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

2007 ◽  
Vol 5 (1) ◽  
pp. 39-47 ◽  
Author(s):  
H. J. Binns ◽  
D. Lanier ◽  
W. D. Pace ◽  
J. M. Galliher ◽  
T. G. Ganiats ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Care Network ◽  
Care Survey ◽  
Ambulatory Medical Care

scholarly journals 2424

2017 ◽  
Vol 1 (S1) ◽  
pp. 78-78
Author(s):  
Brianna M. D’Orazio ◽  
Joel Correa da Rosa ◽  
Jonathan N. Tobin
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Ambulatory Care ◽  
Low Income ◽  
Health Workers ◽  
Safety Net ◽  
Emergency Department Visits ◽  
Data Set ◽  
Care Survey ◽  
Ambulatory Medical Care

OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) recurrence ranges from 16% to 43% and presents significant challenges to clinicians, patients, and families. The number of emergency department visits for SSTIs increased from 1993 to 2005 from 0.48 to 1.16 ED visits per 100 US residents (95% CI 0.94 to 1.39; p<0.001); high safety-net status EDs saw a 4-fold increase in visits. The CA-MRSA Project (CAMP2) comparative effectiveness research (CER) study aims to evaluate a home-based intervention implemented by Community Health Workers (CHWs) or “promotoras” to prevent recurrence and transmission of CA-MRSA in primarily low-income, minority patients presenting to primary care with SSTIs. The intervention disseminates and implements methods found effective in the REDUCE MRSA trial. The present analysis was conducted using publically available data set to characterize the national patterns of healthcare utilization for treatment of SSTIs. METHODS/STUDY POPULATION: An analysis was conducted using data downloaded from the CDC National Ambulatory Medical Care Survey (NAMCS) and the CDC National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2012 (most recent data available) to evaluate the addition of Emergency Departments (EDs) as compared to Ambulatory Care as recruitment sources for a clinical trial to reduce CA-MRSA SSTI recurrence and household transmission. “Low-income” population was defined using “Expected Source of Payment” categories “Medicaid” and “Uninsured,” and ICD-9-CM dermatologic diagnosis codes for SSTIs and ICD-9-CM Procedure Codes for Incision and Drainage (I&D) were used to define a visit for SSTI treatment. RESULTS/ANTICIPATED RESULTS: In all patients, I&D was performed at a higher rate in EDs as compared with the ambulatory care setting (49.57 vs. 1.44 per 10,000 US residents in Medicaid and Uninsured; 44.48 vs. 5.24 per 10,000 US residents in all other insurance types). Nationally, low-income patients are 4 times more likely to have I&D procedure performed (OR 4.05, 95% CI 0.614–26.759, p<0.0001) and 5 times more likely to be diagnosed with an SSTI (OR 5.10, 95% CI 2.987–8.707, p<0.001) in the ED setting. DISCUSSION/SIGNIFICANCE OF IMPACT: These results confirm that low income patients seek primary care for SSTIs in both EDs and ambulatory care, such as Federally Qualified Health Centers (FQHCs). This also confirms the trend we have experienced in FQHCs in NYC, many of whom refer patients to the ED for the I&D procedure, and those patients return to the FQHC for follow-up. Thus, the most comprehensive test of using CHWs to disseminate and implement the findings from the REDUCE MRSA trial would engage both EDs and Ambulatory Care/FQHCs for patient identification and recruitment.

scholarly journals Collaborative practice trends in US physician office visits: an analysis of the National Ambulatory Medical Care Survey (NAMCS), 2007–2016

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e035414
Author(s):  
Shahpar Najmabadi ◽  
Trenton J Honda ◽  
Roderick S Hooker
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Nurse Practitioners ◽  
Healthcare Delivery ◽  
Physician Assistants ◽  
Collaborative Practice ◽  
Office Visits ◽  
Physician Office ◽  
Care Survey ◽  
Ambulatory Medical Care

ObjectivePractice arrangements in physician offices were characterised by examining the share of visits that involved physician assistants (PAs) and nurse practitioners (NPs). The hypothesis was that collaborative practice (ie, care delivered by a dyad of physician-PA and/or physician-NP) was increasing.DesignTemporal ecological study.SettingNon-federal physician offices.ParticipantsPatient visits to a physician, PA or NP, spanning years 2007–2016.MethodsA stratified random sample of visits to office-based physicians was pooled through the National Ambulatory Medical Care Survey public use linkage file. Among 317 674 visits to physicians, PAs or NPs, solo and collaborative practices were described and compared over two timespans of 2007–2011 and 2012–2016. Weighted patient visits were aggregated in bivariate analyses to achieve nationally representative estimates. Survey statistics assessed patient demographic characteristics, reason for visit and visit specialty by provider type.ResultsWithin years 2007–2011 and 2012–2016, there were 4.4 billion and 4.1 billion physician office visits (POVs), respectively. Comparing the two timespans, the rate of POVs with a solo PA (0.43% vs 0.21%) or NP (0.31% vs 0.17%) decreased. Rate of POVs with a collaborative physician-PA increased non-significantly. Rate of POVs with a collaborative physician-NP (0.49% vs 0.97%, p<0.01) increased. Overall, collaborative practice, in particular physician-NP, has increased in recent years (p<0.01), while visits handled by a solo PA or NP decreased (p<0.01). In models adjusted for patient age and chronic conditions, the odds of collaborative practice in years 2012–2016 compared with years 2007–2011 was 35% higher (95% CI 1.01 to 1.79). Furthermore, in 2012–2016, NPs provided more independent primary care, and PAs provided more independent care in a non-primary care medical specialty. Preventive visits declined among all providers.ConclusionsIn non-federal physician offices, collaborative care with a physician-PA or physician-NP appears to be a growing part of office-based healthcare delivery.

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