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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. Selected trends in office visits are also presented., Methods: The data presented in this report were collected in the 2004 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates using an estimator that uses a revised nonresponse adjustment., Results: During 2004, an estimated 910.9 million visits were made to physician offices in the United States, an overall rate of 315.9 visits per 100 persons. Overall, 58.9 percent of visits were to physicians in the specialties of general and family practice, internal medicine, pediatrics, and obstetrics and gynecology. In 2004, primary care specialists provided 87.2 percent of all preventive care visits. The percentage of visits relying on Medicaid or the State Children's Health Insurance Program increased by 36% between 2001 and 2004. Essential hypertension, malignant neoplasms, acute upper respiratory infection, and diabetes mellitus were the leading illness-related primary diagnoses. There were an estimated 105.3 million injury-related visits in 2004, or 36.5 visits per 100 persons. Diagnostic or screening services were ordered or provided at 85.9 percent of visits, and counseling, education, therapeutic, or preventative services were ordered or provided at 42.0 percent of visits. Medications were prescribed or provided at 64.2 percent of visits.

Objective: 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. This report also highlights visits to primary care specialties., Methods: The data presented in this report were collected from the 2002 National Ambulatory Medical Care Survey (NAMCS). NAMCS is a part of the ambulatory care component of the National Health Care Survey that measures health care utilization across 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 1992, 1993, 1995, and 1997 are also presented., Results: During 2002, an estimated 890 million visits were made to physician offices in the United States, an overall rate of 314.4 visits per 100 persons. From 1992 through 2002, the visit rate for persons 45 years of age and over increased by 14%, from 407.3 to 465.8 visits per 100 persons. The visit rate to physician offices in metropolitan statistical areas (MSAs) (337.3 visits per 100 persons) was significantly larger than the rate in non-MSAs (221.9 visits per 100 persons). For one-half of all office visits, regardless of specialty, physicians indicated they were the patient's primary care physician (PCP). Of the visits to physicians other than the patient's PCP, about one-third (31.1 percent) were referrals. New patients, representing 12.1 percent of the visits in 2002, are down 18% since 1992. Primary care specialists provided 90 percent of all preventive care visits. Essential hypertension, acute upper respiratory infection, diabetes mellitus, and arthropathies were the leading illness-related primary diagnoses. There were an estimated 104.0 million injury-related visits in 2002, or 36.7 visits per 100 persons. On average, 2.3 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 nonsteroidal anti-inflammatory drugs (NSAIDs) (4.9 mentions per 100 visits) and antidepressants (4.5 mentions per 100 visits). Of primary care specialists, 25.8 percent reported not accepting new patients who are Medicaid enrollees.

Objective: 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., Methods: 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., Results: 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.

Objective: This report describes ambulatory care visits made to physician offices within the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit. Highlights of trends in physician office visit utilization from 1997 through 2000 are also presented., Method: The data presented in this report were collected from the 2000 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 across 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. Trends are based on NAMCS data from 1997 through 2000., Results: During 2000, an estimated 823.5 million visits were made to physician offices in the United States, an overall rate of 300.4 visits per 100 persons. Approximately half of the visits were made to the patient's primary care physician. The proportion of office visits where a physician or physician group was the owner of the practice has steadily increased since 1997 (74.3 percent in 1997 versus 88.1 percent in 2000). Of all visits made to these offices in 2000, approximately 57 percent listed private insurance as the primary expected source of payment, and 29 percent were made by patients belonging to a health maintenance organization. There were an estimated 89.9 million injury-related visits during 2000, or 32.8 visits per 100 persons. Blood pressure check was the leading diagnostic screening test (45.3 percent) and males were more likely than females to have no diagnostic or screening services mentioned. The proportion of visits with at least one prescription for cardiovascular-renal drugs, hormones, or metabolic/nutrient drugs has increased since 1997.

Objectives: This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are presented on selected hospital, clinic, patient, and visit characteristics. Highlights of trends in OPD utilization from 1997 through 2000 are also presented., Methods: The data presented in this report were collected from the 2000 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NHAMCS is a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. Trends are based on NHAMCS data from 1997 through 2000., Results: During 2000, an estimated 83.3 million visits were made to hospital OPDs in the United States, about 30.4 visits per 100 persons. Females had higher OPD visit rates than males (35.3 versus 25.2 visits per 100 persons). The OPD utilization rate for black persons was higher than for white persons (48.3 versus 28.0 visits per 100 persons). Of all visits made to hospital OPDs in 2000, private insurance (38.5 percent), Medicaid (22.1 percent), and Medicare (16.9 percent) were listed as the leading primary expected source of payment. Approximately 21 percent of OPD visits reported that patients belonged to an HMO. There were an estimated 9.5 million injury-related OPD visits in 2000. Since 1997, the percent of OPD visits that were for injuries increased by 24% (from 9.2 percent to 1.4 percent). Most of these visits were for unintentional injuries (57.6 percent), including those caused by falls (12.9 percent). Medications were prescribed at 64.0 percent of visits. On average, 1.6 medications were ordered at each OPD visit. In 2000, patients saw one or more physicians (i.e., staff physician, resident/intern, or other physician) at approximately 79 percent of visits. Most patients were given an appointment to return to the clinic (57.2 percent).

Objective: This report describes ambulatory care visits made to physician offices within 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 from the 1997 National Ambulatory Medical Care Survey (NAMCS). NAMCS is part of the ambulatory care component of the National Health Care Survey, which measures health care utilization across 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 estimates., Results: During 1997 an estimated 787.4 million visits were made to physician offices in the United States, an overall rate of 3.0 visits per person. One quarter of these visits were made to general and family physicians, which was a significantly higher proportion compared to the other 13 specialties. Persons aged 75 years and over had the highest rate of physician office visits, 6.5 visits per person. Females had a significantly higher rate of visits to physician offices than males overall, as did white persons compared with black persons. Of all visits made to these offices in 1997, approximately 50 percent listed private insurance as the primary expected source of payment, and almost 30 percent were made by patients belonging to a health maintenance organization (HMO). There were an estimated 81.6 million injury-related visits during 1997, or 30.6 visits per 100 persons. Two-thirds of these visits were for unintentional injuries.

Objectives: This report describes the utilization of ambulatory medical care services as provided by nonfederally employed, office-based orthopedic surgeons during the period 1995-96. Statistics are presented on selected physician, patient, and visit characteristics., Methods: The data presented in this report were collected from the 1995 and 1996 National Ambulatory Medical Care Surveys (NAMCS). NAMCS is a national probability sample survey of visits to nonfederally employed, office-based physicians. Sample data are weighted to produce annual estimates. The survey is a component of the National Health Care Survey, which measures health care utilization across a variety of providers. Data are presented in this report as annual averages, unless otherwise noted., Results: During 1995-96, an estimated 76.5 million office visits were made to orthopedic surgeons, an average of 38.3 million visits per year. The annual average visit rate was 14.5 visits per 100 persons. This represents an increase over the 1975-76 estimate of 11.3 visits per 100 persons. Visits to orthopedic surgeons accounted for 5.3 percent of all office-based ambulatory care visits during 1995-96, but this specialty received 28.3 percent of all injury-related office visits. The most frequent reasons given by patients for visiting orthopedic surgeons were knee symptoms, postoperative visits, back symptoms, and shoulder symptoms.

Objectives: This report compares the health status of selected Asian national origin groups., Methods: 1992-94 National Health Interview Survey (NHIS) data were analyzed for six Asian national origin groups (Chinese, Filipino, Asian Indian, Japanese, Vietnamese, and Korean), the Asian and Pacific Islander (API) population as a whole, and the non-Hispanic white population. Unadjusted and age-adjusted estimates and standard errors of health indicators and sociodemographic characteristics were generated. A broad range of health issues was studied including respondent-assessed health status, activity limitation, physician contacts, restricted activity days, hospital episodes, smoking status, and knowledge of acquired immunodeficiency syndrome (AIDS)., Results: A greater age-adjusted percent of Vietnamese (17.2 percent) and Korean (12.8 percent) persons had fair or poor respondent-assessed health status than persons of Chinese, Filipino, and Japanese descent (6.1-7.4 percent). A lower age-adjusted percent of Chinese persons (6.5 percent) experienced activity limitation compared with Filipino, Japanese, and Vietnamese persons (9.4-13.2 percent). Japanese persons (4.9 contacts) had a greater average annual number of physician contacts than Chinese persons (3.1 contacts) after age adjusting the data. When the data were age adjusted, a higher percent of Korean adults (22.5 percent) were current smokers than Chinese (10.0 percent) and Asian Indian adults (8.7 percent). A higher age-adjusted percent of Vietnamese (21.2 percent) and Asian Indian (18.0 percent) adults reported knowing nothing about AIDS compared with Japanese adults (5.1 percent). A greater proportion of Vietnamese adults (91.6 percent) had not been tested for the AIDS virus infection compared with Chinese, Filipino, Asian Indian, and Japanese adults (72.6-78.5 percent) after age adjusting the data., Conclusions: Differences in health emerge when data on the API population are analyzed by national origin group. Estimates of health presented for the API population as a whole mask differences among subgroups.

Objectives: This report describes ambulatory care visits made to physician offices within the United States. Statistics are presented on selected physician, patient, and visit characteristics of ambulatory care visits., Methods: The data presented in this report were collected from the 1996 National Ambulatory Medical Care Survey (NAMCS). The NAMCS is part of the ambulatory care component of the National Health Care Survey, which measures health care utilization across various types of providers. The NAMCS is a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual estimates., Results: During 1996, an estimated 734.5 million visits were made to physician offices in the United States, an overall rate of 2.8 visits per person. One quarter of the NAMCS visits were made to general and family physicians, which was significantly higher than the other 13 specialties. Persons 75 years and over had the highest rate of physician office visits, 6.3 visits per person. Females had a significantly higher rate of visits to physicians offices than males did overall, as did white persons compared with black persons. Of all visits made to these offices in 1996, 87 percent were covered by some form of insurance, and 8.7 percent were paid "out-of-pocket." There were an estimated 87.6 million injury-related visits during 1996, or 33.1 visits per 100 persons. Three-quarters of these visits were for unintentional injuries.

Objectives: This report describes medications provided or prescribed during ambulatory medical care visits in 1992. Total ambulatory care medication therapy combines data from office-based physicians, hospital outpatient departments (OPD's), and hospital emergency departments (ED's). Drug therapy is described along three dimensions: number of drugs provided or prescribed (drug mention), whether a visit had any drugs mentioned (drug visit), and average number of drugs mentioned per 100 visits (drug mention rate). Utilization in ambulatory care settings is compared in terms of patient, drug, provider, and visit characteristics., Methods: Annual use of medication therapy was determined using data collected in the 1992 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). NAMCS includes office visits to nonfederal physicians principally engaged in office practice. The target universe of NHAMCS includes visits to ED's and OPD's of non-Federal, short-stay, or general hospitals. Sample data were weighted to produce annual estimates. Drug mentions are defined as the number of drugs mentioned on the patient record from., Results: An estimated 1.1 billion medications were provided or prescribed at ambulatory care visits in 1992. The setting with the greatest percent of visits with medication therapy was the ED; OPD's had the lowest percent with medications. Patients at the ED were provided more pain relief type drugs. The rate of drug mentions and percent of visits with medications were significantly higher in OPD clinics of general medicine and pediatrics compared with other types of OPD clinics. In office-based settings, physicians specializing in cardiovascular diseases were most likely to prescribe medications. Also, cardiovascular-renal type drugs accounted for the largest percent of office-based drug mentions. Visits with illness diagnoses are most likely to receive medication therapy. Trend data comparing 1980 to 1992 office-based mentions showed significant changes on several characteristics: single-ingredient drug status, physician specialty, and patient age., Conclusions: The profile of patients using office- and hospital-based ambulatory care settings are quite different as is the case-mix of conditions. These differences play an important role in medications utilized. The aging of the U.S. population from 1980 to 1992 appeared to have significant effects on several drug mention characteristics.

Objective: This report describes ambulatory care visits made to physician offices within the United States. Statistics are presented on selected physician patient, and visit characteristics for aggregated ambulatory care visits., Methods: The data presented in this report were collected from the 1995 National Ambulatory Medical Care Survey (NAMCS). NAMCS is part of the ambulatory care component of the National Health Care Survey, which measures health care utilization across various types of providers. NAMCS is a national probability survey of visits to office-based physicians in the United States. Sample data were weighted to produce annual estimates., Results: During 1995, an estimated 697.1 million visits were made to physician offices in the United States, an overall rate of 2.7 visits per person. One quarter of the NAMCS visits were made to general and family physicians, which was significantly higher than the other 13 specialties. Persons 75 years of age and over had the highest rate of physician office visits 5.9 visits per person. Females had a significantly higher rate of visits to physician offices than males did overall, as did white persons compared with black persons. Of all visits made to these offices in 1995, 86% were covered by some form of insurance, and 11 percent were paid "out-of-pocket." There were an estimated 81.6 million injury-related visits during 1995, or 31.2 visits per 100 persons. A significantly higher proportion of injury visits were made by white persons compared with black persons. Over two-thirds of all injury visits were for unintentional injuries.

Objective: This report describes ambulatory visits for asthma in the United States across three ambulatory care settings. The primary focus is on visits to office-based physicians., Methods: The data sources include the National Ambulatory Medical Care Survey (NAMCS), a national probability survey of visits to office-based physicians in the United States, and the National Hospital Ambulatory Medical Care Survey (NHAMCS), a national probability survey of visits to hospital emergency and outpatient departments in the United States. Most estimates presented are annual averages for the 2-year period, 1993-94. Visits for asthma are defined as those for which asthma was the first-listed diagnosis. A trend analysis compares office visit data collected in 1993-94 to data in the 1980-81 NAMCS., Results: There was an average annual estimate of 13.7 million ambulatory care visits for asthma in 1993-94, an annual rate of 53.4 visits per 1,000 persons. Four-fifth of ambulatory care utilization for asthma was conducted in physician offices. Relative utilization of office-based physicians was less for adolescent and black patients. The office visit rate for asthma increased 50 percent between 1980-81 and 1993-94. During 1993-94, use of office visits for asthma averaged 43 visits per 1,000 persons of 11 million office visits per year. The office visit rate in the Northeast was almost 2.5 times that in the South, although the prevalence of asthma was similar among regions. There were 5.8 return asthma visits for every new problem encounter. More than 40 percent of asthma visits had one or two comorbidities, mostly other respiratory conditions. Spirometry was used in 28 percent of asthma visits by new patients. Bronchodilators and anti-inflammatory agents were the most common medications prescribed. The use of corticosteroids and beta2-adrenergic agonists, either alone or in combination, increased substantially since 1980-81. The rate of utilization of methylxanthines decreased 61 percent between 1980-81 and 1993-94., Conclusions: The patient populations receiving care for asthma vary depending on the ambulatory care setting. Patients relying on hospital outpatient care for chronic asthma conditions may receive differential treatment and have different outcomes compared with patients of office-based physicians. For office-based ambulatory care, visits for asthma have increased substantially since 1980. Medication is the primary method of treatment with an increasing use of anti-inflammatory agents. The preferred bronchodilator has changed from methylxanthines to beta2-adrenergic agonists.

Data from the National Ambulatory Medical Care Survey show a steady increase in the number and rate of physician office visits for otitis media over the period from 1975 to 1990. The annual visit rate during this period more than doubled, and for children under age 15, increased 175 percent. Though the increase is greatest for males under age 2, there are substantial increases for males and females under age 15. Reasons for this dramatic increase are not readily apparent. Data from the National Health Interview Survey (NHIS), however, suggest that the increased visit rate may reflect an increase in the incidence of ear infections. According to NHIS data, the incidence of acute ear infections among the U.S. population increased by about 40 percent between 1982 and 1990, from 6.1 to 8.6 conditions per 100 persons per year. This compares with an increase of about 52 percent in the physician office visit rate for otitis media, from 1980 to 1990. (Because of gaps in data collection, it is not possible to compare precisely concurrent time periods.) The under 15 age group, which accounts for about 80 percent of otitis media physician office visits, experienced a 60 percent increase in office visit rate from 1980 to 1990. This parallels data from the NHIS that show a 60 percent increase in the incidence of acute ear infections among the under 17 age group from 1982 to 1990. The reporting of an acute ear infection in the NHIS does not necessarily equate to an incidence of otitis media, but the parallel increases in ear infection incidence and otitis media physician visits are mutually supportive and likely to be related.