Article Figures & Data
Figures
- Figure 1.
Operationalization of Andersen’s Behavioral Model of Health Services Use. Abbreviations: PCP, primary care provider; PA, physician assistant; NP, nurse practitioner.
- Figure 2.
Use of low-value prostate-specific antigen and digital rectal exam in primary care clinics during 2013 to 2018. Abbreviations: PSA, prostate-specific antigen; DRE, digital rectal exam; CI, confidence interval.
Tables
- Table 1.
Patient, Provider, and Visit Characteristics of National Ambulatory Medical Care Survey Sample (Unweighted n = 2,964, Weighted n = 121,633,833)
Frequency Weighted Frequency Percent of Visits (Weighted) Race/ethnicity Non-Hispanic White 2478 91,850,330 75.51 Non-Hispanic Black 164 7,532,330 6.19 Hispanic 206 13,372,045 10.99 Non-Hispanic other 116 8,879,128 7.30 Type of payment Private insurance 404 17,932,724 14.74 Medicare 2497 101,265,017 83.25 Medicaid/CHIP 52 2,088,510 1.72 Other 11 347,583 0.29 Type of visit New problem 893 34,348,869 28.24 Chronic problem, routine 1205 50,643,006 41.64 Chronic problem, flare-up 205 8,072,268 6.64 Preventive visit 661 28,569,691 23.49 Primary care provider—yes 2668 113,553,967 93.36 Established patient—yes 2820 116,606,883 95.87 “Does the patient now have: cancer?” Yes 378 13,879,478 11.41 Type of provider seen† Physician seen 2926 119,453,948 98.21 Physician assistant seen 114 3,178,117 2.61 Nurse practitioner/midwife seen 83 3,528,765 2.90 Type of doctor seen MD—doctor of medicine 2599 110,605,835 90.93 DO—doctor of osteopathy 365 11,027,998 9.12 Type of practice (solo/nonsolo) Nonsolo 1958 76,949,970 63.26 Rural—yes 593 19,335,184 15.90 Survey year 2013 1208 26,139,690 21.49 2014 1079 24,881,460 20.46 2015 329 26,557,922 21.83 2016 188 18,515,875 15.22 2018 160 25,538,886 21.00 Mean Standard Error of Mean Patient age—years 77.95 0.23 Total number of chronic conditions Total number of services ordered or provided during visit* Number of medications coded 2.87 0.06 Time spent with physician—minutes 6.29 0.14 5.78 0.28 21.46 0.46 Abbreviation: CHIP, Children’s Health Insurance Program.
↵* Total number of services reported as ordered or provided during the visit. Includes vital signs and write-in entries.
† Types of providers seen during visits are not mutually exclusive and do not add up to 100%; multiple provider types could have been included in the visit.
- Table 2.
Multivariable Logistic Regression Results Predicting Low-Value Prostate-Specific Antigen Blood Test and Digital Rectal Exam (Unweighted n = 2,964, Weighted n = 121,633,833)
Prostate-Specific Antigen (PSA) Digital Rectal Exam (DRE) Variable Odds Ratio 99.5% Confidence Limits Point Estimate 99.5% Confidence Limits Cancer—yes 1.53 0.52–4.52 – – Age 0.95 0.90, 1.00 – – Number of previous visits 0.96 0.88, 1.04 0.92* 0.85, 0.996* Number of services provided* 1.49* 1.33, 1.67* 1.37* 1.15, 1.63* Time spent with physician 1.01 0.98, 1.04 1.02 0.98, 1.06 Reason for visit—new problem Ref Ref Ref Ref Preventive visit 1.01 0.30, 3.34 3.34 0.85, 13.18 Chronic problem, routine 0.64 0.20, 2.12 0.63 0.15, 2.62 Chronic problem, flare-up 0.37 0.07, 2.00 3.53 0.45, 27.92 DRE—yes 0.64 0.07, 5.57 – – Solo—yes – – 3.03 0.63, 14.61 PSA—yes – – 0.72 0.10, 5.45 Nurse practitioner included in visit—yes – – 3.95 0.31, 50.78 *Statistically significant at P < .005 level.
International Classification of Diseases–Ninth Revision Code (2013-2015) International Classification of Diseases–Tenth Revision Code (2016, 2018) Description 185- C61 Malignant neoplasm of prostate 5990- N39.0 Urinary tract infection 600- N40 Prostate diagnoses N41 N42 6089- N50.9 Disorder of male genital organs, unspecified 1539- C18 Malignant neoplasm of colon 2572- E29 Testicular hypo-/hyperfunction 60784- N52 Erectile dysfunction 1899 C68.9 Malignant neoplasm of urinary organ, unspecified 1953 C76.3 Malignant neoplasm of pelvis 1991 C80.1 Malignant (primary) neoplasm, unspecified 2349 D09.9 Carcinoma in situ, unspecified 2398 D49.8 Neoplasm of unspecified behavior of other specified sites 7893 R19.00 Intra-abdominal and pelvic swelling, mass and lump V10- Z85.3 Personal history of malignant neoplasm of breast V101 Z85.0 Personal history of malignant neoplasm of tongue V104 Personal history of malignant neoplasm of stomach V102 Z85.8 Personal history of malignant neoplasms of organs and systems
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