Drug Utilization in 

Off ice-Based 

Practice, A Summary 

of Findings 

National Ambulatory 

Medical Care Survey: 

United States, 1980 

This report uses the findings of the 1980 

National Ambulatory Medical Care Survey to 

highlight the utilization of drugs in the physician’s office-based practice. It establishes 

several unique indexes for measuring the 

frequency and intensity with which drugs 

were ordered or provided, using these indexes 

to evaluate patterns of drug use as they 

varied with different patients, physicians, 

diagnoses, and othervariables of office-based 

ambulatory care. The report also presents 

findings on certain key characteristics of the 

drugs: their entry status (generic or brand 

name), prescription status (prescription or 

over-the-counter), level of potential abuse, 

and composition (single ingredient or 

combination form). 

Data From the National Health Survey 

Series 13, No. 65 

DHHS Publication No. (PHS) 83-1726 

U.S. Department of Health and Human Services 

Public Health Service 

National Center for Health Statistics 

Hyattsville, Md. 

.March 1982 
COPYRIGHT INFORMATION 

The National Center for Health Statistics has obtained permission from the 

copyright holders to reproduce certain quoted material in this report. 

Further reproduction of this material is prohibited without specific 

permission of the copyright holders. All other material contained in this 

report is in the public domain and may be used and reprinted without 

special permission; citation as to source, however, is appreciated. 

SUGGESTED CITATION 

National Center for Health Statistics, H. Koch: Drug utilization in officebased practice, a summary of findings, National Ambulatory Medical Care 

Survey. United States, 1980. Vital and Healfh Statistics, Series 13, No. 65. 

DHHS Pub. No. (PHS) 83-1726. Public Health Service, Washington, 

U.S. Government Printing Office, March, 1983. 

Library of Congress Cataloging in Publication Data 

Koch, Hugo K. 4 8 P 

Drug utilization in%mce-ff&ed’prktice. .) ;.* 

(Data from the natk~l h&J?f;‘~u~ey ; ser. 13, no. 65 (DHHS 

publication ; no. (PHS) 83-l 726). , ,+a 

Bibliography: p. 

Supt. of Dots. no.: HE 20.6209:13/72 

1. Drug utilization-United States. 2. Physician services 

utilization-United States. 3. Ambulatory medical care-Unrted States. 

4. Health surveys-united States. 5. United States-Statistics, Medical. 

I, Title. II. Series: Vital and health statistrcs. Series 13. Data from the 

national health survey; no. 65. III. Series: DHHS publication : no. (PHS) 

83-l 726. (DNLM: 1. Drug utilization-United States-Statistics. 

W2 A N148vm no. 721 

PA407.3.A349 no. 72 [RM261.3.U6] 362.1’1’0973s 82-600346 

ISBNO-8406-0270-7 1615.5’8’09731 
National Center for Health Statistics 

MANNING FEINLEIB, M.D., Dr. P.H., Director 

ROBERT A. ISRAEL, Deputy Director 

JACOB J. FELDMAN, Ph.D., Associate Directorfir 

Analysis and Epidemiology 

GAIL F. FISHER, Ph.D., Associate Directorfor the 

Cooperative Health Statistics System 

GARRIE J. LOSEE, Associate Directorfor Data 

Processing and Services 

ALVAN 0. ZARATE, Ph.D., Assistant Directorfor 

International Statistics 

E. EARL BRYANT, Associate Directorfor Interview and 

Examination Statistics 

ROBERT L. QUAVE, Acting Associate Directorfor 

Management 

MONROE G. SIRKEN, Ph.D., Associate Directorfor 

Research and Methodology 

PETER L. HURLEY, Associate Directorfor Vital 

and Health Care Statistics 

ALICE HAYWOOD, Information Oflcer 

Division of Health Care Statistics 

W. EDWARD BACON, Ph.D., Director 

JOAN F. VAN NOSTRAND, Deputy Director 

JAMES E. DELO&ER, ChieJ Ambulatory Care Statistics 

Branch 

MANOOCHEHR K. NOZARY, ChieJ; Technical Services 

Branch 
Contents 

lntroduction...............................................................‘.........................~. 1 

Section I. General patterns of office-based drug utilization .................................................... 4 

Overview ........................................................................................... 4 

Diagnosis .......................................................................................... 4 

Patent ............................................................................................ 5 

Physician .......................................................................................... 7 

Other visit characteristics ............................................................................. 7 

Section1 I. Keydrugdimensions ......................................................................... IO 

Entrystatus ......................................................................................... 10 

Prescriptionstatus............: ...................................................................... 10 

Federalcontrolstatus..................................; ............................................. 11 

Compositionstatus.. ................................................................................. 11 

References........................................................................................... 13 

Listofdetailedtables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 

Appendixes 

I. Technicalnotes .................................................................................... 39 

II. Definition of terms ................................................................................. 46 

List of figures 

1. Patientrecord..................................................................................... 2 

2. Utilization of three therapeutic categories of drugs by age of patient, based on percent of drug mentions within respective 

age groups: United States, 1980.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 

3. Drug mention rate by sex and age of patient: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . :. . . . . . . . . . . . . . . . . 6 

4. Drug mention rate by specialty: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 

List of text tables 

A. Number and percent distribution of all drug mentions by major therapeutic categories: United States, 1980. . . . . . . . 5 

B. Number of mentions of major drug categories by physician specialty with the largest fraction of mentions for each 

category: United States, 1980. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I . . . . . . . . . . . . . . . . . . . . . . . . . . 8 

iii 
7’ : ., :*, , 

,, ‘8 

I’ 

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 (more than 

30-percent relative standard error) 

# Figure suppressed to comply with 

confidentiality requirements 

iv 
Drug Utilization in 

Office-Based Practice, 

A Summary of 

Findings: National 

Ambulatory Medical 

Care Survey 

by Hugo Koch, Division of Health Care Statistics 

Introduction 

If mortality rates for certain diseasesprevailed 

today as they did at the turn of the century,

almost 400,000 Americans would lose their 

lives this year to tuberculosis, almost 300,000 

to gastroenteritis, 80,000 to diphtheria, and 

55,000 to poliomyelitis. Instead, the combined 

toll of all four diseases is projected to be less 

than 10,000 lives. That the toll is 10,000 instead of 835,000 is largely due tomedicines. . . . 

The curative revolution is, in essence, a drug 

revolution.1 

With so much popular attention currently being 

directed to the tragic misuseof drugs, there is sometimes 

a tendency to forget the overwhelming benefits that 

result from their rational use, and the vital role that they 

play in the prevention, diagnosis, and treatment of disease.The purpose of this report is to describe this role in 

one treatment setting-a setting that often does not 

receive its proper share of attention-the doctor’s office. 

To accomplish this task, the report usesthe findings 

of the National Ambulatory Medical Care Survey for 

calendar 1980. Each year since 1973 the National 

Center for Health Statisticshas usedthe National Ambulatory Medical Care Survey (NAMCS) to collect descriptive data about the medical care provided in the 

doctor’s office. NAMCS data collectors contact arepresentative sample of the Nation’s doctors of medicine 

and osteopathy whose primary professional effort lies in 

office-based, patient care practice. The sampled physicians in turn complete records (figure 1, Patient Record) 

for a systematic random sample of their office visits over 

a weekly reporting period. When the sampled findings 

for 1980 were expanded to approximate the national 

universe of office visits, the result was an estimated 

575,745,OOO visits. A summary of general NAMCS 

findings, based on these 575.7 million office visits, has 

beeygublished.2 

e year 1980 was the first in the 8-year history of 

NAMCS that the respondents reported the number and 

names of the specific drugs-thatthey used. On the collection instrument (figure 1, item 11) four spaces were 

allowed for drugs associatedwith the principal diagnosis 

and an additional four spaces for drugs used “for all 

other reasons.” Physicians responded with an estimated 

679,593,OOOmentions of pharmaceutical agentsordered 

or provided-by any route of administration-for the 

purpose of prevention, diagnosis,or treatment. Mentions 

included immunizing and desensitizing agents and nonprescription as well asprescription drugs. Along with all 

new drugs, the physician also recorded continued medications if the patient was specifically instructed during 

the visit to continue the medication. The methodology 

used to collect, classify, and process drug information 

for the 1980 NAMCS is reported elsewhere.3 

It should be emphasizedfrom the outsetthat NAMCS 

drug findings are designed to measure utilization-that 

is, the ordering or providing of medications (drugs) in a 

given treatment setting-the doctor’s office. They are 

not intended to serve as a market barometer. In the few 

places in this report where trade names appear, they are 

used only to illustrate patterns of utilization; their appearance does not imply endorsement by the Public Health 

Service or the U.S. Department of Health and Human 

Services. Further, the term utilization does not extend 

beyond the ordering or providing of a drug in the physician’s office. Ultimate utilization of a drug depends on 

the patient’s compliance with the doctor’s instruction 

and cannot be determined from NAMCS findings. 

In the pages that follow, the 1980 findings on drug

utilization will be presented in two sections: 

Section I. General patterns of drug utilization, by 

diagnosis, patient, physician, and other 

visit characteristics. 

Section II. Dimensions of the drugs utilized, namely: 

entry choice (generic or brand name), prescription status (prescription or nonprescription), level of potential abuse, and 

composition status (single-ingredient or 

combination), by patient, physician, and 

visit characteristics. 
1 DATE OF VISIT . 

/ / NATIONAL AMBULATORY MEDICAL CARE SURVEY 

time 

patient entered on line *, also corn- REASON&l FOR WVlSlT [In patient’s own words] 

plete the patient record ta the right. 

10 HISPANIC 

ORIGIN 

a. MOSTIMPORTANT 

VISIT SLANDER 

of visit on the log below. For the Q. COLOR OR RACE 5. ETHNICITY 6. PATIENT’S COMPLAINT(SI, SYMPTOM(S), OR OTHER 

PATIENT’S NAME TIME OF 

I 30 ASIAN/PACIFIC ’q N,q:PAN,Cb. OTHER 

4 q AMERICAN INDIAN, 

ALASKAN NATfVE 

7. MAJOR REASON FOR THIS 8 DIAGNOSTIC SERVICESTHISVISIT 8 PHYSICIAN’S DIAGNOSES . VISIT [Check one] n [Check all ordered or provided/ 

10 NONE ,,-,EKG a. PRINCIPAL DIAGNOSIS/PROBLEM ASSOCIATED WITH ITEM 6s. 

1 0 ACUTE PROBLEM 2 0 LIMITED HISTORYIEXAM. 9 ,-, VISION TEST 

2 0 CHRONIC PROBLEM. ROUTINE 3 q GENERAL HISTORY/EXAM. 10 0 ENDOSCOPY 

30 CHRONIC PROBLEM. FLAREUP MENTAL STATVS 

4 nPOSTSURGERY/POST INJURY : ;:;:ki:: LAB TEST 

” q EXAM. b. OTHER SfGNIF,CANT CURRENTDIAGNOSES 

5 ONON-ILLNESS CARE 03ouT1NE 6 OX-RAY 

I.? f-J OTHER ,sprei,y, 

PRENATAL. GENERAL EXAM., 

WELL BABY. ETC.1 70 BLOOD PRESSURE CHECK 

10 HAVE YOU SEEN 11 MEDICATION THERAPY THIS VISIT 0 NONE . ’ PATIENT BEFORE? /Using brand or generic names, record all new and continued medications otiered, injected, administered. or o1herwi.w 

provided at this visi Include immunbtngand desensitizing agents] 

a. FOR PRINCIPAL DIAGNOSES IN ITEM %. b. FOR ALLOTHER REASONS. 

L. 1. 

2. 2. 

3. 3. 

10 YES 2 ON0 4. 

4. 

12, NON.MEDICATION THERAPY 

[Check all services ordered or prc wided flds visit] 1

13.WAS PATIENT 14. DISPOSITION THISVISIT 15, DURATION 

REFERRED [Check oN that apply] OF THIS 

FOR THIS VISIT VISIT 1 q ND FOLLOW-UP PLANNED BY ANOTHER [Time actually

DIET COUNSELING PtiYSICIAN? RETURN AT SPECIFIED TlME : spent wirfr 20 physician] 20 PHYSIOTHERAPY 7 j-+AMILY,SOCIAL 3 ORETURN IF NEEDED. P.R.N. . ‘. COUNSELING 

OFFICE SURGERY 

8 n MEDICAL COUNSELING I OYES 40 TELEPHONE FOLLOW-UP PLANElEO 

4 u FAMILY PLANNING REFERRED TO OTHER PHYSICiAN 

i 0 PSYCHOTHERAPY/ 

CONTINUE LISTING PATIENTS 8 n OTHER ,Spr‘.Vy, .-

ON NEXT PAGE PI-IS-6105-D (g/79) ‘OMB NNo.,cm-q14i 

: . 

Figure 1. Patient Record 

THERAPEUTIC LISTENING 

60 

OTWER ,S,w+, T L 

6 

50 

a 

ORETURNED TO REFERRING PHYSICIAN 

-’ 

Ml”“lLI 

,a”0 

ADMITTO HOSPITAL . 

.1 . 
Data users are urged to review the two appendixes to 

this report:They provide information necessary for the 

proper understanding and interpretation of the statistics 

presented. Appendix I contains a general description of 

the survey methods, sample design, and data collection 

and processing procedures. Imputation methods, estimation techniques, and estimates of sampling variation 

are also presented. Since the statistics in the report are 

based on a sample of ambulatory visits rather than on all 

visits, they are subject to sampling errors. Therefore, 

particular attention should be paid to the section in 

appendix I entitled “Reliability of estimates.” Appendix II presents defmitions of the terms used in this report 

and in the survey-operations.

Inquiries about the NAMCS drug database may be 

addressed to: 

Hugo Koch 

National Center for Health Statistics 

Ambulatory Care Statistics Branch 

Center Building, Room 2-43 

3700 East-West Highway 

Hyattsville, Maryland 20782 

Phone: (301) 436-7132 
Section I. General patterns 

of off ice- based drug utilization 

The survey findings presentedin this section explore 

general patterns of drug utilization in the doctor’s office. 

Several terms used in this general evaluation require 

clarification at the outset. 

The term drug is interchangeable with the term 

medication. 

Adrug mention is the physician’s entry of a pharmaceutical agent ordered or provided-by any route of 

administration-for the purposeofprevention, diagnosis, 

or treatment. Mentions include immunizing and desensitizing agents,and nonprescription as well asprescription 

drugs. Along with all new drugs, the physician also 

recorded continued medication if the patient was specifically instructed during the visit to continue the medication. An estimated 679,593,OOOdrug mentions resulted 

from the 1980 survey.

A drug visit is an office visit at which one or more 

drugs were ordered or provided. In 1980 there were an 

estimated 363,489,OOOdrug visits, comprising 63 percent of the total 575,745,OOOoffice visits. The percent 

of office visits represented by the drug visits will sometimes be called the drug visitproportion. 

.The drug mention rate is the average number of 

drugs utilized per office visit, obtained by dividing

the number of drug mentions by the number of office 

visits. Its magnitude is therefore influenced by the 

number of offtce visits where no drug was utilized. For 

the entire universe of 575,745,OOO office visits, the 

overall drug mention rate was 1.18 drugs per average 

office visit. 

The drug intensity rate is the average number of 

drugs utilized per drug visit, obtained by dividing the 

number of drug mentions by the number of drug visits. 

This index of utilization is especially useful when 

it, is desired to ignore the non-drug visits and to focus 

on the sheer volume of the drug therapy given, along 

with its potentials for drug-drug interactions. For the 

entire 363,489,OOO drug visits, the intensity rate 

was 1.87 drugs ordered or provided per average drug

visit. 

Overview 

Table 1 offers the data user an alphabetized listing 

of the 100 agentsmost frequently utilized by physicians 

in office practice. The listed drugs arc ‘in the form’of 

generic substances. Their frequency of mention combines their mentions as single-entity agents with their 

mentions as ingredients of combination products;Thus, 

the 26,334,OOO total mentions of the ranking generic 

substance, hydrochlorothiazide, include 1$,6.04,000 

mentions of hydrochlorothiazide as a single-entity drug 

and its 14,730,OOOmentions as an ingredient of a combination product. An earlier publication borrows’from 

the 1980 NAMCS findings, to list the, 200 $rand or 

generic names most frequently entered by respondirig 

physicians.4

A second useful overview of office-based drug utilization appears in table 2. Here, the total 679,593,OOO 

drug mentions are described by the chief therapeutic 

effect that each was intended to produce. A comprehen: 

sive listing of 68 therapeutic categoriks is used.s.,The 

therapeutic categories were selectedfrom the American 

Hospital Formulary Classification System, copyright

American Society of Hospital Pharmacists,(reproduced 

with the Society’s permission). Table A,recaps the 16 

major therapeutic groupings according to their relative 

prominence of mention. The data user may ‘note the 

obvious preeminenceenjoyed by nontopical anti-infective 

agents and by central nervous system drugs. Together

they accounted for 32 percent of all drug,mentions. 

Diagnosis 

Proper evaluation of the patterns of drug utilization 

requires that the data user look first to the diseasesthat 

the drugs were intended to prevent, diagnose, or’cure. 

The most direct and frequent linkage. occurs here. A 

drug is seldom ifever utilized for the sole reasonhat the 

patient is over 65, or a female; or that the physician is an 

4 
Table A. Number and percent distribution of all drug mentions by 

major therapeutic categories: United States, 1980 

Number Percent 

in thousands 

All categories.. . . . . . . . . . . . . . _. . . . . . . 679,593 1100.0 

Antihistamine drugs. . . . . . . . . . . . . . . _ . . . . 43,939 6.5 

Anti-infective agents (nontopical). . . . . . . . 104,898 15.4 

Antineoplastic agents . . . . . . . . . . . . . . . . . 5,371 0.8 

Autonomic drugs.. . . . . . . . . . . . . . . . . . . . . 25.237 3.7 

Blood formation and coagulation . . . . . _ . . . 8,312 1.2 

Cardiovascular drugs.. . . . . . . . . . . . . . . . . . 64,463 9.5 

Central nervous system drugs.. . . . . . . . . . 1 10,706 16.3 

Electrolyfic. caloric, and water balance . . . . 51 a956 7.6 

Expectorants and cough preparations . . . . . 18,899 2.8 

Eye, ear, nose, and throat preparations . . . 26,076 3.8 

Gastrointestinal drugs. . . . . . . . . . . . . . _ . . . 24,140 3.6 

Hormones and synthetic substances.. . . 55,843 8.2 

Serums, toxoids, and vaccines.. . . . . . . . . . 23.711 3.5 

Skin and mucous membrane preparations.. . 55,188 8.1 

Spasmolytic agents.. . . . . , . . . . . . . . . . . . . 11,541 1.7 

Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24,244 3.6 

Residual (otheragentsand therapeutic effect 

undetermined) . . . . . . . . *. . . . . . . . . . . . . 25,068 3.7 

Major therapeutic categories’ of mentions distribution 

’ Based on the pharmacologic-therapeutic classification of the American Society of Hospital Pharmacists: selected categories reproduced with the Society’s permission. 

internist, or a pediatrician. When variations in the rhythm

of utilization occur, they usually reflect differing patterns 

of morbidity. . 

It is fundamental then to examine drug utilization in 

terms of the diagnoses’rendered in office-based care. 

Table 3 makes this exploration, using the drug mentions 

specific to the first-listed (principal) diagnosis associated 

with each office visit (figure 1, item 1 la). It is readily

evident that two major diagnostic categories-respiratory 

diseaseand circulatory disease-dominate the world of 

office-based ambulatory care. Their dominance appears 

in the number of office visits in which they figure as a 

principal diagnosis; it also can be seen in most of the 

various measures of drug utilization ‘associated with 

their treatment. For example: 

Respiratory and circulatory diseaseslead other major diagnostic categories in the proportion of their 

office visits at which one or more drugs was given 

(about 89 percent for respiratory disease and 79 

percent for circulatory.) 

The two disease groups also command the highest 

proportions of total drug mentions (about 20 percent 

for respiratory diseaseand 15 percent for circulatory). 

With about 1.6 drug mentions for each category per 

average office visit, they outrank the other major 

disease categories in drug mention rate. 

In its drug intensity rate, the circulatory disease 

category clearly outranks all others; for example, 

chronic,ischemic heart disease, with 2.4 drug mentions per average drug visit, dramatically exceeds 

the other disease categories or specific diseases 

within those categories. 

Drug utilization by diagnosis has received detailed 

attention in two reports based on the 1980 NAMCS 

findings.%6Therefore, it will not undergo extensive analysis in this general report. 

Patient 

Tables 4-8 examine the manner in which drug utilization varies with selected characteristics of the office 

patient. (An earlier report has used advance findings of 

the 1980 NAMCS to highlight variations in utilization 

based on the age and sex of the patient.)7

Table 4, with its application of drug mention and 

intensity rates, reveals two peaks occurring along the 

spectrum of patient age-a minor.peak at the youngest 

end and a major peak at the oldest. The provision of 

prophylactic immunizations helps to explain the minor 

peak. But the most arresting fact emerging from the age 

findings is the steep increase in average drug utilization 

beginning with age 45 and reaching its highest point at 

65 years and over. Higher rates in this group, of course, 

signalthe onset-and sometimesconcomitant presenceof the chronic, debilitating diseasesthat afflict the aging. 

Table 5 measures drug utilization from another perspective. Here the differences between the age groups 

are described in terms of the therapeutic effects that the 

drugs were intended to produce. Note especially the 

dramatic increase in the utilization of the diuretics and 

cardiovascular drugs that begins with age 45 years and 

continues beyond age 64. More than any other category 

of drugs, these agents contribute chiefly to the peak in 

average utilization that characterizes the oldest age 

group.

Not all the therapeutic categories, however, show 

similar increases in drug utilization with advancing age. 

Figure 2 graphically shows varying patterns by the three 

most-mentioned categories-cardiovascular drugs, central nervous system drugs, and systemic anti-infectives. 

In direct contrast with the cardiovascular category, the 

anti-infectives are most frequently utilized by the age 

group under 25 years; their usagethen falls away abruptly

in an inverse relationship to advancing years. The use of 

the central nervous system drugs increases sharply between ages25-44 years, then subsidesgradually throughout the later years of life. 

The relationship between the sex of the patient and 

drug utilization requires careful evaluation. 

The findings in table 4 supply the general framework 

for this evaluation. If simple volume of utilization is the 

desired criterion, then-depending on the degree of 

precision required-the data user may count the number 

of drug visits or drug mentions. When this simple enumeration is applied to a study of sex differences, it becomes 

readily apparent that drug visits or mentions for female 

patients substantially outnumbered drug visits or mentions for males. The ratio of about 6 to 4 in favor of 

female patients closely parallels the ratio for office visits 

in general. However, when drug utilization by the sexes 

5 
- Anti-infective agent 

mm.... Cardiovasculardrugs 

- - Central nervous system drugs 

25.0 

Under 15-24 25-44 45-64 65 years 

15 years years years years and over 

Age of patient 

Figure 2. Utilization of three therapeutic categories of drugs by age of 

patient, based on percent of drug mentionswithin respective age groups: 

United States, 1980 

is viewed from other perspectives, especially those of 

averageusage,a different picture emerges-for example, 

the respectivedrug visit proportions. For female patients, 

the drug visit proportion was 63.3 percent, for male 

patients 62.8. The difference is not statistically significant; it could be due to sampling error or variability. 

In terms of the drug mention rates or drug intensity 

rates, there is also no marked difference between the 

averagefemale and male patient. In fact, if the mentions 

of prenatal multivitamins, estrogens, and oral contraceptives-agents unique to female use-are subtracted 

from the female total of drug mentions, the drug mention 

rate for the average female patient is reduced to 1.14, 

suggesting an even closer agreement in average drug 

use. 

This near equivalence in average drug utilization 

prevails up to age 65 (table 4 and figure 3). Beyond that 

point the utilization paths for the sexes diverge perceptibly, an effect probably due to a more intensive female 

use of the central nervous system drugs-chiefly, analgesics, psychotherapeutic agents, sedatives, and hypnotics (table 7).

Thus the generalindexesof averageutilization seldom 

reveal any marked differences between men and women. 

Proceeding to a more specific level, tables 6 and 7 

explore sex variations in the utilization of selected therapeutic groups of drugs. A comparison of the sexes 

reveals that female patients exceeded male patients in 

6 

1.80 7 Female r - I Male 

1.70 

1.60 

0.90 

Under 15-24 25-44 45-64 65 years 

15 years years years years and over 

Age of patient 

IAverage number of drugs ordered or provided per office visit.: 

Figure 3. Drug mention rate by sex and age of patient United States, 1980 

the proportion of their drug mentions representedby the 

following therapeutic categories: 

l Antineoplastic agents. .,I 

l Central nervous system drugs (however, the use of 

analgesics, anticonvulsants, and tranquilizers was 

roughly equivalent between the sexes). 

l Electrolytic, caloric, and water balance substances. 

l Hormones and synthetic substalices(however, there 

was no difference in the use of adrenals and of 

antidiabetic agents between the sexes). ‘.’ 

0 Vitamins. 

Male patients exceeded female patients in their utilization of: 

l Antihistamine drugs. ,’ 

l Anti-infective agents. 

l Cardiovascular drugs (except hypotensives, used 

about equally by both sexes). 

l Serums, toxoids, and vaccines. 

l Spasmolytic agents. 

In the utilization of the following drug categories, there 

was either no difference between male and female proportions or the difference was so slight that much of it 

may be explained by the presence of sampling error. 

l Autonomic drugs. 

l Blood formation and coagulation agents (females 
made more use of anti-anemia drugs; males made 

more use of anticoagulants). 

l Gastrointestinal drugs. 

l Expectorants and cough preparations. 

l Eye, ear, nose, and throat preparations. 

l Skin preparations. 

By listing the 10 generic substances(in singlsingredient plus combination ‘form) most frequently utilized 

by each sex-agegroup, table 8 shows a final perspective

of utilization as it varied with patient age and sex. 

Table 4 provides general indexes of drug utilization 

for three categories of race: white, black, and “other,” 

which chiefly includes American Indians and patients 

of Asian or Pacific Island origin. For the “other” category, drug utilization deservesthe attention of the analyst. Although their drug visit proportion is about equivalent to the proportion for white patients, their indexes 

of averagedrug utilization, as expressedin drug mention 

and intensity rates, are somewhat lower than those of 

the white or black patients, It is not in the scope of this 

general report to explore all the reasons for these lower 

rates, but the explanation seemsto lie partly in the fact 

.that 75 percent of these “other” visits were made by 

patients under 45 years of age. For black visits, the 

contrasting proportion was 65 percent; for white visits, 

a relatively modest 5 9 percent. Sincethe “other” patients 

were more youthful, their visits were less frequently 

involved with such drug-intensive conditions as Circulatory disease.In fact, Circulatory diseaseas a principal 

diagnosis appeared in only 4 percent of their visits 

compared with 9 percent for white visits. 

Except that black patients showed a slightly higher 

drug visit proportion, the findings in table 4 reveal no 

marked difference between white and black visits in 

average, overall drug utilization. Nor were there many 

marked differences in their respective utilization of the 

specific drug categories (table 9). For the following

major therapeutic groups, the differences were so slight 

that they were probably due in large part to the presence

of sampling error: 

Adrenals. 

Antihistamine drugs. 

Anti-infective agents. 

Autonomic drugs. 

Blood formation and coagulation agents. , 

Cardiac drugs. 

Electrolytic, caloric, and water balance agents. 

Expectorants and cough preparations. 

Eye, ear, nose, and throat preparations. 

Gastrointestinal drugs. 

Sedatives and hypnotics. 

Serums, toxoids, and vaccines. 

0 Spasmolytic agents. 

0 Vitamins. 

White patients significantly exceeded black patients in 

only three of the categories-antineoplastic agents,psychotherapeutic agents, and skin preparations. Black 

patients exceeded white patients. only in their use of 

analgesics, hypotensives, and antidiabetic agents. 

Physician 

Drug utilization, as it varies with physician characteristics, will receive detailed attention in a separate 

seriesof NAMCS reports.8Therefore, it will not undergo 

extensive exploration in these pages. 

Table 10 directs attention to the physicians who 

order or provide the drugs utilized in offrce practice, by 

providing general indexes of drug utilization according 

to the physician’s specialty, geographic region of practice, type of practice, and age. 

Note the considerable variation that exists among 

the individual specialties in the frequency and intensity

of their drug utilization. Drug visit proportions, for example, range from a high of 76.9 percent for dermai 

tologists to a low of 29.6 percent for orthopedic surgeons.Drug intensity rates range from a high of 2.44 for 

cardiovascular specialists to a low of 1.28 for urologists. The variation in drug mention rates is graphically 

displayed in figure 4. 

In sheer volume of utilization, however, it is the 

general or family practitioner who clearly dominates the 

scene. With 41 percent of the total 679,593,OOOmentions, this physician led all other specialities (table lo), 

maintaining this dominance throughout 12 of the 16 

major drug categories (table B). 

Table 10 reports several other findings that are 

worthy of note. Regardless of the measure of utilization 

applied, the following contrasts emerge sharply enough 

to warrant further exploration in separate NAMCS 

reports: 

l The West Region fell substantially below the other 

geographic areas. 

0 Solo practitioners utilized drugs more frequently 

and intensively than their counterparts in multiple 

member practice. 

l Physicians under 45 years of age were less likely to 

resort to drug therapy than older physicians. j 

Other visit characteristics 

Table 11 applies the familiar indexes of drug utilization to various other dimensions of the office visit.‘Certain of the findings are highlighted below. Some point 

the way to more detailed analysis. 

An examination of drug visit proportions reveals 

that the new patient is much less likely to receive drug 

7 
Above average 

Internal medicine 

Cardiovascular disease 

Dermatology 

Neurology 

General and family practic :e 

Below average 

Pediatrics 

Otolaryngology I

Average 

Ophthalmology 

Psychiatry 

Urology 

Obstetrics/gynecology 

General surgery 

Orthopedic surgery 

0.4 0.5 0.6 0.7 0.8 0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6, 1.7 1.8 

Drug mention rate’ 

‘The average number of drugs ordered or provided per office visit. 1 : 

Figure 4. Drug mention rate by specialty: United States, 1980 

.I ,I. 

therapy than the patient whom the doctor has seen a newproblem-whether it is a problem presented by a 

before. This is especially true if the new patient has been new patient or a problem not encountered before in an 

referred by another physician. If one or more drugs are old patient-will probably result in fewer drugs ordered 

utilized, however, the drug intensity rates suggest that or provided,. Thus newness of patient or problem (or 

Table B. Number of mentions of major drug categories by physician specialty with the largest fraction of mentions for each category: United States, 1980’ ,, 

All Specialty with the largest single Major drug categories specialties fraction of mentions, 

Total number 

of mentions 

in thousands 

Allcategories.............................................................. 679,593 General and family practice (41 .I percent)’ 

Antihistamine drugs. . . . . . . 43,939 General and family practice (46.6 percent) 

Anti-infective agents (nontopical). 104,898 General and family practice (44.9 percent) 

Antineoplastic agents . 5,371 Internal medicine (85.0 percent) 

Autonomic drugs 25,237 General and family practice (54.3 percent) 

Blood formation and coagulation 8,312 General and family practice (52.3 percent) 

Cardiovascular drugs ...... 64,463 General and family practice (46.4.pement) 

Central nervous system drugs.. ...... 1 10.706 General and family practice (49.8 percent) 

Electrolytic, caloric, and water balance 51,956 General and family practice (53.2 percent) 

Expectorants and cough preparations. . . . . 18,899 General and family practice (51.4 percent) 

Eye, ear, nose, and throat preparations 26,076 Ophthalmologists (61;2 percent) 

Gastrointestinal drugs I.... ...... 24,140 General and family practice (58.2 percent) 

Hormones and synthetic substances ...... 55,843 General and family practice (44.1 percent) 

Serums, toxoids, and vaccines ...... 23,71 1 Pediatrics (56.9 percent) 

Skin and mucous membrane preparations ...... 55,168 Dermatology (46.1 percent) 

Spasmolytic agents . . . . . ...... 11,541 General and family practice (48.9 percent) 

Vitamins 24,244 General and family practice (50.4 percent) 

8 
both) seems to invite a more conservative approach to 

drug therapy. 

Does the use of drug therapy tend to preclude the use 

of other treatment mechanisms? The answer depends 

directly on the specific condition being treated. Detailed 

analysisby diagnosisis required. However, the evidence 

presented in table 11 does point up the fact that drug 

therapy was the only form of treatment utilized in the 

majority (54 percent) of the 363,489,OOO drug visits. 

The data on visit disposition sho;w.that drugs are 

more frequently and ‘intensely utilized when a followup 

ofsome kind has been ordered by the doctor. In fact,,the 

intensity of the drug therapy may to some extent determine the specificity of the followup instruction. Thus a 

scheduled return visit is associatedwith a drug intensity 

rate of 1.97, a planned telephone contact with an intensity rate of 1.89, and the least specific “return if needed” 

with the relatively low rate of 1.78. 

Does the utilization of drugs substitute for time 

spent in face-to-face contact with the physician? The 

drug intensity rates for visit duration suggest that the 

opposite is true. They vary in direct proportion to the 

encounter time between physician and patient, from a 

low of 1.40 for drug visits that involved no face-t-face 

contact to a high of 2.03 for drug visits that exceeded 15 

minutes in the duration of encounter time. 

9 
Section I I. Key drug dimensions 

In this section, attention is focused on four key 

characteristics of the drug products used in 1980 office practice: 

l Their entry status: generic or brand name? 

a Their prescription status: prescription (I$) or overthe-counter (OTC)? 

l Their Federal controlstatus: level of potential abuse 

or dependence. 

l Their composition status: single-ingredient or combination? 

Table 12 summarizes the overall distribution of 

these drug variables. 

Table 17 describes their utilization according to the 

major therapeutic categories of drugs. 

Tables 18-20 show the degree to which the drug 

dimensions varied with different diagnoses, patients, 

and physicians. 

Tables 13- 16 use the names of specific products to 

list the generic entries, nonprescription drugs, controlled 

drugs, and combination agentsmost frequently utilized. 

Entry status 

The NAMCS drug data base permits the description 

of drug mentions by their entry status, that is, whether 

the doctor recorded the medication by brand name or by 

generic name. (NAMCS respondents were instructed 

to use the same form of entry on the NAMCS visit 

record that they used on the patient’s medical record 

and on any prescription written.) 

During the past decade, extensive interest has centered on the merits of prescribing by brand-name drug 

versus prescribing by the (usually) less costly generic 

drug. Since 1970, the generic drug business has grown

faster than the total pharmaceutical market. By 1980, 

about 15 percent of all new prescriptions were written 

generically.

It should be emphasized that the extent of generic 

utilization revealed by the NAMCS data in table 12 

(24.2 percent of all drugs mentioned) reflects the total 

utilization of generic drugs in one treatment settingthe doctor’s office. Thus, along with generically written 

prescriptions (new ones or refills), the NAMCS generic 

fraction includes nonprescription generics (for example, aspirin or insulin); most serums, toxoids, and vaccines(for example, diphtheria tetanus toxoid pertussis); 

many diagnostic agents(for example, tuberculin); and a 

substantial number of other agents (chiefly the antibiotic injectibles) administered in the doctor’s office. 

Table 13 lists the 38 genericsmost frequently entered 

by office-based physicians. 

Of the major drug groups, the following exceeded 

the overall average in the proportion of their mentions 

that were generically identified (table 17): 

a Anti-infective agents. 

l Antineoplastic agents. 

l Serums, toxoids, and vaccines. 

0 Vitamins. 

Of the major diagnostic groups, the following were 

significantly above average in the proportion of generic 

agents applied to their treatment (table 18): 

l Neoplasms. 

l Endocrine, nutritional, and metabolic diseasesand 

immunity disorders. 

l Diseases,of blood and blood-forming organs. 

l Health supervision of infant or child. 

Prescription status 

Drugs are subdividedinto two major classificationsprescription (legend or I$) and nonprescription (overthe-counter or OTC) drugs.The use of a prescription drug 

represents the judgment of a physician about a patient’s 

medical care needs.The use of an over-the-counter drug 

represents a much greater reliance on self-care by the 

patient. In many cases there are also significant cost 

differences between prescription and nonprescription 

10 

I 
drugs used for the same purpose, for example, aspirin or 

Darvon used for analgesic effect. Furthermore, some 

over-the-counter drugs are extremely important in medical care (for example, aspirin for fever, insulin for 

diabetes, antacids for peptic ulcer). For these reasons 

the NAMCS drug data base distinguishes between prescription and nonprescription drugs. 

Nonprescription drugs accounted for 85,344,OOO 

(12.6 percent) ofthe 679,593,OOOdrug mentions (table 

12). Table 14 lists the 30 nonprescription drugs most 

frequently utilized in office-based drug therapy. 

Of the major drug groups, the following significantly

exceededthe overall average in their proportion of nonprescription drug mentions (table 17): 

l Blood formation and coagulation substances. 

l Central nervous system drugs (chiefly the analgesics). 

l Expectorants and cough preparations. 

l Eye, ear, nose, and throat preparations. 

l Gastrointestinal drugs. 

l Skin and mucous membrane preparations. 

0 Vitamins. 

Of the major diagnostic groups, the following were 

significantly above average in the proportion of nonprescription drugs applied to their treatment (table 18): 

l Infectious and parasitic diseases. 

l Endocrine, nutritional, and metabolic diseasesand 

immunity disorders. 

l Diseases of blood and blood-forming organs. 

l Acute upper respiratory infections. 

l Diseases of digestive system. 

l Symptoms, signs, and ill-defined conditions. 

a Normal pregnancy. 

Federal control status 

A very important issue in health and social policy

is the use of medications having significant potential for 

addiction or habituation. Such medications are under 

the regulatory control of the Drug Enforcement Administration (DEA), an agency of the U.S. Department of 

Justice. In table 12, the medications used in office practice are characterized by their DEA control category 

(Schedule). Each successiveSchedule, from II through 

V, reflects a decreasing potential for abuse, as follows: 

l ScheduleII (morphine, amphetamine, and so forth.)

High potential for abuse. Abuse may lead to severe 

psychological or physical dependence. 

l Schedule III (paregoric, chlorphentermine, and so 

forth.) Potential for abuselessthan for drugsin Schedule II. Abuse may lead to moderate or low physical

dependence or high psychological dependence. 

ScheduleIV (diazepam, phenobarbital, and so forth.) 

Potential for abuse less than for drugs in Schedule 

III. Abuse may lead to limited physical or psycho 

logical dependence. 

Schedule V (Lomotil, Donnagel-PG, and so forth.)

Potential for abuse and dependence less than for 

drugs in Schedule IV. 

NAMCS data in table 12 reveal that a small, but 

critical, proportion (8.6 percent) of all drug mentions 

were controlled drugs, with drugs in Schedule IV showing the highest frequency of mention. 

Table .I5 lists the 20 con$rolleddrugs most frequently 

utilized by office-based physicians. 

All except a handful of controlled drugs belonged in 

three therapeutic categories (table 17): 

l Central nervous system drugs (accounted for nearly 

80 percent of all controlled mentions). 

l Expectorants and cough preparations. 

l Gastrointestinal drugs (chiefly, antidiarrhea agents). 

Of the diagnoses encountered in office practice, the 

following were significantly above average in the pro 

portion of controlled drugs applied to their treatment 

(table 18): 

l Obesity. 

l Mental disorders. 

l Diseases of central nervous system. 

l Diseases of digestive system. 

l Diseases of musculoskeletal system. 

l Symptoms, signs, and ill-defined conditions. 

l Injury and poisoning. 

From the findings in table 19, it is evident that 

patient age 25-54 years was the period of life most 

frequently associated with controlled drug therapy. Female patients slightly exceededmales in their utilization 

of controlled agents, the difference being most prominent in the age groups over 44 years. 

Composition status 

Table 12 revealsthat 26.4 percent ofthe 679,593,OOO 

drug mentions were combination drugs. (The proportion includes the mentions of multivitamins.) An issue 

of long-standing debate in drug utilization concerns the 

use of drugs in fixed-ratio combinations as opposed to 

single-ingredient drugs. Combination drugs offer more 

potential convenience to the patient; however, they 

usually cost more and permit less flexibility in dosage 

adjustment. The NAMCS drug database allows for 

differentiating single-ingredient drugs from combination drugs and can identify the specific ingredients of the 

combinations if this information is required.

Table 16 lists the 39 combination drugs most fre11 

I 
quently utilized, along with their active ingredients and 

the therapeutic effect or effects desired. 

Of the major drug groups, 10 significantly exceeded 

the average in the proportion of their mentions represented by combination drugs (table 17): 

Antihistamine drugs. 

Autonomic drugs. 

Hypotensive agents. 

Expectorants and cough preparations. 

Eye, ear, nose, and throat preparations. 

Gastrointestinal drugs. 

Serums, toxoids, and vaccines. 

Skin preparations. 

Spasmolytic agents. 

Vitamins. 

Of the primary diagnosesencounteredin office practice, the following were significantly above average in 

the proportion of combination drugs applied to their 

treatment (table 18): 

Diseases of eye and adnexa. 

. Otitis media. 

Acute upper respiratory infections. 1 

Diseases of digestive system. 

Diseases of genitourinary system. 

Injury and poisoning. 

Normal pregnancy (largely due to prenatal multivitamins. 

Health supervision of infant or child (largely due to 

combined vaccines). 

The following specialties significantly exceededthe 

average in their utilization of combination drugs (table 

20): 

l Pediatrics (largely due to the use of combined vaccines). 

l General surgery. 

o Obstetrics and gynecology (largely due to the useof 

prenatal multivitamins). 

0 Urology. 

0 Otolaryngology. 

12 

l 

I 
References *t : .,

‘. ” 1 

,’ 

., .-’ I ,:, (( ,.! 

I. 

.­

‘Goyan, J. E.: From product to patient: The importance of clinical 

pharmacy. Pharmacy Times, pp, 23-26, Aug. 1980. 

2National Center for Health Statistics,,T. McLemore and H. Koch: 

1986 Summary, National Ambulatory Medical Care Survey. AdvanceData From VitaIandHealth Statistics, No. 77. DHHS Pub. 

No. (PHS) 82-1250. Public Health Service,Hyattsville, Md. Feb. 22, 

1982. 

3National Center for Health Statistics, H. Koch: The collection and 

processingof drug information, National Ambulatory Medical Care 

Survey, United States, 1980. Vitaland Health Statistics. Series 2-

No. 90. DHHS Pub. No. (PHS) 82-1364. Public Health Service. 

Washington. U.S. Government Printing Office, Mar. 1982. 

4National Center for Health Statistics, H. Koch: Drugs most frequently used in office basedpractice, National Ambulatory Medical 

Care Survey. AdvanceDataFrom VitaIandHealth Statistics, No. 

78. DHHS Pub. No. (PHS) 82-1250. Public Health Service, Hyattsville, Md. May 12, 1982. 

5National Center for Health Statistics, B. Cypress: Medication 

therapy in office visits for hypertension: National Ambulatory Medical Care Survey, 1980. Advance Data From Vital and Health 

Statistics, No. 80. DHHS Pub. No. (PHS) 82-1250, Public Health 

Service. Washington. U.S. Government Printing Office, July 22, 

1982. 

6National Center for Health Statistics, B. Cypress: Medication 

therapy in offke visits for selected diagnoses:National Ambulatory

Medical Care Survey, 1980. Vital and Health Statistics. Series 13-

No. 7 1. DHHS Pub. No. (PHS) Public Health Service.Washington.

U.S. Government Printing Office, Jan. 1983. 

7National Center for Health Statistics, H. Koch: Drug utilization in 

offke practice by age and sex of the patient: National Ambulatory 

Medical Care Survey, 1980. Advance Data From Vital andHealth 

Statistics, No. 81. DHHS Pub. No. (PHS) 82-1250. Public Health 

Service. Washington. U.S. Government Printing Office, July 26, 

1982. 

8National Center for Health Statistics, B. Cypress: Drug utilization 

in offke visits for primary care physicians: National Ambulatory 

Medical Care Survey, 1980. Advance Data From Vital andHealth 

Statistics, No. 86. DHHS Pub. No. (PHS) 82-1250. Public Health 

Service. Washington. U.S. Government Printing Oflice, Oct. 8, 

1982. 

13 
List of detailed tables 

1. Number of drug mentions and therapeutic use of the 100 

,generic substances most frequently utilized: United States, 

1980:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

2. Number and percent distribution of drug mentions, by selected 

therapeutic categories: United States, 1980. . . . . . . . . . . . 

3. Numberand percent distribution of office visits and drug mentions, number of drug visits and their percent of office visits, 

drug mention rate and drug intensity rate, by major clinical 

problems: United States, 1980.. . . . . . . . . . . . . . . . . 

4. Number and percent distribution of office visits and drug mentions, number of drug visits and their percent of office visits, 

drug mention rate and drug intensity rate, by patient characteristics: United States, 1980. . . . . . . . . . . . . . . . 

5. Number and percent distribution of drug mentions by selected 

therapeutic categories, according to age of patient: United 

States,1980........................................ 

6. Number and percent distribution of drug mentions by selected 

therapeutic categories, according to sex of patient: United 

States.1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

7. Number and percent distribution of drug mentions by selected 

therapeutic categories, according to age and sex of patient: 

United States, 1980 . . . . . . . . . . . . . . . . . . . . . . 

8. Number of mentions and number of mentions per 1,000 office 

visits of the 10 generic substances most frequently utilized, by 

sex-age groups of patient: United States, 1980 . . . . . . . . . . 

9. Number and percent distribution of drug mentions by selected 

therapeutic categories, according to race and ethnicity of patient: United States, 1980.. . . . . . . . . . . . . . . . . 

IO. Number and percent distribution of office visits and drug mentions, number of drug visits and their percent of office visits, 

drug mention rate and drug intensity rate, by physician characteristics: United States, 1980. . . . . . . . . . . 

11. Number and percent distribution of office visits and drug mentions, number of drug visits and their percent of office visits, 

drug mention rate and drug intensity rate, by selected visit 

15 characteristics: United States, 1980 1 . . . . . . . . . . . . . . . . . . 29 

12. Number and percent distribution of drug mentions by entry 

17 status, prescription status, Federal control status, and composition status: United States, 1980 . . . . . . . . . . . . .’1 . . . . . . 30 

13. Number of mentions and therapeutic use of the generic agents 

most frequently named by ph,ysicians as entry choices: United 

18 States, 1980.. . . . . . . . . . . :. . . . . . . . , . . . . . . . , , . . . . . . . , , 3i 

14. Number of mentions and therapeutic use of the nonprescription 

drugs most frequently named by physicians as entry choices: 

United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . .32 

19 i 5. Number of mentions and therapeutic use of controlled drugs 

most frequently named by physicians as entry choices: United 

States,1980........................................ 32 

20 16. Number of mentions and therapeutic use of combination drugs 

most frequently named by physicians as entry choices: United 

States,1980........................................ 33 

22 17. Number and percent of drug mentions according to entry status, 

prescription status, Federal control status, and composition 

status, by selected therapeutic categories: Unitad States, :. 

24 1980.............................................. 34 

18. Number and percent of drug mentions according to entry status, 

prescription status, Federal control status, and composition 

26 status, by selected principal diagnoses: United States, 

1980.................................,.~....~..... 35 

27 

19. Numberand percent of drug mentions according to entry status, 

prescription status, Federal control status, and composition 

status, by patient characteristics: United States, 1980. . . . . . 36 I 

20. Number and percent of drug mentions according to entry status, 

28 prescription status, Federal control status, and composition 

status, by physician characteristics: United States, 1980. . . . 37 r 

14 
Table 1. Number of drug mentions and therapeutic use of the 100 generic substances most frequently utilized: United State;, 1980 ’ 

Number 

Rank 100 generic substances most frequently utilized of mentions Therapeutic we 

in thousands’ 

9 Acetaminophen ................................................... 11,990 Analgesic, antipyretic 

54 Aluminumhydroxide ............................................... 4,396 Antacid 

70 Amitriptyline.. ................................................... 3,159 Antidepressant 

13 Amoxicillin ....................................................... 11,114 Antibiotic 

12 Ampicillin ........................................................ 11,549 Antibiotic 

2 Aspirin ............................................................ 18,840 Analgesic, antipyretic 

41 Atropine ......................................................... 5.790 Anticholinergic 

57 Benzoylperoxide .................................................. 4.097 Keratolytic, acne treatment 

55 Betamethasone....................................~ .............. 4,343 Glucocorticoid 

20 Brompheniramine.....~ ........................................... 8,319 Expectorant 

27 Caffeine ......................................................... 7.031 Stimulant 

56 Cephalexin ....................................................... 4,334 Antibiotic 

59 Chlordiazepoxide .................................................. 4.057 Emotional disturbance, sedative 

81 Chlorothiazide .................................................... 2,800 Diuretic 

11 Chlorpheniramine ................................................. 11,902 Antihistaminic 

68 Chlorpropamide ................................................... 3,215 Hypoglycemic agent 

46 Chlorthalidone .................................................... 5,203 Diuretic, antihypertensive 

49 Cimetidine ....................................................... 4,852 Ulcer and gastro-intestinal disease 

75 Clindamycin ...................................................... 2,994 Antibacterial 

92 Clorazepate ...................................................... 2,383 Tranquilizer 

17 Codeine ......................................................... 9.171 Analgesic, antitussive 

48 Dexamethasone ................................................... 4,853 Anti-inflammatory 

67 Dextromethorphan ................................................. 3,268 Cough suppressant 

32 Diazepam ........................................................ 6,674 Sedative, tranquilizer 

10 

38 

Digoxin .......................................................... 

Diphtheria tetanus toxoids pertussis.................................. 

11,906 

6,092 

Cardiotonic 

Immunization 

52 Diphenhydramine ................................................. 4,588 Antihistaminic 

98 Doxepin...~ ..................................................... 2,153 Antidepressant 

99 Ephedrine.......................: ................................ 2,122 Adrenegic (bronchodilator) 

5 Erythromycin ..................................................... 15.693 Antibiotic 

37 Estradiol ......................................................... 6.154 Estrogen replacement therapy 

80 Estrogens ........................................................ 2,854 Estrogen replacement therapy 

96 Flurazepam ....................................................... 2,202 Hypnotic 

15 Furosemide ...................................................... 10,001 Diuretic _, 18 Guaifenesin .................................. . ............... . ... 8,837 Cough suppressant 

61 Hydralazine ...................................................... 3,625 Antihypertensive 

1 Hydrochlorothiazide ............................................... 26,334 Diuretic 

19 Hydrocortisone ................................................... 8,654 Anti-inflammatory 

69 Hydroxyzine ....................................................... 3,209 Tranquilizer 

42 Hyoscyamine ..................................................... 5,491 Anticholinergic 

40 Ibuprofen ........................................................ 5,819 Anti-inflammatory 

66 Indomethacin ..................................................... 3,275 Anti-inflammatory 

87 lnfluenzavirusvaccine ............................................. 2,556 Immunization 

44 Insulin ................................ . ......................... 5,264 Antidiabetic 

63 Iron preparations ................................................... 3,467 Iron deficiency 

60 Isopropamideiodide ............................................... 4,013 Anticholinergic 

47 lsosorbide ....................................................... 4,957 Coronary vasodilator 

89 Levothyroxine .................................................... 2,478 Thyroid hormone 

83 Lidocaine ........................................................ 2,641 Local anesthetic 

86 Meclizine ........................................................ 2,592 Antinauseant 

J 88 

82 

Meprobamate ..................................................... 

Metoproiol ....................................................... 

2,535 

2,692 

Tranquilizer, sedative 

Beta-adrenergic blocker 

22 

84 

Methyldopa ...................................................... 

Methylprednisolone............................................... 

7.710 

2,626 

Antihypertensive 

Glucocorticoid 

91 Miconazole ...................................................... 2,475 Antifungal 

25 Multivitamins general .............................................. 7,096 Vitamins 

33 Multivitamins prenatal .............................................. 6,404 Vitamins 

71 Naproxen ........................................................ 3,158 Anti-inflammatory, antipyretic, analgesic 

16 Neomycin ........................................................ 9.719 Antibiotic 

43 Nitroglycerin ..................................................... 5,452 Vasodilator 

90 Norethindrone .................................................... 2,475 Oral contraceptive 

97 Norgestrel ....................................................... 2,200 Oral contraceptive 

79 Nystatin ......................................................... 2,875 Antifungal 

3 Penicillin ........................................................ 16,937 Antibiotic 

36 Phenacetin ....................................................... 6,255 Antipyretic, analgesic 

28 

72 

PhenobarbitaL .................................................... 

Phentermine..................................................... 

7.014 

3.114 

Anticonvulsant, hypnotic, sedative 

Anorexiant 

94 Phenylbutarone .................................................. . 2,296 Anti-inflammatory 

6 Phenylephrine .................................................... 15,369 Sympathomimetic 

See footnote at e&l of table. 

15 
..-_l 

Table 1 , Numbe r o f d rug men tions and ’th e rapeu tic use o f the 100 gene ric subs tances mos t frequen tly u tilized : Uni ted Sta te& 1980 - C o n . 

Numbe r 

Rank 100 gene ric subs tances mos t frequen tly u tilized o f men tidns 

in thoi /sands ’ 

4 

31 

21 

35 

P henylp ropanolamine ............... 

Polio vaccine . ..................... 

Polymixin B ....................... 

Po tassium replacemen t solu tions . ..... 

. . 

. . :. 

161565 

6 ,686 

7 ,784 

6 .274 

51 

76 

Po tassium guaiacolsul fona te ......... 

Pr ednisolone ...................... 

4 ,760 

2 ,924 

39 

85 

Pr ednisone . ....................... 

Pr ochlo rpe razine ................... 

6 ,051 

2 ,600 

26 

14 

Pr ome thazine . ..................... 

Pr op renolol ....................... 

7 ,042 

10 ,351 

58 

8 

45 

74 

65 

78 

100 

77 

34 

95 

64 

7 

Pr opoxyphene ..................... 

Pseudoephed rine . .................. 

Rese rpine . ........................ 

Salicylic acid ...................... 

Scopolamine ...................... 

Sime thicone ....................... 

Sodium ci tra te ...................... 

Spi ronolac tone .................... 

Sul fame thoxazole .................. 

S ul fisoxazole...................... 

Sulindac .......................... 

Te tracycline ....................... 

4 ,062 

12 ,321 

5 ,216 

3 ,048 

3 ,376 

2 ,884 

2 ,094 

2 ,887 

6 ,296 

2 ,275 

3 .446 

12 ,991 

240 

73 

Theophylline ...................... 

Thy roid ........................... 

6 ,750 

3 .071 

29 

23 

50 

53 

24 

93 

62 

T riamcinolone ..................... 

T riam te rene ....................... 

T rip rolidine . ....................... 

Tube rculin ........................ 

Vi tamin B-l 2 . . .................. 

W a rfa ri n.......................... 

Zinc topical agen ts ................. 

6 ,846 

7 ,626 

4 ,831 

4 ,488 

7 ,610 

2 ,340 

3 ,536 

Sympa thomime tic .‘/, II 

Immuniza tion ., L I: . 

A n tibac te rial ‘) 

P o tassium replacemen t th e rapy 

Cough p repa ra tions / ’ : 

A n ti -i n flamma to ry “, 

A n ti -i n flamma to ry 

A n tieme tic 

A n tihis tamine , a n tieme ti c , seda tive 

B e ta blocke r , 

Analgesic . 

A n tihis tamine , cough supp ressan t I 

A n tihype rtensive ‘, ‘,. .: 4 ..,Y.:: 

A n ti fungal , k e ra toly tic I 

Hypno ti c , seda tive , e n ticholine rgic 

A n ti fl a tulen t 

A n ticoagulan t : 

Diu re tic ,.‘. ._ ’ 

A n tibac te rial 

A n ti -i n fe c tive sul fa . 

Analgesic , a n tipy re tic 

A n tibio tic . 

C o rona ry vasodila to r, diu re tic 8 

Thy roid h o rmone ” 

A n ti -i n flamma to ry 

Diu re tic 

An tihis taminic 

T B skin te s t ,; 

V itamins 

An ticoagulan t 

Skin disease (a s tringen t, a n tisep ti c ) 

‘F requency o f men tion combines the men tions o f a gene ric subs tance as a single -ing redien t agen t w i th i ts men tions as an ing redien t o f a combina tion d ru g . 

., ,. ,: .‘,,‘. 

16 
-. . ,-,Table 2. Number and percent distribution of drug mentions, by selected therapeutic categories: United States, 1980 * 

. 

Selected tFFrap+c cat&goriesl 

All categories ............ . ............. 

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

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

Antibiotics ............................ 

Cephalosporins.................. 

Erythromycins.................. 

Penicillins ........... : .......... 

Tetracyclines ................... 

Sulfonamides ...................... 

Antineoplastic agents ..... i ............... Autonomic drugs ........................ 

Parasympatholytic agents .............. 

Sympathomimetic agents. ............. 

Skeletal muscle relaxants. ............ 

Blood formation and coagulation ........... 

Anti-anemia drugs ................... 

Anticoagulants ...................... 

Cardiovascular drugs. .................... 

Cardiac drugs ...................... 

Hypotensive agents ............... : .. 

Vasodilating agents ................. 

Central nervous system drugs ....... : ...... 

Analgesics and antipyretics ........... 

Anticonvulsants ....................... 

Psychotherapeutic agents ............ Antidepressants ................ 

Tranquilizers ................... 

Respiratory and cerebral stimulants .... 

Sedatives’ and hypnotics ............. 

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

Replacement solutions. ............... 

‘Diuretics .......................... 

Expectorants and cough preparations. ...... 

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

Anti-infectives. ..................... 

Antibiotics. .................... 

Number 

of mentions Percent 

in thousands distribution 

679,593 100.00 

43,939 6.47 

104,898 15.44 

90,081 13.26 

7,532 1.11 

14,989 2.2 1 

41,529 6.1 1 

17,507 2.58 

8,315 1.22 

5.371 0.79 

25,237 3.71 

11,353 1.67 

7,114 1.05 

5,041 0.74 

8,312 1.22 

. 5,820 0.86 

‘, 2;457 0.36 

. 64;463 9.49 

26,331 3.87 

22.633’ 3.33 

14,646 2.16 

1 10,706 16.29 

57.800 8.51 

2.745 0.40 

16,395 2.41 

10,403 1.53 

5.077 0.75 

‘8.719 1.28 

25.036 3.68 

51,956 7.65 

7,132 1.05 

42,834 6.30 

18,899 2.78 

26.076 3.84 

6,740 0.99 

4,747 0.70 

Number 

Sele+d therapeutic categories’ of mentions Percent 

in thousands distribution 

Eye, ear, nose and throat preparations-Con. 

Anti-inflammatory agents ............. 

Local anesthetics ................... 

Miotics ............................ 

Mydriatics ......................... 

Vasoconstrictors .................... 

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

Antacids and adsorbents............. 

Antidiarrhea agents .................. 

Antiflatulents. .............. ; ....... 

Cathartics and laxatives .............. 

Emetics and anti-emetics ............. 

Hormones and synthetic substances ........ 

Adrenals .......................... 

Contraceptives ..................... 

Estrogens .......................... 

Gonadotropins ................ .: ... 

Insulins and antidiabetic agent ........ 

Insulins ....................... 

Thyroid and antithyroid .............. 

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

Toxoids ........................... 

Vaccines .......................... 

Skin and mucous membrane preparations ... 

Anti-infectives. ..................... 

Fungicides ..................... 

Anti-inflammatory agents. ............ 

Antipruritics and local anesthetics ..... 

Emollients, demulcentsandprotectants. .. 

Keratolytic agents ................... 

Spasmolytic agents ................ _. .... 

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

Vitamin B complex .................. 

Multivitamin preparations ............. 

4,411 0.65 

2,642 0.39 

1,583 0.23 

2,696 0.40 

3,012 0.44 

24,140 3.55 

3,732 0.55 

3,734 0.55 

2.884 0.42 

3.755 0.55 

4,282 0.63 

55,843 8.22 

18,312 2.69 

7.807 l.i5 

6,133 ,: 0.90 

1,668 0.25 

11,198 1.65 

5,264 0.77 

6,846 1.01 

23,711 3.49 

9,355 1.38 

13.655 2.01 

55,188 8.12 

12,570 1.85 

5,332 0.78 

22,307 3.28 

4.053 0.60 

3,014 0.44 

7,213 1.06 

11,541 1.70 

24,244 3.57 

7.888 1.16 

12.800 1.88 

1 Based on the pharmacologic-therapeutic classification of the American Society of Hospital Pharmacists: selected categories reproduced with the Society’s permission. 

17 
Table 3. Number and percent distribution of office visits and drug mentions, number of drug visits and their percent of office visits, drug mentionrate a$d 

drug intensity rate, by major clinical problems: United States, 1980 

[Drug information is limited tc drugs ordered or provided for principal diegnosis only according to Patient Record] 

Office visits Drug visits’ Drug mentions 

Drug Drug 

Major clinical problem Number Percent Number Drug Number Percent in in visit in 

thousands distribution thousands proportion2 thousands distribution 

mention 

rate3 

intensity 

rate4 

All major clinical problems ................ 575,745 100.0 347,536 60.4 581,231 100.0 1 .Ol 1.67 

Principal diagnosis5 

Infectious and parasitic diseases ........... 19,628 3.4 14,274 72.7 21,007 3.6 1.07 1.47 

Neoplasms ............................. 16,021 2.8 5,103 31.9 9,546 1.6 0.60 1.87 

Endocrine, nutritional, and metabolic diseases 

and immunity disorders ................. 24,166 4.2 18,064 74.7 33,240 5.7 1.38 1.84 

Diseases of endocrine glands .......... 13,558 2.4 9,986 73.7 16,523 2.9 1.22 1,.65. 

Obesity and other hyperalimentation .... 8.081 1.4 6,346 78.5 13,554 2.3 1.68 2.14. 

Diseases of blood and blood-forming organs ... 3,077 0.5 2,088 67.9 3.457 0.6 1.12 1.66 

Mental disorders ......................... 24,343 4.2 12,039 49.5 18,324 3.2 0.75 1.52 

Nonpsychotic disorders ............... 20,753 3.6 9,593 46.2 13,925 2.4 0.67 1.45 

Diseases of nervous system and sense organs ... 52,593 9.1 30,422 57.8 48,964 8.4 0.93 1.61 

Diseases of central nervous system ..... 3,722 0.6 2,932 78.8 5,413 0.9 

Disorders of eye and adnexa........... 25,362 4.4 10,634 41.9 15,855 2.7 

1.45 

0.63 

1.85 

1.49 

Otitis media (suppurative and unspecified) ............................. 11,748 2.0 10,009 85.2 17,398 3.0 1.48 1.74 

Diseases of the circulatory system .......... 53,691 9.3 42,526 79.2 84,213 14.5 1.57 1.98 

Essential hypertension ................ 25,137 4.4 21,527 85.6 38,463 6.6 1.53 1.79 

lschemic heart disease ............... 10.430 1.8 8,489 81.4 20,599 3.5 1.97 2.43’ 

Diseases of respiratory system ............. 72,886 12.7 64.718 88.8 1 16,302 20.0 1.60 1.80 

Acute upper respiratory infections ...... 15,050 2.6 13,942 92.6 26,300 4.5 1.75 1.89 

Asthma ............................ 5,921 1 .o 5,447 92.0 10,594 1.8 1.79 I.‘94 

Diseases of digestive system ............... 23,421 4.1 14,282 61 .O 24,646 4.2 1.05 1.73 

Diseases of genitourinary system ........... 32,936 5.7 19,435 59.0 26,658 4.6 0.81 1.37 

Diseases of male genital organs. ....... 4,267 0.7 2,460 57.7 3,023 0.5 0.71 1.23 

Diseases of female genital organs ...... 14,718 2.6 8,761 59.5 12,550 2.2 0.85 I.43 

Diseases of skin and subcutaneous tissue. ... 36.214 6.3 28.162 77.7 53,416 9.2 1.48 1.90 

Diseases of musculoskeletal system ......... 36,839 6.4 23,075 62.6 37,544 6.5 1.02 1,63 

Arthropathies ....................... 10,684 1.9 8,449 79.1 14,447 2.5 1.35 1.71 

Symptoms, signs, andill-definedconditions ... 19,020 3.3 10,512 55.3 17,093 2.9 0.90 1.63 

Injury and poisoning ...................... 46,187 8.0 20,227 43.8 27,264 4.7 0.59 1.35 

Normal pregnancy ....................... 26,256 4.6 8.166 31.0 9,908 1.7 0.38 1.21 

Health supervision of infant or child. ........ 17,496 3.0 9,701 55.4 15,219 2.6 0.87 1.57 

Residual ............................... 70,971 . . . . . . . . . . . . . . . . 

Problem categories 

Acute problem .......................... 208.428 36.2 147,587 70.8 241,946 41.6 1.16 1.64 

Chronic problem, routine. ................. 162,075 28.2 108,692 67.1 194,718 33.5 1.20 1.79 

Chronic problem, flareup .................. 52.703 9.2 38,303 72.7 68,903 11.9 1.31 1.80 

Post surgery/post injury ................... 50.169 8.7 11,961 23.8 18,019 3.1 0.36 1.51 

Non-illness care ......................... 102,370 17.8 40,993 40.0 57,645 9.9 0.56 1.41 

‘An office visit at which one or mere drugs were ordered or provided. 

~Percent of office visits at which one or more drugs were ordered or provided. 

The average number of drugs ordered or provided per office visit. 4 The average number of drugs ordered or provided per drug visit. 

5Based on the international Classification of Diseases, 9rh Revision, Clinical Modification (ED-g-CM). 

18 
Table 4. Number and percent distribution of office visits and drug mentions, number of drug visits and their percent of office visits, drug mention rate and 

drug intensity rate, by patient characteristics: United States, 1980 

Office visits Drug visits’ Drug mentions 

Drug Drug 

Patient characteristic Number 

in 

thousands 

Percent 

distribution 

Number 

in 

thousands 

Drug 

visit 

proportion2 

Number Percent in distribution thousands menrion 

rate3 

intensity 

rate4 

All patients ............................. 575,745 100.0 363,489 63.1 679,593 100.0 1 .'I8 1.87 

Age 

Under 5 years ........................... 56,557 9.8 38,854 68.7 65,167 9.6 1 .15 .68 

5-14years ............................. 52,799 9.2 32,910 62.3 50,476 7.5 0.96 .53 _ 

15-24 years. ........................... 81,561 14.2 46,353 56.8 75,213 11.1 0.92 .62 

25-34 years ............................ 93,167 16.2 50,889 54.6 83,802 12.4 0.90 .65 

35-44years ............................ 61,529 10.7 36,454 59.2 64,324 9.5 1.05 .76 

45-54 years ............................ 61,472 10.7 40,006 65.1 78.351 11.5 1.27 .96 

55-64years ............................ 68,173 11.8 46,320 67.9 97.221 14.3 1.43 2.10 

65-74years ............................ 60,917 10.6 43,906 72.1 98,924 14.5 1.62 2.25 

75yearsandover ........................ 39,571 6.9 27,798 70.2 66.1 15 9.7 1.67 2.38 

Sex 

Female ................................. 346,106 60.1 219.216 63.3 413,570 60.9 1.19 1.89 

Male .................................. 229,639 39.9 144,274 62.8 266,023 39.1 1.16 1.84 

Sex and age 

Female 

Under 15 years .......................... 50,503 8.8 33,395 66.1 54,723 8.1 1.08 1.64. 

15-24years ............................ 54,879 9.5 31,350 57.1 49,823 7.3 0.91 1.59 

25-44years ............................ 103,562 18.0 58.025 56.0 97,947 14.4 0.95 1.69 

45-64years ............................ 76,385 13.3 52,223 68.4 106.333 15.6 1.39 2.04 

65yearsandover ........................ 60.777 10.6 44,222 72.8 104.745 15.4 1.72 2.37 

Male 

Underl5years .......................... 58,852 10.2 38,368 65.2 60,920 9.0 1.04 1.59 

15-24 years .................... ..- ...... 26,682 4.6 15,003 56.2 25.391 3.7 0.95 1.69 

25-44 years ............................ 51,134 8.9 29,318 57.3 50.179 7.4 0.98 1.71 

45-64 years ............................. 53,260 9.3 34,105 64.0 69,239 10.2 1.30 2.03 

65 years and over ........................ 39.712 6.9 27,481 69.2 60.294 8.9 1.52 2.19 

Race 

White .................................. 516,616 89.7 324,648 62.8 608.346 89.5 1.18 1.87 

Black .................................. 52,872 9.2 34,903 66.0 64.808 9.5 1.23 1.86 

Other5 ................................. 6,257 1.1 3,938 62.9 6,439 0.9 1.03 1.64 

Ethnicity 

Hispanic ............................... 28.720 5.0 18,949 66.0 34,239 5.0 1.19 1.81 

Not Hispanic ............................ 547,025 95.0 344.540 63.0 645,354 95.0 1.18 1.87 

‘An office visit at which one or more drugs were ordered or provided. 

~Percent of office visits at which one’or more drugs were ordered or provided. 

The average number of drugs ordered or provided per office visit. 

+h e average number of drugs ordered or provided per drug visit. 

5Asian, Pacific Islander, American Indian, or Alaskan Native. 

19 
. 

Table 5. Number and percent distribution of drug mentions by selected therapeutic categories, according to age of patient: United States, IS& :““: 

Age of patient 

Under 25 years 25-44 years 45-64 years 65 years and over 

_ 

Selected therapeutic categories’ Number Number Number is Number ‘, ‘, 

of 

mentions 

in 

Percent 

distribution 

of 

mentions 

in 

Percent 

distribution 

of 

mentions 

in 

Percent 

distribution 

of 

mentions 

in 

Percent 

distribution 

thousands thousands thousands thousands 

All categories ....................... 190,856 100.00 148,126 100.00 175.572 100.00 165,038 

Antihistamine drugs. ................. 22.710 11.90 10.61 1 7.16 6,840 3.90 3,779 2.29 

Anti-infective agents ................. 53,728 28.15 25,435 17.17 15,334 8.73 10,402 6.30 

Antibiotics. ..................... 49,068 25.70 21,351 14.41 12,308 7.01 7,353 4.46 

Cephalosporins. ............. 3,562 1.87 1,957 1.32 1,241 0.71 772 0.47 

Erythromycins ............... 8,132 4.26 3,259 2.20 2,322 1.32 1,275 0.77 

Penicillins. ................. 26,658 13.97 8,305 5.61 4,394 2.50 2,173 1.32 

Tetracyclines. ............... 6,338 3.32 5,517 3.72 3,235 1.84 2,417 1.46 

Sulfonamides ................... 3,202 1.68 1,683 1.14 1,698 0.97 1.732 1.05 

Antineoplastic agents ................ *218 *0.11 ‘672 ‘0.45 2,591 1.48 1,889 1.14 

Autonomic drugs .................... 5,537 2.90 7,273 4.91 7,275 4.14 5,153 3.12 

Parasympatholytic agents ......... 2,344 1.23 3,263 2.20 3,133 1.78 2,612 1.58 

Sympathomimetic agents ......... 2,437 1.28 1,582 1.07 1,785 1.02 I,31 1 0.79 

Skeletal muscle relaxants ......... ‘622 *0.33 2,102 1.42 1,727 0.98 *589 *0.36 

Blood formation and coagulation 1,595 0.84 1,757 1.19 2,078 1.18 2,883 1.75 

Anti-anemia drugs ............... 1,581 0.83 1,496 1 .Ol 1.080 0.62 1,663 1 .Ol 

Anticoagulants .................. 2 0.00 *241 *0.16 982 0.56 1,220 0.74 

Cardiovascular drugs ................. 794 *0.42 4,293 2.90 23,991 13.66 35,386 21.44 

Cardiac drugs ................... +450 ‘0.24 1,620 1.09 9,272 5.28 14,990 9.08 

Hypotensive agents .............. *220 ‘0.12 1,956 1.32 9,585 5.46 10,872 6.59 

Vasodilating agents .............. *110, *0.06 *557 ‘0.38 4,877 2.78 9,102 5.52 

Central nervous system drugs .......... 15,442 8.09 32,221 21.75 36,375 20.72 26,669 16.16 

Analgesics and antipyretics. ....... 9,997 5.24 14,656 9.89 18.135 10.33 IS,01 3 9.10 

Psychotherapeutic agents ......... 1,420 0.74 5,022 3.39 6,281 3.58 3,672 2.22 

Antidepressants ............. ‘632 ‘0.33 3.06.4 2.07 4,144 2.36 2,562 1.55 

Tranquilizers ................ 

Respiratoryandcerebralstimulants, 

$748 

927 

*0.39 

0.49 

1,539 

4,629 

1.04 

3.13 

1,763 

2,342 

1 .oo 

1.33 

1.027 

821 

0.62 

0.50 

Sedatives and hypnotics .......... 2,500 1.31 7,044 4.76 8.743 4.98 6,750 4.09 

Electrolytic. caloric, and waterbalance. ... 1,845 0.97 6,839 4.62 20,485 11.67 22,787 13.81 

Replacement solutions ............ *535 ‘0.28 *702 *0.47 2,913 1.66 2,982 1.81 

Diuretics ....................... 943 0.49 5,697 3.85 16,909 9.63 19,285 11.69 

Expectorants and cough preparations. ._ 9,988 5.23 3,980 2.69 3,166 1.80 1,766 1.07 

Eye. ear, nose, and throat preparations. ... 6,969 3.65 5,128 3.46 5,756 3.28 8,223 4.98 

Anti-infectives. .................. 2,633 1.38 1,864 1.26 1,293 0.74 950 0.58 

Antibiotics. ................. 1,831 0.96 1,348 0.91 905 0.52 *663 *0.40 

Anti-inflammatory agents. ......... 919 0.48 1,052 0.71 1 ,176 0.67 1,264 28.65 

Gastrointestinal drugs ................ 4,278 2.24 5,063 3.42 7,268 4.14 7,530 4.56 

Antacids and adsorbents .......... *469 *0.25 808 0.55 1,362 0.78 1,093 0.66 

Antidiarrhea agents .............. 1,638 0.86 *753 *0.51 ‘748 0.43 *596 *0.36 

Antiflatulents ................... *353 *0.18 *669 *0.45 1,058 0.60 804 0.49 

Cathartics and laxatives. .......... *570 *0.30 ‘745 *0.50 1,069 0.61 1,372 0.83 

Emetics and antiemetics .......... 893 0.47 +740 ‘0.50 944 0.54 1,705 1.03 

Hormones and synthetic substances .... 9,566 5.01 13,883 9.37 18,335 10.44 14,060 8.52 

Adrenals ....................... 3,500 1.83 4,483 3.03 6,109 3.48 4,220 2.56 

Contraceptives .................. 4,534 2.38 3,136 2.12 *124 *0.07 z 0.00 

Estrogens ...................... *178 ‘0.09 1 ,I 38 0.77 3,694 2.10 1,123 0.68 

Insulins and antidiabetic agents., *331 *0.17 1,113 0.75 4,335 2.47 5,419 3.28 

Insulins .................... ‘263 “0.14 826 0.56 2,124 1.21 2,051 1.24 

Thyroid and antithyroid ........... *322 *0.17 1,912 1.29 2,531 1.44 2.082 1.26 

Serums, toxoids, and vaccines ......... 18,660 9.78 1,205 0.81 I ,738 0.99 2,109 1.28 

Toxoids ........................ 8,050 4.22 *603 *0.41 *527 *0.30 ‘176 *0.11 

Vaccines ....................... 10,341 5.42 ‘359 +0.24 1,093 0.62 1,861 1.13 

Skin and mucous membrane 

preparations ...................... 21,612 11.32 15,917 10.75 10,047 5.72 7,613 4.61 

Anti-infectives. .................. 5,149 2.70 3,932 2.65 1,938 1.10 1,551 0.94 

Fungicides. ................. 2,059 1.08 1,930 1.30 854 0.49 *489 ‘0.30 

Anti-inflammatory agents. ......... 7,497 3.93 6,310 4.26 5,027 2.86 3,473 2.10 

Antipruritics and local anesthetics 843 0.44 1,431 0.97 934 0.53 845 0.51 

Emollients. demulcents, and 

protectants ................... 856 0.45 993 0.67 *610 ‘0.35 ‘555 ‘0.34 

Keratolytic agents. ............... 4,769 2.50 1.705 1.15 ‘427 ‘0.24 *312 *0.19 

See footnote at end of table. 

‘ioo.bo. ’ 

20 
Table 5. Number and percent distribution of drug mentions by selected therapeutic categories, according,to age of patient: United States, 1980-Con. 

Age of patient 

Under 25 years 25-44 years 45-64 years 65 years and over 

Selected therapeutic categories’ Number Number Number Number 

of Percent of Percent of Percent

mentions distribution mentions distribution mentions distribution

in . in in 

of 

mentions 

in 

Percent 

distribution 

thousands thousands thousands thousands 

Spasmolytic agents .................. 2,447 1.28 . 1,520 1.03 3,223 1.84 4.350 2.64 

\ Vitamins ........................... 5,807 3.04 7,214 4.87 5,179 2.95 6,043 3.66 

Vitamin B complex ............... *437 *0.23 1,502 1 .Ol 2,498 1.42 3,451 2.09 

Multivitamin preparations ......... 4,169 2.18 4,801 3.24 1,866 1.06 1,964 1.19 

1 From the pharmacologic-therapeutic classification of the American Society of Hospital Pharmacists: selected categories reproduced with the Socievs permission. 

21 
Table 6. Number and percent distribution of drug mentions by selected therapeutic categories, according to sex of patient: United States, 1980 

Sex of patient 

Female Male 

Selected therapeutic categories’ 

Number 

of mentions 

in thousands 

Percent 

distribution 

Number 

of mentions 

in thousands 

Percent 

distribution 

Allcategories ........................................................ 413,570 100.00 266,023 100.00 

Antihistaminedrugs .................................................. 24,580 5.94 19,360 7.28 

Anti-infective agents .................................................. 59,385 14.36 45.513 17.11 

Antibiotics ...................................................... 49,594 11.99 40,487 15.22 

Cephalosporins .............................................. 3.848 0.93 3,684 1.38 

Erythromycins ............................................... 8,026 1.94 6,963 2.62 

Penicillins.. ................................................ 22,346 5.40 19,183 7.21 

Tetracyclines ................................................ 9,938 2.40 7,568 2.84 

Sulfonamides .................................................... 4,722 1.14 3,594 1.35 

Antineoplastic agents .................................................. 4,114 0.99 1,257 0.47 

Autonomicdrugs ..................................................... 15,312 3.70 9,925 3.73 

Parasympatholytic agents .......................................... 7,107 1.72 4,245 1.60 

Sympathomimetic agents .......................................... 3,933 0.95 3,181 1.20 

Skeletal muscle relaxants .......................................... 2,914 0.70 2,127 0.80 

Blood formation and coagulation ........................................ 5,721 1.38 2,591 0.97 

Anti-anemiadrugs ................................................ ‘4,637 1.12 1,183 0.45 

Anticoagulants ................................................... 1,065 0.26 1,392 0.52 

Cardiovasculardrugs .................................................. 35,360 8.55 29,103 10.94 

Cardiacdrugs .................................................... 13,370 3.23 12,961 4.87 

Hypotensiveagents ............................................... 14,135 3.42 8,498 3.19 

Vasodilatingagents ............................................... 7,401 1.79 7,244 2.72 

Central nervous system drugs ........................................... 70,576 17.06 40,131 15.09 

Analgesics and antipyretics ........................................ 34,544 8.35 23,256 8.74 

Anticonvulsants .................................................. 1,535 0.37 1,210 0.45 

Psychotherapeuticagents .......................................... 10,817 2.62 5,578 2.10 

Antidepressants .............................................. 7,239 1.75 3,164 1.19 

Tranquilizers.. .............................................. 3,065 0.74 2,011 0.76 

Respiratory and cerebral stimulants ...................................... 6.928 1.68 1,791 0.67 

Sedativesandhypnotics ............................................... 16,746 4.05 8,290 3.12 

Electrolytic, caloric, and water balance. .................................. 33,285 8.05 8,671 7.02 

Replacement solutions ............................................ 4,589 1.11 2,543 0.96 

Diuretics ........................................................ 27.700 6.70 15,134 5.69 

Expectorants and cough preparations .................................... 10,460 2.53 8.439 3.17 

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

Anti-infectives................................................... 

14,807 

3,342 

3.58 

0.81 

11,269 

3,398 

4.24 

1.28 

Anti-inflammatory agents., ........................................ 2,536 0.61 1,875 0.70 

Localanesthetics ................................................. 1,658 0.40 985 0.37 

Miotics .......... ............................................... 1,010 0.24 *573 0.22 

Mydriatics.. .................................................... 

Vasoconstrictors................................................. 

1,572 

1,535 

0.38 

0.37 

1,124 

1.477 

0.42 

0.56 

Gastrointestinal drugs ................................................. 14,371 3.47 9,768 3.67 

Antacidsandadsorbents .......................................... 2,004 0.48 1,728 0.65 

Antidiarrhea agents ............................................... 2,367 0.57 1,367 0.51 

Antiflatulents. ................................................... 1,628 0.39 1,256 0.47 

Cathartics and laxatives ........................................... 2,482 0.60 1,273 0.46 

Emetics and anti-emetics .......................................... 2.817 0.68 1,465 0.55 

Hormonesandsyntheticsubstances ..................................... 41,266 9.98 14,577 5.48 

Adrenals ........................................................ 11,034 2.67 7.279 2.74 

Contraceptives ................................................... 7,807 1.89 

Estrogens ....................................................... 5,792 1.40 ‘341 ‘0.13 

Gonadotropins ................................................... 1,411 0.34 ‘257 ‘0.10 

Insulins and antidiabetic agents ..................................... 6,699 1.62 4,499 1.69 

Insulins ..................................................... 3,180 0.77 2,084 0.78 

Thyroidandantithyroid ............................................ 5,832 1.41 1 ,015 0.38 

Serums, toxoids, and vaccines .......................................... 12,154 2.94 11,557 4.34 

Toxoids ......................................................... 4,768 “1.15 4,587 1.72 

Vaccines ........................................................ 7,036 1.70 6,619 2.49 

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

Anti-infectives................................................... 

32,487 

7,559 

7.86 

1.83 

22,701 

5.01 1 

8.53 

1.88 

Fungicides .................................................. 3,51 1 0.85 1,821 0.68 

Anti-inflammatory agents .......................................... 12,556 3.04 9,751 3.67 

Antipruritics and local anesthetics ................................... 2.430 0.59 1,623 0.61 

Emollients, demulcents, and protectants .............................. 1,549 0.37 1,465 0.55 

Keratolytic agents ................................................ 4,536 1 .lO 2,677 1 .Ol 

See footnote at end of table. 

22 
Table 6. Number and percent distribution of drug mentions by selected therapeutic categories, according to sex of patient: United States, 1980-Con, 

Sex of patient 

Female Male 

Selected therapeutic categories’ 

Number Percent Number Percent of mentions distribution of mentions distribution in thousands in thousands 

Spasmolyticagents ................................................... 5,809 1.40 5.732 2.15 

Vitamins ............................................................ 19,301 4.67 4,943 1.86 

Vitamin 8 complex ............................................... 5,678 1.37 2,210 0.83 

Multivitamin preparations ........................................... 10,779 2.61 2,021 0.76 

’ Based on the pharmacologic-therapeutic classification of the American Society of Hospital Pharmacists. Selected categories reproduced with Society’s permission. 

23 
1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

Table 7. Number and percent distribution oi drug mentions by selected therapeutic categories, according to age and sex of patient: United States, 1980 .? ’ 

Age and sex of patient 

Under 25 years 25-44 years ’ 

1.9 

20 

21 

22 

23 

24 

25 

26 

27 

28 

Selected therapeutic categories’ 

All categories ......................... 

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

Anti-infective agents (non-topical) ........ 

Antibiotics ........................ 

Antineoplastic agents .................. 

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

Blood formation and coagulation ......... 

Cardiovascular drugs ................... 

Cardiac drugs ..................... 

Hypotensive agents ................ 

Vasodilating agents ................ 

Central nervous system drugs ............ 

Analgesics and antipyretics. ......... 

Psychotherapeutic agents ........... 

Sedatives and hypnbtics ............ 

Electrolytic, caloric, and water balance .... 

Diuretics ......................... 

Expectorants and cough preparations. ..... 

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

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

Hormones and synthetic substances ...... 

Adrenals ......................... 

Insulins and antidiabetic agents ...... 

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

Skin and mucous membrane preparations 

Anti-inflammatory agents ............ 

Spasmolytic agents ..................... 

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

Female Male Female 

< 

of mentions 

in thousands 

Percent 

distribution 

Number 

of mentions 

in thousands 

Percent 

distribution of mentions 

in thousands ,++wiio~ 

104,546 100.00 86.31 1 100.00 97.947 100.0~ 

10,713 10.25 11,998 13.90 6,878 7.02 

28,333 27.10 25,395 29.42 16,633 16.98 

25,253 24.15 23,815 27.59 13,322 13.60 

z 0.00 *166 *0.19 ‘486 ‘0.50 

2,557 2.45 2,980 3.45 4,654 4.75 

1,457 1.39 *138 *0.16 1,528 *‘Xl& 

*343 *0.33 *451 *0.52 2,103 ’ ,2.15 

‘116 +0.11 *333 *0.39 770 0.79 

‘132 *I .26 *a8 *0.10 1,022 1.04 

‘79 *0.07 Z 0.00 *227 *0.23 

8,709 8.33 6,732 7.80 20,332 20.76 

5,188 4.96 4,809 5.57 8,086 8.26 

843 0.81 *577 *0.67 3,1,31 ,3.20 

1,593 1.52 907 1.05 4,713 4.81 

1,320 1.26 *525 *0.61 4,833 4.93 

‘763 *0.73 ‘180 *0.21 4,189 4.28 

5,165 4.94 4,824 5.59 .2,226 2.27 

3,599 3.44 3,370 3.90 2,581 2..64 

2,526 2.42 1,752 2.03 2,907 .2.97 

7,498 7.17 2,067 2.39 11,274 11.51 

1,901 1.82 1,600 1.85 2,781 2.84 

‘165 ‘0.16 ‘166 *0.19 *659 *0.67 

9,206 8.81 9,454 10.95 *645 *0.66 

11,756 11.24 9,856 11.42 10,409 10.63 

3,736 3.57 3,760 4.36 3,81 7 3.90 

864 0.83 1,584 1.84 992 1 .Ol 

5,109 4.89 *699 *0.81 6,433 6.57 

Number Number Percent 

1 Based on the pharmacologic-therapeutic classification of the American Society of Hospital Pharmacists; selected categories reproduced with the Society’s permission. 

24 
1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

Table 7. Number and percent distribution of drug mentions by selected therapeutic categories, accdrding to aie and sex of patient: United States, 1980-Con. 

Age and sex of patient-Con. . 

25-44 iears-Con. 45-64 years 65 years and over 

Male Female Male Female Male 

Number Number Percent Number Percent Number Percent Number Percent of mentions Percent of mentions of mentions of mentions 

in thousands distribution of mentions distribution in thousands distribution in thousands distribution in thousands distribution in thousands 

50,179 100.00 106,333 100.00 69,239 100.00 104.745 100.00 60,294 100.00 

3,733 7.44 4,431 4.17 2,409 3.48 2,558 2.44 1,220 2.02 

8,802 17.54 8,912 8.38 6,422 9.27 5,507 5.26 4,895 8.12 

8,030 16.00 7,188 6.76 5,120 7.39 3,831 3.66 3,522 5.84 

'186 *0.37 2,119 1.99 '472 *0.68 1,457 1.39 '432 *0.72-

2.619 5.22 4,562 4.29 2,713 3.92 3,540 3.38 1,613 2.67 

,f229 '*0.46 1,068 1 .oo 1,009 1.46 1,669 1.59 1,214 2.01 

2,190 4.36 11,432 10.75 12,559 18.14 21,483 20.51 13,903 23.06 

850 1.69 3,79.l 3.57 5,481 7.92 8,694 8.30 6,296 10.44 

934 1.86 5,579 5.25 4,006 5.79 7.402 7.07 3.470 5.76 

'330 '0.66 1,982 1.86 2,896 4.18 5,113 4.88 3,989 6.62 

11,849 23.69 23,025' 21.65 13,349 19.28 18,509 17.67 8.160 13.53 

6,570 13.09 11,033 10.38 7,101 IO.26 10.237 9.77 4,776 7.92 

1,891 3.7.7 4.027 3.79 2,254 3.26 2,815 2.69 856 1.42 

2,331 4.64 5,742 5.40 3,001 4.33 4,698 4.49 2,051 3.40 

2,006 4.00 12,525 11.78 7,960 11.50 14,607 13.95 8,179 13.57 

1,508 3.01 10,282 9.67 6,627 9.57 12,466 11.90 6,818 11.31 

1,754 3.50 2,120 1.99 1,046 1.51 951 0.91 815 1.35 

2,547 5.08 3,437 3.23 2,320 3.35 5:191 4.96 3,031 5.03 

2,156 4.30 4,136 3.89 ' 3.132 4.52 4,802 4.58 2,728 4.52 

2,609 5.20 13,201 12.41 5,134 7.41 9,292 8.87 4,768 7.91 

‘1.702 3.39 3.771 3.55 2,338 3.38 2,581 2.46 1,639 2.72 

*453 '0.90 2,468 2.32 1.867 2.70 3,407 3.25 2,012 3.34 

'560 '1.12 1,044 0.98 '693 *1.00 1,260 1.20 849 1.41 

5,508 10.98 5.807 5.46 4,240 6.12 4,515 ,4.31 3,097 5.14 

2,493 4.97 . 2.817 2.65 2.210 '3.19 2,186 2.09 1,287 2.14 

'528 1.05 1,710 1.61 1,513 2.19 2,244 2.14 2,107 3.49 

781 1.56 3,387 3.18 1,792 2.59 4,372 4.17 1,671 2.77 

. 

'24 

25 

26 

27 

28 

? . 

. 

. 

25 

I 
1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

Table 8. Number of mentions snd number of mentions per 1,000 office viaita of the 10 generic substances most frequently utilized, 

by sex-age groups of patient United States, 1980 

Number of Number Number of Number 

Rank Sex-age group and generic mentions of mentions Rank Sex-age group and generic mentions of mentions 

substances most frequently utilized in per 7,000 substances most frequently utilized in per 1,000 

thousands office visits2 thousands? office visits2 

Female patients under 15 years 

Phenylpropanolamine. . ..’.... ., 3,833 76 

Penicillin . . . . . . . . . . . . . . . . . . . . . . . 3,511 70 

Phenylephrine. .,.,..........,.. 3,427 68 

Amoxicillin . . . . . . . . . . . . . . . . . . . . 3,359 67 

Polio vaccine ., . . . . . . . . . . . . . . . 3,178 63 

Diphtheria tetanus toxoida pertussis. . 3,028 60 

Erythromycin . . . . . . . . . . . . . . . . . . . . 

Ampicillin . . . . . . . . . . . . . . . . . . . . . . 

Brompheniramine. . . . . . . . . . . . . . . 

Chlorpheniremine. . . . . . . . . . . . . . . 

Female patienta 15-24 years 

Estradiol . . . . . . . . . . . . . . . . . . . . . . 

Multivitamin prenatal ., ., . . . . . . . 

Tetracycline . . . . . . . . . . . . . . . . . . . 

Penicillin . . . . . . . . . . . . . . . . . . . . . ,. 

Norethindrone, . . . . . . . . . . . . . . . . ,. 

Ampicillin, . . . . . . . . . . . . . . . . . . . . 

Erythromycin, . . . . . . . . . . . . . . . . . . . 

8enzoyl peroxide,.,......,.,., 

Norgestrel . . . . . . . . . . . . . . . . . . . . . . 

Aspirin ., ., ., ., . .,, ., . .,.,...,. . 

Female patients 25–44 years 

Multivitamins prenatal . . . . . ., ., . . 

Aspirin . . . . . . . . . . . . . . . . . . . . . . . 

Tetracycline . . . . . . . . . . . . . . . . . . . 

Pseudoephedrine, . . . . . . . . . . . . . . 

Penicillin . . . . . . . . . . . . . . . . . . . . . 

Erythromycin . . . . . . . . . . . . . . . . . . . . 

Acetaminophen ., . . . . . . . . . . . . . ., 

Hydrochlorothiazide, . . . . . . . . . . . 

Eatradiol . . . . . . . . . . . . . . . . . . . . . . 

Phenylpropanolam ine. . . . . . . . . . . . 

Female patients 45-64 yeers 

Hydrochlorothiazide, ., ., 

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . 

Propranolol ...,.,.,......,.,., 

Methyldopa .,.,.,.,......,.,., 

Estrogens . . . . . . . . . . . . . . . . . . . . . 

Furosemide ...,.,.,......,., .,. 

Acetaminophen .,.,........,., . . 

Triamterene. ..,.,........,., .,. 

Potasaium replacement solutions . . 

Ibuprofen . . . . . . . . . . . . . . . . . . . . . . . 

Female patienta 65 years and over 

Hydrochlorothiazide, . . . . . 

Dioxin . . . . . . . . . . . . . . . . . . . . ,,. . 

Methyldopa. . ., . . . . . . . . . . . . . . . . 

Furosemide . . . . . . . . . . . . . . . . . .,. 

Aspirin . . . . . . . . . . . . . . . . . . . . . . . 

Propranolol . . . . . . . . . . . . . . . . . . . . . 

Vitamin B-12 . . . . . . . . . . . . . . . . . . . . 

Triamterene. ..,.,.,......,.,.,.. 

Reserpine . . . . . . . . . . . . . . . . . . . . . . 

Nitroglycerin ..,.,.,......,.,.,.. 

2,981 59 

2,267 45 

2,070 41 

2,031 40 

3,025 55 

2,931 53 

2,097 38 

1,979 36 

1,446 26 

1,371 25 

1,348 25 

1,315 24 

1,293 24 

1,272 23 

3,382 33 

3,144 30 

2,651 26 

2,144 21 

2,109 20 

2,041 20 

2,037 20 

2,028 20 

2,017 19 

1,930 19 

6,575 86 

2,699 35 

2,085 27 

1,912 25 

1,828 24 

1,820 24 

1,799 24 

1,721 23 

1,663 22 

1,652 22 

8,133 134 

4,882 80 

3,037 50 

3,026 50 

2,941 48 

2,720 45 

2,658 44 

2,642 43 

1,937 32 

1,809 30 

Male patients under 15 years 

Phanylephrine . . . . . . . . . . . . . . . . . . . 

Amoxicillin . . . . . . . . . . . . . . . . . . . . . 

Phenylpropanolamine. . . . . .. . . . . . . . 

Erythromycin . . . . . . . . . . . . . . . . . . . 

Penicillin . . . . . . . . . . . . . . . . . . . . . . 

Polio vaccine . . . . . . . . . . . . . . . . . . . 

Brompheniramine . . . . . . . . . . . . . . . 

Diphtheria tetanus toxoids pertuaais. 

Paeudoephedrine . . . . . . . . . . . . . . . . 

Guaifenesin . . . . . . . . . . . . . . . . . . . ,. 

Male patients 15-24 years 

Tetracycline . . . . . . . . . . . . . . . . . . . . 

Penicillin . . . . . . . . . . . . . . . . . . . . . . . 

Benzoyl peroxide . . . . . . . . . . . . . . . . 

Erythromycin . . . . . . . . . . . . . . . . . . . . 

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . 

Clindamycin . . . . . . . . . . . . . . . . 

Ampicillin . . . . . . . . . . . . . . . . . . . 

Pseudoephedrine . . . . . . . . . . . . . . . . 

Phenylpropanolamine. . . . . . . . . . . 

Acetaminophen . . . . . . . . . . . . . . . . 

Male patients 25-44 yeara 

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . 

Penicillin . . . . . . . . . . . . . . . . . . . . . . 

Acetaminophan . . . . . . .. l....... 

Tetracycline . . . . . . . . . . . . . . . . . . . 

Pseudoephedrine . . . . . . . . . . . . . . 

Erythromycin . . . . . . . . . . . . . . . . . . . . 

Chlorpheniramine . . . . . . . . . . . . . . . . 

Phenylephrine . . . . . . . . . . . . . . . . . . . 

Caffeine . . . . . . . . . . . . . . . . . . . . . . 

Phenylpropanolam ine. . . . . . . . . . 

Mala patients 45–64 years 

Hydrochlorothiazide. . . . . . . . . . . . . . 

P~opranolOl . . . . . . . . . . . . . . . . . . . . . 

Aspirin, . . . . . . . . . . . . . . . . . . . . . . . . 

Dioxin . . . . . . . . . . . . . . . . . . . . . . . . 

Triamtarene . . . . . . . . . . . . . . . . . . . . . 

Diazepam . . . . . . . . . . . . . . . . . . . . . . 

Furoaemide . . . . . . . . . . . . . . . . . . . . . 

Nitroglycerin . . . . . . . . . . . . . . . . . . . . 

Isosorbide . . . . . . . . . . . . . . . . . . . . 

Erythromycin . . . . . . . . . . . . . . . . . . . . 

Male patienta 65 years and over 

Hydrochlorothiazide. . . . . . . . . . . . . . 

Dioxin. . . . . . . . . . . . . . . . . . . . . 

Furosemide . . . . . . . . . . . . . . . . . . . . . 

Propranolol . . . . . . . . . . . . . . . . . . . . . 

Isosorbide . . . . . . . . . . . . . . . . . . . . 

Nitroglycerin . . . . . . . . . . . . . . . . . . . 

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . 

Methyldopa . . . . . . . . . . . . . . . . . . . . . 

Theophylline . . . . . . . . . . . . . . . . . . . . 

Potaasium replacement solutions . . 

4,621 79 

4,583 78 

4,564 78 

3,469 59 

3,455 59 

3,144 53 

3,037 52 

2,860 49 

2,429 41 

2,311 39 

1,884 71 

1,366 51 

1,140 43 

891 33 

873 33 

792 30 

756 28 

740 28 

678 25 

636 24 

2,104 41 

1,582 31 

‘1,510 30 

1,485 29 

1,334 26 i 

1,251 24 

1,088 21 

1,083 21 I 

1,065 21 

1,056 21 

4,062 76 

2,427 46 

1,862 35 

1,791 34 

1,279 24 

1,186 22 

1,157 22 

1,102 21 

1,089 20 

1,037 19 

4,156 105 

3,590 90 

2,258 57 

1,776 45 

1,461 37 

1,345 34 

1,266 32 

1,172 30 

1,073 27 

1,073 27 

1 Fra~uencY of mention ~~mbine~ ~ha ~antio”~ of o generic substance as a single. ingredient agent with its mentions as an ingredient of a combination drug. 

2For each ~ex.age ~roUp, the number of office visits may ba obtainad from table 4. 

/ 

26 
Table 9. Number and percent distribution of drug mentions by selected therapeutic categories, according to race and ethnicity of patient: United States, 1980 

Race’of patient’ Ethnichy of patient 

Black White Hispanic Non-Hispanic 

Selected therapeutic categories2 Number Number Number Number 

of 

mentions 

in 

Percent 

distribution 

of 

mentions 

in 

Percent 

distribution 

of 

mentions 

in 

Percent 

distribution 

of 

mentions 

in 

Percent 

thousands thousands thousands thousands 

All categories ....................... 6480.8 100.00 608,346 100.00 34,239 100.00 645,354 100.00 

Antihistamine drugs ................... 3,565 5.50 39,924 6.56 1,602 4.68 42,337 6.56 

Anti-infective agents ................. 9,541 14.72 94,050 15.46 6,143 17.94 98,755 15.30 

Antibiotics. ..................... 8,050 12.42 80,818 13.28 5,149 15.04 84,931 13.16 

Antineoplastic agents ................ ‘254 *0.39 5,103 0.84 ‘40 *0.12 5.331 0.83 

Autonomic drugs .................... 3,130 4.83 21,844 3.59 1,551 3.71 23,686 3.67 

Blood formation and coagulation ....... 1,190 1.84 7,049 1.16 *213 0.62 8,099 1.25 

Cardiovascular drugs ................. 6,342 9.79 57.785 9.50 1,858 5.43 62,605 9.70 

Cardiac drugs ................... 2,022 3.12 24,219 3.98 *610 1.78 25,721 3.99 

Hypotensive agents .............. 3,174 4.90 19,270 3.17 ‘696 2.03 21,937 3.40 

Vasodilating agents .............. 1 ,I 01 1.70 13,487 2.22 *513 1.50 14,133 2.19 

Central nervous system drugs .......... 11,386 17.57 98,137 16.13 6,376 18.62 104.330 16.17 

Analgesics and antipyretics ........ 6,697 10.33 50,316 8.27 3,112 9.09 54,688 8.47 

Psychotherapeutic agents ......... 990 1.53 15,320 2.52 994 2.90 15,401 2.39 

Sedatives and hypnotics .......... 2,365 3.65 22,481. 3.70 1,630 4.76 23,406 3.63 

Electrolytic, caloric, and waterbalance. ... 5,608 8.65 46,009 7.56 1,677 4.90 50.279 7.79 

Diuretics ....................... 4,765 7.35 37,862 6.22 1,368 4.00 41,466 6.43 

Expectorants and cough preparations .... 2,117 3.27 16,553 2.72 1,321 3.86 17,578 2.72 

Eye. ear, nose, and throat preparations. ... 2,485 3.83 23,392 3.85 912 2.66 25,165 3.90 

Gastrointestinal drugs ................ 2,323 3.59 21,581 3.55 1,313 3.83 22,827 3.54 

Hormones and synthetic substances .... 5,854 9.03 49,503 8.14 3.097 9.05 52,746 8.17 

Adrenals ....................... 1,459 2.25 16,757 2.75 780 2.28 17.532 2.72 

Insulins and antidiabetic agents .... 1,864 2.88 9,117 1.50 *712 2.08 10,486 1.62 

Serums, toxoids, and vaccines ......... 1,835 2.83 21,555 3.54 1,481 4.33 22,230 3.44 

Skin and mucous membrane 

preparations ...................... 3,998 6.17 50,804 8.35 3,033 8.86 52,155 8.08 

Anti-inflammatory agents .......... 1,488 2.30 20,605 3.39 1,409 4.1 1 20,898 3.24 

Spasmolytic agents .................. 1 ,172 1.81 10,234 1.68 809 2.36 10,732 1.66 

Vitamins ........................... 2,198 3.39 21,792 3.58 1,490 4.35 22,754 3.53 

’ Excludes data on Asians, Pacific Islanders. American Indians. and Alaskan Natives. 

‘Based on the pharmacologic-therapeutic classification of the American Society of Hospital Pharmacists; selected categories reproduced with the Society’s permission. 

27 
Table 10. Number and percent distribution of office visits and drug mentions, num.ber of drug visits and their percent of office visits,cdrug mention rate anddrug intensity rate, by physician characteristics: United States, 1980 

Office visits Drug visits’ Drug mentions 

Drug Drug 

Physician characteristic Number 

in 

thousands 

Percent 

distribution 

Number Drug 

in visit 

thousands proponion 

Number Pergent in distribution thousands mention 

rate3 

intensity 

rate” 

All office-based physicians ............... 575,745 100.0 363,489 63.1 679,593 100.0 1.18 1.87 ; 

Specialty 

General and family practice 191,744 33.3 144,478 75.3 279,186 41 .I 1.46 1.93 

Internal medicine ........ 69,481 12.1 53,091 76.4 118,943 17.5 1.71 2.24 

Pediatrics .............. 64,223 11.2 45,575 71.0 72,825 10.7 1.13 1.60 

General surgery ......... 28,315 4.9 28,329 34.8 15,881 2.3 0.56 1.61 

Obstetrics and gynecology 55,123 9.6 23,984 43.5 33,026 4.9 0.60 1.38 

Orthopedic surgery ....... 26,326 4.6 7.787 29.6 11,529 1.7 0.44 1.48 

Cardiovascular disease. ... 6,154 1.1 4.159 67.6 10,162 1.5 1.65 

.2.4~ ;’ I 

Dermatology. ........... 27,857 4.8 21,434 76.9 45.287 6.7 1.63 2.11 

Urology. ............... 8.761 1.5 4,106 46.9 5,265 0.8 0.60 1.28 

Psychiatry. ............. 15,856 2.8 5,706 36.0 9,655 1.4 0.61 1.69 

Neurology. ............. 2,499 0.4 1,848 73.9 3,824 0.6 i .53 2.07 

Ophthalmology. ......... 30,810 5.4 12,666 41 .I 19,281 2.8 0.63 1.52,

Otolaryngology.......... 12,282 2.1 6,269 51.0 9,229 1.4 0.75 1.47 

Region of practice 

Northeast ............... 147,396 25.6 94,525 64.1 172,835 25.4 1.17 1.83 

North Central ............ 139,623 24.3 89,324 64.0 165,899 24.4 1.19 1.86 

South. .................. 182,275 31.7 120.250 66.0 234,866 34.6 1.29 1.95 

West ................... 106,451 18.5 59,389 55.8 105,994 15.6 1 .oo 1.78 

Type of practice 

Solo.................... 313,963 54.5 205,830 65.6 390,716 57.5 1.24 1.90 

Multiole member . 261,783 45.5 157,659 60.2 288,877 42.5 1 .I0 i.83 

Age of physician (M.D.s only) 

Under 45 years. ........... 199.050 36.9 115,863 58.2 207.714 33.2 1.04 1.79 

45-60 years. ............. 251,252 46.6 160,923 64.0 306,001 48.9 1.22 1.90 ,i 

60 years or over ........... 89,291 16.5 59,765 66.9 112,271 17.9 1.26 1.88 

‘An office visit at which one or more drugs was ordered or provided. 

iThe percent of office visits at which one or more drugs were ordered or provided. 

The average number of drugs ordered or provided per office visit. 4 The average number of drugs ordered or provided per drug visit. 

28 
Table 1 I. Number and percent distribution of office visits and drug me&ions, number of drug visits and their tiercent of office visits, drug mention rate and 

drug intensity rate, by selected visit characteristics: United States, 1980 

Office visits Drug visits’ Drug mentions 

Drug Drug 

Selected visit characteristic Number Percent Number Drug Number Percent mention intensity 

in 

thousands distribution in thousands 

visit 

proportion* 

in 

thoukands distribution rate3 rate4 

All .................................... 575,745 100.0 363,489 63.1 679.593 100.0 1.18 1.87 

Referral status 

Referred by another physician .............. 25.370 4.4 10.983 43.3 18,958 2.8 0.75 1.73 

Not referred by another physician. .......... 550,375 95.6 352.506 64.0 660,635, 97.2 1.20 1.87 

Patient visit status 

New patient ............................ 85.519 14.9 46.371 54.2 80,380 11.8 0.94 1.73 

Old patient ............................... 490,226 85.1 317,118 64.7 599,213 88.2 1.22 1.89 

Old patient, new problem ............. 130.294 22.6 93,626 71.9 164,279 24.2 1.26 1.75 

Old patient, old problem .............. 359,932 62.5 223,492 62.1 434,934 64.0 1.21 1.95 

Non-drug therapy5 

None .................................. 303.017 52.6 195,028 64.4 356,386 52.4 1.18 1.83 

Physiotherapy .......................... . 29,281 5.1 18,013 61.5 32,923 4.8 1 ..l 2 1.83 

Officesurgery ........................... 

Family planning ......................... 

Psychotherapy/therapeutic listening ......... 

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

Family/social counseling .................. 

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

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

Disposition5 

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

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

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

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

Referred to another physician. ............. 

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

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

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

Duration6 

0 minutes (no face-to-face contact with physician) ................................. 

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

6-lominutes ........................... 

11-15 minutes.. ........................ 

16 minutes or more ...................... 

43,089 7.5 20,945 48.6 34.055 5.0 0.79 1.63 

12,828 2.2 7,888 61.5 10,360 1.5 0.81 1.31 

29.024 5.0 15,601 53.8 31,127 4.6 1.07 2.00 

48,886 8.5 39,128 80.0 85.155 12.5 1.74 2.18 

13.148 2.3 8.970 68.2 16,468 2.4 1.27 1.86 

133,425 23.2 90,523 67.8 183.126 26.9 1.37 2.02 

15.618 2.7 5,136 32.9 8,467 1.2 0.54 1.65 

67,442 11.7 34,528 51.2 55,116 8.1 0.82 1.60 

346,414 60.2 225,443 65.1 443.7 19 65.3 1.28 1.97 

131,404 22.8 92.796 70.6 165,113 24.3 1.26 1.78 

19,955 3.5 13.924 69.8 26,266 3.9 1.32 1.89 

15.157 2.6 6,934 45.7 13,123 i.9 0.87 1.89 

3.677 6.6 1,942 52.8 3.699 0.5 1.01 1.90 

13,088 2.3 2.644 20.2 4,617 0.7 0.35 1.75 

1,380 0.2 *453 ‘32.8 *763 l 0.1 ‘0.55 l 1 .68 

13.813 2.4 10,606 76.8 14,868 2.2 1.08 1.40 

71,894 12.5 40,758 56.7 64,169 9.4 0.89 1.57 

175,660 30.5 117,290 66:s 214,321 31.5 1.22 1.83 

157,619 27.4 104,288 66.2 202.437 29.8 1.28 1.94 

156.758 27.2 90,548 57.8 183,798 27.0 1.17 2.03 

‘An office visit at which one or more drugs were ordered or provided. 

pe percent of office visits at which one or more drugs were ordered or provided. 

The average number of drugs ordered or provided per office visit. 

4The average number of drugs ordered or provided per drug visit. 

5May not add to 100.0 since more than one treatment or disposition was possible. 

6Time spent in face-to-face contact between physician and patient. 

29 -
Table 12. Number and percent distribution of drug mentions by entry status, prescription status, Federal control status, and-composition status: ’ 

United States, 1980 

-,,Number Percent Drug dimension of mintions distribution in thousands ,. 

: ., ,a 

Total............................................................................................... 679,593 1 00.0 

,,, 

Entry status : ., 

Genericname.....................................................................,...............~.. 164,464 24.2 

Brandname......................................................................................... 483,587 7.1.2 

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31,542 4.6 

Prescription status 

Prescription drug .............. ......................................... . . . . . . . . . . . . . . . . . . . . . . . . 561,228 82.6 

Nonprescription drug ........... ......................................... . . . . . . . . . . . . . . . . . . . . . . . 85,344 12.6 

Unknown .................... ......................................... . . . . . . . . . . . . . . . . . . . . . . . . . 33,021 ‘, 4.9 r :,“‘I.) 

Federal control status 

Controlled by DEA ’ ............ . . . . . ................... ...... . . . . . . . . . . . . . . . . . . . . . . . . . 58,550 8.6 

Schedule II ............... ................... ..... . ......................... 5,763 :0.8 

Schedule Ill .............. ................... ...... ......................... 12,037 I.8 

Schedule IV .............. ................... ...... ......................... 30,305 4.5 

Schedule V ............... ................... ......................... 10,445 1.5 

Uncontrolled ................. ................... ......................... 588,022 86.5 

Unknown.. .................. ................... . . . . . . ......................... 33.02.1 .4.9 

Composition status 

Single-ingredientdrug.................................................................................. 468,752 69.0 

Combinationdrug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 165,798 24.4 

Multivitamins................................:................................................... 13,500 2..d-:’ 

Unknown...................................................................,....................... 31,542 4.6 

’ Drug Enforcement Administration. 

30 
Table 13. Number Bf mentions and therapeutic use of the generic agents most frequently named by physicians as entry choices: United States, 1980 

_. Number 

Generics most frequently named es entry choices of mentions Therapeutic use 

in thousands 

Allgenericentrychoices.......; ..................................................... 164,464 

Amihophylline .................................................................... 887 

Amoxicillin ....................................................................... 5,506 

Ampicillin .......... . ............................................................. 9,795 

Aspirin .......................................................................... 8,800 

Chorionicgonadotropill ............................................................. 1,568 

Cortisone ........................................................................ 1,100 

Digoxin .......................................................................... 4,801 

Diphtheria tetanus toxoids .......................................................... 1,167 

Diphtheria tetanus toxoids pertussis .................................................. 6.067 

Erythromycin.. ................................................................... 5,363 

Estrogens ....... ..’ ................................................................ 1,043 

FluorouraciL ...................................................................... 1,609 

Hydrochlorothiazide ................................................................ 5,751 

Hydroconisone .................................................................... 1.732 

lnfluenzavintsvaccine ............................................................. 2,225 

Insu~n...........:.: ............................................................. 5,248 

lronpreparations.....-...................................~ ......................... a74 

Liver ............................................................................ 747 

Meprobamate ...................................................................... 945 

Methotrexate ..................................................................... 1,044 

Multivitamins prenatal ................................................................ 2,082 

Nitroglycerin ...................................................................... 3,132 

Penicillin ......................................................................... 9,736 

Phenobarbital ..................................................................... 1,790 

Phentermine ...................................................................... 718 

Pilocarpine ....................................................................... 979 

Poliovaccine ..................................................................... 6,535 

Potassium............,....................................................- ...... 2,161 

Prednisone ....................................................................... 5,879 

Quinidine ......................................................................... 1.107 

Reserpine ......................................................................... 1,170 

Rubella virus vaccine ............................................................... 581 

Salicylicacid ..................................................................... 922 

Tetanustoxoid..........................., ........................................ 1,583 

Tetracyc~ne...............................................................: ...... 9,478 

Thyroid .......................................................................... 3.071 

Tuberculin ........................................................................ 4,488 

Vitamin B-1 2 ..................................................................... 5,813 

Smooth muscle relaxant 

Antibiotic 

Antibiotic 

Analgesic, antipyretic 

Hypogonadotropic conditions 

Anti-inflammatory 

Cardiotonic 

Immunization 

Immunization 

Antibiotic 

Hormones 

Antineoplastic 

Diuretic 

Anti-inflammatory 

Immunization 

Antidiabetic 

Hematinic 

Hematinic 

Tranquilizer, sedative 

Antineoplastic 

Vitamins 

Vasodilator 

Antibiotic 

Anticonvulsant, hypnotic, sedative 

Anorexiant 

Miotic, parasympathomimetic 

Immunization 

Potassium replacement 

Anti-inftammatory 

Cardiac depressant 

Antihypertensive 

Immunization 

Keratolytic, antifungal 

Immunization 

Antibiotic 

Hormones 

Diagnostic aid 

Vitamins 

33 
Table 14. Number of mentions and therapeutic use of the nonprescription drugs most frequently named by physicians as entry chqjces: United States,,.? % 

.,.. Number 

Nonprescription drugs most frequently named as entry choices, with their generic names of mentions, ,,.Therqpeutic use ,,,,’ 

in thousands 

.- . 

All nonprescription entry choices.. . . . . . . . . . . . . . . . . . . . . . . ..a.. 85,344 1.. ” .,,,’ 

Anusol (bismuth salts, zinc oxide, etc.). ..................... . . . . . . . 652 Skin irritation/inflammation * .‘\: 

Ascriptin (aspirin) ....................................... . . . . . . 1,389 Analgesic, antipyretic ‘,I .’ d 1 

Aspirin .................................................. . . . . . . 8,800 Analgesic, antipyretic ‘_,. ‘: :Z c 

Betadine (povidone-iodine). ................................. . . . . . . . 767 Antiseptic b 1 1” 

Dimetane (brompheniramine). ............................... 

Donnagel (hyosciamine, atropine. etc.). ....................... 

Dramamine (dimenhydrinate) 

. . . . . . . . . . . . . . . 2,824 

924 

Antihistamine, d&ongestint.; expectorant 

Antidiarrheal ‘,,./ ,.. ( 

................................ . . ...... 825 Motion sickness *. ,’ 

Duofilm (salicylic acid, lactic acid). ........................... . ...... 545 Warts, keratolytic agent : ‘I’ 

Feosol (ferrous sulfate) ..................................... . . ...... 696 Iron deficiency ‘, 

Ferroussulfate ............................................ ...... ...... 834 Iron deficiency 

Gaviscon (aluminum hydroxide, magnesium trisilicate) ........... ...... ...... 443 Antacid 

Insulin.. ................................................ ...... ...... 5,248 Hypoglycemia $’c I :. “xt,i.*: ’ 

Maalox (aluminum hydroxide, magnesium hydroxide) ............ ...... ...... 1,400. Antacid ‘,, .’ 

Materna (prenatal multivitamins) ............................. ...... ...... 1,491 Multivitamins ‘. : .I,’ 

Metamucil (psyllium). ...................................... ...... ...... 1,160 Laxative : * * ..,, 

Mylanta (aluminum hydroxide, magnesium hydroxide). ........... ...... ...... 1,598 Antacid, antiflatulent ,. 1 : : ” I~,, ., 

Mylicon (simethicone). ..................................... . . . . . 619 Antiflatulent .a..: 

Neo-synephrine (phenylephrine) ............................. . . . . 952 Decongestant i 

Niacin (3-pyridinecarboxylic acid) ............................ . . . . . . 491 Vitamin B-complex component .;:. 

Novahistine (d&xtromethorphan, pseudoephedrine). ............. . 904 Antitussive, decongestant, expectorant :’ 

Podophyllum ............................................. ...... ...... 460 Caustic ‘. 

Prenatal vitamins (unspecified). .............................. ....... ...... 2,082 Multivitamins ‘,., ..,. 

Robitussin (guaifenesin, dextromethorphan, phenylpropanolamine). ...... ...... 1,617 Antitussive, decongestant, expectorant 

Salicylicacid ............................................. ...... ...... 776 Antifungal :.,I 

Stresstabs (general multivitamins). ........................... ...... ...... 594 Multivitamins .. : ..,+ / 

Sudafed(pseudoephedrine) ................................. ...... ...... 1,435 Decongestant ~.- : 

Triaminic (pyrilamine, pheniramine, phenylpropanolamine). ....... ...... ...... 953 Antitussive. decongestant, expectorank 

Tylenol (acetaminophen). ................................... ...... 3.815 Analgesic . . I 

Vitamin B-l 2. ............................................ ...... 1.815 Vitamins ’ 

. . .: 

’ 

Table 15. Number of mention’s and therapeutic use of controlled drugs most frequently named by physicians as entG choices: United State& i 980 ” . 

DEA ’ Number 

Controlled drugs most frequently named as entry choices, with their generic names control of mentions Therapeutic use 

schedule in thousands 

Allcontrolledentrychoices..................................................... 58,550 

Ativan (lorazepam) ............................ . . . . . . . IV 1,503 Tranquilizer 

Dalmane (flurazepam). ......................... . . . . IV 2,202 Hypnotic’a$ent 

Dawocet-N (propoxyphene, acetaminophen) ....... . . . . . IV 3,043 Analgesic 

Darvon(propoxyphene) ........................ . . . . . . IV 1,104 Analgesic 

Demerol (meperidine). ......................... . . . . II 879 Analgesic 

Empirin with codeine (aspirin and codeine) ........ . . . Ill 1,687 Analgesic 

Fastin (phentermine). .......................... . . . IV 1 ,012 Appetite suppressant 

Fiorinal (butalbital, aspirin, phenacetin. caffeine). ... . . . . . . . . Ill 1,435 Analgesic, sedative 

lonamin (phentermine). ........................ . . . . . . . . IV 1,108 Appetite suppressant 

Librium (chlordiazepoxide). ..................... . . . . . . . . . . . . . IV 1.343 Anxiety relief 

Limbitrol (chlordiazepoxide, amitriptyline) ......... ,... . . . . . . IV 900 Qepression therapy 

Lomotil (diphenoxylate, atropine) ................ . . . . . . . . V 1,610 Antidiarrhea 

Meprobamate ................................ . . IV 945 Trariquilizer; sedative 

Percodan (oxycodone, aspirin). .................. . . . II 1,105 Analgesic 

Phenergan with codeine (promethazine and codeine) . . I . . . . . V 2,783 Expectorant 

Phenobarbital ................................ . . . . IV 1,790 Anticonvulsant, hypnotic;sedative 

Talwin (pentazocine) .......................... 

Tranxene (clorazepate) . . . . . . . IV 779 Analgesic 

......................... . . . . . . . . . . IV 2,217 Tranquilizer 

Tylenol with codeine (acetaminophen and codeine) . . . . . . . . . Ill 3,661 Analgesic 

Valium (diazepam) ............................ . . .,.... . . . IV 6,499 Anxiety relief : 

‘Drug Enforcement Administradon. 

32 
“.’ Table 16. Number bf mentions and therapeutic use of combination drugs meet frequently named by physicians as entry choices: United States, 1980 

Number 

Combination drugs most frequently named as entry choices, with their generic ingredients of mentions Therapeutic use 

in thousands . 

Actifed (triprolidine, pseudoephedrine). .............................................. 

Aldactazide (spironolactone, hydrochlorothiazide). .................................... 

Aldoril (methyldopa, hydrochlorothiazide) ........ _ ................................... 

Bactrim (sulfamethoxazole, trimethoprim). ............................................ 

Combid (isopropamide iodide, prochlorperazine). ..................................... 

Cortisporin (polymixin-8, bacitracin, neomycin, hydrocortisone) ......................... 

Darvocet-N (propoxyphene, acetaminophen) ............................................ 

Dimetapp (brompheniramine, phenylephrine, phenylpronolamine). ....................... 

Donnagel (hyoscyamine, atropine) ................................................. 

Donnatal (hyoscyamine, atropine, hyoscine, phenobarbital). ............................ 

Drixoral (brompheniramine. pseudoephedrine). ........................................ 

Dyazide (triamterene, hydrochlorothiazide). .......................................... 

Empirin with codeine (aspirinand codeine) .......................................... 

Fiorinal (butalbital, caffeine, aspirin, phenacetin). ..................................... 

Fluress (fluorescein, chlorobutamol)................................................ 

Librax (clidinium bromide, chlordiazepoxide) ......................................... 

Lomotil (diphenoxylate, atropine) .................................................. 

Lo/ovral (norgestrel, estradiol). .................................................... 

Maalox (aluminum hydroxide, magnesium hydroxide). ................................. 

Maxitrol (dexamethasone, neomycin, polymixin-8) ..................................... 

Mycolog (triamcinolone, neomycin, nystatin). ........................................ 

Mylanta (magnesium hydroxide, aluminum hydroxide) ................................. 

Naldecon (phenylephrine, phenylpropanolamine, chlorpheniramine). ..................... 

Neosporin (polymixin-8, neomycin) ................................................. 

Norgesic (orphenadrine, aspirin, caffeine, phenacetin) ................................. 

Novahistine (dextromethorphan, guaifenesin, etc.) .................................... 

Ornade (chlorpheniramine, phenylpropanolamine, isopropamide iodide) .................. 

Ortho-novum (norethindrone, estradiol) ............................................. 

Ovral (norgestrel, estradiol) ....................................................... 

Parafon forte (chlorzoxazone, acetaminophen). ....................................... 

Percodan (aspirin, oxycodone) ..................... . ................................ 

Phenergan with codeine (promethazine and codeine). ................................. 

Rondec (pseudoephedrine, carbinoxamine maleate) .................................... 

Septra (sulfamethoxazole, trimethoprim) ............................................ 

Ser-Ap-Es (reserpine, hydralazine, hydrochlorothiazide) ................................ 

Triaminic (pyrilamine maleate, pheniramine, phenylpropanolamine) ...................... 

Triavil (perphenazine, amitriptyline) ................................................ 

Tuss-Omade (chlorpheniramine, phenylpropanolamine, isopropamide iodide) .............. 

Tylenol with codeine (acetaminophen and codeine) .................................... 

4,019 Common cold, allergic rhinitis 

2,257 Antihypertensive 

2,133 Antihypertensive 

2,943 Urinary infections, otitis media, pneumonitis 

1,443 Gastro-intestinal disorders 

3,009 Anti-inflammatory 

3.043 Analgesic 

5,377 Antihistaminic, decongestant 

924 Antidiarrhea 

2.520 Sedative, antispasmodic 

1,656 Decongestant, antihistamine 

7,435 Diuretic 

1,687 Analgesic, antipyretic 

1,435 Analgesic, sedative 

952 Aplanation tonometiy 

1.670 Gastro-intestinal disorders 

1,610 Antidiarrhea 

1,244 Oral contraceptive 

1,400 Antacid 

1,162 Ocular inflammation 

1,649 Anti-inflammatory (skin) 

1,598 Antacid, antiflatulent 

1,166 Hayfever, sinus, congestion 

2,386 Bacterial infections, topical 

1,224 Analgesic 

1,557 Antitussive. decongestant, antihistamine 

1,511 Decongestant 

1,697 Oral contraceptive 

956 Oral contraceptive 

1,171 Skeletal muscle relaxant 

1,105 Analgesic 

2,783 Expectorant 

1,241 Decongestant, antitussive 

2,781 Urinary infections, otitis media, pneumonitis 

1,306 Hypertension 

997 Antitussive, decongestant, expectorant 

1,305 Tranquilizer, antidepressant 

929 Antitussive, decongestant 

3,661 Analgesic 

33 
Table 17. Number and 

Selected therapeutic categories’ 

All categories ............... 

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

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

Antibiotics ............. 

Antineoplastic agents ........ 

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

Blood formation and 

coagulation. .............. 

Cardiovascular drugs ......... 

Cardiac drugs ........... 

Hypotensive agents. ..... 

Vasodilating agents. ..... 

Central nervous system drugs . . 

‘Analgesics and 

antipyretics. .......... 

Psychotherapeutic agents, 

Sedatives and hypnotics . . 

Electrolytic, caloric, and water 

balance .................. 

Diuretics. .............. 

Expectorants and cough 

preparations. ............. 

Eye, ear, nose, and throat 

preparations. ............. 

Gastrointestinal drugs. ....... 

Hormones and synthetic 

substances ............... 

Adrenals ............... 

Serums, toxoids, and vaccines. 

Skin and mucous membrane 

preparations. ............. 

Spasmolytic agents .......... 

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

percent of drug mentions according to entry status, prescription status. Federal control status, and 

by selected therapeutic categories: United States, 1980 

Number Entry status Prescription status federal control stark 

of drug Non- Un­ mentions Generic Brand Prescription prescription Controlled controlled in thousands name name drug drug drug drug 

679,593 24.2 71.2 82.6 

43,939 1.3 73.8 67.6 

104,898 40.4 58.9 98.8 

90,081 46.3 52.8 99.1 

5,371 61.9 37.8 99.8 

25,237 5.5 93.9 92.0 

8,312 24.2 75.3 64.4 

64,463 19.1 80.5 99.0 

26,331 25.9 74.1 98.4 

22,633 9.4 89.5 98.9 

14,646 23.0 77.0 100.0 

110,706 17.0 81.8 83.3 

57,800 20.9 79.1 70.4 

16,395 10.3 89.3 99.6 

25,036 13.7 85.7 99.4 

51,956 19.1 79.9 97.1 

42,834 15.0 83.8 98.7 

18,899 *3.2 95.1 67.5 

26,076 11.8 85.8 80.8 

24,140 4.1 92.6 36.8 

55,843 37.1 61.5 98.6 

18,312 43.8 56.2 00.0 

23,711 80.3 14.5 94.8 

55.188 10.9 86.2 72.1 

11,541 16.6 83.4 9512 

24,244 52.3 38.9 37.4 

Percent of drug mentions 

12.6 8.6 88.5 

7.5 ‘0.5 74.8 

‘0.5 99.3 

98.1 

99.8 

7.2 ‘0.9 98.3 

35.1 99.5 

*0.8 *0.1 99.5 

*1.6 100.0 

98.9 

‘0.5 99.5 

15.5 41.5 57.3 

29.6 27.2 72.7 

7.2 92.3 

88.7 10.7 

1 .s 99.0 

*0.2 98.8 

30.8 44.0 54.3 

16.8 97.6 

59.9 13.2 83.5 

10.0 98.8 

100.0 

94.8 

23.5 95.5 

*4.8 ‘4.7 95.3 

53.8 91.2 

composition status, 

Composition stqtus -, 

Single- Combinaingredient ,, , tion :, 

drug drug3 

89.0 28.4 

26.9 48.2 

90.0 9.2 

98.1 ‘i.1 

99.8 ,., -, 

52.2 47.1 

77.7,. ‘( ?f.‘6. 

86.2 135 

100.0 -

61.2 37.7 

99.1 *6.9 

79.0 19.8, 

73.8 26.3 , 

83.7 15.9 

87.4 12.0 

78.9 22.1 

75.5 23.3 

9.9 88.4 

59.3 38.3 

56.7 40.0 

83.9 lb.7 

97.0 ‘3.0 

48.0 46.8 

62.8 34.4 

70.5 ’ ; 29.5 

39.5 52.7 

‘Based on the pharmacologic-therapeutic classification of the American Society of Hospital Pharmacists: selected categories reproduced with the Society’s permission. .’ ‘The totals in this column contain a residual for which entry status, prescription status. Federal control status, and composition status are unknown. 

‘Includes multivitamina (with 13.500.000 mentions). 

34 
Table 18. Number and percent of drug mentions according to entry status, prescription status, Federal control status, and composition status, 

by selected principal diagnoses: United States, 1980 

[Drug information,is.limited to drugs ordered or provided for principal diagnosis only (Patient Record, item 11 a)] 

. 5: Number Entry srarus Prescription status Federal control status Composition status 

of drug Selected principal diagnoses’ Non- Un- Single Combina- mentions Generic Brand Prescription prescription Conrrolled controlled ingredient rion in thousands2 name name drug . drug drug .drug drug drug3 

Percent of drug mentions 

All principal diagnoses . . . . . . . . . 581,231 24.8 70.3 82.4 12.4 8.6 86.5 68.2 26.8 

lnfecticus and parasitic 

diseases . . . . . . . . . . . . . . . . . . 21:007 25.7 70.1 75.1 19.7 4.4 90.4 70.8 25.0 

Neoplasms . . . . . . . . . . . . . , . . . . 9,546 40.7 56.2 ‘90.4 l 6.4 *7.3 89.5 83.5 13.4 

Endocrine, nutritional, and 

metabolic diseases and 

immunity disorders . . . . . . . . * 33.240 34.9 61.9 82.0 14.6 16.5 80.1 86.2 10.6 

Diseases of endocrine 

glands................ 16,523 35.7 62.7 74.2 23.9 l 3.5 94.5 88.7 9.7 

Obesity and other 

.hyperalimentation _ . . . . . 13,554 37.8 56.8 90.1 ‘4.5 34.5 60.4 84.1 10.5 

Diseases of blood and blood- , . . 

forming organs.. . . . . . . . . . . . 3.457 46.4 50.5 74.8 22.1 *4.6 92.3 72.5 24.5 

Mental disorders . . . . . . _ . . . . . 18,324 13.1 84.4 90.7 .6.6 30.9 66.5 80.7 16.8 

Nonpsychotic disorders. . _ . 13,925 1.2.2 84.7 8849 7.9 36.6 6b. 1 77.3 19.6 

Diseases of nervous system and 

sense organs . . . . . . . :. . . . . . 48,964 20.6 76.5 85.6 11.4 5.0 92.1 61.9 35.2 

Diseases of central nervous 

system . . . . . . . . . . . . . . . 5,413 15.9 79.8 90.2 *5.5 23.2 72.6 71.8 23.9 

Disorders of eye and 

adnexa . . . . . . . . . . . . . . . 15,855 15.9 80.5 87.0 9.5 *0.4 96.1 67.8 28.5 

Ofitis media (suppurative 

and unspecified). . . A . . . . 17,398 26.7 71 .o 87.3 . ‘10.3 +3.4 94.2 57.8 39.i 

Diseasesof circulatorysystem. . . 84,213 21 .o 77.0 90.6 7.3 4.0 93.8 79.5 18.4 

‘Essential hypertension . . . 38,463 17.4 80.7 93.7 4.4 4.2 93.9 73.2 24.9 

,lschemic heart disease . . . . 20,599 24.5 74.1 92.6 6.0 *3.7 94.9 90.8 7.5 

Diseases of respiratory system. . . 116,302 25.2 66.8 79.4 12.5 7.9 84.0 63.6 28.3 

Acute upper respiratory 

infections . . . . . . . _ , . . . 26,300 23.1 73.8 79.9 17.0 10.0 86.9 59.0 37.8 

Asthma . . . . . ., . . . . . . . . . 10,594 18.5 66.0 78.7 . 5.7 ‘4.1 80.3 69.8 14.6 

Diseases of digestive system . . . 24,646 15.4 80.4 70.3 25.4 13.2 82.6 55.8 40.0. 

Diseases of genitourinary 

system . . . . . . . . . . . . . . . . . 26,658 16.2 80.2 91.0 5.4 5.7 90.7 63.2 33.3 

Diseases of male genital 

organs. . . . . . . . . . . . . . . 3.023 18.6 79.6 93.8 l 4.4 ‘4.4 93.8 62.8 35.4 

Diseases of female genital 

. organs.. . _ . . . . . . . . . _ 12,550 18.9 77.2 89.5 6.6 ‘6.2 89.8 65.0 31.1 

Diseases of skin and 

subcutaneous tissue . . . . . . . 53,416 25.4 71.5 83.6 12.2 l 1.1 94.7 78.9 i 8.0 . Diseases of musculoskeletal 

system . . . . . . . . . . . . . . . . . . . 37,544 20.0 77.9 85.0 13.0 13.1 84.9 77.3 20.6 

Arthropathies.. . ;. . . . . 14,447 24.0 74.0 82.3 15.7 8.4 89.6 84.7 13.3’ 

Symptoms, signs, and ill-defined 

conditions. . . . . . . . . . . . . . . . . 17.093 16.2 79.3 79.5 16.0 15.9 79.5 66.6 28.9 

Injury and poisoning . . . . . _ . . . . 27.264 20.6 68.3 77.1 11.7 17.7 71.2 58.6 30.3 

Normal pregnancy.. , . : . . . . . . 9,908 26.8 65.2 41.6 50.4 *0.3 91.6 17.8 74.2 

Health supervision of infant 

or child.. . . . . . . . . . . . . . . . . 15,219 77.6 18.4 .92:2 l 3.8 ‘0.4 95.6 54.3 41.7 

’ Based on the International Classification of Diseases, 9tb Revision, Clinical Modification (ICD-g-CM). 

2The totals in this column contain a residual for which entry status, prescription status. Federal control status and composition status are unknown. 

31ncludes multivitamins (with 11.705.000 mentions). 

. 35 
Table IS. Number and percent of drug mentions according to entry status, prescription status, Federal control status, and composition status, 

by patient characteristics: United States, 1980 

Number EnOy status Prescription status Federal control status Composition status 

Patient characteristic of drug 

mentions 

in thousands1 

Generic Brand 

name name 

Non- Prescription prescription drug drug 

Un- Controlled controlled drug drug 

Single Combinaingredient tion 

drug drug2 

Percent of drug mentions , 

All patients .................. 679,593 24.2 71.2 82.6 12.6 8.6 86.5 69.0 , 26.4 

Age 

Under 5 years ................ 65,167 36.5 59.8 81.8 14.4 4.3 91.9 58.4 37.9 

5-I 4 years. ................. 50,476 27.2 62.8 76.6 13.3 4.8 85.1 61 .O 29.0 

15-24 years. ................ 75,213 25.8 67.9 74.1 15:3 6.9 86.5 60.4 33.3 

25-34 years ................. 83,802 22.4 71.6 79.7 14.0 12.4 81.4 62.9 31.1 

35-44 years ................. 64,324 21 .o 74.6 83.9 11.2 13.3 81.9 70.6 h,‘,s .a,.,25..9 

45-54 years. ................ 78,351 21.5 73.6 84.8 10.2 11.5 83.4 72.8 / 22.3 

55-64 years ................. 97,221 21.7 74.8 85.1 11.1 9.1 87.2 75.2 21.2 

65-74 years. ................ 98,924 22.0 75.3 87.5 11.5 7.3 99.8 76.1 21.1,: 

75 years and over ............ 66,115 23.5 74.2 84.3 13.0 6.2 91 .I 76.8 29.8 b 

SW i 

Female ..................... 413,570 23.6 71.9 82.7 12.7 9.1 86.2 68.3 27.2 

Male ....................... 266,023 25.2 69.9 82.4 12.4 7.8 87.0 70.0 ‘25.1 

Sex and age 

Female 

Under I5 years ............... 54,723 33.4 61 .O 80.4 13.9 4.8 83.5 60.4 34.1 ,‘( 

15-24 years. ................ 49,823 24.0 69.7 77.3 16.3 6.8 86.8 56.5 37.2.. 

25-44 years. ................ 97,947 21.5 73.2 81.4 13.0 12.6 81.8 65.3 29.5 

45-64 years ................. 106,333 21.3 74.5 85.4 10.2 11 .o 84.7 73.5 22.2 

65 years and over ............ 104.745 22.5 75.0 84.9 12.4 7.4 89.8 75.6 21.9 

Male 

Under I5 years ............... 60,920 31.6 61.1 78.7 14.0 4.2 88.4 58.8 33.9 

15-24 years. ................ 25,391 29.3 64.3 73.7 13.3 7.1 86.0 68.0 25.7 

25-44 years. ................ 50,179 22.3 72.4 81.9 12.4 13.2 81.2 68.2 26.5 ’ 

45-64 years. ................ 69,239 22.2 73.9 84.4 11.4 9.0 86.8 75.2 20.9!:, 

65 years and over ............ 60,294 22.7 74.6 85.6 Il.5 5.8 91.3 77.9 ‘IS.4 

Race 

White ...................... 608,346 24.2 70.9 82.5 12.4 8.5 86.4 69.1 26.6 

Black ....................... 64,808 23.7 73.5 83.6 13.5 9.9 87.2 67.8 29.4 

Other3 ...................... 6,439 25.9 70.5 79.3 17.1 9.6 86.8 66.1 30.3 

Ethnicity 

Hispanic .................... 34,239 22.4 72.3 81.2 13.1 10.6 83.7 66.0 28.7 

Not Hispanic ................ 645,354 24.3 71.1 82.7 12.5 8.5 86.7 69.1 26.3 

. ‘The totals in this column contain a residual for which entry status, prescription status. Federaicontrol status, and composition status are unknown: . . 21ncludes multivitamins (with 13.500.000 mentions). 

‘Asian, Pacific Islander. American Indian. or Alaskan Native. 

36 
,Table 20. Number and percent of drug mentions according to entry status, prescription status, Federal control status, and composition status, 

by physiCian characteristics: United States, 1980 

Number Entry status Prescription status Federal control status Composition status 

Physician characteristic of drug 

mentions 

in thousands’ 

Generic Brand 

name name 

Non- Prescription prescription drug drug 

Un- Controlled controlled

drus drug 

Single 

ingredient 

drug 

dombination 

drug2 

Percent of drug mentions 

All office-based physicians. .... 679.593 24.2 71.2 82.6 12.8 8.6 86.5 69.0 28.4 

Specialty 

General and family practice. .... 279,186 24.3 71.2 83.3 12.0 10.9 84.5 68.3 27.2 

Internal medicine. ............ 118,943 24.3 72.8 84.6 12.5 8.2 88.9 78.2 18.9 

Pediatrics ................... 72,825 34.9 57.8 79.5 13.1 ,, 4.6 88.0 58.9 33.8 

General surgery .............. 15,881 17.2 80.5 83.1 14.4 16.7 81.7 66.3 31.4 

. :. .. 33,026 17.6’ 77.8 75.9 19.3 5.2 90.0 47.5 47.8 

Orthopedic surgery ........... 11,529 11.4 86.0 88.6 8.8 22.5 74.8 69.9 27.5 

Cardiovascular disease ........ 10.162 25.9 71.3 87.9 9.3 ’ ‘6.2 91.0 81.8 15.4 

Dermatology. ................ 45,287 24.2 71.4 79.1 15.1 *0.5 93.6 76.5 19.1 

Urology ..................... 5,265 14.b 83.6 93.0 l 4.5, *5.5 92.0 68.3 29.3 

Psychiatry ................... 9,655 15.9 82.6 92.9 ‘5.3 23.8 74.4 86.9 11.6 

Neurology. .................. 3,824 *15.4 83.7 89.4 ‘9.7 *14.9 84.2 84.3 ‘14.7 

Ophthalmology. .............. 19,281 15.8 80.4 85.5 10.7 *0.8 95.4 68.0 28.2 

Otolaryngology. .............. 9.229 14.2 81.2 82.9 . 11.9 ‘4.0 SO.8 54.9 40.5 

Region of practice 

Northeast ................... 172,835 29.1 64.0 80.2 12.7 7.3 85.6 69.4 23.8 

North Central ................ 165,899 23.4 73.3 82.8 13.5 6.9 89.5 68.9 27.7 

South.. .................... 234,866 20.2 75.4 82.9 12.6 10.8 84.8 67.8 27.8 

West ....................... 105,994 26.3 70.0 85.3 10.6 8.7 87.3 71.0 25.4 

Type of practice 

Solo . . . . . . . . . . . . . . . . . . . . . . . 390,716 24.4 70.1 82.2 12.6 9.1 85.8 68.4 25.7 

Multiple member.. . . . . . . . . .. . . 288,877 23.3 71.7 83:0 12.5 8.0 87.5 68.4 27.3 

Age of physician (M.D.s only) 

Under 45 years. .............. 207,714 23.3 72.7. 82.5 13.2 6.3 89.4 68.9 27.1 

4576O.years. .. :. ............ 306.001 24.6 70.8 82.3 13.0 8.9 86.4 68.8 26.7 

60 years or over .............. 112,271 24.6 70.2 82.9 ’ 11.5 10.3 84.1 68.4 25.3 

‘The totals in this column contain a residual for w ’hich entry status, prescription status, Federal control status, and composition status are unknown. 

21noltides multivitamins (with 13.500.000 mentions). 

Obstetrics and,gynecology 

37 
Appendixes 

Contents 

I. Technical notes .................................................................................... 39 

Statisticaldesign.. .............................................................................. 39 

Scope ofthesurvey ............................................................................ 39 

Sampledesign ................................................................................ 39 

Data collection and processing ..................................................................... 40 

Fieldprocedures ............................................................................... 40 

Datacollection ................................................................................ 40 

Data processing.. .............................................................................. 41 

Estimation procedures ............................................................................ 41 

Inflation by reciprocals of probabilities of selection .................................................. 41 

Adjustmentfornonresponse ..................................................................... 41 

Ratio adjustment to fixed totals .............................................................. .I ... 41 

Reliabilityofestimates ............................................................................ 42 

Estimatesofaggregates ......................................................................... 42 

Estimatesofpercentages ........................................................................ 42 

Estimates of rates where the numerator is not a subclass of the denominator. ............... 1 ............ 45 

Estimates of differences between two statistics ..................................................... 45 

Testsofsignificance .............................................................................. 45 

Roundingofnumbers ............................................................................. 45 

Systematicbias .................................................................................. 45 

II. Definitionofterms ................................................................................. 46 

Terms relating to the survey ....................................................................... 46 

Terms relating to the Patient Record form ............................................................ 47 

List of appendix tables 

I. Distribution of physicians in the universe (AMA and AOA) and the National Ambulatory Medi,cal Care Survey sample, by 

physician’s specialty: United States, 1980 . . . . . . . . . . . . . _ . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 

List of appendix figures 

I. Approximate relative standard errors for estimated numbers of officevisits based on all physician specialties(A) and individual specialties (B), 1980 National Ambulatory Medical Care Survey. . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 

II. Approximate relative standard errors for estimated numbers of drug mentions based on all physician specialties (A) and 

individual specialties (B), 1980 National Ambulatory Medical Care Survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 

38 
Appendix I. Technical notes 

This report is based on data collected during 1980 

in the National Ambulatory Medical Care Survey 

(NAMCS), an annual sample survey of officsbased 

physicians conducted by the Division of Health Care 

Statistics of the National Center for Health Statistics. 

Statistical design 

Scope of the survey 

The target population of NAMCS encompasses 

office visits made within the conterminous United States 

by ambulatory patients to nonfederally employed physicians who are principally engagedin offrcsbased patient 

care practice, but not in the specialties of anesthesiology, pathology, or radiology. Telephone contacts and 

nonoffice visits are excluded. 

Sample design 

The NAMCS utilizes a multistage probability design that involves probability samples of primary sampling units (PSU’s), physician practices within PSU’s, 

and patient visits within physician practices. The firststage 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 frames for SMSA’s and for 

nonmetropolitan counties was used to select the sample 

PSU’s. After sorting and stratifying by size, region, and 

demographic characteristics of the PSU’s, each frame 

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 masterfiles 

maintained by the American Medical Association 

(AMA). and the American Osteopathic Association 

(AOAj as of December 3 1,1979, who met the following criteria: 

l Office-based, as defined by AMA and AOA. 

l Principally engaged in patient care activities. 

l Nonfederally employed. 

l Not in the specialties of anesthesiology, pathology, 

or radiology. 

The 1980 NAMCS physician universeincluded 2 17,500 

doctors of medicine and 10,058 doctors of osteopathy 

(see table I).

Within each PSU, all eligible physicians were ar- . 

ranged by nine specialty groups: general and family 

practice, 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 the NAMCS physician sample included 2,959 physicians. Sample physicians were 

screenedat the time of the survey to ensurethat they met 

the aforementioned criteria; 611 physicians did not 

meet all 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 2,348 inscope (eligible) physicians, 1,869 (79.6 percent) participated in the study. 

The physician sample size and response data by physician specialty are shown in table I.. 

The final stage was the selection of patient visits 

within the annual practices of the sample physicians. 

This stage involved two steps. First, the total physician 

sample was divided into 52 random subsamples of ap

proximately equal size, and each subsample was randomly assignedto 1 of the 52 weeks in the survey year. 

Of the participating physicians, 249 saw no patients 

39 
. . 

Table I. Distribution of physicians in the universe (AMA and AOA)’ and in the National Ambulaton/ Medical Care Survey sample, by physician’s specialty: 

United States, 1980 

Gross our Net Non- Respondents Rkponsik ’ Physician specialty Universe of total total respondents 

All specialties.. 

General and family practice. 

Medical specialties.. . 

Internal medicine. . . . 

Pediatrics . . . . 

Other medical specialties 

Surgical specialties . . 

General surgery , 

Obstetrics and gynecology 

Other surgical specialties.. 

Other specialties. . . . . . 

scoae 

. . 227,558 2,959 611 2,348 479 1,869 

...... . . 53,147 676 155 521 133 388 

...... ...... . . 66,692 864 172 692 138 554 

...... ...... . . 35,199 458 92 366 85 281 

...... ...... 16,043 204’ 46 158 19 139 

...... ...... 1545.0 202 34 168 34 134 

...... ...... . 77,625 1,002 131 871 164 707 

...... ...... . 21,486 269 39 230 . 60 170 

...... ...... . 18,246 247 36 211 27 184 

...... ...... . 37,893 486 56 430 77 353 

’ rare I 

ii.6’ 

74.5’ 

80.1 

76,.,8 

88.0 

79.8 

81.2 

73.9 

87.2 

82.1 

83.3 

86.9 

77.1 

. . . 

...... ...... . 30,094 417 153 264 44 220 

Psychiatry. . . . . . . . . ...... ...... . 16,662 223 55 168 22 146 

Other specialties. . . . . . . . . . . . . 13,432 194 98 96 22 ‘. 74 

1 AMA = American Medical Association, AOA = American Osteopathic Association. 

during their assignedreporting period because of vacations, illnesses, or other reasons for being temporarily 

out of office-based practice. Second, a systematic random sample of visits was selected by the physician 

during the assignedweek. The 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 by which the sampling rate was determined 

is described later in this appendix.‘During 1980,46,08 1~ 

usable Patient Record forms were completed by physicians participating in NAMCS. 

Data collection and processing 

Field procedures 

Both mail and telephone contacts were used to enlist sample physicians for NAMCS. Initially, physicians were sent introductory letters from the Director of 

NCHS. When appropriate, a letter from the physician’s 

specialty organization endorsing the survey and urging 

participation was enclosed with the NCHS letter. Ap 

proximately 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 requestedto 

reconsider participation in the study. 

During the personal interview the field representative determined the physician’s eligibility for the study, 

obtained his or her cooperation, delivered survey materials with verbal and printed instructions, and assigneda 

predetermined Monday-Sunday reporting period. A 

short induction interview concerning basic practice 

characteristics, such as type of practice and expected

number of offrce visits, was conducted. Office staff who 

were to assistwith data collection were invited to attend 

40 

the instructional.sessionor were offered separateinstructional sessions. 

Before the beginning and again during the week assigned for data collection, the field representativetelephoned the sample physician to answer,questions that 

might have arisen and to ensure that survey procedures, 

were going smoothly. At the end of the reporting week, 

the participatingphysicianmailed the completed survey

materials to the field representative, who edited the 

forms for completeness before transmitting them .for 

central data processing. At this stage 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, assistedby office staff when pas: 

sible. Two data collection forms were employed by the 

physiciamthe Patient Log and the Patient Record form 

(figure 1). The Patient Log, a sequential listing of patients seen in the physician’s office during his or her 

assigned reporting week, served as the sampling frame 

to indicate the office 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 protecting the 

confidentiality 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, eachphy&ian was assigneda patient-sampling 

rate. The patient-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 each day recorded data for all visits, those expecting more than 10 
visits per day recorded data for every second, third, or 

fifth visit, based on the predetermined sampling interval. 

These patient-sampling procedures minimized the physician’s data collection workload and maintained ap 

proximately equal reporting levels among sample 

physicians regardlessof practice size. For physicians recording data for every second,third, or fifth patient visit, 

a random start was provided on the first page of the 

Patient Log so that predesignatedsample 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 staff, numerous clerical edits 

were performed on data received for central data processing. These manual procedures proved quite efficient, 

reducing item nonresponse rates to 2 percent or less for 

most data items. 

The patient’s problem or reason for visit (item 6 of 

the Patient Record form) was coded according to the 

Reason for Visit Classzscation forAmbulatory Care 

(RVC). Diagnostic information (item 9 of the Patient 

Record form) was coded according to the International 

Classz2cation ofDiseases, 9th Revision, ClinicaEModification (ICD-g-CM). 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 Patient Record forms per batch. 

Quality control for the medical coding operation involved a two-way 5 percent independent verification 

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 medical 

coding operation were 1.9 percent for item 6 and 2.8 

percent for item 9. A dependent procedure was used to 

review and adjudicate all records in batches with excessive error rates. This procedure further reduced the 

estimated error rates to 1.8 percent for item 6 and 2.5 

percent for item 9. 

The NAMCS medication data (item 11 of the Patient Record form) was classified and coded according 

to a schemedeveloped at NCHS based on the American 

Society of Hospital Pharmacists’Drug Product Information File. A detailed description of the development

of the new drug coding scheme and of the NAMCS drug 

data processing procedures are contained in Vital and 

Health Statistics Series ~-NO. 90. A two-way 100 

percent independent verification procedure was used to 

control the medication coding operation. 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 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. 

Estim.ation procedures 

Statistics from the 1980 NAMCS were-derived by a 

multistage estimation procedure which 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 fixed totals. A description 

of each component follows. 

Inflation by reciprocals of 

probabilities of selection 

Becausethe 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 a patient visit within the physician’s practice. The last probability was defined as the 

exact number of office 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 

Estimates from NAMCS data were adjusted to account for sample physicians who 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. 

Ratio adjustment to fmed totals 

A poststratification adjustment was made within 

each of nine physician specialty groups. The ratio adjustment was a multiplication factor which 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 in that particular 

specialty group. The numerator was based on figures

obtained from the AMA and AOA masterfiles, and the 

denominator was based on data from the sample. 

41 
Reliability of estimates 

As in any survey, results are subject to both sampling and nonsampling errors. Nonsampling errors include reporting and processing errors, as well as biases 

due to nonresponseor incomplete response.The magnitude ,of the nonsampling errors cannot be computed. 

However, these errors were kept to a minimum by procedures built into the survey’s operation. Careful attention and extensive pretesting were given to the phrasing 

of the questions, terms, and definitions employed to 

eliminate ambiguities and encourage uniformity of reporting. 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 discussedin 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 to sampling variability alone. 

Because the statistics presented’in this report are 

basedon 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 probability design of 

NAMCS permits the calculation of sampling errors. 

The standard error is primarily a measure of sampling

qariability 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. It 

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 2% times as 

large.

The relative standard error of an estimate is ob 

tained 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-samplereplication. 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 pub 

lished. Approximate relative standard errors for aggregate estimates are presented in figures I and II. To 

derive error estimatesthat would be applicable to a wide 

variety of statistics 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. 

42 

Estimates of aggregates 

Approximate relative standard errors (in percent), 

for aggregatestatistics are presented in figures I and II.: 

Figure I presents approximate relative standard errors. 

for estimates of office visits, while figure II presents 

approximate relative standard errors for estimates of 

drug mentions. 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. It 

Alternatively, relative standard errors for aggregate

estimates may be calculated directly using the following 

formulae where x is the aggregateof interest in thousands. 

For visit estimates based on all physician specialties, 

36.36433 RSE(x) = 0.00164987 + x. * 100.0 

For visit estimates based on an individual physician 

specialty, 

36.97024. ioo o RSE(x) = 0.00434821 + 

X 

For drug mention estimates based on all physician spe-.

cialties, 

71.2643.1 . 1oo o RSE(x) = 0.003 16979 + 

X 

For drug mention estimates based on an individual 

physician specialty, 

RSE(x) = 0.00827256 + 

69.54527 . ‘1oo o 

X 

Estimates of percentages 

Approximate relative standard errors (in percent) 

for estimates of percentages 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 percentage. 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 .05 percent or if the relative standard errors of the 

numerator and denominator are both less than . 10 percent. 

Alternatively, relative standard errors for percentages may be calculated directly using the following

formulae wherep is the percent of interest and x is the 

base of the percentage in thousands. For visit percent-, 

age based on all physician specialties, 

RSE@) =~K%=y 100.0 
-

‘88 

80 

70 

60 60 

50 50 

40 40 

30 30 

20 20 

2 2 

0.6 

0.5 

0.4 

0.2 0.2 

0.1 0.1 

1 

Size of estimate (in thousands) 

E ramp/e ofuse ofchart: An estimate of 20 million office visits to general surgeons (read from scale at bottom of chart) has a relative standard error of 7.9 percent (read from curve E on scale at leftoi fchart) 

01 a standard error of 1,580,OOO office visits (7.9 percent of 20 million office visits). 

Figure I. Approximate relative standard errors for estimated numbers of office visits based on all physician specialties (A) and individual specialties (5). 1980 

National Ambulatory Medical Care Survey i 
‘3 

80 

70 

60 60 

50 50 

40 40 

30 

20 

‘8 ‘ii 

8 

7 t= ; 

6 

5 

4 

3 

2 I 2 

8.; l---n 1 

8:: 

017 0.7 

0.6 0.6 

0.5 0.5 

0.4 I I I I I I I11111111111 I I I I I1111111111111 I I I I I I I Il~IIIIIIIII I I llllll’~ 0.4 

0.3 0.3 

0.2 0.2 

0.1 0.1 

A 2 3 4 5 6789A 2 3 4 5 6789A 2 3 4 56789A 2 3 4 5 6789A 

100 1,000 10,000 100,000 1 .ooo,ooo 

Size of estimate(in thousands) 

Example of use of chart; An estimate of 60 million drug mentions to general practitioners (read on scale at bottom of chart) has a relative standard error of 9.7 percent (read from curve B on scale EIt left 

of chart) or a standard error of 5.820.000 drug mentions (9.7 percent of 60 million drug mentions). 

:Figure II. -Approximate relative standard errors’for estimated numbers of drug mentions based on all physician specialties (A) and individual specialties (B), 1980 

National Ambulatory Medical Care Survey 
For visit percentages based on an individual physician 

specialty, 

For drug mention percentages based on all physician 

specialties, 

RWP) =p=yTJ. loo*o 

For drug mention percentages based on an individual 

physician specialty, 

-pyyJ. lo*.o RSE(p) -

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 from figures 

I and 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 differences, such as “higher, ” “less,” and so forth, 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 

between any two estimates does not mean that the difference was tested and found to be not significant 

Rounding of numbers 

Estimates presentedin this report have been rounded 

to the nearest thousand. For this reason detailed figures 

within tables do not always add to totals. Rates and 

percents were 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 under-represent 

the total number of office visits. 

1. Although physicians who participated in NAMCS 

did a thorough and conscientious job in keeping the 

Patient Log, postsurvey interviews with participating physicians indicate that a small number of 

patient visits may have been accidentally omitted 

from the Patient Log. While this number is quite 

small, such omissions would result in an undercoverage of offrce visits.. 

The same postsurvey interviews indicate that 

the inclusion of patient visits which did not actually 

occur was infrequent and would have a negligible 

effect on survey estimates. 

2. As previously stated, the universe for the 1980 

NAMCS included all nonfederal, of&e-based, patient-care physicians in the AMA and AOA, masterfiles. The NAMCS was designed to provide statistically unbiased estimates of office visits to this 

designated population. Not included in the universe were physicians classified in such categories 

as federally employed, hospital-based, research, 

teaching, administration, or other nonpatient care 

activity. Consequently, any ambulatory patient

visits to physicians not in the NAMCS universe, an 

included in NAMCS estimates. 

In an attempt to measure the number of office 

visits to physicians not in the NAMCS universe, an 

NAMCS Complement Survey was conducted in 

1980. This study involved a sample of approximately 2,000 physicians selected from among the 

226,000 physicians in the AMA and AOA masterfiles who were not eligible (inscope) 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 universe ‘saw some ambulatory patients in an office setting. An estimated 69 

million office visits were made to these physicians 

in 1980. This indicates that the total number of 

office visits to all physicians during 1980 was about 

645 million (69 million plus 576 million). 

45 
Appendix I I. Definition of 

terms 

Terms relating to the survey 

Ofice.-Premises identified by the physician as 

locations for his or her ambulatory practice. The responsibility over time for patient care and professional 

services rendered there generally resides with the individual physician rather than with any institution. 

Ambulatory patient.-An individual seeking personal health services, who is neither bedridden nor currently admitted to any health care institution on the 

premises. 

Physician.-Classified as either: 

l Inscope.-All duly licensed doctors of medicine 

and doctors of osteopathy currently in practice who 

spend some time caring for ambulatory patients at 

an office location. 

l Out ofscope.-Those physicians who treat patients 

only indirectly, including physicians in the specialties of anesthesiology, pathology, and 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 full time by an industry or 

institution and having no private practice, for 

example, physicians who work for the Veterans 

Administration, the Ford Motor Company, and 

so forth. 

Physicians who spend no time seeing ambulatory patients, for example, physicians who only 

teach, are engaged in research, or are retired. 

Patients.-Classified as either: 

l Inscope.-All patients seen by the physician or a 

staff member in his or her office(s). 

0 Out of scope.-Patients seen by the physician in a 

hospital, nursing home, or other extended care institution, or 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 inscope. The following 

types of patients are considered out of scope: ’ ’ 

l Patients seen by the physician in an institution, 

including outpatient clinics of hospitals,for whom 

the institution has primary responsibility over 

time. 

l Patients who contact and receive advice from 

the physician via telephone. .’ 

l Patients who come to the office only to leave a 

specimen, pick up insurance forms, or pay.their 

bills. 2. . . \A’ 

l Patients who come to the office only to pick up

medications previously prescribed.by the physician. .. . 

Visit.-A direct, .personal exchange between an 

ambulatory patient and a physician ora member of his 

or her office staff for the purpose of seeking care’and 

rendering health services. >‘. Physician specialty. -Principal specialty,.including 

general practice, as designated by the physician at the 

time of the survey. Those physicians for Whom a spei 

cialty was not obtained were assigned the principal 

specialty recorded in the physician masterfiles maintained by the American Medical Association or the . American Osteopathic Association. 

Region ofpractice location.-The four geographic 

regions, excluding Alaska and Hawaii, that correspond 

to those used by the U.S. Bureau of the Census:. ., 

Region States included ., 

Northeast . . . . Connecticut, Maine, Massachusetts, New 

Hampshire, New Jersey, New York, PennSylvania, Rhode Island, Vermont 1’. 

North Central. . Illinois, Indiana, Iowa, Kansas, Michigan, 

Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakot’a, Wiiconsi,; -

South. . . . Alabama, Arkansas, Delaware, .District of 

Columbia, Florida, Georgia, Kentucky, Loui­

. 

46 
Region-Con. Stares included-Con. 

siana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia 

West . . . . . . . . . . Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, 

Washington, Wyoming 

Metropolitan status ofpractice location.-A physician’s practice is classified by its location in a metropolitan or nonmetropolitan area. Metropolitan areas 

are standardmetropolitan statistical areas( SMSA’s) as 

defined by the U.S. Ofice of Management and Budget. 

The definition of an individual SMSA involves two 

considerations: first, a city or cities of specified population which 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 which are metropolitan in character 

so that the periphery of the specific metropolitan area 

may be determined. SMSA’s may 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. 

CoZor or race.-On the Patient Record form, color 

or race ‘includes four categories: White, Black, Asian/ 

Pacific Islander, and American Indian/Alaskan Native. 

The physician was instructed to mark the category which 

in his ‘or her judgment was most appropriate for the 

patient based on.observation or prior knowledge. The 

. following definitions were provided to the .physician: 

White.-Asperson having origins in any of the original peoples of Europe, North Africa, or the Middle 

East. 

Black. -A person having origins in any of the black 

racial groups of Africa. 

Asia$P&fic Islander.-A person having’origins 

in any ofthe original peoples ofthe Far East, Southeast Asia, the Indian subcontinent, or the Pacific 

Islands. This area includes, for example, China, 

India, Japan, Korea, the Philippine Islands, and 

Samoa. 

American Indian/Alaskan Native.-A person having origin: in any of the original peoples ofNorth 

America, and who maintains cultural identification 

through tribal affiliation or community recognition. 

Ethnicity.-The physician was instructed to mark 

the category which in his or herjudgment was most appropriate. The following definitions were provided. 

a Hispanic origin.-A person of Mexican, Puerto 

Rican, Cuban, Central or South American, or other 

Spanish culture or origin, regardless of race. 

l Not Hispanic. -Any person who is not of Hispanic 

origin. .! 

l Patient’s complaint(s), symptom(s), or other reason(s) for this visit(inpatient’s own words).-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 v&it-The physician was 

instructed to check one major reason for the patient’s 

visit. 

l Acuteproblem: A visit primarily for a condition or 

illness having a relatively sudden or recent onset 

(within three months of the visit). 

l Chronic problem, routine: A visit primarily to receive regular care or examination for a pre-existing 

chronic condition or illness (onset of condition was 

three months or more before the visit). 

l Chronicproblem, flareup: A visit primarily to receive care for a sudden exacerbation I

of a pre-existing chronic condition or illness. 

l Post surgery and/orpost injury: A visit primarily 

for followup care of injuries or for care required 

following surgery, for example, removal of sutures 

or cast. 

l Non-illness care (routine prenatal, general exam, 

well baby, etc.): General health maintenance examinations and routine periodic examinations of 

presumably healthy persons, both children and 

adults. Includes prenatal and postnatal care,: annual physicals, well child examinations, and insurance examinations. 

Diagnostic services this visit.-Physicians were 

instructed to check any of the following services that 

were ordered or provided during the current visit:’ 

Limited history and/or exam: History or physical 

examination which is limited to a specific body site 

or system or which is concerned primarily with the 

patient’s chief complaint, for example, pelvic examination or eye examination. 

General history and/or exam: History or physical

examination of a comprehensive nature, including 

all or most body systems. 

Pap test: Papanicolaou test, self-explanatory. 

Clinical lab test: One or more laboratory procedures or tests, including examination ofblood, urine, 

sputum, smears, exudates, transudates, feces, and 

gastric content, and including chemistry, serology,

bacteriology, and pregnancy test. Excludes Pap 

test. 
X-ray: Any single or multiple X-ray examination 

for diagnostic or screeningpurposes. Excludes radiation therapy. 

BZood pressure check: Self-explanatory. 

EKG: Electrocardiogram, self-explanatory. 

I%ion 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 which are not included in the preceding categories. 

Principal diagnosis. -The physician’s diagnosis of 

the patient’s principal problem, complaint, or symptom. 

In the event of multiple diagnoses, the physician was 

instructed to list them in order of decreasingimportance. 

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 significant 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. The 

second part of item 10 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 suppositories, ordered, injected, administered, or provided this visit. Included are prescription 

and non-prescription drugs, vaccinations, immunization 

and desensitization agents.Also included are drugs and 

medications which were ordered or provided prior to the 

visit and which the physician instructed or expected the 

patient to continue taking. Medications for the principal 

diagnosis are listed in item 11 a; and all other drugs in 

item 11b. 

Nonmedication therapy.-Physicians were instructed to check any of the following services that were 

ordered or provided during the current visit: 

l Physiotherapy: Any form of physical therapy ordered or provided, including any treatment using 

heat, light, sound, or physical pressure or movement, for example, ultrasonic, ultraviolet, infrared, 

whirlpool, diathermy, cold, and manipulative therapy. 

l Ofice surgery: Any surgical procedure performed in 

the office 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,

and irrigations, aspirations, dilations, and excisions. 

0 Family planfling: Services, counseling, or advice 

that might enable patients to determine the number 

and spacing of their children. Includes both contraception and infertility services. 

0 Psychotherapy and)/or therapeutic listening All 

treatments designed to produce a mental or emo 

tional response through suggestion, persuasion, :reeducation, reassurance, or support, including psychological counseling, hypnosis, psychoanalysis, 

and transactional therapy. 

0 Diet counseling: Instructions, ‘recommendations, 

or advice regarding diet or dietary habits. 

0 Family an&or social counseling: Advice regarding 

problems of family relationship, including marital 

or parent-child problems, or social problems, including economical, educational, occupational, 

legal, or social adjustment difficulties. 

0 Medicalcounseling: Instructions 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. Excludes family planning, diet counseling, and family or social counseling. 

0 Other: Treatments or non-medication therapies ordered or provided which are not listed or included in 

the above categories. 

Waspatientreferredfor 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 ofthe case. 

The physician was instructed to check as many of the 

categories as apply: 

No followup planned: No return visit or telephone 

contact was scheduled for the patient’s problem. 

Return atspeciJied time: Patient was told to schedule 

an appointment or was instructed to return at a 

particular time. 

Return if 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 his or her progress, or if the 

need arose. 

Referred to otherphysician: Patient was instructed to 

48 
/ 

consult or seek care from another physician. The 

patient may or may not return to this physician at a 

later date. 

l Returned to referring physician: Patient was referred to this physician and was not instructed to 

consult again with the physician who referred him or 

her. 

l Admit to hospitak Patient was instructed that further care or treatment would be provided in a hospital:No further oflice visits were expected prior to 

hospital admission. 

l Other: Any other disposition of the case not included in the above categories. 

Duration of this visit.-Duration includes time 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 records, test results, etc. 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 

zero minutes. 
Vital and Health Statistics series descriptions

I 

SERIES 1. Programs and Collection Procedures.-Reports describing SERIES 14. Data on Health Resources: Manpower and Facilitiesthe general programs of the National Centerfor Health Statis- Statistics on the numbers, geographic distribution, and chartics and its offices and divisions and the data collection acteristics of health resources including physicians. dentists. 

methods used. They also include definitions and other material nurses, other health occupations, hospitals, nursing homes. 

necessary for understanding the data. and outpatient facilities. 

SERIES 2. Data Evaluation and Methods Research.-Studies of new SERIES 15. Data From Special Surveys.-Statistics on health and healthstatistical methodology including experimental tests of new related topics collected in special surveys that are not a part of 

survey methods, studies of vital statistics collection methods, the continuing data systems of the National Center for Health 

new analytical techniques, objective evaluations of reliability Statistics. 

of collected data, and contributions to statistical theory. SERIES 20. Data on Mortality.-Various statistics on mortality other than 

SERIES 3. Analytical and Epidemiological Studies.-Reports presenting as included in regular annual or monthly reports. Special 

analytical or interpretive studies based on vital and health sta- analyses by cause of death, age, and other demographic 

tistics, carrying the analysisfurtherthan the expositorytypesof variables; geographic and time series analyses; and statistics 

reports in the other series. on characteristics of deaths not available from the vital records 

SERIES 4. Documents and Committee Reports.-Final reports of major based on sample surveys of those records. 

committees concerned with vital and health statistics and SERIES 21. Data on Natality, Marriage, and Divorce.-Various statistics 

documents such as recommended model vital registration laws on natality, marriage, and divorce other than as included in 

and revised birth and death certificates. regular annual or monthly reports. Special analyses by demoSERIES 10. Data From the National Health Interview Survey.-Statistics graphicvariables; geographicand timeseriesanalyses:studies 

on illness, accidental injuries, disability, use of hospital, of fertility: and statistics on characteristics of births not 

medical, dental, and other services, and other health-related available from the vital records based on sample surveys of 

topics, all based on data collected in the continuing national those records. 

household interview survey. SERIES 22. Data From the National Monthly and Natality Surveys.-

SERIES 11. Data From the National Health Examination Survey and the Discontinued in 1975. Reports from these sample surveys 

from direct examination, testing, and measurement of national respectively. 

samples of the civilian noninstitutionalized population provide SERIES 23. Data From the National Survey of Family Growth.-Statisthe basis for (1) estimates of the medically defined prevalence tics on fertility, family formation and dissolution, family 

_ of specific diseases in the United States and the distributions planning, and related maternal and infant health topics derived 

of the population with respect to physical, physiological, and from a periodic survey of a nationwide probability sample of 

psychological characteristics and (2) analysis of relationships ever-married women 15-44.years of age. 

among the various measurements without reference to an 

explicit finite universe of persons. 

National Health and Nutrition Examination Survey.-Data based on vital records are included in Series 20 and 21. 

SERIES 12. Data From the Institutionalized Population Surveys.-Discontinued in 1975. Reports from these surveys are included in 

Series 13. For a list of titles of reports published in these series, write to: 

SERIES 13. Data on Health Resources Utilization.-Statistics on the utili- Scientific and Technical Information Branch 

zation of health manpower and facilities providing long-term National Center for Health Statistics 

care, ambulatory care, hospital care, and family planning Public Health Service 

services. Hyattsville. Md. 20782