Ambulatory and Primary Care

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Ambulatory and Primary Care

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Presentation Objectives

o Define ambulatory care o Define primary care o Explain subsets of ambulatory care o Explain ambulatory care and accreditation o Challenges and future of ambulatory care

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What is Ambulatory Care?

oDefine ambulatory care oDefine primary care oExplain subsets of ambulatory care oExplain ambulatory care and accreditation oChallenges and future of ambulatory care

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What is Ambulatory care?

? Personal health care provided to individuals who are not occupying a bed in a health care institution or in a health facility.

? Ambulatory care vs. primary care ? Follow-up care following inpatient

episodes ? A contemporaneous shift to ambulatory

care

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Where is Ambulatory Care Service Provided?

In a variety of settings, including: Freestanding provider offices Hospital-based clinics School-based clinics Public health clinics Community health centers

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Ambulatory Care Visits

Number of Ambulatory Care Visits

8

7

6

5 3.1

4

3

1.5

2

1

0 15-24

3.9 2.1

7.5 7.5

25-44

75+

Male Female

6 Source: Health United States 2000 (1998 data)

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Physician Office Visit

(National Center for Health Statistics. 2006)

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Physician Office Visit

(National Center for Health Statistics. 2006)

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Physician Office Visit Data-1:

(National Center for Health Statistics. 2006)

Trend of Office Visit by Type of illness and Season

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Ambulatory Care Visits:

Physician-visits by Race

Number of Ambulatory Visits by Race

90 80 70 60 50 40 30 20 10

0 ER

Hospital Outpatient Black White Other

Physician's Office

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? Annual rate of visits to office-based physicians by patient race and ethnicity

11 (National Center for Health Statistics. 2006)

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Trends in Ambulatory Care Visit

(1980-1990-2000)

Trends in Ambulatory Care Visits (% of Visits)

60

50

40

30

20

10

0

Primary Care Visits

General/Family Practitioner

Internist

1980 1990 2000

Pediatrician

Source: US Dept. of HHS 2000

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Organization

of Ambulatory Care Services

? Two major categories

1. Physicians offices (solo, group, managed care)

2. Hospital based ambulatory services

? Clinics ? Hospital sponsored group practice ? Health promotion centers ? Free standing surgical centers ? Etc...

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Composition of total ambulatory care visits

Emergency Department

10%

Hospital Outpatient

7%

Physician Office 83%

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Reasons for physician office visits

Why do people go to the physician's office?

30

28.1

25

20

18.2 17.5

15

10

5 1.5

0.7

0

Arthritis

Chronic renal failure

19.9

6 4.9

10.4 7.3

11.9 7.8

8.7 8.3

COPD

Depression

Diabetes

Hypertension

Obesity

1995 2005

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