慢性病的患者从内科医生或执业护士/医师助理/注册护士处获得护理的可能性高于从初级保健医生处。相比之下，患有2种或更多慢性病的患者看初级保健医生的倾向大于看执业护士/医师助理/注册护士。
尽管对初级保健服务的需求不断增加，但初级保健医生就诊量的下降令人担忧，需要进一步研究。急性和慢性护理就诊量的下降趋势引发了关于当前形式的初级保健是否能够继续提供其基本属性和服务的问题。
