national urgent care chart survey - practice · pdf filenational urgent care chart survey ......

National Urgent Care Chart Survey

July 2008Pre-Publication Results – please do not cite, quote or distribute this research

Scope of the Survey

This survey was designed to identify:• Some demographics of patients presenting to urgent

care centers• What their presenting complaints were• What diagnoses were most common• What prescriptions were actually written• What OTCs were recommended• What procedures and tests were performed*

*The procedures and tests portion of this study was performed through a separate sample. See that slide for additional details.

Design & MethodologySurvey Design:

The survey methodology and data abstraction form were designed by researcher Robin M. Weinick, PhD. Dr Weinick is an Assistant Professor at Harvard Medical School and a Senior Scientist at the Institute for Health Policy, Massachusetts General Hospital.

Methodology: • 1,263 blinded patient charts• Drawn on an nth basis from a database of over 1.2 million patient

charts as accessed through a large, billing processing company• Original database spanned over 350 different urgent care clinics,

located in over 30 different states• Randomized charts drawn from the 6 month period July – December

2007. For each chart, specific data were abstracted and entered into the survey database by a Registered Nurse


Male45%

Female55%

July 2008 NUCCS

Patient Gender


August16%

December8%

September20%

November20%

July16%

October20%

July 2008 NUCCS

Visits By Month


14-2213%

23-3525%

60+12%

Infant to 1313%

36-5937%

July 2008 NUCCS

Patient Age Breakout

Chief Complaints by % of Visits

2.3%

2.5%

2.7%

6.1%

6.6%

7.4%

8.0%

9.4%

17.2%

18.6%

19.2%

0% 5% 10% 15% 20%

Pulmonary

OTO-ENT

Psych/Neuro

Musculoskeletal Pain -Traumatic

Other

Gastro

Dermatological

Musculoskeletal Pain - Non-traumatic

Wound Care

Urological

Ophthalmic

Patient complaints that the clinician noted in the chart

Top Diagnosis Categories by % of Visits

3.0%

3.2%

3.2%

3.6%

4.0%

4.4%

5.7%

5.7%

6.3%

6.6%

6.8%

8.4%

9.2%

12.1%

13.5%

0% 5% 10% 15%

Other

Infection, Wound

Sinusitis

Infection, Upper Respiratory

Bronchitis

Infection, Ear

Pharyngitis

Fracture

Wound

Muscle Sprain

Conjunctivitis

Cough

Abdominal Pain

UTI

Pain, Joint

Based upon diagnosis codes which were written in the chart

Top Diagnosis Categories by % of Visits (continued)

1.1%

1.2%

1.2%

1.3%

1.4%

1.5%

1.7%

2.0%

2.1%

2.4%

2.4%

2.5%

2.5%

2.9%

2.9%

0% 5%

Eye Injury

Open Wound

Dermatitis

Herpes

Allergic Rhinitis

Strep Throat

Insect Bite

Hypertension

Fatigue

Dizziness

Headache

Ear Problem

Anxiety

Asthma

Rash


Top Prescriptions Written (% of Visits)

1.7%

2.5%

2.5%

2.7%

2.9%

3.2%

4.5%

5.8%

7.4%

8.8%

9.7%

19.5%

19.9%

46.2%

0% 10% 20% 30% 40% 50%

Antibiotic

Allergy, Flu

Analgesic, Non-narcotic

Corticosteroids

Cough Rx

Neuro/Psych

Analgesic, Narcotic

Asthma

Opthalmic

Cardiovascular

Dermatological

Otic Rx

Gyn

Gastro

Based upon documentation noted in the chart

Top Prescriptions (Projected Total Volume, 2008)

1.7

2.5

2.5

2.7

2.9

3.2

4.5

5.8

7.4

8.8

9.7

19.5

19.9

46.2

0 10 20 30 40 50

Millions

Antibiotic

Allergy, Flu

Analgesic, Non-narcotic

Corticosteroids

Cough Rx

Neuro/Psych

Analgesic, Narcotic

Asthma

Opthalmic

Cardiovascular

Dermatological

Otic Rx

Gyn

Gastro

Projections based on 100 Million patient visits to 8,335 urgent care clinics annually

Top Prescriptions from Urgent Care, 1 - 20Rank Rx Drug % of Visits Scripts Projected

1 Zithromax Z-Pak 6.5% 6,492,4782 Amoxicillin 4.4% 4,354,7113 Bactrim DS 4.1% 4,117,1814 Prednisone Oral 4.0% 4,038,0055 Augmentin 3.9% 3,879,6526 Nasonex 2.9% 2,929,5337 Amoxil 2.9% 2,929,5338 Keflex 2.8% 2,771,1809 Levaquin 2.3% 2,296,12010 Medrol DosePak 2.2% 2,216,94411 Cipro 2.2% 2,216,94412 Biaxin 2.1% 2,137,76713 Omnicef 2.1% 2,137,76714 Rocephin 2.0% 1,979,41415 Zyrtec 1.8% 1,821,06116 Vicodin 1.8% 1,821,06117 Naprosyn 1.8% 1,821,06118 Flexeril 1.7% 1,662,70819 Ibuprofen 1.5% 1,504,35520 Tramadol 1.5% 1,504,355


Top Prescriptions from Urgent Care, 21 - 40Rank Rx Drug % of Visits Scripts Projected

21 Doxycycline 1.5% 1,504,35522 Albuterol Aerosol 1.5% 1,504,35523 Entex-PSE 1.5% 1,504,35524 Darvocet-N 100 1.4% 1,425,17825 Decadron Inj 1.3% 1,266,82526 Phenergan Tabs 1.2% 1,187,64827 Ultram 1.1% 1,108,47228 Pyridium 1.1% 1,108,47229 Motrin 1.0% 1,029,29530 Flonase 1.0% 950,11931 Avelox 1.0% 950,11932 Cephalexin 1.0% 950,11933 Toradol IM 0.9% 870,94234 Tylenol #3 0.9% 870,94235 Bactroban 0.9% 870,94236 Macrobid 0.9% 870,94237 Tessalon Perles 0.9% 870,94238 Methocarbamol 0.8% 791,76639 Entex LA 0.8% 791,76640 Hydrocodone 0.8% 791,766


OTC Recommendations (% of Visits)

0.6%

0.6%

0.6%

0.9%

1.0%

1.1%

1.4%

1.5%

1.8%

2.4%

3.6%

4.2%

4.4%

4.7%

7.5%

10.9%

19.4%

0% 5% 10% 15% 20%

NSAID

Acetaminophen

Splints, Braces & ACE

Fluids

Allergy/Antihistamines

Heat/Ice Packs

Wound Care Products

Cough

Derm Products

Nasal Spray

Gargle/Spray for throat

Cold/Flu

Ear Product

Antibiotic Ointment

Eye Care

Gastro

Other

Based upon OTC recommendations noted in the chart

OTC Recommendations (Projected Total Volume, 2008)

0.61

0.70

0.700.96

1.13

1.22

1.57

1.65

2.00

2.61

3.92

4.62

4.79

5.14

8.27

12.02

21.34

0 5 10 15 20 25

Million

NSAID

Acetaminophen

Splints, Braces & ACE

Fluids

Allergy/Antihistamines

Heat/Ice Packs

Wound Care Products

Cough

Derm Products

Nasal Spray

Gargle/Spray for throat

Cold/Flu

Ear Product

Antibiotic Ointment

Eye Care

Gastro

Other



Rank OTC Name PercentageProjected

Recommendations1 Ibuprofen 11.5% 11,480,6022 Tylenol 10.9% 10,926,3663 Fluids 4.7% 4,671,4174 Motrin 4.6% 4,592,2415 Heat/ice packs 4.2% 4,196,3586 Wound care 3.1% 3,087,8867 Advil 2.3% 2,296,1208 Splint 2.2% 2,216,9449 Benedryl 1.8% 1,821,06110 Sudafed 1.7% 1,662,70811 Ace muscle/body support 1.3% 1,346,00212 Mucinex 1.3% 1,346,00213 Nasal spray/drops/inhale 1.1% 1,108,47214 Sling 1.1% 1,108,47215 Robitussin 0.9% 870,94216 Neosporin 0.9% 870,94217 Aleve 0.8% 791,76618 Gargle 0.7% 712,58919 Claritin 0.6% 633,41320 Back support 0.6% 554,23621 Debrox 0.6% 554,236



Rank OTC Name PercentageProjected

Recommendations21 Debrox 0.6% 554,23622 Chloraseptic 0.6% 554,23623 OTC ear wax softeners 0.5% 475,05924 Knee immobilizer 0.5% 475,05925 Ortho shoe 0.5% 475,05926 Buddy tape 0.5% 475,05927 Brace 0.5% 475,05928 Crutches 0.4% 395,88329 Biofreeze 0.4% 395,88330 Eye/lens care solutions 0.3% 316,70631 Cortaid 0.3% 316,70632 Calamine 0.3% 316,70633 Saline 0.3% 316,70634 warm moist compresses 0.3% 316,70635 Naproxen 0.2% 237,53036 Sudafed PE 0.2% 237,53037 Mucinex D 0.2% 237,53038 Hydrocortisone 0.2% 237,53039 Afrin 0.2% 237,53040 loratadine 0.2% 237,530


Procedures Performed at Urgent Care Facilities

• Urgent care facility procedures were gathered in a separate survey, from the same billing processing company– 494,000 patient visits– Nationwide– 7/1/2007 to 6/30/2008

Top Urgent Care Procedures (% of Total Visits)

Category Category Percent Projected to UniverseInjection 22.9% 22,894,908Lab test 17.0% 17,002,274X-Ray 13.5% 13,535,212Blood Analysis 9.4% 9,416,829Urinalysis 8.3% 8,275,408Inhalation Treatment 6.3% 6,254,964Vaccination 5.6% 5,588,477Oximetry 4.3% 4,302,248Special Supplies 4.2% 4,189,851Injury treatments 3.0% 3,037,834Brace/Support 2.9% 2,856,254Wound Repair 1.5% 1,506,867IV Therapy 1.4% 1,445,371ECG 1.4% 1,414,623


Top Procedures by % of Visits

1.5%

2.9%

3.0%

4.2%

4.3%

5.6%

6.3%

8.3%

9.4%

13.5%

17.0%

22.9%

0% 5% 10% 15% 20% 25%

Injection

Lab test

X-Ray

Blood Analysis

Urinalysis

Inhalation Treatment

Vaccination

Oximetry

Special Supplies

Injury treatments

Brace/Support

Wound Repair


Top Procedures (Projected Total Volume, 2008)

1.5

2.9

3.0

4.24.3

5.6

6.3

8.3

9.413.5

17.022.9

0 5 10 15 20 25

Millions

Injection

Lab test

X-Ray

Blood Analysis

Urinalysis

Inhalation Treatment

Vaccination

Oximetry

Special Supplies

Injury treatments

Brace/Support

Wound Repair


Top Blood Tests (Projected Total Volume, 2008)

0.3

0.4

0.4

0.6

0.8

1.8

2.4

0 1 1 2 2 3

Millions

CBC

CMP

HETEROPHILE ANTIBODIES

LIPID PANEL

BMET

ASSAY THYROID STIMHORMONE

HEPATIC FUNCTION PANEL


Top Lab Tests (Projected Total Volume, 2008)

0.2

0.2

0.2

1.2

5.1

9.4

0 2 4 6 8 10

Millions

STREP A

INFLUENZA

CULT,BACT

SMR,PRI SRC

N.GONORRHOEAE

CHYLMD TRACH


Top Vaccinations (Projected Total Volume, 2008)

0.0

0.1

0.1

1.5

1.7

2.1

0 1 1 2 2 3

Millions

Immunization Admin

Flu

Tetanus

Hep A/B

Pneumococcal

MMR Vaccine


Disposition of Visits to Urgent Care Facilities

2%

14%

14%

19%

85%

100%

0% 20% 40% 60% 80% 100%

Released

Follow up Visit PRN

Follow up Visit Scheduled

Refer to Primary CarePhysician

Refer to Specialist

Refer to the ER

The Braveheart Group - Bio• Peter Murphy

– Former Publisher of JAMA and American Medical News –12 years

– Former VP/GM of Advanstar Medical Economics’ Primary Care Group – 2 years

• Stuart Williams– Former Director of Sales at American Medical Association –

10 years– Former Publisher of Medical Economics Magazine and

Patient Care Magazine – 2 years

41 Years of Combined Medical Publishing Experience

Contact Peter Murphy or Stuart Williams:Peter: 201-847-1934 or [email protected]: 201-529-4004 or [email protected]

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