Article Figures & Data
Tables
- Table 1.
Weighted Percentage Distributions of Office Visits, by Physician Category, NAMCS Data, 1997–2000
Physician Category Visits for Work-Related Conditions (n = 2,387) Visits for Non–Work-Related Conditions (n = 93,796) NAMCS = National Ambulatory Medical Care Survey. General practice Family practice (FP) 22.0 21.5 Family practice–geriatric medicine (FPG) 0.0 0.1 Family practice–sports medicine (FSM) 0.0 0.0 General practice (GP) 1.0 3.2 Internal medicine 8.9 16.6 Pediatrics 0.2 11.7 General surgery 2.4 2.5 Obstetrics and gynecology 0.0 9.0 Orthopedic surgery 33.7 4.3 Cardiovascular diseases 0.1 2.4 Dermatology 0.4 4.1 Urology 0.1 2.2 Psychiatry 2.8 3.0 Neurology 2.6 1.0 Occupational medicine 7.5 0.0 Ophthalmology 1.1 6.0 Otolaryngology 1.0 2.3 Other 16.2 10.7 Total 100.0 100.0 - Table 2.
Patient Characteristics, Weighted Percentage of Office Visits, NAMCS Data, 1997–2000
Visit Type Patient Characteristic FP-WR* (n = 326) OP-WR (n = 2,061) OccMed-WR (n = 180) FP-NWR (n = 12,865) Note: For ethnicity, some values were missing, so percentages do not add up to 100%. NAMCS = National Ambulatory Medical Care Survey; FP-WR = visit to family practice physician for work-related condition; OP-WR = visit to non–family practice physician for work-related condition; OccMed-WR = visit to occupational medicine physician for work-related condition; FP-NWR = visit to family practice physician for non–work-related condition. * Reference category for comparison. † P <.05 ‡ P <.01 § P <.001 Age, y, % ≤14 1.3 0.9 0.0 14.4§ 15–24 12.7 8.1‡ 7.0§ 9.7 25–44 54.5 52.1 62.3† 27.6§ 45–64 27.2 35.3† 30.7 27.0 65–74 3.1 2.9 0.0† 10.9‡ ≥75 1.2 0.8 0.0 10.5§ Age, mean, y 39.5 41.2‡ 39.4 42.6‡ Sex, % Female 38.1 39.0 39.6 58.3§ Male 61.9 61.0 60.4 41.7§ Race, % White 84.9 83.7 74.9† 89.8† Black 13.4 12.8 17.8 7.8‡ Asian/Pacific Islander 1.0 2.3 3.4† 2.0 American Indian/Eskimo/Aleut 0.8 1.3 3.9† 0.4 Ethnicity, % Hispanic 8.6 14.0‡ 25.5§ 7.3 Not Hispanic 71.0 64.8 65.6 70.8 Visit Type Medical Care Characteristic FP-WR* (n = 326) OP-WR (n = 2,061) OccMed-WR (n = 180) FP-NWR (n = 12,865) NAMCS = National Ambulatory Medical Care Survey; ICD-9 = International Classification of Diseases, Ninth Revision; FP-WR = visit to family practice physician for work-related condition; OP-WR = visit to non–family practice physician for work-related condition; OccMed-WR = visit to occupational medicine physician for work-related condition; FP-NWR = visit to family practice physician for non–work-related condition; RN = registered nurse; LPN = licensed practical nurse; HMO = health maintenance organization. * Reference category for comparison. † P <.05 ‡ P <.01 § P <.001 Major reason for visit Acute problem 55.3 35.4§ 48.5 48.4† Chronic problem, routine 16.9 20.7 7.1§ 22.7† Chronic problem, flare-up 10.5 9.1 5.4‡ 8.7 Presurgery or postsurgery/injury follow-up 12.2 30.4§ 36.1§ 2.4§ Non-illness (eg, routine prenatal, general examination, well-baby) 3.5 2.1 1.8 16.1‡ Patient’s chief complaints and symptoms Musculoskeletal symptoms 46.5 50.7 50.8 10.3§ Injury or poisoning 28.5 16.0§ 25.3 2.7§ Physician’s diagnosis of patient’s condition (ICD-9 groupings) Infectious and parasitic diseases 0.1 0.2 0.0 3.5§ Neoplasm 0.0 0.1 0.0 1.2 Endocrine, nutritional, metabolic, and immune disorders 0.0 0.2 0.0 7.3§ Mental disorders 1.1 4.0§ 1.0 3.8§ Diseases of nervous system, sense organs 5.5 6.7 2.7‡ 5.7 Diseases of circulatory system 1.5 0.5† 0.0 9.6§ Diseases of respiratory system 1.7 0.5‡ 0.0 19.4§ Diseases of digestive system 0.6 1.3 0.8 3.9† Diseases of genitourinary system 0.5 0.1 0.0 4.7‡ Diseases of skin, subcutaneous tissue, hair, nails 1.2 1.2 0.0 4.4§ Diseases of musculoskeletal system, connective tissue 25.3 28.9 28.5 8.0§ Symptoms, signs, and ill-defined conditions 1.8 2.5 2.0 7.1§ Injury and poisoning 54.0 43.9‡ 58.8 6.4§ Supplementary classification and other diagnoses 6.1 9.8 5.4 14.1† Visit was related to a specific injury or poisoning 94.1 89.4 95.2 10.2§ Visit was related to a self-inflicted injury or poisoning 0.0 0.4 0.0 0.0 Patient’s condition resulted from an assault 2.4 2.1 1.3† 0.1§ Services provided during visit Diagnostic and screening services 72.2 56.6§ 74.3 80.8‡ Blood pressure reading 57.2 24.2§ 54.6 66.7† Radiograph 20.0 21.2 21.8 6.3§ Therapeutic and preventive services 46.0 50.3 68.7§ 36.7† Exercise counseling and education 14.9 14.2 14.9 13.1 Injury prevention counseling and education 15.4 13.5 43.5§ 2.9§ Mental health counseling and education 0.8 2.1† 0.0 2.4§ Surgical procedures 4.5 2.6‡ 2.6 2.6 Therapy provided during visit Physiotherapy 19.6 23.6 32.7‡ 2.5§ Psychotherapy 0.0 3.6§ 1.3† 0.7 Psychopharmacotherapy 0.3 3.2‡ 0.0 0.5 At least 1 drug was prescribed during the visit 65.2 46.7§ 52.8 76.3§ Medical professionals seen during the visit Physician 96.3 96.8 94.2 95.1 Physician assistant 1.0 2.7† 0.1§ 1.7 Nurse-practitioner 2.1 0.5‡ 0.0 1.8 Nurse-midwife 0.0 0.1 0.3 0.1 RN 19.8 7.5§ 8.7‡ 16.1 LPN 20.1 6.4§ 0.0§ 18.6 Medical/nursing assistant 23.2 15.6§ 17.9 25.6 Other 1.9 5.6§ 5.3† 3.0 Physician was patient’s regular primary care physician 59.2 13.1§ 7.9§ 84.8§ Primary expected source of payment for the visit Private insurance 16.3 10.3§ 0.7§ 58.3§ Medicare 2.0 2.0 0.0 17.3§ Medicaid 3.0 0.3§ 0.0† 9.3§ Self-pay 2.4 1.0† 0.3‡ 7.0‡ Workers’ compensation 73.3 83.4‡ 93.8§ 0.0§ No charge 0.7 0.1 0.0 0.3 Other 1.1 2.1 5.3§ 5.3§ Unknown 0.5 0.5 0.0 1.8 Care was provided in an HMO setting 15.9 10.2‡ 10.7 31.0§ Capitated payment basis for the visit 7.2 4.2 6.2 16.9‡ Patient was a new patient 19.7 22.1 26.5 8.0§ Patient was referred by another physician/health plan 9.6 31.5§ 21.1† 3.3‡ Authorization from insurer was required for care 19.6 40.4§ 47.0§ 3.2§ Time spent with physician, mean, min 16.1 19.4§ 22.0§ 16.3 - Table 4.
Weighted Percentage Distributions of Medications Prescribed or Administered During Office Visits, by Category, NAMCS Data, 1997–2000
Visit Type Medications Category FP-WR* OP-WR OccMed-WR FP-NWR NAMCS = National Ambulatory Medical Care Survey; FP-WR = visit to family practice physician for work-related condition; OP-WR = visit to non–family practice physician for work-related condition; OccMed-WR = visits to occupational medicine physician for work-related condition; FP-NWR = visit to family practice physician for non–work-related condition. * Reference category for comparison. † P <.05 ‡ P <.01 § P <.001 Anesthetics 2.0 1.4 1.5 0.6‡ Antimicrobials 4.3 3.5 1.1 13.2§ Hematologic agents 0.3 0.5 0.0 1.6† Cardiovascular-renal drugs 6.4 3.4† 0.0‡ 16.2§ Central nervous system drugs 8.4 12.5‡ 2.3‡ 8.1 Contrast media/radiopharmaceuticals 0.0 0.1 0.0 0.3 Gastrointestinal agents 1.1 1.1 0.0 4.5§ Metabolic agents/nutrients 0.9 0.8 0.3 5.8§ Hormones/hormonal mechanisms 4.8 4.4 1.7 10.4§ Immunologics 1.5 1.3 5.2† 3.5† Skin/mucous membrane agents 5.0 5.2 9.1 4.3 Neurologic drugs 11.4 10.6 12.0 2.1§ Oncolytics 0.0 0.2 0.0 0.1 Ophthalmics 0.4 2.4† 4.0‡ 0.7 Otologics 0.2 0.2 0.0 0.9 Analgesics 48.6 47.1 60.8‡ 11.8§ Antiparasitics 0.0 0.3 0.0 0.3 Respiratory tract agents 2.6 3.5 1.8 12.9§ Unclassified/miscellaneous 1.9 1.2 0.3 2.7 Homeopathic products 0.3 0.1 0.0 0.1 Total 100.0 100.0 100.0 100.0 Total no. prescribed/ordered 317 1,347 122 17,883 - Table 5.
Medical Care Characteristics by Selected Visit Characteristics, Percentage of Office Visits to Family Physicians for Treatment of Work-Related Conditions (N = 326 Visits), NAMCS Data, 1997–2000
Visit Characteristic* Was Paid For by Workers’ Compensation Physician Was Patient’s Regular Primary Physician Patient Was a New Patient Medical Care Characteristic Yes (n = 241) No (n = 85) Yes (n = 213) No (n = 113) Yes (n = 59) No (n = 267) NAMCS = National Ambulatory Medical Care Survey; ICD-9 = International Classification of Diseases, Ninth Revision; FP-WR = visit to family physician for work-related condition; OP-WR = visit to non–family physician for work-related condition; OccMed-WR = visit to occupational physician for work-related condition; FP-NWR = visit to family physician for non–work-related condition; RN = registered nurse; LPN = licensed practical nurse; HMO = health maintenance organization. * Comparisons were between No column and corresponding Yes column. † P <.05 ‡ P <.01 § P <.001 Major reason for visit Acute problem 56.0 53.4 49.5 63.8† 64.8 54.0 Chronic problem, routine 18.1 13.7 21.4 10.4‡ 6.0 19.0† Chronic problem, flare-up 10.6 10.1 14.4 4.8§ 5.1 11.8 Presurgery or postsurgery/injury follow-up 9.2 20.3† 9.6 16.0 13.8 11.8 Non-illness (eg, routine prenatal, general examination, well-baby) 3.9 2.5 2.5 5.0 10.3 1.9‡ Patient’s chief complaints and symptom Musculoskeletal symptoms 48.3 41.7 45.9 47.4 33.2 49.8 Injury or poisoning 29.0 27.4 27.2 30.5 40.6 25.6 Physician’s diagnosis of patient’s condition (ICD-9 groupings) Infectious and parasitic diseases 0.0 0.4 0.0 0.3 0.0 0.2 Neoplasm 0.0 0.0 0.0 0.0 0.0 0.0 Endocrine, nutritional, metabolic, and immune disorders 0.0 0.0 0.0 0.0 0.0 0.0 Mental disorders 1.0 1.2 1.7 0.2§ 0.4 1.2§ Diseases of nervous system, sense organs 5.5 5.3 5.2 5.9 6.6 5.2 Diseases of circulatory system 2.0 0.0 0.9 2.4 4.9 0.6† Diseases of respiratory system 1.6 2.1 2.9 0.0 0.0 2.1 Diseases of digestive system 0.9 0.0 1.0 0.0 0.0 0.8 Diseases of genitourinary system 0.0 1.7 0.8 0.0 0.0 0.6 Diseases of skin, subcutaneous tissue, hair, nails 0.7 2.5 1.4 0.9 4.3 0.4§ Diseases of musculoskeletal system, connective tissue 26.8 21.1 28.6 20.5 16.3 27.5 Symptoms, signs, and ill-defined conditions 1.9 1.6 2.3 1.2 0.0 2.3 Injury and poisoning 53.7 55.1 50.6 59.1 53.0 54.3 Supplementary classification and other diagnoses 5.8 6.8 3.6 9.6 14.5 4.0‡ Visit was related to a specific injury or poisoning 92.0 100.0† 93.5 95.0 89.7 95.2 Visit was related to a self-inflicted injury or poisoning 0.0 0.0 0.0 0.0 0.0 0.0 Patient’s condition resulted from an assault 0.0 0.0 2.3 2.4 2.1 2.4 Services provided during visit Diagnostic and screening services 69.8 78.6 72.1 72.3 74.3 71.6 Blood pressure reading 56.6 58.8 59.1 54.4 52.9 58.2 Radiograph 17.0 27.2 19.5 20.6 28.3 17.9 Therapeutic and preventive services 43.7 52.1 49.9 40.2† 36.4 48.3 Exercise counseling and education 13.7 18.0 14.8 14.9 11.5 15.7 Injury prevention counseling and education 15.6 14.9 17.6 12.1 9.1 16.9 Mental health counseling and education 0.3 2.1 1.3 0.0 0.0 1.0 Surgical procedures 3.4 7.4 4.8 4.0 2.4 5.0 Therapy provided during visit Physiotherapy 18.4 22.8 22.9 14.9 12.7 21.3 Psychotherapy 0.0 0.0 0.0 0.0 0.0 0.0 Psychopharmacotherapy 0.3 0.0 0.4 0.0 0.0 0.3 At least 1 drug was prescribed during the visit 63.3 70.4 65.9 64.2 51.9 68.5 Medical professionals seen during the visit Physician 95.9 97.3 97.7 94.2 92.1 97.3 Physician assistant 0.5 2.5 1.5 0.3 0.6 1.1 Nurse-practitioner 2.9 0.0 1.4 3.2 6.5 1.0 Nurse-midwife 0.0 0.0 0.0 0.0 0.0 0.0 RN 21.5 15.3 17.5 23.3 18.6 20.1 LPN 19.1 22.8 20.1 20.0 18.7 20.4 Medical/nursing assistant 23.1 23.6 24.3 21.6 23.9 23.0 Other 2.1 1.3 1.9 2.0 4.9 1.2‡ Physician was patient’s regular primary care physician 52.7 77.1§ 100.0 0.0 18.0 69.4§ Primary expected source of payment for the visit Private insurance 0.0 61.0 23.9 5.2§ 4.9 19.1§ Medicare 0.0 7.5 3.4 0.0† 0.0 2.5 Medicaid 0.0 11.2 4.0 1.5 1.4 3.4 Self-pay 0.0 9.1 1.2 4.2 4.6 1.9 Workers’ compensation 100.0 0.0 65.2 85.0§ 89.1 69.4§ No charge 0.0 2.5 0.0 1.6 0.0 0.8 Other 0.0 4.1 1.8 0.0 0.0 1.4 Unknown 0.0 1.9 0.0 1.3 0.0 17.9§ Care was provided in an HMO setting 10.2 31.5§ 23.3 5.1§ 7.7 7.7 Capitated payment basis for the visit 4.9 13.7§ 8.4 5.5 5.4 0.0§ Patient was a new patient 24.0 8.0‡ 6.0 39.7§ 100.0 0.0 Patient was referred by another physician/health plan 11.1 5.5 4.4 17.1§ 21.9 6.6‡ Authorization from insurer was required for care 24.8 5.5§ 16.0 24.0† 28.9 17.4 Time spent with physician, mean, min 16.1 15.9 16.8 14.9 13.6 16.7
Additional Files
The Article in Brief
Background Many family physicians provide care for patients with occupational illnesses and injuries, but little is known about the services they provide or how they compare with services provided by other types of physicians. This study aims to learn more about the care family physicians provide for patients with work-related disorders.
What This Study Found Family physicians account for approximately 3 times as many visits each year for injured workers when compared with occupational medicine specialists. Patients receive more comprehensive care when they see their family physician for occupational injuries. During these visits, patients are more likely to have their blood pressure taken, receive diagnostic and screening services, and have prescription drugs prescribed or administered, compared with patients seeing other types of physicians.
Implications
- Family physicians often use visits for work-related conditions as opportunities to assess the patient��s overall health and provide other needed care.
- A family medicine approach offers added value to occupational illness care.
- These findings may be useful for establishing benchmarks to help family physicians assess the extent and type of services currently provided for work-related conditions.
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