Employment in Office-Based and Intensive Behavioral Health Settings in the US, 2016-2021

This study uses employment census data to show trends in behavioral health employment during and after the COVID-19 pandemic.

Association between nutritional guidance or ophthalmological examination and discontinuation of physician visits in patients with newly diagnosed diabetes: A retrospective cohort study using a nationwide database

AIMS/INTRODUCTION

Discontinuation of diabetes care has been studied mostly in patients with prevalent diabetes and not in patients with newly diagnosed diabetes, whose dropout risk is highest. Because enrolling patients in a prospective study will influence adherence, we retrospectively examined whether guideline-recommended practices, defined as nutritional guidance or ophthalmological examination, can prevent patient discontinuation of diabetes care after its initiation.

MATERIALS AND METHODS

We retrospectively identified adults with newly screened diabetes during checkups using a large Japanese administrative claims database (JMDC, Tokyo, Japan) that contains laboratory data and lifestyle questionnaires. We defined discontinuation of physician visits as a follow-up interval exceeding 6 months. We divided the patients into those who received guideline-recommended practices (nutritional guidance or ophthalmology consultation) within the same month as the first visit and those who did not. We calculated propensity scores and carried out inverse probability of treatment weighting analyses to compare discontinuation between the two groups.

RESULTS

We identified 6,508 patients with at least one physician consultation for diabetes care within 3 months after their checkup, including 4,574 patients without and 1,934 with guideline-recommended practices. After inverse probability of treatment weighting, patients with guideline-recommended practices had a significantly lower proportion of discontinuation than those without (17.2% vs 21.8%; relative risk 0.79, 95% confidence interval 0.69-0.91).

CONCLUSIONS

This study is the first to show that after adjustment for both patient and healthcare provider factors, guideline-recommended practices within the first month of physician consultation for diabetes care can decrease subsequent discontinuation of physician visits in patients with newly diagnosed diabetes.

Healthcare costs for abortions performed in ambulatory surgery centers vs office-based settings

BACKGROUND

Several states require that abortions be provided in ambulatory surgery centers. Supporters of such laws argue that they make abortions safer, yet previous studies have found no differences in abortion-related morbidities or adverse events for abortions performed in ambulatory surgery centers versus office-based settings. However, little is known about how costs of abortions provided in ambulatory surgery centers differ from those provided in office-based settings.

OBJECTIVE

To compare healthcare expenditures for abortions performed in ambulatory surgery centers versus office-based settings using a large national private insurance claims database.

MATERIALS AND METHODS

A retrospective cohort study compared expenditures for abortions performed in ambulatory surgery centers versus office-based settings. Data on women who had abortions in an ambulatory surgery center or office-based setting between January 1, 2011, and December 31, 2014 were obtained from the MarketScan Commercial Claims and Encounters database. The sample was limited to women who were continuously enrolled in their insurance plans for at least 1 year before and at least 6 weeks after the abortion. Healthcare expenditures were assessed separately for the index abortion and the 6-week period after the abortion. Costs were measured from the perspective of the healthcare system and included all payments to the provider, including insurance company payments and any patient out-of-pocket payments.

RESULTS

Overall, 49,287 beneficiaries who had 50,311 abortions met inclusion criteria. Of the included abortions, 47% were first-trimester aspiration, 27% first-trimester medication, and 26% second-trimester or later abortions. Most abortions (89%) were provided in office-based settings, with 11% provided in ambulatory surgery centers. Unadjusted mean index abortion costs were higher in ambulatory surgery centers than in office-based settings ($1704 versus $810; P < .001). After adjusting for patient clinical and demographic characteristics, costs of index abortions were $772 higher (95% confidence interval, $746-$797), total follow-up costs for abortions that had any follow-up care were $1099 higher (95% confidence interval, $1004-$1,195), and total follow-up costs for abortions that had an abortion-related morbidity or adverse event were not significantly different in ambulatory surgery centers compared to office-based settings. There were also no significant differences in the likelihood of having any follow-up care or abortion-related event follow-up care.

CONCLUSION

Abortions performed at ambulatory surgery centers are significantly more costly than those performed in office-based settings, with no difference in the likelihood of receiving follow-up care. Laws requiring that abortions be provided in ambulatory surgery centers may only result in increased costs for abortions, with no effect on abortion safety.

Towards ending the human immunodeficiency virus epidemic in the US: State of human immunodeficiency virus screening during physician and emergency department visits, 2009 to 2014

Human immunodeficiency virus (HIV) testing is important for prevention and treatment. Ending the HIV epidemic is unattainable if significant proportions of people living with HIV remain undiagnosed, making HIV testing critical for prevention and treatment. The Centers for Disease Control and Prevention (CDC) recommends routine HIV testing for persons aged 13 to 64 years in all health care settings. This study builds on prior research by estimating the extent to which HIV testing occurs during physician office and emergency department (ED) post 2006 CDC recommendations.We performed an unweighted and weighted cross-sectional analysis using pooled data from 2 nationally representative surveys namely National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 2009 to 2014. We assessed routine HIV testing trends and predictive factors in physician offices and ED using multi-stage statistical survey procedures in SAS 9.4.HIV testing rates in physician offices increased by 105% (5.6-11.5 per 1000) over the study period. A steeper increase was observed in ED with a 191% (2.3-6.7 per 1000) increase. Odds ratio (OR) for HIV testing in physician offices were highest among ages 20 to 29 ([OR] 7.20, 99% confidence interval [CI: 4.37-11.85]), males (OR 1.34, [CI: 0.91-0.93]), African-Americans (OR 2.97, [CI: 2.05-4.31]), Hispanics (OR 1.80, [CI: 1.17-2.78]), and among visits occurring in the South (OR 2.06, [CI: 1.23-3.44]). In the ED, similar trends of higher testing odds persisted for African Americans (OR 3.44, 99% CI 2.50-4.73), Hispanics (OR 2.23, 99% CI 1.65-3.01), and Northeast (OR 2.24, 99% CI 1.10-4.54).While progress has been made in screening, HIV testing rates remains sub-optimal for ED visits. Populations visiting the ED for routine care may suffer missed opportunities for HIV testing, which delays their entry into HIV medical care. To end the epidemic, new approaches for increasing targeted routine HIV testing for populations attending health care settings is recommended.

Association between income levels and irregular physician visits after a health checkup, and its consequent effect on glycemic control among employees: A retrospective propensity score-matched cohort study

AIMS/INTRODUCTION

The present study aimed to evaluate the effects of income levels on physician visit patterns and to quantify the consequent impact of irregular physician visits on glycemic control among employees' health insurance beneficiaries in Japan.

MATERIALS AND METHODS

We obtained specific health checkup data of untreated diabetes patients from the Fukuoka branch of the Japanese Health Insurance Association. We selected 2,981 insurance beneficiaries and classified 650 and 2,331 patients into, respectively, the regular visit and irregular visit group. We implemented propensity score matching to select an adequate control group.

RESULTS

Compared with those with a standard monthly income <$2,000 (US$1 = ¥100), those with a higher monthly income were less likely to have irregular visits; $2,000-2,999: odds ratio 0.74 (95% confidence interval 0.56-0.98), $3,000-3,999: odds ratio 0.63 (95% confidence interval 0.46-0.87) and ≥$5,000: odds ratio 0.58 (95% confidence interval 0.39-0.86). After propensity score matching and adjusting for covariates, the irregular visit group tended to have poor glycemic control; increased glycated hemoglobin ≥0.5: odds ratio 1.90 (95% confidence interval 1.30-2.77), ≥1.0: odds ratio 2.75 (95% confidence interval 1.56-4.82) and ≥20% relatively: odds ratio 3.18 (95% confidence interval 1.46-6.92).

CONCLUSIONS

We clarified that there was a significant relationship between income and irregular visits, and this consequently resulted in poor glycemic control. These findings would be useful for more effective disease management.

Cancer care spending and use by site of provider-administered chemotherapy in Medicare

OBJECTIVES

To compare cancer care spending and utilization by site of provider-administered chemotherapy in Medicare.

STUDY DESIGN

A retrospective analysis using 2010-2013 Medicare claims.

METHODS

The study population was a random sample of Medicare fee-for-service beneficiaries with cancer who initiated provider-administered chemotherapy in a hospital outpatient department (HOPD) or physician office (PO). We assessed the following outcomes during the 6-month follow-up period: (1) spending on cancer-related outpatient services excluding chemotherapy, (2) spending on cancer-related inpatient services, (3) utilization of select cancer-related outpatient services (evaluation and management, commonly used expensive billing codes, and radiation therapy sessions), and (4) the number of cancer-related hospitalizations. We used regression analyses to adjust for patient health risk factors and market characteristics.

RESULTS

During the 6-month follow-up period, risk-adjusted spending on nonchemotherapy outpatient services was slightly lower among patients receiving chemotherapy in HOPDs than in POs ($12,183 [95% CI, $12,008-$12,358] vs $12,444 [95% CI, $12,313-$12,575]; P <.05). Risk-adjusted cancer-related inpatient spending was higher in the HOPD group than in the PO group ($3996 [95% CI, $3837-$4156] vs $3168 [95% CI, $3067-$3268]; P <.01). The HOPD group had fewer visits in all select outpatient services but had a higher number of hospitalizations than the PO group.

CONCLUSIONS

Differences in cancer care spending by site of chemotherapy (HOPDs vs POs) vary by service type. Those differences are partially driven by utilization differences. As the site of chemotherapy shifts from POs to HOPDs, spending and utilization patterns in both settings need to be monitored.

Characteristics of Office-based Physician Visits, 2016

In 2016, most Americans had a usual place to receive health care (86% of adults and 96% of children) (1,2). The majority of children and adults listed a doctor's office as the usual place they received care (1,2). In 2016, there were an estimated 883.7 million office-based physician visits in the United States (3,4). This report examines visit rates by age and sex. It also examines visit characteristics-including insurance status, reason for visit, and services-by age. Estimates use data from the 2016 National Ambulatory Medical Care Survey (NAMCS).

Characteristics of Office-based Physician Visits, 2015

In 2015, most Americans had a usual place to receive health care (85% of adults and 96% of children) (1,2). The majority of children and adults listed a doctor's office as the usual place they received care (1,2). In 2015, there were an estimated 990.8 million office-based physician visits in the United States (3,4). This report examines visit rates by age and sex. It also examines visit characteristics-including insurance status, reason for visit, and services-by age. Estimates use data from the 2015 National Ambulatory Medical Care Survey (NAMCS).

Mental Health-related Physician Office Visits by Adults Aged 18 and Over: United States, 2012-2014

In 2016, mental illness affected about 45 million U.S. adults (1). Although mental health-related office visits are often made to psychiatrists (2), primary care physicians can serve as the main source of treatment for patients with mental health issues (3); however, availability of provider type may vary by geographic region (3,4). This report uses data from the 2012-2014 National Ambulatory Medical Care Survey (NAMCS) to examine adult mental healthrelated physician office visits by specialty and selected patient characteristics.

Physician visits and the timing of skeletal-related events among men newly diagnosed with metastatic prostate cancer: A cohort analysis

INTRODUCTION

Men diagnosed with metastatic prostate cancer (PCa) are at increased risk for skeletal complications which are associated with significant morbidity and mortality. Although both the urologist and the medical oncologist play important roles in the management of patients with advanced PCa, there is limited information regarding their role in the context of skeletal complications. The current study investigated these relationships among newly diagnosed metastatic patients with PCa.

METHODS AND MATERIALS

This retrospective cohort study used Surveillance, Epidemiology and End Results cancer registry data for incident stage IV metastatic (M1) cases diagnosed from 2000 to 2007 with linked Medicare claims. Postdiagnosis urologist and medical oncologist visits were identified using billing codes. We considered skeletal-related events (SREs) that occurred after the urologist or medical oncologist visit. We used Cox proportional hazards models to examine the relationship between a physician visit and the timing of the first SRE with and without propensity-score matching to account for observable selection.

RESULTS

The sample included 5,572 patients with stage IV M1 prostate cancer. Seventy-six percent of the patients were non-Hispanic White, 16% were non-Hispanic African American, and 8% were of other races; 75% of patients saw a urologist (median time to first visit = 19 days) and 44% saw an oncologist (median = 80 days), whereas 41% experienced at least one SRE (median = 309 days). Covariate-adjusted Cox models showed a longer time to an SRE for patients with only a medical oncologist visit (hazard ratio [HR] = 0.53, 95% CI: 0.45-0.61), only a urologist visit (HR = 0.35, 95% CI: 0.31-0.39) or both a urologist and medical oncologist visit (HR = 0.34, 95% CI: 0.31-0.38), compared to individuals without these visits. Among men with a urologist visit, a medical oncologist visit was not associated with the time to the first SRE (HR = 0.97, 95% CI: 0.90-1.05). Among those without a urologist visit a medical oncologist visit was associated with a longer time to an SRE (HR = 0.54, 95% CI: 0.46-0.64). Results were comparable using propensity-score matched samples.

CONCLUSION

Among men newly diagnosed with metastatic PCa, 4 of 10 patients experienced an SRE. Patients experienced a delay in skeletal complications when managed by a urologist or a medical oncologist compared to patients who did not see either specialist.

Association between supplementary private health insurance and visits to physician offices versus hospital outpatient departments among adults with diabetes in the universal public insurance system

BACKGROUND

Diabetes mellitus is a chronic disease with a high prevalence across the world as well as in South Korea. Most cases of diabetes can be adequately managed at physician offices, but many diabetes patients receive outpatient care at hospitals. This study examines the relationship between supplementary private health insurance (SPHI) ownership and the use of hospitals among diabetes outpatients within the universal public health insurance scheme.

METHODS

Data from the 2011 Korea Health Panel, a nationally representative sample of Korean individuals, was used. For the study, 6,379 visits for diabetes care were selected while controlling for clustered errors. Multiple logistic regression models were used to examine determinants of hospital outpatient services.

RESULTS

This study demonstrated that the variables of self-rated health status, comorbidity, unmet need, and alcohol consumption significantly correlated with the choice to use a hospital services. Patients with SPHI were more likely to use medical services at hospitals by 1.71 times (95% CI 1.068-2.740, P = 0.026) compared to patients without SPHI.

CONCLUSIONS

It was confirmed that diabetic patients insured by SPHI had more use of hospital services than those who were not insured. People insured by SPHI seem to be more likely to use hospital services because SPHI lightens the economic burden of care.

Characteristics of Office-based Physician Visits, 2014

In 2014, most Americans had a usual place to receive health care (86% of adults and 97% of children) (1,2). A majority of children and adults listed a doctor’s office as the usual place they received care (1,2). In 2014, there were an estimated 885 million office-based physician visits in the United States (3,4). This report examines office-based physician visit rates by age and sex. It also examines visit characteristics, including insurance status, reason for visit, and services, by age. Estimates use data from the 2014 National Ambulatory Medical Care Survey (NAMCS).

Collecting Practice-level Data in a Changing Physician Office-based Ambulatory Care Environment: A Pilot Study Examining the Physician induction interview Component of the National Ambulatory Medical Care Survey

Objective This report examines ways to improve National Ambulatory Medical Care Survey (NAMCS) data on practice and physician characteristics in multispecialty group practices. Methods From February to April 2013, the National Center for Health Statistics (NCHS) conducted a pilot study to observe the collection of the NAMCS physician interview information component in a large multispecialty group practice. Nine physicians were randomly sampled using standard NAMCS recruitment procedures; eight were eligible and agreed to participate. Using standard protocols, three field representatives conducted NAMCS physician induction interviews (PIIs) while trained ethnographers observed and audio recorded the interviews. Transcripts and field notes were analyzed to identify recurrent issues in the data collection process. Results The majority of the NAMCS items appeared to have been easily answered by the physician respondents. Among the items that appeared to be difficult to answer, three themes emerged: (a) physician respondents demonstrated an inconsistent understanding of "location" in responding to questions; (b) lack of familiarity with administrative matters made certain questions difficult for physicians to answer; and (c) certain primary care‑oriented questions were not relevant to specialty care providers. Conclusions Some PII survey questions were challenging for physicians in a multispecialty practice setting. Improving the design and administration of NAMCS data collection is part of NCHS' continuous quality improvement process.

Out-of-hospital births in the United States 2009-2014

OBJECTIVE

To evaluate recent trends of out-of-hospital births in the US from 2009 to 2014.

METHODS

We accessed data for all live births occurring in the US from the National Vital Statistics System, Natality Data Files for 2009-2014 through the interactive data tool, VitalStats.

RESULTS

Out-of-hospital (OOH) births in the US increased from 2009 to 2014 by 80.2% from 32,596 to 58,743 (0.79%-1.47% of all live births). Home births (HB) increased by 77.3% and births in freestanding birthing centers (FBC) increased by 79.6%. In 2014, 63.8% of OOH births were HB, 30.7% were in FBC, and 5.5% were in other places, physicians offices, or clinics. The majority of women who had an OOH birth in 2014 were non-Hispanic White (82.3%). About in one in 47 non-Hispanic White women had an OOH in 2014, up from 1 in 87 in 2009. Women with a HB were older compared to hospital births (age ≥35: 21.5% vs. 15.4%), had a higher live birth order(≥5: 18.9% vs. 4.9%), 3.48% had infants <2500 g and 4.66% delivered <37 weeks' gestation. 4.34% of HB were patients with prior cesarean deliveries, 1.6% were breech, and 0.81% were twins.

CONCLUSIONS

Since 2004 the number of women delivered out of the hospital, at home and in freestanding birthing centers has significantly increased in the US making it the country with the most out of hospital births among all developed countries. The root cause of the increase in planned OOH births should be identified and addressed by the medical community.

A Large Outbreak of Hepatitis B Virus Infections Associated With Frequent Injections at a Physician's Office

Objectives:

To determine whether hepatitis B virus (HBV) transmission occurred among patients visiting a physician's office and to evaluate potential transmission mechanisms.

Design:

Serologic survey, retrospective cohort study, and observation of infection control practices.

Setting:

Private medical office.

Patients:

Those visiting the office between March 1 and December 26, 2001.

Results:

We identified 38 patients with acute HBV infection occurring between February 2000 and February 2002. The cohort study, limited to the 10 months before outbreak detection, included 91 patients with serologic test results and available charts representing 18 case-patients and 73 susceptible patients. Overall, 67 patients (74%) received at least one injection during the observation period. Case-patients received a median of 14 injections (range, 2-25) versus 2 injections (range, 0-17) for susceptible patients (P < .001). Acute infections occurred among 18 (27%) of 67 who received at least one injection versus none of 24 who received no injections (RR, 13.6; CI95, 2.4-undefined). Risk of infection increased 5.2-fold (CI95, 0.6-47.3) for those with 3 to 6 injections and 20.0-fold (CI95, 2.8-143.5) for those with more than 6 injections. Typically, injections consisted of doses of atropine, dexamethasone, vitamin B12, or a combination of these mixed in one syringe. HBV DNA genetic sequences of 24 patients with acute infection and 4 patients with chronic infection were identical in the 1,500-bp region examined. Medical staff were seronegative for HBV infection markers. The same surface was used for storing multidose vials, preparing injections, and dismantling used injection equipment.

Conclusion:

Administration of unnecessary injections combined with failure to separate clean from contaminated areas and follow safe injection practices likely resulted in patient-to-patient HBV transmission in a private physician's office.

Variation in Physician Office Visit Rates by Patient Characteristics and State, 2012

In 2012, 74% of children and adults with a usual place to visit listed a doctor's office as their usual place for care (1,2). This report examines the rate of physician office visits by patient age, sex, and state. Visits by adults with private insurance as their expected source of payment were also examined. Estimates are based on the 2012 National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of physician office visits. State estimates for the 34 most populous states are available for the first time. State refers to the location of the physician office visit.

Service setting impact on costs for bevacizumab-treated oncology patients

OBJECTIVES

To investigate treatment patterns and healthcare costs of patients with metastatic colorectal cancer (mCRC) or lung cancer (LC) who were treated with bevacizumab in a physician office (OFF) setting versus a hospital outpatient (HOP) setting.

STUDY DESIGN

Retrospective analysis of claims from a national US health plan.

METHODS

mCRC and LC patients initiating treatment with bevacizumab (index date) between January 1, 2006, and July 31, 2012, were identified. Patients were aged ≥18 years with ≥6-month pre- (baseline) and ≥6-month post index (follow-up) data, retaining patients who died with <6 months of follow-up. Differences by site of service were analyzed by χ2 and t test (bevacizumab administrations, dose) and general linear model adjusted for demographic and clinical characteristics (all-cause healthcare costs).

RESULTS

A total of 1687 mCRC (OFF: 1292; HOP: 395) and 1232 LC patients (OFF: 983; HOP: 249) were identified. Mean age was 61.3 years, 56.3% were male, and 78% were treated in OFF. Treatment in OFF declined from 2006 (84% of patients) to 2012 (61%). For OFF versus HOP, mean length of treatment (208.3 vs 191.0 days; P=.007), number of bevacizumab administrations per month (1.4 vs 1.1; P<.001), and mean weekly dose (eg, for 2012, 4.34 vs 3.11 mg/kg, P<.05) were higher in OFF. Adjusted monthly HOP costs (vs OFF) were higher by 37.8% for mCRC patients (cost ratio=1.378; 95% CI, 1.282-1.482) and 31.1% for LC patients (cost ratio=1.311; 95% CI, 1.204-1.427) CONCLUSIONS: Despite fewer administrations and lower weekly dose of bevacizumab in HOP, adjusted total costs were 31% to 38% higher for mCRC and LC patients treated in the HOP setting.

Effects of the expansion of doctors' offices adjacent to private pharmacies in Mexico: secondary data analysis of a national survey

OBJECTIVES

To compare the sociodemographic characteristics, reasons for attending, perception of quality and associated out-of-pocket (OOP) expenditures of doctors' offices adjacent to private pharmacies (DAPPs) users with users of Social Security (SS), Ministry of Health (MoH), private doctor's offices independent from pharmacies and non-users.

SETTING

Secondary data analysis of the 2012 National Survey of Health and Nutrition of Mexico.

PARTICIPANTS

The study population comprised 25 852 individuals identified as having had a health problem 15 days before the survey, and a random sample of 12 799 ambulatory health service users.

OUTCOME MEASURES

Sociodemographic characteristics, reasons for attending healthcare services, perception of quality and associated OOP expenditures.

RESULTS

The distribution of users was as follows: DAPPs (9.2%), SS (16.1%), MoH (20.9%), private providers (15.4%) and non-users (38.5%); 65% of DAPP users were affiliated with a public institution (MoH 35%, SS 30%) and 35% reported not having health coverage. DAPP users considered the services inexpensive, convenient and with a short waiting time, yet they received ≥3 medications more often (67.2%, 95% CI 64.2% to 70.1%) than users of private doctors (55.7%, 95% CI 52.5% to 58.6%) and public institutions (SS 53.8%, 95% CI 51.6% to 55.9%; MoH 44.7%, 95% CI 42.5% to 47.0%). The probability of spending on consultations (88%, 95% CI 86% to 89%) and on medicines (97%, 95% CI 96% to 98%) was much higher for DAPP users when compared with SS (2%, 95% CI 2% to 3% and 12%, 95% CI 11% to 14%, respectively) and MoH users (11%, 95% CI 9% to 12% and 32%, 95% CI 30% to 34%, respectively).

CONCLUSIONS

DAPPs counteract current financial protection policies since a significant percentage of their users were affiliated with a public institution, reported higher OOP spending and higher number of medicines prescribed than users of other providers. The overprescription should prompt studies to learn about DAPPs' quality of care, which may arise from the conflict of interest implicit in the linkage of prescribing and dispensing processes.

State variability in supply of office-based primary care providers: United States, 2012

Data from the National Ambulatory Medical Care Survey (NAMCS) and the NAMCS Electronic Health Records Survey In 2012, 46.1 primary care physicians and 65.5 specialists were available per 100,000 population. From 2002 through 2012, the supply of specialists consistently exceeded the supply of primary care physicians. Compared with the national average, the supply of primary care physicians was higher in Massachusetts, Rhode Island, Vermont, and Washington; it was lower in Arkansas, Georgia, Mississippi, Nevada, New Mexico, and Texas. In 2012, 53.0% of office-based primary care physicians worked with physician assistants or nurse practitioners. Compared with the national average, the percentage of physicians working with physician assistants or nurse practitioners was higher in 19 states and lower in Georgia. Primary care providers include primary care physicians, physician assistants, and nurse practitioners. Primary care physicians are those in family and general practice, internal medicine, geriatrics, and pediatrics (1). Physician assistants are state-licensed health professionals practicing medicine under a physician's supervision. Nurse practitioners are registered nurses (RNs) with advanced clinical training (2-6). The ability to obtain primary care depends on the availability of primary care providers (3). This report presents state estimates of the supply of primary care physicians per capita, as well as the availability of physician assistants or nurse practitioners in primary care physicians' practices. Estimates are based on data from the National Ambulatory Medical Care Survey (NAMCS), Electronic Health Records (EHR) Survey, a nationally representative survey of office-based physicians.

Routine prenatal care visits by provider specialty in the United States, 2009-2010

Data from the 2009 and 2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey •At 14.1% of routine prenatal care visits in the United States in 2009-2010, women saw providers whose specialty was not obstetrics and gynecology (ob/gyn). •The percentage of routine prenatal care visits that were made to non-ob/gyn providers was highest (20.5%) among women aged 15-19. •Visits to non-ob/gyn providers accounted for a higher percentage of routine prenatal care visits among women with Medicaid (24.3%) and women with no insurance (23.1%) compared with women with private insurance (7.3%). •The percentage of routine prenatal care visits to non-ob/gyn providers was lower among women in large suburban areas (5.1%) compared with those in urban areas (14.4%) or in small towns or suburbs (22.4%). Early and adequate prenatal care is a Healthy People 2020 objective (1). Previous studies have focused on practice patterns of obstetricians/gynecologists or overall ambulatory care utilization by women (2-5). However, the amount of routine prenatal care delivered by obstetrics and gynecology (ob/gyn) providers and non-ob/gyn providers has not been quantified. Understanding which providers deliver prenatal care may yield valuable information about training and workforce needs. This report quantifies the amount of routine prenatal care delivered by non-ob/gyn providers among women aged 15-54 who were seen in physicians' offices, community health centers, and hospital outpatient departments (OPDs).

Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001-2013

In 2013, 78% of office-based physicians used any type of electronic health record (EHR) system, up from 18% in 2001. In 2013, 48% of office-based physicians reported having a system that met the criteria for a basic system, up from 11% in 2006. The percentage of physicians with basic systems by state ranged from 21% in New Jersey to 83% in North Dakota. In 2013, 69% of office-based physicians reported that they intended to participate (i.e., they planned to apply or already had applied) in "meaningful use" incentives. About 13% of all office-based physicians reported that they both intended to participate in meaningful use incentives and had EHR systems with the capabilities to support 14 of the Stage 2 Core Set objectives for meaningful use. From 2010 (the earliest year that trend data are available) to 2013, physician adoption of EHRs able to support various Stage 2 meaningful use objectives increased significantly. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 authorized incentive payments to increase physician adoption of electronic health record (EHR) systems (1,2). The Medicare and Medicaid EHR Incentive Programs are staged in three steps, with increasing requirements for participation. To receive an EHR incentive payment, physicians must show that they are "meaningfully using" certified EHRs by meeting certain objectives (3,4). This report describes trends in the adoption of EHR systems from 2001 through 2013, as well as physicians' intent to participate in the EHR Incentive Programs and their readiness to meet 14 of the Stage 2 Core Set objectives for meaningful use in 2013.

Risk of redocumenting penicillin allergy in a cohort of patients with negative penicillin skin tests

BACKGROUND

Even though electronic documentation of allergies is critical to patient safety, inaccuracies in documentation can potentiate serious problems. Prior studies have not evaluated factors associated with redocumenting penicillin allergy in the medical record despite a proven tolerance with a penicillin skin test (PST).

OBJECTIVE

Assess the prevalence of reinstating inaccurate allergy information and associated factors thereof.

DESIGN

We conducted a retrospective observational study from August 1, 2012 to July 31, 2013 of patients who previously had a negative PST. We reviewed records from the hospital, long-term care facilities (LTCF), and primary doctors' offices.

SETTING

Vidant Health, a system of 10 hospitals in North Carolina.

SUBJECTS

Patients with proven penicillin tolerance rehospitalized within a year period from the PST.

MEASUREMENTS

We gauged hospital reappearances, penicillin allergy redocumentation, residence, antimicrobial use, and presence of dementia or altered mentation.

RESULTS

Of the 150 patients with negative PST, 55 (37%) revisited a Vidant system hospital within a 1-year period, of whom 21 were LTCF residents. Twenty (36%) of the 55 patients had penicillin allergy redocumented without apparent reason. Factors associated with penicillin allergy redocumentation included age >65 years (P = 0.011), LTCF residence (P = 0.0001), acutely altered mentation (P < 0.0001), and dementia (P < 0.0001). Penicillin allergy was still listed in all 21 (100%) of the LTCF records.

CONCLUSIONS

At our hospital system, penicillin allergies are often redocumented into the medical record despite proven tolerance. The benefits of PST may be limited by inadequately removing the allergy from different electronic/paper hospital, LTCF, primary physician, and community pharmacy records.

Impact of electronic health records on malpractice claims in a sample of physician offices in Colorado: a retrospective cohort study

BACKGROUND

Electronic health records (EHRs) might reduce medical liability claims and potentially justify premium credits from liability insurers, but the evidence is limited.

OBJECTIVES

To evaluate the association between EHR use and medical liability claims in a population of office-based physicians, including claims that could potentially be directly prevented by features available in EHRs ("EHR-sensitive" claims).

DESIGN

Retrospective cohort study of medical liability claims and analysis of claim abstracts.

PARTICIPANTS

The 26 % of Colorado office-based physicians insured through COPIC Insurance Company who responded to a survey on EHR use (894 respondents out of 3,502 invitees).

MAIN MEASURES

Claims incidence rate ratio (IRR); prevalence of "EHR-sensitive" claims.

KEY RESULTS

473 physicians (53 % of respondents) used an office-based EHR. After adjustment for sex, birth cohort, specialty, practice setting and use of an EHR in settings other than an office, IRR for all claims was not significantly different between EHR users and non-users (0.88, 95 % CI 0.52-1.46; p = 0.61), or for users after EHR implementation as compared to before (0.73, 95 % CI 0.41-1.29; p = 0.28). Of 1,569 claim abstracts reviewed, 3 % were judged "Plausibly EHR-sensitive," 82 % "Unlikely EHR-sensitive," and 15 % "Unable to determine." EHR-sensitive claims occurred in six out of 633 non-users and two out of 251 EHR users. Incidence rate ratios were 0.01 for both groups.

CONCLUSIONS

Colorado physicians using office-based EHRs did not have significantly different rates of liability claims than non-EHR users; nor were rates different for EHR users before and after EHR implementation. The lack of significant effect may be due to a low prevalence of EHR-sensitive claims. Further research on EHR use and medical liability across a larger population of physicians is warranted.

Centers for Disease Control and Prevention (CDC). Place of influenza vaccination among adults --- United States, 2010-11 influenza season

The 2010-11 influenza season was the first season after the 2009 influenza A (H1N1) pandemic and the first season that the Advisory Committee on Immunization Practices (ACIP) recommended influenza vaccination for all persons aged ≥6 months (1). During the pandemic, many new partnerships between public health agencies and medical and nonmedical vaccination providers were formed, increasing the number of vaccination providers (2). To provide a baseline for places where adults received influenza vaccination since the new ACIP recommendation and to help vaccination providers plan for the 2011-12 influenza season, CDC analyzed information from 46 states and the District of Columbia (DC) on influenza vaccination of adults aged ≥18 years for the 2010-11 season, collected during January-March 2011 by the Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which found that, for adults overall, a doctor's office was the most common place (39.8%) for receipt of the 2010-11 influenza vaccine, with stores (e.g., supermarkets or drug stores) (18.4%) and workplaces (17.4%) the next most common. For those aged 18-49 years and 50-64 years, a workplace was the second most common place of vaccination (25.7% and 21.1%, respectively). Persons aged ≥65 years who were not vaccinated at a doctor's office were most likely (24.3%) to have been vaccinated at a store. The results indicate that both medical and nonmedical settings are common places for adults to receive influenza vaccinations, that a doctor's office is the most important medical setting, and that workplaces and stores are important nonmedical settings.

Abortion incidence and access to services in the United States, 2008

CONTEXT

The incidence of abortion has declined nearly every year between 1990 and 2005, but this trend may be ending, or at least leveling off. Access to abortion services is a critical issue, particularly since the number of abortion providers has been falling for the last three decades.

METHODS

In 2009 and 2010, all facilities known or expected to have provided abortion services in 2007 and 2008 were contacted, including hospitals, clinics and physicians' offices. Data on the number of abortions performed were collected and combined with population data to estimate national and state-level abortion rates. Abortion incidence, provision of early medication abortion, gestational limits, charges and antiabortion harassment were assessed by provider type and abortion caseload.

RESULTS

In 2008, an estimated 1.21 million abortions were performed in the United States. The abortion rate increased 1% between 2005 and 2008, from 19.4 to 19.6 abortions per 1,000 women aged 15-44; the total number of abortion providers was virtually unchanged. Small changes in national abortion incidence and number of providers masked substantial changes in some states. Accessibility of services changed little: In both years, 35% of women of reproductive age lived in the 87% of counties that lacked a provider. Fifty-seven percent of nonhospital providers experienced antiabortion harassment in 2008; levels of harassment were particularly high in the Midwest (85%) and the South (75%).

CONCLUSIONS

The long-term decline in abortion incidence has stalled. Higher levels of harassment in some regions suggest the need to enact and enforce laws that prohibit the more intrusive forms of harassment.

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.

Assessment of time to follow-up visits in newly-treated hypertensive patients using an electronic medical record database

OBJECTIVE

Use of electronic medical record (EMR) data for evaluating healthcare processes and outcomes is relatively new. Using EMR data, this study evaluated the time from antihypertensive initiation to the first follow-up office visit controlling for adverse events (AEs) and other factors that could influence follow-up timing. Findings were compared to treatment guidelines which recommend monthly follow-up in treatment naive patients until blood pressure (BP) levels are controlled.

RESEARCH DESIGN AND METHODS

Treatment-naïve hypertensive adult patients in the General Electric Centricity EMR database (1996-2006) with a new antihypertensive prescription were evaluated. Time from treatment initiation to first office visit was identified and stratified by occurrence of AEs and therapy change. BP was assessed at 120 +/- 30 days.

RESULTS

The mean +/- SD time from first antihypertensive prescription (index date) to the first office visit was 96.2 +/- 160.6 days; 38% returned within a month of treatment initiation. Controlling for baseline demographic and clinical characteristics, the adjusted time until first office visit was shorter for those with an AE and therapy change than for those with neither event (61 vs. 158 days). Of the patients with follow-up BP data for analysis (n = 27,875), more of those seen within a month of treatment initiation achieved BP goal at 120 days (<140/90 mmHg) than those who were not seen within a month (64.3 vs. 61.7% respectively; p < 0.001).

CONCLUSIONS

This study demonstrates that EMR data can be used to assess quality measures which in turn can inform efforts to improve treatment outcomes. Specifically, this study evaluated mean time to first office visit after antihypertensive therapy initiation controlling for clinical factors that could influence office visit intervals based on data available in a national EMR dataset. A key limitation of this study is that the EMR may not represent patient care delivered by other providers, thus, use of antihypertensives, changes in therapy, and office visits may be underreported.

Substance Abuse and Dependence Treatment in Outpatient Physician Offices, 1997–2004

OBJECTIVE

To examine patient, physician, and visit characteristics associated with treatment for substance abuse during outpatient physician visits.

METHODS

Secondary data was obtained from the 1997-2004 National Ambulatory Medical Care Survey.

RESULTS

A substance abuse diagnosis was recorded in .9% of general and family practice visits, .8% of internal medicine visits, and 5.1% of psychiatry visits. Multivariable logistic regression found that women, elderly, non-White, and established patients were less likely to be given a substance abuse diagnosis.

CONCLUSION

Increased screening, particularly of existing patients, may lead to decreased gender, age, and racial disparities in diagnosis and treatment.

Research of urinary tract infections in family medicine physicians' offices--empiric antimicrobial therapy of urinary tract infections--Croatian experience

In the period between October 1st and November 30th, 2006, we investigated a total of 3188 episodes of UTI (802 among males; 2386 among females) recorded in 108 family medicine offices in 20 cities in Croatia. The most common UTIs in women were acute uncomplicated cystitis (62%), complicated UTIs - cystitis and pyelonephritis (14%), urethritis (9%), acute uncomplicated pyelonephritis (6%), recurrent cystitis (5%), asymptomatic bacteriuria (3%) and recurrent pyelonephritis. The most common UTIs in men were complicated UTIs - cystitis and pyelonephritis (48%), urethritis (25%), prostatitis (24%) and asymptomatic bacteriuria (3%). Etiological diagnosis was made in 999 (31%) UTI episodes before antimicrobial therapy was given. The most frequently isolated causative pathogens were Escherichia coli (77%), Enterococcus faecalis (9%), Proteus mirabilis (5%), Klebsiella spp (3%), Streptococcus agalactiae (3%) and Enterobacter (1%). Antimicrobial drug was administered in 2939 (92.19%) UTI episodes, in 1940 (66.01%) as empirical therapy, and in 999 (34%) as targeted antimicrobial therapy. The most commonly administered drug in empirical therapy for acute uncomplicated cystitis, recurrent cystitis and urethritis in women was cephalexin, for acute uncomplicated pyelonephritis and complicated UTIs in women co-amoxiclav, and for UTIs in males ciprofloxacin. The results of this research of 3188 UTI episodes in family medicine physicians' offices provide a confirmatory answer to question whether empirical antimicrobial therapy of UTI prescribed by Croatian family practitioners is in accordance with the national guidelines.

Low-income and minority patient satisfaction with visits to emergency departments and physician offices for dental problems

OBJECTIVES

Individuals lacking access to dentists may use hospital emergency departments (EDs) or physicians (MDs) for the management of their dental problems. This study examined visits by minority and low-income individuals to physicians and hospital emergency departments for the treatment of dental problems with the goal of exploring the nature of treatment provided and patient satisfaction with the care received.

METHODS

Eight focus group sessions were conducted with 53 participants drawn from low-income White, Black, and Hispanic adults who had experienced a dental problem and who had sought MD/ED care at least once during the previous 12 months.

RESULTS

Toothache pain or more generalized jaw/face pain was the most frequent oral problem resulting in MD/ED visits. Pain severity was the principle reason for seeking care from MDs/EDs, with financial barriers most often mentioned as the reason for not seeking care from dentists. Expectations of MD/ED visits were generally consistent with care received; most participants limited their expectations to the provision of antibiotics or pain medication. Nearly all of the participants thought they would eventually need to see a dentist for resolution of their dental problem.

CONCLUSIONS

Poor/minority individuals seek relief from oral pain through MDs/ EDs while recognizing that such care is not definitive.

Correlates of expected satisfaction with electronic health records in office practices by practitioners

Practitioners' resistance towards electronic health records (EHRs) is a known barrier to implementation and use. This is a cross-sectional study 467 practitioners working at 12 ambulatory care outpatient practices. We analyzed how mean expected satisfaction for future use of EHRs differed at both the level of the provider and the practice. We found that practitioners generally have positive expectations of EHR systems. However, these expectations depend on comfort with IT and typing skills.

Providers' expectations of ambulatory electronic health records (EHRs)

Little is known about how providers expect the implementation of a new electronic health record (EHR) will affect their clinical workflow. We found that providers currently completing clinical tasks electronically are more satisfied with task completion than those completing similar tasks on paper. Yet, these already electronic providers expect less future satisfaction with the new EHR compared with paper-based providers. Further understanding of provider expectations can assist in optimally tailoring implementation plans.

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%.

Association of socioeconomic and demographic factors with utilization of rheumatology subspecialty care in systemic lupus erythematosus

OBJECTIVE

To examine the role of sociodemographic factors (age, race/ethnicity, and sex) and socioeconomic factors (income and education) in the utilization of rheumatology subspecialty care in a large cohort of subjects with systemic lupus erythematosus (SLE).

METHODS

Data were derived from a cohort of 982 English-speaking subjects with SLE. Between 2002 and 2004, trained survey workers administered a telephone survey to subjects eliciting information regarding demographics, SLE disease status, medications, health care utilization, health insurance, and socioeconomic status. We identified predictors of utilization of rheumatology subspecialty care, defined as at least 1 visit to a rheumatologist in the previous year. In addition, we examined factors associated with identifying any specialist as primarily responsible for SLE care.

RESULTS

Older age, lower income, Medicare insurance, male sex, and less severe disease were associated with lack of rheumatology care. However, race/ethnicity and educational attainment were not significantly related to seeing a rheumatologist. After multivariate adjustment, only older age, lower income, and male sex remained associated with absence of rheumatology visits. Those least likely to identify a specialist as primarily responsible for their SLE care included older subjects and those reporting lower incomes.

CONCLUSION

Although elderly subjects and those with lower incomes traditionally have access to health care through the Medicare and Medicaid programs, the presence of health insurance alone did not ensure equal utilization of care. This finding suggests that additional barriers to accessing rheumatology subspecialty care may exist in these patient populations.

Medication therapy in ambulatory medical care: United States, 2003-04

OBJECTIVE

This report describes medication therapy at visits to physician offices, hospital outpatient departments, and emergency departments in the United States during 2003 and 2004. Office-based care is further subdivided into three categories-primary care, surgical specialties, and medical specialties.

METHODS

Data from the 2003 and 2004 National Ambulatory Medical Care Surveys (NAMCS) and National Hospital Ambulatory Medical Care Surveys (NHAMCS) were combined to produce averaged annual estimates of ambulatory medical care utilization.

RESULTS

An estimated 1.9 billion drugs per year were provided, prescribed, or continued at ambulatory care visits in the United States during 2003 and 2004. Two-thirds of the 1.1 billion ambulatory care visits per year included medication therapy. The rate was highest at visits to medical specialists (2.3 drugs per visit). The rate of drugs per visit increased with patient age in each ambulatory care setting. Cardiovascular-renal was the class of drugs most frequently cited at visits to primary care physicians and medical specialists. Pain relievers were the drugs reported most often at hospital emergency and outpatient department visits. Of the 50 drugs most frequently reported overall, three-quarters of them were accounted for by six therapeutic classes-pain relievers, cardiovascular-renal agents, respiratory tract drugs, central nervous system drugs (antianxiety agents and antidepressants), hormonal agents, and antimicrobials. Ibuprofen, aspirin, atorvastatin calcium, acetaminophen, and albuterol were the five most frequently reported medications. From 1993 to 2004, the number of drugs provided, prescribed, or continued per visit increased for all settings.

Competition keeps getting hotter for ambulatory surgery

With fast-paced advances in medicine and technology, certain types of surgery that could once only be performed on an inpatient basis are now moving to ambulatory surgery centers. Hospitals are exploring a variety of strategies to hold on to--and even expand--their share of the few profitable areas of health care today.

Impact of deliveries on the office practice of family medicine

INTRODUCTION

To prospectively evaluate the frequency of late-night deliveries and the cost of lost office hours, physicians serving mainly uninsured and Medicaid patients in an urban area established databases tracking office demographics and detailed information on each delivery.

SUBJECTS AND METHODS

Time needed in the hospital during routine office hours and late night was tabulated for each delivery. Complete calendar years 2000-2003 were tabulated separately and in total. Overhead and opportunity costs were calculated using historical norms and actual costs.

RESULTS

During the study, there were 490 deliveries, with 113 (23%) occurring late at night. Physicians retrospectively self-reported an average of 2.8 hours in the hospital for the average delivery, which included 105 (21%) Cesarean deliveries. There were an average of 9.5 prenatal visits with each delivery, and 23% of deliveries occurred late at night (11 p.m.-6 a.m.). The average delivery produced a net revenue of dollar 1,339. Deliveries caused physicians to be absent from the office for 371.5 hours over the four years. After deducting opportunity cost and continuing overhead, net revenue for the 48-month study period was dollar 646,858. Ancillary revenues were beyond the scope of the study design.

CONCLUSION

These data suggest that delivery services in this community of urban underserved minorities can be self-supporting. This is the first study in the medical literature to provide data describing the impact of deliveries on physician practices outside of residency. Loss of physician sleep and revenue lost secondary to time away from the office were successfully measured. These data suggest that common beliefs frequently overestimate lifestyle interruptions and underestimate the financial losses of failure to deliver babies in this region. Future studies are suggested.

Utility and barriers to performance of the ankle-brachial index in primary care practice

Peripheral arterial disease is prevalent, associated with increased cardiovascular morbidity and mortality, and is underdiagnosed. Nevertheless, systematic efforts to provide early office-based peripheral arterial disease detection are not routinely implemented in office practice. The PARTNERS Program implemented the ankle-brachial index (ABI) measurement in primary care outpatient clinics in order to model practical dissemination of this technique and thus improve office-based peripheral arterial disease detection. The objective of this study was to identify clinician-defined factors that were perceived to foster acceptance of, or create barriers to, the use of the ABI in office practice. The ABI Utilization Survey was administered to primary care clinicians who participated in the PARTNERS Program, as well as to additional primary care clinicians who participated in the PARTNERS Preceptorship. The survey assessed six parameters: pre- and post-participation office ABI utilization; perceived clinical utility of the ABI; perceived value of the ABI data relative to other commonly used office disease detection methods; feasibility of implementing office-based ABI testing; definition of factors limiting utilization of the ABI in office practice; and the role of office staff in performing the ABI test. Survey data were obtained from 886 respondents. A total of 68% of respondents did not measure the ABI prior to participation in the PARTNERS Program. After Program participation, the frequency of office ABI use increased from 12% to 43% weekly and 13% to 39% monthly. The few participants who reported using the ABI only once a year (annually) did not significantly change after the program. Most clinicians believed that the ABI was useful in the diagnosis and management of both symptomatic (96%) and asymptomatic (89%) peripheral arterial disease. Moderate to major barriers to use of the ABI included time constraints (56%), lack of reimbursement (45%), and staff availability (45%). Nearly all (88%) clinicians believed that it was feasible to incorporate ABI into daily practice. Overall, most clinicians (57-75%) believed that ABI was equal to, or more useful, than other widely available and reimbursed screening tests in preserving their patients' health. In conclusion, the ABI was perceived by primary care clinicians to be a clinically useful diagnostic test. Limited reimbursement and time were identified as the primary barriers to its widespread use. Once learned, most clinicians stated that the ABI would continue to be frequently used in their office practice. The ABI is a simple peripheral arterial disease detection tool that can be successfully applied in primary care office practices.

Outpatients: here today, gone tomorrow?

Your outpatient volume is booming and that's got you feeling pretty good, right? Uh-oh. The fact is, most hospitals are losing outpatient market share to competitors like physicians' offices and nonhospital-owned facilities, and proposed changes to DRG payments could aggravate the situation. But some hospitals are finding ways to regain the upper hand.

Utilization of the office, hospital and emergency department for adult sickle cell patients: a five-year study

Sickle cell disease (SCD) is a hematological disorder that is manifested primarily by severe pain and chronic organ damage. Little normative data exists on what the usual healthcare utilization is of a population of SCD patients, especially adults. Our study analyzed the office, emergency department (ED) and hospital use data for 142 patients who received care for three consecutive years. Relationships between health service use, patient age, gender and sickle cell phenotype were described. Multivariate analyses studied relationships between demographic and clinical characteristics and levels of office, independent ED and inpatient encounters over a five-year period (1997-2001). We found female patients were older and had less ED and hospital admissions. The 20% highest inpatient utilizers accounted for 54% of the ED total visits, 52% of the ED independent visits, 54% of hospital bed days and 24% of office visits. The ED was a common place for utilization, with a mean of 7.4 visits per patient year, a third of which resulted in a hospital admission. The healthcare utilization of our adult sickle cell population is very complex, with a subset of our patients accounting for a majority of the resources used and female patients living longer but with less ED and hospital admissions.

The burden of neuropathic pain: results from a cross-sectional survey

BACKGROUND

There are few published data on the treatment patterns and burden of neuropathic pain. We have investigated this in a large, observational, cross-sectional survey.

METHODS

We surveyed 602 patients with neuropathic pain recruited from general practitioners in six European countries. Physicians recorded demographic and treatment information, including prescription medications. Patients completed Brief Pain Inventory (BPI) severity and interference questions, the EuroQol (EQ-5D), and questions about their productivity, non-prescription treatments, and frequency of physician visits. The BPI Pain Severity score (range: 0-10) is the mean of worst, least, average, and current pain ratings, with scores of 4-6 and 7-10 considered moderate and severe, respectively. We evaluated the impact of pain severity on functioning using analysis of variance models and chi2 tests.

RESULTS

Mean (SD) age was 62.9 (14.4) years (50% female). Most patients reported moderate (54%) or severe (25%) pain. Nearly all patients (93%) were prescribed medications for their neuropathic pain: analgesics (71%); anti-epileptics (51%); antidepressants (29%); sedatives/hypnotics (15%). Seventy-six percent visited their physician at least once in the past month. Employment status was affected in 43% of patients; those employed missed a mean (SD) of 5.5 (9.8) workdays during the past month. Pain severity was associated significantly (P<0.001) with poorer EQ-5D scores (mild=0.67, moderate=0.46, severe=0.16), greater disruption of employment status (mild=24%, moderate=48%, severe=54%), and more frequent physician visits (% with one or more visits: mild=66%, moderate=79%, severe=83%).

CONCLUSIONS

Patients with neuropathic pain visit their physician frequently and report substantial pain that interferes with daily functioning despite receiving treatment.