We obtained 2007-2016 data on the total US population as well as the age, sex, race, insurance status, and setting of US adults from the Current Population Survey (CPS).įor each visit, we described patient characteristics (age, sex, race, insurance status, setting) and the primary visit diagnosis or patient reason for visit (Supplemental Tables 1 and 2, ). Lastly, for each physician practice selected, visits are sampled during a randomly selected 1-week period. The second stage sample consists of practicing physicians selected from the American Medical Association Masterfile. The first stage sample includes 112 primary sampling units consisting of geographic segments (eg, counties and towns) within the United States. NAMCS uses a 3-stage stratified sampling design that allows for calculation of national estimates at the visit and physician level. NAMCS also collects physician and practice-level data through a physician induction survey. Through a standardized form completed by a physician or an outside coder using the medical record, NAMCS collects visit-level data on patient demographic information and clinical details, such as the main visit diagnoses, services provided, and visit disposition. NAMCS is a nationally representative survey conducted annually by the National Center for Health Statistics (NCHS) to examine patient visits to physicians in non–federally funded, non–hospital-based offices. We used NAMCS data from Januto December 31, 2016. Therefore, we assessed national trends in primary care visits and practice capabilities using 2007-2016 data from the National Ambulatory Medical Care Survey (NAMCS). Understanding the potential contribution of primary care practice changes to a decline in visit rates may help policy makers and health care leaders make sense of and respond to this trend. 15, 16 Yet, there is little evidence of how the use and content of primary care visits and physician practice capabilities have changed in this context over the past decade. 11, 12 With the encouragement of initiatives like the 2009 Health Information Technology for Economic and Clinical Health Act (HITECH) 13 and the patient centered medical home model, 14 PCPs may also provide more non–face-to-face care outside of those visits (eg, through secure messaging or virtual visits). 8 For example, aided by electronic health records, 9, 10 PCPs may be able to address more issues during a given in-person visit. 5 Yet, there is recent evidence of a 6%-25% decline in primary care visit rates over the past decade across commercial, Medicare, and nationally representative samples 6– 8 and it is unclear why.Īmong other mechanisms, the decline may be explained in part by changes in how physicians provide primary care both during and outside of in-person visits. For example, the Patient Protection and Affordable Care Act eliminated co-payments for recommended preventive services and introduced the Annual Wellness Visit for Medicare patients. In kind, many US policy initiatives over the past decade have sought to bolster primary care use and access. 1 Patients with access to a regular primary care physician (PCP) are more likely to receive recommended screenings, have fewer preventable hospital admissions, and experience lower mortality. Primary care is an essential component of a high-performing health care system.
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