Emergency Department Visits for Injuries Sustained During Sports and Recreational Activities by Patients Aged 5–24 Years, 2010–2016

November 15, 2019

Questions for Lead Author Anna Rui, Health Statistician, of “Emergency Department Visits for Injuries Sustained During Sports and Recreational Activities by Patients Aged 5–24 Years, 2010–2016.”

Q: What do you think is the most significant finding in this report?

AR: The top activities that caused emergency room (ER) visits for sports injuries by patients ages 5-24 years were football, basketball, pedal cycling, and soccer. There was wide variation by age and sex in the types of activities causing ER visits for sports injuries.


Q: Out of all of the sports, which sport or activity was found to have the largest increase in ER visits over time?

AR: We did not assess trends over time in the report.


Q: Is it accurate to say that the sports in the study are the most dangerous? Or do they have the most ER visits because they are simply the most popular?

AR: There are likely other health care utilization measures besides ER visits that others would want to look at as well, but the purpose of the report was to estimate the number of ER visits for sports injuries, and these are the sports that account for the most visits.


Q: What are some limitations of the report?

AR: The definition of sports and recreational activities relied on data processing and manual review of medical records, which could have resulted in over- or under-estimation of the sports injury ER rate. The study did not include patients who sought care in other settings or who did not seek care; thus the estimates in the report are an underestimate of all health care utilization for sports injuries.


Q: Why is this report important?

AR: Many young Americans engage in some type of sports or recreational activity each year, and sports and recreation-related injuries are a common type of injury seen in hospital ERs. It’s important to understand the types of injuries that are most commonly seen in the ER and which sports account for those injuries in order to monitor and guide injury prevention efforts. In addition, we provide updated estimates of treatments administered in the ER for sports injuries, which provides new information that can be used to monitor improvements to the quality and value of care and serve as a benchmark for future studies.


Opioids Prescribed at Discharge or Given During Emergency Department Visits Among Adults in the United States, 2016

May 31, 2019

Questions for Lead Author Anna Rui, Health Statistician, of “Opioids Prescribed at Discharge or Given During Emergency Department Visits Among Adults in the United States, 2016.”

Q: Why did you decide to focus on opioids prescribed at discharge or given during emergency department visits in the United States for this report?

AR:

Prescription opioid abuse and overdose continue to be critical public health issues. Opioid misuse, abuse, and overdose are affected by multiple factors including the number of people exposed. The Emergency Department (ED) is one setting where people could become exposed to opioids. In 2016, 27.5% of adult ED visits included opioids given in the ED, prescribed at ED discharge, or both (data not shown in report). The ED setting is where people frequently receive their first opioid treatment, after which patients with moderate to severe pain are often sent home with a prescription for an opioid, leaving them with the option of filling/not filling the prescription, or diverting filled prescriptions.

In the National Hospital Ambulatory Medical Care Survey (NHAMCS), information is collected on whether drugs are given during the ED visit, prescribed at discharge, or both.  However, in our published reports, the focus is on estimates of drugs and visits with drugs rather than how they are administered.  I wanted to assess visits with opioids prescribed at discharge separately to see how they compared with those given in the ED, in order to glean new information that has not previously been reported.  This could hopefully provide additional insight into patient populations visiting the ED who are exposed to opioids.


Q: How do rates of visits with opioids only given in the ED compare with opioids only prescribed at discharge and visits with both given and prescribed opioids?

AR: Generally, the rate of ED visits with opioids given during the visit was higher than the rate of ED visits with opioids prescribed at discharge.  Compared with the rate of ED visits with opioids prescribed at discharge, the rate where opioids were only given in the ED was higher among patients aged 45 and over and for both women and men.  Adults aged 18-44 were more likely to receive a prescription for an opioid at discharge compared with adults 45 and over.


Q: How did the data vary by emergency department visits where opioids were given, prescribed or both by primary diagnosis?

AR: The type of opioid administration among ED visits where opioids were given, prescribed, or both varied for certain selected diagnoses. For visits with a primary diagnosis of injury or trauma with opioids given or prescribed, the percentage with opioids only prescribed at discharge (40.7%) was higher than both the percentage of visits with opioids only given at the ED visit (26.3%) and visits with opioids both given and prescribed at discharge (32.7). Conversely, at visits for chest pain and abdominal pain with opioids given and/or prescribed, a higher percentage of opioids were only given at the ED visit. There was no variation across the types of opioid administration for back pain and extremity pain.


Q: Was there a specific finding in your report that surprised you?

AR:I was surprised at the high percentages of visits with opioids prescribed at discharge compared with those only given in the ED for certain diagnoses.  For example, among visits with a primary diagnosis of injury or trauma and where opioids were given or prescribed, a total of 73.4% included an opioid prescription at discharge.  Among visits primarily for extremity pain and where opioids were given or prescribed, 67.9% included an opioid prescription at discharge. Finally, among visits primarily for back pain in which opioids were given or prescribed, 64.5% included an opioid prescription at discharge. However I should also note that these estimates are based only on visits where the patient got opioids during the visit or at discharge.  For example, there are other ED visits made for injury where the patient did not get opioids at all, but we did not assess this in the report.


Q: Do you foresee the number of prescription opioids at emergency department visits increasing in the future?

AR: We do not make predictions about future data trends, but other research published by CDC for recent years showed stable or declining trends in the percentage of visits with opioids given in the ED, prescribed at discharge, or both.


QuickStats: Percentage of Emergency Department Visits Made by Patients with Chronic Kidney Disease Among Persons Aged 18 Years or Older, by Race/Ethnicity and Sex

January 11, 2019

During 2015–2016, 3.5% of adult visits to the emergency department were made by those with chronic kidney disease.

A higher percentage of visits were made by men with chronic kidney disease than women (4.1% compared with 2.7%).

The same pattern was observed for non-Hispanic black men (5.0%) and women (2.4%).

Although the pattern was similar, there was no statistically significant difference in emergency department visits by sex for Hispanic and non-Hispanic white adults.

SOURCE: National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey, 2015–2016.

https://www.cdc.gov/mmwr/volumes/68/wr/mm6801a7.htm


Mental Health-related Physician Office Visits by Adults Aged 18 and Over: United States, 2012-2014

June 6, 2018

Donald Cherry, M.S., Health Statistician

Questions for Donald Cherry, M.S., Health Statistician, and Lead Author of “Mental Health-related Physician Office Visits by Adults Aged 18 and Over: United States, 2012-2014

Q:  Was there a result in your study that you hadn’t expected and that really surprised you?

DC:  Most of the results confirmed what we’ve seen in current research, so there really was not a finding in this study that surprised me. But confirming existing knowledge is an important finding! Specifically, the results examining urban-rural visit differences are exactly in the expected direction; that is, in large metropolitan areas, psychiatrists are more concentrated (as suggested by prior research), and we would expect to see a higher percentage of visits to them for mental health-related issues. Rural areas have less psychiatrists and more primary care physicians (PCPs) (as suggested by prior research), and seeing 54% of mental health-related visits occurring at primary care physician offices suggests that in these rural areas, availability of provider type for outpatient mental health treatment might be limited.

Also, the results show no difference in a couple of areas. One area where you can see this is in the percent of health-related visits to psychiatrists vs. PCPs when Medicare is the expected source of payment. We see this too, in the rate of visits when the patient age is 65 years and older – which is interesting for its possible implications.  These results together may indicate that older adults, who are also assumed more likely to use Medicare, are as inclined to visit a primary care physician as they are a psychiatrist for mental health-related issues.


Q:  What would you say is the take-home message of this report?

DC:  I think the real take-home message of this report is that continued monitoring of the utilization of mental health services is important in identifying the present and future needs of the U.S. adult population. As one might expect, the composite of mental health-related visits occur in psychiatrists’ offices; however, this does not seem to be a phenomenon that is always consistent. Differences in mental health-related visits by physician specialty did vary by age, payment type, and within patient sex. The most interesting difference is in large metropolitan areas where a higher percentage of mental health-related office visits are to psychiatrists compared to primary care physicians (PCPs). In rural areas, an opposite trend is observed. This is consistent with past research and further suggests that a greater supply of, and access to, primary care physicians vs. psychiatrists occurs in rural areas.


Q:  What made you decide to conduct this study on mental health-related doctor’s office visits?

DC:  My background is in psychology, and I’m very interested in mental health issues, so mental-health related doctor’s office visits is a natural topic for me to explore. Having access to the National Ambulatory Medical Care Survey (NAMCS) data has given me the opportunity to examine different research topics. In the past, I have also been privileged to collaborate with prominent researchers in the field who have used NAMCS data. I have specifically been interested in where people are going to get treatment for mental health issues. Data accessibility in NAMCS is especially useful becauses it collects visit details on both primary care physicians and psychiatrists in the same survey sample design.


Q:  What differences or similarities did you see between or among various demographic groups in this analysis?

DC:  We did note some differences among different age groups, between sexes, and between rural and urban areas of the United States. When examining age, the mental health-related office visit rate to psychiatrists is higher compared with the rate to primary care physicians among all adults, and among adults in age groups 18–34, 35–49, and 50–64. But there was no significant difference among adults aged 65 and over. Not seeing a difference in rates for the oldest patients is interesting, and some researchers indicate that psychiatrists have a proportionately smaller role in office-based mental health care among older adults — than younger — perhaps due to age-related attitudinal differences toward psychiatric services.

Looking at sex, mental health-related office visit rates to psychiatrists are higher compared with primary care physicians for both men and women, but the visit rate is higher for women compared to men (1,380 vs. 1,111 visits per 10,000 adults).  Within-sex differences were expected given the overall premise of where adults as a group are getting their care. Within-sex differences follow 2016 data presented by The National Institutes of Mental Health that show the prevalence of any mental health illness is higher in women (21.7%) vs. men (14.5%).

Large metropolitan areas experienced a higher percentage of mental health-related office visits to psychiatrists compared to PCPs. In rural areas, an opposite trend was observed. This is consistent with past research and further suggests that a greater supply of, and access to, primary care physicians vs. psychiatrists occurs in rural areas. In medium to small metropolitan areas there was no difference in the percent of visits to either physician specialty, suggesting a possible absence of a supply-demand issue.


Q:  What sort of trend data do you have on this topic that will help us see how mental health-related doctor’s office visits have evolved over time?

DC:  Although we did not examine mental health-related office visits across years for this analysis, we certainly have the ability to examine the same characteristics in future research. An interesting finding in our current report is that mental health-related office visit rates to psychiatrists are higher compared with primary care physician visit rates in all age groups — except for adults aged 65 and over, and as a percentage of visits among all primary expected payment types except Medicare. These results together may indicate that older adults, who are assumed more likely to use Medicare, are as inclined to visit a primary care physician as they are a psychiatrist for mental health-related issues.


Q:  What information do you have on the differences between or among the different types of physicians that are visited for mental health, e.g. what do patients get at a psychiatrist’s office visit that they may not receive at a primary care physician’s – and vice versa?

DC:  There is information available about the type of care patients receive for mental health from different types of physicians. We do have the ability to determine some components of care which patients receive at mental health-related visits; for example, did the patient receive psychotherapy, health education/counseling, psychotropic medications, etc. However, this topic has been examined before as researchers outside The National Center for Health Statistics (NCHS) have studied care received at psychiatrist vs. PCP offices, so this data brief did not explore these factors extensively. Perhaps in a future NCHS study! The uniqueness of this research in how we define a mental health-related office visit should be recognized – and will be very useful in future studies. By using the patient’s reason for a visit, and not a physician’s diagnosis, we attempt to control that at least the initial reason for the visit was for a mental health issue.


Characteristics of Office-based Physician Visits, 2015

June 5, 2018

Jill Ashman, Ph.D., Health Statistician

Questions for Jill Ashman, Ph.D., Health Statistician, and Lead Author of “Characteristics of Office-based Physician Visits, 2015

Q: What made you write this report on doctors’ office visits?

JA: Our intent in producing this data brief is to provide the annual summary of National Ambulatory Medical Care Survey (NAMCS) data. Last year we created the format for this NAMCS summary report using 2014 data, and we are currently working on the 2016 summary. These summary reports provide a snapshot of the care provided at office-based physician offices.


Q: Was there a result in your study that surprised you?

JA:  While there is a notable finding in the report, generally the patterns are what we expected to find and are consistent with a similar report looking at office visits in 2014. One notable finding is the relatively low percentage of visits for preventive care among adults 18 years or older (21% for ages 18-64 and 13% for those aged 65 years or older).


Q: What differences or similarities did you see between or among various demographic groups, such as age and sex, in this analysis?

JA:  We noted a number of differences among various groups examined in this report. In terms of visit rates, we found that females visited the doctor’s office at a higher rate than males. We also found that the visit rate for infants and older adults exceeded the rates for those aged 1-64 years.

We also found age variation with primary expected sources of payment, the major reason for a doctor’s office visit, and for the services provided at the physician visit. Medicaid was the primary expected source of payment at a higher percentage of visits by children (38%) than adults, and Medicare was the primary expected source of payment at a higher percentage of visits by adults aged 65 and older (79%) compared with patients under 65 years. Having no insurance at all was at a higher percentage of visits by adults aged 18-64 (9%) than those aged 65 and over (2%). Also, compared with adults, a larger percentage of office visits by children were for either preventive care (33%) or a new problem (41%). Additionally, visits by children (compared with adults) were less likely to include a laboratory test, imaging service, or procedure that was ordered or provided. No variation by age was observed for office visits for an injury or that included an examination or screening service.


Q:  What is new in this report that has not already been published?

JA: This report provides the most recent nationally representative estimates of office-based physician visits in the United States. To our knowledge, age differences in the selected characteristics of patients accessing the doctor’s office in 2015 have not already been published.


Q: What sort of trend data do you have on this topic that will help us see how doctor’s office visits have evolved over time?

JA: With a number of years of data, we can look at trends over time by examining other National Center for Health Statistics reports. We released a similar report last year that looked at age variation in the same selected characteristics of office-based physician visits made in 2014. Comparing the results of both reports shows little change in the patterns of selected characteristics from 2014 to 2015. However, one notable change was an observed increase from 2014 to 2015 in the percentage of health education and counseling services ordered or provided overall and among the three age groups examined.

For older years of data, we provide detailed summary tables on our website going back as far as 2008 that can be used to help see how office-based physician visits have evolved over time. The summary tables can be found here.


Q: What would you say is the take-home message of this report?

JA: The take-home message from this report is that there is a wide variation by age in the characteristics of visits to office-based physicians in the United States in 2015. Larger differences were observed in the services ordered or provided and in the major reason for the office visit between children under 18 years and adults aged 18 or older.


Emergency Department Visits by Patients aged 45 and over with Diabetes: United States, 2015

February 8, 2018

Questions for Pinyao Rui, Statistician and Author of, “Emergency Department Visits by Patients aged 45 and over with Diabetes: United States, 2015.”

Q: Why did you decide to examine emergency department (ED) visits made by patients aged 45 years older with diabetes?

PR: We decided to examine emergency department visits made by patients aged 45 years and older because we wanted to focus on visits made by older patients who are at higher risk of developing or having diabetes and who comprise a majority of all diabetes cases in the U.S.  Additionally, we wanted to use more recent data not currently available in the literature to examine characteristics of an ED visit for a condition that is projected to rise and contribute to increasing burden of medical care systems.


Q: How did the rate of emergency department visits by patients aged 45 and over with diabetes change with age?

PR: The rate of emergency department visits by patients aged 45 and over increased with age. The rate increased from 69 per 1,000 persons for those aged 45-64 years and more than doubled to 164 per 1,000 persons for those aged 75 years and over.


Q: Were there differences in the percentage of visits that ended in inpatient hospital admission by diabetes status?

PR: Yes, the percentage of ED visits with diabetes that ended in inpatient hospital admission was significantly higher than the percentage of ED visits without diabetes among visits made by patients aged 45-64 and 65 and over.


Q: Are there any findings that surprised you from this report?

PR: One finding from the report that surprised me was that among ED visits made by 45-64 year olds, a higher proportion of diabetes visits were paid by Medicare compared with visits made by patients without diabetes (24% versus 14%).


Q: What is the take home message in this report?

PR: I think the take home message is that the percentage of ED visits by older patients with diabetes reported in the medical record has been increasing in recent years with the highest proportion observed in patients aged 65-74 (32% in 2015).


QuickStats: Percentage of Emergency Department Visits for Acute Viral Upper Respiratory Tract Infection That Had an Antimicrobial Ordered or Prescribed, by Metropolitan Statistical Area — United States, 2008–2015

January 29, 2018

From 2008–2011 to 2012–2015, the percentage of visits for acute viral upper respiratory tract infection that had an antimicrobial ordered or prescribed decreased from 37.1% to 25.5% among emergency departments (EDs) located in nonmetropolitan statistical areas, but this decline was not seen among EDs in metropolitan statistical areas.

In 2008–2011, the percentage was higher among nonmetropolitan EDs than metropolitan EDs, but there was no difference in 2012–2015.

Source: National Hospital Ambulatory Medical Care Survey, 2008–2015
https://www.cdc.gov/mmwr/volumes/67/wr/mm6703a7.htm