Adult Ambulatory Care Visits for Illness-related Complaints in the United States, 1995/1996

Abstract

The purpose of this study was to describe the characteristics of a subset (illness-related complaints) of adult ambulatory care visits during 1995 and 1996 to physician offices (MDO), emergency departments (ED), and outpatient departments (OPD), using a nationally representative sample. Additionally, visits for selected illness conditions (chest pain, abdominal pain, asthma, and depression), visits resulting in hospital admission, and visits occurring in the ED were analyzed using logistic regression to construct utilization profiles. Approximately 701 million visits were made nationwide to physician offices, hospital outpatient departments and emergency departments by adults (≥25 years) for illness-related complaints during 1995 and 1996. The vast majority of visits (85%) were to MDOs, followed by EDs (9%) and OPDs (6%). The annual visit rate to all settings combined was 2.1 per person with higher rates for females (2.4 per person) compared to males (1.7 per person). Gender differences in utilization were consistent across all settings. Visit rates increased with age in all settings except the ED where the rate for the youngest age group (25–44 years) exceeded that for those 45–64 years of age. Visit rates for all races were highest in the MDO setting compared to the OPD and ED. Blacks had the highest rate of ED utilization (twice that of whites). Hispanics also used EDs at a 20% higher rate than non-Hispanics. Some form of health insurance covered the majority of visits (85%). The west, with the highest percentage of managed care enrollees, had the lowest ED visit rate (16 per 100 persons per year) compared to all other regions. Depression was among the top five reasons for visit in the MDO and OPD settings and was more prevalent in the youngest age category and in the northeast geographic region. Approximately 3% of visits resulted in hospital admission, the majority of which came from the ED (69%). ED reasons for visit and diagnoses were more acute than those in MDOs and OPDs, suggesting appropriate utilization of services. Future research linking utilization patterns to data about perceived access and health status are needed.