Highlights
of a new report from the National Center for Health Statistics (NCHS)
Ambulatory Care
Visits for Asthma: United States, 1993-94
Advance Data Report,
No. 277
September 26, 1996
More Americans are
seeking medical care for asthma, with visits to the doctor's office up 50
percent in the past decade. Over this time, treatment of asthma has
changed, focusing more on prevention of acute attacks. In line with
guidelines developed for asthma management, today's patients are more
likely to receive anti-inflammatory drugs for long-term control.
A new report from the
National Center for Health Statistics, Centers for Disease Control and
Prevention, profiles medical care for asthma in physicians' offices and
hospital emergency departments (ED) and outpatient departments (OPD). This
is the first analysis to use data across three ambulatory settings to
provide a comprehensive perspective on the impact of asthma on the health
care system and changes in use patterns over time. The report also
documents differences in use of OPD and ED facilities by age and race and
differences in care provided in each.
Asthma prevalence,
morbidity, and mortality are increasing in the United States. Physicians
and patients are more aware of the condition and patients are urged to
seek care utilizing new treatment approaches. "Ambulatory Care Visits
for Asthma: United States, 1993-94," describes the 14 million visits
made for asthma each year. Highlights of the report show:
About
80 percent (11 million) of the 14 million ambulatory visits for asthma were
made to office-based physicians; 1 million visits were made to OPD's and
1.6 million to ED's.
Asthma was the 6th most
frequent diagnosis (illness or injury) in office-based visits and in the
OPD and 11th in the ED. Most asthma patients are instructed to return for
repeat visits. Only hypertension, diabetes, and otitis media have more
repeat visits than asthma.
Children were more
likely than teens and adults to receive asthma care in the outpatient
department; adolescents and young adults were more likely than other age
groups to visit the ED for treatment. Choice of ambulatory care setting
also differed by race, with higher visit rates by black patients than
white patients to both outpatient and emergency departments. Health care
coverage and access to care may account for these differences.
Patients who visit
office-based physicians are more likely to receive medication for asthma
treatment and control and more likely to return for repeat visits than
those who visit the OPD. Only 5 percent of the visits to office-based
physicians do not include medication therapy; 3 times as many visits to
the OPD do not include medication therapy.
Doctors who see
patients in all settings are about equally likely to recommend that a
patient return for continued care; however, OPD visits are more likely
than office-based visits to be by new rather than returning patients.
Changes in treatment by
physicians reflect the guidelines for diagnosis and management from the
National Asthma Education and Prevention Program, with a greater emphasis
on prevention and long-term management. Between 1980-81 and 1993-94, the
use of corticosteroids rose substantially and were used in 41 percent of
all visits to office-based physicians in 1993-94. The use of
bronchodilators continued but changed from those utilizing methylxanthines
(down 61 percent) to those with beta2-adrenergic agonists.
Patients in the
northeast have a higher visit rate for asthma. This may reflect the
general pattern of higher physician visit rates for all causes in that
region or more localized factors such as extreme weather changes that may
exacerbate the asthmatic condition.
One-quarter of all
asthma office visits are to general and family practice physicians, more
than any other specialty. However, about one-third of all visits to
allergists and immunologists were for asthma.
"Ambulatory Care
Visits for Asthma: United States, 1993-94" was written by Catharine
W. Burt, Ed.D. and Deanne E. Knapp, Ph.D., using data based on a
nationally representative sample of visits to providers participating in
the National Ambulatory Medical Care Survey and the National Hospital
Ambulatory Medical Care Survey.
For more information
or for a copy of this report, contact the NCHS Public Affairs Office at
(301) 458-4800 or by email at: paoquery@cdc.gov.