How Primary Care Utilization Patterns Changed Over the Decade Article Swipe

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Anuradha Jetty , Jeongyoung Park , Yalda Jabbarpour ·

YOU? · · 2023 · Open Access · · DOI: https://doi.org/10.1370/afm.22.s1.5127

CONTEXT: Little is known about what drives the declining trends in primary care visits. OBJECTIVE: To 1) examine trends in outpatient visits over a decade, (2) assess the number of diagnoses per visit by clinician type and (3) investigate sociodemographic factors associated with primary care physician (PCP) visit versus subspecialist visit. STUDY DESIGN: Repeated Cross-sectional study. ANALYSIS: Summary statistics to examine the patterns of healthcare service use by clinician type. Logistic regression to evaluate sociodemographic characteristics associated with PCP visits. SETTING OR DATASET: Medical Expenditure Panel Survey data 2010-2019. POPULATION STUDIED: Nationally representative sample of the US population. OUTCOME MEASURES: The outcomes were (1) total number of ambulatory care visits, preventive care, acute care, chronic care, and diagnosis visits to five clinician types -primary care physicians (PCP), Internal Medicine-subspecialists (IM-subspec), Obgyn, psychiatrist, and nurse practitioners or physician assistants (NP/PAs); and (2) PCP versus subspecialist visit. RESULTS: The PCP (26.8% in 2010 to 19.2% in 2019) and subspecialist visits (34.1% to 28.5%) decreased over time. The non-physician visits increased from 39.2% to 52.3%. Further stratification by clinician type showed a decline in outpatient visits for PCPs, IM-subspec, and Obgyns, while they remained stable for psychiatrists. NPPA visits rose from 6.4% in 2010 to 9.0% in 2019. Preventive care visits for PCPs and NP/PAs were greater in 2019 than in 2010. Acute care visits were reduced for all clinicians except NP/PAs who saw an increase. Chronic care visits were lower in 2019 than in 2010 for all clinician types. PCPs had a greater proportion of visits with two or more diagnoses per visit (69% in 2019 vs. 58% in 2010). Regression results demonstrated higher odds of PCP visit than subspecialists among patients older than 40 years compared to 18-29 years [Odds Ratio (OR) 1.4, 95% Confidence Interval (CI) 1.2-16], those without high school versus with high-school diploma [OR 1.2, CI 1.1-1.4], White versus Black [OR 1.1, CI 1.0-1.2], and Hispanic adults [OR 1.1, CI 1.0-1.3] and those who reported poor health status and multiple chronic conditions [OR 1.4, CI 1.2-1.6]. CONCLUSION: Although overall primary care visits decreased over time, trends varied by visit type. The PCPs saw a higher volume of complex visits and more medically and socially vulnerable patient populations.

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Medicine Primary care Ambulatory care Context (archaeology) Logistic regression Family medicine Population Medical diagnosis Health care Acute care Ambulatory Emergency medicine Environmental health Internal medicine Pathology Economics Economic growth Biology Paleontology

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Type: article
Language: en
Landing Page: https://doi.org/10.1370/afm.22.s1.5127
PDF: https://www.annfammed.org/content/annalsfm/21/Supplement_3/5127.full.pdf
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Cited By: 1
Related Works: 10
OpenAlex ID: https://openalex.org/W4388719649

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DOI: https://doi.org/10.1370/afm.22.s1.5127

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Title: How Primary Care Utilization Patterns Changed Over the Decade

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Language: en

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Publication year: 2023

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Publication date: 2023-11-01

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Authors: Anuradha Jetty, Jeongyoung Park, Yalda Jabbarpour

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Landing page: https://doi.org/10.1370/afm.22.s1.5127

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Concepts: Medicine, Primary care, Ambulatory care, Context (archaeology), Logistic regression, Family medicine, Population, Medical diagnosis, Health care, Acute care, Ambulatory, Emergency medicine, Environmental health, Internal medicine, Pathology, Economics, Economic growth, Biology, Paleontology

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abstract_inverted_index.examine	17, 60
abstract_inverted_index.factors	40
abstract_inverted_index.greater	213, 250
abstract_inverted_index.overall	340
abstract_inverted_index.patient	367
abstract_inverted_index.primary	11, 43, 341
abstract_inverted_index.reduced	223
abstract_inverted_index.results	269
abstract_inverted_index.service	65
abstract_inverted_index.visits,	109
abstract_inverted_index.visits.	13, 79
abstract_inverted_index.without	298
abstract_inverted_index.-primary	123
abstract_inverted_index.1.0-1.3]	322
abstract_inverted_index.1.2-16],	296
abstract_inverted_index.Although	339
abstract_inverted_index.CONTEXT:	0
abstract_inverted_index.DATASET:	82
abstract_inverted_index.Hispanic	317
abstract_inverted_index.Internal	127
abstract_inverted_index.Interval	294
abstract_inverted_index.Logistic	70
abstract_inverted_index.RESULTS:	145
abstract_inverted_index.Repeated	53
abstract_inverted_index.STUDIED:	90
abstract_inverted_index.compared	284
abstract_inverted_index.evaluate	73
abstract_inverted_index.multiple	331
abstract_inverted_index.outcomes	101
abstract_inverted_index.patients	279
abstract_inverted_index.patterns	62
abstract_inverted_index.remained	190
abstract_inverted_index.reported	326
abstract_inverted_index.socially	365
abstract_inverted_index.(NP/PAs);	138
abstract_inverted_index.1.0-1.2],	315
abstract_inverted_index.1.1-1.4],	308
abstract_inverted_index.1.2-1.6].	337
abstract_inverted_index.ANALYSIS:	56
abstract_inverted_index.MEASURES:	99
abstract_inverted_index.clinician	34, 68, 121, 175, 245
abstract_inverted_index.declining	8
abstract_inverted_index.decreased	161, 344
abstract_inverted_index.diagnoses	30, 258
abstract_inverted_index.diagnosis	117
abstract_inverted_index.increase.	232
abstract_inverted_index.increased	167
abstract_inverted_index.medically	363
abstract_inverted_index.physician	45, 136
abstract_inverted_index.2010-2019.	88
abstract_inverted_index.Confidence	293
abstract_inverted_index.Nationally	91
abstract_inverted_index.OBJECTIVE:	14
abstract_inverted_index.POPULATION	89
abstract_inverted_index.Preventive	205
abstract_inverted_index.Regression	268
abstract_inverted_index.ambulatory	107
abstract_inverted_index.assistants	137
abstract_inverted_index.associated	41, 76
abstract_inverted_index.clinicians	226
abstract_inverted_index.conditions	333
abstract_inverted_index.healthcare	64
abstract_inverted_index.outpatient	20, 181
abstract_inverted_index.physicians	125
abstract_inverted_index.preventive	110
abstract_inverted_index.proportion	251
abstract_inverted_index.regression	71
abstract_inverted_index.statistics	58
abstract_inverted_index.vulnerable	366
abstract_inverted_index.CONCLUSION:	338
abstract_inverted_index.Expenditure	84
abstract_inverted_index.IM-subspec,	185
abstract_inverted_index.high-school	303
abstract_inverted_index.investigate	38
abstract_inverted_index.population.	97
abstract_inverted_index.demonstrated	270
abstract_inverted_index.populations.	368
abstract_inverted_index.(IM-subspec),	129
abstract_inverted_index.non-physician	165
abstract_inverted_index.practitioners	134
abstract_inverted_index.psychiatrist,	131
abstract_inverted_index.subspecialist	49, 143, 156
abstract_inverted_index.psychiatrists.	193
abstract_inverted_index.representative	92
abstract_inverted_index.stratification	173
abstract_inverted_index.subspecialists	277
abstract_inverted_index.Cross-sectional	54
abstract_inverted_index.characteristics	75
abstract_inverted_index.sociodemographic	39, 74
abstract_inverted_index.Medicine-subspecialists	128
cited_by_percentile_year.max	95
cited_by_percentile_year.min	91
countries_distinct_count	0
institutions_distinct_count	3
citation_normalized_percentile.value	0.72440412
citation_normalized_percentile.is_in_top_1_percent	False
citation_normalized_percentile.is_in_top_10_percent	False