Plan and Operations of the National Health and Nutrition Examination Survey, August 2021-August 2023.

The continuous National Health and Nutrition Examination Survey began data collection in 1999 and proceeded without interruption until operations were suspended in March 2020 in response to the COVID-19 pandemic. Once the Division of Health and Nutrition Examination Surveys was able to determine and resume safe field operations, the next survey cycle was conducted between August 2021 and August 2023. This report describes the survey content, procedures, and methodologies implemented in the August 2021-August 2023 National Health and Nutrition Examination Survey cycle.

Polypharmacy in nursing home residents in the United States: results of the 2004 National Nursing Home Survey.

BACKGROUND: Despite the need for and benefits of medications, polypharmacy (defined here as concurrent use of > or =9 medications) in nursing home residents is a concern. As the number of medications taken increases, so does the risk for adverse events. Monitoring polypharmacy in this population is important and can improve the quality of nursing home care. OBJECTIVES: The aims of this article were to estimate the use of polypharmacy in residents of nursing homes in the United States, to examine the associations between select resident and facility characteristics and polypharmacy, and to determine the leading therapeutic subclasses included in the polypharmacy received by these nursing home residents. METHODS: This was a retrospective, cross-sectional study of a nationally representative sample of US nursing home residents in 2004; the outcome was use of polypharmacy. The 2004 National Nursing Home Survey was used to collect medication data and other resident and facility information. Resident characteristics included age, sex, race, primary payment source, number of comorbidities, number of activities of daily living (ADLs) for which the resident required assistance, and length of stay (LOS) since admission. Facility characteristics included ownership and size (number of beds). RESULTS: Of 13,507 nursing home residents who received care, 13,403 had valid responses for all 9 independent variables in the analyses. The prevalence of polypharmacy among nursing home residents in 2004 was approximately 40%. A multiple regression model controlling for resident and facility factors revealed that the odds of receiving polypharmacy were higher for residents who were female (odds ratio [OR] = 1.10; 95% CI, 1.00-1.20), were white, had Medicaid as a primary payer, had >3 comorbidities (OR = 1.57-5.18; 95% CI, 1.36-6.15), needed assistance with < or =4 ADLs, had an LOS since admission of 3 to <6 months (OR = 1.25; 95% CI, 1.04-1.50), and received care in a small, not- for-profit facility (data not shown for reference levels [OR = 1.00]). The most frequently reported medications for residents who received polypharmacy included gastrointestinal agents (laxatives, 47.5%; agents for acid/peptic disorders, 43.3%), drugs that affect the central nervous system (antidepressants, 46.3%; antipsychotics or antimanics, 25.9%), and pain relievers (nonnarcotic analgesics, 43.6%; antipyretics, 41.2%; antiarthritics, 31.2%). CONCLUSIONS: Despite awareness of polypharmacy and its potential consequences in older patients, results of our analysis suggest that polypharmacy remains widespread in US nursing homes. Although complex medication regimens are often necessary for nursing home residents, monitoring polypharmacy and its consequences may improve the quality of nursing home care and reduce unnecessary health care spending related to adverse events.

National Ambulatory Medical Care Survey: 2006 summary.

OBJECTIVES: This report describes ambulatory care visits made to physician offices in the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit. METHODS: The data presented in this report were collected in the 2006 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits to nonfederal office-based physicians in the United States. Sample data are weighted to produce annual national estimates of physician visits. RESULTS: During 2006, an estimated 902 million visits were made to physician offices in the United States, an overall rate of 306.6 visits per 100 persons. In over one-quarter of office visits, electronic medical records were utilized by physicians, while at 85.5 percent of visits, claims were submitted electronically. Since 1996, the percentage of visits by adults 18 years and over with chronic diabetes increased 40%, and during the same time period, visits increased for chronic hypertension (28%), and depression (27%). Among visits by females, a Pap test was ordered or provided more frequently than a human papilloma virus DNA test (5.6 versus 0.6 percent). Private insurance visits were more likely to include liquid-based Pap tests (6.3 percent) compared with visits using conventional or unspecified tests (3.7 percent), whereas visits utilizing Medicaid and other sources of payment were equally likely to provide conventional or unspecified, and liquid-based Pap tests. Medication therapy was reported at 636.7 million office visits, accounting for 70.6 percent of all office visits. In 2006, there were about 1.9 billion drugs mentioned, resulting in an overall 210.3 drug mentions per 100 visits. Visits to primary care physicians at community health centers were more likely to document health education compared with office-based practices, whereas diagnostic or screening services, drug mentions, and any nonmedication treatment occurred at approximately the same proportion of visits for primary care providers in both type of settings.

Electronic medical record use by office-based physicians and their practices: United States, 2006.

OBJECTIVES: This report presents the latest information on the use of electronic medical records in physician offices. Percentages of medical practices and physicians within the practices using electronic medical records (EMR) are presented for 2006 by selected physician and practice characteristics. METHODS: Data from the physician induction interviews of the 2006 National Ambulatory Medical Care Survey (NAMCS) are presented. NAMCS includes a national probability sample of nonfederal office-based physicians who saw patients in an office setting. Sample data were weighted to produce national estimates of physicians. Estimates of medical practices were derived from NAMCS physician data by adjusting the weighting scheme using a multiplicity estimator. RESULTS: In 2006, 29.2 percent of office-based physicians reported using full or partial EMR systems, which represented a 22% increase since 2005 and a 60% increase since 2001, when the NAMCS began monitoring this technology. Starting in 2005, the NAMCS included questions about EMR system features that health information technology experts consider minimal for a comprehensive EMR, namely computerized orders for prescriptions, computerized orders for tests, reporting of test results (lab or imaging), and clinical notes. Based on these requirements, 12.4 percent of physicians surveyed used comprehensive EMR systems in 2006, a figure not significantly different from the 9.3 percent reported for 2005. From 2005 to 2006, the percentage of medical practices using full or partial EMR systems increased by 42% (from 18.3 to 25.9 percent), but the percentage of medical practices using a comprehensive EMR system did not change.

National Ambulatory Medical Care Survey: 2005 summary.

OBJECTIVES: This report describes ambulatory care visits made to physician offices in the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit. METHODS: The data presented in this report were collected in the 2005 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits to nonfederal office-based physicians in the United States. Sample data are weighted to produce annual national estimates of doctor visits. RESULTS: During 2005, an estimated 963.6 million visits were made to physician offices in the United States, an overall rate of 331.0 visits per 100 persons. In one-quarter of office visits, electronic medical records were utilized by physicians, while at 83.9 percent of visits, claims were submitted electronically. As the baby boomer generation aged, there was a shift in utilization, as the majority of visits in 1995 were by patients 25-44 years of age compared with 2005, when most visits were by patients 45-64 years of age. In 2005, 52.7 percent of office visits were made by patients with at least one chronic condition. Hypertension was the most frequent condition (22.8 percent), followed by arthritis (14.3 percent), hyperlipidemia (13.5 percent), and diabetes (9.8 percent). Medication therapy was reported at 679.2 million office visits, accounting for 70.5 percent of all office visits. In 2005, there were about 2.0 billion drugs prescribed, resulting in an overall rate of 210.7 drugs per 100 visits. Drugs with amoxicillin were more likely to be new prescriptions (85.4 percent), while ibuprofen and acetaminophen were just as likely to be a new or continued drug. The overall mean time spent with a physician, excluding psychiatrists, has not changed since 1995; however, visits with a duration of 6-10 minutes decreased by 28% from 1995, while visits lasting 16-30 minutes increased by 20%.

National Ambulatory Medical Care Survey: 2004 summary.

OBJECTIVES: This report describes ambulatory care visits made to physician offices in the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit. Selected trends in office visits are also presented. METHODS: The data presented in this report were collected in the 2004 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates using an estimator that uses a revised nonresponse adjustment. RESULTS: During 2004, an estimated 910.9 million visits were made to physician offices in the United States, an overall rate of 315.9 visits per 100 persons. Overall, 58.9 percent of visits were to physicians in the specialties of general and family practice, internal medicine, pediatrics, and obstetrics and gynecology. In 2004, primary care specialists provided 87.2 percent of all preventive care visits. The percentage of visits relying on Medicaid or the State Children's Health Insurance Program increased by 36% between 2001 and 2004. Essential hypertension, malignant neoplasms, acute upper respiratory infection, and diabetes mellitus were the leading illness-related primary diagnoses. There were an estimated 105.3 million injury-related visits in 2004, or 36.5 visits per 100 persons. Diagnostic or screening services were ordered or provided at 85.9 percent of visits, and counseling, education, therapeutic, or preventative services were ordered or provided at 42.0 percent of visits. Medications were prescribed or provided at 64.2 percent of visits.

National Ambulatory Medical Care Survey: 2002 summary.

OBJECTIVE: This report describes ambulatory care visits made to physician offices in the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit. This report also highlights visits to primary care specialties. METHODS: The data presented in this report were collected from the 2002 National Ambulatory Medical Care Survey (NAMCS). NAMCS is a part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NAMCS is a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates. Selected trends from 1992, 1993, 1995, and 1997 are also presented. RESULTS: During 2002, an estimated 890 million visits were made to physician offices in the United States, an overall rate of 314.4 visits per 100 persons. From 1992 through 2002, the visit rate for persons 45 years of age and over increased by 14%, from 407.3 to 465.8 visits per 100 persons. The visit rate to physician offices in metropolitan statistical areas (MSAs) (337.3 visits per 100 persons) was significantly larger than the rate in non-MSAs (221.9 visits per 100 persons). For one-half of all office visits, regardless of specialty, physicians indicated they were the patient's primary care physician (PCP). Of the visits to physicians other than the patient's PCP, about one-third (31.1 percent) were referrals. New patients, representing 12.1 percent of the visits in 2002, are down 18% since 1992. Primary care specialists provided 90 percent of all preventive care visits. Essential hypertension, acute upper respiratory infection, diabetes mellitus, and arthropathies were the leading illness-related primary diagnoses. There were an estimated 104.0 million injury-related visits in 2002, or 36.7 visits per 100 persons. On average, 2.3 medications were ordered or provided at each office visit with any mention of a medication. The leading therapeutic class for drugs mentioned at office visits included nonsteroidal anti-inflammatory drugs (NSAIDs) (4.9 mentions per 100 visits) and antidepressants (4.5 mentions per 100 visits). Of primary care specialists, 25.8 percent reported not accepting new patients who are Medicaid enrollees.

National Ambulatory Medical Care Survey: 2001 summary.

OBJECTIVE: This report describes ambulatory care visits made to physician offices in the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit. Results highlighting new items on continuity of care are presented. They include whether the visit was the first or a followup for a problem, number of visits to this provider in the past 12 months for established patients, and whether other physicians shared care for the patient's problem. The report also highlights estimates of practice characteristics for office-based physicians. METHODS: The data presented in this report were collected from the 2001 National Ambulatory Medical Care Survey (NAMCS). NAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization by various types of providers. NAMCS is a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates. Selected trends from the 1992 and 1997 NAMCS are also presented. RESULTS: During 2001, an estimated 880.5 million visits were made to physician offices in the United States, an overall rate of 314.4 visits per 100 persons. From 1992 through 2001, the visit rate for persons 45 years of age and over increased by 17%, from 407.3 to 478.2 visits per 100 persons. The mean age of patients at each office visit has steadily increased from 1992 through 2001 as has the mean number of diagnoses rendered and the overall drug mention rate. The visit rate to physician offices in metropolitan statistical areas (MSAs) (338.3 visits per 100 persons) was significantly larger than the rate in non-MSAs (218.0 visits per 100 persons). Females had a higher visit rate compared with males, and white persons had a higher rate than black or African-American persons. Half of all office visits were to the patient's primary care physician (PCP). Of the visits to physicians other than the patient's PCP, about one-third (32.6 percent) were referrals. About 1 in 10 office visits were made by new patients (11.8 percent), down 20% since 1992. More than one physician shared the care for the patient's condition at about one-fifth of the office visits. Of all visits made to offices in 2001, 58.8 percent listed private insurance as the primary expected source of payment, followed by Medicare (21.8 percent) and Medicaid and/or State Children's Health Insurance Program (7.2 percent). For preventive care visits, the female visit rate was over 75% higher than the rate for males (67.1 versus 37.7 visits per 100 persons). Essential hypertension, arthropathies, acute upper respiratory infection, and diabetes mellitus were the leading illness-related primary diagnoses. There were an estimated 99.8 million injury-related visits in 2001, or 35.6 visits per 100 persons. Diagnostic and screening services were ordered or provided at 82.8 percent of visits, therapeutic and preventive services were ordered or provided at 41.4 percent of visits, and medications were prescribed or provided at 61.9 percent of visits. On average, 2.4 medications were ordered or provided at each office visit with any mention of a medication. The leading therapeutic class for drugs mentioned at office visits included cardiovascular-renal drugs (14.7 percent of mentions) and pain-relieving drugs (12.1 percent of mentions). A physician was seen at a majority of visits (95.8 percent), and a registered or licensed practical nurse was seen at 31.3 percent of visits. From 1992 through 2001, changes were observed in the leading diagnoses, therapeutic drug classes, and drug mentions. Physician estimates revealed that primary care physicians were twice as likely as specialists to make home visits during an average week of work; when they conducted them, they made twice as many (6 versus 2-3 visits per week) as specialists. Approximately 3 in 10 physicians reported not accepting new capitated, privately insured patients, whereas only 6.8 percent did not accept noncapitated, privately insured patients.

National Ambulatory Medical Care Survey: 2000 summary.

OBJECTIVE: This report describes ambulatory care visits made to physician offices within the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit. Highlights of trends in physician office visit utilization from 1997 through 2000 are also presented. METHOD: The data presented in this report were collected from the 2000 National Ambulatory Medical Care Survey (NAMCS). NAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NAMCS is a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates. Trends are based on NAMCS data from 1997 through 2000. RESULTS: During 2000, an estimated 823.5 million visits were made to physician offices in the United States, an overall rate of 300.4 visits per 100 persons. Approximately half of the visits were made to the patient's primary care physician. The proportion of office visits where a physician or physician group was the owner of the practice has steadily increased since 1997 (74.3 percent in 1997 versus 88.1 percent in 2000). Of all visits made to these offices in 2000, approximately 57 percent listed private insurance as the primary expected source of payment, and 29 percent were made by patients belonging to a health maintenance organization. There were an estimated 89.9 million injury-related visits during 2000, or 32.8 visits per 100 persons. Blood pressure check was the leading diagnostic screening test (45.3 percent) and males were more likely than females to have no diagnostic or screening services mentioned. The proportion of visits with at least one prescription for cardiovascular-renal drugs, hormones, or metabolic/nutrient drugs has increased since 1997.