Primary Care Visits in the USA and Australia 2000-2016

Abstract

Background: There are major concerns about the sustainability of the US primary care (PC) system.

Objective: We use similar data from the USA and Australia on adult visits to primary care physicians to examine how primary care service delivery and content in the countries have changed since the year 2001.

Design/setting/participants: Longitudinal analyses of nationally representative data collected in a similar manner on outpatient visits to PC in the USA (National Ambulatory Medical Care Survey, NAMCS) and Australia (Bettering the Evaluation and Care of Health, BEACH), 2001-2016.

Main measures: For each visit, we ascertained the problems/diagnoses managed; the length of the visit in minutes; what medications were recorded; whether counseling, advice, or education was provided; the rate of imaging and diagnostics tests; the laboratory tests ordered; and whether the visit resulted in a referral to another physician.

Key results: Between 2001 and 2016, there were 128,770 encounters with adult patients in NAMCS and 1,338,963 in BEACH. In the USA, the proportion of encounters with 3 or more problems managed increased from 28.7 to 54.8% whereas Australia started at a lower proportion (10.6%) and increased to just 14.1%. Visit times in the USA increased from 17.2 min in 2001 to 22.9 min in 2016 as compared to 14.4 min increasing to 15.2 in Australia. There were significantly more medications recorded over time in NAMCS than BEACH (2.02 in 2001 to 3.32 in 2016, USA, and 1.10 and 1.04, Australia), and US encounters resulted in imaging studies, lab tests, or referrals with relatively increasing frequency.

Conclusion: Relative to Australia, PC visits in the USA increasingly entail more complexity with visits that have grown comparatively longer over time, with more problems addressed, and with more content.

Keywords: ambulatory care; international comparisons; primary care.

Figure 1

Consultation length and complexity. a Proportion of encounters with patients aged 18+ where three or more problems were managed by study year (error bars = 95% CIs). b Average consultation length in minutes for encounters with patients aged 19+ by year (error bars = 95% CIs).

Figure 2

Distribution of most commonly managed problems at US and Australian PHP encounters: 2001–2004 and 2013–2016.

Figure 3

Prescription drug use.