Highlights of a new report from the National Center for Health Statistics

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.