Article Figures & Data
Figures
- Figure 1
Percent change in per capita visit rates by main visit diagnosis from 2008-2015.
NACMS = National Ambulatory Medical Care Survey.
Visits per capita calculated by dividing NAMCS visits for each diagnosis by Current Population Survey total population estimate. Eight-year trend calculated for each subgroup by multiplying per year regression coefficient across study period. Changes were significant at P <.05 for all diagnoses except type 2 diabetes and allergic rhinitis.
- Figure 2
Change in the percentage of primary care physicians (PCPs) reporting practice capabilities.
EMR = electronic medical record.
Percentage of PCPs reporting practice capabilities, 2008 vs 2015 (EMR, e-mail consult, telephone consult, after-hours appointments) and 2011 vs 2015 (secure messaging).
Tables
- Table 1
Annual Rate of Primary Care Visits Per Person by Patient Characteristics, 2008-2015a
2008b 2015b 8-Year Trend, Visits per Personc (95% CI) Total population 1.5 1.2 −0.25 (−0.32 to –0.19) Sex Female 1.7 1.5 −0.29 (−0.44 to –0.13) Male 1.3 1.0 −0.20 (−0.30 to –0.11) Age, y 18-24 0.7 0.6 −0.18 (−0.26 to –0.11) 25-44 1.0 0.8 −0.23 (−0.27 to –0.19) 45-64 1.6 1.4 −0.22 (−0.32 to –0.11) ≥65 2.9 2.2 −0.68 (−0.87 to –0.49) Race White 1.6 1.0 −0.57 (−0.81 to –0.33) Black 1.4 1.3 −0.16 (−0.44 to 0.12) Hispanic 1.2 1.1 0.05 (−0.25 to 0.35) Other 1.2 1.0 −0.04 (−0.36 to 0.28) Insurance type Private 1.5 1.1 −0.39 (−0.48 to –0.31) Medicare 2.3 1.8 −0.46 (−0.59 to –0.33) Medicaid 1.5 1.1 −0.37 (−0.58 to –0.16) Otherd 0.4 0.3 −0.09 (−0.15 to –0.02) Practice setting Metro 1.8 1.5 −0.27 (−0.43 to –0.11) Rural 1.5 1.1 −0.48 (−0.86 to –0.10) NACMS =National Ambulatory Medical Care Survey.
↵a Visit rate per person year calculated by dividing NAMCS visits by Current Population Survey population estimates per subgroup.
↵b Presented as 3-year rolling averages.
↵c Eight-year trend calculated for each subgroup by multiplying per year regression coefficient across study period.
↵d Other includes uninsured, workers’ compensation, military health, and other classifications.40
2008a 2015a Percent Changeb 8-Year Trendc
(95% CI)Mean visit duration, mind 19.3 21.6 12 2.4 (1.1-3.8) Mean diagnoses, No.e 2.0 2.3 15 0.30 (0.16-0.43) Mean medications, No.f 3.1 3.9 26 0.82 (0.59-1.1) Mean preventive services, No.g 0.34 0.59 76 0.24 (0.12-0.36) Mean procedures, No.h 0.06 0.08 33 0.02 (0.01-0.03) NACMS = National Ambulatory Medical Care Survey.
↵a Presented as 3-year rolling averages.
↵b Percent change of each visit characteristic between 2008-2015.
↵c 8-year trend calculated for each subgroup by multiplying per-year regression coefficient across study period.
↵d Direct time spent with physician in minutes.
↵e NAMCS allows up to 3 write-in ICD-9/ICD-10 visit diagnoses (see Supplemental Appendix, http://www.AnnFamMed.org/content/17/6/538/suppl/DC1).
↵f NAMCS allows up to 8 write-in medications.
↵g Mean of the following 9 preventive services that were consistent in NAMCS 2007-2016: cholesterol, A1c, mammogram, depression screening, colonoscopy referral, bone-density, vaccines, chlamydia screening, Papanicolaou smear.
↵h Mean of up to 4 write-in ICD-9/ICD-10 procedures (see Supplemental Appendix, http://www.AnnFamMed.org/content/17/6/538/suppl/DC1), based on limit from 2007-2016.
- Table 3
Percentage of Primary Care Visits With Scheduled Follow-Up by Patient Characteristics and Visit Type, 2008-2015
2008a
n = 6,615b
n = 336,822,936c
%2015a
n = 6,555b
n = 298,516,838c
%8-Year Trend, Percentage
Point Changed
(95% CI)Total population 61.9 56.7 −6.0 (−12.4 to 0.46) Patient characteristics Age, y 18-24 42.7 37.5 −6.0 (−18.0 to 6.9) 25-44 52.8 48.2 −5.2 (−13.0 to 2.6) 44-64 62.3 58.9 −4.2 (−10.5 to 2.1) ≥65 72.3 62.9 −10.4 (−15.5 to –5.2) Chronic conditions, no 0 45.6 40.3 −5.7 (−14.9 to 3.4) 1-2 65.3 57.9 −7.5 (−13.2 to –1.9) 3-5 75.7 67.3 −9.7 (−16.7 to –2.6) 6-10 80.5 71.7 −6.1 (−12.6 to 0.4) Visit type Preventive visit 49.5 55.0 3.6 (−5.7 to 13.0) Acute visitse Upper respiratory infection 38.7 32.8 −4.9 (−19.0 to 9.2) Urinary tract infection 43.0 28.0 −12.3 (−35.4 to 10.7) Allergic rhinitis 49.8 61.4 3.3 (−12.8 to 19.4) Joint pain 52.9 50.0 −4.2 (−11.5 to 3.1) Back pain 58.8 53.0 −5.3 (−10.3 to –0.4) Headache 53.5 52.1 −1.9 (−5.1 to 1.3) Chronic condition visitse Hypertension 82.4 74.0 −10.2 (−14.1 to –6.4) Type 2 diabetes 74.6 64.0 −8.3 (−13.0 to –3.6) Mental illness 82.0 76.4 −12.2 (−18.7 to –5.7) NACMS = National Ambulatory Medical Care Survey.
↵a Data as 3-year rolling averages.
↵b Unweighted number of NAMCS visits.
↵c Weighted number of NAMCS visits.
↵d 8-year trend calculated for each subgroup by multiplying per-year regression coefficient across study period.
↵e Diagnosis groups created by authors for analysis (see Supplemental Appendix, http://www.AnnFamMed.org/content/17/6/538/suppl/DC1).
Supplemental Appendixes
Supplemental Appendixes
Files in this Data Supplement:
- Supplemental data: Appendixes - PDF file
The Article in Brief
National Trends in Primary Care Visit Use and Practice Capabilities, 2008-2015
Ishani Ganguli , and colleagues
Background Recent evidence shows a national decline in primary care visit rates over the last decade. It is unclear how changes in practice--including the use and content of primary care visits--may have contributed.
What This Study Found Researchers analyzed a weighted sample of 3.6 billion adult primary care visits from 2008 to 2015, collected through physicians surveyed by the National Ambulatory Medical Care Survey. They found primary care visits declined from 336 million to 299 million visits per year, representing a 20 percent decline over the study period. The decline in visits was most pronounced among adults 65 and older, white adults, and those in rural areas. Simultaneously, primary care physicians provided more preventive services and procedures per visit, with more diagnoses addressed and medications prescribed. During the study period, the number of physicians who reported offering secure online messaging increased by 60%, with a 44% increase in the use of electronic medical records.
Implications
- The findings offer an optimistic interpretation that the decline in primary care visits per capita may be driven in part by two key improvements in primary care practice, namely, physicians conducting longer, more comprehensive visits and the increased use of non-face-to-face care to address issues outside of in-person visits.
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