To assess ambulatory care settings for visits associated with chronic obstructive pulmonary disease (COPD) or asthma.
This study used three 2001 US nationally-representative surveys to estimate the numbers of visits to physician offices, hospital clinics, and emergency rooms (ERs) with a listed diagnosis of COPD or asthma. Rates of tobacco use and smoking cessation counseling also were evaluated for the physician office setting.
For COPD, we projected 11.0 million physician office, 500,000 hospital clinic, and 900,000 ER visits, while for asthma we projected 17.5, 2.3, and 2.5 million visits for these settings, respectively. The estimated cost of ambulatory medical care for these conditions was $2.6 billion ($800 million for COPD and $1.8 billion for asthma). Fifty-four percent of these costs were for care provided in hospital clinics or ERs. The US public sector pays for approximately 69% of COPD visits and 33% of asthma visits. Approximately 30% of adult COPD patients visiting physician offices reported currently using tobacco and one-half of these patients received counseling for smoking cessation. The smoking rate among adult asthmatics was much lower (about 9%).
For asthma and especially COPD, the vast majority of outpatient visits are provided in physician offices. However, more than one-half of the cost of ambulatory care is incurred in hospital-based settings.
The use of hospital clinics and emergency rooms among patients with asthma or COPD accounts for a disproportionate share of the costs of outpatient medical services.
L. Boulanger, None.