US Pharm. 2016;41(12):6.

Settings for healthcare visits for illness include the healthcare provider’s (HCP) office, the emergency department (ED), clinics, and home visits by HCPs. In 2012, 15.7% of persons in the United States had no healthcare visits in the past year, 47.3% had one to three visits, 24.0% had four to nine visits, and 13.1% had ≥10 visits. In 2011, there were 126 million visits to hospital outpatient departments and 136 million visits to hospital EDs. The rate of ambulatory care visits for digestive diseases increased by one-third from 1992 to 2005, from 26.4 per 100 population to 35.3 per 100.

Care Settings: According to the National Institute of Diabetes and Digestive and Kidney Diseases, 60 to 70 million people had digestive diseases in 2009, a primary diagnosis of which necessitated 48.3 million visits to the ambulatory care setting. A primary diagnosis of digestive disease was made during physician office visits (36.6 million), EDs (7.9 million), and outpatient departments (3.8 million). Digestive disease was the primary reason for 21.7 million hospitalizations, 5.4 million inpatient medical procedures, and 245,921 deaths. Surgical procedures (20.4 million) for digestive diseases were performed at both inpatient and ambulatory care settings. Of all inpatient procedures performed, 12% were for digestive diseases, and 20% of all write-in procedures were performed in ambulatory care settings.

Ambulatory Care Visits: Patients with symptoms of digestive diseases who visited ambulatory care settings were diagnosed and treated most often for gastroesophageal reflux (8.9 million), followed by chronic constipation (4 million), abdominal-wall hernia (3.6 million), diverticular disease (2.7 million), gastrointestinal (GI) infections (2.3 million), gallstones (2.2 million), irritable bowel syndrome (IBS; 1.6 million), hemorrhoids (1.1 million), Crohn’s disease (CD; 1.1 million), ulcerative colitis (UC; 0.72 million), and peptic ulcer (0.7 million).

Prescriptions: In 2004, >100 million prescriptions were written for digestive diseases. The most prescriptions were written for gastroesophageal reflux (64.6 million), followed by IBS (5.9 million), chronic constipation (5.3 million), peptic ulcer (5 million), abdominal-wall hernia (3.7 million), diverticular disease (2.8 million), hemorrhoids (2 million), gallstones (1.65 million), GI infections (0.9 million), and inflammatory bowel disease (3.9 million), which includes CD (1.8 million) and UC (2.1 million). Although the most prevalent digestive disease among inpatients and outpatients was GI infections, for every three visits to an HCP, one prescription was written. When inpatient and outpatient visits were combined, for every three visits nearly five prescriptions were written for peptic ulcer and GI reflux. For abdominal-wall hernia, diverticular disease, and chronic constipation, one prescription was written for every visit, and one prescription was written for every two visits for gallstones, liver disease, and pancreatitis.

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