National trends in venous disease

Abstract

Background: The national burden of venous disease and use of ultrasound (US) in the outpatient and emergency department (ED) settings has not been well described. The objective of this study is to describe venous disease in the outpatient and ED settings nationally as well as to characterize the use of US for diagnosis of venous disease, including phlebitis.

Methods: Data from the 1997 to 2006 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) were compiled, and complex sampling methods were used to describe the number of outpatient and ED visits for adults given a diagnosis of venous disease or phlebitis by ICD-9 coding. Logistic regression analysis with calculated odds ratios are used to examined patient visit characteristics and use of US.

Results: During the 10 years studied, an office or ED visit for venous disease occurred over 46 million times, for an average of 4.6 million visits per year, with this rate increasing from 4.03 million to 5.71 million per year (odds ratio [OR] 1.01, confidence interval [CI] 1.00-1.01). The majority of these patients were seen by specialists, such as surgeons or cardiologists, but a significant number were also seen by primary care providers (PCP). There were 2 million office visits (PCP and specialists) on average per year with no significant increase. There were approximately 236,000 ED visits for deep vein thrombosis (DVT) on average per year, which showed a small increase (OR 1.01, CI 1.00-1.01). Visits for DVT and phlebitis were as likely to be seen by PCPs as ED physicians. Non-DVT venous disease is much more likely to be seen by a surgeon (OR 4.88, CI 3.53-6.74) than a PCP. DVT is much less likely to be diagnosed by a specialist (OR 0.27, CI 0.18-0.29) than a PCP. Insurance status and geographic region were not associated with DVT or non-DVT venous disease diagnosis.

Conclusions: Nationally, a significant and growing number of patients with venous disease are being seen in the outpatient setting by PCPs and specialists. A significant number of patients with DVT are being seen in the outpatient setting, but without a trend away from care in the ED over the 10-year study period. Additionally, the majority of patients with DVT diagnosis do not seem to be getting ultrasounds at the same visit. Many of these patients are being seen by PCPs who may require additional training and infrastructure for appropriate patient care.