Research ArticleOriginal Research

Describing Primary Care Encounters: The Primary Care Network Survey and the National Ambulatory Medical Care Survey

Helen J. Binns, David Lanier, Wilson D. Pace, James M. Galliher, Theodore G. Ganiats, Margaret Grey, Adolfo J. Ariza, Robert Williams and ; for the Primary Care Network Survey (PRINS) Participants
The Annals of Family Medicine January 2007, 5 (1) 39-47; DOI: https://doi.org/10.1370/afm.620

Article Figures & Data

Tables

  • Table 1.

    Characteristics of PRINS Clinicians and NAMCS Physicians

    Percentage of Clinicians, Weighted
    CharacteristicPRINSNAMCS Mean (95% CI)
    PRINS = Primary Care Network Survey; NAMCS = National Ambulatory Medical Care Survey; CI = confidence interval; MSA = Metropolitan Statistical Area; APN = advanced practice nurse; NP = nurse-practitioner; NA = not available or not applicable.
    * Response choices as listed on the PRINS form. The NAMCS response choice “medical/academic health center” is included in “hospital.”
    † PRINS includes 2 categories (owner, employee/contractor); NAMCS includes 3 categories (owner, employee, contractor).
    Specialty
    Family medicine/general practice34.243.2 (40.8–45.6)
    Internal medicine8.736.7 (34.7–38.7)
    Pediatrics52.920.1 (18.5–21.7)
    Other4.20.0 (–)
    Region
    Northeast20.422.8 (20.8–24.8)
    Midwest25.623.4 (21.0–25.8)
    South28.729.7 (26.5–32.9)
    West25.324.2 (21.6–26.8)
    MSA status
    MSA77.579.1 (77.3–80.9)
    Non-MSA19.720.9 (17.1–24.7)
    Missing2.80.0 (–)
    Discipline
    Physician89.0100.0 (NA)
    Resident3.90.0
    APN/NP5.40.0
    Physician’s assistant1.70.0
    Missing0.00.0
    Sex
    Male53.076.8 (NA)
    Female47.023.2
    Age
    <50 years70.066.5 (63.7–69.3)
    ≥50 years28.433.5 (30.7–36.3)
    Missing1.60.0 (–)
    Ethnicity
    Non-Hispanic94.0NA
    Hispanic5.3
    Missing0.7
    Race
    White85.3NA
    Black/African American3.3
    Asian10.0
    Native Hawaiian/other Pacific Islander0.4
    American Indian/Alaska Native0.1
    More than 1 race0.3
    Missing0.6
    Who owns this practice?*
    Hospital24.98.6 (6.8–10.4)
    Physician or physician group54.675.9 (73.1–78.7)
    Other health care corporation15.28.3 (6.5–10.1)
    Health maintenance organization0.13.2 (2.2–4.2)
    Other3.94.0 (2.8–5.2)
    Missing1.30.0 (–)
    Employment status†
    Owner37.663.8 (60.6–67.0)
    Employee (or contractor–PRINS)61.130.8 (27.6–34.0)
    Contractor (NAMCS)–5.4 (4.2–6.6)
    Missing1.30.0 (–)
  • Table 2.

    Characteristics of PRINS Patient Visits and NAMCS Patient Visits

    Percentage of Visits, Weighted
    CharacteristicPRINSNAMCS Mean (95% CI)
    PRINS = Primary Care Network Survey; NAMCS = National Ambulatory Medical Care Survey; CI = confidence interval.
    Specialty of the clinician
    Family medicine/general practice55.046.4 (43.5–49.3)
    Internal medicine4.331.1 (28.7–33.5)
    Pediatrics38.722.5 (20.6–24.5)
    Other2.00.0 (–)
    Sex
    Male41.144.2 (43.8–44.7)
    Female58.455.8 (55.3–56.2)
    Missing0.50.0 (–)
    Age, years
    ≤ 1443.127.4 (25.8–28.9)
    15–2410.47.3 (6.9–7.6)
    25–4415.520.2 (19.5–21.0)
    45–6420.223.1 (22.4–23.7)
    65–746.511.1 (10.6–11.6)
    ≥ 754.610.9 (10.2–11.6)
    Missing0.70.0 (–)
    Ethnicity
    Non-Hispanic84.768.1 (65.4–70.7)
    Hispanic12.59.4 (7.3–11.5)
    Missing2.822.6 (20.1–25.0)
    Race
    White61.085.2 (82.7–87.6)
    Black/African American25.410.2 (8.5–12.0)
    Asian2.34.0 (2.2–5.8)
    Native Hawaiian/other Pacific Islander0.10.4 (0.3–0.5)
    American Indian/Alaska Native0.70.1 (0.1–0.2)
    More than 1 race6.50.1 (0.0–0.1)
    Missing4.00.0 (–)
    Insurance
    Private insurance47.257.7 (56.0–59.4)
    Medicare9.718.2 (17.0–19.3)
    Medicaid25.210.0 (8.7–11.2)
    Self-pay9.15.4 (4.8–6.0)
    No charge0.50.3 (0.3–0.3)
    Worker’s compensation0.31.0 (0.8–1.2)
    Other5.44.4 (3.9–4.8)
    Don’t know or missing2.53.1 (2.8–3.5)
    Major reason for visit
    Acute problem48.546.3 (45.3–47.2)
    Chronic problem, routine18.223.0 (22.0–23.9)
    Chronic problem, flare-up8.27.4 (7.0–7.9)
    Presurgery or postsurgery/injury follow-up1.12.0 (1.8–2.2)
    Nonillness care/preventive care22.818.4 (17.5–19.3)
    Missing1.12.9 (2.4–3.5)
    Clinician is this patient’s primary care clinician
    Yes76.684.2 (83.0–85.5)
    No17.510.5 (9.6–11.4)
    Don’t know5.95.3 (4.5–6.1)
    Any diagnostic service or other assessment provided
    Yes98.876.4 (74.9–78.0)
    No/missing1.223.6 (22.0–25.1)
    Blood pressure obtained
    Yes58.957.5 (55.7–59.2)
    No41.142.5 (40.8–44.3)
    Any counseling/education services provided
    Yes63.836.5 (35.1–38.0)
    No/missing36.263.5 (62.0–64.9)
    Counseling/education on diet/nutrition provided
    Yes37.719.2 (18.4–20.0)
    No62.380.8 (80.0–81.6)
    Counseling/education on growth/development provided
    Yes14.44.8 (4.4–5.2)
    No85.695.2 (94.8–95.6)
    Counseling/education on tobacco use/exposure provided
    Yes10.63.5 (3.2–3.8)
    No89.496.5 (96.2–96.8)
  • Table 3.

    Percentage of Visits by Primary Diagnosis Group

    Percentage of Visits, Weighted
    Primary Diagnosis GroupICD-9-CM CodesPRINSNAMCS Mean (95% CI)
    ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; PRINS = Primary Care Network Survey; NAMCS = National Ambulatory Medical Care Survey; CI = confidence interval.
    * Includes diseases of the blood and organs (280–289); complications of pregnancy, childbirth, and the puerperium (630–677); congenital anomalies (740–759); certain conditions originating in the perinatal period (760–779); and diagnoses that were uncodable (patient left before being seen; patient was transferred to another facility; health maintenance organization did not authorize treatment; entry was “none,” “no diagnosis,” “no disease,” or “healthy”). Unknown includes blank diagnoses, uncodable diagnoses, and illegible diagnoses.
    Infectious and parasitic diseases001–1394.73.5 (3.3–3.7)
    Neoplasm140–2390.81.1 (1.0–1.2)
    Endocrine, nutritional, metabolic diseases; immunity disorders240–27910.29.5 (9.0–9.9)
    Mental disorders290–3195.34.2 (4.0–4.4)
    Diseases of the nervous system and sense organs320–3897.66.1 (5.9–6.4)
    Diseases of the circulatory system390–4599.911.9 (11.3–12.6)
    Diseases of the respiratory system460–51915.816.5 (16.0–17.1)
    Diseases of the digestive system520–5794.04.2 (4.0–4.4)
    Diseases of the genitourinary system580–6293.63.6 (3.4–3.8)
    Diseases of the skin and subcutaneous tissue680–7094.43.7 (3.5–3.9)
    Diseases of the musculoskeletal and connective tissue710–7395.18.0 (7.6–8.4)
    Symptoms, signs, and ill-defined conditions780–7998.08.0 (7.7–8.3)
    Injury and poisoning800–9993.74.5 (4.3–4.8)
    Supplementary classificationV01–V8215.313.8 (13.1–14.5)
    All other diagnoses/unknown–*1.71.3 (1.2–1.4)
  • Table 4.

    Distribution of Visits for the Top 15 PRINS Diagnostic Clusters

    Rank OrderPercentage of Visits, Weighted
    Diagnostic ClusterPRINSNAMCSPRINSNAMCS Mean (95% CI)
    PRINS = Primary Care Network Survey; NAMCS = National Ambulatory Medical Care Survey; CI = confidence interval.
    Routine health maintenance1115.911.2 (10.6–11.8)
    Upper respiratory infection226.97.1 (6.7–7.5)
    Hypertension336.06.5 (6.2–6.9)
    Otitis media445.43.4 (3.2–3.6)
    Diabetes mellitus553.63.0 (2.8–3.2)
    Depression or anxiety692.22.0 (1.9–2.1)
    Asthma7112.11.7 (1.6–1.8)
    Rhinitis8122.11.6 (1.4–1.9)
    Sinusitis961.92.9 (2.6–3.1)
    Hyperlipidemia1081.92.1 (1.9–2.3)
    Lower respiratory infection11171.71.3 (1.1–1.4)
    Eczema12161.61.4 (1.3–1.6)
    Peptic disease13151.41.5 (1.4–1.6)
    Pregnancy-related14301.30.6 (0.5–0.8)
    Nonfungal skin infection15271.30.8 (0.7–0.9)
  • Table 5.

    Percentage of Visits Within Age-groups With the Diagnosis of Routine Health Maintenance

    Percentage of Visits, Weighted
    Patient Age-groupPRINSNAMCS Mean (95% CI)
    PRINS = Primary Care Network Survey; NAMCS = National Ambulatory Medical Care Survey; CI = confidence interval.
    ≤ 14 years28.025.6 (24.5–26.7)
    15–24 years13.912.2 (11.3–13.1)
    25–44 years6.36.8 (6.1–7.5)
    45–64 years6.15.3 (4.8–5.8)
    65–74 years1.93.6 (2.9–4.2)
    ≥ 75 years1.72.8 (2.5–3.2)

Additional Files

  • Supplemental Appendix

    Supplemental Appendix. Table 1. 2001 NAMCS Definitions; Supplemental Appendix. Table 2. Characteristics of PRINS Clinicians by Discipline; Supplemental Appendix. Table 3. Characteristics of PRINS Patient Visits by Discipline; Supplemental Appendix. Table 4. Services Provided in PRINS Patient Visits by Discipline; Supplemental Appendix. Table 5. Distribution of Visits for the Top 15 PRINS Diagnostic Clusters by Discipline

    Files in this Data Supplement:

  • The Article in Brief

    Describing Primary Care Encounters: The Primary Care Network Survey and the National Ambulatory Medical Care Survey

    Helen J. Binns, MD,MPH , and colleagues

    Background Practice-based research networks (PBRNs) are groups of practices that join together to conduct research and quality improvement activities. Many primary care PBRNs, however, do not have accurate, up-to-date data describing their members and patients, information that is necessary for conducting studies. Twenty PBRNs administered the Primary Care Network Survey to collect data about clinicians and patient visits, while testing the survey for use by other PBRNs.

    What This Study Found Clinicians who took the survey included doctors (89%), doctors in residency training (4%), advanced practice nurses/nurse-practitioners (5%), and physician�s assistants (2%). Most (53%) specialize in pediatrics, 34% in family medicine, and 9% in internal medicine. Compared with the National Ambulatory Medical Care Survey, these participants had more visits for preventive care and had more children, members of minority racial groups, and low-income individuals in their practices.

    Implications

    • The Primary Care Network Survey is the first systematic effort to catalog health care delivery in primary care offices by a large, diverse group of PBRN members.
    • These results help describe delivery of health care services in primary care offices and may offer a more in-depth view of particular aspects of primary care. The results are also important for examining research questions in PBRNs.
Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
Get Permissions

Jump to section

Related Articles

Cited By...

More in this TOC Section

Similar Articles

Subjects