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Epidemiology of Primary Care and relation to preventive medicine - public health CMG Buttery MB BS MPH Figure 1. Percent of office visits by physician specialty: United States, 2000 24.1 29.4 General & Family Practice Internal Medicine Pediatrics Ob/Gyn Opthalmology 15.2 5.6 Orthopedic Surgey All Other 5.2 7.9 12.6 10 Advance Data No. 328 + June 5, 2002 Table 1. Number, percent distribution, and annual rate of office visits with corresponding standard errors, by selected physician practice characteristics: United States, 2000 • • • • • • • • • • • • • • • • • Physician practice characteristic 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 Number of visits in thousands 823,542 198,578 125,556 103,734 65,135 46,155 42,735 34,509 28,864 21,598 18,703 16,897 16,399 8,411 96,269 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 823,542 Age Under 15 years 142,466 15–24 years 67,172 25–44 years 196,833 45–64 years 216,783 65–74 years 102,447 75 years and over 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 • • • • • • • • • • • • • • • 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 S440 X205 T205 S455 S860 S305 S925 S905 X105 S545 Number of visits in thousands 823,542 63,952 32,776 22,360 22,085 21,178 17,519 13,365 12,965 12,533 12,464 12,457 12,275 T115 11,424 S355 D510 S110 S210 S400 S050 S010 488, 11,288 10,398 10,043 9,320 8,857 8,833 8,801 650 X100 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 All visits None Counseling/education Diet Exercise Injury prevention Growth/development Stress management Prenatal instructions Mental health Tobacco use/exposure Breast self-examination Skin cancer prevention Family planning/contraception HIV/STD transmission Other therapy Complementary and alternative medicine Physiotherapy Psycho-pharmacotherapy Psychotherapy thousands 823,542 515,550 26,988 80,839 24,610 21,460 18,403 18,396 18,221 18,213 17,827 14,311 9,564 5,190 31,589 22,273 19,947 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 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 19.7 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 TOTAL NUMBER OF PROBLEMS IDENTIFIED TOTAL COMMON PROBLEMS as PERCENT OF TOTAL PROBLEMS FP 591 159/26.9 GIM 520 147/28.3 PED 353 90/25.5 OBG 277 69/24.9 NUMBER AND PROPORTION OF COMMON PROBLEMS SEEN BY PHYSICIAN B AS A SUBSET OF TOTAL COMMON PROBLEMS SEEN BY PHYSICIAN A Physician A Physician B FP GIM PED OBG FP 159/100 110/73.8 74/83.1 41/61.2 GIM 110/69.2 149/100 53/59.6 33/49.3 PED 74/46.9 53/35.6 89/100 27/40.3 OBG 41/25.8 33/22.1 27/30.3 67/100 Types of Prevention • Primary – Before signs or symptoms of disease • Immunization • Diet • Exercise 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 Triple Drug 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 29.8 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 patieints. 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 • CAS – Periodic review of death records with Rx for prevention activities