Doctor Visits Up Among Persons Aged 45 and Older

Patients aged 45 years and older are visiting the doctor's office more often than persons in that age group did 10 years ago. In 2001, persons aged 45 years and older accounted for 53.1% of all physician visits.

These findings are from the National Ambulatory Medical Care Survey (NAMCS), which was conducted by the CDC. The survey looks at medical care provided in physicians' offices.

The CDC reports that "seniors and older baby boomers are visiting the doctor more often to manage multiple chronic conditions, obtain newly available drugs, and seek preventive care."

The number of persons aged 45 years and older increased by 11% during the last decade, but the percentage of physician visits by this age group over this same period increased by 26%. The total number of physician visits per person per year for persons aged 45 years and older increased 17%, from 4 in 1992 to 4.7 in 2001.

During 2001, an estimated 880.5 million visits were made to physicians' offices in the United States, an average of 3.1 visits per person. Although the US population has increased 12% since 1992, the number of visits to physicians' offices increased 16%, from 762 million annual visits. Females had a higher visit rate than males, and whites had a higher rate of visits (3.4 visits per person) than blacks (1.9 visits).

More medications are being prescribed as well, according to the report. In 2001, 1.3 billion drugs were prescribed or ordered by physicians for their patients, compared with 922.6 million in 1992.

Between 1992 and 2001, physician visits on average became more complex, with patient age increasing, more diagnoses rendered per visit, and more patients having multiple medications to manage (Cover Figure). One reason for the increase in complexity is that the mean patient age increased from 40 years to 44.6 years.

About half of all visits were to the patient's primary care physician. More than one third of office visits were for chronic conditions, 35.3% were for acute conditions, 16.8% for preventive care, 11.2% for injuries, and 5.6% for pre- and postsurgical consultations. The percentage of visits by new patients decreased by 20% from 1992 to 2001.

Diagnostic and screening services were ordered or provided at 82.8% of visits, and therapeutic and preventive services were ordered or prescribed at 41.4% of visits.

A total of 1.3 billion drugs were prescribed or provided at 61.9% of office visits. Although the percentage of office visits with any drug mention remained fairly constant (63.8% in 1992 and 61.9% in 2001), the average number of drug mentions increased from 1.21 mentions per visit in 1992 to 1.43 in 2001, up 22%. On average, 2.4 medications were ordered or provided at each office visit with any mention of a medication. As the number of past visits to the physician increased, so did the average drug-mention rate. The percentage of visits with at least 1 drug mention ranged from 80.6% for psychiatrists to 21.6% for general surgeons.

In 2001, 89.2% of physician office visits had a duration of 6 to 30 minutes. Overall, the mean time spent with a physician was 18.6 minutes. Time spent in face-to-face contact between the physician and the patient was estimated and recorded by the physician.

The 20 most frequently reported primary diagnoses for 2001 accounted for 41.7% of all physician office visits. Essential hypertension, ar throp athies and related disorders, acute upper respiratory tract infections (excluding pharyngitis), and diabetes mellitus were the leading illness-related primary diagnoses.

The top 5 therapeutic classes for drugs mentioned during visits were cardiovascular-renal drugs (14.7% of mentions), pain relievers (12.1%), respiratory tract drugs, hormones, and CNS drugs. Increases were seen in the use of CNS agents, metabolic and/or nutrient agents, and hormones. The increase in metabolic drugs is directly related to the increase in the use of lipid-lowering drugs.

In 1992, the 5 drugs prescribed most often were amoxicillin, Amoxil, Lasix, Ceclor, and Zantac. In 2001, the top 5 drugs were Lipitor, Celebrex, Vioxx, Claritin, and Lasix (Table). Changes also occurred in the types of services provided by physicians. There were more diagnostic services, counseling services, and surgical procedures ordered or provided in 2001 than in 1992.

Half of office-based physicians were in primary care, 22.1% were in surgical specialties, and 2.6% were in medical specialties. Approximately one third of office-based physicians were in solo practice, 40.8% were in a single-specialty group practice, and 25.9% were in a multispeciality group practice. During a typical week, physicians in office-based practices averaged 80 office visits, 16 telephone consults, 13 hospital visits, 0.9 house calls, and 0.5 e-mail consultations. Approximately 10% of physicians reported not having any managed care contracts, while 35.1% reported having more than 10 contracts.

Private insurance was the primary expected payment source (58% of visits). Government agencies (Medicare and Medicaid and/or state Children's Health Insurance Program) were the payment source for 29% of office visits, with Medicare accounting for 21.8%.

From 1997 through 2001, the percentage of visits by patients with private insurance increased from 53.1% to 58.8%. This was offset by a decline in percentage of visits by patients who self-paid, which dropped to 4% in 2001 from 7.7% in 1992. The percentage of visits paid by Medicare and Medicaid remained fairly constant between 1997 and 2001.

The 2001 NAMCS survey also found that 18.2% of office-based physicians had electronic patient medical records.

Data for the Cover Figure and in "Trend of the Month" are from the National Ambulatory Medical Care Survey: 2001 Summary. Additional information about physician office visits is available from the NCHS Ambulatory Health Care Web site: www.cdc.gov/nchs.

Drug Benefit Trends 15(9):6-7, 2003. © 2003 Cliggott Publishing, Division of SCP Communications
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