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. .

Patterns of

Ambulatory Care in

Pediatrics:

The National

Ambdatory Medicai

Care Survey

United States, January

1980–December 1981

A profile of pediatric medical practice is

developed using data on visits to officebased physicians collected during the

National Ambulatory Medical Care Survey in

1980 and 1981. Descriptive statistics

highlight physician and practice

characteristics, patient characteristics, and

aspects of patient condition and

management. The first group includes

analyses of visit data according to the type

and location of the physician’s practice,

and sex and age of the physician. The

demographic characteristics of patients

visiting pediatricians are also explored.

Under patient condition and management

statistics are presented on patients’

reasons for visit, principal diagnoses

rendered by physicians, diagnostic services,

medication and nonmedication therapy,

and duration and disposition of the visit.

Data From the National Health Suwey

%ties 13, No. 75

DHHS Publication No. (PHS) 84–1 736

U.S. Department of Health and Human

Setvices

Public Health Setvice

National Center for Health Statistics

Hyattsville, Md.

October 1983

.
4

.

Copyright Information

All material appearing inthisreport isinthe public domain and may

be reproduced or copied without permission; citation as to source,

however, is appreciated.

Sugge!rted Citation

Nationa lCenterfo rHealthStatistics,B. K. Cypress Patterns of

ambulato~ care in pediatrics, the National Am bulato~ Medical Care

Survey, United States, January 1980-December 1981. Vital and Health

Statistics. Series 13, no. 75. DHHS Pub. no. (PHS) 84-1736.

Public Health Service. Washington. U.S. Government Printing Office,

Ott 1983

Libra~ of Congress Cataloging in Publication Data

Cypress, Beulah K.

Patterns of ambulatory care in pediatrics.

(Data from the national health survey. Series 13 ;

no. 75) (DHHS publication ; no. (PHS) 83-1 736)

Includes bibliographical references.

1. Ambulatory medical care for children—United

States-- Utilization—Statistics. 2. Physician setvices

utilization-United States—Statistics. 3. Children

—Diseases—United States—Statistics. 4. Health surveys—l)nited States. 5. United States—Statistics,

.

Medical. L National Center for Health Statistics

(U. S.) II The national ambulato~ medical care

auwey, January 1980-December 1981. Ill. Title.

.

IV. Series: Vital and health statistics. Series 13,

Data from the national health survey: no. 75.,

V. Series: DHHS publication ; no. (PHS) 83-1736.

RJ102.C95 19B3 362.1 ‘9892 83-17204

ISBN 0-8406-0285-0

.

,,
d

National Center for Health Statistics

Manning Feinleib, M.D., Dr. P. H., Director

Robert A. Israel, DepuV Director

Jacob J. Feldman, Ph.D., Associate DirectorforAnaZysis and

Epidemiology

Garrie J. Losee, Associate Director for Data Processing

and Services

Alvan O. Zarate, Ph.D., Assistant Director for International

Statistics

E. Earl Bryant, Associate Direct&-for Interview and

Examination Statistics

Robert L. Quave, Associate Director for Management

Gail F. Fisher, Ph.D., Acting Associate Directorfor Program

Planning, Evaluation, and Coordination

Monroe G. Sirken, Ph.D., Associate Director for Research

and Methodology

Peter L. Hurley, Associate Director for Vital and Health Care

Statistics

Alice Haywoocl, Information O@cer

Vital and Health Care Statistics Program

Peter L. Hurley, Associate Director

Gloria Kapantais, Assistant to the Director for Data Policy,

Planning and Analysis

Division of Health Care Statistics

W. Edward Bacon, Ph.D., Director

Joan F. Van Nostrand, Deputy Director

James E. Delozier, ChieJ Ambulatory Care Statistics Branch

.

.
a

Contents

.

.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Purpose and background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Scope of the survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Source andlimitations of thedata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Visits by specialty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Physician and practice characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . .

Type of practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Location of practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Physician age and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3

3

5

5

Patient characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Se~. race. mdetiici~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wsitrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8

8

8

Patient condition and management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex and age of the patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prior visit status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reason forvisit enddiagnostic services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Principal diagnosis and therapy, duration, disposition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11

11

14

14

14

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . 16

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

List of detailed tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Appendixes

I. Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

II. Definitions of terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111. Survey instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. American Hospital Formulary Service Classification System and therapeutic category codes. . . . . . . . . . . . . . . . . . . . . . .

40

47

50

60

List of figures

1. Percent distribution of office visits, by specialty United States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . .

2. Percent of office visits to pediatricians, by type of practice and age of physiciam United States, January 1980-Decem2

ber1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Average annual rate of office visits to pediatricians, by age of patienb United States, January 1980-December 1981 . . . .

4. Average annual rate of oi%ce visits to pediatricians, by race and age of patient United States, January 1980-Decem7

9

.

ber 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. Percent of office visits to pediatricians, by selected major reasons for visit and patient age: United States, January 1980-

December.1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10

.

12

List of text tables

A. Percent distribution of otllce visits by physician specialty, according to selected age groups of patients: United States,

1975 and 1980-81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

.

Ill
B.

c.

D.

E.

F.

G.

H.

J.

Annual rate of office visits for 1975 and average annual rate for 1980–81, by age of patient and physician specialty:

United States, 1975 and 1980-81 ‘. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of oflice visits to pediatricians by location of physician’s practice and percent distribution by type of practice,

according to location of physician’s practice: United States, January 1980–December 1981 . . . . . . . . . . . . . . . . . . . . . . . .

Number of oflice visits to pediatricians, number and percent of drug visits, number of drugs mentioned, drug mention rate

per visit, and drug intensity rate per drug visit, by type and location of physician’s practice: United States, .January

1980–December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Average number of office visits per week and mean duration of visits to pediatricians, by age and sex of physician: United

States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of office visits to pediatricians, number and percent of drug visits, number of drugs mentioned, drug mention rate

per visit, and drug intensity rate per drug visi~ by age and sex of physician: United States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Annual visit rate by age of patient, and percent of office visits to pediatricians, by selected characteristics: United States,

1975 and 1980-81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of oftlce visits to pediatricians, number and percent of drug visits, number of drugs mentioned, drug mention

rate per visit, and drug intensity rate per drug visit, by selected characteristics: United States, January 1980–I)ecember 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mean duration of otlice visits to pediatricians, by selected principal diagnosis categories and prior visit status: United

States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

3

.

4

‘5

6

13

14

15

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

*

Figure does not meet standards of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements

iv
.

Patterns of Ambulatory Care

in Pediatrics

The hlaticma~Amhdatory

Medical Care Survey

by BEulah K. Cypress, Ph. D., Division of Health Care Statistics

introduction

Purpose and background

This report is a presentation of national estimates of the use

of ambulatory medical care services provided by nonfederally

employed otlice-baaed pediatricians in the conterminous United

States during the calendar years 1980–81. It is the second in a

series of reports based on the visit characteristics of various

medical and surgical specialties. The data were gathered by the

National Center for Health Statistics by means of the National

Ambulatory Medical Care Survey, a sample survey of physicians’ office visita conducted annually through 1981 by the Division of Health Care Statistics. Data collection and processing

for the 1980 and 1981 National Ambulatory Medical Care Surveys were the responslblliiy of the National Opinion Researach

Center at the Universi& of Chicago. Sample selection was accomplished with the assistance of the American Medical Association

and the American OsteopatMc Association.

A brief repoti based on 1975 estimates of visits to pediatricians was published in Advance Data&m Vital and Health

Stati!rtics No. 13.1 However, because of the revision of the reason

for visit coding system in use in 1977 and of the IntemationaI

Clas@cation ofDiseases in use in 1979, data from that report

may not be strictly comparable to those in this report. Summary

statistics for 1979, including selected characteristics of visits to

pediatricians among other specialists, were presented in Vital

and Iiealth Statistics, Series 13, No. 66.2

Detailed information on the background and methodolow

of the swey was published in Vital and Health Statirti”cs, Series

2, No. 61.3A description of the 1980 and 1981 surveys, including statistical design, data collection and prosessin~ and estimation procedures, may be found in appendix I of this report. Technical details regarding reliability of estimates are also given in

appendix I. Deftitions of terms used in the survey axe provided

in appendix II. Facsimiles of swey instruments appear in appendix III. Prior to data presentation, the scope of the survey and

limitations of the data are described briefly to assist the reader

in interpreting the estimates.

Scope of the survey

The basic sampling unit for tie National Ambulatory Medical Care Survey (NAMC S) is the physician-patient encounter

or visit. The current scope of NAMCS includes all office visits

within the conterminous United States made by ambulatory

patients to nonfederally employed, oflice-based physicians as

classified by the American Medical Association or the American Osteopathic Association. The NAMCS physician universe

excludes anesthesiologists, pathologists, and radiologists, and

physicians principally engaged in teaching, research, or administration. Telephone con~cts and visita conducted outside the

physician’s office also are excluded.

Source and limitationsof the data

The data in this report are based on information obtained

ffom a patient encounter form, the Patient Record (see appendix III), for a sample of visits provided by a national probability

sample of ofice-based physicians. The combined samples for

th~ 1980 and 1981 NAMCS included 5,805 physicians, 1,124

of whom were ineligible because they were out of scope at the

time of the survey. Of 4,681 eligible physicians, 3,676 (78.5

percent) participated (see appendix I). There were 414 pediatricians in the sample of whom 83 were out of scope. Of331 eligible pediatricians, 289 participated (87.3 percent).

Sample physicians listed all office visits during a randomly

assigned 7day reporting period. During the 2-year period, information was recorded on Patient Records for a systematic random sample of 89,447 visits including 9,030 visits to pediatricians.

The 1980 and 1981 NAMCS were. conducted in identical

fashion using the same instruments, definitions, and procedures.

The 2 years of data were combined to provide more reliable

estimates. Therefore, the reader should note that estimates of

number of visits and drug mentions contained in this report are

for a 2-year period, but ratios and rates represent average annual

estimates.

The information in this report is derived from a complex

srunple survey, and the appendixes should be reviewed to insure

a proper understanding and interpretation of the statistical estimates presented. Since the statistics are based on a sample of

office visita rather than on all visits, they are subject to sampling

errors. Therefore, particular attention should be paid to the section “Reliability of estimates.” Charts on relative standard errors

and instructions for their use are also given.

Visitsby speciatty

The percent distribution of 1980–81 oflice visits, according

to medical and surgical specialty, is illustrated in figure 1.

1
Other All

medical other

specialties specialties

Obstetrics 7.5

I J’

5.4

and

Figure 1. Percent,distributionof office visits by specialty:

United States,January 1980-Dec,ember 1981

Pediatrics accounted for 11 percent of the visits, the third highest

proportion among individual specialties. Visits to pediatricians

increased from 8 percent of the visits to all physicians in 1975

to 11 percent in 1980–8 1.2

Changes in the utilization of pediatricians and other specialists by children under 15 years of age during these two time

periods is evident in table A. Within each age group the proportion treated by pediatricians increased. Some of the decrease in

visits to general and family practice physicians maybe attributed

to a corresponding decrease in the proportion of these doctors in

office-based practice. They constituted 28 percent of the NAMCS

universe in 1975, compared with 24 percent in 1980–81.

However, the proportion of pediatricians in the NAMCS universe increased only from 6 percent to 7 percent. Thus, it is not

likely that the 38 percent visit increase, from 46,684,000 in

1975 to an average of 64,381,000 in 1980-81, was due solely

to an increase in the number of physicians in pediatric practice.

An examination of visit rates by children under 15 years of age

reveals statistically significant differences between 1975 and

1980-81 (table B). The data suggest that a shift in visits frbm

other specialties to pediatrics may have been partially responsible for the increased shine of pediatricians’ visits. This reasoning is based on the fact that visit rates for the three age grotips

were higher in 1980–81 than in 1975, and that pediatrics showed

an increase while the rates of all other specialties decreased.

The following sections of this report describe ambulatory

care provided by pediatricians in terms of physician and practice

characteristics, patient characteristics, and patient condition and

management. The profile is developed within the structure of

the variables used in the NAMCS Patient Record form and

data collected in the physician’s induction interview (see appendix III). It should be kept in mind when reading this report that

data are restricted to visits to pediatricians. Analysis of data on

children’s visits to other specialists may result in different statistics. The utilization of all physicians in 1975 by children and

young adults is described in Vital and Health Statistics, Series

13, No. 39.4

Table B. Annual rate of office viaits for 1975 and average annual

rate for 1980-81 by age ‘of patient and physician specialty:

United States, 1980-81

Age of patient

Physician specialty Under

2 years

2-5 years 6-14 years

All specialties Rate per 100 population

1975, . . . . . . . . . . . . . . . . . . . . . 432 206 140

1980-81 . . . . . . . . . . . . . . . . . . 510 220 144

Pediatrics

1975, . . . . . . . . . . . . . . . . . . . . . 244 106 45

1980-81, . . . . . . . . . . . . . . . . . 351 133 57

All other specialties

1976 . . . . . . . . . . . . . . . . . . . . . . 188 101 95

1980-81 . . . . . . . . . . . . . . . . . . 159 87 86

Table A. Percent distribution of office visits by physician specialty, according to selected age groups of patients: United Statea, 1975 and 1980-81

Under 2 years 2-5 years 6-14 years

Physician specialty

1975 1980-8 ? 1975 7980-8 ? 7975 1980-81

Percent distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0 100.0

General and family practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.7 20.9 31.9 23.0 36.7 28.2

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56.5 68.9 51.1 60.5 32.4 40.0

Obstetrics and gynecology ..,.., . . . . . . . . . . . . . . . . . *1.9 80.5 “0.6 ‘0.2 80.9 0.5.

General surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *1.4 1.5 ●1.7 1.B 3.8 2.7

Internal medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “0.8 0.7 *1,4 1.0 3,1 2.2

Orthopedic surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4 1.5 2.3 1.7 4,0 5.2

Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “1.0 0.8 1.9 2.0 5.6 5.0*

Otolayngology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *1.3 1.4 4.6 4.1 5.1 3.7

Dermatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ‘0.5 “0.6 “0.5 1.5 2.2 4.6

Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ‘0.0 “0.3 “0.3 *0.3 1.4 1.5

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *1.5 2.9 3.7 3.9 4.8 6.4

2
~ Physician and practice

characteristics

Type of practice

The organization of medical practice has changed significantly in the United States. In 1975 the Center for Health Services Research of the American Medical Association reported

an 8 percent average annual growth rate in group medical practice over a 40-year periods A decline in the proportion of visits

to physicians in solo practice since 1975 reflects a continued

trend toward multiple practice. In 1980–81 physicians in solo

practice accounted for 38 percent of all visits to pediatricians

(table C), a decrease from the 42 percent reported in NAMCS

in 1975.] However, there were regional dtierences in the d&ribution of visits by type of practice. Visits to multiple-member

practices were more likely in the South and West Regions where

71 percent and 69 percent of the visits, respectively, were made

to such offices. But in the Northeast and North Central Regions

less than average proportions of visits (62 percent for all pediatricians) were to group practices (52 percent and 57 percent,

respectively). Some of the increase in nonsolo practice visits in

the NAMCS data Ilom 1975 to 1980–81 may be due to the

higher proportion of all visits in the South Region (38 percent,

compared with 28 percent in 1975) because this region was also

higher than average in its proportion of multiple practice visits.

Vksits to physicians in metropolitan and nonmetropolitan

areas were similarly distributed by type of practice. However,

there was a higher proportion of visits to pediatricians in nonmetropolitan areas (15 percent) in 1980–81 than in 1975 (11

percent).

Selected characteristics of all visits and of visits distributed

by type of practice are shown in table 1. On the average 92

percent of the visits to pediatricians included patients under 15

years of age. New patients accounted for the smallest proportion of visits (9 percent). However, there were no statistically

significant dtierences in the proportions by age or prior visit

status, according to the type of practice. Acute problems were

the major reasons in 54 percent of all visits. However, compared

with patients visiting solo practitioners, patients seen by physicians having other practice arrangements were more likely to

present acute problems. In addition, their reasons for visiting

physicians were more likely to be expressed as symptoms. Visits

to SOIC}practitioners were more likely to be motivated by routine

chronic problems than those to other pediatricians were.

.

aThe American Medical Association defines group practice as the provision of

medical services by three or more physicians. In this report the terms “group”

and “multiple” practice are used to describe provision of medical services by

more tharr one physician.

Table C. Number of office visits to pediatricians by location of

physician’s prsctice, and percent distribution by type of practice,

according to location of physician’s practice United Statea,

January 1980-December 1981

Number of Type of practica

Location of practice visits in

thousands Total solo Otherl

All visita . . . . . . . . . . . . . . . . . 128,762

Geographic region

Northeast . . . . . . . . . . . . . . . . 35,724

North Central . . . . . . . . . . . . . 26,897

South . . . . . . . . . . . . . . . . . . . 48,844

West . . . . . . . . . . . . . . . . . . . 17,297

Area

Metropolitan . . . . . . . . . . . . . 110,071

Nonmetropolitan. . . . . . . . . . 18,691

Percent distribution

100.0 37.6 62.4

100.0 48.3 51.7

100.0 42.8 57.2

100.0 29.1 70.9

100.0 31.2 68.8

100.0 38.0 62.0

100.0 35.5 64.5

llnchsdes partnership, group, and other types of practice.

In NAMCS patients’ reasons for visit, expressed as closely

as possible in the patients’ own words, are recorded by the physician in item 6 of the Patient Record form. The reason given by

the patient (or the accompanying adult in the case of a child),

which in the physician’s judgment is most responsible for the

visit, is the fret-listed or principal reason for the visit. Reasons

for visit are coded and grouped in eight modules according to a

classification system that is detailed inA Reason for Visit Classification forAnzbulatory Care (RVC)! These modules are listed

in table 1. (Specific reasons for visit are discussed in the section

“Patient condition and management.”) The symptom module

and the diagnostic, screening, and preventive module accounted

for 83 percent of all visits. Patients visiting multiple practices

were more likely to present reasons in the symptom module

than those visiting solo practices were, but other differences

were not statistically significant. The higher proportion of symptomatic reasons may be a reflection of the higher proportion of

acute problems associated with group practice visits.

The diagnostic services ordered or provided by pediatricians

most often were the limited history and/or examination (58 percent), general history and/or examination (29 percent), and the

clinical laboratory test (26 percent). Of these three types of

services, physicians differed only in their use of the limited history

and/or examination, which was more likely to be used by physicians in multiple practice than by those in solo practice. Compared with visits to other physicians, blood pressure checks were

proportionately infrequent in pediatricians’ oftlces. Only 9 per3
cent of the visits included this measurement. However, solo

practitioners were more likely to use it for diagnosis than other

pediatricians were (10 percent of the former’s visits, compared

with 8 percent of the latter’s, a small but statistically significant

difference). However, when all types of diagnostic services are

considered, proportionately more visits to pediatricians in multiple practice than to those in solo practice included some type of

diagnostic service because the proportion of their visits that had

no services was smaller.

Nonmedication therapy was not provided in 60 percent of

the pediatricians’ visits. In contrast to diagnostic services, solo

practitioners were more likely to offer some type of nonmedication therapy than their counterparts in group practice were. This

was usually in the form of diet or medical counseling.

Medication was the most common form of therapy in pediatric practice. One or more drugs were prescribed in 72 percent

of all visits (table D). Estimates of drug utilization in NAMCS

are based on the physicians’ entries on the Patient Record form.

These entries may be brandb or generic names of prescription or

over-the-counter drugs, or a therapeutic effect. Drug mentions

include all new or continued drugs listed in item 11. Physicians

may make up to eight such entries. The methodology used to

collect and process this drug information is described in Vital

and Health Statistics, Series & No. 90.7

A single drug was more commonly mentioned during visits

(41 percent) than multiple drugs were (table 1). This conservative use of medication is reflected in the rates of drug use shown

in table D.

In addition to counting the number of drugs prescribed during a visit and the percent of visits in which one or more drugs

were ordered (drug visits), drug utilization may be measured by

b~e “se of brad or trade names is for identification purposes only md doss

not impIy endorsement by the Public HeeM Service or the U.S. Department of

Heaklr and Human Services.

two utilization rates. The drug mention rate is the number of

drug mentions divided by all visi~, the drug intensity rate is the

number of drug mentions divided by the number of drug visits.

Differences in the proportions of drug visits or rates by type of

practice were not statistically significant.

Drug mentions are listed by the therapeutic effects they&e

intended to produce in table 2. Therapeutic categories are based

on the American Hospital Formulary Service classification system (AHFS) (see appendix IV).8 In the NAMCS drug file e;ch

drug entry was assigned to one AHFS category although for

some drugs more than one therapeutic effect is possible. Only

three categories accounted for, about 63 percent of all drugs

used by pediatricians. Anti-infectives was the largest group (30

percent) followed by serums, toxoids and vaccines ( 17 percent),

and antihistamines (15 percent). Anti-infectives consisted chiefly

of antibiotics and sulfonamides. Serums, toxoids and vaccines

consisted chiefly of substances used for childhood immunizations. Central nervous system drugs were mentioned during 5

percent of the visits. These were usually analgesics and antipyretics. (Specific drugs are discussed in the section “Patient condition and’management.”) With regard to therapeutic categories,

the physician’s type of practice had no observable effect on the

utilization of drugs. The drugs mentioned proportionately most

oflen during visits were clearly related to the most frequent problems presented by pediatric patients. The principal (first-listed)

diagnoses rendered by physicians during visits are listed by categories based on the International ClasszYcation of Diseases,

9th Revisio~ Clinical Modification (ICD-9-CM)9 in table 1.

The leading catego~ was the supplementary classification (3 1

percent) which includes a large number of routine infant or child

health checks (also called well-baby examination) and general

medical examinations. (These specific diagnoses as well as others

are discussed in the section “Patient condition and management.”) The next two major categories were dkeases of the

respiratory system (28 percent) and diseases of the nervous

Table D. Number of office visits to pediatricians, number and percent of drug visits, number of drug mentions, drug mention rata per visit,

and drug intensity rate per drug visit, by type and location of physician’s practica: United Statea, January 1980-December 1981

Number Drug Percent Number Drug Drug

Type and location of visits visits of of drug mention intensity

of practice in in drug mentions rate rate per

thousands thousandsl visits in thousands per visitz drug visitz

Type of practice

Alltypes of practice . . . . . . . . . . . . . . . . . . . . . . . 128,762 92,500 71.8 146,515 1.14 1.58

solo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48,408 35,541 73.4 55,276 1.14 1.56

Othefl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80,354 56,959 70.9 91,239 1.14 1.60

Geographic region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35,724 26,312 73,7 39,004 1.09 1.48

North Central . . . . . . . . . . . . . . . . . . . . . . . . . . 26,897 19,081 70.9 30,124 1.12 1.58

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48,844 36,984 75.7 62,288 1,28 1.68

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,297 10,123 58.5 15,099 0.87 1.49.

Area

Metropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110,071 79,527 72.3 125,733 1.14 1.58

Nonmetropolitan . . . . . . . . . . . . . . . . . . . . . . . . 18,691 12,973 69.4 20,782 1.11 1.60”

1A visit in which one or more drugs were prescribed.

‘Drug mentions divided by number of visits.

3Drug mentions divided by number of drug visits.

‘Includes partnership, group, and other types of practice.

4
system and sense organs (15 percen~ chiefly otit.is media). There

were no statistically signiilc&t differences-in the propokons of

diagnosis categories by type of practice.

The majority of visits in which pediatricians had a face-t~

face encounter with the patient were relatively short (less than

t

11 minutes, table 1). Vkits in which patients were seen only by

a staff member accounted for only 4 percent of all visits regardless of the type of practice. The average duration of a visit was

. 12.8 minutes, which is less than the NAMCS average for all

specialties.

In about half of all the visits, appointments were scheduled

for return consultation. Instructions to return at a specitled time

wexe more likely to be given when patients visited solo physicians

than when other types of practice were involved. In visits to

physicians in multiple practice the instruction to return if needed

was the more common culmination of the visit. This disposition

is generally used in visits for acute, self-limited conditions that

were shown ‘previously to be associated with pediatricians in

mukiple practice.

Locationof practice

Pediatricians in the South and West Regions saw proportionately more new patients and treated proportionately more

patients with acute problems tlum physicians in the Northeast

and North Central regions did (table 1). It was shown previously

that care of acute problems is a major component of health care

delivery in multiple pediatric practice. Also, as shown in table C,

the South and West Regions had significantly higher proportions

of visits to physicians in multiple practice than other regions did.

On the average, nonillness care was the major reason for

visit in about 1 of 3 visits, but physicians in the Northeast and

North Central Regions were more likely to encounter such reasons than those in the South and West Regions were. In the

NAMCS data there is usually a positive correlation between

the diagnostic general history and/or examination and nonillness

cam. This is apparent in the data for the Northeast Region,

which had a relatively high proportion of visits for nonillness

care and also the highest proportion of visits including a general

history and/or examination (37 percent) among the four geographic regions. Similarly, blood pressure measurement, which

is more likely to be included when an extensive workup is done

than in other children’s visits, was proportionately higher in the

Northeast and North Central Regions than in the other two

regions.

Pediatricians in the South exceeded those in all other regions

in the proportion of visits with no nonmedication therapy, while

those in the Northeast and West were predominant in their provision of family or social, and medical counseling. Physicians in

the West Region had the highest proportion of visits with no

medication therapy (42 percent) or, expressed in terms of drug

visits, the lowest proportion of drug visits (59 percent, table D).

A similar result was observed for general and family practice

physicians in the West Region.lo

The practice profiles of pediatricians in metropolitan snd

nonmetropolitan areas varied in only a few aspects. Physicians

in metropolitan areas were more likely than those in nonmetr~

pcditan areas were to perform general examinations and to measure blood pressure. They also treated a higher proportion of

patients visiting for diseases of the respirato~ system. There

were proportionately more visits in nonrnetropolitan areas in

which there was no face-teface encounter between patient rind

physician (9 percent, compared with 3 percent in metropolitan

areas). Other differences were not statistically significant.

Physician age and sex

Therelationship of the physician’s age and sex to the content and organization of pediatric practice is explored in this

section. Similar to the findings in general and family practice,10

pediatricians 45–54 years of age had the highest average number

of weekly visits while physicians aver 55 years of age had the

lowest (table E). In both specialties male physicians exceeded

female physicians in the average number of visits per week. But

unlike general and family practitioner, weekly visits to pediatricians under 45 years of age and those older were not as disparate.

The mea duration of visits did not vary significantly for different

age groups, but female pediatricians (like female general and

family practice physicians) spent more time, on the average,

with patients than male physicians did.

Characteristics of visits to pediatricians are shown for physician age and sex groups in table 3, and drug mentions are listed

by therapeutic categories in table 4. The reader will note that in

previous tables the rounded total of visits was about 128.8 million

and the number of drug mentions was 146.6 million. However,

iu tables 3 and 4 the comparable rounded totals are 126.7 million

aud 144.0 millioz respectively. This is because tables relating to

the age and sex of the physician do not include visits to doctors

of osteopathy because data on the age of these physicians were

unavailable. It is not likely that the distribution of visits, with the

omission of the 2.1 million visits made in 1980–81 to doctors of

osteopathy in pediatic practice would dfier significantly from

the distribution that includes them.

It was concluded in an earlier study10 that much of the

variation in the practice patterns of diiTerent age groups of general

Table E. Average number of office visits per week and

mean duration of visits to pediatricians, by age and sex

of physician: United States, January 1980-December 1981

Average Mean

number of duration

Age and sex of physicianl visits per of visit

physician in

per week minutes

Age

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . 106.9 12.8

Under 35 years . . . . . . . . . . . . . . . . . . . 111.2 12.9

35-44 yeara . . . . . . . . . . . . . . . . . . . . . 105.2 13.0

45-54 yeara . . . . . . . . . . . . . . . . . . . . . 119.4 12.3

55-64 years . . . . . . . . . . . . . . . . . . . . . 97.1 13.2

65 years and over . . . . . . . . . . . . . . . . . 78.7 13.3

Sex

Female . . . . . . . . . . . . . . . . . . . . . . . . . . 95.8 14.6

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108.9 12.5

lDoes not include doctors of osteopathy.

5
and family physicians could be attributed to the age of the patients likely to visit them. Because the age range of pediatricians’

patients is relatively narrow, compwed with the ages of patients

in other practices, less variation by physician age can be expected.

However, there were some differences among age groups of

pediatricians in proportions of visits by patient age, visit status,

and major reason for visit. As a result, patient condition and

treatment varied in tandem. In about 50 percent of the visits to

pediatricians under 35 years of age the patients were infants

under 2 years of age, compared with 39 percent in the next

older group of physicians. The proportion of new patients (12

percent) visiting the youngest group of physicians also exceeded

those of the next two older groups (9 percent and 7 percent,

respectively). The youngest and the newest patients tend to dominate the caseloads of young physicians in most specialties.

The relative distribution of visita by major reason for visit

did not differ significantly among physician age groups, but the

oldest group (65 years of age and over) had proportionately less

than average visits due to acute problems and proportionately

more for nonillness care.

The type of health care sought by the patients of older physicians is reflected by higher than average proportions of visits

classilled in the diagnostic, screening, and preventive module of

the RVC (37 percent) and in the supplementary classification of

the ICD-9-CM (42 percent). Older physicians also included

blood pressure checks in their workups proportionately more

often than their younger counterparts did. This may also be a

reflection of the age of their patients because the number of

infants seen by younger physicians may contraindicate their use

of this diagnostic tool. One or more forms of counseling (diet,

family or social, medical) was included in at least 46 percent of

the visits to physicians 65 years and over, a signMcantly higher

proportion than any other group. Lest it be argued that direct

patient counseling is a more likely event when older children are

patients (as is the case for older physicians), it should be noted

that physicians 45–64 years of age had approximately the same

proportions of patients tlom 6 to 14 years of age as physicians

65 years and over did, but proportionately less coutiseling was

given.

A single medication was more likely to be prescribed by

physicians over 54 years of age than by younger physicians. AS

a result the drug mention and drug intensity rates of the older

groups were lower than others (table F). Only 3 classes of c!rugs

(serums, toxoids and vaccines; anti-infective agents; and antihistamine drugs) accounted for more than 60 percent of the

drug mentions regardless of the physician’s age group (tabl& 4).

This is consistent with the narrow range of diagnoses made during visits (table 3).

Physicians under 35 years of age were less likely than other

physicians were to offer nonmedication therapy because in 72

percent of their visits no nonmedication service was indicated.

They were also less likely to treat patients with diseases of the

respiratory system (18 percent, compared with 27 percent for

the next older group); but more likely to see patients with diseases

of the nervous system and sense organs (28 percent, compared

with 15 percent).

Physicians under 45 years of age tended to instruct patients to return at a specified time proportionately more often

than other physicians did, but because their proportion of visits

by returning patients with old problems was not correspondingly higher it is not possible to determine whether the physicim’s instruction was instrumental in return visits.

A significant difference by type of practice among physician age groups is illustrated in figure 2. Proportions of visits to

‘pediatricians in solo practice increase with the increasing age

group of the physician, but the opposite is true for other types

of practice. The trend towards multiple practice by more recent

graduates of medical school was also observed in data on general

and family practice.10 It can also be seen in table 3 that 78

percent of the visits to physicians over 65 years of age were to

physicians practicing alone, compared with only 33 percent to

those under 35 years of age.

The female-to-male ratio was higher for pediatricians than

for other physicians in the NAMCS universe. Women constiTable F. Number of office visits to pediatricians, number and percent of drug visits, number of drug mentions, drug mention rata per visit,

and drug intensity rate per drug visit, by age and sex of physician: United States, January 1980-December 1981

Age and sex ofphysiciarrl

Number Drug Percent Number Drug Drug

of visits visits of of drug mention intensity

in in drua mentions rate rate r3er

thousands thousandsl visits in thousands per visit3 drug visi@

Age

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . 126,663 90,729 71.6 144,011 1.14 1.59

Under 35 years . . . . . . . . . . . . . . . . . . . . . . 15,701 10,604 67.5 16,899 1.08 1,59

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . 38,868 27,632 71.1 44,563 1.15 1,61

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . 43,827 32,583 74.3 54,579 1,25 1.68

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . 21,420 14,658 68.4 20,594 0.96 1.40

65 years and over . . . . . . . . . . . . . . . . . . . . . . 6,847 5,253 76.7 7,376 1.08 1.4.0

Sex

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,336 13,344 77.0 23,110 1.33 1.73

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109,328 77,386 70.8 120,901 1.11 1,5%

I Does not includa doctors of osteopathy.

‘Visits in which one or more drugs were prescribed.

3Drug mentions divided by number of v!sits.

4Drug mentions divided by number of drug vls!ts.

6
80 —

70

60

50

40

30

o~

Under 35-44 45-54 55-64 65

35 and

over

Age of physician in years

N13TE Does not include doctors of osteopathy.

Figure!2. Percent of office visits to pediatricians, by type of

practice and age of physician Unitad States, Janus~ 1980-

Decamber 1981

tuted 19 percent of the pediatricians in 1980–81, a larger proportion than the other specialties investigated. (The next largest

was psychiatry, 10 percent, followed by dermatology, 8 percent). Of all female physicians in NAMCS, pediatricians were

the largest group, 30 percent. This is not surprising because

pediatrics has traditionally been a popular choice of female

residents in medicine.l 1

Although the average number of weekly visits to female

pediatricians in 1980–81 was lower than that to males in the

same specialty, it increased from 82.1 in 1977 to 95.8 in 1980–

81 while that of male pediatricians remained about the same

(108.0 and 108.9).

TJnlike visits to other specialMs,10,:2 there was no difference

between the proportions of visits to female and male pediatricians

based on the sex of the patient (table 3). The tendency of female

patients to visit female physicians apparently does not include

children. However, female pediatricians saw proportionately more

children under 6 years of age than their male counterparts did

(72 percent, compared with 63 percent), and had proportion-

*

ately more new patients (13 percenq compared with 8 percent).

The female pediatricians in the NAMCS universe were younger

than their male counterparts, and younger physicians tend to

treat proportionately more” young patients and new patients.

The pattern of illness presented by patients visiting physicians of both sexes did not vary to any great degree. Major

reasons for visit, principal reason for visit modules, and principal

diagnosis categories were proportionately similar. One exception

was in the higher proportion of visits for diseases of the nervous

system and sense organs to female pediatricians (21 percent,

compared with 14 percent to male pediatricians).

However, there were some differences in the pattern of

treatment based on the sex of the physician. Females chose to

utilize the general history and/or examination in 43 percent of

their visi~ males used this technique in 27 percent. The limited

history and/or examination was utiliied by males in 60 percent

of their visits, compared with 48 percent by females in pediatric

practice. Females had higher proportions of visits that included

blood pressure checks (12 percent, compared with 8 percent of

male pediatricians’ visits), diet counseling (17 percen~ compared

with 11 percent of male pediatricians’ visitk), and family or

social counseling (8 percent, compared with 4 percent of male

pediatricians’ visits). Medication was a type of therapy more

commonly used by female than by male pediatricians. About

77 percent of females’ visits included one or more drugs, compared with 71 percent of males’ (table F). Two or more drugs

were prescribed in 42 percent of visits to females but in only 29

percent of those to males (table 3). Male pediatricians ordered

no drugs or only one drug in 71 percent of their visits while the

comparable proportion for females was 58 percent.

Similar to the visit patterns of general and family practitioners, female pediatricians spent more time, on the average,

with patients than male pediatricians did. In contrast to males,

females had a higher proportion of relatively long visits (16

minutes or longer, 25 perceng compared with 14 percent, respectively). Relatively short visits (10 minutes or less) accounted

for 25 percent of females’ visits but 53 percent of males’. Fe- “

males were also more likely than males to schedule return

appointments for their patients.

One apparent reversal of the general trend towards multiple

practice was observed in the data on female pediatricians. A

higher proportion (68 percent) of their visits were to physicians

in solo practice than to those in other types of practice, as

opposed to male pediatricians where only 34 percent of visits

were to those in solo practice. Female pediatricians also differed

from female general and family practitioners where the majority

of visits were to physicians in multiple practice.10 It is possible

that these data resulted from the higher concentration of visits

to female pediatricians in the Northeast and North Central

Regions (55 percent, table 3) where visits to physicians in solo

practice were more common than those in the South and West

Regions were (table C). The majority of visits to male pediatricians (53 percent) were in the South and West Regions. The

greater proportion of visits to all pediatricians was in metropolitan, rather than nonmetropolitan areas, but visits to female

pediatricians were more likely to be in metropolitan locations

than those to males were (94 percent, compared with 84 percent, respectively). In this respect females in pediatric practice

were similar to females in general and family practice. *OThese

results support the suggestion that female physicians prefer urban

areas where services are available that enable them to perform

both professional and family roles.
*

Patient characteristics

In the previous section the focus of this report was on the

characteristics related to the physician. Profiles were developed based on the location of practice, age of the physician,

and sex of the physician. In this section, the emphasis is on the

demographic characteristics of patients seen by pediatricians.

Statistics on the sex, race, and ethnicity of patients are presented by age of the patient in table 5. Visit rates are also

shown in this table.

Sex, race, and ethnicity

The distribution of visits by sex of the patient closely parallels the distribution of children under 15 years of age in the

population. Thus, pediatrics is the only one of the most frequently visited speciakies where visits by males exceeded those

by females. About 86 percent of the visits were made by white

~ patients and 12 percent by black patients. By contrast, only 9

percent of all children under 15 years of age who visited all

other specialties were black. Hispanic and non-Hispanic children visited pediatricians in the same proportions as they did

all other specialists, with about 6 percent Hispanic.

Visit rates

The majority of patients were children under 6 years of

age (64 percent). Visit rates were highest for infants under 1

year old and declined with each older age group (figure 3 and

table 5). Visit rates for white. children exceeded those for black

children during early infancy (under 1 year) and from 2 to 10

years of age (figure 4), but other differences between rates by

race were not statistically significant.

The general rate of visits to pediatricians by children under

15 years of age increased fkom 82.7 per 100 population in 1975

to an average of 116.5 in 1980-81. This increase was apparent

in each of the age groups listed in table G. The largest increase

occurred in the rate for children under 2 years of age. One note

of caution is needed when using these figures. The difference

between the 2 years of data is statistically significant, but a

comparison of two points in time does not necessarily indicate

a trend.
,

450

400

350

300

250

200

50

00

50

0

—

Under 1 2-5 6-10 11-14 15-20 21

1 and

over

Age in years

Figure 3. Average annual rate of office visits to pediatricians, by age of patiant United Statas, January 1980-December 1981

9
50(

45C

40C

25a

200

150

100

50

0

White

Black

\

\

\

\

\

\

\

\

\

\

\

\

\

\

\

\

\

\

\

\

\

\

\

\

\

\

\

\

\

w%

--

I I I I I I

Under 1 2-5 6-10 11-14 15-20

1

21

and

over

Age in years

.

*

Figure 4. Average annual rate of office visits to pediatricians, by race end age of patient United States, January 1980-December 1981

10
F~atient condition and

management

.

.

In this section, the clinical characteristics of visits are presented in relation to the sex, age, and prior visit status of patients. Condition of the patient is explored in tables 6–11 by

means of patients’ reason~ for visit and physicians’ diagnoses.

In tables 12-16, statistics are presented on patient management exemplified by the pediatrician’s use of diagnostic tools,

nonmedication therapy, and medication therapy as well as the

duration and disposition of the visit. In table 17, patients’ reascms for visit are analyzed by the diagnostic services ordered or

provided in their presence. The number of medications ordered

or prescribed for patients with certain diagnoses are shown in

table 18. To conclude the description of patient management,

the duration and disposition of the visit appear with selected

diagnosis categories in table 19,

SIBXand age of the patient

Patterns of care difYered minimally by sex of the patient,

as maybe expected with children’s visits. There were no statistically significant differences in proportions of reasons for visit,

principal diagnoses, visit status, diagnostic services, or therapy.

Neither did the time spent with the patient nor the disposition

of the visit differ according to the patient’s sex. One of the

reasons that patterns of ambulatory care are similar for boys

and girls is the large amount of preventive care and treatment

of acute, self-limited episodes of illness rendered by offlcebased pediatricians. Utilization of health care facilities is higher

for boys than for girls under 15 years of age, however, when the

illness or injury requires hospitalization.13

Infants under 12 months of age were most likely to be

brought to the physician’s ofiice for nonillness care (55 percent

of visits), (table 6). Acute problems caused 38 percent of their

vi:;its. But the ranks are reversed for older children where the

majority of visits were caused by acute problems, with nonillness care the second Ieadmg major reason. These changes in

the major reasons for visit by age of the patient are illustrated

in figure 5. A small but gradual increase in visits for chronic

problems may also be seen in the figure.

. The epidemiological pattern of childhood is further demonstrated by the increasing proportions of visits by successively

older age groups in the disease and treatment modules of the

. RVC. Visits classified in the disease module are usually return

visits for previously diagnosed conditions; those in the treatment module often include therapy, such as allergy shots.

The higher than average proportion of visits due to injuries

and adverse effects made by patients over 10 years old r~

fleets increased participation in sports and recreational activities.

The most frequent specific reasons for visit are listed in

table 7. The first 10 reasons accounted for about two-thirds of

the visits. In 49 percent of the visits patients were brought to

pediatricians for examinations or prophylactic inoculations.

Another 35 percent of the patients presented symptoms of illness, such as fever, earache, cough, sore throat, or cold.

The most frequent reasons for visit for each age group are

shown in table 8. The large number of examinations requested

for patients is evident in every age group through 20 years. It is

noteworthy that hrdf of all visits by infants under 1 year were

for the purpose of a well-baby examination. It is also interesting that allergy medication was among the leading reasons

for visit beginning with the age group 6-10 years and it remained high on the list to adulthood.

A 1 to 1 correlation between reason for visit and diagnosis

is not expected in NAMCS data. However, the principal diagnosis categories, shown in table 9, reflect the priority of patients’ reasons. Diseases of the respiratory system and diseases

of the nervous system and sense organs were the leading illnessrelated conditions requiring treatment by pediatricians for all

age groups. However, the last category tended to decrease with

increasing age group, with a high of 25 percent of the visits by

l-year olds to a low of 5 percent for young adults 15-20 years

old. As expected, injury and poisoning accounted for a larger

proportion of visits by patients 11–20 years of age than of

those made by younger patients.

Specific principal diagnoses are shown in table 10 and

classified by age groups in table 11. It is apparent that the

relatively high proportion of visits in the category diseases of

the nervous system and sense organs was due largely to otitis

media. This condition accounted for 12 percent of all visits, but

23 percent of those by l-year olds decreasing gradually to 4

percent of those by children 11–14 years of age. From infancy

to 10 years of age it was the leading illness diagnosed by pediatricians. Otitis media was also the most frequent diagnosis made

in 1975 when it constituted 8 percent of pediatricians’ visitsi.

A comparison of principal diagnosis categories in the 1975

NAMCS and the average of 1980–8 1 may be made using the

data shown in table G. The differences between proportions of

visits in the two time periods for otitis media and asthma are

statistically significant, with both showing an increase. There

was, however, a statistically significant decrease in visits for

11
Under

1

1

n

n

•l Chronic problem,

❑ Acute problem

routine or flareup

❑ Nonillness care

2-5 6-10 11-14

Age in years

15-20

Figure 5. Percent of office visits to pediatricians, by selected major reasons for visit and age of the patient January 1980-December 1981

contact dermatitis and other eczema. Other differences were

not statistically significant.

Probably because of the consistency of diagnosis patterns

across age groups, diagnostic services did not vary appreciably

by age group (table 12). Blood pressure checks tended to be

proportionately more frequent as the groups advanced in age,

but remained less than the overall NAMCS average of 35 percent. OffIce surgery also increased with increasing age group.

—

—

Diet counseling, probably instructions given mothers on infant

feeding, was given proportionately more often in visits by children under 1 year of age (25 percent) than in those by other

children.

Current data indicate some change since 1975 in the fr&

quencies of diagnostic tools used in pediatric visits (table G).

From 1975 to 1980–81 there was a decline in the use of the

general history and/or examination (from 33 percent to 29 per12
Table G. Annual visit rate by age of patient, and percent of office visits to Pediatricians- by sele~ed chara~eristi= United states,

1975 and 1980-81

—

Selected characteristic 1975 1980-81 Selected characteristic 1975 1980-81

Age

Uncler 2 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.p~, ye~~~. . a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-10 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11-14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.

Principal diagnosis catego~z

infectious andparasitic diseases3 . . . . . . . . . . . . . .

Streptococcal sore throat and scarlet fever. . . . .

Diseases of the nervous system and sense

organs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otitis media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the respiratory’ system. . . . . . . . . . . . . .

Acute pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . .

Acute tonsillitis . . . . . . . . . . . . . . . . . . . . . . . . . . .

Acute la~ngitis andtracheitia . . . . . . . . . . . . . . .

Acute upper respiratory infection of multiple or

unspecified sites . . . . . . . . . . . . . . . . . . . . . . . . .

Bronchitis, unqualified . . . . . . . . . . . . . . . . . . . . .

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allergic rhinitis (hay fever) . . . . . . . . . . . . . . . . . .

Diseases of theskin andsubcutaneous tisaue . . . .

Contact dermatitis and other eczama4. . . . . . . . .

Rate per 100

population

244 351

106 133

57 72

33 41

Percent of

visitsl

7.0 6.1

1.7 1.4

9.9 14.8

8.1 12.4

28.3 28.0

3.9 4.8

3.2 2.7

1.1 0.6

6.3 6.9

3.7 3.1

1.6 2.7

2.1 2.5

6.1 3.8

3.4 1.3

Principal diagnosis category2-Con.

Symptoms, signs, and ill-defined conditions. . . . . .

Observation and evaluation for suspected

conditions., . . . . . . . . . . . . . . . . . . . . . . . . . . . .

lnjurysnd poisoning6 . . . . . . . . . . . . . . . . . . . . . . . .

Supplementary classification . . . . . . . . . . . . . . . . .

Routine infant or child health check, or general

medicai examinationa . . . . . . . . . . . . . . . . . . . . .

Diagnostic or therapeutic service

Limited history and/or examination . . . . . . . . . . . . .

General history and/or examination. . . . . . . . . . . . .

Clinical laboratory test . . . . . . . . . . . . . . . . . . . . . . .

X-ray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Blood pressure check . . . . . . . . . . . . . . . . . . . . . . . .

Vision test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Office surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disposition of visit

No followup planned . . . . . . . . . . . . . . . . . . . . . . . . .

Return atspecified time . . . . . . . . . . . . . . . . . . . . . .

Return if needed . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Telephone followup planned . . . . . . . . . . . . . . . . . .

Referred to other physician . . . . . . . . . . . . . . . . . . . .

Percent of

visitsl —Con.

4.2

1.6

4.7

32.4

26.7

41.0

33.4

22.4

4.1

7.7

4.2

3.2

23.6

44.5

23.6

9.9

2.9

3.1

1.3

4.6

31.0

25.9

58.4

29.3

25.6

2.3

8.5

3.8

7.1

15.8

49.8

30.6

5.6

2.3

—

lBased on a total of 46,684,000 viaits in 1975 and 128,762.000 visits in 1980-81.

‘Diagnostic groups for 1975 are based on Eighth Revision International classification of Diseases, Adapted for rJsa in the united States WDA-% those for 1980-81

are based on International Classification of Diseases, 9th Revision, Clinical Modification ([CD-9-CM).

3Tho similar ICDA-8 category was named infective and parasitic diseases.

~hu similar ICDA-8 category was namad other eczema and dermatitis..

5Tho similar ICDA-8 catsgory waa named obsewation, without need for further medical care.

%he similar ICDA-8 categow waa named accidents, poisoning, and violance.

7The similar ICDA-8 catagory was named spatial conditions and examinations without sickness.

%hm similar ICDA-8 categow was named medical or special examination.

cent) and an increase in the use of the limited history and/or

ex,arnination (from 41 percent to 58 percent). There was also

an increase in the proportion of clinical laboratory tests ordered,

but a decrease in X-rays. 0fi5ce surgery also increased proportionately from one time period to the other. It is difficult to

attribute these changes to any specific variation in the patterns

of illness.

There was some veriation in the percents of drug visits by

difFerent age groups (table H) but there is no ready explanation

for it. For all age groups the major portion of drugs mentioned

were in three categories: serums, toxoids rmd vaccines; antiinfective agenty and antihistamine drugs (table 13). As expectecL

semms, toxoids and vaccines were proportionately highest and

srrtihistsmines lowest, for the youngest group. The most frequent specific drugs named by pediatricians are listed in table 14,

md also by age group in table 15. The wide variety of antibiotics selected by pediatricians included arnoxicillin, penicillin,

erythrornycin, and ampicillin. The usual childhood imrmmizations are represented by poliomyelitis vaccine’; diphtheria and

tetanus toxoids and pertussis vaccine (DPT); and measles,

mumps, rubella virus vaccine; among others. Allergy relief or

shots is listed for about 4 percent of the mentions but it is not

possible to identi$ the specific sub8t8nces used. Aspirin and

~lenol were both entered on Patient Record forms by physicians. Other nonprescription drugs commonly mentioned were

dirnetane, triaminic, novahistine, and robitussin.

A large proportion of visits to pediatricians are for routine

examinations, immunizations, allergy medications or shots, or

diagnostic tests which may be performed by a member of the

physician’s staff. Such visits are designated as lasting “O” minutes because there is no face-to-face encounter between physician and patient. Surprisingly, only 4 percent of the visits were

so classified (table 16). Only in visits by patients over 10 years

of age was this average exceeded by a small but statistically

signii3cant proportion. Relatively short visits (10 minutes or

less) were more common among visits by patients between the

ages of 1 year and 10 years than other age groups were. Relatively long visits (16 minutes or more) were more likely to be

related to visits by patients over 10 years of age.

For every initial visit made to pediatricians, there were

about 10 return visits (table 6). Except for psychiatry, thk

return visit ratio was higher than that of any other specialty.

This high rate can be attributed partially to parents’ awareness

of the need for preventive health care. But ofien the physician’s

disposition of the visit influences the continuity of care. In about

half of their visits in 1980-81, pediatricians instructed patients

to return at a specified time. This is less than the NAMCS

average of61 percent for thk disposition, but it may be due to

the high proportion of acute cases treated by pediatricizu... However, it represents an increase since 1975 when 45 percent

were scheduled for return visits (table G). This instruction was

most evident when patients were infants under 1 year (table 16).

13
Table H. Number of office visits to pediatricians, number and percent of drug visits, number of drug mentions, drug mention rate per visit,

and drug intensity rate per drug visit, by selected characteristics: United States, January 1980-December 1981

Number Drug Percent Number Drug Drug

Selected characteristic of visits visits of of drug mention intensity

in in drug mentions rate rate per

thousands thousandsl visits in thousands per visid drug v/~it3

Sex

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128,762 92,500 71.8 146,515 1.14 1.58

Female. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61,278 43,464 70.9 69,571 1.14 1.60

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67,484 49,037 72.7 76,944 1.14 1.57

Age

Under l year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31,119 20,842 67.0 34,925 1.12 1.68

I year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,514 14,013 80.0 22,845 1.30 1.63

2-5 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33,910 25,055 73.9 40,735 1.20 1.63

6-10years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,979 17,437 72.7 25,424 1.06 1.46

11-14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,778 7,759 65.9 11,389 0.97 1.47

15-20 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,232 4,823 66.7 6,693 0.93 1.39

21 years and over . . . . . . . . . . . . . . . . . . . . . ... . . 3,230 2,571 79.6 4,506 1.40 1.75

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110,635 79,473 71.8 125,038 1.13 1.57

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,904 11,438 71.9 19,249 1.21 1.68

Another . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,224 1,589 71.5 2,228 1.00 1.40

Ethnicity

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,505 5,612 74,8 9,178 1.22 1.64

Non-Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121,257 86,889 71.7 137,337 1.13 1.5B

lVisitsin which one or more drugs were ordered.

‘Drug mentions divided by visits.

3Drug mentions divided by drug visits.

Prior visit status

Patients presenting new problems were likely to visit for

acute problems, while patients returning to the physician for

care of continuing problems were likely to visit for nonillness

care (table 6). The reasons given for visits by returning patients

were less likely to be expressed as symptoms than those of

patients visiting with acute problems were.

Pediatricians used proportionately more general history

and/or examinations, clinical laboratory tests, and X-rays with

new patients than with returning patients (table 12). However,

physicians were less likely to prescribe drugs for new patients

than for others because 36 percent of their visits included no

drugs, compared with about 28 percent of returning patients’

visits.

The duration of a new patient’s visit is usually longer than

that of a patient the physician has seen before because sometimes the workup is more intense for the new patient, or the

physician has medical data available in the returning patient’s

file that is not yet gathered for the new patient. About 41 percent of the visits by new patients were less than 11 minutes,

compared with 61 percent of those by returning patients; 26

percen~ compared with 15 percent were longer than 16 minutes.

The proportionately greater use of some diagnostic procedures

for new patients probably contributed to the duration disparity.

Reason for visit and diagnostic services

The relationship between patients’ reasons for visit and

diagnostic services is shown in table 17. Except for X-ray and

limited history and/or examination, proportionately more services were rendered during visits classified in the administrative module than”in any other. These visits were chiefly examinations required for school or extracurricular activities. It is

encouraging to find that 57 percent of those visits included a

blood pressure check. This is a much greater proportion than

average in children’s visits.

Principal diagnosis and therapy,

duration, disposition

On the average, medication therapy (72 percent) was more

likely to be used by pediatricians than nonmedication therapy

was (40 percent). It was seen in table 12 that 60 percent of the

visits included no nonmedication therapy and that only medical counseling reached a proportion of 25 percent of the visits.

Therefore, it was of interest to examine the rates of therapy (or

more specifically, the rates of no therapy) associated with diagnosis. Visits for each diagnosis category are distributed by number of medications and the percent of visits with no nonmedication therapy in table 18.

The “None” column in the number of medications is the

complement of the percent of drug visits. Therefore discussion

may focus equally on the number of visits with no medication

prescribed or the number of drug visits. For example, if 15

percent of the 19.1 million visits for diseases of the nervous

system and sense organs had no drugs mentioned, then 85 percent were drug visits. An interesting corollay is that 72 percent of the same visits had no other type of therapeutic service.

14
Tablo J. Mean duration of office visits to pediatricians, by selected principal diagnosis categories and prior visit status United States,

Jar!uary 1980-Decamber 1981

Prior visit status

Principal diagnosis category and ICD-9-CM code~ Old patients

All Naw

.

patients patients New Old

problem problem

Mean duration in minutes

Alldisgnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.8 15.8 12.4 12.5

Infactioue andparasitic diseases.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...000-139 11.4 11.0 11.7 10.9

Endocrina, nutritional and metabolic diseasas, and immunity disorders . . . . ...240-279 12.9 *12.7 12.9

Diseaaes of tha nervous systam and sense organs . . . . . . . ~. . . . . . . . . . . . . ...320-389

.

11.9 15.2 12.4 11.0

Diseases oftha respiratory system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...460-519 12.0 16.0 12.2 11.2

Diseases ofthadigestiva systam. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...520-579 13.6 14.6 13.0 15.2

Oisaasas of the genitourinary systam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...580-629 14.4 “10.3 16.2 13.4

Oiseases of tha skin and subcutaneous tiasua. . . . . . . . . . . . . . . . . . . . . . . . . ...680-709 11.8 11.4 10.7 15.2

Oiseases of the musculoskeletal systam and connective tissue . . . . . . . . . . . . . . 710-739 13.9 “1 3.7 14.4 “1 2.8

Symptoms, signs, and ill-defined conditions. . . . . . . . . . . . . . . . . . . . . . . . . . ...780-799 14.0 16.6 13.2 14.3

Injury and poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-999 11.8 13.4 11.9 10.9

Supplementary classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. VO1-V82 13.8 16.2 13.0 13.8

lBasedon lrrtenrational Classification of Diseases. 9th Revisiorr, Clinical Modification (lCD-9-CM).g

Thus, in this case a high proportion of drug utilization was

assclciated with a low utilization of other therapy. A simiiar

association was observed for dkeases of the respiratory system

where 90 percent were drug visits and about 28 percent had

other therapy (the complement of 72 percent with no nonmedication therapy). When visits were not illness-related this

situation was somewhat different. In visits due to iqjury and

poisoning about 47 percent were drug visits (relatively low)

and about 57 percent had another form of therapy (about average). Diagnoses in the supplementary classflcation (chiefly

examinations) were associated with drug visits in 57 percent

and other therapy in about 50 percent.

These data do not necessarily indicate a causal relationship

between therapy modalities, although some of the results are

provocative. More indepth exrunination of the nature of the illness or other diagnosis is required before hypotheses may even

be proposed.

Visits are distributed by duration and disposition of the

visit for diagnosis categories in table 19. The largest proportion

of visits in each category was in the 6–1 Ominute range. But on

the average, visit duration varied for some categories (table J).

There was also a noticeable difference in the length of the visit

depending on its status. On the average, visits by new patients

took 15.8 minutes while the time used for old patients was

about 12.5 minutes. Longer visits by new patients was associated

with five categories; diseases of the nervous system and sense

organs; @iseases of the respiratory system; symptoms, signs,

and illdefmed condition injury and poisonin% and supplementary classification.

.

.

15
Conclusion

.

This report has provided a general profile of pediatric practice in the United States and an analysis of health care patterns

based on practice, physician, and patient variables.

It is generally acknowledged that the nature of pediatric

practice precludes great variation in the patterns of care based

on such variables. Most of the patients are under 15 years of

age and they present with a limited number of symptoms and

conditions. Preventive care consumes much of the pediatrician’s

time regardless of practice or physician characteristics.

Because of the large number of females in pediatric practice,

compared with those in other specialties, the analysis by sex of

the physician may be particularly meaningfid. There was no

evidence that gender had any appreciable effect on the pattern

of patient care. Like females in general and family practice,

female pediatrician saw, on the average, fewer patients than

male pediatricians did, but tended to spend more time with

them. Female physicians and newly established physicians of

both sexes in all specializes tend to have young patients, patients

who are new to the physician, and who visit for preventive care

and for treatment of acute problems.

.

16
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1269. Health Services and Mental Health Adminktration. Washington. U.S. Government Printing OffIce, Apr. 1966.

15National Center for Health Statistics, P. J. McCarthy Pseud@

replication, Further evaluation and application of the balanced halfsample technique. Vital and Health Statistim Series 2, No.31. DHEW

Pub No. (HSM) 73-1270. Health Services and Mentrd Health Administration. Washington. U.S. Government Printing OffIce, Jan. 1969.

.

17
List of detailed tables ‘

.

I.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Number of office visits to pediatricians by type and location

of physician’s practice and percent distribution by selected

visit characteristics, according to type and kwation of physician’s practice: United States, January 1980-December

1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of dnrgs mentioned in ofice visits to pediatricians

by type and location of physician’s practice and percent distribution by therapeutic catego~, according to type and location of physician’s practice: United States, January 1980–

December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of office visits to pediatricians by age and sex of

physician and percent distribution by selected visit characteristics, accordkg to age and sex of the physiciam United

States, January 1980-December 1981 . . . . . . . . . . . . . . . . .

Number of drugs mentioned in ofilce visits to pediatricians

by age and sex of physician, and percent distribution by

therapeutic category, according to age and sex of the physician: United States, January 1980-December 1981 . . . . . .

Number of ofice visits to pediatricians by sex, race, and

ethnicity of the patient, percent distribution by age of the

patient, according to sex, race, and ethnicity of patien~ and

average annual rate of visits by age, sex, race, and ethnici~

of patient United States, January 1980-December

1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of oflice visits to pediatricians by sex and age of

patient and prior visit status; percent distribution by selected

visit characteristics, according to sex and age of patient and

prior visits status; and return visit ratio by sex and age of

patient and prior visit status: United States, January 1980-

December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number, percent, and cumulative percent of otlice visits to

pediatricians, by most frequent principal reasons for visit

United States, January 1980-December 1981 . . . . . . . . . . .

Number, percent, and cumulative percent of otlice visits to

pediatricians, by age of patient and most frequent principal

reason for visit: United States, January 1980-December

1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of ofilce visits to pediatricians by sex and age of

patient and prior visit status, and percent distribution by principal diagnosis categories, according to sex and age of patient and prior visit status: United States, January 1980-

December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number, percent, and cumulative percent of office visits to

pediatricians, by most frequent principal diagnoses: United.

States, January 1980–December 1981 . . . . . . . . . . . . . . . . .

19

21

22

24

25

26

27

28

29

30

11.

12.

13.

14.

15.

16.

17.

18.

19.

Number, percent, and cumulative percent of otlice visits to

pediatricians, by age of patient and most frequent principal

diagnoses United States, January 1980-December

1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of ofllce visits to pediatricians by sex and age of

patient and prior visit statuq percent of visits by diagnostic

services, nonmedlcation therapy, sex and age of patient, and

prior visit statu$ and percent distribution by number of medications, according to sex and age of patient and prior visit

status: January 1980-December 1981 . . . . . . . . . . . . . . . . .

Number of drugs mentioned in office visits to pediatricians

by sex and age of patient and prior visit status, and percent

distribution according to sex and age of patient and prior

visit status: United States, January 1980-December

1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number, percent, smd cumulative percent of drugs mentioned

in ofllce visits to pediatricians, by name of most frequently

mentioned dregs: United States, January 1980-December

1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number, percent, and cumulative percent of drugs mentioned

in office visits to pediatricians, by age of patient and name of

most frequently mentioned drugs United States, January

1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of ofFice visits to pediatricians by sex and age of

patient and prior visit status, and by duration and disposition

of visits, according to sex and age of patient and prior visit

status: United States, January 1980-December 1981 . . . . .

Number of oflice visits to pediatricians by major reason for

visit and principal reason for visit module, and percent of

visits by diagnostic services, major reason for visit, ancl principal reason for visit module: United States, January 1980-

December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of ofice visits to pediatricians by principal diagnosis

categories; percent distribution by number of medications,

according to principal diagnosis categories; and percent of

visits with no nonmedication therapy by principal diagn~

sis categories United States, January 1980-December

1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of oftice visits to pediatricians by selected principal

diagnosis categories, and percent distribution by duration

and disposition of visits, accordkg to selected principal diagnosis categories: United States, January 1980–December

1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31

32

33

34

35

36

37

37

.

38

.

18

“
Table 1. Numbar of office visits to padiatriciana by type and location of physician’s practice, and parcent distribution by selectad visit

characteristics, according to type and location of physician’s practice United States, January 1980-December 1981

.

Type of practice Geographic region Area

Selected visit characteristic All

types of solo Otherl Northeast North South West Metro- Nonpractice Central politan metropolitan

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sax of patiant

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age of patient

Undarl year. . . . . . . . . . . ...<... . . . . . .

Iyesr . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z+jyaars . . . . . . . . . . . . . . . . . . . . . . . . . .

6-10years . . . . . . . . . . . . . . . . . . . . . . . . .

n--14 years . . . . . . . . . . . . . . . . . . . . . . . .

16-20 yeara . . . . . . . . . . . . . . . . . . . . . . . .

21yaars and over . . . . . . . . . . . . . . . . . . .

Prior visit status

New patient . . . . . .. . . . . . . . . . . . . . . . . . .

Old, patient, new problem . . . . . . . . . . . . .

Olal patient, old problem . . . . . . . . . . . . . .

Referral statua

Referred by another physician . . . . . . . . .

Not raferred by another physician. . . . . . .

Major reason for viait

Acute problem . . . . . . . . . . . . . . . . . . . . . .

Chronic problem, routine. . . . . . . . . . . . . .

Chronic problem, flare-up . . . . . . . . . . . . .

Postsurgery or postinjury. . . . . . . . . . . . . .

Nonillness care . . . . . . . . . . . . . . . . . . . . .

Principal raason for visit

module and RVC codez

Symptom module . . . . . . . . . S001-S999

Disaaae module. . . . . . . . . . . DOOI-D999

Diagnostic, screening, and preventive

module . . . . . . . . . . . . . . . . .X100-X599

Treatment module . . . . . . . . . T100-T899

Injuries and adverse effects

module. . . . . . . . . . . . . . . . . JOO1-J999

Test results module. . . . . . . . RI 00-R700

Administrative modula . . . . . Al00-A140

Otl]aP . . . . . . . . . . . . . . . . . . . . . . . . .. . . .

Diagnostic servica4

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Limited histoty andlor examination . . . . .

General history and/or examination . . . . .

Clinical Iaboratoty teat. . . . . . . . . . . . . . . .

X-ray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. Blood pressure check . . . . . . . . . . . . . . . .

~$iontest t . . . . . . . . . . . . . . . . . . . . . . . .

Other< . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. See footnotes at end of table.

128,762

100.0

47.6

52.4

24.2

13.6

26.3

18.6

9.2

5.6

2.5

8.7

37.6

53.7

1.5

98.5

53.7

9.0

4.5

1.7

31.2

55.9

5.7

27.1

5.3

2.9

“0.1

1.8

1.2

6.6

58.4

29.3

25.6

2.3

6.5

3.8

4.2

48,408

100.0

47.5

52.5

25.1

13.0

25.0

18.0

9.6

5.9

3.3

8.0

37.9

54.1

1.7

98.3

48.6

13.1

3.7

1.5

33.1

52.2

6.9

28.1

6.2

2.6

“0.2

2.5

1.3

11.1

54.1

29.2

25.0

1.9

9.8

3.5

3.1

80,354

100.0

47.7

52.3

23.6

14.0

27.1

19.0

8.9

5.4

2.0

9.1

37.4

53.5

1.4

98.6

56.7

6.6

5.0

1.7

30.0

58.1

5.0

26.6

4.8

3.1

*0.1

1.4

0.9

3.9

60.9

29.4

26.0

2.6

7.7

3.9

4.8

Number in thousands

35,724 26,897 4S,844

Percent distribution

100.0

47.7

52.3

21.8

12.5

26.7

19.4

10.1

6.7

2.8

6.5

37.6

56.0

1.6

.98.4

49.4

9.0

2.6

3;:;

100.0

50.0

50.0

25.0

14.3

26.0

17.4

8.5

5.7

3.2

6.4

42.9

50.7

1.2

98.8

50.7

7.4

6.3

2.8

32.8

100.0

47.2

52.9

24.4

14.4

27.0

19.3

8.6

4.1

2.1

9.0

35.9

55.1

1.6

98.4

57.3

9.9

4.8

1.5

26.5

17,297

100.0

44.8

55.2

27.1

12.6

24.3

16.9

9.8

7.5

●1.8

16.0

34.1

49.9

1.4

98.6

56.7

9.2

4.8

“0.7

28.7

110,071

100.0

47.3

52.7

23.8

13.8

26.5

18.8

9.0

5.7

2.4

8.5

36.9

54.6

1.5

88.5

53.4

9.1

4.8

1.7

31.1

50.3 55.2 60.0 57.0 55.6

6.1 6.1 4.3 8.4 6.0

34.2 27.1 22.8 24.8 27.4

4.2 4.6 7.6 “2.3 5.1

2.3 3.1 3.0 3.7 2.9

“0.2 “0.0 “0.1 “0.4 “0.1

2.2 3.2 1.0 ‘0.8 1.7

0.5 0.7 1.2 2.6 1.2

7.6 4.0 7.5 6.2 6.5

51.8 63.7 58.3 63.7 57.6

36.7 24.4 28.6 23.9 30.0

26.2 28.9 25.7 19.1 25.5

1.9 2.7 2.2 2.7 2.3

11.0 11.4 5.5 7.4 - 9.0

5.4 5.2 2.1 2.8 3.9

4.4 5.3 3.0 5.3 4.3

18,691

100.0

49.0

51.0

26.3

12.6

25.6

17.4

10.2

4.9

3.0

9.8

41.9

48.2

1.5

98.5

55.3

8.6

2.9

*7.4

31,8

57.9

4.1

25.7

6.5

3.1

*0.2

2.3

0.2

7.2

63.1

25.3

26.4

2.5

5.6

2.8

3.6

19
Table 1. Number of office visits to pediatricians by type and location of physician’e practice, and percent distribution by selected visit

characteristics, according to type and location of physician’s practice: United Statas, January 1980-Dacamber 1981 —Con.

Type of practice Geographic region Area

Selected visit characteristic All

types of solo Otherl Northeast North south West Metrcs- NonCentral practice politan metropolirhrn

Nonmedication therapfl

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Physiotherapy . . . . . . . . . . . . . . . . . . . . . . .

Office surgery, . . . . . . . . . . . . . . . . . . . . . .

Therapeutic listening . . . . . . . . . . . . . . . . .

Diet counseling . . . . . . . . . . . . . . . . . . . . .

Family or social counseling. . . . . . . . . . . .

Medical counseling . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of medications

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 or more . . . . . . . . . . . . . . . . . . . . . . . . . .

Principal diagnosis and

ICD-9-CM codes

Infectious and parasitic

diseaaes . . . . . . . . . . . . . . . . . . 000-139

Neoplasms . . . . . . . . . . . . . . . ..l4O-239

Endocrine, nutritional and metabolic

diseases, and immunity

disorders . . . . . . . . . . . . . . . ...240-279

Mental disordera . . . . . . . . . ...290-319

Diseases of the nervous system and

sense organs . . . . . . . . . . . ...320-389

Diseaaea of the circulator

system . . . . . . . . . . . . . . . . . . . .390-459

Diseases of the reapirato~

system . . . . . . . . . . . . . . . . . . . . 460-519

Diseases of the digestive

system . . . . . . . . . . . . . . . . . . . .520-579

Diseaaes of tha genitourinary

system . . . . . . . . . . . . . . . . . . ..580-629

Diseaaes of the skin and subcutaneous

tissue. . . . . . . . . . . . . . . . . . ...680-709

Diseaaes of the musculoskaletal systam

and connective tissue . . . . ...710-739

Symptoms, signs, snd ill-defined

conditions . . . . . . . . . . . . . . . . .780-799

Injury and poisoning . . . . . . ...800-998

Suppiementaty classification. . . VO1 -V82

Another diagnosea . . . . . . . . . . . . . . . . . .

Unknown diagnoses . . . . . . . . . . . . . . . . .

Duration of visit

O minuteaa . . . . . . . . . . . . . . . . . . . ... . . . ,

1-5 minutes. . . . . . . . . . . . . . . . . . . . . . . .

6-10 minutes . . . . . . . . . . . . . . . . . . . . . . .

11-15 minutea . . . . . . . . . . . . . . . . . . . . .

16-30 minutes . . . . . . . . . . . . . . . . . . . . .

31minutes or longer . . . . . . . . . . . . . . . . .

Disposition of visit7

No followup planned . . . . . . . . . . . . . . . . .

Return at specified time . . . . . . . . . . . . . .

See footnotes at end of table.

60.0

1.4

7.1

1.3

11.5

4.8

24.6

0.9

28.2

40.6

23.0

8.1

2.2

“:;

0.6

0.5

14.8

“0.3

28.0

2.9

1.3

3.8

0.8

3.1

4.6

31.0

1.1

0.9

3.9

14.9

37.6

28.5

13.3

1.9

15.8

49.8

56,7

“0.8

7.4

1.3

13.1

6.1

28.5

0.7

26.6

43.6

21.5

6.2

2.2

5.3

*0.2

‘0.6

‘0.3

13.2

“0.2

28.9

3.3

1.5

3.s

“0.5

3.1

4.0

33.0

1.5

80.5

3.7

15.3

35.7

28.1

14.8

2.4

16.5

52.8

61.9

1.7

6.8

1.3

10.6

4.0

22.2

1.0

29.1

38.8

23.9

6.0

2.2

“;:

0.6

0.7

15.9

*0.4

27.5

2.7

1.1

3.7

1.0

3.0

5.0

29.8

0.9

1.1

4.0

14.7

38.7

28.7

12.4

1.5

15.4

48.0

Percent distribution

51.5

1.5

7.9

2.0

13.3

8.0

33.5

*1.O

26.4

45.0

23.0

4.7

‘1.0

5.9

“0.1

“0,7

“0.4

13.1

●0.1

27.5

2.0

1.2

3.3

“0.8

2.2

3.8

37.7

“0.9

“0,4

2.2

15.3

38.5

27.9

13.9

2.2

13.5

53.1

58.3

●1.4

9.6

●1.5

12.2

3.6

22.3

●o.a

29.1

40.3

22.2

6.8

1.7

5.6

‘0.1

“;0.8

“0.9

14.7

“0.9

24.0

3.8

*1.5

4.8

‘1.0

3.6

4.5

31.9

●1.1

‘0.9

483

12.4

45.1

28.2

9.4

“0.7

18.4

49.9

69.3

1.0

5.3

“0.7

9.9

2.1

16.S

●1.O

24.3

39.2

25.4

7.3

3.8

6.9

“0.1

“0.3

“0.5

15.1

“0.2

31.3

3.5

1.2

3.4

“0.7

2.7

4.5

27.7

1.2

“0.7

5.7

16.6

34.7

26.8

14.1

1.9

14.9

46.5

52.0

*1,9

6.4

*1.6

11.7

7.6

31.7

‘0.6

41.5

36.0

17.3

“z

5.2

“0.4

“0.8

“0.4

17.8

‘0.4

26.0

1.9

“1.2

4.0

*1.1

4.8

6.9

25.3

“1.7

“2.2

●1.8

12.5

31.8

34.9

16.2

2.8

19.5

52.0

59.7

1.4

7.3

1.4

11.9

4.8

24.9

0.7

27.8

41.0

23.0

6.1

2.2

6.1

●oal

0.6

0.6

14.4

“0.4

28.7

2.9

1.3

3.6

0.9

3.0

4.7

30.8

1.1

“1.0

3.0

16.2

37.2

28.0

13.6

2.0

16.1

50.1

61.5”

“1.0

5.9

0.8

9.2

4.5

22.8

“2.0

30.6

38.2

23.0

6.1

2.0

6.3

“0.3

‘0.4

“0.5

17.5

90.1

23.9

3.3

“1.2

4.7

‘0.8

3.2

4,1

32.2

1.3

“0.3

9.3

7.7

39.7

31.3

11.8

0.8

14.2 .

48.1

20
.. . .. . . . .. . . . . . . . -,, . . . . . . . .

;“’ . . . ..* -

Tabl,B1. Number of office visits to pedietriciarts by type and location of physician’s practica. and percent distribution by selected visit

chsractwiatica, according to type ●nd location of physician’s practice: Unitad States. January 1980-December 1981 —Con.

Type of practice Geographic region Aree

Selected visit characteristic Ail

types of solo Otherl Northeest North

South West

Metro- NonCentral practice politan metropolitan

Disposition of visit7—Con. Percent distribution

Return if needed . . . . . . . . . . . . . . . . . . . . 30.6 25.3 33.s 28.5 25.3 37.5 23.7 29.5 37.0

Telephone followup planned. . . . . . . . . . . 5.6 6.8 4.9 7.6 4.2 4.6 6.0 6.0 3.4

Referred to other physician. . . . . . . . . . . . 2.3 2.4 2.2 2.9 1.9 2.1 ●2.2 2.4 ●1.7

Returned to referring physician . . . . . . . . . “0.3 “0.3 “0.3 “0.6 “0.2 “0.3 “0.4

Admit to hospital . . . . . . . . . . . . . . . . . . . . 0.7

80.1

“0.6 0.8 ●0.3 ●1.0 1.0 “0.4 0.6 ●1.4

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “0.1 “0.1 “0.1 ‘0.1 ‘0.1 80.1 “0.2 80.1 “0.2

1Includes psrtnerahip, group. andothertypsaof practica.

2Bsafld on A Reason for Visit Ctassifieation for Ambulatory Cam (RVC).6

31ncl,,d6a blanks ~mblam$, ~ompjaintr not slsewhara claaaifiad: sntrias of %OItd”; and illagibk entriaa.

4Perctents will not total 1CO.Obacause mors than 1 disgnoatic sewics or nonmedicstion therapy msy hava been randered during s visit.

‘Baa!)don InternationalClassificationof Diseases, 9th Revision, Clinical Modification (ICO-9-CM).9

aRepresenta visits in which there wa$ no face-to-faca encounter betwaen patient ●nd physician.

7Percents will not total 100.0 because more than 1 dtspoaition wss possible.

Table 2. Numbar of drugs mentioned in offica visits to pediatricians by type and location of physician’s practice, and percent distribution by

therapeutic categow, according to type and location of physician’s practice: United Statea, January 1980-December 1981

Therapeutic categoryl

Type of practice Geographic region Area

AJI

types of solo Other2 Northeast North

South West Metro- Norrpractice Central poiitan metropolitan

Alkategories . . . . . . . . . . . . . . . . . . . . . . . 146,515

Total . . . . . . . . . . . , . .. . . . . . . . . . . . . . . . . 100.0

Antihistamine drugs. . . . . . . . . . . . . . . . . . 15.2

Anti-infactive agents . . . . . . . . . . . . . . . . . 30.1

Autonomic drugs . . . . . . . . . . . . . . . . . . . . 2.6

Central narvous system drugs. . . . . . . . . . 4.9

Diagnostic agents . . . . . . . . . . . . . . . . . . . 4.2

Electrolytic, caloric, andwatarbalance . . . 0.6

Expectorants and cough preparations . . . 6.7

Eye, ear. nose, and throat preparations. . . . 3.1

Gastrointestinal drugs . . . , . . . . . . . . . . . . 1.7

Hormones and synthetic substitutes . . . . 1.6

Serums, toxoids and vaccines. . . . . . . . . . 17.4

Skin and mucous membrane

preparations . . . . . . . . . . . . . . . . ... . . . . . 5.9

Spwsmolyticagenta . . . . . . . . . . . . . . . . . . 2.2

Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.9

Other, unclassified, or undetermined . . . . 2.8

55,276

100.0

15.8

28.4

2.6

4.9

5.2

“0.4

5.2

3.4

1.6

1,1

19.2

5.9

2.5

●0.6

3.2

Number in thousands

91,239 39,004 30.124 62,288

Percent distribution

100.0 100.0 1OQ.O

14.9 14.8 12.8

31.2 25.6 27.9

2.7 2.6 2.5

4.9 6.6 5.1

3.5 5.7 6.3

0.7 “0.4 1.6

7.6 5.3 5.1

2.9 2.5 3.4

1.8 1.2 1.8

1.9 “0.9 *1.4

16.3 22.9 16.5

5.9 5.3 7.8

2.1 1.6 1.7

1.1 “0.6 1.5

2.6 3.7 2.6

100.0

17.0

33.6

2.3

4.2

2.3

“0.3

9.0

3.3

2.1

2.2

13.3

5.1

2.4

0.9

2.2

15,099 125,733 20,782

100.0

14.0

31.6

4.6

3.4

3.8

‘0.3

3.6

3.1

●1.6

●1.1

18.1

7.0

3.7

“0.3

3.7

100.0

15.2

30.4

2.5

4.9

4.3

0.6

6.5

3.0

1.8

1.7

17.6

5.5

2.1

0.9

2.6

100.0

15.6

28.4

3.2

5.0

3.2

“0.4

7.5

3.3

*1,5

●1.0

14.8

8.3

3.4

“0.6

4.0

1Bar.ad on the classification system of the American Hospital Formulary Service. a

‘Includes partnership, group, and other types of practice.
... ...-” .“. . . . :, . . . . .. . . . . . . . . . ,, ... ..’ ..* -

Table 3. Number of office visits to pe’diatriciana by age and sax of physician. and Percent distribution by salected visit characteriati=

according to age and sex of physician United States, January 1980-December 1981 —Con.

Age of physicianl Sex of ph ysician

Selected visit characteristic All Under 35 35-44 45-54 55-64 65 years

Female Male

ages years years years years and over

Nonmedication therap@—Con.

. Family orsocial counseling . . . . . . . . . . . . . . . . . . . . . . . .

Meoical counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of medication

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Principal diagnosis and ICD-9-CM code5

lnfectioua and parasitic diseases. . . . . . . . . ...000-139

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Endocrine, nutritional and metabolic diseases, and

immunity disorders . . . . . . . . . . . . . . . . . . . ...240-279

Mental disorders . . . . . . . . . . . . . . . . . . . . . . ...290-319

Diseases of the nervous system and

senae organs . . . . . . . . . . . . . . . . . . . . . . . . ...320-389

Diseases of the circulatory system . . . . . . . ...390-459

Diseases of the respiratory system . . . . . . . ...460-519

Diseases of the digestive system . . . . . . . . ...520-579

Diseases of the genitourinary system . . . . . ...580-629

Diseases of the skin andsubcutanaous tissue. .. 680-709

Diseases of the musculoakeletal system and

connective tissues . . . . . . . . . . . . . . . . . . . . ..71 O-739

Symptoms, signs, and ill-defined conditions . ..780-799

Injury and poisoning . . . . . . . . . . . . . . . . . . . ...800-999

Supplementary classification . . . . . . . . . . . . . . . VOI -V82

All other diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Duration of visit

O minutess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l-5 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-10 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11-15 minutas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...”..

16-30 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31minutes orlonger . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disposition of visit7

No foiiowup planned . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Return at specified time . . . . . . . . . . . . . . . . . . . . . . . . . . .

Return if needed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Telephone followup planned . . . . . . . . . . . . . . . . . . . . . . .

Raferred toothar physician . . . . . . . . . . . . . . . . . . . . . . . .

Returned to referring physician. . . . . . . . . . . . . . . . . . . . .

Admittoho spital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Type of practice

solo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See footnotes at end of table.

4.8

24.4

0.9

28.4

40.4

22.9

6.2

2.2

6.1

“0,2

0.6

0.5

14.9

80.3

27.9

3.0

1.3

3.7

0.8

3.1

4.6

31.2

1.1

0.8

4.0

15.1

37.1

28.5

13.5

1.9

15.9

50.0

30.5

5.7

2.3

“0.3

0.7

“0.1

38.2

61.8

2.9

15.9

“0.6

32.5

34.8

26.1

5.9

‘0.7

5.8

*0.1

“0.9

“0.2

28.4

80.1

18.3

3.3

●1.3

3.7

“0.4

3.4

3.7

28.2

●1.4

●1.O

●1.6

15.5

36.1

26.5

19.5

“0.8

16.2

58.0

26.5

2.9

*2.1

“0.6

“0.9

*O, 1

32.8

67.2

4.2

27.0

“0.7

28.9

37.5

25.5

6.6

1.6

5.9

*0.O

80.5

‘0.7

14.7

*0.6

27.0

3.1

1.5

4.6

●1.1

3.4

4.0

30.8

1.3

●1.O

4.5

12.1

43.9

24.7

12.2

2.6

15.9

53.4

29.0

5.0

2.1

*0.2

‘0.3

“0.2

30.3

69.8

Percent distribution

4.7

19.5

1.4

25.7

39.5

23.7

7.3

3.8

7.1

*0.1

“0.3

“0.4

12.6

“0.3

30.7

3.1

“0.8

3.4

1.0

2.7

5.3

30.6

“0.8

80.7

4.3

18.3

35.1

29.4

11.3

1.7

16.2

44.8

34.2

4.7

2.6

“0.2

1.0

*0.1

35.4

64.6

6.3

29.1

80.5

31.6

47.4

15.8

3.8

*1.4

4.8

“0.5

“0.9

“0.4

11.4

“0.2

31.5

2.4

*1.8

3.2

“0.5

3.1

5.2

32.0

●1.3

81.0

5.3

13.7

28.1

37.1

14.6

*1.2

16.2

49.8

28.5

7.1

81.7

“0.5

●0.8

“0.0

49.8

50.2

9.0

46.2

23.3

53.5

17.2

“4.5

●1.5

*5.5

“0.2

*1.2

*1.3

9.6

80.1

25.1

*2.6

*1.5

*2.3

“0.4

*2.5

*4.7

41.8

*1.2

“0.3

*0.1

14.8

42.6

22.3

16.8

?3.5

11.7

45.6

30.6

17.4

“3.1

●0.2

“0.1

77.9

22.1

7.6

27.7

“0.5

23.0

34.9

30.7

8.8

*2.5

5.0

“0.1

“0.5

*0.5

21.1

‘0.3

27.1

4.0

*1.6

2.8

“0.4

3.5

3.2

28.8

“0.5

‘0.7

4.8

11.3

33.2

25.8

22.1

2.7

9.1

58.6

28.4

5.5

‘2.4

‘0.4

*1.2

‘0.1

62.0

38.0

4.4

23.9

0.9

29.2

41.3

21.6

5.7

2.2

6.2

80.2

0.6

0.5

13.9

“0.3

28.0

2.8

1.2

3.9

0.9

3.0

4.9

31.6

1.2

0.9

3.8

15.7

37.7

29.0

12.1

1.7

16.9

48.6

30.8

5.7

2.2

*0.3

0.6

“0.1

34.4

65.6

23
Table 3. Number of office Visits to pediatricians by age and sex of physician, and percent diatrikrution by selected viait characteristics,

according to age and sex of physiciarx United States, Janua~ 1980-December 1981—Con.

Age ofphysicianl Sex of ph ysician

Selected visit characteristic

Ail Under 35 35-44 45-54 55-64 65 years

ages years years

Female

years years

Male and over

.

Geographic region Percent distribution

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.6 18.0 27.8 22.7 32.2 65.5 17.3 29.?

North Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.6 25.7 2S.6 13.5 18.7 14.4 37.6 17.9

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38.2 36.9 31.0 53.4 27.6 17.3 40.3 37.8

West . . +. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.7 19.5 12.5 10.4 21.5 *2.8 4.8 15.1

Area

Metropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85.2 84.2 88.1 80.7 89.7 87.1 93.5 83.9

Nonmetropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.8 15.8 11.9 19.4 10.3 13.0 6.5 16.1

I Does not include visits to doctors of osteopathy.

‘Based on A Reason for Visit Classification for Ambulatory Care (RVC).6

31ncludesblanks; problems, complaints not alsewhere classified entrias of ‘“none”;and illegible entries.

4Percents will not total 100.0 because more than 1 diagnostic setvice or nonmedication therapy may have been rendered during a visit.

5 Based on International Classification of Dke8SeS, 9th Revision, Clinical Modification (lCO-9-CM).g

6Represents visits in which thare was no face-to-face encounter between patient and physician.

7Percents will not total 100.0 because more than 1 disposition was possible.

‘Includes partnership, group, and other types of practice.

Table 4. Number of drugs mentioned in office visits to pediatricians by ege and sex of physician, and percent distribution by therapeutic

category, according to age and sex of physiciam United Stataa, Januaty 1980-December 1981

Age of physician Sex of physician

Therapeutic categoryl

All Under 35 35-44 45-54 55-64 65 years

agesz years years

Female Male

years years and over

Allcategoriea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ToteI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antihistamine drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anti-infective agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Autonomic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Central ne!vous system drugs . . . . . . . . . . . . . . . . . . . . . .

Diagnostic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Electrolytic, caloric, and water balance. . . . . . . . . . . . . . .

Expectorants and cough preparations. . . . . . . . . . . . . . . .

Eye, ear, nose, and throat preparations. . . . . . . . . . . . . . .

Gastrointestinal drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hormones and synthetic substitutes. . . . . . . . . . . . . . . . .

Serums, toxoids and vaccines . . . . . . . . . . . . . . . . . . . . . .

Skin and mucous membrane preparations . . . . . . . . . . .

Spasmolytic agents . . . . . . . . . . . . . . . . . . . . . . . . . ...’..

Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other, unclassified, or undetermined . . . . . . . . . . . . . . . .

144,011

100.0

15.2

30.0

2.7

5.0

4.2

0.6

6.7

3.0

1.7

1.6

17.4

5.9

2.3

0.9

2.8

16,899

100.0

13.6

36.8

*2.2

2.7

2.2

“0.2

9.6

●1.7

“1.7

“0.9

16.9

6.5

*2.2

“1.0

*1.7

44,563

100.0

15.6

27.9

2.5

5.3

4.1

1.2

6.2

2.4

1.4

80.9

19.1

7.0

2.3

“1.0

2.8

Number in thousands

54,579 20,594

Percent distribution

100.0 100.0

15.2 16.6

31.0 28.3

2.7 3.7

4.7 5.1

3.4 6.6

“0.4 ‘0.1

7.8 3.9

4.2 2.4

1.9 *2.1

2.4 *1.8

14.3 19.4

5.5 4.4

2.0 3.0

1.0 “0.5

3.6 ●1.9

7,376

100.0

11.0

25.0

*1.7

9.5

8.3

“0.6

*3.2

*2.6

*1.3

“1.5

25.9

*3.7

*2.3

0.8

●2.6

23,110

100.0

15.5

32.2

2.7

3.9

3.3

“0.6

8.2

*1.7

*1.4

0.6

17,0

6.9

2.2

“1.7

2.2

120,901

100.0

15.2

29.6

2.6

5.2

4,4

0.6

6.5

3<3

1,6

1.8

17.5

5.7

2.3

0.7

2.9

1Based on the classification system of the American Hospital Formuiary Servica. a

2D0es not include doctors of osteopathy.

24
.. ...” . . . . . ,.. .,,

.. . . . . . . . . . . .

. . ..ATable 5. Number of office visits to pedistriciens, by sex. race, and athnicity of the patient percent distribution by age of patient. according to

sex, race, and ethnicity of patient and average annual rate Of visits, by age, sex race. and ethriicity Of patienti United State% Jmmw 1930-

Dec@mber 1981

.

Age of patient

Sex of patient Race of patient .Et/rnicity of patient

Both Female Male White Black All Hispanic Nonsexes other Hispanic

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under l year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2-5 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-10 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11-14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-20 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under l year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l ye . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2-5 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-l Clyears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11-14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-20 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21yr!ara and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

128,762

100.0

24.2

13.6

26.3

18.6

9.2

5.6

2.5

28.9

441.5

257.6

132.9

71.5

41.0

14.9

1.1

61,278

100.0

23.6

13.5

25.4

18.6

9.1

6.3

3.5

26.6

421.1

249.0

124.8

69.4

39.8

15.8

1.4

Number in thousands

67.484 110,635 15,904 2,224

Percent distribution

100.0 100.0 100.0 100.0

24.7 23.8 25.3 32.1

13.7 13.2 16.6 *1 4.1

27.2 26.8 23.4 22.9

18.7 19.0 16.3 *1 6.5

9.2 9.3 8.4 *8.9

5.0 5.6 6.4 *3.8

1.6 2.4 3.7 *1.8

Visit rate par 100 population

31.4 29.0 30.5 20.1

461.0 463.4 351.9 327.2

265.6 262.2 255.2 *1 46.6

140.7 142.4 97.2 61.2

73.6 76.3 51.4 “39.5

42.2 43.2 31.4 ‘26.1

13.9 15.1 15.0 *6.9

0.8 1.0 1.9 “0.6

7,503

100.0

27.8

13.2

24.1

20.7

7.9

“5.6

“0.8

. . .

. . .

..-

-..

.-.

---

.-.

. . .

121,257

100.0

23.9

13.6

26.5

18.5

9.2

5.6

2.6

---

..-

.-.

. . .

. . .

-..

. . .

. . .

.

.

25
Table 6. Number of office visits to pediatricians by sex and age of patient and prior visit status; percent distribution by selectedvisit characteristics.according to sex end age of pstient and

prior visit status; and return visit ratio by sex and age of patient and prior visit status United States, Januaw 1980-Dacember 1981

Selected visit characteristic

Sex of patient Age of patient Prior visit status

Both 21 years

Old

Under

Old

Female Male 1 year

2-5 6-10 11-14 15-20 Naw patient,

saxas 1 year

and patient,

years yaars years years

over

patient new old

problem problem

All visits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major reason for visit

Acute problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chronic problem, routine . . . . . . . . . . . . . . . . . . . . . .

Chronic problem, flareup . . . . . . . . . . . . . . . . . . . . . .

Postsurgery orpostinju~ . . . . . . . . . . . . . . . . . . . . . .

Nonillness cara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Principal reason for visit module and RVC codel

Symptom module . . . . . . . . . . . . . . . . ..s001-s999

Disease module, . . . . . . . . . . . . . . . . .. DDO1-D999

Diagnostic, screening, and preventive

models . . . . . . . . . . . . . . . . . . . . . . . .. X1 OO-X599

Treatment module . . . . . . . . . . . . . . . .. TIOO-T899

Injuries and adverse effects module ., . JOO1 -J999

Test reaulta module. . . . . . . . . . . . . . . . R1OO-R7OO

Administrative module . . . . . . . . . . . . .. A1OO-A14O

OtherZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prior visit status

New patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oldpatient, newproblem . . . . . . . . . . . . . . . . . . . . .

Oldpatient, old problem.......,.. . . . . . . . . . . . .

Return visit ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

128,762

100.0

53.7

9.0

4.5

1.7

31.2

55.9

5.7

27.1

5.3

2.9

*0.1

1.8

1.2

8.7

37.6

53.7

10.5

61,278

100.0

54.6

8.7

4.4

1.3

31.0

56.8

5.6

27.9

4.1

3.0

“0.2

1.7

‘0.7

9.7

38.2

52.2

. 9.3

67,484

100.0

52.8

9.4

4,8

1.9

31.3

55.1

5.9

26.5

6.5

2.9

‘0.1

1.9

1.1

7.8

37.1

55.1

11.8

31,119

100.0

37.6

4.6

2.2

“0.5

55.2

41.6

2.9

51.5

2.3

“0.5

“0.2

“1.0

11.2

33.0

55.9

7.9

17,514

100.0

57.6

4.5

4.4

“1.8

31.7

60.4

3.9

28.8

3.1

2.8

“1.0

5.8

37.7

56.5

16.4

Number in thousands

33,910 23,979 11,778

Percant distribution

100.0

62.9

6.6

5.8

1.7

23.0

64.6

5.8

18.9

4.5

2.7

“0.2

2.8

“0.5

7.6

40.4

52.0

100.0 100.0

60.7 54.3

12.8 15.9

4.9 4.6

2.4 “2.0

19.2 23.2

62.0 55.0

7.5 7.6

15.7 18.1

8.2 9.8

3.5 6.2

●o. 1

1.9 “2.7 -

*1.1 “0.6

8.6 9.2

39.5 39.2

51,8 51.6

Return visit ratios

12.1 10.6 9.9

7,232

100.0

51.6

16.2

*4.6

*3.3

24.3

50.0

7.6

15.6

10.2

7.5

“0.2

7.1

*1.8

8.6

41.3

50.1

10.7

3,230

100.0

40.1

33.7

●9.4

●1.6

15.1

49.7

17.4

13.9

●7.9

●2.4

‘1.9

●6.8

10.4

24.3

65.2

8.6

11,178

100.0

63.1

5.7

●3.2

“0.9

27.1

63.7

“3.0

24.5

*1.7

●3.7

●1.4

‘2,0

.,.

,..

. . .

. . .

48,426

100.0

77.6

2.7

2.1

2.1

15.6

74.1

3.2

12.8

2.1

!3.4

“0.0

1.8

80.6

. . .

. . .

. . .

.

69,158

100.0

35.4

14.0

6.4

1.5

42.8

41.9

7.9

37.6

8.2

1.0

“0.3

1.8

1.3

. . .

. .

. . .

. . .

1Based rmA Reason for Visit Classification for Ambulatory Care (RVC).6

‘Includes blanks; problems, complaints rmt elsewhere classified; entries of “none”; and illegible entriaa.

3AII old patients divided by new patients.

.
., .. . . . . .. . . . . .

.-. . . . ., .?

Table 7. Number, percent and cumulative percent of office visits to pediatricians, by most frequent principaI raasons for visit United Statzx,

Januaw 1980-December 1981

—

Number

of Percent Cumulative

Principal reason for visit and RVC codel visits of percent of

in visitsz visits

thousands

Well baby examination orgeneral medical examination .- . . . . . . . . . . . . . . . . . . . . . . .. X1 OO. XIO5

Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..- . . . . . . .. S010

Earache, ear infection, or other symptoms referable to the ears,

nc,t elsewhere classified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S355. S365

cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S440

Symptoms referable to throat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S455

Head cold, upper respiratory infection (coryza) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...3445

Skin rash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S860

Allergy medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T100

Nasal congestion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S400

Vomiting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..~~~

Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Physical examination for school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A11O

,“ Otitis media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0450

Prophylactic innoculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X400

Progress visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T800

Headache, paininh ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S210

Wheezing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S425

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..- . . . . . . .. D625

Suture—insertion, removal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..- . . . .. T555

Allwgy, not otherwise specified.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S090

Stomsch pain, cramps, and spasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S545

General symptoms of infants, not elsewhere classified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S080

Abdominal pain, cramps snd spasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S550

Hay fever (allergic rhinitis) . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D635

Skin lesion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S865

Bronchitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D61O

Neck symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S900

Injections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T11O

—

1Based on A Reason for Visit Classification for Ambulatory Care (RVC).a

‘Based on a total of 12B,762,000 visits.

32,365

11,537

10,406

8,640

6,977

4,478

3,536

3,135

2,441

1,919

1,752

1,625

1,504

1,419

1,243

1,167

1,108

1,090

1,048

989

9B5

922

819

724

653

605

595

589

25.1

9.0

8.1

6.7

5.4

3.5

2.7

2.4

1.9

1.5

1.4.

1.3

1.2

1.1

1.0

0,9

0.9

0.8

0.8

0.8

0.8

0.7

0.6

0.6

0.5

0.5

0.5

0.5

25.1

34.1

42.2

48.9

54.3

57.8

60.5

62.9

64.8

66.3

67.7

69.0

70.2

71.3

72.3

73.2

74.1

74.9

75.7

76.5

77.3

78.0

78.6

79.2

79.7

80.2

80.7

81.2

.

27
.

Table 8. Number, percent, and cumulative percent of office visits to pediatricians, by age of patient and most frequent principal reasons for

visit United States, January 1980-December 1981

Number Number

Age of patient, principal of Percent Cumulative Age of patient, principal of Percent Cumulative

visits of

reason for visit, and J?VC codel percent of visits of

in visits visits

reason for visit, and RVC codel

percent of

in visits visits

thousands thousands .

Under 1 year

Well baby examination. . . . S105

Fever . . . . . . . . . . . . . . . . .. SOl O

Head cold, upper respiratory

infection (coryza) . . . . . . . S445

Cough . . . . . . . . . . . . . . . .. S44O

Earache, ear infection, or other

symptoms referable to the

ears, not eleewhere

classified . . . . . . . . S355, S365

Skin raah . . . . . . . . . . . . . . . S860

Diarrhea . . . . . . . . . . . . . . .. S595

Naaal congestion . . . . . . . . S400

Vomiting . . . . . . . . . . . . . .. S530

General symptoms of

infants . . . . . . . . . . . . . . .. S080

1 year

Well baby examination. . . . S105

Fever . . . . . . . . . . . . . . . . .. SOl O

Earache, ear infection or other

symptoms referable to the

eara, not elsewhere

classified . . . . . . . . S355, S365

Cough . . . . . . . . . . . . . . . .. S44O

Head cold, upper respirato~

infection (coryza) . . . . . . . S445

Skin rash . . . . . . . . . . . . . . . S860

Nasal congestion . . . . . . . . S400

2-5 yeara

General medical

examination . . . . . . . . . .. X1OO

Fever . . . . . . . . . . . . . . . . .. SOIO

Earache, ear infection, or other

symptoms referable to the

eers, not elsewhere

classified . . . . . . . . S355, S365

Cough . . . . . . . . . . . . . . . .. S44O

Symptoms referable to

throat . . . . . . . . . . . . . . . .. S455

Head cold, upper respiratory

infection (coryza) . . . . . . . S445

Physical examination for

school . . . . . . . . . . . . . . ..Al 10

Skin rash . . . . . . . . . . . . . .. S86O

15,697

2,173

1,459

1,455

1,317

916

874

707

698

575

4,675

2,535

1,865

1,353

893

594

474

5,743

4,498

4,221

3,399

1,879

1,393

922

905

50.4

7.0

4.7

4.7

4.2

2.9

2.8

2.3

2.2

1.8

26.7

14.5

10.6

7.7

5.1

3.4

2.7

16.9

13.3

12.4

10.0

5.5

4.1

2.7

2.7

50.4

57.4

62.1

66.8

71.0

73.9

76.7

79.0

81.2

83.0

26.7

41,2

51.8

59.5

64.6

68.0

70.7

16.9

30.2

42.6

52.6

58.1

62.2

64.9

67.6

6-10 yesrs

General medical

examination . . . . . . . . . .. X1OO

Symptoms referable to

throat . . . . . . . . . . . . . . . .. S455

Earache, ear infection, or other

symptoms referable to the

eara, not elsewhere

classified . . . . . . .. S355. S365

Fever . . . . . . . . . . . . . . . . .. SOl O

Cough . . . . . . . . . . . . . . . ..s440

Allergy medication . . . . . . . T100

Headache, pain in head. . . S21 O

Skin rash . . . . . . . . . . . . . . . S860

11-14 years

General medical

examination . . . . . . . . . .. X1OO

Symptoms referable to

throat. ..- . . . . . . . . . . . .. S455

Allergy medication . . . . . . . T100

Earache, ear infection, or other

symptoms referable to the

ears, not elsewhere

classified . . . . . . . . S355, S365

Cough . . . . . . . . . . . . . . . .. S44O

15-20 yeara

General medical

examination . . . . . . . . . .. X1OO

Symptoms referable to”

throat . . . . . . . . . . . . . . . .. S455

Allergy medication . . . . . . . T100

Cough . . . . . . . . . . . . . . . .. S44O

21 years and over

Hay fever (allergic

rhinitia) . . . . . . . . . . . . . .. D635

Allergy medication . . . . . . . T100

Prenatal examination,

routine . . . . . . . . . . . . . . .. X2O5

3,316

2.467

1,048

1,803

1,373

1,221

630

619

1,819

1,106

758

702

576

1.008

850

*393

*353

*275

*234

’200

13.8 13.8 “

10.3 24.1

8.1 32.2

7.5 39.7

5.7 45.4

5.1 50.5

2.6 53.1

2.6 55.7

5.4

9.4

6.4

6.0

4.9

13.9

11.8

*5.4

*4.9

*8.5

*7.2

●6,2

15.4

24.8

31.2

37.2

42.1

13.9

25.7

31.1

36.0

8.5

15.7

21.9

7Based on A Reason for Visit Classification for Ambulatory Care (RVC).6

28
.

.

.

...

Tabla 9. Numbar of office visits to pediatrician by sex and age of patient and prior visit status. and percent distribution by Principal diagnosis categories according to sex end age of patient and

.

prior visit status United Statee, January 1980–December 1981

Sex of patient Age of patient Prior visit status

>

Principal diagnosis category and ICD–9-CM code~ 21 yeara

Old Old

Both Female Male

Under 1 year

2-5 6-10 11-14 15-20 New

and

patient, patient,

sexes 1 year years yaars years years

ovar

patient new old

problem problem

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious and parasitic diseases. . . . . ...001-139

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . ..140-239

Endocrine, nutritional and metabolic diseases,

and immunity disorders . . . . . . . . . . . ...240-279

Mental disorders . . . . . . . . . . . . . . . . . . . . .290-319

Diseasea of the nervous system and sense

organs . . . . . . . . . . . . . . . . . . . . . . . . . ...320-389

Diseases of the circulatory system . . . ...390-459

Diseases of the respirato~ system . . . ...460-519

Diseases of the digestive system . . . . ...520-579

Diseases of the genitourinary system . ...580-629

Diseasas of the skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . ...680-709

Diseeses of the musculoskeletal system snd

connective tissue . . . . . . . . . . . . . . . . ...710-739

Symptoms, signs, and ill-defined

conditions . . . . . . . . . . . . . . . . . . . . . . ...780-799

Injury and poisoning. . . . . . . . . . . . . . . ...800-999

Supplementary classification. . . . . . . . . . . VOI -V82

All other diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . .

128,762

100.0

6.1

“0.2

0.6

0.5

14.8

●0.3

28.0

2.9

1.3

3.8

0.8

3.1

4.6

31.0

1.1

0.9

61,278

100.0

6.2

“0.1

‘0.7

“0.6

14.5

“0.4

26.6

3.2

1.9

4.1

“0.7

3.4

4.3

31.6

1.0

“0.6

67,484

100.0

6.0

‘0.2

“0.5

“0.5

15.2

*0.2

29.3

2.7

0.7

3.4

1.0

2.6

4.9

30.4

1.3

1.1

31,119

100.0

4.0

“0.2

“0.5

“0.1

12.1

*0.1

17.3

4.0

“0.5

3.6

“0.2

3.3

“0.7

51.0

1.9

‘0.7

t 7,514

100,0

6.5

●O!l

*0.2

25.3

●0,2

24.5

2.9

“0.3

3.3

“0.2

*2.O

3.5

29.8

‘0.3

‘1.0

Number in thousends

33,910 23,979 11,778

Percent distribution

100.0 100.0 100.0

6.9 7.9 6.3

“0.3 ●0.3

●0.3 ‘0.8 “1.0

‘0.3 ‘1.0 ●1.1

19.1 12.2 7.6

“0.3 ‘0.1 ●ocl

31.8 35.9 29.3

2.0 2.9 ●3.2

1.4 *1.5 *1.9

3.1 4.0 6.4

“0.4 *1.2 *2.9

2.8 3.6. 3.8

4.4 5.5 10.2

25,2 21.1 25.0

“1.0 *1.4 ‘0.5

“0.9 “0.9 *0’.7

7,232

I 00.0

●5.9

“0.1

●1.9

●1.1

*5.3

“0.9

29.4

*2.4

“4.6

●4.4

●1.9

“3.0

12.0

24.8

‘0.7

●1.6

3,230

100.0

●2.3

*1.5

*4.5

●7.4

●4.9

44.6

*2.9

*2.2

●2.4

*2.4

●1.1

*7,1

14,8

“1.3

“0.5

11,178

100.0

5.7

●0.6

“1.0

13.8

‘0.3

28.3

“3.0

●1.2

5.3

‘0.7

4.7

6.9

25.8

1.9

“0.9

48,426

100.0

10.5

“0.2

“0.4

“0.7

14.6

“0.0

30.1

5.5

1.6

6.6

1.5

4,2

6.3

16.1

1.0

‘0.8

69,158

100.0

3.1

.

“0.1

0.9

“0.4

15.2

‘0.5

26.5

1.1

1.1

;

1.6

“0.4

2.0

3.1

42.2

1.1 “

0.9

I Based on Irrternarional Classification of Diseases, 9rh Revision, Clinical Modification. g

rro
Table 10. Number, percent, and cumulative percent of office visits to pediatricians, by most frequent principal diagnoses: United States,

Januaty 1980-December 1981

Principal diagnosis and

ICD-9-CM codei

Number

of Percent Cumulative

visits of percent of

in visits2 visits

thousands

Principal diagnosis and

ICD-9-CM codel

Number

of Percent Cumulative

visits of percent of

in visitsz visits

thousands

Routine infant or child health

check, or general medical

examination . . . . . . V20.2, V70

Otitia media . . . . . . . . . 381, 382

Acute upper respiratory

infections of multiple or

unspecified sites. . . . . . ...465

Acute pharyngitis . . . . . . ...462

Acute bronchitis and

bronchiolitis or bronchitis,

not specified as acute or

chronic . . . . . . . . . ...466. 490

Acuta tonsillitis. . . . . . . . ...463

Asthma . . . . . . . . . . . . . . ...493

Allergic rhinitis (hay faver). .. 477

viral infections in conditions

fIOt classified elsewhere and of

unspecified site. . . . . . . . .. 079

Other noninfectious

gastroenteritis and

colitis . . . . . . . . . . . . . . . . . . 558

Streptococcal sore throat and

scarlet fever. ., . . . . . . . ...034.

Contact dermatitis and other

eczema . . . . . . . . . . . . . . . . 692

Observation and evaluation

forsuspected conditions. . . V71

33,339

15,998

8,856

6,144

4,016

3,477

3,415

3,162

2,126

2,121

1,753

1,723

1,621

25.9 25.9

12.4 38.3

6.9 45.2

4.8 50.0

3.1 53.1

2.7 55.8

2.7 58.5

2.5 61.0

1.7 62.7

1.6 64.3

1.4 65.7

1.3 67.0

1.3 68.3

1Based on International Classification of Diseases, 9th Revision, Clinic81 Modification. 9

2Basad on a total of 128,762,000 visits.

Desenaitization to

allergens . . . . . . . . . . . .. VO7.l

Allergy, unclassified . . ...995.3

influenza . . . . . . . . . . . . . ...487

Acute nasopharyngitis

(common cold) . . . . . . . ...460

Other diseaaea due to viruaea

and Chlamydiae . . . . . . . ..078

Pneumonia, organism

unspecified . . . . . . . . . . ...486

Disorders of external ear . ..380

Disorders of conjunctival. . ..372

Chronic sinusitis. . . . . . . ...473

Followup examination . . . . . V67

General symptoms . . . . . ...780

Acute Iaryngitia and

tracheitis . . . . . . . . . . . . . . . 464

Other disorders of urethra and

urinary tract ..,..........599

impetigo . . . . . . . . . . . . . ...684

Symptoms involving respirato~

systam and other chest

symptoms . . . . . . . . . . . ...786

Chronic pharyngitia and

nesopharyngitia. . . . . . . . . .472

1,112

1,057

1,051

1,015

976

959

946

912

896

850

813

790

756

664

659

647

0,9

0.8

0<8

0.8

0.8

0.7

0.7

0.7

0.7

0.7

0.6

0.6

0.6

0.5

0.5

0.5

69.2

70.0 -

70.8

71.6

72.4

73.1

73.8

74.5

75.2

75.9

76.5

77.1

77.7

78.2

78.7

79.2

30
. . . .. ----- . ..., .,.

,

. . . . . . .

Table 11. Number, percent and cumulative percent of office visits to pediatricians. by age of patient and most fraquant principal diagnoses:

LlrritedStates, Januaw 1980-December 1981

Number Number

Age ofpatienr, principal diagnosis,

of Percent Cumulative of Percent Cumulative Age ofpatient, principal diagnosis, visits

and ICD-9-CM codel

of percent of and ICD—9-CM code~

visits of

in visits

percent of

visits in visits visits

thousands thousands

Under 1 yea+

Routine infant or child

check . . . . . . . . . . . . . . .. V20.2

Otitia madia . . . . . . ...381.382

Acute uppar respiratory

infection of multiple or

unspecified sites. . . . . . ...465

Acute bronchitis and

bronchiolitis or bronchitis,

not specified as acute or

chronic . . . . . . . . . . ..466.49O

Other noninfectious

gastroenteritis and

colitis . . . . . . . . . . . . . . . ...558

A:ute pharyngitis . . . . . . ...462

Vral infections in conditions

classified elsewhere and of

unspecified sites. . . . . . . . . 079

1 yes$

Routine infant or child

check . . . . . . . . . . . . . . . . V20.2

Otitis media . . . . . . ...381. 382

Acute upper respiratory

infection of multiple or

unspecified sites. . . . . . ...465

Acute phetyngitis . . . . . . ...462

Bronchitis, not specified as

acute or chronic . . . . . . ...490

Acute tonsillitis. . . . . . . . ...463

2-5 yeara4

General medical

examination . . . . . . . . . . . ..V70

Chitis media . . . . . . ...381.382

Acute upper respirato~

infection of multiple or

unspecified sites. . . . . . ...465

Acute pharyngitis . . . . . . ...462

Acute tonsillitis. . . . . . . . ...463

Acute bronchitis and

bronchiolitis or bronchitis,

not specified as acute or

chronic . . . . . . . . . ...466. 490

~treptococcal aore throat and

scariet fader . . . . . . . . . . . . . 034

Aathms . . . . . . . . . . . . . . ...493

Observation and evaluation for

suspected conditions. . . . . V71

Viral infections in conditions

classified elsewhere and of

unspecified sits’s. . . . . . . . . 079

15,124

3.200

2,191

1,086

789

565

457

4,463

4,042

1,391

538

516

467

6,670

5,746

2,952

2,008

1,320

1,313

753

738

690

611

48.6

10.3

7.0

3.5

2.5

1.8

1.5

25.5

23.1

7.9

3.1

2.9

2.7

19.7

16.9

8.7

5.9

3.9

3.9

2.2

2.2

2.0

1.8

48.6

58.9

65.9

69.4

71.9

73.7

75.2

25.5.

48.6

56.5

59.6

62.5

65.2

19.7

36.6

45.3

51.2

55.1

59.0

61.2

63.4

65.4

67.2

2-5 yeara4-Con.

Contact dermatitis and

other eczema . . . . . . . . . . . 692

Other noninfectious

gastroenteritis and

colitis . . . . . . . . . . . . . . . ...558

6-10 year+

General medical

examination . . . . . . . . . . . ..V7O

Otitis media . . . . . . ...381.382

Acute pharyngitis . . . . . . ...462

Acute upper respiratory

infection of multiple or

unspecified sites. . . . . . ...465

Asthma . . . . . . . . . . . . . . ...493

Allergic rhinitis(hayfever). .. 477

Acute tonsillitis.. . . . . . . ...463

Streptococcal sore throat and

scariet fever . . . . . . . . . . . ..O34

Acute bronchitis and

bronchiolitis or bronchitis,

not specified as acute or

chronic . . . . . . . . . ...466. 490

influenza . . . . . . . . . . . . . ...487

Desansitization to

allergens ,... V07 . . . . .. VO7.I

11-14 yearse

General medical

examination. . . . . . . . . . . . . V70

Asthma . . . . . . . . . . . . . . ...493

Allergic rhinitis (hay fever). ..477

Acute pharyngitis . . . . . . ...462

Acute upper respirato~

infection of multiple or

unspecified sitas. . . . . . ...465

Otitis media . . . . . . ...361.382

15-20 years7

General medical

examination. . . . . . . . . . . . . V70

Acute pharyngitis . . . . . . ...462

Asthma . . . . . . . . . . . . . . ...493

Allergic rhinitis(hayfever]. .. 477

21 years and ove~

Allergic rhinitis (hay fever). ..477

Asthma . . . . . . . . . . . . . . ...493

504

469

3,655

2,200

1,918

1,471

1,103

1,039

984

540

519

480

471

1,887

594

593

577

502

460

1,392

457

“364

“359

614

●298

1.5

1.4

15.2

9.2

8.0

6.1

4.6

4.3

4.1

2.3

2.2

2.0

2.0

16.0

5.0

5.0

4.9

4.3

3.9

19.2

6.3

“5.0

85.0

19.0

9.2

68.7

70.1

15.2

24.4

32.4

38.5

43.1

47.4

51.5

53.8

56.0

58.0

60.0

16.0

21.0

26.0

30.9

35.2

39.1

19.2

25.5

30.5

35.5

19.0

28.2

1 Based on International Classification of Diseases. 9th Revision, Clinical Modification. 9

‘Based on a total of 31,119,000 visits.

3Based on a total of 17,514,000 visits.

4Based on a total of 33,910,000 visits.

‘Based on s total of 23,979,000 visits.

‘Based on a total of 11,778,000 visits.

‘Based on a total of 7,239,000 visits.

‘Based on a total of 3,230,000 visits.

31
Table 72. Number of office visits to pediatriciansby sex and age of petient and prior Visit stetus; percent of visits by diagnostic servica, nonrnedkatiorr therapy, sex and age of parkxrt, and prior

visit status; and percent distribution by numfmr of medications, according to sex and age of patient and prior visit statu% United Statea, Janue~ 1980–December 1981

Sex of patient Age ofpatient Prior visit status

Both Under 2 f years

Old

2-5 6-10

Old

Female Male 1 year

11-14 15-20 flew

sexes 1 year

patierrf,.

yesrs

and pstient,

years years years

over

patient new old

probtem problem

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oisgnostic servicel

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Limited histo~ and/or examination. . . . . . . . . . . . . .

Genersl history and/or examination . . . . . . . . . . . . .

Clinical Iaboratoty te.q . . . . . . . . . . . . . . . . . . . . . . . .

X-ray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Blood preaaure check........,.,., . . . . . . . . . . . .

Vkiontast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other ., . . . . . . . . . . .. j . . . . . . . . . . . . . . . . . . . . . . .

Nonmedication therapyt

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Physiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Office Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Therapeutic listening . . . . . . . . . . . . . . . . . . . . . . . . .

Diet counseling, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Family orsocial counseling . . . . . . . . . . . . . . . . . . . .

Medical counseling . . . . . . . . . . . . . . . . . . . . . . . . . .

Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of medications

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 . . . . ..-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. .$.,.. .

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

40rmore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

128,762

6.6

58.4

29.3

25.6

2,3

8.5

3.0

4.2

60.0

1.4

7.1

1.3

11.5

4.8

24.6

0.7

100.0

28.2

40.6

23.0

6.1

2.2

61.278

6.5

56.8

29.8

27.4

2.4

8.4

3.6

4.1

59.0

1.6

6.9

1.3

12.2

4.8

24.8

1.0

100.0

29.1

39.2

23.3

6.2

2.2

67,484

7.6

58.0

28.9

24.0

2.2

8.6

4.0

4.3

60.8

1.1

7.2

1.4

10.9

4.7

24.4

0.6

100.0

27.3

41.9

22.7

6.0

2.2

31,119

3.4

53.7

40.6

14.9

‘1.0

‘0.9

“0.5

t .5

51.5

*1.O

3.6

‘1.1

24.5

6.9

27.4

0.2

100.0

33.0

33.5

24.6

6.4

2.5

174514

3.1

63.6

29.5

17.6

*2.2

●2.2

“0.6

5.3

63.0

“0.7

5.3

*1.6

12.9

4.6

23.8

‘0.6

100.0

20.0

41.9

27.7

8.7

1.8

Number in thoussnds .

33,910 23,979 11,778

Percent of visits

3.9

62,6

26.9

29.1

1.9

8.1

5.3

5.2

64.3

1.3

7.5

“0.9

6.3

3.6

23,7

*0.5

9.5

57.9

24.5

34.6

2.5

11.9

5.6

5.7

63.0

“1.2

8.7

*1.6

5.4

4.3

24.8

“0.7

13.4

55.1

21.5

34.0

4.3

17.1

6.3

3.6

58.2

*2.2

11.7

1.7

5.9

4.4

24. ?

*2.4

Perceot dkwibution

100.0 100.0 100.0

26.1 27.3 34.1

39.9 47.3 42.5

24.6 19.3 18.1

6.8 4,6 *3.3

2.6 1.6 “2.0

7.232

11,7

54.8

27.6

34.9

●5.3

26.2

9.4

3.9

57.5

●2.7

12.4

‘2.0

6.4

“3.2

22.7

“1.9

100.0

33.3

45.5

17.7

*2.8

‘0.7

3,230

28,0

53.1

14.5

18.3

*3.6

23.2

‘0.3

“5.3

68.7

●3.3

*2.O

●1.7

81?.8

4.8

14.4

“0.4

100.0

20.4

42.2

21.5

*9.8

‘6.0

11,178

4.2

51.0

39.2

31.6

4.5

8.1

*3.7

6.0

50.7

*1,8

5.7

‘1.3

13.7

4.2

29.8

1.5

100.0

35.9

35.7

22.5

4.1

*1.9

48,426

2.3

67,3

23.5

26.3

2.9

6.6

2.8

2.1

58.8

2.4

6.8

1.0

9.9

2.9

26.2

0.8

100.0

26.5

42.3

23.6

5.5

2.1

69,158

10.1

53.3

31.8

24.2

1.5

9.9

4.5

5.4

62.2

“0.5

7.5

1.6

12.3

6.2

22.6

0.9

100.0

28.0

40.2

22.6

6.8

2.3

]Percents will not total’100.0 because more than 1 diagnostic sewice or nonmedication therapy may have been rendered during a visit,
. .

Table 13. Number of drugs mentioned in office visits to pediatricians by sex and age of patient and prior viait status, and percent distribution by therapeutic categories, according to sex and aga

of patiant and prim visit status Unitad States, Janua~ 1980-December 1981

Sex of patient Age of patient Prior visit status

Therapeutic category

old

Both Under 2-5 6-10 11-14 15-20

21 years

Female Male 1 year

New and patient,

sexes 1 year years years years years

over

patiant new

problem

All categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antihistamine drugs . . . . . . . . . . . . . . . . . . . . . . . . . .

Anti-infective agenta . . . . . . . . . . . . . . . . . . . . . . . . .

Autonomic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Central nervous system drugs.... . . . . . . . . . . . . . .

Diagnostic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Electrolytic, caloric, and water balance. . . . . . . . . . .

Expectorants and cough preparations. . . . . . . . . . . .

Eye, ear, nose, and throat preparations. . . . . . . . . . .

Gastrointestinal drugs . . . . . . . . . . . . . . . . . . . . . . . .

Hormones and synthetic substitutes. ., . . . . . . . . . .

Serums, toxoids and vaccines. . . . . . . . . . . . . . . . . .

Skin and mucous membrane preparations . . . . . . . .

Spasmolytic agents . ... . . . . . . . . . . . . . . . . . . . . . .

Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other, unclassified or undetermined. . . . . . . . . . . . .

146,515

100.0

15.2

30.1

2.6

4.9

4.2

0,6

6.7

3.1

1.7

1.6

17.4

5.9

2.2

0.9

2.8

69,571 76,944 34.925

1‘ilo.o 100.0 100.0

14.4 16.0 9.1

30.4 29.9 20.5

2.3 2.9 1.8

5.0 4.9 3.9

4.5 3.9 2.6

0.8 *0.4 ‘1.0

6.8 6.6 4.3

3.5 2.7 3.0

1.7 1.7 2.2

1.6 1.6 *1.2

17.6 17.2 35.7

6.2 5.7 7.3

1.5 2.9 1.6

1.0 0.8 *1.2

2.9 2.7 4.6

22,845

100.0

13.9

33.7

*1.4

3.7

2.7

“0.4

7.5

2.9

2.5

“1.1

21.1

5.2

1.9

“0.4

*1.6

Number in thousands

40,735 25,424 11,389

Percent distribution

100.0 100.0 100.0

14.5 20.3 23.2

36.6 34.8 25.0

2,3 4.3 4.1

5.0 5.1 6.6

4.7 5.4 6.6

*0.O “0,1 *0.1

8.7 7.0 6.1

3.1 3.0 4.3

1.4 ●1.1 1.1

1.6 2,1 *2.1

11.8 5.3 8.3

4.8 6.2 6.5

2.2 3.0 *3.4

“0.8 *0.6 “0.9

2.5 1.6 *1.8

6,693

100.0

18.4

28.0

“3.0

6.2

7.5

*0.7

“4.7

*2.7

●2.3

*1.5

13.0

7.3

*2.3

“0.4

●2.1

4,506

100.0

23.3

17.5

●3.8

11,7

“0.8

*7.1

*5.9

●1.8

*0.8

*3.7

●5.8

“4!1

*2.6

*3.8

●7,3

11,215

100.0

12.3

33.1

*3.2

5.3

*2.7

*0.4

7.7

4.0

“1.1

*1.9

12.0

8.8

*1.6

“0.6

5.3

55,518

100.0

13.0

35.2

2.8

7.4

2.7

“0.5

7.7

4.4

2.7

1.2

9.5

8.4

1.8

“0.5

2.1

Old

patient,

old

problem

79,783

100.0

17.3

26.2

2.4

3.2

5.4

0,7

5.8

2.0

1.1

1.8

23.7

3.7

2.6

1.2

3.0

1Based on the classification system of the American Hospital Formulary Sewice. a
Table 14. Number, percent, and cumulative percent of drug mentions in office visits to pediatricians, by name of most frequently mentioned

drugs: United States, Janua~ 1980-December 1981

Number of Percent Cumulative Number of Percent Cumulative

Name of drugl drug of percent of

Name of drugf drug of

mentions drug drug

percent of

mentions drug drug

in thousands mentions2 mentions in thousands merrtionsz mentions

,

Poliomyelitis vaccine. . . .

Diphtheria and tetanus

toxoids and pertussis

vaccine . . . . . . . . . . . . . .

Amoxicillin . . . . . . . . . . . .

Tuberculin tine test , . . . .

Allergy relief or shots . . .

Amoxil (arrwxiciilin). . . . .

Penicillin . . . . . . . . . . . . .

E.E.S. (erythromycin) . . . .

Dimetapp . . . . . . . . . . . . .

Ampicillin . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . .

Actifed . . . . . . . . . . . . . . .

Dimetane . . . . . . . . . . . . .

Rondec . . . . . . . . . . . . . . .

Phenergan . . . . . . . . . . . .

M-M-R (measles,

mumps, rubella virus

vaccine) . . . . . . . . . . . . .

Bicillin (penicillin) . . . . . .

Septra . . . . . . . . . . . . . . . .

Larotid (arnoxicillin). , . . .

Bactrim. . . . . . . . . . . . . . .

Tylenol . . . . . . . . . . . . . . .

Ceclor . . . . . . . . . . . . . . . .

Erythromycin . . . . . . . . . .

Naldecon . . . . . . . . . . . . .

Benad~i . . . . . . . . . . . . . .

Pen-Vee K . . . . . . . . . . . .

Ilosone (erythromycin). . .

Diphtheria and tetanus

toxoids . . . . . . . . . . . . . .

Vaccination

(undetermined). . . . . . . .

9,307

9,263

6,519

6,079

5,444

4,564

3,911

3,700

3,500

2,796

2,624

1,967

1,934

1,907

1,854

1,739

1,725

1,677

1,611

1,602

1,576

1,554

1,496

1,452

1,442

1,440

1,410

1,371

1,369

6.4

6.3

4.4

4.1

3.7

3.1

2.7

2.5

2.4

1,9

1.8

1.3

1.3

1.3

1.3

1.2 “

1.2

1,1

1.1

1.1

1.1

1.1

1.0

1.0

1.0

1.0

1.0

0.9

0.9

6.4

12.7

17.1

21.2

24.9

28.0

30.7

33.2

35.6

37.5

39.3

40.6

41.9

43.2

44.5

45.7

46.9

4B.O

49.1

50.2

51.3

52.4

53.4

54.4

55.4

56.4

57.4

58.3

59.2

V-Cillin (penicillin). . . . . .

Triaminic . . . . . . . . . . . . .

Novahistine . . . . . . . . . . .

Padiazole

(erythromycin) . . . . . . . .

Neoaporin . . . . . . . . . . . . .

Tusa-ornade . . . . . . . . . . .

Kflex . . . . . . . . . . . . . . . . .

Phenergan with

codeine . . . . . . . . . . . . . .

Cortisporin . . . . . . . . . . . .

Donnatal . . . . . . . . . . . . . .

Gantrisin . . . . . . . . . . . . . .

Mycolog y. . . . . . . . . . . . .

Robitussin . . . . . . . . . . . .

Benylin syrup . . . . . . . . . .

Donnagel . . . . . . . . . . . . .

Sudafed . . . . . . . . . . . . . .

Hydrocortisone . . . . . . . .

Rubella virus vaccine,

live . . . . . . . . . . . . . . . . .

Mycoatstin . . . . . . . . . . . .

Poly-vi-flor . . . . . . . . . . . .

Actifed-C . . . . . . . . . . . . .

Celestone . . . . . . . . . . . . .

Measles virus vaccine . . .

Quibron (theophylline). . .

Neo-synephrine . . . . . . . .

Slo-phyllin

(theophylline). . . . . . . . .

Influenza virus vaccine,

type A, B. . . . . . . . . . . . .

1,359

1,238

1,214

1,173

1,076

1,015

1,000

923

851

842

826

743

728

688

654

651

562

538

535

535

517

512

510

491

487

460

445

0.9

0.8

0.8

0.8

0.7

0.7

0.7

0.6

0.6

0.6

0.6

0.5

0.5

0.5

0.4

0.4

0.4

0.4

0.4

0.4

0.4

0.3

0.3

0.3

0.3

0.3

0.3

60.1

60.9

61.7 .

62.5

63.2

63.9

64.6

65.2

65.8

66.4

67.0

67.5

68.0

68.5

68.9

69.3

69.7

70.1

70.5

70.9

71.3

71.6

71.9

72.2

72.5

72.8

73.1

I Based on the physician’s entry on the Patient Record form,

2Baaed on @total of 146,515,000 drug mentions.

.

34
.,. . . ... , .-

.

Tal}le 15. Number, percent and cumulative parcent of druga mentioned in office visits to pediatricians, by ege of patient and name of most

fmquantly mentioned drug= Unitad Statea, January 1980-Decembar 1981

—

Number of Percent Cumulative Number of Percent

Age of patient and

Cumulative

drug of percent of Age of patient and drug of

name of drug~

percent of

mentions drug drug name of drug~ mentions drug drug

in thousands mentions mentions in thousands mentions mentions

—

Under 1 yea~

Diphtheria and tetanus

toxoids snd pertussis

veccme . . . . . . . . . . . . . . . .

Poliomyelitis veccine. . . . . .

Amoxicillin . . . . . . . . . . . . . .

Tuberculin tine test . . . . . . .

Amoxil (amoxicillin). . . . . . .

Dirnetap p. . . . . . . . . . . . . .

Rondec . . . . . . . . . . . . . . . . .

E.E.S. (erythromycin) . . . . . .

Septr a. . . . . . . . . . . . . . . . .

Tylenol . . . . . . . . . . . . . . . . .

Vaccination

(undetermined).. . . . . . . . .

1 yea~

M-LM-R (maaslea, mumps,

ruballa vinas vaccine). . . . .

Amoxicillin . . . . . . . . . . . . . .

Diphtheria and tetanus

toxoids and pertussis

wccma . . . . . . . . . . . . . . . .

Poliomyelitis vaccine. . . . . .

Amoxil (amoxicillin). . . . . . .

Dimetapp. . . . . . . . . . . . . . .

Tuberculin tine test . . . . . . .

Ampicillin . . . . . . . . . . . . . . .

E.E.S. (erythromycin) . . . . . .

Rondec . . . . . . . . . . . . . . . . .

Penicillin . . . . . . . . . . . . . . . .

Ce,clor . . . . . . . . . . . . . . . . . .

Actifed . . . . . . . . . . . . . . . . .

Sestra . . . . . . . . . . . . . . . . . .

2-5 years4

Amoxicillin . . . . . . . . . . . . . .

Tuberculin tine tast . . . . . . .

Diphtheria and tetanus

tc,xoids and pertussis

wccme.. . . . . . . . . . . . . . .

Poliomyelitis vaccine. . . . . .

Amoxil (amoxicillin) . . . . . . .

E.E.S. (erythromycin) . . . . . .

Penicillin . . . . . . . . . . . . . . . .

Dimetapp . . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . .

5,824

5,524

1,605

924

867

806

757

586

496

487

466

1,383

1,249

1,245

1,172

1,102

779

611

546

504

500

500

459

446

426

2,216

1,901

1,857

1,794

1,746

1,327

1,181

993

959

16.7

15.8

4.6

2.6

2.5

2.3

2.2

1.7

1.4

1.4

1.3

16.7

32.5

37.1

39.7

42.2

44.5

46.7

46.4

49.8

51.2

52.5

6.1 6.1

5.5 11.6

5.5 17.1

5.1 22.2

4.8 27.0

3.4 30.4

2.7 33.1

2.4 35.5

2.2 37.7

2.2 39.9

2.2 42.1

2.0 44.1

2.0 ‘ 46.1

1.9 48.0

5.4 5.4

4.7 10.1

4.6 14.7

4.4 19.1

4.3 23.4

3.3 26.7

2.9 29,6

2.4 32.0

2.4 34.4

2-5 years4-Con.

Ampicillin . . . . . . . . . . . . . . .

Allergy relief or shots . . . . .

Dimetane . . . . . . . . . . . . . . .

Actifed . . . . . . . . . . . . . . . . .

Phenergan . . . . . . . . . . . . . .

Bicillin (penicillin) . . . . . . . .

Erythromycin . . . . . . . . . . . .

Caclor . . . . . . . . . . . . . . . . . .

Imotid (amoxicillin).. . . . . .

Bactrim . . . . . . . . . . . . . . . . .

Ilosona (arythromycin) . . . . .

Tuss-omade . . . . . . . . . . . . .

Pediazole (erythromycin)...

Novahistine . . . . . . . . . . . . .

V-Cillin (penicillin) . . . . . . . .

6-10 yearss

Allargy ralief or shots . . . . .

Tuberculin tine test . . . . . . .

Penicillin . . . . . . . . . . . . . . . .

Amoxicillin . . . . . . . . . . . . . .

E.E.S. (arythromycin) . . . . . .

Amoxi[ (amoxicillin). . . . . . .

Dimetane . . . . . . . . . . . . . . .

Dimetapp . . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . .

Ampicillin . . . . . . . . . . . . . . .

V-Cillin (penicillin).. . . . . . .

Iloaonej (arythromycin).. . . .

11-14 yearas

Allergy relief or shots . . . . .

Tuberculin tins test . . . . . . .

Aspirin . . . . . . . . . . . . . . . . .

Penicillin . . . . . . . . . . . . . . . .

15-20 years7

Allergy relief or shots . . . . .

Tuberculin tine test . . . . . . .

Diphtheria and tetanus

toxoids . . . . . . . . . . . . . . . .

Penicillin . . . . . . . . . . . . . . . .

21 yaars and ova$

Allergy reliaf or shots . . . . .

797

763

695

676

626

596

580

574

559

548

544

490

484

467

450

1,937

1,366

1,278

1,013

773

586

566

539

519

500

474

473

1,284

751

●326

*31 3

688

504

“306

“227

665

2.0

1.9

1.7

1.7

1.6

1.5

1.4

1.4

1.4

1.3

1.3

1.2

1.2

1.1

1.1

7.6

5.4

5.0

4.0

3.0

2.3

2.2

2.1

2.0

2.0

1.9

1.9

11.3

6.6

2.9

2.7

10.3

7.5

4.6

3.4

14.8

36.4

38.3

40.0

41.7

43.2

44.7

46.1

47.5

48.9

50.2

51.5

52.7

53.9

55.0

56.1

7.6

13.0

18.0

22.0

25.0

27.3

29.5

31.6

33.6

35.6

37.5

39.4

11.3

17.9

20.8

23.5

10.3

17.8

22.4

25.B

14.8

1Based on the physician’a entry on the Patient Record I

‘Based on a total of 34,925,000 drug mentions.

3Based on a total of 22,845,000 drug mentions.

4Based on a total of 40,735,000 drug mentions.

5Based on a total of 25,424,000 drug mentions.

%ased on a total of 11 ,3 B9,000 drug mentions.

7Based on a totsl of 6,693,000 drug mentions.

aBased on a total of 4,506,000 drug mentions.

.

35
62

0)

Tabla 16. Numbar of office visits to pediatriciansby sex and age of patiant and prior visit status. and percent distribution by duration and disposition of visits, according to sex and age of patient

and prior visit status United States, January 1980–December 1981

Sex of patient Age of patient Prior visit status

Duration and disposition of visit Both

Old

Under 2-5 21 years

Old

Female Male 1 year

6-10 11-14 15-20 New

sexes 1 year

and patient, patient,

years years years years

over

patiant new old

problem problem

All visits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Duration of visit

O minutes! . . . . ---- . . . . . . . . . . . . . . . . . . . . . . . . .

1-5 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-10 minutas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11-15 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16-30 minutes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31minutes orlmtger . . . . . . . . . . . . . . . . . . . . . . . . .

Disposition of visitz

No followup planned . . . . . . . . . . . . . . . . . . . . . . . . .

Raturnat specified time . . . . . . . . . . . . . . . . . . . . . . .

Return if needed . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Telephone followup planned. . . . . . . . . . . . . . . . . . .

Referred to other physician . . . . . . . . . . . . . . . . . . . .

Returned to refarring physician. . . . . . . . . . . . . . . . .

Admit to hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

128,762

100.0

3.9

14.9

37.6

2s.5

13.3

1.9

15.8

49.8

30.6

5.6

2.3

“0.3

0.7

“0.1

61,278

100.0

3.5

14.3

39.2

27.7

13.7

1.7

15.5

49.1

31.1

6.0

1.9

‘0.4

0.9

“0.1

67,484

100.0

4.3

15.5

36.1

29.2

13.0

2.0

16.2

50.4

30.2

5.3

2.6

“0.3

“0.6

“0.1

31,119

100.0

2.6

9.9

3S.6

34.6

12.0

2.2

8.5

6s.6

22.1

3.6

1.5

*0.3

“1.0

“0.1

17,514

100.0

3.2

15.8

41.4

26.6

11.9

●1.1

14.5

54.5

29.5

4.1

“2.3

“0.7

“0.4

Number in thousands

33,910 23,979 11,77s

Percent distribution

100.0

2.5

14.9

40.4

28.8

12.1

1.5

20.3

40.6

34.9

6.2

2.0

“0.2

“0.5

*0.1

100.0

5.3

18.6

36.9

23.9

13.3

2.1

17.6

3s.1

37.9

7.8

2.1

“0.4

“0.7

●0.1

100.0

7.0

16.4

29.9

26.9

18.6

●1.3

1S.6

44.5

32.0

5.9

4.5

*o. 1

“0.6

“0.3

7,232

100.0

6.8

16.4

29.3

26.9

17.5

●3.1

21.5

42.5

30.0

6.6

●3.1

“0.2

●1.1

3,230

100.0

●6.5

22.2

26.4

21.0

18.3

●3.8

“1O.9

62.3

16.S

●7.7

●4.5

“2.2

11,178

100.0

“1.6

7.7

33.3

31.4

22.6

●3.4

14.7

48.0

30.6

4.9

●3.3

“2.0

“1.0

“0.5

48,426

100.0

2.6

15.0

42.5

27.3

10.7

2.0

19.6

35.1

38.6

8.4

2.3

“0.2

“0.5

“0.1

69,158

100.0

5.2

16.0

34.8

28.9

13.7

1.5

13.4

60.4

25.0

3.8

2.1

*0.2

0.8

“0.0

I Represents visits in which there was no face-to-face encounter betwaen patient and physician.

‘Percents will not total 100.0 because mare than 1 dispositicmwas possible.
Table 17. Number of office visits to pediatricians by mejor reason for visit and principal reason for visit module, and parcent of visits by

diagnostic aarvice, major reason for viait and principal reason for visit modules Unitad Statea, January 1980-December 1981

.

Number Diagnostic servicel

Major reason for visit and

of

visits Limited General

principal reason for visit module

Clinical Blood

in None history and/or history and/or [aborato~ X-ray Vision

pressure other

thousands examination examination test check test

Major reason for visit

.

Awte problem . . . . . . . . . . . . . . . . . . . . .

Chronic problem, routine . . . , . . . . . . . . .

Chronic problem, flareup . . . . . . . . . .. . .

Pcsteurga~ or postinjuty.. . . . . . . . . . . .

Noniilnes scare . . . . . . . . . . . . . . . . . . . .

Principal reaaon for viait module

and RVC code 2

Symptom module. . . . . . . . . S001 -S999

Disease module. . . . . . . . . . DOO1 -D999

Diagnostic, screening, and preventive

nlodule . . . . . . . . . . . . . . . .X100-X599

Treatment module . . . . . . .. TIOO-T899

injuries and adverse effacts

nlodule . . . . . . . . . . . . . . . .. JOOl-J999

Test results module. . . . . . . RI 00-R700

Administrative module. . . . .Al00-A140

69,085

11,639

5,784

2,128

40,128

71,995

7,366

34,942

6,869

3,747

’180

2,291

Percent of viaita

1.8 73.5 17.6 24.8 3.3 4.0 80.4

40.2 40.9 14.1 13.2 ●2.1 6.3 “0.5

2.7 69.1 21.8 19.6 “3.0 57.1

13.2 69.4 “9.3 ●8.4 “3.4 *5.8 “0.6

5.4 35.2 56.2 32.5 “0.5 17.2 11.3

2.3 71.7 19.5 24.8 2.6 4.4 ‘0.4

18.5 64.0 12.2 14.0 83:3 “3.6 “0.4

3.7 34.9 57.5 33.9 “0.6 15.5 9.8

52.0 39.1 ●5.5 ●5.5 “0.5 “4.4 “0.1

*4.6 70.2 15.8 ●8.1 14.1 ●8.6 “2.3

. ●57.2 *1 7.8 ~30.8 *1 1.2

26.1 65.4 59.0 ●2.7 57.0 43.5

2.4

6.4

5.3

●2.1

6.7

2.6

7.7

5.9

*3.3

“3.3

22.9

1Persemts will not tote.1 100.0 because more than 1 diagnostic setvice may hava been rendered during a visiL

‘Based on A Reason far Visit Classification ferAmbulatofy Care (RVC).6

T$}ble1S. Number of office visits to pediatrician by principal diagnosis categories; parcent distribution by numbar of medication, according

to principel diagnosis categonea; and percent of viaita with no nonmedication tfrerapy by principal diagnoaia catagorie~ Unitad Statea,

Jlanua~ 1980-December 1981

—

Number

of Number of medications Percent of

visits with

Principal diagnosis category and lCD-9-Ch4 codal visits no nonin

Total None 1 2 3 4 or more

medication

thousands therapy

.

All diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious snd perasitic diseases. . . . . . . . . . . . ...001-139

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Endocrine, nutritional and metabolic diseases, and

immunity d[sordere . . . . . . . . . . . . . . . . . . . . . . ...240-279

Mental diaordere . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319

Diseeses of the nervous system and sensa organs. .. 320-389

Diseases of the circulato~ system. . . . . . . . . . . ...390459

Diseaaes of the respireto~ system ., . . . . . . . . ...460-519

Diaeaaes of the digestive system. . . . . . . . . . . . ...520-579

Diseases of the genitourinary system . . . . . . . . ...580-629

Diaaasea of the skin and subcutaneous tissue . ...680-709

Diseasea of the musculoskeletal system and connective

tiaaue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-739

Symptoma, signs, andill-defirte dconditions . . ...780-799

Injury andpoiaoning . . . . . . . . . . . . . ., ...,......800-999

Supplementary classification . . . . . . . . . . . . . . . . . . VO1 -V82

‘A[lothar diagnoses . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . .

128,762

7,859

●196

765

689

19,108

416

36,059

3,767

1,646

4)839

1,077

3,936

5,943

39,906

1,458

100.0 28.2

100.0 30.2

100.0 ●56.6

100.0 ●54.2

100.0 “43.0

100.0 15.1

100.0 “20.6

100.0 “ ‘“9.8

100.0 39.1

100.0 35.9

100.0 11.5

100.0 59.6

100.0 46.8

100.0 52.8

100.0 43.4

100.0 48.0

Percent distribution

40.6

62.1

“31 .2

“27.0

“34.7

41.7

“20.0

48.3

38.0

45.0

51.4

“33.0

36.3

35.8

31.9

●26.8

23.0

12.6

*8.2

●22.3

31.4

●23.6

30.5

16.2

“13.7

23.5

*5.5

12.2

9.3

19.2

*21 .3

6.1

●3.2

●12.2

*10.1

8.9

●26.9

7.4

“6.1

●2.8

*8.9

“0.8

*3.2

“1.4

5.0

*2.9

2.2

●1.9

“0.6

2.9

“9.0

4.1

“0.6

*2.6

“4.8

“0.9

“1.5

“0.8

“0.4

‘1.0

60.0

64.1

●21 .0

●26.6

“29.0

71.8

●35.5

71.6

38.3

59.1

58.6

“40.6

54.9

42.7

50.4

50.5

lBes.ed onlnternationa/ Classification of Diseases, 9th Revision, t2inica/Modification (lCD-9-CM).g

.

37
w

03

Table 19. Number ofoffice visits topediatricians byseletied principal &agnosis categories, andpercent distribution byduration anddispostion ofvisks, according to selected principal

diagnosis categories: United States, Januaw1980-Decembar 1981

Principal diagnosis category and ICD-9-CM codel

Infectious Diseases of Diseases Diseases Diseases Diseasas of Symptoms,

Duration and disposition end the nervous of the of the of the the skin and Injury s!gns, and Supplementary

parasitic system and respiratory digestive genitourinery subcutaneous and ill-defined classification

diseases sense organs system system system tissue conditions poisoning

001-139 320–389

W1-W2

460-519 520-579 580-629 680-7Q9 780-799 800–999

Number of visite in thousanda

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Duration of visit

0minutes2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1-5 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-10 minutes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11-15 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16–30 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31minutes or longer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disposition of visits

No followup planned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Return at specified time . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Return if needsd. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Telephone followup planned . . . . . . . . . . . . . . . . . . . . . . . . .

Refsrrad to other physician . . . . . . . . . . . . . . . . . . . . . . . . . .

Returned to referring physician . . . . . . . . . . . . . . . . . . . . . . .

Admit to hospital . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .

Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7,859 19,108

100.0 100.0

6.1 ‘2.0

18.7 15.0

40.5 45.8

24.0 24.9

9.7 11.0

●0,9 ●1.3

20.9 12.0

20.2 61.4

46.8 24.2

11.6 3.9

*1.4 3.6.

“0.4 “0.3

“2.4 “0.5

80.2

36,059

100.0

4.1

19.7

39.9

24.5

9.7

2.1

15.9

35.4

41.4

9.2

“1.0

“0.6

“0.6

3,767

100.0

●3.9

“10.3

38.8

26.3

18.0

*2.8

12,4

32.5

42.2

14.9

“2.4

●3.2

“0.3

1,646 4,839

Percent distribution

100.0 100.0

“2.7 ●0.1

*1 4.4 22.1

30.8 40.6

27.4 26.8

●21 .2 7.5

●3.6 *3.1

*1O.3

45.0

34.2

●12.6

●8.7

“2.0

21.6

30.0

45.5

“4.3

“2.0

“0.3

3,936 5,943

100.0 100.0

“0.8 *3.8

*9.3 23.1

36.4 33.3

31.5 25.2

20.4 14.3

●1.7 “0.3

●11.O 21.2

42.1 36.0

39.5 34.7

12.0 *2.7

●4.1 “5.6

“0.4 “o. 1

‘1.2 “0.9

“0.1

39,906

100.0

4.7

8.7

32.2

35.9

16.7

1.6

16.4

69.5

17.3

“0.9

1.2

‘0.1

“0.2

“0.1

1Ba!jedon International Classification of Diseases, 9th Revision, Clinicel Modification (ICD-9-CM).9

2Represents visits in which there was no face-to-face encounter between patient and physician.

3Percrmts will not total 100.0 because more than 1 disposition was possible.
Appendixes

.

,

Contents

I. Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Statistical design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Scope oftiesuwey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sample design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data collection and processing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Field procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimation procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Inflation byreciprocals of probabilities of selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Adjustment for nonresponse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ratio adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reliability of estimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimates of aggregates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimates of percents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimates of rates where thenumerator isnot a subclass of the denominator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimates ofdifferences between twostatistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tests of significance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Population figures and rate computation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rounding of numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Systematic bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

II. Definitions ofcetitems usedhtiis repoti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terms relating tothe survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terms relating tothe Patient Record Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

III. Survey instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

btitiucto~`letier from Director. NCHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patient Record Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Induction Interview Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. tiericm Hospital Fomul~Sefice classification system adtierapeutic catego~ codes . . . . . . . . . . . . . . . . . . . . . . . .

List of appendix figures

I. Approxtiate relative stmdmdemors forestimated numbers ofofice visi@based onallphysician specialties (A), and

individual specialties (ii), 1980–81 National kbulato~Medcal Cme Sumey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

II. Approxhate relative stindud emorsfor estimated numbers oftigmentions based onall physician specialties(A),

. andindividual specialties (13), 1980-81 National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

List of appendix tables

.

I. Distribution of physicians in the 1980–81 National Ambulatory Medical Care Survey sample and response rates, by

physician specialty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

H. Estimates of the civilian noninstitutionalized population of tie United States used incomputing annual visit rates in

thisreport, byage, race, andsex: 1980-81 . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

40

40

40

40

40

40

41

41

42

42

42

42

42

45

45

45

45

45

46

46

46

47

47

47

50

50

51

52

60

41

46

43

44

,

39
Appendix I

Technical notesc

This report is based on data collected during 1980 and

1981 in the National Ambulatory Medical Care Survey

(NAMCS), an annual sample survey of ofice-based physicians conducted by the Division of Health Care Statistics of

the National Center for Health Statistics (NCHS). The two

surveys were conducted with identical instruments, definitions,

and procedures. Two years of data were combined to increase

the reliability of the estimates. The annual survey design and

procedures are presented in the following sections.

Statistical design

Scope of the survey

The target population of NAMCS includes oflice visits

made within the conterrninous United States by ambulatory

patients to nonfederally employed physicians who are principally engaged in office-based patient care practice, but not in

the specialties of anesthesiology, pathology, or radiology. Telephone contacts and nonotllce visits are excluded from

NAMCS.

Sample design

The NAMCS utilizes a three-stage survey design that involves probability samples of primary sampling units (PSU’S),

physician practices within PSU’S, and patient visits within physician practices. The first-stage sample of 87 PSU’S was selected by the National Opinion Research Center (NORC) of

the University of Chicago, the organization responsible for

NAMCS field and data processing operations under contract

to NCHS. A PSU is a county, a group of adjacent counties,

or a standard metropolitan statistical area (SMSA). A modified probability-proportional-to-size procedure using separate

sampling lku-nes for SMSA’S and for nonmetropolitan counties

was used to select the sample PSU’S. Each frame was stratified

by region, size of population, and demographic characteristics

of the PSU’S, and was divided into sequential zones of 1 million residents; then, a random number was drawn to determine

which PSU came into the sample from each zone.

The second stage consisted of a probability sample of practicing physicians, selected from the mastetilles maintained by

the American Medical Association (AMA) and the American

Osteopathic Association (AOA), who met the following criteria:

. Ofiice-based, as defined by AMA and AOA.

● Principally engaged in patient care activities.

cPrepared by Thomas McLemore, Division of Health Care Statistics.

●

●

Nonfederally employed.

Not in the specialties of anesthesiology, pathology, clinical pathology, forensic pathology, radiology, diagnostic

radiology, pediatric radiology, or therapeutic radiology,

Within each PSU, all eligible physicians were sorted by

nine specialty groups: general and family medicine, internal

medicine, pediatrics, other medical specialties, general surgery,

obstetrics and gynecology, other surgical specialties, psychiatry, and all other specialties. Then, within each PSU, a systematic random sample of physicians was selected so that the

overall probability of selecting any physician in the United

States was approximately constant.

During 1980–81 the NAMCS physician sample included

5,805 physicians. Sample physicians were screened at the time

of the survey to ensure that they met the aforementioned criteria; 1,124 physicians did not meet the criteria and were,

therefore, ruled out of scope (ineligible) for the study. The most

common reasons for being out of scope were that the physician

was retired, deceased, or employed in teaching research, or

administration. Of the 4,681 inscope (eligible) physicians, 3,676

(78.5 percent) participated in the study. Of the participating

physicians, 509 saw no patients during their assigned reporting

period because of vacations, illnesses, or other reasons for being temporarily out of office-based practice. The physician sample size and response data by physician specialty are shown

in table I.

The third stage was the selection of patient visits within

the amual practices of the sample physicians. This stage involved two steps. Firsg the total physician sample was divided

into 52 random subsamples of approximately equal size; then

each subsample was randomly assigned to 1 of the 52 weeks

in the survey ~~ear. Second, a systematic random sample of

visits was selected by the physician during the assigned reporting week. The visit sampling rate varied for this final step from

a 100 percent sample for very small practices to a 20 percent

sample for very large practices. The method for determining

the visit sampling rate is described later in this appendix and

in the Induction Interview form in appendix III. During 1980–

81, sample physicians completed 89,447 usable Patient Record forms.

Data collection and processing

Field procedures

Both mail and telephone contacts were used to enlist sam- -

ple physicians for NAMCS. Initially, physicians were sent introductory letters from the Director of NCHS (see appendix

III). When appropriate, a letter from the physician’s specialty

40
Table i. Distribution of physicians in the 1980-81 National Ambulatory Medictil Care Survey samples and rasponse rates, by physician speciafty

Physician specialty Gross totai Out of scope Net total Nonrespondents Respondents Response

rate

* All specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General and fami[y practice . . . . . . . . . . . . . . . . . . . . . . . .

Medical specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Internal medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

pediatrics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other medicai specialties . . . . . . . . . . . . . . . . . . . . . . . .

Surgical specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12bstetrics and gynecology . . . . . . . . . . . . . . . . . . . . . .

Other aurgical specialties . . . . . . . . . . . . . . . . . . . . . . . .

Other specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Others pecialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5,805

1,340

1,695

871

414

410

1,978

521

484

973

792

414

378

1,124

289

296

158

83

55

246

75

71

100

293

96

197

4,681

1,051

1,399

713

331

355

1,732

446

413

873

499

318

181

1,005

272

298

182

42

74

351

115

63

173

84

43

41

3,676

779

1,101

531

289

281

1,381

331

350

700

415

275

140

78.5

74,1

78.7

74.5

87.3

79.2

79.7

74.2

84.7

80.2

83.2

86.5

77.3

.

organization endorsing the survey and urging his participation

was enclosed with the NCHS letter. Approximately 2 weeks

prior to the physician’s assigned reporting period, a field representative telephoned the physician to explain briefly the study

and arrange an appointment for a personal interview. Physicians who did not initially respond were usually recontacted

via telephone or special explanatory letter and requested to

reconsider participation in the study.

During the personal interview the field representative determined the physician’s eligibility for the study, obtained his cooperation, delivered survey materials with verbal and printed

instructions, and assigned a predetermined Monday-Sunday

reporting period. A short induction interview concerning basic

practice characteristics, such as type of practice and expected

number of oflice visita, was conducted. OffIce staff who were

to assist with data collection were invited to attend the instructional session or were offered separate instructional sessions.

The field representative telephoned the sample physician

prior to and during the assigned reporting week to answer questicns that might have arisen and to ensure that survey procedures were going smoothly. At the end of the reporting week,

the participating physician mailed the completed survey materkds to the field representative who edited the forms for completeness before transmitting them for central data processing.

At this point problems of missing or incomplete data were resolved by telephone followup by the field representative to the

sample physician; if no problems were found, field procedures

were considered complete regarding the sample physician’s participation in NAMCS.

Data collection

The actual data collection for NAMCS was carried out by

the physician, assisted by his office staff when possible. Two

dnta collection forms were employed by the physiciam the Patient Log and the Patient Record form (see append~ III). The

Patient Log, a sequential “listing of patients seen in the physician’s office during his assigned reporting week, served as the

sampling frame to indicate the oflice visits for which data were

to be recorded. A perforation between the patient’s name and

patient visit information permitted the physician to detach and

retain the listing of patients, thus, assuring the anonymity of

the physician’s patients.

Based on the physician’s estimate of the expected number

of office visits and expected number of days in practice during

the assigned reporting week each physician was assigned a

visit sampliig rate. The visit sampling rates were designed so

that about 30 Patient Record forms would be completed by

each physician during the assigned reporting week. Physicians

expecting 10 or fewer visits per day recorded data for all visits.

Those physicians expecting more than 10 visits per day recorded data for every secon& third, or fifth visit based on the

predetermined sampling interval. These visit sampliig procedures minimized the physician’s data collection workload and

maintained approximately equal reporting levels among sample

physicians regardless of practice size. For physicians recording

data for every second, third, or fifth patient visit, a random

start was provided on the fmt page of the Patient Log so that

the predesignated sample visits recorded on each succeeding

page of the Patient Log provided a systematic random sample

of patient visits during the reporting period.

Data processing

In addition to followups for missing and inconsistent data

made by the field sti, numerous clerical edits were performed

on data received for central data processing. These manual

edh procedures proved quite efflcien~ reducing item nonresponse rates to 2 percent or less for most data items.

Information contained in item 6 (Patient’s problem or reason for visit) of the Patient Record form was coded according

to A Reason for Visit Classification for Ambulatory Care

(RVC).C Diagnostic information (item 9 of the patient Record

form) was coded according to the International Classz~cation

of Diseases, 9th Revision, Clinical Modz#7cation (ICD-9-

CM).9 A maximum of three entries were coded from each of

these items. Prior to coding, Patient Record forms were grouped

into batches with approximately 650 forms per batch. Quality

control for the medical coding operation involved a two-way

5-percent independent verificathn procedure. Error rates were

defined as the number of incorrectly coded entries divided by

the total number of coded entries. The estimated error rates

for the 1980–8 1 medical coding operation were 1.7 percent for

NOTE: A list of references follows the text.

41
item 6 and 2.3 percent for item 9. Additionally, a dependent

verification procedure was used to review and adjudicate all

records in batches with excessive error rates. This procedure

fiu-ther reduced the estimated error rates to 1.6 percent for item

6 and 2.1 percent for item 9.

The NAMCS medication data (item 11 of the Patient Record form) was classified and coded according to a scheme developed at NCHS based on the American Society of Hospital

Pharmacists’ Drug Product Information File. A description of

the new drug coding scheme and of the NAMCS dmg data

processing procedures is contained in Vital and Health Statistics, Series 2, No. 90.7 A two-way 100 percent independent verification procedure was used to control the medication

coding operation. As an additional quality control, all Patient

Record forms with differences between drug coders or with

illegible drug entries were reviewed and adjudicated at NCHS.

Information from the Induction Interview and Patient Record forms was keypunched with 100 percent verification and

converted to computer tape. At this point, extensive computer

consistency and edit checks were performed to ensure complete and accurate data. Incomplete data items were imputed

by assigning a value from a randomly selected Patient Record

form with similar characteristics; patient sex and age, physician specialty, and broad diagnostic categories were used as

the basis for,these imputations.

Estimation procedures

Statistics from NAMCS were derived by a multistage estimation procedure that produces essentially unbiased national

estimates and has three basic components: (1) inflation by reciprocals of the probabilities of selection, (2) adjustment for nonresponse, and (3) a ratio adjustment to f~ed totals. Each component is briefly described below.

Inflation by reciprocals of probabilities of selection.

Because the survey utilized a three-stage sample design,

three probabilities of selection existed (1) the probability of

selecting the PSU, (2) the probability of selecting the physician

within the PSU, and (3) the probability of selecting an office

visit within the physician’s practice. The third probability was

defined as the number of oftice visits during the physician’s

assigned reporting week divided by the number of Patient Record forms completed. All weekly estimates were inflated by a

factor of 52 to derive annual estimates.

Adjustment for nonresponse

NAMCS data were adjusted to account for sample physicians who were inscope, but did not participate in the study.

This adjustment was calculated in order to minimize the impact of response on final estimates by imputing to nonresponding physicians the practice characteristics of similar responding

physicians. For this purpose, physicians were judged similar if

they had the same specialty designation and practiced in the

same PSU.

NOTE: A list of references follows the text.

42

Ratio adjustment

A poststratification adjustment was made withifi each of

nine physician specialty groups. The ratio adjustment was a

multiplication factor that had as its numerator the number of

physicians in the universe in each physician specialty group

and as its denominator the estimated number of physicians i:

that particular specialty group. The numerator was based on

figures obtained from the AMA and AOA master files, an{

the denominator was based on data from the sample.

Reliability of estimates

As in any survey, results are subject to both sampling and

nonsampling errors. Nonssmpling q-rors include reporting and

processing errors, as well as biases due to nonresponse and

incomplete response. ne magnitude of the nonsarnpling errors

cannot be computed. However, these errors were kept to a minimum by procedures built into the survey’s operation. To eliminate ambiguities and encourage uniform reporting, careful

attention was given to the phrasing of questions, terms, and

definitions. Also, extensive pretesting of most data, items and

survey procedures was performed. The steps taken to reduce

bias in the data are discussed in the sections on field procedures and data collection. Quality control procedures and consistency and edit checks discussed in the data processing section reduced errors in data coding and processing. However,

because survey results are subject to sampling and nonsampling

errors, the total error will be larger than the error due lo sampling variability alone.

Because the statistics presented in this report are based on

a sample, they differ somewhat from the figures that would be

obtained if a complete census had been taken using the same

forms, definitions, instructions, and procedures. However, the

probabdity design of NAMCS permits the calculation of sampling errors. The standard error is primarily a measure of

sampling variability that occurs by chance because only a

sample rather than the entire population is surveyed. The standard error, as calculated in this report, also reflects part of the

variation that arises in the measurement process, but does not

include estimates of any systematic biases that may be in the

data. The chances are about 68 out of 100 that an estimate

from the sample would differ from a complete census by less

than the standard error. The chances are about 95 out of 100

that the difference would be less than twice the standard error,

and about 99 out of 100 that it would be less than 21Atimes

as large.

The relative standard error of an estimate is obtained by

dividing the standard error by the estimate itself and is expressed as a percent of the estimate. For this report, an asterisk (*) precedes any estimate with more than a 30 percent relative standard error.

Estimates of sampling variability were calculated using the

method of half-sample replication. This method yields overall

variability through observation of variability among random

subsamples of the total sample. A description of the development and evaluation of the replication technique for error estimation has been published.14’*5 Approximate relative standard

errors for aggregate estimates are presented in figures I and II.

.
. .

100

90

80

70

60

50

40

30

20

6

5

4

3

2

0.:

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

100

90

80

70

60

50

40

30

20

10

9

8

7

6

5

4

3

2

:.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

A 2 3 4 56789A 2 3 4 56789A 2 3 4 66789A 2 3 456789A 2 3 456789A

100 1,000 10,000 100.000 1,000,000 10,000,000

Size of esttmate(in thousands)

EXAMPLE: An estimate of 20 million off!cc visits to general surgeons (read from scale at bottom of chart) has a relative standard error of 7.7 parcent (read from cuwe B on scale at left of chart) or a standard error

of 1,540,000 office visits (7.7 percent of 20 million wsita).

Figure 1, Approximate relativestandard errorsfor estimated numbers of office visits based on all physician specialties (.4),and individual spacialtias(8), 1980-81National Ambulatory Madical

8 Care Survey
100

90

80

70

60

50

40

30

20

10

:

7

6

5

4

3

2

;.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

A 2 3 456789A 2 3 456789A 2 3 466789A 2 3 456789A 2 3 456789A

100 1,000 ?0.000 100,000 1,000,000 10,000,000

Size of estimate(in thousands)

EXAMPLE: An estimate oi 60 million drug mentions (read from scale at bottom of chart) has a relative standard error of 5.1 percent (read from cuwe A on scale at left of chart) or a standard error of 3,060,000 drug

mentions (5.1 percent of 60 million drug mendona).

Figure Il. Approximaterelativestandarderrorsfor estimatednumbers of drug mentions based on all physicianspecialties(A), and individual specialties(8), 1980-81 National Ambulatory Medical

Care Survey

.

.

. ●
.

.

To derive error estimates that would be applicable to a wide

variety of sta&tics and could be prepared at moderate cost,

several approximations were required. As a result, the relative

standard errors shown in figures I and II should be interpreted

as approximate rather than exact for any specific estimate. Directions for determining approximate relative standard errors

follow.

Estimates of aggregates

Approximate relative standard errors (in percent) for aggregate statistics are presented in figures I and II. The approximate relative standard errors for aggregate estimates of oflIce

visits are shown in figure I, and the approximate relative standard errors for aggregate estimates of dmg mentions are shown

in figure II. In each figure, curve A represents the relative

standard errors appropriate for estimates based on all physician specialties, and curve B represents relative standard errors appropriate for estimates based on an individual physician

specialty. For the specific case where the aggregate estimate

of interest is the number of mentions of a specific drug, for

example, the number of mentions of Dyazide, figure I, curve

B should be used to obtain approximate relative standard

errors.

Instead of using figures I and II, relative standard errors

fcr aggregate estimates may be calculated directly using the

following formulae where x is the aggregate estimate of interest in thousands. For visit estimates based on all physician

specialties,

RSE(X) =

~’”””

For visit estimates based on an individual physician specialty,

RSE(X) =

~’”””

For drug mention estimates based on all physician specialties,

For drug mention estimates based on an individual physician

specialty,

Estimates of percents

Approximate relative standard errors (in percent) for estimates of percents may be calculated from figures I and II as

follows. From the appropriate curve obtain the relative

standard error of the numerator and denominator of the

percents. Square each of the relative standard errors, subtract

the resulting value for the denominator from the resulting value

for the numerator, and extract the square root. This approximation is valid if the relative standard error of the denominator

is less than 0.05 or if the relative standard errors of the

numerator and denominator are both less than 0.10,

Alternatively, relative standzwd errors for percentages

may be calculated directly using the following formulae where

p is the percent of interest and x is the base of the percent in

thousands. For visit percentages based on all physician specialties,

RSE(p) =

d

39.84195 .(1 –p) .1000

p.x

For visit percentages based on an individual physician specialty,

-)’-’””

For drug mention percentages based on all physician specialties,

RSE@) =

d

58.48328 .(1 –p) .1000

p.x

For drug mention percents based on an individual physician

specialty,

Estimates of rates where the numerator

is not a subclass of the denominator

Approximate relative standard errors for rates in which

the denominator is the total United States population or one

or more of the age-sex-race groups of the total population are

equivalent to the relative standard error of the numerator that

can be obtained fkom figures I or II.

Estimates of differences between

two statistics

The relative standard errors shown in this appendix are

not directly applicable to differences between two sample estimates. The standard error of a difference is approximately the

square root of the sum of squares of each standard error considered separately. This formula represents the standard error

quite accurately for the difference between separate and uncorrelated characteristics, although it is only a rough approximation in most other cases.

Tests of significance

In this report, the determination of statistical inference is

based on the t-test with a critical value of 1.96 (0.05 level of

significance). Terms relating to dfierences, such as “higher,”

and “less” indicate that the differences are statistically significant. Terms such as “similar” or “no difference” mean that

no statistical significance exists between the estimates being

compared. A lack of comment regarding the difference be~een

any two estimates does not mean that the difference was tested

and found to be not significant.

45
Table IL Estimates of the civilisn noninstitutionalized population of the United States used in computing average annual visit rates in this

publication, by age, sex, end race of patient United States, 1980-81

Sex Race

Age Both Mate Female White Bfack

All

sexes other

Allagesl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under l year..............,.. . . . . . . . . . . . . . . . . . . . . . .

l year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2-5 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-10 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11-14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-20 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

222,674

3,524

3,400

12.754

16,759

14,354

24,313

747,570

107,429

1,804

1,740

6,522

8,568

7,351

12,118

69,326

115,244

1,720

1,661

6,232

8,190

7,002

12,196

78,245

191,052

2,846

2,776

10,425

13,785

11,860

20,309

129,062

26,107 5,575

572 109

518 707

1,913 417

2,511 463

2,117 377

3,393 - 612

15,083 3,430

1Figures may not add to totala due to rounding.

NOTE: Excludes Alaaka and Hawaii.

Population figures and rate

computation

The population figures used in computing &mual visit

rates are presented in table II. The figures are based on an

average of the July i, 1980, and July 1, 1981, estimates of

the civilian noninstitutionalized population of the United

States provided by the U.S. Bureau of the Census. Because

NAMCS includes data for only the conterminous United

States, the original population estimates were modified to account for the exclusion of Alaska and Hawaii from the study.

For this reason, the population estimates should not be considered official and are presented here solely to provide denominators for rate computations.

Estimates of numbers of visits and drug mentions in this

report are for a 2-year period, but ratios and rates represent

average annual estimates. For example, the average annual

visit rates are calculated as follows. The numerator is obtained

by dividing the estimated number of oftlce visits for 1980-81

by 2 to obtain an average annual number of oflice visits. This

number is then divided by the appropriate population figure to

obtain an average annual visit rate. As previously discussed,

estimates of reliability for average annual visit rates may be

calculated from figures I and II.

Rounding of numbers

Estimates presented in this report are rounded to the nearest thousand. For this reason detailed figures within tables do

not always add to totals. Rates and percents are calculated on

the basis of the original, unrounded figures and may not necessarily agree precisely with percents calculated from rounded

data.

Systematic bias

No formal attempt was undertaken to determine or measure

systematic bias in the NAMCS data. But it should be noted

that there are several factors affecting the data which indicate

that these data undevepresent the total number of oilice visits.

Some of these factors are briefl y discussed below.

. Physicians who participated in NAMCS did a thorough

and conscientious job in keeping the Patient LOG however,

post survey interviews with participating physicians indicate that a small number of patient visits may have been

accidentally omitted from the Patient LOG although this

number is quite small, such omissions would result in an

undercoverage of oftice visits.

The same post survey interviews indicate that the inclusion of patient visits that did not actually occur was

infrequent and would have” a negligible effect on survey

estimates.

● As previously stated, the physician universe for the

1980-81 NAMCS included all nonfederal, office-based,

patient-care physicians on the AMA and AOA mastetlles.

The NAMCS was designed to provide statistically unbiased estimates of ofilce visits to this designated population. Not included in the universe were physicians who

were classified as federally employecL or hospital-based;

or who were principally engaged in research, teaching, administration, or other nonpatient care activity. Consequently, ambulatory patient visits to these physicians in

an ot%ce setting would not be included in NAMCS estimates. In an attempt to measure the number of office visits

to physicians not in the NAMCS universe, a NAMCS

Complement Survey was conducted in 1980. This study

involved a sample of approximately 2,000 physicians

selected from among the 230,000 physicians in the AMA

and AOA mastefllles who were not eligible (in scope) for

the 1980 NAMCS. Details of the Complement Survey

methodology and results are forthcoming. Preliminary results indicate that about 17 percent of the Complement.

Survey physicians saw some ambulatory patients in an

otlice setting and that an estimated 69 million office visits

were made to these physicians in 1980. .

46
.

Appendix II

Definitions of certain terms

used in the report

Terms relatirw to the survev ● Patients who contact and receive advice from the

Oflce-Premises identified by physicians as locations for

physician via telephone.

their ambulatory practices. The responsibility over time for

. Patients who come to the office only to leave a specpatient care and professional services rendered there generaIIy

imen, to pick up insurance forms, or to pay a bill.

● Patients who come to the ofice only to $ck up medresides with the individual physician rather than with any in- dications previously prescribed by the physician.

stitution.

Ambulatov patient—An individual seeking personal

health services who is neither bedridden nor currently admitted

to any health care institution on the premises.

Physician—Classitled as eithe~

● In scope—All duly licensed doctors of medicine or doctors of osteopathy currently in practice who spend some

time caring for ambulatory patients at an ofllce location.

●’ Out of scope—Those physicians who treat patients only

indirectly, including physicians in the specialties of anesthesiology, pathoIogy, forensic pathology, radiology, therapeutic radiolom, and diagnostic radiology, and the following physicians:

● Physicians who are federally employed, including

those physicians in military service.

. Physicians who treat patients only in an institutional

setting, for example, patients in nursing homes and

hospitals.

● Physicians employed fill time in industry or by an

institution and having no private practice, for example,

physicians who work for the Veterans’ Administration or the Ford Motor Company.

. Physicians who spend no time seeing ambulatory patients, for example, physicians who only teachj are engaged in research, or are retired.

Patients—Classified as eithe~

o In scope—All patients seen by the physician or a staff

member in the oftlce of the physician.

o Out ofscope–Patients seen by the physician in a hospital,

nursing home, or other extended care institution, or in the

patient’s home. (Note: If the physician has a private office, meeting the definition of “office,” located in a hospital, the ambulatory patients seen there are considered

in scope.) The following types of patients are considered

out of scope:

● Patients seen by the physician in an institution, includh-ig outpatient clinics of hospitals, for whom the

institution has primary responsibility over time.

Visit—A direct, personal exchange between an ambulatory patient and a physician or a staff member for the purpose

of seeking care and rendering health services.

Physician specialV—Principal specialty, including general practice, as designated by the physician at the time of the

survey. Those physicians for whom a specialty was not obtained

were assigned the principal specialty recorded in the physician

master files maintained by the American Medical Association

or the American Osteopathic Association.

Reg”on of practice location-The four geographic regions,

excluding Alaska and Hawtil, that correspond to those used

by the U.S. Bureau of the Census:

Region States includad

Northeast. . . . . . Connecticut, Maine, Massachusetts, New

Hampshire, New Jarsey, New York,

Pennsylvania, Rhode Island, and

Vermont

North Central . . . illinois, Indiana, Iowa, Kanaaa, Michigan, Minnesota, Missouri, Nebraaka,

North Dakota, Ohio, South Dakota, and

Wisconsin

South . . . . . . . . . Alabama, Arkansaa, Delaware, District

of Columbia, Florida, Georgia, Kentucky, Louisisna, Msryland, Mississippi,

North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and

West Virgins

West . . . . . . . . . . Arizona, California, Colorado, Idaho,

Montsna, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming

Metropolitan status of practice location—A physician’s

practice is classified by its location in a metropolitan or nonmetropolitan area. Metropolitan areas are standard metropolitan

statistical areas (SMSA’S) as defined by the U.S. OffIce of

Management and Budget. The definition of an individual

SMSA involves two considerations: first, a city or cities of

specified ‘@pulation that constitute the central city and identify

the county in which it is located as the central county; second,

economic and social relationships with “contiguous” counties

that are metropolitan in character so that the periphery of the

specific metropolitan area may be determined. SMSA’S may

47
cross State lines. In New England, SMSA’S consist of cities

and towns rather than counties.

Terms relating to the

Patient Record Form

Age—The age calculated from date of birth was the age

at last birthday on the date of visit.

Race—White, Black, Asian or Pacitlc Islander, or American Indian or Alaskan Native. Physicians were instructed to

mark the category they judged to be the most appropriate for

each patient based on observation or prior knowledge. The

following definitions were provided to the physician:

● White-A person having origins in any of the original

peoples of Europe, North Africa, or the Middle East.

. B/ack—A person having origins in any of the black racial

groups of Africa.

● Asian or Pac13c Islander—A person having origins in

any of the original peoples of the Far East, Southeast

Asia, the Indian subcontinent, or the Pacific Islands, includlng, for example, China, India, Japan, Korea, the

Philippine Islands, and Samoa.

● Amenkan Indian or Alaskan Native—A person having

origins in any of the original peoples of North America

and who maintains cultural identification through tribal

aflliation or community recognition.

Ethnici~—Category judged by the physician to be the

most appropriate. The following definitions were provided:

● Hispanic origin-A person of Mexican, Puerto Rican,

Cuban, Central or South American, or other Spanish culture or ongin, regardless of race.

. Not Hispanic—Any person not of Hispanic origin.

Patient’s complaint(s), symptom(s), or other reason(s)

for this visit (in patient’s own word.r)-The patient’s principal

problem, complaint, symptom, or other reason for this visit as

expressed by the patient. Physicians were instructed to record

key words or phrases verbatim to the extent possible, listing

that problem first which, in the physician’s judgment, was

most responsible for the patient’s visit.

Major reason for this visit—The one major reason (selected from the following list) for the patient’s visit as judged

by the physicirux

●

●

b

●

Acute problem—A visit primarily for a condition or illness having a relatively sudden or recent onset (within 3

months of the visit).

Chronic problem, routine—A visit primarily to receive

regular care or examination for a preexisting chronic

condition or illness (onset of condition was 3 months or

more before the visit).

Chronic problem, jlareup-A visit primarily to receive

care for a sudden exacerbation of a preexisting chronic

condition or illness.

Postsurge~ orpostinju~—A visit primarily for followup

care of injuries or for care required following surgery, for

example, removal of sutures or cast.

● Nonillness care (routine prenatal, general exam, wellbaby)—General health maintenance examinations and

routine periodic examinations of presumably healthy persons, both children and adults, including prenatal and

postnatal care, annual physicals, well-child examinations,

and insurance examinations.

Diagnostic semices this visit—Physicians were instructed

to check any of the following services that were ordered &

provided during the current visih

●

●

●

●

●

●

●

●

●

●

●

Limited history and/or examination-History or physical examination limited to a specific body site or system

or concerned primarily with the patient’s chief complaint,

for example, pelvic examination or eye examination.

General history and/or examination—History or physical examination of a comprehensive nature, including all

or most body systems.

Pap test—Papanicolaou test.

Clinical lab test—One or more laboratory procedures or

tests, including examination of blood, urine, sputum,

smears, exudates, transudates, feces, and gastric content,

and including chemistry, serology, bacteriology, and pregnancy tes~ excludes Pap test.

X-ray—Any single or multiple X-ray examination for

diagnostic or screening purposes; excludes radiation

therapy.

Blood pressure check.

17KG-Electrocardiogram.

Vision test—Visual acuity test.

Endoscopy—Examination of the interior of any body

cavity except ear, nose, and throat by means of an endoscope.

Mental status exam-Any formal, clinical evaluation designed to assess the mental or emotional status of the patient.

Other—All other diagnostic services ordered or provided

that are not included in the preceding categories.

Principal diagnosis—The physician’s diagnosis of the

patient’s principal problem, complaint, or symptom. ln the

event of multiple diagnoses, the physician was instructed to

list them in order of decreasing importance. The term “principal” refers to the first-listed diagnosis. The diagnosis represents the physician’s best judgment at the time of the visit and

may be tentative, provisional, or definitive.

Other signl~cant current diagnoses—The diagnosis of

any other condition known to exist for the patient at the time

of the visit. Other diagnoses may or may not be related to the

patient’s reason for visit.

Have you seen patient before?—” Seen before” means

provided care for at any time in the past. Item 10b refers to

the patient’s current episode of illness. .

Medication therapy this visit—The physician was instructed to list, using brand or generic names, all medications,

including drugs, vitamins, hormones, ointments, and supposi- s

tories ordered, injected, administered, or provided this visit

including prescription and nonprescription drugs, vaccinations,

immunization, and desensitization agents. Also included are

48
drugs and medications ordered or provided prior to the visit

that the physician instructed or expected the patient to continue taldng. Medications for the principal diagnosis are listed

in item 11a; ail other drugs are listed in item 11b.

Nonmedication therapy—Physicians were instructed to

check any of the following services that were ordered or provided during the current visiti

●’

e

o

0

ID

ID

●

●

Physiotherapy—Any form of physical therapy ordered or

provided, including any treatment using heat, Iighb sound,

or physical pressure or movemen~ for example, ultrasonic,

ultraviolet, inflared, whirlpool, dlathenny, cold, and

manipulative therapy.

Oflce surge~-Any surgical procedure performed in the

ofllce this visit, including suture of wounds, reduction of

fractures, application or removal of casts, incision and

draining of abscesses, application of supportive materials

for fractures and sprains, irrigations, aspirations, dilations,

and excisions.

Family pIanning—Services, counseling, or advice that

might enable patients to determine the number and spacing of their children, includlng both contraception and infertility services.

Psychotherapy or therapeutic listening—All treatments

designed to produce a mental or emotional response

through suggestion, persuasion, reeducation, reassurance,

or support, including psychological counseling, hypnosis,

psychoanalysis, and transactional therapy.

Diet counseling—Instructions, recommendations, or advice regarding diet or dietary habits.

Family or social counseling—Advice regarding problems

of family relationships, including marital or parent-child

problems, or social problems, including economic, educational, occupational, legal, or social adjustment dif13cukies.

Medical counseling—Instmctions and recommendations

regarding any health problem, including advice or counsel

about a change of habit or behavior. Physicians were instructed to check this category only if medical counseling

was a significant part of the treatment. Family planning,

diet counseling, and family or social counseling are excluded.

Other—Treatments or nonmedication therapies ordered

or provided that are not listed or included in the preceding categories.

Was patient refered for this visit by anotherphysician?—

Referrals are any visits that are made at the advice or direction of a physician other than the one being visited. The interest is in referrals for the current visit and not in referrals for

any prior visit.

Disposition this visit—Eight categories are provided to

describe the physician’s disposition of the case. The physician was instructed to check as many of the categories as

apply:

●

●

●

●

●

●

●

●

No foIlowup planned—No return visitor telephone contact was scheduled for the patient’s problem.

Return at specfied time-Patient was told to schedule an

appointment or was instructed to return at a particular

time.

Return ~ needed, P.R. N.—No future appointment was

made,, but the patient was instructed to make an appointment with the physician if the patient considered it necessary.

Telephone followup planned—Patient was instructed to

telephone the physician on a particular day to report either

on progress, or if the need arose.

Referred to other physician—Patient was instructed to

consult or seek care from another physician. The patient

may or may not return to this physician at a later date.

Returned to refem”ng physician—Patient was instructed

to consult again with the referring physician.

Admit to hospital—Patient was instructed that fixther

care or treatment would be provided in a hospital. No

further ofiice visits were expected prior to hospital admission.

Other—Any other disposition of the case not included in

the preceding categories.

Duration ofthis visit—Tne the physician spent with the

patient, not including time the patient spent waiting to see the

physician, time the patient spent receiving care from someone

other than the physician without the presence of the physician,

and time the physician spent in reviewing such things as records

and test results. If the patient was provided care by a member

of the physician’s staff but did not see the physician during

the visit, the duration of visit was recorded as O minutes.

49
Appendix III

Survey instruments

Endorsing Organizations

American Academy

of DermarologV

American Academy of

Family Physicians

American Academy

of Neurologv

American Academv of

Orthopedic Surgeons

American Academv

of Pediatrics

American Association of

Neurological Surgeons

American College of

Emergency Physicians

American College of

Obstetricians and

Gvnecologisrs

American College

of Physicians

American College of

Prevenwe Medicine

American Osteopathic

Association

American Societv of

Colon and Rectal

Surgeons

Amer!can Psychiatric

Association

American Societv of

Internal Medicine

American Societv of

Plastic and Reconstruct

Surgeons, Inc.

American Urological

Association

Association of American

Medical College$

National Medical

Association

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PuBLIC HEALTH SERVICE

OFFICE OF HEALTH RESEARCH, STATISTICS AND TECHNOLOGY

HYATTSVILLE, MARYLAND 20782

NATIONAL AMBULATORY

MEDICAL CARE SURVEY

The National Center for Health Statistics, as part

of its continuing program to provide information on

the health status of ‘theAmerican people, is conducting

a National Ambulatory Medical Care Survey (NAMCS).

The purpose of this survey is to collect information

about ambulatory patients, their problems, and the

resources used for their care. “The resulting published

statistics will help your profession plan for more

effective health services, determine health manpower

requirements, and improve medical education.

Since practicing physicians are the only reliable source

of this information, we need your assistance in the

NAMCS . As one of the physicians selected ih.our national

sample, your participation is essential to the success

of the survey. Of course , all information that you

provide is held in strict confidence.

Many organizations and leaders in the medical profession

have expressed their support for this survey, including

those shown to the left. In particular, your own specialty society has reviewed the NAMCS program and supports

this effort (see enclosure). They join me in urging

your cooperation in this important research.

Within a few days, a survey representative will telephone

you for an appointment to discuss the details of your

participation. We greatly appreciate your cooperation.

:tlve Sincerely yours,

Dorothy P. Rice

Director

Enclosure

50
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for Ihtslmutn k

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P.

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.1 2“ ,I@,v,dul, a (xac,, ce. of a“ ,S,,bl,,hwn, w[l be held co”ld,”,,,l. w,llb. .wd.n!”

Iw Dermm ●mqqtd m wd 10, lb. U. Z1,OWS.1 [be SWWV ..d w,ll mm lx dml.sedm ce

lea,,’I,OO!Mr De<,O”, w”*d Iora”v.,he, o.,g.a$e

7, MAJOR REASON FOR THIS

VISIT /C/teck cme/

1 ❑ACUTE PROBLEM

2 ❑CHRONICPROBLEM, ROUTINE

3 ❑CHRONIC PROBLEM. FLAR6Up

4 ~FOSTS”BGERYIPOST INJ”RY

5 U NON4LLNESS CARE IROUTINE

PRENATAL. GENERAL ExAM ,

WELL SABY, ETCI

IF YES, FOR THE

CONOITION IN

lTEM9a~

NATIONAL AMBULATORY MEDICAL CARE SURVEY

#m COLOR OR RACE I& ETHNICITY

I ❑ wHITE

2 ❑BLACK

1 ❑HISPANIC

ORIGIN

3 ❑A51AN/pAclFlc

ISLANOER .

2 ❑NOT

HISPANIC

4 UAMERICAN iNOIANI

ALASKAN NATIVE

8 DIAGNOSTIC SERVICES THIS VISIT

“ [Check al! ordewd or provided/

I ❑NONE 8 ❑EKG

2 ❑ LiMITEoHIsTOflY/ExAM. 9 ❑V1510N TEST.

3 ❑ GENERAL H15T0RV/EXAM. ,. ❑ENDOSCOPY

4 ❑PAP TEST *I ❑M:;:;L5 TATus

5 ❑Clinical LA8 TEST

M ❑0THE17(Sp,Cify)

6 ❑X. RAY

7 l_JBL000PflES5u17E cHECK

& PATI ENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER

REASON(S) FOR ~ VISIT //rI paficnt k ow w,mis/

a. MOST IMPORTANT

b. OTHER

90 PHYSICIANS DIAGNOSES

, PRINCIPAL OIAGNOSISIPROBLEM ASSOCIATE WIT I{ 111 M ii,

b OTHER SIGNIFICANT CURRENT OIAGNOSES

II, MEDICATION THERAPY THIS VISIT ❑ NONE

/UsiIIg brand or xeneric name., record all new and continued medications ordered, ht\ected, udministervd, or othmrm

provided at this vim. Include inmmizing mid desensitizing ogeu 1s/

a. FOR PRINCIPAL DIAGNOSES IN ITEM 9,. b. FOR ALL OTHER REASONS

1, 1.

2 2.

3 3.

4 4.

Izm NON.MEDICATION THERAPY

/Cl#eck all serwt’s urdered or provided this viw’t/

I ❑NONE 6 ❑ DIET COUNSELING

2 ❑PHYSIOTHERAPY 7❑ FAMILY/SOCIAL

J ❑ OFFICE S“FIGERY

COUNSELING

4 l_JFAMILypLANN,NG

8DMEOICALCOUNSELING

5 ❑p5YcH07HERApy/

9HOTHER ,S,.,,,,,

THERAPEUTIC LISTENING

13.WAS PATlENT

REFERRED

FOR THIS VISIT

BY A~HER

PHYSICIAN?

,’DYES

2DN0

14 DISPOSITION THIS VISIT

“ /CIIt,ck all that appl.vl

I ❑t.IoFoLLOWuppLANNEO

2 l_J*ETURNATSPECIF+EO TOAE

3 l_JRETuRN IF NEEOEO, P.R. N.

4 ❑TELEPI+ONE FOLLOW.”P PLANNED

5 ❑REFERREOTOOTHER PHYSICIAN

6 ❑RETURNED TO REFERRING PHv51c,AN

I ❑ADMIT TO HosPITAL

15. ;:~y

VISIT

/ Ii)ll’.d(’f,,”//,.

ycnt wiflf

/1/1ITtl’lutl\

*.1 !!,, !!-,

VI

.-

PHS.61 05-C (9/79) C3MB No. 613-R149Ci
CONFIDENTIAL*

NORC-4284

BEGIN DECK 3

~

FOR OFFICE USE

ONLY:

_m

5-6f

m

7-101

NATIONAL /@fBUL/iTORYMEDICAL CARE SURVEY

INDUCTION INTERVIEW

BEFORJZ STARTING INTERVIEW

1. EMCER PHYSICIAN I.D. NUMEER IN BOX TO

RIGHT .

2. ENTER DATES OF ASSIGNED REPORTING WEEK IN

Q. 2, P. 2.

Doctor, before I begin, let me take a minute to give you a little background about .

this survey.

Although ambulatory medical care accounts for nearly 90 percent of all medical care

received in the United States, there is no systematic infozmatiou about the characteristics and problems of people who consult physicians in their offices. ThiS kind

of informationhas been badly needed by medical educators and others concerned with

the medical manpower situation.

In response to increasing demands for this kind of information, the National Center

for Health Statistics, in close consultation with representativesof the medical

profession,has developed the National Ambulatory Medical Care Survey.,

Your own task in the survey is simple, carefully designed, @ should not take much .

of your time. Essentially, it consists of your participation during a specified

7-day period. During this period, you simply check off a minimal amount of information concerning patients that you see.

Now, before we get into the

your practice. The answers

analysis, and of course all

actual procedures, I have a few questions to ask about

you give me will be used only for classification and *

informationyou provide is held in strict confidence.

1. First, you are a

(ENTER SPECIALTY FROFfCODE ON FACE SHEET hiJ3EL.)”

Is that right? Yes . . . . . . . . .

No...”. (ASKA) . .

A. IF NO: What is your specialty (includinggeneral practice)?

(Name of Specialty)

. . x

. . Y

[Ill

11-13/

The National Ambulatory Medical Care Survey fs authorized by

Congress in Public Law 93-353, section 308. It is a voluntary

study and there are no penalties fcr refusing to answer any

question. All information collected is confidential and will

be used only to prepare statistical summaries. No information

which will identify an individual or a physician’s practice

will be released.

52
-2-

2. Now, doctor, this study will be concerned with the ambulatorx patients you will

see in your office during the week of (READ REPORTING DATES ENTERED BELW).

Are

A.

(that’s a (that’s a

1 Monday) through / Sunday)

month date month date

you likely to see ~ ambulatory patients in your office during that week?

Yes. . . . . .(GOTOQ.3). .X

NO .“. . . . . (ASK A). . . . Y

IF NO: tlhyis that? RECORD VERBAT~ THEN READ P~GRAPH BKLW

Since it’s very important, doctor, that we include any ambulatory patients

that you ~ happen to see in your office during that week, I’d like to

leave these forms with you anyway--just in case your plans change. 1’11

plan to check baclTwith your office just before (STARTING DATB) to make

sure, and I can explain them in detail then, if necessary.

GIVE DOCTOR THE ~ PATIENT RECORD FORMS AND GO TO Q. 9, P. 6.

53
-3- ...

3, A, At what office location will you be aee$

7-day period? RECORD UNDER A BELOW AND %

ambulatory p@t8nt# @~t$l$ thf?t

N CODE B.

B. FOR EACH OFFICE LOCATION ENTERED IN A, CODE YES OR NO TO “IN SCOPE.”

IN SCOPE (Yes) \ OUT OF SCOPE (No){

Private offices Hospital emergency rooms

Free-standing clinics Hospital outpatient departments

(non-hospitalbased) College or university infirmaries

Groups, partnerships Industrial outpatient facilities

Kaiser, HIP, Mayo Clinic Family planning clinics

NeighborhoodHealth Centers Government-operatedclinics

Privately operated clinics ~, maternal & child health, etc.)

(except family planning)

IN CASE OF DOUET, ASK: Is that (clinic/facility/institution)hospital based?

Is that (cl’Lnic/facility/institution)government

operated?

c. Is that all of the office locations

patient~uring that week?

at which you expect to see ambulatory

Yer3. . . . . . . . . . . X

No . . . . . . . . . . .I!

IF NO: OBTAIN ADDITIONAL OFFICE LOCATION(S), ENI!ERIN “A” BELCXJ,AND REPEAT.

A. I

n.

Office Location In Scope?

Yes I

No

(1) 1 0

(2)

(3)

(4) 1 0

1 0

1 0

TOTAL IN-SCOPE LOCATIONS: u “’

IT ALL LOCATIONS ARE OUT OF SCOPE, THANK THE DCXTOR AND LEAVE.

.

.

54
-4- DECK 3

4. A. During that week (REPEAT DATES),, how many ambulatory patients do you expect

to see in your office practice? (DO NOT COUNT PATIENTS SEEN AT [OUT-OF-SCOPE

LOCATIONS] CODED IN 3-B.)

ENTER TOTAL UNDER “A” BELOW AND CIRCLE NUMBER CATEGORY ON .API’ROF~TE ~

B. And during those seven days (REPEAT DATES IF NECESSARY), on how many ~ do

you expect to see any ambulatory patients? COUNT EACH DAY IN WHICH DOCTOR

EXPECTS TO SEE ANY PATIENTS AT AN IN-SCOPE OFFICE LOCATION.

CIRCLE NUMBER OF DAYS IN AJ?PROPRIATECCLUMN UNDER “B” BELOW.

DETERMINE PROPER PATIENT LOG FORM FROM CHART BELOW. READ ACROSS

ON “TOTAL pATIENTS” LINE UNDER “A” AND CIRCLE LETTER IN @PROPRIATE

“DAYS” COLUMN UNDER “B.”

THIS LETTER TELLS YOU WHICH OF THE FOUR PATIENT LOG FORMS (A, B, C, D)

SHOULD BE USED BY THIS DOCTOR.

1 A. i B. 1

LOG FORM DESCRIPTION Expected total Total ~ in practice

patients during during week.

survey week.

ENTER TOTAL FROM

A--Patient Record is to be Q. 4-A.

completed for ALL

patients liste~m Log. 15-17/ m“ ,I,lsr:l,l,l;

1- 12 PATIENTS AAAAAAA

13- 25 “ B

~

AAAAA

B--Patient Record is to be 26- 39 “

completed for every

CBAAAAA

SECOND patient listed 40- 52 “ CBBAAAA

on Log. 53- 65 “ DCBBAAA

66- 79 “ DCBBBAA

C--Patient Record is to be

completed for every

THIRD patient listed

on Log.

~

*D--Patient Record is to be

completed for every

L

132-145 “ IDDDCCBB

146-158 “ DDDCCBB

159-171 “ DDDCCCC

FIFTH patient listed

on Log.

172-184 “ DDDCCCC

185-197 “ DDDDDDD

198-210 “ DDDDDDD

I 211+ It ID DDDDDD

*

In the rare instance the physician will see more than 500 patients during

his assigned reporting week, give him two D Patient Log Folios and instruct him

to complete a patient record form for only every tenth patient. Then you are

to draw an X :hraugh the Patient Record on every other page of the two folio pads,

starting with Page 1 of the pad. The physician then completes the Patient Log

on every page, but completes the Patient Record on every second page.

55
-5-

5. FI~ LOG FOLIIYWITH APPROPRIATE LETTER,AND CIRCLE LETTER, ENTER FIRST FOUR

OF THE FORM AND NUMBER OF LINES STAMPED “BEGIN ON NEXT LINE” FOR THE B-C-D

FORMS (if no lines are stamped, enter “O”) BELOW.

DECK 3

NUMBERS

LOG

FOLIO No. Lines FOR OFFICE USE ONLY

Stamped “BEGIN Number patient record

Letter .Number ON NEXT LINE” forma Completed.

A

I

B

c

D

d

19-23/

24”26/

6. HAND DOCTOR HIS FOLIO AND EXPLAIN H(X?FORMS ARE 7!0BE FILLED”OUT. SHOW DOCTOR

INSTRUCTIONSON THE POCti. OF FOLIO, ITEMS ~ AND 11 ON CARI# IN POCKET

OF FOLIO AND ITEM DEFINITIONS ON THE BACK OF FOLIO, TO WHICH HE CAN REFER AFTER

YOU LEAVE.

EMPHASIZE THAT EVERY PATIENT VISIT EXCEPT ADMINISTRATIVE PURPOSE ONLY IS TO BE

RECORDED ON THE LOG FOR ENTIRE REPORTING PERIOD. FOR EXAMPLE, IF A MEDICAL

ASSISTANT GAVE THE PATIENT AN INOCULATION, OR A TECHNICIAN ADMINISTERED AN

ELECTROCARDIOGRAMAND THE PATIENT DID N(YI!SEE THE DOCTOR. THIS VISIT MUST STILL BE

LISTED ON THE LOG.

RXCORD VERBATIM BEL(XJANY CONCERN, PROBLEMS OR QUESTIONS THE DOCTOR RAISES.

70 IF DOCTOR EXPECTS TO SEE AMBULATORY PATIENTS AT MORE THAN ONE IN-SCOPE LOCATION

DURING ASSIGNED WEEK, TELL HIM YOU WILL DELIVER THE FORMS TO THE OTHER LOCATION(S).

ENTER THE FORM LETTER AND NUMBER(S) AND NUM8ER OF LINES STAMPED “BEGIN ON NEXT

LINE” FOR THE B-C-D LOG FOR THOSE LOCATIONS BELOW, BEFORE DELIVERING FORM(S).

FOLIO No. Lines q FOR OFFICE USE ONLY:

Location Stamped “BEGIN Number patient record

Letter .Number ON NEXT LINE” forms completed ._

27-31/

32-34/*

35-39/

40-42/

43-47/$

48-50/

56
.. -6- - DECK 3

8. Duringthe surveyweek (REPEATEXACT DATES),will anyone be availableto help

you in fillingout these recosds (at each IN-SCOPElocation)?

Yea . . . . (ASKA) ...1 51/

No . . . . . . . . . . .2

A. IF YES: Who would that be?

RECORDNAME,POSITIONAND LOCATION.

I

I POSITION [ LOCATION i

PERSONALLY BRIEF EACN PERSON LISTEDABOVE.

EMPNASIZETHAT EVERY PATIRNTVISIT DURINGTHE ENTIREWEEK IS TO BE RECORDEDONTRE

LOG EXCEPT“ADMINISTRATIVEPURPOSEONLY.”

9. Do you have a SO1O practice,or are you amociatedwith other phyaicianain a

par~neruhip,in a grouppractice,or in mme otherway?

solo. , . ● . (GOTO.Q. 10)

Partnership. . (ASKA-C) .

Group . . . . . (ASKA-C) .

<--- other (WECIPYAND ASKA-C)

IF PARTNERSHIP, GROUP. OR OTNER:

A. Is this a prepaidgrouppractice? Yea . . (ASK[l]) .

,[1] IF WS TO A: What percent

No . . . . . . . .

of patientsare

prepaid? per cent

. . 1 52/

. . 2

● * 3

. . 4

. . 1 53/

. . 2

54-56/

B. How many otherphysiciansare

associatedwith you? NUMBEROF PHYSICIANS: . 57-59/

c. What are the specialtiesof the other physiciansassociatedwith you?

(Howmany of theseare there?)

Svecialty Number of Physicians

(1)

(2)

(3)

(4)

(5)

D. CIRCLE ONE:

All physicians in this partnership/group practice

have the same specialty . . . . . . . . . . . . . . . . . . 1

More than one specialty in this partnership/group practice . . 2

60/

.57
10. Now I have just

IN

A.

B.

LARGE GROUP,

one

THE

-7- BEGIN DECK 4

more question about your practice. (NOTE: IF DOCTOR PRACTICES

FOLLOWING INFORMATION CAN BE OBTAINED FROM SOMEONE ELSE.)

What is the total number of full-time (35 hours or more per week) employees of your (partnership/

group) practice? Include persons regularly employed who-are nou on vacation, teW~rari~ Lll,

etc. Do not include other physicians. RECORD ON BOTTOM LINS OF COLUM A BELOW.

(1) H@—manyof these full-time ●mployees are a . . . (READ CATEGORIES BELCW AS ti%CESSARY

ASD RECORD NUMBER OF EACH IN COLUMN A.)

And whst i. the total number of part. tfme (less than 35 hours per week) employee. of your

(partnership/group) practice? Again, include persons regularly employed who are now on vacation,

ill, etc. Do not include other physicians. RECORD ON B~TOl! LINE OF COLIJINB BELOW.

(1) W=yof these part-time eatployeea sre s . . . (RSAD CATEGORIES BELW AS NSCESSARY

ANO RECORD HUMSER OF EACH IN COLti B.)

B. “

.Employeec *mll’1-tf.a!e Part-time

(35 or more hours/week)

●

(Leas than 35 boors/week) I

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Registered Surse . . . . . . ...!. 11-13/

Licensed Rsctical Surse . . . . . . . 14-16/

Suraing Aide . . . . . . . . . . . . . 17-19/

physician Ae#i@tent* . . . . . . . . . 20-22/

Technician . . . . . . . . . . . . . . 23-25/

Sacretary or Receptionist . . . . . . 26-28/

Other (SI&CIPY) 29-31/

35-37/

38-40/

41-43/

44-46/

47-49/

50-52/

53-5!i/

*PIIysLcien Assistant mmt be a graduate of en acc~dfted training program for Phymicien

Aesfotents (Fhysician Extenders, Xedex, etc. ) or certified by the NationalBoard of Mdical

tiiners through the certification Exem for Assistant to the Rimery Cere Phyaicien.

BEFORE YOU LEAVE, AGAIN STRESS THAT EACH AND EVERY AMBULATORY PATIENT SEEN BY THE

DOCTOR OR HIS STAFF DURING THE 7-DAY~~IOD A= IN-SCOPE OFFICE LOCATIONS (=EAT

THEM) IS TO BE INCLUDED IN THE SURVEY, THAT EAC~ATIE~ IS TO BE RECORDED ON THE LOG,

AND ONLY THE APPROPRIATE NUMBER OF PATIENT RECORDS COMPLETED.

Thank you for your time, Dr. If you have any (more).questions,

please feel free to call me. F@ phone n=er is written in the folio. I’ll

call ~ on Monday morning of your survey week just to remind YOU.

11. TIME INTERVIEW ENDED . . . . . . . . AM

PM

12. DATEOF INTERVIEW . . . . . . . . . . . . . . .

1 Ill I I I

(Month) (Day) (Year)

58
-8-

.

INTERVIEWER NUMBER

HIHI

INTERVIEWER’ S SIGNATURE

FOR OFFICE USE ONLY:

No. of Patients

Total. Day; in Practice

‘een:clm‘9-’1’

during Week: n

62/

59
Appendix N

American Hospital Formulary

Service classificationsystem

and therapeutic category codes

>

AMERICAN HOSPITAL FORMULARY SERVICE CLASSIFICATION SYSTEM

AND THEWEUT’IC CATEGORY CODES (AHFW)

(Clsssi6ations h parenthesesarcprmisiond but my be used in —DPIF)

AMERSCAN

HOSPITAL

FORMULARY

SERV3CE

CLASSIFSCATION

SYSTEM

04:00 ANTSH3STAMSNEDRUGS

0S:00 ANTS-INFECT3VEAGENTS

0804 Anubacidet

0s:08 Anrhdmindcs

08:12 Antibiotic

0s 1202 Audn092Yc0tkdes

061204 Aerkfuti Antibiotka

061206 Ccphdospolills

08:1208 CTdoramphonicol

08:12.12 Erytbromycins

08:12.16 Penicillins

081224 TctncYckinu

08:12.24 Other AlltibiOtiCs

0816 Antituberculotit Agentt

0618 titivirak

0%20 Plasmwliti&s

0824 Sulfonamides

08:26 Stdfones

0828 Treponemicide$

0S 32 Trichomonscidcs

08:36 UrinaryGermicides

08:40 Other AIIti+fective

10:00 ANT3NEOFLAST3C AGENTS

1200 AUTONOM3CDRUGS

12:04 ParaaympmhomimeticAgentt

1208 Panwmpatbolytic Agents

1212 SympathomkntericAg-mta

12:16 SympatholytkcAgents

1220 SkeletalMuscleRda.xants

16:00 BLOODDERIVATIWS

20:00 BLOODFORMATSONANDCOAGULA2TON

20:04 AntkmnklDru@

2004.04 bon Prorations

20:04.08 Liveran~ Stornwh

Reparation

2012 Ceagukmtsand AnMcaagulams

20:12.04 AnticOsgulants

201208 AndheParin A8CIXS

2012.12 Coagrdanu

201216 Hemosratict

2040 Thrombolydc Agrnts

24:00 CARD1OVASCULARDRUGS

X:04 CardiacDrugs

U:04 .kdkipemic @n*

24:o8 HypotonsiveAgents

2412 VasedilatingAgenu

24:16 Sckming Agmtt

28:oO CENTRALNERVOUSSYSTEMDRUGS

28:04 GeneralAnesthetics

2608 Anak2eti- and A@iPYIdiC!

28:10 NaIcOtiC Antagonist!

28:12 Anticon@santt

2*16 Psychotherapeutic Agc.nts

2S:16.04 Antidepre$s$mU

28: 16.0% Tranquilizers

28:16.12 Other Psychotherapeutic

Agents

2.S:20 Retpirdory and Cerebrat

stidant5

28:24 Sedativesand Hypnotics

26:00

36:04

36:08

36:12

36:16

36:18

36:24

36:2S

36:26

36:28

36:30

36:32

36:34

36:36

3638

36:40

36:44

36:48

36s2

36:s6

36:60

36:61

36:62

36:64

36:66

36:68

36:72

36:76

36:78

36:80

36:84

36:8S

4000

4004

4008

4010

40:12

40:16

W18

a 20

40:24

40:28

40:36

4040

44:00

48:00

S2:O0

S204

DIAGN08T3CAGENTS

AdmnOcOrticdlnmftiitmY

Amyloidosis

Bloc-iVolume

Brtw+lodt

Cudizc Function

Circulation Tiie

(Cystic Fibrosis)

LhbetuMeUitus

Diphthork

DrugHypersensitivity

Fungi

GallbladderFunction

Castic Fenctkon

Intestinal Absorption

XktneYFuectken

Liwt Function

LymphogranufomaV.mereum

Mumpn

MYa$thenisGr.vis

Myxcdema

Pm=mmaticFunction

PhenyLket0nuri8

Pho0chr0mecyt0m8

Pktitary Function

Rcentgcnogmphy

Scarlet F.5wJr

Sw’dng

(Thyroid Function)

Trkhine:is

Tuketcutotit

Urim &ntenU

SLECTROLYTSC,CALORIC,AND

WATERBALANCE

AddkfyknsAgenu

AbOnizkg .4gmm

Ammonia Detoskclm$

ReplacementBoIutiont

8a2iunrRernwing RcsiIu

Potusium-Removing Resim

C91ericAgmts

Saktand SugarSubstitutes

Dkuretics -

IrrigatingSolutions

UrlcomricAsentt

ENzYMZS

EXPE13’ORANTS AND COUGH

PRSPARATIONS

EYE, EAR, NOSEANDTHROAT

PRSPARATIONS

Antk-Infectivrs

52:04.04 Antibiotics

S204.06 Mtiviralt

S204.08 Sulfonamides

S2:04.12 MitGAnti-infectkvcs

520s

52:10

52:12

S2:16

5220

S2:24

52:28

5232

S2:36

56:oO

56:o4

56:08

56:1o

56:12

56:16

56:20

56:24

56:40

<i-Ietlamrnltory Agents

&bonic Anhydmse Inhibiton

Contact Lzns Solutions

LocalAnetthetkcs

Miotics

MYdriatica

Mouth Wmhotand GUEICS

Vatecomtrictors

UnctasaitiedAgents

GASTROINTESTINALDRUGS

Antaddt and Adserbants

Anti-Dhrrhea Agmtu

AnWlatulents

@h@iC$ and LaSatives

m~~-t~

Emetict and Anti-Emetics

Lipotropic Agents

Mkt. Cl Drugt

600iI GOLDCOMPOUNDS

6400 HEAVY METAL ANTAGONISTS

68:00 HORMONESANDSYNTHETIC

SUBSTITUTES

6B:04 Adrenaks

68:08 Andmgcns

68:12 COntnceptivas

6%16 S$trogem

68:18 t%mdotropint

6820 Snndinsnnd Anli-Dmbctic

hems

6620.0S Imelim

68:24

68:28 Pituita

68:32 Pro&st~gms

6834 Other CoQus Luteum Hormone$

68:36 Thyroid md Antitbyroid

7200

76:00

7SW

80W

80T34

Bmos

8012

LOCALANESTHETICS

OXYT@ICS

RADIOACTIVEAGENTS

SERUMS,TOXO1OSAND VACCINSS

Serums

Toxoidt

Vaccines

SKIN AND MUCOUSMEMBRANE

PRSPARATIONS

Aeti-hfectivet

S4ao

84:04

84:04.04 Antibiotics

B4xM.08 Fungicides

*04. 12 Scabicidesand Pediculicidcs

84:04.16 Mist LocalAnti-Infectivcs

84:C.5 Anti.lntlammatary A8ent$

84:08 Antimucitic#and Local

Ancs”theti84:12 .4StIil18Cllt~

84:16 CdlWkrnulanuand Proliferant!

84:20 Deterrents

8424 Emo~ents, Demulcents and

Rotectants

84:24.04 BasicLotion$and Liniments

84:24.08 BasicOtis and Other Solvents

84:24.12 BasicOintments and

Rotectants

8424.16 BasicPowders and Dcmulccnu

84:28 Keratolytic Agents

84:32 Kemtopbttic A8ents

84:36 hlitcelhneous Agents

84:50 Pigmenting& DcpigmentingAgenu

0$: S0.04 DepigmentingAgents

84:S0.06 PigmentingAgents

84:80

86:00

88:00

8%04

88:08

88:12

8816

88:20

88:24

S8:28

9200

94!00

96:00

SunscreenAgents

SPASMOLYTICAGENTS

vITAMINS

Vitamin A

Vitamin BComplex

Vitamin C

Vitamin D

vitamin E

Vitamin K Activity

MultivitaminFrepantions

UNCLASSIFIEDTHERAPEUTICAGENTS

(PHARMACEUTICSAIDS)

Copyright @1980. Drug Products Information File: American Society of Hospital Pharmacists, Bethesda, Maryland.

All”&i& reserved. Re~rinted with permission.

60