RT Journal Article
SR Electronic
T1 How Primary Care Utilization Patterns Changed Over the Decade
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 5127
DO 10.1370/afm.22.s1.5127
VO 21
IS Supplement 3
A1 Jetty, Anuradha
A1 Park, Jeongyoung
A1 Jabbarpour, Yalda
YR 2023
UL http://www.annfammed.org/content/21/Supplement_3/5127.abstract
AB 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.