Epidemiology of Primary Care and Preventive Medicine in Public Health
Explore the epidemiology of primary care in relation to preventive medicine and public health in the United States based on data from 2000. Discover insights on the distribution of office visits by physician specialty, patient demographics, and the principal reasons for healthcare visits. Gain valuable information on the prevalence of primary care physicians and their role in promoting community health.
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Epidemiology of Primary Care in relation to preventive medicine -public health CMG Buttery MB BS MPH 2015
Figure 1. Percent of office visits by physician specialty: United States, 2000 24.1 General & Family Practice Internal Medicine 29.4 Pediatrics Ob/Gyn Opthalmology 15.2 Orthopedic Surgey 5.6 All Other 5.2 7.9 12.6
10 10 Advance Data No. 328 + June 5, 2002 Advance Data No. 328 + June 5, 2002 Table 1. Number, percent distribution, and annual rate of office Table 1. Number, percent distribution, and annual rate of office visits with corresponding standard errors, by selected physician visits with corresponding standard errors, by selected physician practice characteristics: United States, 2000 practice characteristics: United States, 2000 Physician practice characteristic Number of visits in thousands 823,542 All visits Physician specialty General and family practice Internal medicine Pediatrics Obstetrics and gynecology Orthopedic surgery Ophthalmology Dermatology Psychiatry Cardiovascular diseases Urology General surgery Otolaryngology Neurology All other specialties 198,578 125,556 103,734 65,135 46,155 42,735 34,509 28,864 21,598 18,703 16,897 16,399 8,411 96,269 >50% of ALL office visits are to primary care physicians.
Advance Data No. 328 June 5, 2002 Table 3. Number, percent distribution, and annual rate of office visits by patient s age, sex, and race: United States, 2000 Patient s age, sex, and race Number of visits in thousands All visits Under 15 years 15 24 years 25 44 years 45 64 years 65 74 years 75 years and over 823,542 Age 142,466 67,172 196,833 216,783 102,447 97,842
16 Advance Data No. 328,June 5, 2002 Table 9. Number and percent distribution of office by the 20 principal reasons for visit most frequently mentioned by patients, United States, 2000 Number of visits in Principal reason for visit and RVC code1 All visits General medical examination* Progress visit, not otherwise specifiedT800 Cough Routine prenatal examination* Postoperative visit Symptoms referable to throat Skin rash Vision dysfunctions Knee symptoms Back symptoms Well-baby examination* Stomach pain, cramps, and spasms Medication, other and unspecified kinds Earache or ear infection Hypertension Depression Headache, pain in head Nasal congestion Chest pain and related symptoms Fever All other reasons thousands 823,542 63,952 X100 32,776 S440 X205 T205 17,519 S860 S305 S925 S905 X105 S545 T115 S355 D510 10,043 S210 S400 S050 S010 488, 22,360 22,085 21,178 S455 13,365 12,965 12,533 12,464 12,457 12,275 11,424 11,288 10,398 S110 9,320 8,857 8,833 8,801 650 * Prevention visits
Advance Data No. 328,June 5, 2002 Table 16. Number and percent of office, by therapeutic and preventive services ordered or provided, United States, 2000 Number of Therapeutic and preventive visits in services ordered or provided thousands All visits None Counseling/education Diet Exercise Injury prevention Growth/development Stress management Prenatal instructions Mental health Tobacco use/exposure Breast self-examination 17,827 Skin cancer prevention 14,311 Family planning/contraception HIV/STD transmission 5,190 Other therapy Complementary and alternative medicine Physiotherapy Psycho-pharmacotherapy19,947 Psychotherapy 823,542 515,550 26,988 80,839 24,610 21,460 18,403 18,396 18,221 18,213 9,564 31,589 22,273 18,669
Table 26. Mean time spent with physician by physician specialty: United States, 2000 Mean time spent with physician (Mins.) Physician specialty All visits Psychiatry Neurology Cardiovascular diseases Internal medicine 19.7 General surgery Obstetrics-gynecology Orthopedic surgery General, family practice Ophthalmology Otolaryngology Urology Dermatology Pediatrics All other specialties 18.9 36.0 28.0 21.5 19.0 18.2 17.1 17.0 16.9 16.8 16.2 15.8 15.4 23.5
PRIMARY CARE PROBLEMS IDENTIFIED BY PRIMARY PRACTITIONERS Prepared for NAPCRAG meeting in 1984 TOTAL NUMBER OF PROBLEMS IDENTIFIED (have ICD code) 591 TOTAL COMMON PROBLEMS as PERCENT OF TOTAL PROBLEMS 159/26.9 FP 520 147/28.3 GIM 353 90/25.5 PED 277 69/24.9 OBG
NUMBER AND PROPORTION OF COMMON PROBLEMS SEEN BY PHYSICIAN B AS A SUBSET OF TOTAL COMMON PROBLEMS SEEN BY PHYSICIAN A Physician A GIM Physician B FP PED OBG FP 159/100 110/73.8 74/83.1 41/61.2 GIM 110/69.2 147/100 53/59.6 33/49.3 PED 74/46.9 53/35.6 90/100 27/40.3 OBG 41/25.8 33/22.1 27/30.3 69/100
Types of Prevention Primary Before signs or symptoms of disease Immunization Diet Exercise Aspirin to reduce stroke events
Prevention (Continued) Secondary Signs and symptoms present but early Lower Blood Pressure Reduce Smoking Reduce Weight Reduce Stress Reduce Salt Intake INH for TB Infection
Prevention (Continued) Tertiary Late disease, intent to delay progress Physical Therapy after Injury Anticoagulant after Stroke Weight Reduction for Morbid Obesity HAART Therapy for PWA Tamoxifen after Breast Cancer Surgery Insulin Pump for Type 1 Diabetic
PROPORTION OF OFFICE VISITS FOR DIAGNOSES AMENABLE TO PRIMARY OR SECONDARY PREVENTION MD FP GIM PED OBG Prim 129.8 31.9 31.8 54.1 Sec 5.4 l0.6 0.2 0.9
How do we improve the links between Primary Care and Public Health/Prevention Pay for Prevention Services Add Physician Extenders to Practice NP, PA, H.Ed., MH Counsellor Use of Computerized Records that Remind need of Immunizations Remind Need for Routine Management Provide Health Ed. Material Computer links to patients.
PC PH Prevention Links Closer Health Department Practicing physician ties. Weekly or monthly surveillance reports Databases of Community Health Status Prevention talks at Hospital meetings Epidemiologic Surveys of patient records CASA/CDC Periodic review of death records with Rx for prevention activities Place PHNs in Physician s offices
How many Doctors? Current US population: Approximately 320Mn. AFP Recommended patient load: 1 FP/1800 patients
How Many Doctors -II For 320 Million People: 170,000 FPs. Assume 48 work weeks per MD Assume 10% will be in nonproductive positions teaching. Need =220,000 Outside the US maximum ratio of Specialist to PCPs is 1:1
How Many Doctors III Maximum number of physicians needed for Primary care 400,000 According to AMA practicing non-federal Physicians 814776 non-federal
How Many Doctors -IV Most physicians are in Patient Care (80.0%). Patient Care includes: Office-Based physicians Full-Time Hospital Staff (9.2%), and Residents/Fellows (14.0%). Physicians not in Patient Care are in Other Professional Activity, which includes: Administration (1.9%), Teaching(1.2%), Research (1.7%), and Other (0.5%). None of these percentages has changed significantly over the last 30 years.
