Patterns of Ambulatory

care in Office visits to

General Surgeons

The National

Ambulatory Medical

Care Survey

UnitedStates,January 1980-

Dacember 1881

Data on the characteristics of office visits to

general surgeons by ambulato~ patients

are presented. Individual profiles are

detailed for physicians in solo and group

practices, for those in the four major

geographic regions, and in metropolitan

and nonmetropolitan areas. Information on

the medical and surgical care provided by

different age groups of physicians is

provided. The condition of patients is

described according to their demographic

characteristics using such descriptors

as patients’ reaaona for visit and diagnoses

rendered by physicians. Patient

management is described in terms of

diagnostic services, nonmedication and

medication therepy, duration and

disposition of the visit. Comparisons sre

made between 1975 and 1980-81 data

on general surgeons, and between general

surgeons and other surgical specialists.

Date From the Netional Heelth Sunrey

Seriee 13, No. 79

DHHS Publication No. (PHS) 8+1740

U.S. Depanment of Health and Human

Services

Public Health Service

National Center for Health Statistics

Hyattsville, Md.

September 1984
Copyright Information

All material appearing in this report is in the public domain and may

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

however, is appreciated.

Suggested Citation

National Center for Health Statistics, B. K. Cypress: Patterns of

Ambulato~ Care in OffIce Visits to General Surgeons, The National

Ambulatory Medical Care Survey, United States, January 1980–

December 1981. Vital and Health Statistics. Series 13, No. 79.

DHHS Pub. No. (PHS) 84-1740. Public Health Service. Washington.

U.S. Government Printing Office, Sept. 1984.

Library of Congress Cataloging in Publication Data

Cypress, Beulah K.

Patterns of ambulatory care in office visits to

general surgeons.

(Data from the national health survey. Series 13:

no. 79) (DHHS publication ; no. (PHS) 84-1 740)

Bibliography p.

Supt. of Dots. no.: HE 20.6209:13179

1. Surgery, Outpatient—United States—Statistics.

2. Physician services utilization—United States—

Statistics. 3. Health surveys-United States.

4. United States—Statistics, Medical. 1. National

Center for Health Statistics (U. S.) Il. Title.

*

II 1. Series: Vital and health statistics. Series 13,

Data from the national health survey : no. 79.

IV. Series: DHHS publication ; no. (PHS) 84-1740.

[DNLM: 1. AmbulatoV Care—United States—statistics

2. Office Visits—United States—statistics.

3. Surgery-United States—statistics.

W2 A N148vm no. 79]

RD110.C97 1984 362.1’ 2’0973 84–800207

ISBN 0-6406-0299-5

For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402
National Center for Health Statistics

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

Robert A. Israel, Deputy Director

Jacob J. Feldman, Ph. D., Associate Directorfor Analysis

and Epidemiology

Garrie J. Losee, Associate Director for Data Processing

and Services

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

Statistics

E. Earl Bryant, Associate Director for Interview and

Examination Statistics

Robert L. Quave, Acting Associate Director for Management

Gail F. Fisher, Ph. D., Associate Director for Program

Planning, Evaluation, and Coordination

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

and Methodology

Peter L. Hurley, Associate Director for Vital and Health

Care Statistics

Alice llaywood, Information O#icer

Vital and Health Care Statistics Program

Peter L. Hurley, Associate Director

Gloria Kapantais, Assistant to the Director for Data Policy,

Planning, and Analysis

Division of Health Care Statistics

W. Edward Bacon, Ph. D., Director

Joan F. Van Nostrand, Deputy Director

James E. Delozier, Chief Ambulatow Care Statistics Branch
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Purpose andbackground . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Scope ofthe survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Source andlimitations ofthe data..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Overview ofvisit characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Physician andpractice characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Type ofpractice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Location ofpractice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age ofphysician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Age and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age, race, and ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patient condition andmanagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sexofthepatient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age ofthe patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . .

Reason forvisit and diagnostic services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Priorvisit status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Compansonwith other surgical specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Comparison with 1975 data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hospital care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

List ofdetailedtables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appendixes

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

11. Definitions ofcertainterms used in this report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

IV. American Hospital Fonnulary Service classification systernan dtherapeuticcategory codes . . . . . . . . . . . . . . . . . . . . . . . .

List of text figures

1.

2.

3.

4.

Percent distribution ofofficevisitsby specialty United States, January 1980-December 1981 . . . . . . . . . . . . . . . .

Percent distribution ofofllce visits to general surgeons bytype ofpractice, according to age ofphysiciarx United

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

Percent distribution of office visits to general surgeons by location of practice, according to age of physiciam United

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

Average annual rate of office visits to general surgeons by sex and age of patienti United States, January 1980–

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

1

1

1

1

2

2

4

4

5

5

8

8

9

10

10

12

13

13

13

15

15

15

17

18

19

40

48

51

61

2

6

7

8

...

Ill
5.

6.

7.

8.

Average annual rate of office visits to general surgeons by race and age of patienti United States, January 1980-

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

Percent of office visits to general surgeons by prior visit status and age of patienti United States, January 1980–

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

Percent of offlcevisits to general surgeons by chronicity ofproblem and ageofpatienti United States, January

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

Percent of all office visits with a disposition admit to hospitalby selected surgical specialties: United States,

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

List of text tables

A.

B.

c.

D.

E.

F.

G.

H.

J.

K.

L.

M.

N.

iv

Number and percent distribution of ofilce visits to general surgeons by type of practice, according to location of physician’spractice: United States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number ofofflce visits to general surgeons, number and percent ofdrugvisits, number ofdrug mentions, drug mention

rate, anddrugintensity rate,bytypeand location ofphysician’ spractice United States,January 1980-December 1981...

Average number of ofilce visits per week and mean duration of visits to general surgeons, by age of physician: United

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

Number of office visits to general sur~ons, number and percent of drug visits, number of drug mentions, drug mention

rate, and drug intensity rate,by age ofphysician: United States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . .

Number of office visits to general surgeons that included office surgery and percent, by selected principal reasons for

visit rmdsexofthe patienC United States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of office visits to general surgeons, number and percent of drug visits, number of drug mentions, drug mention

rate, and drug intensity rate, bysex, age, and visit status: United States, January 1980–December 1981 . . . . . . . . . . . . . .

Number of drug mentions in office visits to general surgeons and percent, by selected central nervous system categories

and sex ofpatienti United States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of office visits to general surgeons with a disposition admit to hospital by principal

diagnosis category, accordingto sexof patienC United States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . .

Meandurationof oilicevisits togeneral surgeons by selected principal diagnosis category andprior visit status: United

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

Percent of office visits to general surgeons by duration of visit and prior visit status: United States, January 1980-

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

Number and percent distribution of office visits to general surgeons by referral status of patient, according to prior visit

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

Number of office visits per 100 persons per year to general surgeons and percent of visits, by selected characteristics:

United States, 1975 and 1980-1981. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of oflice visits to general surgeons with a second-listed diagnosis followup examination after surgery and percent,

by first-listeddiagnosis: United States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Symbols

--- Data not available

. . . Categoy nonapplicable

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 doesnot meet standards of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements

8

12

13

16

4

5

6

6

10

11

11

12

13

14

14

16

17

. .--------—..-..——- ....“..... - ~ _ .—. . . -_. , . . . . . . . . . . . . . . . . . . . - . .

. . . --- , -...
Patterns of Ambulatory Care

in Office Visits to GeneraI

Surgeons: The National

Ambulatory Medical Care

Survey

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

Introduction

Purpose and background

National estimates of the use of ambulatory medical care

services provided by non federally employed office-based general surgeons in the conterminous United States during the calendar years 1980-81 are presented in this report. Patterns of

medical care are based solely on the provision of health services in the ofilces of general surgeons. Thus they do not include

physicians’ visits to patients in hospitals, procedures performed

in hospitals or other facilities, or “ambulatory surgery” not

performed in the office.

This report is the fourth in a series of reports based on the

visit characteristics of various medical and surgical specialties.

Previous publications highlighted the visit characteristics of

general and family practice, pediatrics, and obstetrics and gynecology. 1-3The ,data were gathered by the National Center for

Health Statistics by means of the National Ambulatory Medical

Care Survey, a sample survey of physicians’ office visits conducted annually through 1981 by the Division of Health Care

Statistics. Data collection and processing for the 1980 and 1981

National Ambulatory Medical Care Surveys were the responsibility of the National Opinion Research Center at the University

of Chicago. Sample selection was accomplished with the assistance of the American Medical Association and the American

Osteopathic Association.

A brief report on 1975 estimates of visits to general surgeons was published in Advance Data From Vital and Health

Statistics, No. 23.4 However, because the reason for visit coding system was revised in 1977 and the Ninth Revision of the

International Classlj%ation of Diseases was introduced for

coding diagnoses in 1979, data ffom that report may not be

strictly comparable to the data in this report.

Detailed information on the background and methodology

of the survey was published in Vital and Health Statistics,

Series 2, No. 61.5A description of the 1980 and 1981 surveys,

including statistical design, data collection and processing,

and estimation procedures, may be found in appendix I of this

report. Technical details regarding reliability of estimates are

also given in appendix I. Definitions of terms used in the survey

are provided in appendix II. Facsimiles of survey instruments

appear in appendix III. Prior to data presentation the scope of

the survey and limitations of the data are described briefly to

assist the reader in interpreting the estimates.

Scope of the survey

The basic sampling unit for the National Ambulatory

Medical Care Survey (NAMCS) is the physician-patient encounter or visit. The current scope of NAMCS includes all

office visits within the conterminous United States made by

ambulatory patients to nonfederally employed, office-based

physicians as classified by the American Medical Association

or the American Osteopathic Association. The NAMCS physician universe excludes anesthesiologists, pathologists, and

radiologists, and physicians principally engaged in teaching,

research, or administration. Telephone contacts and visits conducted outside the physician’s oftlce also are excluded.

Source and limitations of the data

Thedata in this report are based on information obtained

from a patient encounter form, the Patient Record (see appendix III), for a sample of visits provided by a national probability sample of office-based physicians. The combined samples

for the 1980 and 1981 NAMCS included 5,805 physicians,

1,124 of whom were ineligible because they were out of scope

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

(78.5 percent) participated (see appendix I). There were 521

general surgeons in the sample of whom 75 were out of scope.

Of 446 eligible general surgeons, 331 participated (74.2 percent).

Sample physicians listed all of?ice visits during a randomly

assigned 7-day reporting period. During the 2-year period, information was recorded on Patient Records for a systematic

random sample of 89,447 visits including 5,388 visits to general surgeons.

The 1980 and 1981 NAMCS were conducted in identical

fashion using the same instruments, definitions, and procedures.

The 2 years of data were combined to provide more reliable

estimates. The reader should, therefore, note that estimates of

number of visits and drug mentions contained in this report are

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

The information in this report is derived from a complex

sample survey, and the appendixes should be reviewed to insure

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

of ofi=ice visits rather than on all visits, they are subject to

1
sampling errors. Therefore, particular attention should be paid

to the section “Reliability of estimates.” Charts on relative

standard errors and instructions for their use are also given.

Visits by specialty

The percent distribution of 1980–81 office visits, according to medical and surgical specialty, is illustrated in figure 1.

There were an estimated 61 million ofllce visits to general surgeons during the 2-year period. They constituted about 5 percent of the visits to all physicians. General surgeons, ophthalmologists, and orthopedic surgeons accounted for similar proportions of visits, following obstetrics and gynecology, which

led all other surgical specialties in the number of visits. It is

generally acknowledged that the physician’s oftlce is less likely

to be the customary setting of clinical activity for the surgical

specialist than for the medical specialist. Thus, it is not surprising that in terms of visits to all specialties general surgery,

ophthalmology, and orthopedic surgery ranked fifth. However,

it has been reported that 49 percent of all patient encounters by

general surgeons were in the hospital, compared with 14 percent of those by general practitioners, and 24 percent of those

by obstetrician-gy necologists.6-8

Overview of visit chacteristics

In this report separate patterns of ambulatory care are presented for solo and other types of practice, four geographic regions, four age groups of physicians, and patient sex and age

groups. Patterns are also described for visits that fall into different visit status categories. A general description of visits to

general surgeons has not been published since the first brief

repofi,4 therefore, an overview of the characteristics of visits,

regardless of controlling variables, is offered first. These statistics are shown in the first column of table 1. The percents referred to in the text as “NAMCS average” are proportions

based on visits to all specialties in 1980–81 and are derived

from unpublished data.

Proportions of visits by female patients (56 percent) exceeded those by males. This proportion of visits by females

was less than the NAMCS average of 60 percent, but the dominance of visits to general surgeons by females was similar to

the female-to-male ratio observed in visits to physicians in

most medical specialties and in some surgical specialties. Data

on other surgical specialties are discussed in the section of this

report “Comparison with other surgical specialties.”

About half of the visits to general surgeons were made by

patients 45 years of age and over, compared with the NAMCS

average of 41 percent for such patients. Female patients seen

by general surgeons were older than male patients were. The

median age of the females visiting was 46.6 years, compared

with the male median visit age of 40.8 years. The medbn visit

age for all NAMC S visits was 36.4 years for each sex.

About 64 percent of the visits were made by patients the

physician had seen before returning for c=e of continuing problems, a proportion close to the average for such patients. However, the proportion of new patients (19 percent) exceeded the

NAMCS average of 14 percent. This was probably due to the

Psychiatry

Other surgical 2.7%

specialties

Urological surgery 1.9%

/

1.7% \ \

/ ;.’;; her apec’a’”es

Otorhinolaryngology

‘(---(-’---(l

_JL.v#&

2.3%

Orthopedic surgery

4.8% \A

General surgery

5.3%

?

......... ,

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

,. .......,.,

Ophthalmology ......................,,...

........ ...,...............”

5.4% ............,..,.........

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

Obstetrics andgynecology

9.4% F

k

Other medicel~ ‘

specialties

7.5%

11.1%

Gel

pra

32.

ntel

12.4

neral

ctica

9%

rnal r

.%

and family

tine

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

2
higher than average referral rate of 10 percent, compared with

4 percen~ for all physicians.

As expected, the major reason for visit to general surgeons

was more likely to be postsurgery or postinju~ (34 percent)

than it was for the average physician (9 percent). On the other

hand, the proportion of reasons assigned to the diagnostic,

screening, and preventive module of the NAMCS reason for

visit classification (RVC) was lower than average (7 percent,

compared with 19 percent overall). In NAMCS, patients’ reasons for visit, expressed as closely as possible in the patient’s

own words, are recorded by the physician in item 6 of the Patient Record. The reason given by the patient, which in the

physician’s judgment is most responsible for the visit, is the

first-listed or principal reason for the visit. Reasons for visit are

coded and grouped in eight modules according to a classification system that is detailed in A reason for visit classl~cation

for ambulatory care (RVC).g

Clinical laboratory tests (9 percent) and blood pressure

checks (25 percent) were used for diagnosis by general surgeons in less than average proportions, but X-rays (8 percent)

were ordered or provided in proportionately the same number

of visits as in those by the average physician. However, candidates for elective surgery, who are often referred by another

physician, sometimes bring their X-rays with them when visiting the surgeon.

Office surgery was performed in 16 percent of the visits,

exceeding the NAMCS average of 7 percent for the same type

of treahnent. For the purpose of NAMCS, ofllce surgery is defined broadly. It includes such procedures as incision and excision as well as suture of wounds, and reduction of fractures

among others. (See appendix II.)

General surgeons ordered or prescribed one or more drugs

in only 38 percent of visits in contrast to the 62 percent average for all physicians. When drugs were mentioned, they were

likely to prescribe central nervous system drugs proportionately

more often than other classes (see appendix IV) ofdmgs (25 percent, table 2). This proportion also exceeded the NAMCS

average of 16 percent for the same class of drugs.

Principal (first-listed) diagnoses rendered by general surgeons were coded according to the Ninth Revision of the International Classl~cation of Diseases, Clinical Modz~cation. 10

In general surgical office practice these diagnoses covered a

wide range of the classtilcation system (table 1). The largest

category was diseases of the digestive system (13 percent). Inguinal and other hernia, cholelithiasis, and intestinal disorders

accounted for about half of this category. The distribution of

visits by diagnostic groups indicates that 53 percent of the visits

were for conditions related to six body systems (circulatory,

respiratory, digestive, genitourimuy, skin, and musculoskeletal),

9 percent were for neoplasms, and 12 percent for injuries. This

spectrum of diagnoses suggests the diversity of surgery likely to

be performed by general surgeons.

About half of the average general surgeon’s visits lasted

10 minutes or less. The mean duration of visits was 13.9 minutes, which is close to the mean duration of visits to general

and family practitioners (13.5 minutes).

The higher than average proportion of visits that cuhninated in the patient’s admission to a hospital reflects the clinical

nature of the surgeon’s practice (8 percent, compared with the

NAMCS average of 2 percent). However, considering that in

56 percent of the general surgeon’s visits patients were instructed

to return at a specified time, and that proportionately as many

patients return to the general surgeon for continuing care as

they do to the average physician, it is apparent that followup

care is as common in tie office of the general surgeon as it is

in that of the average medical or surgical specialist.

3
Physician and practice

characteristics

Type of practice

Patterns of care are shown in table 1 for visits to physicians categorized as engaged in solo or other types of practice.

Other types of practice include partnership, group, or any other

organizational arrangements made for the provision of health

care to ambulatory patients by physicians in an office setting.

Visits to general surgeons in solo practice (table A, 52 percent)

exceeded those to physicians in other types of practice (48 percent). This was most evident in the Northeast Region where

63 percent of visits were to physicians practicing alone. Physicians in solo practice in the South Region also had proportionately more visits than physicians in nonsolo practices did.

The opposite was true in the West Region where visits to solo

practices (41 percent) were less likely than those to multiple

practice organizati~ns (59 percent). Proportions of visits to

general surgeons in metropolitan and nonmetropolitan areas

did not differ significantly by type of practice.

Proportions of visits to physicians by type of practice vary

among specialists. For general and family practitioners solo

practice visits were proportionately higher than the NAMCS

average of 55 percent, while for obstetrician-gynecologists

(45 percent), pediatricians (38 percent), and general surgeons

(52 percent), they were lower than average. The trend toward

group practice projected by the American Medical Association is apparently growing at a different rate depending on the

Table A. Number and percent distribution of office visits to general

surgeons by type of practice, according to location of physician’s

practice: United States, January 1980-December 1981

Number of Type of practice

visits in

Geographic region and area thousands Total solo Otherl -

Alldficev isits . . . . . . . . . . . .

Geographic region

Northeast . . . . . . . . . . . . . . . .

North Central . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . .

Area

Metropolitan . . . . . . . . . . . . .

Nonmetropolitan . . . . . . . . . .

Percent distribution

61,013 100.0 51.9 48.1

15,034 100.0 63.1 36.9

15,379 100.0 47.1 52.9

18,001 100.0 54.2 45.8

12,598 100.0 41.0 59.0

43,568 100.0 51.8 48.2

17,445 100.0 52.2 47.8

I Includes partnership, group, and other typas of practice.

specialty involved.ll A contrast between the 1975 and 1980–81

data for general surgeons, includlng type of practice, is shown

in a later section of this report.

Different patterns of care emerged from some of the statistics in table 1. Data on other specialists have shown that patterns of care are often correlated with the sex or age of the

patients the physician is most likely to see. However, sex and

age distributions were similar for general surgeons regardless

of the type of practice. For these physicians, the patterns were

more likely to be related to the status of the problem than to the

demographic characteristics of the patients. Patients the physician had seen before accounted for over 80 percent of visits to

general surgeons regardless of type of practice, but these returningpatients were more likely to present new problems (21 percent) when visiting solo practitioners than when the physician

was in a multiple practice (12 percent).

Solo practitioners also had proportionately more visits for

acute problems (35 percent) than other physicians did (27 percent). Because new problems also tend to be acute problems,

these findings are consistent.

Only 27 percent of visits to solo practices were postsurgery

or postinjury, compared with 41 percent to other types of practice. Patients who receive this type of care are clearly treated

for old problems. Thus, solo practice, with its higher proportion of new problem visits, may be expected to have proportionately fewer patients visiting following surgery or injury.

New problem visits are usually made by patients with symptomatic reasons for visit (as opposed to old problem visits where

treatment or followup care maybe involved). Patients presented

symptoms as their reasons for visit in 53 percent of visits to

physicians in solo practice in contrast to 43 percent of those to

other types of practice. At the same time, reasons in the treatment module were proportionately more numerous for multiple

practices (27 percent) than they were for solo practices

(20 percent).

Statistically significant differences based on some diagnostic services rendered by solo and other practice physicians

were also observed. Solo practitioners used the general history

and/or examination (24 percent) proportionately more often

than physicians in multiple practice did (12 percent), and the

latter used the limited history and/or examination (69 percent)

proportionately more often than the former (62 percent). Blood

pressure checks were also given proportionately more often by

solo practitioners (30 percent) than by other physicians (19 percent). These statistics also correlate with the status of the prob4
lem because comprehensive examinations tend to be related to

● visits for new problems.

Physicians in multiple practice were likely to see proportionately more patients with injuries (15 percent) than were

physicians in solo practice where 10 percent of visits were for

injuries. In view of the broad definition of of%ce surgery used in

NAMCS it is likely to be indicated when injuries are present.

The group with the greater proportion of visits for injuries

(multiple practice) also had the greater proportion of visits with

oftice surgery (18 percent, compared with 13 percent for solo

practice).

While drug therapy was not a major treatment used by

general surgeons, those in solo practice were more likely to

order or prescribe medication than those in other practice organizations were. Drugs were included in 46 percent of visits to

solo physicians, compared with 29 percent of those to other

physicians. The number of chug mentions, percent of drug visits,

and drug rates are detailed in table B. Except for the higher

proportion of drug visits (a visit in which one or more drugs

were prescribed) associated with solo practice, differences in

drug rates were not statistically significant. In. 26 percent of

solo practice visits a single drug was prescribed (table 1), with

a smaller proportion of visits that included two (13 percent).

A single drug (18 percent) was also more likely than two or

more when patients visited physicians in other types of practice.

The duration of visits was also consistent with the clinical

patterns shown thus far. Relatively short visits (less than

11 minutes) constituted only 44 percent of solo practice visits,

compared with 53 percent of those to other types of practice.

Unlike solo practices, multiple practices were characterized by

patients with old problems where data are readily available

from previous visits, and where limited rather than general examinations are likely to be conducted. Thus, visits tend to be

shorter.

Location of practice

The characteristics of visits are proportionately distributed

for each of four geographic regions, and for metropolitan and

nonmetropolitan areas in table 1. Clear patterns did not emerge

from the analysis by location, possibly due to sampling variability. However, there were some differences. Patients were

more likely to be 45 years of age and over in the Northeast and

West Regions than in the North Central and South. Likewise,

visits were proportionately higher for older patients in metropolitan areas than in nonmetropolitan areas. Visits for neoplasms

were also proportionately greater in metropolitan areas than in

nonmetropolitan areas.

Proportions of visits that included office surgery were similar regardless of the location of the physician’s practice. Patients in metropolitan areas were more likely to be admitted to

a hospital than those in nonmetropolitan areas were. This may

be due to the larger proportion of patients over 44 years of age

in metropolitan areas, because the hospital discharge rate for

patients 45 years of age and over is considerably higher than

that of younger patients. 12

Age”of physician

As mentioned previously, general surgeons are not likely

to spend as much time in their offices as medical specialists

are. They averaged 38 visits per physician per week with little

variation due to age (table C). The average visit lasted about

14 minutes for 811general surgeons.

Visit characteristics are outlined in table 3, and proportions of visits are distributed according to age groups of physicians. The majority of visits (32.2 million or 54 percent) were

to physicians 45–64 years of age. This is close to the NAMCS

average of51 percent for this age group. The 22.4 million visits

Table B. Number of office visits to general surgeons, number and percent of drug visits, number of drug mentions, drug mention rate, and

drug intensity rate, by type and location of physician’s practice: United States, Jenuary 1980-December 1981

Office visits Drug Drug

Drug mention intensity

Type and location of practice All visits Drug visits7 mentions rate2 rafe3

Type of practice

Alltypes of practice . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Geographic region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

North Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Area

Metropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonmetropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number

in

thousands

Number

in

thousands Percent

Number

in

thousands

Rate ‘

per

visit

Rate

per drug

visit

61,013

31,657

29,356

15,034

15.379

18,001

12,598

43,568

17,445

23,178

14,628

8,550

4,669

6.305

7,604

4,600

15.675

7,502

38.0

46.2

29.1

31.1

41.0

42.2

36.5

36.0

43.0

38,060

24,644

13,415

6,542

11,054

13,234

7,230

24,553

13,506

0.62

0.78

0.46

0.44

0.72

0.74

0.67

0.56

0.77

1.64

1.68

1.57

1.40

1.75

1.74

1.57

1.57

1.80

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

2Drug mentions divided by number of visits.

3Drug mentions divided by number of drug visits.

41ncludes partnership, group, snd other types of prsctice.

.-

5
Table. C. Average number of office visits per week and maan

duration of visits to general surgeons, by age of physician:

United States, January 1980–December 1981

Average

number Mean

of visits duration

per physician of visit

Age ofphysicianl per week in minutes

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . 38.0 13,9

Under 45 years . . . . . . . . . . . . . . . . . . . .

38.7 14.0

45–54 years . . . . . . . . . . . . . . . . . . . . . . 41.1 13,4

55-64 years . . . . . . . . . . . . . . . . . . . 37.2 14,0

65 years and over, . . . . . . . . . . . . . . . . . 30,9 14.9

lDoes not includedoctorsof osteopathy.

shown for physicians under 45 years of age consisted chiefly of

visits to those aged 35–44 years (20.9 million). There was a

small number of visits (about 802,000 in the 2-year period) to

doctors of osteopathy who identified their specialty as general

surgeon. Because the age of these physiciafis was not available,

such visits are not included in tables 3 and 4, or tables C and D.

Physicians 55 years of age and over saw proportionately

more female patients, and proportionately more patients 45

years of age and over than younger physicians did. The tendency of older patients to visit older physicians has also been

observed in data on other specialties, especially where return

visits are relatively frequent. This suggests that patients use the

same physician as a regular source of care. Thus, it is not surprising that physicians 65 years of age and over treated patients with routine chronic problems in 31 percent of their visits,

compared with about 18 percent by those under 65 years of

age. Where the major reason for visit was postsurgery or postinjury, physicians under 45 years of age had the proportionally

highest number of visits ( 37 percent). This reflects the proportionately higher number of injury diagnoses made by physicians

under 55 years than by those 55 yars of age and over. However, differences among proportions of other diagnostic groups

were not statistically significant.

Drug therapy rates according to physician age groups are

shown in table D. Differences were not statistically significant

and proportions of drug visits were lower than average for all

80

70

60

50

30

20

10

o~

Under 45-54 55-64 65

45 and

over

Age of physicisn in years

Figure 2. Percent distribution of office visits to general surgeons

by type of practice, according to a9e of physician: United Statea?

January 1980-December 1981

age groups of general surgeons. Central nervous system drugs

was the largest therapeutic class prescribed by general surgeons in all age groups except for those under 45 ym.rs where

anti-infectives accounted for about the same proportion of mentions as central nervous system drugs did (table 4).

Table D. Number of office visits to general surgeons, number and percent of drug visits, number of drug mentions, drug mention rate, and

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

.

Office visits Drug Drug

Drug mention intensity

Age of physician All visits Drug Visits2 mentions rate3 rate4

Number

in

thousands

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60,211

Under 45 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22,411

45–54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,924

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,327

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . 5,548

Number

in

thousands

22,909

7,441

7,187

5,915

2,386

Number

in

Percent thousands

38.0 37,568

33.2 12,629

45.1 12,160

36.2 8,666

42.6 4,112

Rate

per

visit

0.62

0.56

0.76

0.53

0.74

Rate

per drug

visit

1.64

1.70

1.69

1.47

1.74

1Does not include doctors of osteopathy.

2A visit in which one or more drugs were prescribed.

3Drug mentions divided by number of visits.

4Drug mentions divided by number of drug visits.

6
100

90

80

70

60

50

40

30

20

10

‘\\

‘\

\, Nonmetropo]itan area

\\

\

\

\

\

\

\

\

Under 45-54 55-64 65

45 and

over

Age of physician in years

The tendency of recent medical school graduates to enter

multiple, rather than solo, practice is illustrated by the opposing

curves in figure 2. The highest proportion of visits to general

surgeons in solo practice is at age group 65 years and over,

while the highest proportion of visits to those in multiple practice is at the age group under 45 years. These findings are

consistent with those of other specialties.

The tendency of newly practicing physicians to locate their

offices in nonmetropolitan areas may be inferred from the visit

curves in figure 3. As the age of the physician increases, the

proportion of visits to general surgeons in nonmetropolitan

areas decreases. Conversely, proportions of visits in metropolitan

areas increase with the advancing age group of the physician.

This phenomenon may reflect the establishment of the National

Health Service Corps, a Federal program enacted to encourage physicians to locate in medically underserved areas. These

areas, designated as Health Manpower Shortage Areas, were

chiefly in nonmetropolitan areas.13

Figure 3. Percent distribution of office visits to general surgeons

by location of practica, according to age of physician: United States,

January 1980-Decamber 1981

7
Patient characteristics

Age and sex

Statistics on the demographic characteristics of patients

treated by general surgeons are shown in table 5. About 80 percent of the visits were made by patients 25 years of age and

over. However, 84 percent of visits by female patients were in

250

200

c

o

~ 150 .-

?

Q

0

Q

0

0

0.

k

n

a)

~ 100

a

50

Under 15-24 25–44 45-64 65

15 and

over

Age of patient in years

this age group, compared with 76 percent of those by males.

Visit rates increased with increasing age group regardless of the

patient’s sex (figure 4). This is typical of all NAMCS visits.

However, women 25–64 years of age visited at a higher rate

than men in the same age group did. For children under 15

ears of age the higher v;sit-rate was that of males, while the

250

200

c

.-

o

150

~

a

n

0

n

o

0

0.

: 100

a

50

/’

White

/

/

/

*

Black

/

I

/

/

I

/

o

Under 15-24 25-44 45-64 65

15 and

over

Age of patient in yeara

Figure 4. Average annual rate of office visits to general surgeons Figure 5. Average annual rate of office visits to general surgeons

by aex and age of patient: United States, January 1980-December by race and age of petienti United Stetes, January 1980-Deoember

1981 1981

8
visit rate was approximately

aged 15-24 years.

Age, race, and ethnicity

the same for females and males

Black patients accounted for about 11 percent of the visits

to general surgeons, which is close to the NAMCS average

of 10 percent of visits to all physicians by black patients. The

median age of black patients visiting general surgeons was 38.6

years, compared with 45.8 years for white patients. Differences

between visit rates of white and black patients were not statistically significant for any age group. The tendency of visit rates

to increase with the advancing age group of the patient was

similar for patients of both races (figure 5).

Only 2.8 million of the 61.0 million visits to general surgeons were by Hispanic patients, but they accounted for the

same proportion of visits to general surgeons as they did for

visits to all physicians (5 percent). The proportionate distributions of visits by age group were similar for Hispanic and nonHispanic patients. However, Hispanic patients visited general

surgeons at a lower rate (about 97 visits per 1,000 persons in

the population) than non-Hispanic patients did (140 per 1,000).

The non-Hispanic visit rate was about 44 percent higher than

the Hispanic visit rate. A similar difference was observed in

visits to all physicians. Differences among the rates of age

groups were not statistically significant, which was probably

due to the hu-ge sampling error associated with the small number of visits by Hispanic patients.

9
Patient condition and

management

Data on the condition of the patient are provided in

tables 6–1 1. Table 6 includes prior visit status, major reason

for visit, and principal reason for visit according to the sex and

age of the patient. In tables 7–8 the most frequent principal

reasons for visit are listed. Diagnostic categories and the most

frequent principal diagnoses are shown in tables 9– 11.

Patient management is described by the diagnostic services

and nonmedication therapy ordered or provided, drugs ordered

or prescribed, duration of the visit, and disposition of the visit

in tables 12– 14. In these tables the sex and age of the patient

are used as control variables.

Sex of the patient

For both sexes at least 81 percent of visits were return

visits to the same physician, but new patients were more likely

to be male (23 percent) than female (17 percent). The ratio of

return visits to initial visits was about 5 to 1 for females’ visits

and about 3 to 1 for males’ visits. Female patients were more

likely to visit for chronic problems (32 percent) than were

males (26 percent), while postsurgery or postinjury was more

likely to be the major reason when male patients visited

(37 percent, compared with 31 percent for females). As may

be expected in the oflice of the general surgeon, postoperative

visit was the leading principal reason for patients’ visits

(16 percent for both sexes). For male patients, hernia of ab

dominal cavity occupied the second place among principal

reasons (5 percent), while lump or mass of breast ranked second

for females (5 percent).

The list of principal diagnoses frequently recorded by general surgeons reflects the complaints, problems, or symptoms

likely to be presented by patients of each sex. Females’ diagnoses were more likely than males’ diagnoses to be associated

with the diagnostic categories neoplasms and diseases of the

genitourinary system; males were more likely to have diseases

of the digestive system, diseases of the skin and subcutaneous

tissue, or injuries. The diagnoses followup examination following surgery, disorders of breast, and inguinal hernia accounted

for 14 percent of all visits. As may be expected, disorders of

breast ranked first (9 percent) in females’ visits; in visits by

males, inguinal hernia (7 percent) led all other diagnoses.

The list of principal diagnoses rendered during otllce visits

offers some insight into the types of procedures likely to be

used by general surgeons when patients were hospitalized.

Diagnoses with the potential for inpatient surgery included

malignant neoplasms of female breast, inguinal hernia, hemorrhoids, varicose veins of lower extremities, hernia of abdominal

cavity, and cholelithiasis.

Except for a proportionately higher number of blood pressure checks made for female patients (27 percent) than for

male patients (21 percent), the proportions of the various diagnostic services included in the NAMCS Patient Record were

similar for females and males. However, nonrnedication therapy

varied by the patient’s sex. Males were more likely to have

ofllce surgery and physiotherapy than females were; females

were more likely to be given diet or medical counseling. The

greater likelihood of physiotherapy and oftlce surgery during

visits by male patients may be related to the fact that males

tend to visit for conditions that can be cured by physiotherapy

or oftlce surgery, such as injuries or skin problems, more often

than female patients do. Office surgery is a more common form

of therapy in the surgeon’s practice than in the medical specialist’s, but surgical procedures are not coded in NAMCS. Therefore, there is no direct method of determining which procedures

the oftlce surgery comprised. However, the reason for visit

classification system includes some detail on anatomical sites

that may suggest the location or kind of surgery performed.

The reason for visit also indicates the patient’s motivation for

the visit. Only those visits that included office surgery are shown

in table E. As expected, in about 30 percent of the 9.5 million

visits that included office surgery the reason was “postoperative

Table E. Number of office visits to general surgeona that included

office surgery and percent, by selected principal reasons for visit

and sex of the patient United States, January 1980-Decermber 1981

Sex ofpetient

Both

Principal reeson for visit and RVC code~ sexes Female Male

Number in thousands

All office visits . . . . . . . . . . . . . . . . . . . . . 9,450 4,653 4,797

Percent

Lump or mass of female breast. . . . S805 4.8 9.7

Skin lesion, infections of skin, skin

moles, warts, or other growths of

skin . . . . . . . . . . . . . S840-S855, S865 18.7 16.4 21.0

Symptoms referable to the musculoskeletal system . . . . . . . S1 900-S1 960 8.3 *8.O *8.6

injuries . . . . . . . . . . . . . . . . .. JO3O-J8l 5 12.4 *5.7 18.9

Postoperative visitz . . . . . . . . . . . . . T205 15.4 18.6 12.3

Suture—insertion, removal . . . . . . . T555 14.2 16.0 12.5

1Based on A reason for visit classification for ambulatory care (RVC).9

‘Includes postoperative suture removal.

10
visit” or “suture-insertion, removal.” This provides liffle information about the site or the procedure other than that sutures

were used. However, four reason groups were more commonly

listed than others were. In 10 percent of the 4.7 million visits

by females a lump or mass of the breast was listed. In 16 percent the reasons were related to the skin. Of the 4.8 million

visits by men, 21 percent were attributed to skin problems and

19 percent to injuries. Visits with surge~ for injuries were

proportionately greater for males than for females.

Visits in which one or more drugs were utilized were equally

uncommon in visits by female and male patients, and drug rates

did not differ significantly (table F). Central nervous system

drugs accounted for the largest proportion of drug mentions

(25 percent) when both female and male patients visited. This

is not surprising in view of the large number of preoperative

and postoperative patients seen by general surgeons. In the

aggregate the proportions of this therapeutic category were

similar for both sexes. However, a more detailed analysis of

the central nervous system group revealed statistically significant differences when certain kinds of central nervous system

drugs were used (table G). Analgesics and antipyretics accounted

for a larger proportion of drugs mentioned during visits by male

patients than during those by females (19 percent, compared

with 13 percent). Motrin, tylenol with codeine, darvocet-N,

and aspirin were the most frequently mentioned analgesics in

visits by both sexes. Mentions of psychotherapeutic agents and

respiratory and cerebral stimulants were proportionately higher

for females than for males. Although as a group the difference

in proportions of anti-anxiety agents, sedatives, and hypnotics

by sex was not statistically significtit, it is noteworthy that

valium, a member of this group, was the leading drug mentioned

during visits by females but not during those of males. Drug

therapy is, by its nature, highly correlated with patients’ diagTable G. Number of drug mentions in office visits to general

surgeons and percent, by selected central nervous system

categories and sex of patient United States, January 1980–

December 1981

Sex of patient

Both

Central nervous system categofyq sexes Femala Male

Number in thousands

All drug mentions . . . . . . . . . . . . . . . . . 38,060 23,046 15,014

Percent

Analgesics and antipyretics . . . . . . . . . 15.3 13.2 18.6

Psychotherapeutic agents . . . . . . . . . . 1.4 2.0 “0.6

Respirato~ and cerebral

stimulants . . . . . . . . . . . . . . . . . . . . . . 2.9 4.1 *1.O

Anti-anxiety agents, sedatives, and

hypnotics . . . . . . . . . . . . . . . . . . . . . . . 4.9 5.5 4.0

1Based on the classification system of the American Hospital Formula~

Service (ace appendix IV).

noses. It may be that an anti-anxie~ agent, such as valium, is

more likely to be indicated when hormonal imbalances, such as

those following female surgery, occur.

There was little or no variation in the duration of visits by

the sex of the patient. Admission to the hospital was not more

likely for one sex than for the other. However, the principal

diagnosis related to the hospital admission differed by sex of

the patient. The principal diagnoses most frequently recorded

in visits when patients were admitted to a hospital are shown in

table H. Neoplasms, diseases of the circulatory system, diseases

of the digestive system, diseases of the genitourimuy system,

and diseases of the skin and subcutaneous tissue accounted for

about 77 percent of such visits regardless of the patient’s sex.

Table F. Number of office visits to general surgeons, number and percent of drug visits, number of drug mentions, drug mention rate, and

drug intensity rate, by sex, age, and visit status: United States, January 1980-December 1981 4

Office visits Drug Drug

Drug

Sex, age, and visit status

mention intensity

All visits Drug visits~ mentions rate2 rate3

Number Number Number Rate

in

Rate

in

Sex

in per

thousands

per drug

thousands Percent thousands visit visit

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61,013 23,178 38.0 38,060 0.62 1.64

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34,373 13,470 39.2

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

23,046 0.67 1.71

26,640 9,707 36.4 15,014 0.56 1.55

Age

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,508 1,304 2B.9

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,613 2,782 36.6

25-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,622 7,637 41.0

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,420 6,820 37.0

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,850 4,633 39.1

Visit status

2,062

4,044

1,647

1,571

8,737

New patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,769 3,645 31.0

Oldpatient, new problem . . . . . . . . . . . . . . . . . . . . . .

5,943

10,264 6,072 59.2

Oldpatient, old problem . . . . . . . . . . . . . . . . . . . . . . .

9,766

38,980 13,460 34.5 22,350

0.46

0.53

0.63

0.63

0.74

0.50

0.95

0.57

1.58

1.45

1.53

1.70

1.89

1.63

1.61

1.66

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

2Dr”g mentions divided by number OfViSitS.

3Drug mentions divided by number of drug visits. .

11
Table H. Number and percent distribution of office visits to general

surgeons with a disposition admit to hospital by principal diagnosis

category, according to sex of patient: United States, January

1980-December 1981

Sex of patient

Principal diagnosis category and Both

ICD-9–CM codel sexes Female Male

All diagnoses . . . . . . . . . . . . . . . . .

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

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

Diseases of the circulatory

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

Diseases of the digestive

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

Diseases of the genitourinary

system3 ...,.....629......580-629

Diseases of the skin and

subcutaneous tissue. . . . . . . 680–709

All other diagnoaes . . . . . . . . . . . residual

Number in thousands

4,950 2,675 2,275

Percent distribution

100.0 100.0 100.0

16.1 17.8 “14.1

14.5 “15.1 *1 3.7

26.7 20.4 34.0

11.2 16.1 *5.6

*8.4 *7.3 “9.7

23.1 23.3 22.9

1Based on the International Classification of Diseases, 9th Revision, Clinical

Modification (ICD-9-CM). 10

‘Includes 542,000 visits for inguinal hernia (550).

31ncludes 354,000” visits for disorders of breast (61 0–61 1).

Varicose veins and hemorrhoids were preeminent among the

circulatory conditions for both sexes. Inguinal hernia was the

largest component of the digestive group for males. Disorders

of the breast represented the majority of visits in the genit~

urinary diseases category for females.

Age of the patient

The high correlation with patient age of certain variables

used to describe visits in NAMCS has been demonstrated in

almost all reports. It has been shown that as the patients age,

proportions of visits by patients the physician has seen before,

returning for care of continuing problems, increase. Likewise,

patients visiting for chronic problems increase. The data on

visits to general surgeons reflect these same tendencies. For

the two oldest groups (45–64 years of age and 65 years and

over), 68 and 75 percent, respectively, of their visits were return

visits, compared with 53 and 60 percent of visits by patients

15-24 and 25-44 years, respectively (figure 6).

The conditions treated by general’ surgeons also varied

with the patient’s age group. The proportion of visits for neoplasms increased from a low of 2 percent for children under 15

years of age to a high of 17 percent for those 65 years of age

and over. Proportions of visits for diseases of the circulatory

system increased similarly. Diseases of the digestive system

were more likely to be diagnosed for patients over 44 years of

age than for those younger. A reverse trend was observed for

visits caused by injuries, which decreased from a proportion of

20 percent of visits by patients 15–24 years of age to 7 percent

of those by the oldest group.

Unlike the average results in NAMCS where percents of

drug visits increased with age, percents of drug visits to general

W

.e

03

.—

>

z

E

al

:

Lt

80

70

60

50

40

30

20

10

Old patients, old problems

0 ●0

‘\

OL—UJJ

Under 15-24 25-44 45-64 65

15 and

over

Age of patient in years

Figure 6. Percent of office visita to general surgeons by prior visit

statua and age of patiant United States, January 1980-Decernber

1981 -

surgeons did not vary appreciably by age. Patients 45 years of

age and over were more likely to have diuretics or cardiovascular

drugs prescribed than younger patients were, which may be

expected in view of the diagnoses usually made for older patients. On the other hand, the use of anti-infective agents tended

to decrease with advancing age.

The age group with the largest proportion of relatively short

visits (less than 11 minutes) was under 15 years old (64 percent, compared with 52 percent for age group 15–24 years,

48 percent for patients 25–44 years, and 45 percent for those

older).

The proportionate increase by age in patients scheduled

for return visits is consistent with the statistics on visit status in

which older patients made proportionately more return visits

than younger patients did. Visits that cuhninated in admission

to a hospital did not vary significantly by age. This appears to

be inconsistent with data reported from the National Hospital

Discharge Survey in which discharge rates increased with age.12

However, NAMCS data on general surgeons simply underscore

the probability that the outcome of a visit to a general surgeon’s

ofllce is likely to be surgery related, regardless of the patient’s

age.

12
Reason for visit and diagnostic services

The diagnostic services ordered or provided by general

surgeons when patients visited for certain reasons are shown in

table 15. Except in the case of nonillness care, which was the

major reason for visit in a relatively small share of all visits, the

limited history andlor examination was the most used service.

However, general examinations, blood pressure checks, and

clinical laboratory tests were more commonly performed during

visits for nonillness care than during those for other reasons.

As expected, patients who visited because of injuries were more

likely to have X-rays(31 percent) than patients who visited for

other reasons were.

Principal diagnosis and therapy, duration

Seven principal diagnosis groups that together accounted

for 67 percent of the ofice visits to general surgeons are shown

in table 16. Management of patients with these conditions is

described in terms of nonmedication therapy, duration, and

disposition of the visit.

Office surgery was the foremost therapy used for neoplasms

(25 percent), diseases of the skin (39 percent), and injuries

(26 percent). Physiotherapy was also proportionately frequent

when injuries were present (17 percent). Medical counseling

was provided in from 16 to 25 percent of visits for the conditions shown in table 16.

The mean duration of visits did not depart appreciably

from the average of 13.9 minutes for any of the seven diagnostic

categories (table J). The small differences can be attributed to

sampling variability.

Prior visit status

About 19 percent of the visits to general surgeons were

made by new patients, 17 percent by old patients with new

problems, and 64 percent by old patients with old problems.

The pattern of ambulatory care provided to each of these groups

by general surgeons may be abstracted from the data in

table 17. New patients were more likely to be male (51 percent)

than were old patients (42 percent). New patients were younger

than returning patients were. About 63 percent of new patients

were under 45 years of age, compared with 53 percent of old

patients with new problems and 45 percent of old patients with

old problems. When general surgeons encountered patients with

new problems, the principal reasons for ~sit expressed by these

patients were likely to be symptoms or complaints. Not surprisingly, the major reason for visit when patients presented old

problems was more likely than when new ones were presented

to be routine chronic problems (figure 7), or postsurgery or

postinjury. The distribution of visits by principal diagnosis did

not vary appreciably among the three groups.

Similar to NAMCS data on most specialists, the general

surgeon’s workup for new patients was more intense than it

was for returning patients. General history and/or examination,

X-ray, and endoscopy were ordered or provided proportionately

more frequently for new patients than for returning patients. As

a result, 39 percent of new patient visits took 16 minutes or

Chronic problem

I 1 I I I

Under 15-24 25-44 45-64 65

15 and

ovar

Age of patient in years

Figure 7. Percent of office visits to general surgeons by chronicity

of problem and age of petierw United States, January 1980-

December 1981

Table J. Mean duration of office visits to general surgeons by selected principal diagnosis catego~ and prior visit status: United States,

January 1980-Decamber 1981

Prior visit status

All New O/d patient, Old patient,

Principal diagnosis categoiy and ICD–9-CM code! visits patient new problem old problem

All diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Diseases of thegenitourinary system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..580–629

Diseases of theskin and subcutaneous tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...680-709

Diseases of the musculoskeletal system and connective tissue . . . . . . . . . . . . . . . . . . ...710-739

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

13.9

14.3

15.0

14.0

14.2

12.8

13.6

13.3

Mean duration in minutes

17.0 15.1 12.7

15.0 17.5 13.7

17.4 15.4 14.3

18.3 15.6 12.3

16.0 19.0 12.4

16.7 14.5 11.0

14.5 13.9 13.1

16.5 14.7 11.5

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM).1 o

13
more, compared with 28 and 18 percent of the other two groups,

respectively (table K). The mean duration of new patient visits

was 17.0 minutes compared with 15.1 minutes for old patients

with new problems and 12.7 minutes for those with old problems

(table J). With each succeeding NAMCS report on physician

specialty it becomes increasingly evident that physicians tend

to provide more in-depth examinations to new patients, and to

spend more time with them than with other patients.

New patients were more likely to be admitted to a hospital

(19 percent) than were either old patients with new problems

(8 percent), or old patients with old problems (5 percent). Also,

return visits were not scheduled as frequently for new patients

(42 percent) as for old patients (63 percent). These statistics

support the prevailing idea that the typical flow of contact with

general surgeons follows a pattern of initial consultation for

examination and preparation, hospital admission or office

surgery, and office followup.

Table K. Percent of office visits to general surgeons by duration of

visit and prior visit ststus: United States, January 1980-

December 1981

Duration

Less than More than

Prior visit status 11 minutes 15 minutes

Percent of visits

New patient . . . . . . . . . . . . . . . . . . . . . . . . 33.1 38.9

Old patiant, new problem. . . . . . . . . . . . 40.9 28.3

Old patient, old problem. . . . . . . . . . . . . 54.5 17.8

Table L. Number and percent distribution of office visits to ganeral

surgaons by referral status of patient, according to prior visit

status: United States, January 1980-December 1981

Referral status

Number Referred Not referred

in by another by another

Prior visit status thousands Total physician physician

New patient . . . . 11,769 100.0 45.5 54.5

Old patient,

new problem. . . 10,264 100.0 7.6 92.4

Old patient,

old problem. . . . 38,980 100.0 100.0

About 46 percent of the 11.8 million new patients were

referred to general surgeons by other physicians (table L). The

patterns of care were similar for referred and nonreferred. new

patients with a few exceptions. Thirty percent of referred patients were 25–44 years of age, compared with 41 percent of

nonreferred patients; but 17 percent of refereed patients were

65 years of age or over, compared with only 6 percent of those

nonrefemed (data not shown). Referred patients were more

likely than nonreferred patients were to visit for neoplasms and

diseases of the digestive system. Nonreferred patients made

proportionately more visits for injuries. Proportions of such

diagnostic services as general examination, clinical laboratory

test, X-ray, and blood pressure check were higher for the nonreferred group. However, referred patients were more likely to

be admitted to a hospital where they were probably examined

and tested prior to surgery.

14
,Conclusion

Comparison with other surgical specialties

There were 355.9 million visits to surgical specialists in

1980-81. This number constituted about 31 percent of the

visits to all ofllce-based physicians, and it comprised the visits

to 10 different surgical specialties. While the fwus of this report

is ambulatory care provided by general surgeons, it is instructive

to examine the pattern of such care from the perspective of care

provided by other specialists with whom general surgeons may

share some kinds of clinical activity. Data on visits to general

surgeons and the nine other surgical specialists represented by

office visits in NAMCS are shown in table 18.

A greater tendency toward solo practice for some specialties than for general surgery is suggested by the higher proportions of such visits to colon and rectal surgeons, ophthahnologists, otorhinolaryngologists, and plastic surgeons where at

least 60 percent of the visits were to solo physicians, compared

with 52 percent to general surgeons. On the other hand, neurological surgeons, obstetrician-gynecologists, orthopedic surgeons, thoracic surgeons, and urological surgeons had higher

proportions of visits to group physicians than general surgeons

did. Although most visits to general surgeons were in metropolitan areas (71 percent), other surgeons had proportionately

more visits in the same type of location than general surgeons

did. The proportions of visits to other surgeons in metropolitan

areas ranged from 82 to 100 percent.

The distributions of visits by sex of the patient were predictable, with almost all visits to obstetrician-gynecologists

made by females, and 66 percent of visits to urological surgeons

made by males. The sex distributions of visits to other surgeons

were similar to that of general surgeons. Age dMribution

tended to be related to the specialized care provided by the

physician. For example, 81 percent of the visits to thoracic

surgeons were made by patients 45 years of age and over, ~

while 39 percent of visits to otorhinolaryngologists were by

patients under 15 years of age. The distribution of visits to

general surgeons by age group was not as skewed as that of

other surgeons.

Neurological surgeons (19 percent), otorhinolaryngologists

(14 percent), thoracic surgeons (14 percent), and urological

surgeons (13 percent) had higher proportions of referred patients than general surgeons did. Referrals to colon and rectal

surgeons and to orthopedic surgeons were proportionately

similar to those of general surgeons, but as may be expected,

referrals to obstetrician-gynecologists and ophthalmologists

were lower.

Probably the most telling statistics insofar as the practice

of the general surgeon is concerned is the distribution of visits

by diagnosis. Predictably, large proportions of visits for certain

diagnoses occurred in the specialties where practices were restricted to the alleviation of such problems, but for general

surgeons proportions of visits by diagnosis were more widely

dispersed. About 65 percent of the visits to colon and rectal

surgeons involved diseases of the circulatory system or diseases

of the digestive system. General surgeons saw such conditions

in 23 percent of their visits. Obstetrician-gynecologists treated

diseases of the genitourinary system in 19 percent of visits,

compared with 9 percent in those of general surgeons. Diseases

of the musculoskeletrd system or injuries accounted for 83 percent of visits to orthopedic surgeons, and 18 percent of those to

general surgeons. Plastic surgeons treated patients with neoplasms in 15 percent of their visits; general surgeons treated

similar problems in 9 percent. Plastic surgeons also treated

patients with diseases of the skin and subcutaneous tissue in

19 percent of visits, while the same category accounted for

8 percent of the general surgeon’s caseload. Thus, two-thirds of

the visits to general surgeons included seven diagnostic categories, while in at least four other specialties only one or two of

the same seven categories were the major focus of practice.

OfFice surgery was more likely to be performed in the otlices

of plastic surgeons than in those of general or other surgeons.

Surgical procedures were used in the office setting in about the

same proportions of visits to general surgeons, colon and rectal

surgeons, orthopedic surgeons, otorhinolaryngologists, and

urological surgeons.

The proportions of visits with a disposition admit to hospital did not vary appreciably among surgical specialties.

However, when all visits that culminated in hospital admission

are considered (26.8 million), the largest share (19 percent)

was attributed to general surgeons (figure 8).

Comparison with 1975 data

As a proportion of all physician visits, visits to general

surgeons decreased from 7 percent in 1975 to an average of

5 percent in 1980–8 1. There were 14 visits per 100 persons in

the population in 1980–81, compared with 20 in 1975

(table M). Visits to general surgeons in solo practice decreased

from 64 percent in 1975 to 52 percent in 1980–81. This is

consistent with the general trend observed for many other

specialties.

There was a statistically significant increase in the proportion of visits by male patients in 1980–81, which may ac15
Specialty

Plastic surgery

Neurological surgery

Urological surgery

Otorhinola~ngology

Orthopedic surgery

Obstetrics and gynecology

General surgery

P

::::::; ...2.4 .,.,.,.

.,. .

P

;:;;; ..1.8

.....

0 10 20

Percent of visits

NOTE: Based on a total of 26,787,000 visits to all physicians.

Ficrure8. Percent of all office visits with a disposition admit to

h&pital by selected surgical specialties: United States, January

1980-Decambar 1981

count for the increase in the diagnostic categories found to be

more closely associated with visits by males than with visits by

females. Diseases of the digestive system rose from 9 to

13 percen~ diseases of the skin and subcutaneous tissue, from

6 to 8 percent and injuries, from 10 to 12 percent. Visits in

these categories were more likely for male patients than for

female patients.

Usually in NAMCS, an increase in the proportion of one

type of medical examination (limited or general) is accompanied

by a decrease in the other. It is noteworthy that in visits to

general surgeons both types of examination increased. since

1975. The small decrease in office surgery was not statistically

significant, and other services were proportionately similar for

the two points in time that were examined.

In 1980–81, 19 percent of the average general surgeon’s

visits were made by new patients, compared with 16 percent in

1975. This may account for the increased frequency of examinations. It also may explain the change in the duration of visits

from the earlier period to the more recent one. Relatively short

visits (less than 11 minutes) accounted for 56 percent of

physician-patient encounters in 1975. This proportion was

48 percent in 1980–81. Simultaneously, relatively long visits

(more than 15 minutes) increased from 18 percent in 1975 to

24 percent in 1980–81. It has been shown that visits by new

16

Table M. Number of office visits per 100 persons per year to

general surgaons and percent of visits, by selacted characteristics:

United States, 1975 and 1980-81 ●

Characteristic 7975 1980-81

Visits perl OOpersons peryear. . . . . . . . . . . . . . .

Percent of all physician visits . . . . . . . . . . . . . . . .

Type of practice

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

Other! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Location of practice

Metropolitan area . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonmetropolitan area . . . . . . . . . . . . . . . . . . . . . . .

Sex of patient

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

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

Age of patient

Under 25 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . .

Prior visit status

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

Oldpatient, new problem . . . . . . . . . . . . . . . . . . . .

Oldpatient, old problem . . . . . . . . . . . . . . . . . . . .

Principal diagnosis

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseaees of tha circulatory system . . . . . . . . . . . .

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

Diseases of the digestive system . . . . . . . . . . . . .

Diseases of the genitourinary system . . . . . . . . . .

Diseases of the skin and subcutaneous tissue . . .

Diseases of the musculoskeletal syetem and

connective tissue ...,..... . . . . . . . . . . . . . . . .

Injury andpoisoningz . . . . . . . . . . . . . . . . . . . . . . .

Diagnostic services and nonmedication therapy

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

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

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

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

Ol%cesurgew . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Duration of visit

Less than 11 minutes . . . . . . . . . . . . . . 1........

More than 15 minutes . . . . . . . . . . . . . . . . . . . . . .

Disposition

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

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

Number

20 14

Percent

7.3

63.5

36.5

72.2

27.8

60.3

39.7

19.5

28.7

34.0

17.8

15.8

19.1

65.1

7.6

8.8

6.1

9.2

7.8

6.0

4.0

9.7

46.6

11.0

11,8

7.3

16.6

55.6

18.4

5.8

61.6

5.3

51.9

48.1

71.0

29.0

56.3

43.7

19.9

30.5

30.2

19.4

19.3

16.8

63.9

9.4

9.9

6.5

13.3

8.9

8.4

5.6

12.2

65.6

18.1

8.5

7.9

15.5

48.0

23.6

8.1

55.9

1Includes partnership, group, and other types of practice.

‘In 1975 this catego~ was “’Accidents, poie.oninga, and violence.”

patients are more time-consuming, on the average, than are

visits by other patients, and an increase in the proportion of

new patient visits to general surgeons may have been the reason

for the longer visit duration.

The proportion of visits that culminated in the patient’s

admission to a hospital increased from 6 to 8 percent over the
two periods, and proportionately fewer patients were scheduled

for return visits.

Table N. Number of office visits to general surgeons with a

second-listed diagnosia followup examination after surgery and

percent, by first-listed diagnosis: United States, January

1980-Decambar 1981

Hospital care

The data collected by means of the NAMCS are generalizable only to the universe of office-based physicians, and patterns of care apply only to the care provided in the ofllce setting.

However, half of the encounters with patients by general surgeons are with hospitalized patients, and the pattern is somewhat incomplete without some mention of these encounters.

The National Hospital Discharge Survey provides extensive national data on surgical procedures in short-stay hospitals,

but information on the surgeons who perform the surgery is not

available. ]2 A list of the leading surgical procedures performed

in hospitals by general surgeons in 1978 was included in the

General Surgey Practice Report of the Division of Research

in Medical Education of the University of California School of

Medicine.d Although the authors stated that the sample was

small (723 encounters) and the weighted number of procedures

relatively unreliable, the results contribute a nominal dimension to the pattern of hospital care. Among the procedures listed

were repair of hernia, operations on the skin, operations on

biliaty tract, and breast surgery. However, there was no information regarding the proportions of all such operations according to surgical specialty or the proportions attributable to general

surgeons.

A study conducted in 1970 by the American College of

Surgeons and the American Surgical Association addressed

the question of the percent of operative procedures performed

by different surgical specialists.]4 There are no more recent,

comparable data. In that study, data for four “areas” were

reported but not averaged. Based on one of these “areas,” it

was found that general surgeons were the responsible surgeons

for (among other operative procedures) 83 percent of inguinal

hernia operations, 28 percent of abdominal hysterectomies,

60 percent of local excisions of skin, 87 percent of cholecystectomies, 7 percent of tonsillectomies, 84 percent of appendectomies, 86 percent of partial mastectomies, 85 percent of

hemorrhoidectomies, and 90 percent of excision and ligation of

varicose veins. The reader will recognize that many of these

operations are closely associated with the diagnoses commonly

rendered in the general surgeon’s office practice. By contrast,

otorhinolaryngologists performed 78 percent of tonsillectomies

obstetrician-gynecologists, 64 percent of abdominal hysterectomies; and urologists, 85 percent of prostatectomies.

NAMCS data on the association of fret-listed and secondIisted diagnoses are a bridge between characteristics of office

visits to general surgeons and the kinds of inpatient surgery

e

SecondIisted

diagnosis

followup

examination

after

First-1isted diagnosis and ICD-9–CM code~ surgery

Number

in

thousands

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,360

Percent

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239 19.8

Malignant neoplasms. . . . . . . . . . . . . . . . . . 140–208 13.4

Benign neoplasms . . . . . . . . . . . . . . . . . ...210-229 *5.1

Diseases of the circulatory system . . . . . . ...390-459 9.3

Diseases of the veins . . . . . . . . . . . . . . . ...454-455 *5.5

Diseases of the digestive system. . . . . . . . ...520-579 32.7

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . ...550 9.5

Other hernia of abdominal cavity without mention

of obstruction or gangrene . . . . . . . . . . . . . . ...553 7.6

Cholelithiasis or other disorders of gall

bladder . . . . . . . . . . . . . . . . . . . . . . . . . . ...574-575 *4.6

Diseases of the genitourinary system . . . . ...580-629 11.0

Benign mammary dysplasia or other disordera

of breast . . . . . . . . . . . . . . . . . . . . . . . . ...610-611 8.9

Diseases of the skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . ...680-709 12.9

I Based on the International Classification of Diseases, 9th Revision, Clinical

Modification (ICD-9-CM). 10

performed. There were 6.4 million visits with a second-listed

diagnosis of followup examination following surgery. In these

cases, the first-listed, or principal, diagnosis is usually the condition that required surgery. It can be seen in table N that

33 percent of followup visits showed a first-listed diagnosis in

the category diseases of the digestive system. Inguinal hernia,

other hernia of abdominal cavity, and cholelithiasis were responsible for the majority of such visits. Another 20 percent of

surgery followup visits was due to neoplasms, with the largest

share (13 percent) because of malignancy. Benign mammary

dysplasia or other disorders of breast accounted for 9 percent

of these visits, and an additional 2 percent were due to diseases

of the genitounnary system other than breast. Diseases of the

circulatory system (chiefly diseases of veins) were the principal

diagnoses in 9 percent of the visits, and diseases of skin and

subcutaneous tissue in 13 percent. The aforementioned diagnoses were present in a total of 86 percent of the visits in which

followup examination following surgery was listed.

17
References

lNati~nal Center for Health Statistics, B. K. cypress: patterns of

ambulatory care in general and family practice, National Ambulatory

Medical Care Survey, United States, January 1980-December 1981.

Vital and Health Shztistics. Series 13, No. 73. DHHS Pub. No.

(PHS) 83-1734. Public Health Service. Washington. U.S. Government Printing Office, Sept. 1983.

zNational Center for Health Statistics, B. K. cYPreW patterns of

ambulatory care in pediatrics, National Ambulatory Medical Care

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

Health Statistics. Series 13, No. 75. DHHS Pub. No. (PHS) 84-

1736. Public Health Service. Washington. U.S. Government Printing

OfYice, Oct. 1983.

3Nationa1 Center for Health Statistics, B. K. Cypress: Patterns of

ambulatory care in obstetrics and gynecology, National Ambulatory

Medical Care Survey, United States, January 1980-December 1981.

Vital and Health Statistics. Series 13, No. 76. DHHS Pub. No.

(PHS) 84-1737. Public Health Service. Washington. U.S. Government Printing Office, Feb. 1984.

4National Center for Health Statistics, R. O. Gagnon: Visits to general

surgeons, National Ambulatory Medical Care Survey, 1975. Advance

Data from Vital and Health Statistics, No. 23. DHEW Pub. No.

(PHS) 78-1250. Public Health Service. Hyattsville, Md., May 24,

1978.

5National Center for Health Statistics, J. Tenney, M. D., K. white,

M. D., and J. Williamson, M. D.: National Ambulatory Medical Care

Survey, background and methodology, United States, 1967-72. Vital

and Health Statistics. Series 2, No. 61. DHEW Pub. No. (HRA)

74– 1335. Health Resources Administration. Washington. U.S. Government Printing Off]ce, Apr. 1974.

‘%University of Southern California, Division of Research in Medical

Education: General Surgety Practice Study Repom Contract No.

HRA 232–78-O 160. Los Angeles, Calif. University of Southern

California, July 1979.

7University of Southern California, Division of Research in Medical

Educatiorx General Practice Study Report. Contract No. HRA

23 1–77–01 15, Los Angeles, Calif. University of Southern California,

July 1978.

8University of Southern California, Division of Research in Medical

Education Obstetrics/Gynecology Practice Study Report. Contract

No. 231 –75–06 16 (P). Los Angeles, Calif. University of Southern

California, Sept. 1977.

gNationa] Center for Health Statistics, D. Schneider, L. Appleton,

and T. McLemore: A reason for visit classification for ambulatory

care. Viral and Health Statistics. Series 2, No. 78. DHEW Pub. No.

(PHS) 79-1352. Public Health Service. Washington. U.S. Government Printing Office, Feb. 1979.

Iou.s. public Health service and Health Care Financing Administration: International Classz~cation of Diseases, 9th Revision, Clinical

Modification. DHHS Pub. No. (PHS) 80-1260. Public Health Service. Washington. U.S. Government Printing OffIce, Sept. 1980.

11Center for Health Services Research and Development, L. J.

Goodman, E. H. Bennett, and R. J. Odem: Group Medical Practice in

the U.S., 1975. American Medical Association. Chicago, 111.,1976.

lzNationa] Center for Health Statistics, E. J. Graves and B. J. Hawt:

Utilization of short-stay hospitals, United States, 1981, Annual summary. Vital and Health Statistics. Series 13, No. 72. DHHS Pub.

No. (PHS) 83– 1733. Public Health Service. Washington. U.S. Government Printing OffIce, Aug. 1983.

13U.S. Department of Health and Human Services, Public Health

Service: Third Report to the President and Congress on the Status of

Health Professions Personnel in the United States. DHHS Pub. No.

(HRA) 82-2. Health Resources and Services Administration. Washington. U.S. Government Printing Office, Jan. 1982.

14The American College of Surgeons and the American Surgical

Association. Surgery in the United States. 1976.

15National Center for Health Statistics, H. Koch The collection and

processing of drug information, National Ambulatory Medical Care

Survey, United States, 1980. Vital and Health Statistics. Series 2,

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

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

lGNationa\ Center for Health Statistics, P. J. McCarthy: Replication,

An approach to the analysis of data from complex surveys. Vital and

Health Statistics. Series 2, No. 14. DHEW Pub. No. (HSM)

73– 1269. Health Services and Mental Health Administration. Washington. U.S. Government Printing Ofllce, Apr. 1966.

lTNational Center for Health Statistics, P. J. McCarthy: Pseudoreplication, Further evaluation and application of the balanced half-sample

technique. Vital and Health Statistics. Series 2, No. 31. DHEW

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

1969.

18
List of detailed tables

1.

2.

3.

4.

5.

6.

7.

8.

9.

10

Number and percent distribution of office visits to general

surgeons by selected visit characteristics, according to type

and location of physician’s practice United States,

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

Number and percent distribution of drug mentions in oftice

visits to general surgeons by therapeutic category, according

to type and location of physician’s practice: United States,

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

Number and percent distribution of ofllce visits to general

surgeons by selected visit characteristics, according to age

of physician: United States, January 1980-December

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

Number and percent distribution of drug mentions in otlice

visits to general surgeons by therapeutic category, according

to age of physiciam United States, January 1980-

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

Number, percent distribution, and average annual rate of

oftlce visits to general surgeons by age of patient, according

to sex, race, and ethnicity: United States, January 1980–

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

Number and percent distribution of otllce visits to general

surgeons by selected visit characteristics, according to sex

and age of patienti United States, January 1980–December

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

Number, percent, and cumulative percent of office visits to

general surgeons, by the 36 most frequent principal reasons

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

Number, percent, and cumulative percent of office visits to

general surgeons by sex of patient, and the 15 most frequent

principal reasons for visiti United States, January 1980-

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

Number and percent distribution of ofllce visits to general

surgeons by principal diagnosis categories, according to sex

and age of patienti United States, January 1980-December

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

Number, percent, and cumulative percent of ofice visits to

general surgeons, by the 30 most frequent principal diagnoses: United States, January 1980-December 1981 . . . . .

20

22

23

25

25

26

27

28

29

30

11.

12.

13.

14.

15.

16.

17.

18.

Number, percent, and cumulative percent of otllce visits to

general surgeons, by sex of patient and the 15 most frequent

principal diagnoses: United States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent of office visits to general surgeons by

diagnostic services, nonmedication therapy, sex, and age of

patient, and percent distribution by number of medications,

according to sex and age of patien~ United States, January

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

Number and percent distribution of drug mentions in ofilce

visits to general surgeons by therapeutic category, according

to sex and age of patienti United States, January 1980-

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

Number and percent distribution of oftlce visits to general

surgeons by duration and disposition of visit, according to

sex and age of patierk United States, January 1980–

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

Number and percent of office visits to general surgeons, by

selected diagnostic services, major reasons for visit, and

selected principal reason for visit modules: United States,

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

Number and percent of office visits to general surgeons,

by selected principal diagnosis categories, nonmedication

therapy, and disposition of visit, and percent distribution of

ofilce visits by duration United States, January 1980–

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

Number and percent distribution of office visits to general

surgeons by selected visit characteristics, according to

prior visit status United States, January 1980–December

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

Number and percent distribution of oflice visits by selected

visit characteristics, according to surgical specialty United

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

31

32

33

33

34

34

35

37

19
Table 1. Number and percent distribution of office visits to general surgeons by selected visit characteristics, according to type and location

of physician’s practice: United States, January 1980-Dacember 1981

Type of practice Geographic region Area

All types NonOf North Metro- matroCharacteristic practice solo Otherl Northeast Central South West politan politan

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

Total, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex of patient

Female ..,.,,.....,......,,. . . . . . . . . . . . .

Male, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age of patient

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . .

15–24 years......,...,.,,,. . . . . . . . . . .

25-44 years......,,......,.. . . . . . . . . .

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . . . . . .

Prior visit statua

New patient.......,.......,,. . . . . . . . .

Oldpatient, new problem . . . . . . . . . . . . . . . . .

Oldpatient, old problem . . . . . . . . . . . . . . . . .

Referral status

Referrad by another physician . . . . . . . . . . . . .

Notreferred by another physician . . . . . . . . .

Major raason for visit

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

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

Chronic problem, flareup . . . . . . . . . . . . . . . . . .

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

Nonillneas care . . . . . . . . . . . . . . . . . . . . . . . . . . .

Principal reason forvisit and RVCcode2

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

Disease module . . . . . . . . . . . . . . . .DOOI–D999

Diagnostic, screening, and preventive

module . . . . . . . . . . . . . . . . . . , . . .. XI X599599

Treatment module . . . . . . . . . . . . TIOO-T899

Injuries and adverse effects

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

Test resulta module , . . . . . . . . . .. RI OO-R7OO

Administrative module . . . . . . . . AI OO-A140

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

Diagnostic service4

None. . .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Paptast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Blood preasure check . . . . . . . . . .

Electrocardiogram . . . . . . . . . . . . . . . . . . . . . . .

Viaion test........,.......,,., . . . . . . . . . . .

Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

61,013

100.0

56.3

43.7

7,4

12.5

30.5

30.2

19.4

19.3

16.8

63.9

10.1

90.0

31.1

18.3

11.3

33.7

5.6

48,5

11.5

6.5

23.4

7.6

“0.5

1.1

0.9

6.9

65.6

18.1

1.1

8.5

7,9

24,6

1.1

1.1

2,4

2.8

31,657

100,0

57.8

42,2

7.8

12.9

31.5

28,7

19.1

17.7

21.4

61,0

8.7

91.3

34.9

18.9

11.8

27.1

7,3

53.4

11.7

7,0

19.8

5.2

‘0.7

1,7

*0.5

6.8

62.4

23.5

*1.2

9.4

6.1

30.0

*1.2

“0,9

1.7

2.7

29,366

100,0

54.8

45.3

7.0

12.0

29.5

31.8

19.8

21.1

11.9

67.0

11.5

88.5

27,0

17.7

10.9

40.8

3.7

43,3

11.3

5.9

27.4

10.2

“0.3

“0.5

“1.1

7.0

69.1

12.2

“0.9

7.6

9.8

18.7

*1.1

“1.3

3.1

3.0

Number in thousands

15,034 15,379 18,001

Percant distribution

100.0

54.1

45.9

6.4

12.3

26.5

34.2

20.6

20.2

12.8

67.0

11.1

88.9

27.6

19.6

11.3

36.9

4.6

51.4

12.3

5.3

22.4

6.1

“0.3

*1.4

“0.9

9.0

65.5

20.2

“0.5

4.4

7.7

13.4

*0.6

3.4

3.3

*2.5

100.0

56.6

43.4

8.1

14.5

30.6

29.5

17,4

18.9

19.5

61.7

10.7

89.3

29,0

16.9

12.0

34.3

7.8

44.6

13.3

6.9

24.1

7.9

“1.6

“1.1

“0.4

7.6

65.8

14.0

*1.2

8.9

8.9

25.6

*1.5

‘0.0

*2.O

3,0

100.0

57.0

43.0

8,2

13.2

33.4

27.2

18.1

19,6

14.9

65.6

8.2

91.8

31.9

19.6

12,2

31.1

5.2

48,4

10,5

7.0

21.9

9.9

“1.4

‘0.5

5.1

65.1

24.4

“1.2

9.1

7,6

26.4

‘0.8

“0.4

“2.1

*1.4

12,598

100.0

57.7

42.3

6.6

9.2

31.1

30.6

22,4

16.3

21.2

60.5

10.6

89.4

36.6

16.6

9.2

32.9

4.7

50.2

9.6

6.6

26.1

5.9

“0.1

*0.6

“0.8

6.4

66.3

11.3

“1.4

12.2

7,3

34.1

“1.9

“0.4

“2.1

5.1

43,568

100,0

57.3

42.8

6.8

11.1

30.5

31.5

20.2

19.4

16.2

64.4

10.8

89.2

32.1

17,7

10.8

34.2

5.2

47.9

12.4

6.4

23.1

7.6

*0.6

1.1

‘0.7

7.1

65.0

18.3

*lo

8.6

7.5

25.6

1.3

1.2

3.0

3.1

17,445

100.0

54.1

45.9

8,9

15,9

30.7

26.9

17.6

19.1

18.3

62.6

8.2

91.8

28.6

19.7

12.7

32.5

6.5

50.1

9.3

6.6

24.3

7.6

‘0.2

1.3

“0.5

6.6

67.2

17.4

“1.2

8.3

8.9

22.1

“0.7

“0.6

“0.9

*2.1

See footnotes at end of tabla.

20

*
Table 1. Number and percent distribution ofotice visits togeneral surgeons byselected visit characteristics, according to~pe and location

of physician’s practice: United States, January 1980 -December 1981 —Con.

Type of practice Geographic region Area

All types NonOf Nonh MetroCharacteristic

metropractice solo Otherl Northeast Central South West politan politan

Nonmedication therapy4

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

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

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

Therapeutic listening .,.,.... . . . . . . . . . . . . . .

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

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

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

Number of medications

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

l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

3 or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Principal diagnosis and ICD-9-CM codes

Infectious and parasitic diseases. . . ..000–139

Neoplasm . . . . . . . . . . . . . . . . . . . . . ..140-23g

Endocrine, nutritional and metabolic diseases,

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

Mental disorders . . . . . . . . . . . . . . . . ..290–319

Diseases of the nervous system andaense

organs . . . . . . . . . . . . . . . . . . . . . . . ..320-38g

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

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

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

Disaasea of the genitourinary system, .. 580-629

Diseases of the skin and subcutaneous

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

Diseases of themusculoskeletal system and

Connective tissue . . . . . . . . . . . . . . . . . 710-739

Symptoms, signs, and ill-defined

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

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

Supplementary classification . . . . . . .. VO1-V82

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

Unknown diagnoses .,, . . . . . . . . . . . . . . . . . . . .

Duration of visit

0minutes6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,,

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

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

11-15 minutes..........,,,. . . . . . . . . . . . . .

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

31mlnutes’0r longer . . . . . . . . . . . . . . . . . . . . . . .

Disposition Ofvisitz

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

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

Return ifneaded . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

56.4

4.0

i5.5

1.1

4.5

20.3

3.3

62.0

21.8

10.3

5.9

1.6

9.4

3.6

1.2

1.9

9.9

6.5 9.6

13.3 13.4

6.9 8.1

59.2

3.0

13.2

“0.6

6.4

19.8

2.8

53.8

25.8

12.6

7.9

1.7

7.7

4.5

2.0

2.0

11.7

8.4 7.8

5.6 5.7

3.9 3.8

12.2 9.9

11.7 10.0

1.1 “1.1

1.1 *1,1

0.8 “0.5

14.5 10.4

33,5 33.3

27.5 30.5

21.6 23.2

2.0 1.9

12.3 13.0

55.9 52.3

20.0 22.5

1.6 2.3

3.5 2.7

1.6 *1.2

8.1 7.6

“0.3 “0.2

53.4

5.1

18.0

1.6

2.4

20.7

3.9

70.9

17.6

7.8

3.7

1.6

11.2

2.7

“0.4

1.8

8.0

3.1

13.1

9.7

9.0

5.4

3.9

14.6

13.6

*1.O

“0.9

‘1.0

19.0

33.8

24.3

19.9

2.1

11.6

59.8

17.3

“0.9

4.4

2.1

8.7

“0.3

Percent distribution

59.8

4.5

15.1

*1.6

6.8

16.3

3.0

68.9

20.6

8.7

*1.7

*1.3

10.5

5.4

“0.4

*2.1

11.4

2.8

14.9

6.9

9.9

6.0

2.7

11.2

12.6

*1.1

‘0.6

“0.7

17.3

31.3

27.9

21.8

“1.0

s

8.8

58.2

20.6

“2.2

3.5

*1.8

9.5

“0.4

54.7

3.9

14.5

“0.7

3.6

22.2

3.5

59.0

22.7

9.7

8.7

“1.5

8.8

3.9

*1.5

*2.4

10.2

6.8

11.2

9.7

8.8

6.5

3.3

11.8

11.7

“1.0

“0.9

“0.9

17.2

40.5

26.1

14.0

*1.4

19.2

52.1

16.8

*1.1

4.5

1.5

7.8

“0.1

58.7

4.7

15.8

“0.4

3.6

18.2

2.8

57.8

22.5

11.8

8.0

‘2.0

6.6

2.9

*1.8

*1.8

8.6

6.8

13.1

10.1

8.4

4.7

5.4

14.7

11.1

“0.8

“1.3

“0.5

13.7

31.0

27.5

24.3

3.1

11.8

55.9

21.9

*1.2

“2.4

“0.9

7.7

“0.3

51.1

*2.6

16.7

“2.0

4.0

25.7

4.3

63.5

21.3

10.8

4.3

“1.7

12.7

*2.1

*1.2

*1.1

9.5

9.9

14.0

8.4

5.9

5.1

3.8

10.0

11.7

“1.6

*1.3

*1,2

9.1

31.4

28.8

26.8

*2.6

9.0

57.7

20.5

*2.2

3.9

*2.5

7.4

*0.3

56.2

4.1

15.5

1.2

5.2

20.2

3.4

64.0

22.4

9.0

4.6

1.7

70.7

4.1

1.2

1.6

10.4

5.2

14.4

9.2

8.5

4.7

3.9

11.4

70.7

1.1

1.1

“0.7

12.5

32.6

28.9

23.0

2.4

11.9

57.0

17.0

1.8

3.9

1.9

9.1

“0.3

57.0

3.8

15.5

“1.0

2.7

20.3

3.1

57.0

20.4

13.4

9.1

*1.5

6.3

*2.5

“1.2

“2.2

8.6

9.5

10.4

8.1

8.0

7.6

3.9

14.0

14.3

“1.1

“0.8

*0.9

19.7

35.9

24.1

18,2

“1,3

13,5

53.2

27.5

“1.1

2.5

“0.8

5.8

“0.1

Ilncludes partnership, group, and other typas of practice.

2Based on A reason for visit classification for ambulatory care (RVC).9

31ncludes blanks; problems, complaints not alsewhere classified; entries of “’none”; and illegible entries.

4Percents will not total 100, Obecause more than 1 sarvice ortherapy may have been rendered during a visit.

5Basedon thelnternational Classification of Diseases, 9th Revision, Clinical Modificati’on (lCD-9-CM).10

6Represents vlsitsin which there wasno face-to-face encounter between patient and physician.

7Percents will not total 100.0 because mors than 1 disposition was possibla.

21
?

Table2. Number andpercent distribution of drug mentions inofice visits togeneral surgeons bytherapeutic category, according to~pe and

Iocationof physician’s practice: United States, January 1980–December 1981

Type of practice Geographic region Area

All types NonOf North Metro- metroTherapeutic category~ practice solo Otherz Northeast Central South West politan politan

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

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

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

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

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

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

Central nervous system drugs . . . . . . .

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

Expectorants and cough preparations . . . . .

Eye, ear, nose and throat preparations

Gastrointestina l drugs.....,,,.. . . . . . .

Hormones and synthetic substitutes . . . . . . .

Skin and mucous membrane preparations

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

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

38,060

100.0

4.9

17.7

4.3

6.5

24.9

5.7

3.1

2.3

6.3

7,5

7,4

3.3

6,1

24,644

100,0

5.4

20.1

3.8

6.9

23.1

5.8

3.9

1.7

6.4

7.0

6.7

3.0

6.3

13,415

100.0

3.9

13.3

5.4

5,7

28,3

5,6

*1,8

3.4

6.2

8.4

8.6

3.7

5.8

Number in thousands

6,542 11,054 13,234

Percent distribution

100.0 100.0

“1.8 5.1

16.9 11.0

*4.6 4.0

7.5 9.4

26.2 24.5

‘4.0 9.8

*2.9 “0.9

*5.5 ‘1.4

*6.1 5.7

*4.9 12.0

11.8 5,2

“0.4 5.5

7.6 5.5

100.0

5.2

22.5

4.9

4.6

28.6

3.7

3.6

“1.8

6.1

4.7

5.9

‘3.0

5.6

7,230

100.0

6.7

20.0

*3.7

*4.9

17.7

*4.8

*5.7

*1.6

7.9

8.0

9.4

*2.9

6.7

24,553

100,0

3,9

15,2

4,5

6.0

26.9

6.1

3.0

2.6

6.8

7.3

8.2

2.7

7.0

13,506

100.0

6.7

22.3

4.0

7.5

21.4

5.1

3.3

“1.7

5.4

7,8

6.0

4.4

4.5

lBaaedon the classification system of the American Hospital Formulary Service (saeappendixlV).

‘Includes partnership, group, andother types of practice.

a

22
Table 3. Number and percent distribution of office visits to general surgeons by selected visit characteristics, according to age of physician:

United States, January 1980-December 1981

* Age of phys!ciarrl

All Under 45-54 55-64 65 years

Characteristic ages 45 years years years and over

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

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

Sex of patient

Age of patient

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prior visit status

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

Oldpatient, new problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oldpatient, old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Referral status

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

Notreferred by another physician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major reason for visit

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

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

Chronic problem, flareup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Postsurgety or postinjury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonillneas care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Principal reason for visit and RVC codez

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

Disease module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. DOO1-D999

Diagnostic, screening, and preventive module . . . . . . . . . . . . . . . . . . . . . . . . . . . . X1 OO-X599

Treatment module..........,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. TIOT89999

Injuries andadverse effects module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. JOO1-J999

Test results module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. R1OO-R7OO

Administrative module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. A1oo-AI4o

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

Diagnostic service4

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

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

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

Pap test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Electrocardiogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Nonmedication therapy4

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

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

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

Therapeutic listening, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

60,211

100.0

56.3

43.7

7.3

12.5

30.5

30.2

19.5

19.1

16.9

64.0

10.0

90.1

31.0

18.4

11.3

33.7

5.6

48.5

11.5

6.4

23.4

7.7

“0.5

1.2

0.8

6.8

65.8

18.0

1.1

8.4

7.9

24.7

1.1

1.0

2.4

2.9

56.6

4.1

15.4

1.1

4.4

20.1

3.4

Number in thousands

22,411 15,924 16,327

Percent distribution

100.0

55.5

44.5

7.2

13.6

31.3

28.8

19.1

20.5

13.4

66.1

11.1

88.9

26.9

17.8

13.3

37.2

4.9

47.1

9.9

6.7

26.0

8.2

*o. 1

“0.8

*1.2

4.0

70.5

14.9

“0.7

8.7

8.4

20.5

*0.8

*1.6

2.4

“2.0

60.5

3.6

13.8

*1.9

2.9

19.2

3.9

100.0

50.2

49.8

8.3

14.3

30.6

28.5

18.4

21.5

21.5

57.0

9.3

90.7

34.6

17.5

10.3

30.0

7.6

49.2

11.3

6.0

20.6

10.1

“0.2

“2.1

“0.5

7.3

59.2

24.1

*1.1

7.7

8.0

31.9

*1.6

*1.2

“2.3

5.1

51.6

5.4

15.2

“0.3

5.1

22.6

3.5

100.0

60.1

40.0

7.9

10.1

30.8

32.2

19.1

15.2

18.6

66.2

9.3

90.7

33.6

16.1

11.1

34.2

5.0

48.7

13.2

6.6

22.7

6.2

“1.0

“1.0

“0.6

8.5

68.3

16.1

*1.3

7.9

7.3

20.6

*1.2

“0.2

*2.4

“2.0

59.2

4.1

16.3

“0.7

3.1

16.6

2.8

5,548

100.0

66.3

33.7

*3.6

9.8

26.1

35.2

25.4

18.2

12.6

69.2

9.3

90.7

28.8

30.7

“7.0

29.2

*4.2

51.5

13.3

*6.4

23.1

*3.5

*1,3

“0.5

~o.4

11,0

58.7

18.6

‘1.8

10.4

“7.0

32.5

“0.7

“0.2

“3.0

*2.7

47.6

“2.0

20.2

*1.5

12.6

27.0

“2.5

See footnotes at end of table.

23
Table 3. Number and percent distribution of office visits to general surgeons by selected visit characteristics, according to age of physician:

United States, January 1980–December 1981 —Con.

Age ofphysicianl

All Under 45-54 55-64 65 years

Characteristic ages 45 years years years and over

Number of medications

None, , . ., . .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,, ., ., .,, . . . . . .

1, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

3 or more. . .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Principal diagnosis and ICD–9–CM code5

Infectious and parasitic diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...000-139

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

Endocrine, nutritional and metabolic diseases, and immunity disorders . . . . . . . . 240-279

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

Diseases of the nervous system and sense organs . . . . . . . . ...320-389

Diseaaes of the circulatory system . . . . . . . . . . . . . . . . . . . . . . . . . . . ., ..,,.......390-459

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

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

Diseases of thegenitourina~ system . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, . . . . . ...580-629

Diseases of theskin and subcutaneous tissue . ., . .,, . . . . . . . . . . . . . . . ,,, ,,, ,, ,680-709

Diseases of the musculoskeletal system and connective tissue . . . . . 710-739

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

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

Supplementary classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. V82–V82

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

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

Duration of visit

Ominutess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l–5 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

11–15 minutes, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Disposition of visit7

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

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

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

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

Referred to other physic ian, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Type of practice

solo ...,...,.,,,.......,.,.,,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Others, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Geographic region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

North Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

South, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vt!est . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Area

Metropolitan, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonmetropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent distribution

66.8

17.7

9.4

6.1

54.9

24.0

13.7

7.5

“0.8

6.1

3.4

“1.8

63.8

24.5

8.2

3.5

57.4

25.6

8.8

8.3

*2.4

14.0

10.4

*0.5

*1.1

13.3

*3.9

14.4

9.6

*6.3

*4.2

*3.1

* 6.4

9.5

“0.7

“0.4

“0.3

11.3

32.1

28,9

24,8

*2,6

9,0

64.8

12.5

“1.6

*4.1

*1.7

8,7

80.0

20.0

34.3

33.9

15.5

16.4

92.6

7.5

62.0

22,0

10.2

6.0

1.6

9.4

3.6

1.2

1.9

9.9

6.4

13.3

8.7

8.4

5.6

3.9

12.3

11.8

1.1

1.1

“1.4

10.5

2.2

9.7

2.1

*1.O

2.2

9.7

7.5

11.7

10.0

8.2

5.4

4.2

13.0

11.4

“1.3

“0.5

3.5

*1.2

*2.7

9.2

6.5

13.5

6.2

8.5

6.8

2.8

17.1

12.6

“1.1

*lo

“1.0

9.9

5.4

14.9

8.9

9.3

5.2

4.7

8.8

12.2

“1.0

“2.1

“0.7

14.7

33.7

27.5

21.5

2.0

“1.1

14.1

34.9

25.5

22.1

2.3 ‘

“0.5

16.6

31.7

30.3

19.2

‘1.6

“0.5

14.8

34.4

26.9

21.7

*1.9

12.4

56.0

i 9.9

1.6

3.5

1.5

8.1

“0.3

11.4 11.3

56.5

23.9

“1.8

3.4

“1.3

6.6

“0.3

15.8

54.9

15,4

“2,0

3.0

“0,9

9.3

“0.2

54.2

22.2

“1,1

3.7

2.1

8.1

“0.4

51.9

48.1

35.1

64.9

63.5

36.5

54.0

46.0

24,6

25,1

29.8

20.6

22.3

23.0

32.1

22.7

26,2

27.0

24.9

21.9

22.8

23.0

36.4

17.8

71.0

29.0

56.0

44.1

73.6

26.4

81.9

16.1

I Does not includs doctors of osteopathy,

‘Based on A reason for visit classifkation for ambulatory care (RVC},9

31ncludes blanks: problems, complaints not elsewhere classified; entriss of “none”; and illegible entries.

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

5Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), Io

aRepresents visits in which there was no face-to-face encounter between patient and physician.

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

alncludes partnership, group, and other types of practice.

24
Table 4. Number and percent distribution of drug mentions in office visits to general surgeons by therapeutic category, according to age of

physician: United States, January 1980-December 1981

Age ofphysician2

All Under 45–54 55-64 65 years

Therapeutic categotyl ages 45 years years years and over

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

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

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

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

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

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

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

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

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

Eye, ear, nose andthroet preparationa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Skin andmucous membrane preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

37,568

100.0

4.8

17.6

4.4

6.5

25.2

5.7

3.0

2.3

6.3

7.5

7.4

3.3

6.1

Number in thousands

12,629 12,160 8,666

Percent distribution

100.0 100.0

7.3 4.6

22.5 14.1

3.9 5.8

5.0 6.8

20.7 31.0

4.9 4.9

3.8 *2.9

*2.6 *1.9

4.9 7.0

7.9 7.3

7.2 6.2

4.1 *2.6

5.2 5.0

100.0

*2.3

18.9

“3.3

7.6

23.6

8.2

“3.0

“2. 1

6.1

5.7

8.6

*1.3

9.4

4,112

100.0

“3.3

*9.6

*3.8

*7,7

25.4

*5.3

“0.8

*3.3

*8.5

10.6

*9.1

“7.0

*5.6

1Based on the classification system of the American Hospital Formulary Service (see appendix IV).

‘Does not include doctors of osteopathy.

Table 5. Number, percent distribution, and average annual rate of office visits to general surgeons by age of patient, according to sex, race,

and ethnicity United States, January 1980-December 1981

Sex Race Ethnicity

Both

Age of patient sexes Female Male White Black Hispanic Non-Hispanic

Number in thousands

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161,013 34,373 26,640 53,932 6,495 2,828 58,185

Percent distribution

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

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4 5.1 10.4 7.1 8.5 *7.8 7.4

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.5 11.3 14.0 12.4 13.1 *1 3.5 12.4

25-44 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30.5 31.0 29.9 29.4 40.2 34.0 30.4

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30.2 32.5 27.2 30.7 25.9 33.1 30.1

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.4 20.2 18.5 20.3 12.4 “11.6 19.8

Vtsit rste per 1,000 population

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137.0 149.1 124.0 141.1 124.4 97.3 139.5

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44.3 35.0 53.3 46.1 36.3 “23.7 46.1

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93.5 94.0 93.0 97.4 78.1 “60.2 95.1

25–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148.6 165.6 130.6 147.0 189.9 119.0 152.0

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209.5 241.5 174.0 212.6 202.9 239.1 207.0

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241.7 239.6 244.7 247.5 196.9 *232.3 243.7

I Includes races other than white or black not shown as separate categories.

?:

25
Table 6. Number and percent distribution of office visits to general surgeons by selected visit characteristics. according to sex and age of

patient: United States, January 1980-December 1981

Sex Age of patient

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

Characteristic sexes Female Male 15 years years years years and over

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

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

Prior visit status

New patient. . .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oldpatient, new problem . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oldpatient, old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Referral status

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

Notreferred by another physician . . . . . . . . . . . . . . . . . . . . . .

Major reason for viait

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

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

Chronic problem, flareup . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Postaurgery or postinjury . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonillneas care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Principal reason for visit and RVC codel

Symptom module . . . . . . . . . . . . . . . . . . . . . . . .. S001–S999

Disease module . . . . . . . . . . . . . . . . . . . . . . . . .. DOO1-D999

Diagnostic, screening, and preventive

module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Xloo–X599

Treatment module . . . . . . . . . . . . . . . . . . . . . . .. TIOO–T899

Injuries and adverse effects module . . . . . . . . JOOI–J999

Test results module . . . . . . . . . . . . . . . . . . . . . .. RI OO–R700

Administrative module. . . . . . . . . . . . . . . . . . . . . AI OO–A140

OtherZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

61,013

100.0

19.3

16.8

63.9

10.1

90.0

31.1

18.3

11.3

33.7

5.6

48.5

11.5

6.5

23.4

7.6

0.5

1.1

0.0

34,373

100.0

16.8

17.2

66.0

8.9

91.1

31.3

20.5

11.8

31.2

5.2

51.4

9.7

7.7

24.3

4.8

“0.7

“0.7

“0.7

26,640

100.0

22.5

16.4

61.1

11.5

88.5

30.8

15.4

10.8

36.9

6.0

44.9

13.7

4.9

22.4

11.2

“0.2

1,7

*1.O

Number in thousands

4,508 7,6;3

Percent distribution

100.0

24.6

16.0

59.4

14.1

85.9

37.5

13.5

*5.7

39.6

“3.7

42.1

14.7

3.7

27.9

9.8

“0.2

“1.0

*0.6

100,0

28.1

18.6

53.3

11.7

88.3

37.6

13.2

9.3

32.5

7.4

49.4

9.5

*4.5

18.4

14.5

‘0.3

“2.8

“0.6

18,622

100.0

22.6

17.6

59.8

9.6

90.4

35.1

17.6

10.5

29.0

7.8

52.4

10.5

7,1

18.5

8.9

“0.2

1.9

0.5

18,420

100.0

16.6

16.7

66.7

9.0

91.0

28.5

19.0

13.3

35.5

3.7

48.4

11.9

6.2

25.4

5.8

“0.9

“0.5

“0.9

11,850

100.0

10.6

14.9

74.5

9.8

90.2

22.2

23.3

13.0

36.9

4.5

44.6

12.5

8.4

29.7

*3.2

“0.7

*0.9

1Bssed on A reason for visit classification for ambulatory care (RVC).9

21ncludes blanks: problems, complaints, not elsewhere classified; entries of “none”; and illegible entries,

*

26
Table 7. Number, percent, and cumulative percent of office visits to general surgeons, by the 36 most frequent principal reasons for visit:

United States, January 1980-December 1981

Number Percent Cumulative

in of percent

Principal reason for visit and RVC code 7 thousands visits 2 of visits

Postoperative visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Tz05

Lump ormass of breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S805

Abdominal pain, cramps, apaams. , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s55o

Skin lesion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S865

%ture-insertion, removal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T555

Hernia ofabdominal cavity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .D660

Progress visit, not otherwise specified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T800

Leg symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s920

General medical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. XIOO

Symptoms referable to anus-rectum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S605

8ack symptoms, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . ..s9o5

Symptoms referable to throat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s455

Breast examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. x220

Foot and toe symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s935

Weight gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s040

Pain, site notreferable toaapecific body system . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . ..so55

Other growtha of skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S855

Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s440

Headache, pain in head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s210

Neck symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s9oo

Head cold, upper respiratory infection (coryza) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s445

Carbuncle, furuncle, boil, cellulitis, abacess, not elsewhere classified . . . . . . . . . . . . . . . . . . . . . . . . . . .. D800

Chest pain and related symptoms, not referable to body system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S050

Hand and finger symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . ..s96o

Hemorrhoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 13545

Counseling, nototherwise specified. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T605

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D510

Armaymptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s945

Tiredness, exhaustion, .,...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s015

8100d pressure test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..x320

Swel!ing of skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S875

Symptoma of skin moles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S845

Warts, not otherwise specified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . .. S850

Fractures anddislocations, upper extremity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..J225

Low back symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s910

Other diaeases of skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D825

9,728

1,887

1,727

1,723

1,497

1,479

1>428

1,385

1,377

1,056

1,021

995

885

850

841

752

678

666

655

652

584

566

565

533

530

471

468

467

459

“440

*437

“434

*41 7

*41 2

“406

“403

15.9

3.1

2.8

2.8

2.5

2.4

2.3

2.3

2.3

1.7

1.7

1.6

1.5

1.4

1.4

1.2

1.1

1.1

1.1

1.1

1.0

0.9

0.9

0.9

0.9

0.8

0.8

0.8

0.8

“0.7

“0.7

“0.7

“0.7

*0.7

“0.7

“0.7

15.9

19.0

21.8

24.6

27.1

29.5

31.8

34.1

36.4

38.1

39.8

41.4

42.9

44.3

45.7

46.9

48.0

49.1

50.2

51.3

52.3

53.2

54.1

55.0

55.9

56.7

57.5

58.3

59.1

*59.8

“60.5

*6 I .2

*61.9

“62.6

*63.3

864.0

lBased on Areason forvisit classification forambulatory care (RVC).S

2Baaed on atotai of 61,012,704 visits.

27
Table8. Number, percent, and cumulative percantof office visits togeneral surgeons byaexof patient and the 15most frequent principal

reasons for visit United States, January 1980–Dec.ember 1981

Number Percent Cumulative

in of percent

Sex and principal reason for visit and RVC codel thousands visits of visits

Femalez

Postoperative visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T205

Lump ormass of breast....,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, .. S805

Abdominal pain, cramps, spasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, .S550

Progress visit, not otherwise specified . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . .. T8OO

Breast examination . .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X220

Suture—insetiion, removal .,..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, . . . . . . . . . . . . . . . . . . . . . .. T555

Leg symptoms,,.....,,...,,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S920

Skin lesion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S865

Weight gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S040

Symptoms referable to anus-rectum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S605

General medical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XIOO

Symptoms referable to throat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... , . . . . . . . . . . . . . . . . . . . . .. S455

Headache, pain in head....,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,.. .. S210

Back symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S905

Foot andtoeaymptoms ...,.,... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S935

Male3

Postoperative visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,. .. T2O5

Hernia of abdominal cavity ..., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D660

Skin lesion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S865

General medical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XIOO

Back symptoms...,,......,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S905

Suture—insertion, removal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T555

Abdominal pain, cramps, spasms... . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . .. S550

Leg symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... .. S920

Other growths of skin.,.....,,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S855

Foot and toe symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S935

Progress visit, not otherwise specified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,, . . . . . . . . . . . . . . . . . . . . .. T8OO

Pain, site notreferable to aspecific body system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S055

Carbuncle, furuncle, boil, cellulitis, abscess, not elsewhere classified . . . . . . . . . . . . . . . . . . . . , . . . . D800

Fractures anddislocations, upper extremity .,,.....,.......,,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. J225

Symptoms referable to anus-rectum . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . .. S605

5,523

1,796

1,171

991

885

875

848

802

736

704

696

653

450

*387

*368

4,205

1,293

921

682

634

622

557

537

498

482

*437

*397

“387

*354

“352

16.1

5.2

3.4

2.9

2.6

2.5

2.5

2.3

2.1

2.0

2.0

1.9

1.3

“1.1

*1.1

15.8

4.9

3.5

2.6

2.4

2.3

2.1

2.0

1.9

1.8

*1.6

*1.5

*1.5

*1.3

“1.3

16.1

21.3

24.7

27.6

30.2

32.7

35.2

37.5

39.6

41.6

43.6

45.5

46.8

*47.9

“49.0

15.8

20.7

24.2

26.8

29.2

31.5

33.6

35.6

37.5

39.3

“40.9

*42.4

*43.9

*45.2

*46.5

‘ Based on A reason for visit classification for ambulatory care (RVC).9

‘Baaed on a total of 34,372,835 visits.

3Based on a total of 26,639,869 visits.

28
Table 9. Number and percent distribution of office visits to general surgeons by principal diagnosis categories, according to sex and age of

patient United States, January 1980-December 1981

Sex Age of patient

Under 15-24 25-44 45-64

Principal diagnosis category and ICD-9-CM code J

65 years

Female Male ?5 years years years years and over

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34,373

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

Infectious and parasitic diseases. . . . . . . . . . . . . . . . . . . . . . . . 000–139

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

Endocrine, nutritional and metabolic diseases, and

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

Mental disorders...........,.. . . . . . . . . . . . . . . . . . . . . . ..29&3lg

Diseases of the nervous system and sense organs . . . . . . . . . 320–389

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

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

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

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

Diseaaes of the skin and subcutaneous tissue . . . . . . . . . . . . . 680-709

. Diseases of the musculoskeletal system and connective

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...71 O-739

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

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

Supplementary classification . . . . . . . . . . . . . . . . . . . . . . . . . .. VO1-V82

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

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

100.0

1.6

11.9

4.9

1.4

1.8

10.3

6.6

10.2

13.6

6.9

4.8

4.1

8.0

11.7

*1.O

“1.2

26,640

100.0

1.7

6.2

2.0

*1.1

2.0

9.3

6.3

17.2

2.8

10.3

6.5

3.6

17.5

11.7

*1.2

*0.8

Number in thousands

4,508 7,613 18,622

Percent distribution

100.0 100.0 100.0

“2.4 *3.8 *1.8

*1.9 ‘4.7 6.9

“0.3 *1.9 6.0

*1.O “0.7 *2.3

*1.3 “3.1 *1.8

*1.O 2.1 5.6

15.5 8.6 7.2

22.5 10.0 10.6

*2.7 10.0 12.3

*6.7 12.9 7.7

*1.6 “5.0 5.5

*6.8 “2.0 3.8

16.6 19.7 15.3

11.3 13.6 10.9

6.2 *1.2 ‘0.6

*2.3 “0.6 ‘1.8

18,420

100.0

“0.6

10.6

3.4

*0.8

“2.0

14.5

4.2

14.2

10.0

8.1

74

3.9

8.5

10.8

“0.4

“0.6

11,850

100.0

*1.4

17.3

“2.5

“0.7

*1.3

17.7

4.0

14.4

*3.4

7.4

4.6

4.1

6.5

13.4

*0.9

“0.3

I Based on the International Classification of Diseases, 9th Rev!sion, Clinical Modification (ICD-9–CM). 10

29
Table 10. Number, percent, and cumulative percent of office visits to general surgeons, by the 30 most frequent principal diagnoses:

United States, January 1980–December 1981

Number Percent Cumulative

in of percent

Principal diagnosis and ICD–9–CM code~ thousands visits 2 of visits

Followup examination, following surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. V67.O

Disorders of breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...610.611

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..550

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 401

Acute upper respiratory infection of multiple or unspecified sites . . . . . . . . . . . . . . . . . . . . . ...465

Sebaceous cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...706.2

Hemorrhoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...455

Malignant neoplasm of female breast. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...174

Other hernia of abdominal cavity without mention of obstruction or gangrene. . . . . . . . . . . . . . . . .. 553

Obesity andother hyperalimentation . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278

Varicose veins of lower extremities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454

Genersl medical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V70

Other disorders ofsynovium, tendon, and bursa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...727

Other cellulitis and abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..682

Chronic ulcer of skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..707

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 574

Sprains andstrains of sacroiliac region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...846

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 789

Other disorders ofinteatine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..569

Other diseases duetoviruses and Chlamydiae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...078

Benign neoplasm of skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..216

Other andunspecified arthropathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 716

Other malignant neoplasm of skin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .173

Neurotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300

Lipoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...214

Other disorders ofskin and subcutaneous tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...709

Attention tosurgical dressings and sutures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V58.3

Symptoms involving cardiovascular system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .785

Diabetes mellitua . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Strains andsprains ofother and unspecified parts of back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...847

33,382

3,380

2,018

1,534

1,477

1,410

1,241

1,170

1,129

1,037

940

882

694

665

654

605

596

596

587

523

522

514

506

477

476

476

460

“440

*439

414

5.5

5.5

3.3

2.5

2.4

2.3

2.0

1.9

1.9

1.7

1.5

.4

.1

.1

.1

.0

.0

.0

5.5

11.0

14.3

16.8

19.2

21.5

23.5

25.4

27.3

29.0

30.5

31.9

33.0

34.1

35.2

36.2

37.2

38.2

1.0 39.2

0.9 40.1

0.9 41.0

0.8 41.8

0.8 42.6

0.8 43.4

0.8 44..2

0.8 45.0

0.8 45.8

“0.7 46.5

“0.7 47.2

“0.7 47.9

I Bssad on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM ).10

‘Based on a total of 61,012,704 visits.

3There were an additional 6,360,000 visits in which V67.O was the second-listed diagnoaia.

30
Table 11. Number, percent, and cumulative percant of office viaits to general surgeons, by sex of patient and the 15 most frequent principal

diagnoses: United States, January 1980-December 1981

Number Percent Cumulative

in of percent

Sex and principal diagnosis and ICL7-9-CL4 code ~ thousands visits of visits

Femalez

Disorders of breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 610,611

Followup examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V67

Malignant neoplasm of female breast. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...174

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Acute upper respirato~ infection of multiple or unspecified sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...465

Obesity andother hyperalimentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278

Hemorrhoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..455

Sebaceous cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...706.2

Varicose veins of lower extremities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .454

Other hernia of abdominal cavity without mention of obstruction or gangrene. . . . . . . . . . . . . . . . . . . . . .. 553

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...574

Neurotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..300

Other disorders of intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..569

Other diseases ofsynovium, tendon, and bursa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...727

Chronic ulcer of skin . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..707

Male3

Inguinal hernia, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..550

Followup examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,. V67

Sebaceous cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...706.2

Other hernia of abdominal cavity without mention of obstruction or gangrene. . . . . . . . . . . . . . . . . . . . . .. 553

General medical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V70

Hemorrhoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...455

Acute upper respiratory infection of multiple or unspecified sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...465

‘Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Sprains andstrains of sacroiliac region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...846

Other cellulitis and abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...682

Varicose veins ofiower extremities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .454

Other disorders ofsynovium, tendon, and buraa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 727

Chronic ulcer of skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..707

Other disorders ofskin and subcutaneous tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...709

Other symptoms involving abdomen and pelvis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 789

3,188

2,248

1,170

992

917

887

676

614

577

477

453

“352

*338

*332

“321

1,836

1,396

796

652

590

566

559

542

*444

“401

“363

*362

“333

“307

“280

9.3

6.5

3.4

2.9

2.7

2.6

2.0

1.8

1.7

1.4

1.3

*1.O

“1.0

*1.O

“0.9

6.9

5.2

3.0

2.4

2.2

2.1

2.1

2.0

*1.7

*1.5

“1.4

*1.4

*1.3

*1.2

“1.1

9.3

15.8

19.2

22.1

24.8

27.4

29.4

31.2

32.9

34.3

35.6

36.6

37.6

38.6

39.5

6.9

12.1

15.1

17.5

19.7

21.8

23.9

25.9

27.6

29.1

30.5

31.9

33.2

34.4

35.5

1Based on the Jrrternational Classification of Diseases, 9th Revision, Clinical Modification (ICD-9–CM).1 0

2Based on a total of 34,372,835 visits.

3Based on a total of 26,639,869 visita.

31
Table 12. Number and percent of office visits to general surgeons, by diagnostic services, nonmedication therapy, sex, and age of patient, and

percent distribution by number of medications, according to sex and age of patient: United States, January 1980–December 1981

Sex Age of patient

Both Under 15-24 25–44 45-64

Service or therapy

65 years

sexes Female Male 15 years years years years and over

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

Diagnostic servicel

None, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Limited histoty and/or examination. . . . . . . . . . . . . . . .

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

Pap test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Electrocardiogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Endoscopy, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Nonmedication therapyl

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

Physiotherapy, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Office surgary .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Therapeutic listening...,.....,.. . . . . . . . . . . . . . . . .

Diet counseling .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Total, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of medication

61,013

6.9

65.6

18.1

1.1

8.5

7.9

24.6

1.1

1.1

2.4

2.8

56.4

4.0

15.5

1.1

4.5

20,3

3.3

100.0

62.0

21,8

10.3

5.9

34,373

6.6

65.6

18.5

1.9

9.3

7.6

27.0

*1.1

“0.7

2.2

2.8

57.9

2.7

13.5

1.5

5.0

21.7

3.3

100.0

60.8

21.3

10.7

7.2

26,640

7.3

65.6

17,5

7.5

8.2

21.4

“1.2

“1.5

2.6

2.9

54,5

5.8

18.0

“0.7

3.8

18.4

3.3

100.0

63.6

22.5

9.7

4.3

Number in thousands

4,508 7,613 18,622

Percent of visits

“6.7 6.8

70.5 65.7

14.9 19.8

‘0.5

*5.9 8.7

“8.4 10.1

“5.8 21.9

“0.3 “0.3

“0.6 “1.5

“0.6 “0.9

*1.9 *1.6 r

63.6 52.9

*1.4 “5.1

17.3 20.7

“0.9 ‘0.9

“0.9 “2.1

5.6 12.2

*2.5 *2.7

Percent distribution

100.0 100.0

71.0 63.5

14.6 24.7

12.0 9.0

*2.4 *2.9

6.6

64.2

21.3

*1.6

9.1

9.0

26.3

“1.2

*1.3

“1.8

3.4

53.0

5.5

15.3

“1.0

6.6

20.0

5.2

100.0

59.0

26.3

9.6

5.1

18,420

6.9

65.5

16.7

*1.3

8.0

8.3

25.8

*1,3

“0.7

3.5

2.4

57.2

3.9

15.4

“1.7

4.9

19.5

2.7

100.0

63.0

20.0

11.0

6.1

11,850

7.7

66.3

15.3

“0.7

9.2

4.0

28.8

“1.6

*1.2

“3.2

3.8

59.9

“2.1

11.8

“0.7

*3.5

23.7

*2.1 .

100.0

60.9

18.4

10.4

10.3

1Percents will not total 100.0 because more than 1 aewice or therapy may have been rendered during a visit.

32
Table 13, Number and percent distribution of drug mentions in office visits to general surgeons by therapeutic category, according to sex and

age of patient: United States, January 1980-December 1981

Sex Age of patient

Both Under 25-44 45-64 65 years

Therapeutic category~ sexes Female Male 25 years years years and over

Number in thousands

All categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38,060 23,046 15,014 6,106 11,647 11,571 8,737

Percent distribution

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

Antihistamine drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.9 4.8 5.0 9.7 6.7 2.4

Anti-infective agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.7 16.6 19.3 31.9 19.9 12.7

Autonomic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.3 4.2 4.5 *3.8 6.0 4.5

Cardiovascular drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 6.6 6.4 *0.8 *2.6 6.3

Central nervous system drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.9 25.1 24.7 25.1 31.0 24.6

Electrolytic, caloric, and water balance. . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7 5.9 5.5 *1.O “1.7 8.2

Expectorants and cough preparations. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1 3.5 *2.6 *5.1 *3.2 4.3

Eye, ear, nose and throat preparations. . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 *1.6 3.4 “1.9 *2.4 *2.6

Gastrointestinal drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3 6.2 6.5 *5.5 4.8 8.0

Hormones and synthetic substitutes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.5 9.2 4.8 *3.6 6.5 9.3

Skin and mucous membrane preparations . . . . . . . . . . . . . . . . . . . . . . . . 7.4 6.6 8.6 *5.7 8.2 6.6

Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3 4.1 *1.9 *1.6 *3.1 *3.8

Other, unclassified, or undetermined . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 5.6 6.8 *4.3 *3.9 6.7

1Based on the classification system of the American Hospital Formulary Senfice (see appendix IV).

100.0

*2.3

11.4

*2.2

16.0

17.1

11.1

*7.3

*1.9

6.7

9.0

8.5

“4.0

8.5

Table 14. Number and percent distribution of office visits to general surgeons by duration and disposition of visit, according to sex and age of

patient United States, January 1980-December 1981

Sex Age

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

Duration and disposition sexes Female Male 75 years years years years and over

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

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

Duration of visit

Ominutesl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

11-15 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Disposition of visitz

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

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

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

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

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

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

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

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

61,013

100.0

0.8

14.5

33.5

27.5

21.6

2.0

12.3

55.9

20.0

1.6

3.5

1.6

8.1

*0.3

34,373

100.0

“0.8

14.2

33.2

28.7

21.1

‘2,0

10.3

57.5

20.3

1.8

3.9

1.6

7.8

“0.2

26,640

100.0

“0.7

15.0

33.9

26.0

22.3

*2.1

15.0

53.8

19.6

*1.3

3.0

1.6

8.5

“0.3

Number in thousands

4,508 7,613

Percent distribution

100.0 100.0

“0.8 “0.6

21.1 17.2

42.6 34.5

21.6 25.8

12.8 20.8

*1,1 *1.1

20.3 19.6

39.3 49.0

27.0 20.5

‘1.7 *1.8

*1.3 “4.8

*3.5 ‘0.9

*8.6 7.0

“0.5 “0.1

18,622

100.0

“0.6

13.8

34.1

26.1

23,1

*2.3

13.2

52.9

22.1

“1.8

4.3

*1.6

6.6

‘0.4

18,420

100.0

*1.1

14.6

30.5

28.6

22.9

*2.3

9.4

58.7

19.2

*1.6

3.1

*1.2

9.8

80.3

1 .850

100.0

“0,5

11.4

33.2

31.4

21.2

*2.3

7.8

66.8 “

15.2

*1.2

“3.0

*1.9

8.5

“0.2

1Represents visits in which there was no face-to-face encounter between patient and physician,

Zpercents ~i[l not total 100.0 because more than 1 disposition was posaibla.

33
Table 15. Number and percent of office visits to generaI surgeons, by selectad diagnostic services, major reasons for visit, and selected

principal reason for visit modules: United States, January 1980–December 1981

Diagnostic service 1

Number

of Limited General

visits examination examination Clinical Blood

Major reason for visit and principal in and/or and/or laboratory pressure

reason for visit module thousands None history histoiy test X-ray check Endoscopy Other

Major reason for visit Percent of viCi*C

3.4 7.0

“1.9 6.0

*6.3 6.9

“0.7 2.7

“0.6 “20.0

18,963

11,165

6,918

20,564

3,404

3.8 62.7

7.3 57.8

*3.3 63.6

10.4 78.4

10.1 34.9

24.2

23.9

23.8

4.1

37.4

11.9 11.8 25.9

7.6 5.6 35.8

8.3 7.6 24.7

3.3 6.2 13.3

24.8 *4.9 48.5

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

Chronic problem, routine . . . . . . .

Chronic problem, flsreup. . . . . . . .

Postsurgery or postinjury . . . . . .

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

Principal reason for visit

and RVC codez

9.9 8.2 26.8

“6.0 *3.2 22.8

4.2 *2.8 15.9

*3.3 30.6 14.6

2.7 6.8

“4.7 *2.8

“1.0 2.9

Symptom module S001-S999

Disease module . . . . . DOO1 –D999

Treatment module . . . . TI 00-T899

Inuries and adverse effects

module . . . . . . . . . . . .. JOOl -J999

29,616

7,007

14,303

4.2 62.5

*5.8 69.5

13.1 76.1

24.1

14.8

4.7

4,648 *7.6 68.8 13.8 *2.1 *4.8

lPercents will not total 100.0 becauae more than 1 service may have been rendered during a visit.

‘Based on “A reason for visit classification for am bulatov care (RVC).”9

Table 18. Number and percent of office visits to general surgeons, by selected principal diagnosis categories, nonmedication therapy, and

disposition of visit, and percent distribution of office visits by duration: United States, January 1980-December 1981

Principal diagnosis category and ICD-9-CA4 code q

Disaases of the

Diseases Diseases Diseases Diseases of musculoskeletal

of the of the of the tha skin and system and hrjury

circulatory digestive genitourinary subcutaneous connective and

Neoplasms system system system tissue tissue

Characteristic

poisoning

140-239 390–459 520-579 580-629 680-709 710-739 800-999

Number in thousands

Number of visits . . . . . . . . . . . . . . . . 5,734 6,025 8,083 5,412 5,098 3.385 7,421

Percent of viaits

62.1 44.5

“0.5 *2.8

11.2 39.1

“1.3 *0.9

22.5 15.6

8.6 *2.7

Nonmedication therapyz

54.4

*1.O

24.8

*1,9

17,8

5.1

59.9

“3.2

8.6

*5.7

24.7

*4.6

64.2

“1.8

5.7

8.2

20.3

*3.7

53.9

*9.8

*9.3

*4.5

22.7

*3.7

41.5

17.4

25.8

‘0.6

15.8

*3.6

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

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

Office surgety . . . . . . . . . . . . . . . . . .

Diet counseling.......,.....,,. . .

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

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

Percent distribution

“0.8 “0.2

19.1 22.2

26.4 35.0

28.3 21.4

23.2 18.6

*2.3 *2.6

Duration

‘0.7

15.3

36.2

26.8

19.2

“1.8

“0.9

14.4

39.4

25.6

17.3

*2.4

0minutes3 . . . . . . . . . . . . . . . . . . . .

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

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

11-15 minutes . . . . . . . . . . . . . . . .

16–30 minutes . . . . . . . . . . . . . . .

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

*1.2

12.8

32.9

28.3

23.8

‘1.1

“0.5

*5.4

33.6

32.4

27.0

“1.2

‘0.2

15.8

30.9

29.0

22.1

*1.9

Disposition

‘6.2

56.2

21.9

“1,6

*5.6

“1.5

10.3

“0.4

12.6

60.1

17.6

‘1.0

*2.3

*1.6

8.2

“1.1

“11.4

49.7

29.5

*1.4

*5.9

“1.0

*6.1

11.9

65.6

21.4

“0.2

*2.7

“0.1

“1.2

No followup . . . . . . . . . . . . . . . . . .

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

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

Telephone followup . . . . . . . . . . . . . . . . .

Referred to other physician. . .

Returned to referring physician .

Admit tohoapital . . . . . . . . . . . . . . . . . . .

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

‘7.0

67.5

8.5

*1,7

*4,3

*1,7

13.9

*0.6

*5.5

65.6

13,0

*2,1

*1.8

*1.8

11.9

12.2

50.6

16.4

“3.0

*3.9

“2.0

16.3

“0.6

1Based on the /ntemationaj Classification of Diseases, 9th Ravisiorr, Chical Modification (1CD-9-CM ).’ 0

‘Percents will not total 100,0 because more than 1 therapy may have been rendered during a visit.

3Represents visits in which there was no face-to-face encounter between patient and physician.

4Percents will not total 100,0 because more than 1 disposition was possible.

34
Table 17. Number and percent distribution of office visits to general surgeons by selected visit characteristics, according to prior visit status:

United States, January 1980-December 1981

Prior visit status

New Old patient, Old patient

Characteristic patient new problem old problem

Number in thousands

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

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

Sex of patient

Age of patient

Under 15 years............,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major reason for visit

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

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

Chronic problem, flareup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Postsurgerf or postinjury .,....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Principal reason for visit and RVC codel

Symptom module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S001-999

Disease module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DOOI :D999

Diagnostic, screening, and preventive module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X1 OO-X599

Treatment module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. TIOO-T899

Injury andadverse effects module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. JO01-J999

Test resuits module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. R1OO-R7OO

Administrative module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. A1OO-A14O

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

Selected principal diagnosis category andlCD-9-CM Code3

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

Diseases of thecirculatot’ system . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . ...390-459

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

Diseases of thegenitourinary system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...580-629

Diseases of theskin and subcutaneous tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...680-709

Diseases of the musculoskeletal system and connective tissue. . . . . . . . . . . . . . . . . . . . 710-739

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

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

Limited histoiy and/or examination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Nonmedication therapy

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

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

Office surgety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Medicai counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

11,769

100,0

49.1

51.0

9.4

18.2

35.7

26.0

10.7

51.4

15.1

12.6

12.2

8.7

59.4

12.1

5.1

6.9

13.0

“0.1

“3.2

“0.2

9.0

8.8

15.0

8.8

8.7

5.7

15.2

*3.3

55.8

31.7

10.8

16.9

21.0

5.3

8.7

53.9

3.8

16.6

“0.8

*3.2

21.6

4.9

10,264

Percent distribution

100.0

57.6

42.4

7.0

13.8

32.0

30.0

17.2

65.5

9.5

10.7

7.9

6.4

73.2

7.0

5.1

4.9

7.7

80.1

*1.5

“0.5

5.4

6.8

9.7

8.4

9.4

7.3

12.4

*3.9

61.8

23.4

11.8

9.3

33.4

‘2.4

9.3

54.5

*3.3

14.4

‘0.6

*3.9

23.8

3.5

38,980

100.0

58.2

41.8

6.9

10.4

28.6

31.5

22.7

15.9

21.6

11.1

47.0

4.4

,

38.8

12.5

7.3

33.3

6.0

‘0.7

“0.4

“1.0

10.6

11.0

13.7

6.0

8.0

5.1

11.2

8.8

69.6

12.5

7.0

4.8

23.4

1.5

4.4

57.7

4.3

15.4

1.4

5.0

18.9

2.8

See footnotes at end of table.

35
Table 17. Number andpercent distribution ofoffice visits to general surgeons byselected visit characteristics, according toprior visit status:

United States, January 1980-December 1981 —Con.

Prior visit status

New Old patient, Old patient

Characteristic patient new problem old problem

Duration Percent distribution

0minutes5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “0.1 *1.O “0.9

l–5 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.9 8.5 18.1

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

25.2 32.4 36.4

11–15 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

28.0 29.8 .26.8

16–30 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Dispositione

No followup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

4.1 26.1 16.7

4.8 *2.2 1.2

5.3 15.0 10.7

2.4 44.3 63.0

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

17.9 27.4 18.7

Telephone followup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

*1.9 *2.8 1.2

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

4.2 5.2 2.9

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

2.8 “0.5 1.5

Admit to hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.0 7.8 4.9

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “0.9 “0.2 “0.1

1 Based on “A reason for visit classification for ambulatory care (RVC). ”9

‘Includes blanks; problems, complaints, not elsewhere classified; entries of “none”; snd illegible entries.

3 Based on the International Classification of Diseases, 9th Revision, Clinical Modification ( ICD–9-CM). 10

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

5Represents visits in which there was no face-to-face encounter between patient and physician.

6Percents will not total 100.0 because more than 1 disposition was possible.

.

36
Table 18. Number and percent distribution of office visits by selected visit characteristics, according to surgical speciaky: United States,

January 1980-December 1981

Surgical specialty

Colon

and Neuro- Obstetrics Ortho- Thor- UrolGeneral rectal logical and Ophthal- pedic Otorhino- Plastic acic ogical

Characteristic surgery surgery surgery gynecology mology surgery Iafyngology surgery surgery surgery

All visits, . . . . . . . . . . . . . . . . . . . . . . . . .

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

Type of practice

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

Other . . . . . . . . . . . . . ? . . . . . . . . . . . . . .

Area

Metropolitan . . . . . . . . . . . . . . . . . . . . . .

Nonmetropolitan . . . . . . . . . . . . . . . . . . .

Sex of patient

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

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

Age of patient

Under 25 years . . . . . . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . . . . . . . . .

65 years and over . . . . . . . . . . . . . . . . . .

Referral status

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

Notreferred by another physician . . . . .

Prior visit stetus

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

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

Old patient, old problem. . . . . . . . . . . . .

Major reason for visit

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

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

Chronic problem, flareup . . . . . . . . . . . .

Postsurgerf or postinjury , . . . . . . . . . . .

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

Principal diagnosis and

ICD-9-CM codelz

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

Diseases of the nervous system and

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

Diseases of the circulatory

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

Diseases of the respiratory

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

Diseases of the digestive

system . . . . . . . . . . . . . . . . ..52 O-579

Diseases of the genitourinary

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

Diseases of the skin and subcutaneous

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

Diseases of the musculoskeletal system

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

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

Supplementary classification, . . VOI -V82

See footnotes at end of table.

61,013

100.0

51.9

48.1

71.4

28.6

56.3

43.7

19.9

30.5

30.2

19.4

10.1

90.0

19.3

16.8

63.9

31.1

18.3

11.3

33.7

5.6

9.4

1.9

9.9

6.5

13.3

8.9

8.4

5.6

12.2

11.7

3,329

100.0

60.5

39.5

90.7

9.3

47.4

52.6

*8.4

31.3

36.9

23.4

9.1

90.9

16.5

*5.6

78.0

20.2

31.2

18.0

26.3

*4.4

“7.0

“0.4

33.4

“0.9

32.0

‘0.4

*5.3

‘2.7

*1.5

“7.4

4,550

100.0

36.1

64.0

95.8

4.3

46.3

53.7

17.5

34.4

37.7

10.4

18.8

81.2

27.1

*.51

67.8

21.2

26.2

13.9

37.3

*1,5

*4. 1

12.4

*3.2

“0.3

“0.4

41.6

15.8

10.4

109,035

100.0

44.1

55.9

81.5

18.5

99.0

1.1

31.8

56.4

9.2

2.5

3.1

96.9

11.7

17.5

70.8

18.2

8.2

4.4

7.1

62.1

*

1.7

*O. 1

1.3

0.7

0.7

19.0

0.5

0.6

0.9

62.7

Number in thouasnds

62,485 55,470

Percent distribution

100.0

62.8

37.2

81.8

18.3

58.5

41.5

19.1

18.7

25.2

37.1

7.2

92.8

25.1

9.1

65.9

22.5

37.0

4.3

12.5

23.7

0.8

75.7

“0.6

“0.4

*o. 1

‘0.0

*0.5

“0.3

4.8

12.5

100.0

31.0

69.0

83.9

16.1

47.0

53.0

27.8

31.6

27.0

13.6

10.9

89.1

22.1

7.1

70.9

26.5

19.6

10.6

41.1

2.2

80.6

2.1

“0.5

“0.2

*0.1

*0.1

1.1

37.5

45.0

7,5

26,151

100.0

60.5

39.5

88.4

11.6

53.6

46.4

38.8

26.0

19.5

15.7

14.0

86.1

32.0

8.0

60.0

36.4

30.6

16.8

14.8

‘1.4

2.6

40.9

‘0.2

29.7

1.9

1.8

*1.O

5.2

8.6

11,104 3,273

100.0 100.0

86.3 35.7

13.7 64.3

86.1 100.0

14.0

58.1

41.9

28.1

36.7

24.0

11,2

7.6

92.4

15.6

4.2

80,3

11.3

10.4

4,6

63.8

9.9

14.7

4.1

‘0.6

‘1.5

*1.6

5.0

18.5

6.6

21.6

19.0

47.8

52.1

*7.7

*11.6

43.1

37.7

13.9

86.1

19.2

“7.6

73.2

24.1

13.1

7.6

52.9

*2.2

*11.O

“0.8

29.8

*8.2

*4.2

*1.5

*4.5

‘2.9

5.9

15.9

19,470

100.0

31.2

68.8

83.0

17.0

34.5

65.5

11.2

25.3

29.6

33.9

13.0

87.0

20.1

5.3

74.6

23.6

38.9

16,5

16.0

4.9

11.5

“1.7

*0.8

“0.3

“0.4

63.8

“0.3

“0.4

*1.3

10.5

37
Table 18. Number and percent distribution of office visits by selected visit characteristics, according to surgical specialty: United States,

January 1980-December 1981 —Con.

Surgical specialty

Colon

and Neuro - Obstetrics Ortho- Thor- UrolGeneral rectal logical and Ophthal- pedic Otorhino- Plastic acic ogical

Characteristic surgery surgery surgery gynecology mology surgery Iaryrrgology surgery surgery surgery

Nonmedication therapy3 ‘ Percent distribution

Office surgery . . . . . . . . . . . . . . . ,., .,. 15.5 16.1 *2.6 4.8 3.0 12,0 11.5 25.3 ‘9.0 15.9

Disposition

Return at specified time ., . ., . . . 55.9 74.4 53.6 75.8 62.6 65.0 55.7 72,2 63.7 69.6

Admit to hospital..,.,,....,,,. . . . . 8.1 *6.1 10.4 3.0 2.1 4.5 6.3 5.8 7.9 7.5

) Based on the International Classification of Diseases, 9th Revision, Clinical Modification (lCD-9–CM),10

2Percents will not total 100.0 because all categories are not listed.

3Percents will not total 100.0 because all categories are not Iiated and more than 1 therapy or disposition was possible.

38
Appendixes

Contents

I. Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Statistical design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Scope ofthesurvey . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Sample design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Datacollection and processing. ..:.. . . . . . . . . . . . . . . . . . . . . . . . . . .- . . - . . . - . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Fieldprocedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . , . . . . . 40

Data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Dataprocessing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Estimation procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Inflation by reciprocals ofprobabilities ofselection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Adjustmentfornonresponse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Ratio adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Reliability ofestimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Estimates ofaggregates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Estimates ofpercents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Estimates ofrates wherethenumerator is not asubclass ofthe denominator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Estimates ofdifferences between two statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Tests ofsignificance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Population figures and rate computation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Rounding ofnumbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Systematic bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

II. Definitions ofcertain terms usedin this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Terms relatingto thesuwey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Terms relatingto the Patient Record Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

111. Survey instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Introductory letter from Director, NCHS . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Patient Record Form... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Induction Interview Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . 53

IV. American Hospital Formulary Service classification system andtherapeutic category codes . . . . . . . . . . . . . . . . . . . . . . . . 61

List ofappendix figures

I. Approximate relative stmdmdemors foresttiated numbers ofofice visi@based ondlphysician specialties (A), md

individual speciaMes( B), 1980-81 National Ambulatory MedicalCare Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

II. Approxkate relative standard emorsfor estimated nubersof dmgmentions based onallphysicim specialties(A),

and individual specialties(l?), 1980–81National Ambulato~ Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

List of appendix tables

I. Distribution of physicians in the 1980–81 National Ambulatory Medical Care Survey samples and response rates,

byphysician specialty . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . - . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . .: . . . . . 41

II. Estimates of the civilian noninstitutionalized population of the United States used incomputing annual visit rates in

this reportby age, race, sex, andHispanic origin 1980-81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

39
Appendix I

Technical notes

This report is based on data collected during 1980 and

1981 in the National Ambulatory Medical Care Survey

(NAMCS). an annual sample survey of office-based physicians conducted by the Division of Health Care Statistics of

the National Center for Health Statistics (NCHS). The two

surveys were conducted with identical instruments, definitions,

and procedures. Two years of data were combined to increase

the reliability of the estimates. The annual survey design and

procedures are presented in the following sections.

Statistical design

Scope of the survey

The target population of NAMCS includes office visits

made within the conterminous United States by ambulatory

patients to nonfederally employed physicians who are principally engaged in ofllce-based patient care practice, but not in

the specialties of anesthesiology, pathology, or radiology. Telephone contacts and nonofllce visits are excluded from

NAMCS.

Sample design

The NAMCS utilizes a three-stage survey design that involves probability samples of primary sampling units (PSU’S),

physician practices within PSU’S, and patient visits within physician practices. The first-stage sample of 87 PSU’S was selected by the National Opinion Research Center (NORC) of

the University of Chicago, the organization responsible for

NAMCS field and data processing operations under contract

to NCHS. A PSU is a county, a group of adjacent counties,

or a standard metropolitan statistical area (SMSA). A modified probability -proportional-to-size procedure using separate

sampling frames for SMSA’S and for nonmetropolitan counties

was used to select the sample PSU’S. Each frame was stratified

by region, size of population, and demographic characteristics

of the PSU’S, and was divided into sequential zones of 1 million residents; then, a random number was drawn to determine

which PSU came into the sample from each zone.

The second stage consisted of a probability sample of practicing physicians, selected from the mastertles maintained by

the American Medical Association (AMA) and the American

Osteopathic Association (AOA), who met the following criteria:

● office-based, as defined by AMA and AOA.

● Principally engaged in patient care activities.

NOTE: Prepared by Thomas McLemore, Division of Health Care Statistics.

40

● Nonfederally employed.

. Not in the specialties of anesthesiology, pathology, clinical pathology, forensic pathology, radiology, diagnostic

radiology, pediatric radiology, or therapeutic radiology.

Within each PSU, all eligible physicians were sorted by

nine specialty groups: general and family medicine, internal

medicine, pediatrics, other medical specialties, general surgery,

obstetrics and gynecology, other surgical specialties, psychiatry, and all other specialties. Then, within each PSU, a systematic random sample of physicians was selected so that the

overall probability of selecting any physician in the United

States was approximately constant.

During 1980–8 1 the NAMCS physician sample included

5,805 physicians. Sample physicians were ‘screened at the time

of the survey to ensure that they met the aforementioned criteri% 1,124 physicians did not meet the criteria and were,

therefore, ruled out of scope (ineligible) for the study. The most

common reasons for being out of scope were that the physician

was retired, deceased, or employed in teaching, research, or

administration. Of the 4,681 inscope (eligible) physicians, 3,676

(78.5 percent) participated in the study. Of the participating

physicians, 509 saw no patients during their assigned reporting

period because of vacations, illnesses, or other reasons for being temporarily out of office-based practice. The physician sample size and response data by physician specialty are shown

in table I.

The third stage was the selection of patient visits within

the annual practices of the sample physicians. This stage involved two steps. First, the total physician sample was divided

into 52 random subsamples of approximately equal size; then

each subsample was randomly assigned to 1 of the 52 weeks

in the survey year. Second, a systematic random sample of

visits was selected by the physician during the assigned reporting week. The visit sampling rate varied for this final step from

a 100 percent sample for very small practices to a 20 percent

sample for very large practices. The method for determining

the visit sampling rate is described later in this appendix and

in the Induction Interview form in appendix III. During 1980-

81, sample physicians completed 89,447 usable Patient Record forms.

Data collection and processing

Field procedures

Both mail and telephone contacts were used to enlist sample physicians for NAMCS. Initially, physicians were sent introductory letters from the Director of NCHS (see appendix

III). When appropriate, a letter from the physician’s specialty
●

Table 1. Distribution of physicians in the 1980-81 National Ambulatory Medical Care Su~ey samples and resPonse rates, by physician sPecia~

Physician specialty Gross total Out of scope Net total Nonrespondents Respondents

Response

rate

All specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,805 1,124 4,681 1,005 3,676 78.5

General and family practice . . . . . . . . . . . . . . . . . . . . . . . . 1,340 289 1,051 272 779 74.1

Medical specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,695 296 1,399 298 1,101 78.7

Internal medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 871 158 713 182 531 74.5

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414 83 331 42 289 87.3

Other medical specialties . . . . . . . . . . . . . . . . . . . . . . . . 410 55 355 281 79.2

Surgical specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,978 246 1,732 3: 1,381 79.7

General surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 521 75 446 115 331 ?4.2

Obstetrics and gynecology . . . . . . . . . . . . . . . . . . . . . . 484 71 413 63 350 84.7

Other surgical specialties . . . . . . . . . . . . . . . . . . . . . . . . 973 100 873 173 700 80.2

Other specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 792 293 499 84 415 83.2

Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414 96 318 43 275 86.5

Other specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378 197 181 41 140 77.3

organization endorsing the survey and urging his participation

was enclosed with the NCHS letter. Approximately 2 weeks

prior to the physician’s assigned reporting period, a field representative telephoned the physician to explain briefly the study

and arrange an appointment for a personal interview. Physicians who did not initially respond were usually recontacted

via telephone or special explanatory letter and requested to

reconsider participation in the study.

During the personal interview the field representative determined the physician’s eligibility for the study, obtained his cooperation, delivered survey materials with verbal and printed

instructions, and assigned a predetermined Monday-Sunday

reporting period. A short induction interview concerning basic

practice characteristics, such as type of practice and expected

number of office visits, was conducted. OffIce staff who were

to assist with data collection were invited to attend the instructional session or were offered separate instructional sessions.

The field representative telephoned the sample physician

prior to and during the assigned reporting week to answer questions that might have arisen and to ensure that survey procedures were going smoothly. At the end of the reporting week,

the participating physician mailed the completed survey materials to the field representative who edited the forms for completeness before transmitting them for central data processing.

At this point problems of missing or incomplete data were resolved by telephone followup by the field representative to the

sample physician; if no problems were found, field procedures

were considered complete regarding the sample physician’s participation in NAMCS.

Data collection

The actual data collection for NAMCS was carried out by

the physician, assisted by his office staff when possible. Two

data collection forms were employed by the physician: the Patient Log and the Patient Record form (see appendix III). The

Patient Log, a sequential listing of patients seen in the physician’s office during his assigned reporting week, served as the

sampling frame to indicate the otlice visits for which data were

to be recorded. A perforation between the patient’s name and

patient visit information permitted the physician to detach and

retain the listing of patients, thus, assuring the anonymity of

the physician’s patients.

Based on the physician’s estimate of the expected number

of office visits and expected number of days in practice during

the assigned reporting week, each physician “was assigned a

visit sampling rate. The visit sampling rates were designed so

that about 30 Patient Record forms would be completed by

each physician during the assigned reporting week. Physicians

expecting 10 or fewer visits per day recorded data for all visits.

Those physicians expecting more than 10 visits per day recorded data for every second, third, or fifth visit based on the

predetermined sampling interval. These visit sampling procedures minimized the physician’s data collection workload and

maintained approximately equal reporting levels among sample

physicians regardless of practice size. For physicians recording

data for every second, third, or fifth patient visit, a random

start was provided on the first page of the Patient Log so that

the predesignated sample visits recorded on each succeeding

page of the Patient Log provided a systematic random sample

of patient visits during the reporting period.

Data processing

In addition to followups for missing and inconsistent data

made by the field staff, numerous clerical edits were perfo~ed

on data received for central data processing. These manual

edit procedures proved quite efficient, reducing item nonresponse rates to 2 percent or less for most data items.

Information contained in item 6 (Patient’s problem or reason for visit) of the Patient Record form was coded according

to A Reason for Visit C1assl~cation for A mbu[atoq~ Care

(RVC).9 Diagnostic information (item 9 of the Patient Record

form) was coded according to the international Classlj7cation

of Diseases, 9th Revision, Clinical iklodz~cation (ICD-9-

CM)~O A maximum of three entries were coded from each of

these items. Prior to coding, Patient Record forms were grouped

into batches with approximately 650 forms per batch. Quality

control for the medical coding operation involved a two-way

5-percent independent 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 1980-81 medical coding operation were 1.7 percent for

NOTE: A list of references follows the text.

41
item 6 and 2.3 percent for item 9. Additionally, a dependent

verification procedure was used to review and adjudicate all

records in batches with excessive error rates. This procedure

further reduced the estimated error rates to 1.6 percent for item

6 and 2.1 percent for item 9.

The NAMCS medication data (item 11 of the Patient Record form) was classified and coded according to a scheme developed at NCHS based on the American Society of Hospital

Pharmacists’ Drug Product Information File. A description of

the new drug coding scheme and of the NAMCS drug data

processing procedures is contained in Vital and Health Statistics, Series 2, No. 90.’5 A two-way 100 percent independent verification procedure was used to control the medication

coding operation. As an additional quality control, all Patient

Record forms with differences between drug coders or with

illegible drug entries were reviewed and adjudicated at NCHS.

Information from the Induction Interview and Patient Record forms was keypunched with 100 percent -verification and

converted to computer tape. At this point, extensive computer

consistency and edit checks were performed to ensure complete and accurate data. Incomplete data items were imputed

by assigning a value from a randomly selected Patient Record

form with similar characteristics; patient sex and age, physician specialty, and broad diagnostic categories were used as

the basis for these imputations.

Estimation procedures

Statistics from NAMCS were derived by a multistage estimation procedure that produces essentially unbiased national

estimates and has three basic components: ( 1) inflation by reciprocals of the probabilities of selection, (2) adjustment for nonresponse, and (3) a ratio adjustment to fixed totals. Each component is briefly described below.

Inflation by reciprocals of probabilities of selection.

Because the survey utilized a three-stage sample design,

three probabilities of selection existed: ( 1) the probability of

selecting the PSU, (2) the probability of selecting the physician

within the PSU, and (3) the probability of selecting an ot%ce

visit within the physician’s practice. The third probability was

defined as the 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 of52 to derive annual estimates.

Adjustment for nonresponse

NAMCS data were adjusted to account for sample physicians who were inscope, but did not participate in the study.

This adjustment was calculated in order to minimize the impact of response on final estimates by imputing to nonresponding physicians the practice characteristics of similar responding

physicians. For this purpose, physicians were judged similar if

they had the same specialty designation and practiced in the

same PSU.

NOTE: A list of references follows the text.

●

Ratio adjustment

A poststratification adjustment was made within each of

nine physician specialty groups. The ratio adjustment was a

multiplication factor that had as its numerator the number of

physicians in the universe in each physician specialty group

and as its denominator the estimated number of physicians 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.

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 nonresponse and

incomplete response. The magnitude of the nonsampling errors

camot be computed. However, these errors were kept to a minimum by procedures built into the survey’s operation. To eliminate ambiguities and encourage uniform reporting, careful

attention was given to the phrasing of questions, terms, and

definitions. Also, extensive pretesting of most data items and

survey procedures was performed. The steps takeri to reduce

bias in the data are discussed in the sections on field procedures and data collection. Quality control procedures and consistency and edit checks discussed in the data processing section reduced errors in data coding and processing. However,

because survey results are subject to sampling and nonsampling

errors, the total error will be larger than the error due to samp

ling variability alone.

Because the statistics presented in this report are based on

a sample, they differ somewhat from the figures that would be

obtained if a complete census had been taken using the same

forms, definitions, instructions, and procedures. However, the

probability design of NAMCS pemnita the calculation of sampling errors. The standard error is primarily a measure of

sampling variability that occurs by chance because only a

sample rather than the entire population is surveyed. The standard error, as calculated in this report, also reflects part of the

variation that arises in the measurement process, but does not

include estimates of any systematic biases that may be in the

data. The chances are about 68 out of 100 that an estimate

from the sample would differ from a complete census by less

than the standard error. The chances are about 95 out of 100

that the difference would be less than twice the standard error,

and about 99 out of 100 that it would be less than 2]% times

as large.

The relative standard error of an estimate is obtained by

dividing the standard error by the estimate itself and is expressed as a percent of the estimate. For this report, an asterisk (*) precedes any estimate with more than a 30 percent relative standard error.

Estimates of sampling variability were calculated using the

method of half-sample replication. This method yields overall

variability through observation of variability among random

subsamples of the total sample. A description of the development and evaluation of the replication technique for error estimation has been published. 16’17Approximate relative standard

errors for aggregate estimates are presented in figures I and II.

42
A 2 3 456789A 2 3 456789A 2 3 456789A 2 3 456789A 2 3 456789A

100 1,000 10,000 100,000 1,000,000 10,000,000

Srze of estimate (m thousands)

EXAMPLE: An eshmate of 20 mlllton office wsrts to general surgeons (read from scale at bottom of chart) has a relatlve ~ta”dard error of 7,7 percent (read from ~uwe B on SCale at left Of chart) or ~ ~ta”dard error

of 1,540,000 office vIsIts (7.7 percent of 20 malltion visits).

Figure 1. Approximate relative standard errora for estimated numbers of office visita based on all physician specialties (A), and individual specialties (B), 1980-81 National Ambulatory Medical

-Pcd Care Survey
100

90

80

70

60

50

40

30

20

10

9

8

7

6

5

4

3

2

1

0.9

;::

0.6

0.5

0.4

0.3

0.2

0.1

A

EXAMPLE:

100

90

80

70

60

50

40

30

20

10

9

8

7

6

5

4

3

2

1

0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

2 3 456789A 2 3 456789A 2 3 456789A 2 3 456789A 2 3 456789A

100 1,000 10,000 100,000 1S300,000 10,000,000

size of estimate (In thousands)

An esttmate of 60 mllllon drug mentmns (read from scale at bottom of chart) has a relative siandard error of 5.1 percent (read from cuwe A on scale at feft of chari) or a standard error of 3.060.000 drug

mentnons (5. t percent of 60 mlillon drug ment!ons).

Figure Il. Approximate relativestandard errorsfor estimated numbers of drug mentions based on allphysician specialties(A), and individual specialties (B), 1980-81 National Ambulatory Medical

Care Survey
To derive error estimates that 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.

Estimates of aggregates

Approximate relative standard errors (in percent) for aggregate statistics are presented in figures I and II. The approximate relative standard errors for aggregate estimates of office

visits are shown in figure I, and the approximate relative standard errors for aggregate estimates of drug mentions are shown

in figure II. In each figure, curve A represents the relative

standard errors appropriate for estimates based on all physician specialties, and curve B represents relative standard errors appropriate for estimates based on m-individual physician

specialty. For the specific case where the aggregate estimate

of interest is the number of mentions of a specific drug, for

example, the number of mentions of Dyazide, figure I, curve

B should be used to obtain approximate relative standard

errors.

Instead of using figures I and H, relative standard errors

for aggregate estimates may be calculated directly using the

following formulae where x is the aggregate estimate of interest in thousands. For visit estimates based on all physician

specialties,

“’(-’)= ~-’”””

For visit estimates based on an individual physician specialty,

‘sE(x)=~l””-”

For drug mention estimates based on all physician specialties,

“’(.)=/===7””-”

For drug mention estimates based on an individual physician

specialty,

“’@)= ~l”””

Estimates of percents

Approximate relative standard errors (in percent) for estimates of percents may be calculated from figures I and II as

follows. From the appropriate curve obtain the relative

standard error of the numerator and denominator of the

percents. Square each of the relative standard errors, subtract

the resulting value for the denominator from the resulting value

for the numerator, and extract the square root. This approximation is valid if the relative standard error of the denominator

is less than 0.05 or if the relative standard errors of the

numerator and denominator are both less than 0.10.

Alternatively, relative standard errors for percentages

may be calculated directly using the following formulae where

p is the percent of interest and x is the base of the percent in

thousands. For visit percentages based on all physician specialties,

“’@)’=’””o

For visit percentages based on ‘an individual physician specialty,

R“(p) =

d

42.88175 .(1 –p). ~ooo

p.x

For drug mention percentages based on all physician specialties,

R’E(p) =

d

58.48328-(1 –p) . ~Wo

p.x

For drug mention percents based on an individual physician

specialty,

“’@)=c

Estimates of rates where the numerator

is not a subclass of the denominator

100.0

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 or II.

Estimates of differences between

two statistics

The relative standard errors shown in this appendix are

not directly applicable to differences between two sample estimates. The standard error of a difference is approximately the

square root of the sum of squares of each standard error considered separately. This formula represents the standard error

quite accurately for the difference between separate and uncorrelated characteristics, although it is only a rough approximation in most other cases.

Tests of significance

In this report, the determination of statistical inference is

based on the t-test with a critical value of 1.96 (0.05 level of

significance). Terms relating to differences, such as “higher,”

and “less” indicate that the differences are statistically significant. Terms such as “similar” or “no difference” mean that

no statistical significance exists between the estimates being

compared. A lack of comment regarding the difference between

any two estimates does not mean that the difference was tested

and found to be not significant.

45
Table Il. Estimates of the civilian noninstitutionalized population of the Unitad States used in computing annual visit rates in this report by age,

race, sex, and Hispanic origin: 1980–81

All Less than 75–24 25-44 45-64 65 years

Race, sex, and Hispanic origin ages 15 years years years years and over

—— -.—

Race and sex Numbers in thousands

All races . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222,674 50,832 40,710 62,658 43,963 24,512

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107,429 25,976 20,076 30,487 20,849 10,042

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115,244 24,856 20,634 32,171 23,114 14,470

White .,,.....,.....,......,,. . . . . . . . . . . . . . . . 191,052 41,693 34,229 53,973 38,993 22,166

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92,640 21,366 17,012 26,558 18,637 9,067

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98,412 20,327 17,217 27,415 20,357 13,098

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26,107 7,627 5,430 6,870 4,143 2,039

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,103 3,840 2,544 3,057 1,838 826

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,005 3,787 2,886 3,814 2,305 1,213

Another . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,515 1,512 1,052 1,816 828 308

Male . . . . . . . . . . . . . . . . . . . . . . . . . . 2,687 770 520 873 375 150

Female, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,829 744 532 943 452 158

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114,528 4,645 3,174 4,047 1,955 706

Non-H ispanic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1208,507 46,525 38,028 58,081 42,233 23,640

lBaaed on the April 1, 1980, census. Figures will not add to total.

NOTE: Excludes Alaska and Hawaii.

Figures may not add to totals due to rounding.

Population figures and rate

computation

The population figures used in computing annual visit

rates are presented in table II. The figures are based on an

average of the July 1, 1980, and July 1, 1981, estimates of

the civilian noninstitutionalized population of the United

States provided by the U.S. Bureau of the Census. Because

NAMCS includes data for only the conterminous United

States, the original population estimates were modified to account for the exclusion of Alaska and Hawaii from the study.

For this reason, the population estimates should not be considered otllcial and are presented here solely to provide denominators for rate computations.

Estimates of numbers of visits and drug mentions in this

report are for a 2-year period, but ratios and rates represent

average annual estimates. For example, the average annual

visit rat& are calculated as follows. The numerator is obtained

by dividing the estimated number of office visits for 1980-81

by 2 to obtain an average annual number of office visits. This

number is then divided by the appropriate population figure to

obtain an average annual visit rate. As previously discussed,

estimates of reliability for average annual visit rates may be

calculated from figures 1 and 11.

Rounding of numbers

Estimates presented in this report are rounded to the nearest thousand. For this reason detailed figures within tables do

not always add to totals. Rates and percents are calculated on

the basis of the original, unrounded figures and may not necessarily agree precisely with percents calculated from rounded

data.

Systematic bias

No formal attempt was undertaken to determine or measure

systematic bias in the NAMCS data. But it should be noted

that there are several factors affecting the data which indicate

that these data underrepresent the total number of office visits.

Some of these factors are briefly discussed below.

● Physicians who participated in NAMCS did a thorough

and conscientious job in keeping the Patient Log, however,

post survey interviews with participating physicians indicate that a small number of patient visits may have been

accidentally omitted from the Patient Los although this

number is quite small, such omissions would result in an

undercoverage of office visits.

The same post survey interviews indicate that the inclusion of patient visits that did not actually occur was

infrequent and would have a negligible effect on survey

estimates.

. As previously stated, the physician universe for the

1980–8 1 NAMCS included all nonfederal, office-based,

patient-care physicians on the AMA and AOA masterlles.

The NAMCS was designed to provide statistically unbiased estimates of office visits to this designated population. Not included in the universe were physicians who

were classified as federally employed; or hospital-based;

or who were principally engaged in research, teaching, administration, or other nonpatient care activity. Consequently, ambulatory patient visits to these physicians in

an oftlce setting would not be included in NAMC S estimates. In an attempt to measure the number of office visits

to physicians not in the NAMCS universe, a NAMCS

Complement Survey was conducted in 1980. This study

46

,
involved a sample of approximately 2,000 physicians suks indicate that about 17 percent of the Complement

selected from among the 230,000 physicians in the AMA Survey physicians saw some ambulatory patients in an

and AOA mastertlles who were not eligible (in scope) for ofilce setting and that an estimated 69 million office visits

the 1980 NAMCS. Details of the Complement Survey were made to these physicians in 1980.

methodology and results are forthcoming. Preliminary re47
Appendix 11

Definitions of certain terms

used in the report

Terms relating to the survey

OJJce—Premises identified by physicians as locations for

their ambulatory practices. The responsibility over time for

patient care and professional services rendered there generally

resides with the individual physician rather than with any institution.

A mbulatoty patient—An individual seeking personal

health services who is neither bedridden nor currently admitted

to any health care institution on the premises.

●

●

●

●

Physi;ian—Classified as either

In scope—All duly licensed doctors of medicine or doctors of osteopathy currently in practice who spend some

time caring for ambulatory patients at an office location.

Out of scope—Those physicians who treat patients only

indirectly, including physicians in the specialties of anesthesiology, pathology, forensic pathology, radiology, therapeutic radiology, and diagnostic radiology, and the following physicians:

● Physicians who are federally employed, including

those physicians in military service.

● Physicians who treat patients only in an institutional

setting, for example, patients in nursing homes and

hospitals.

● Physicians employed full time in industry or by an

institution and having no private practice, for example,

physicians who work for the Veterans’ Administration or the Ford Motor Company.

● Physicians who spend no time seeing ambulatory patients, for example, physicians who only teach, are engaged in research. or are retired.

Patients—Classified as either:

In scope—All patients seen by the physician or a staff

member in the office of the physician.

Out o~scope—Patients seen by the physician in a hospital,

nursing home, or other extended care institution, or in the

patient’s home. (Note: If the physician has a private office, meeting the definition of “office,” located in a hospital, the ambulatory patients seen there are considered

in scope. ) The following types of patients are considered

out of scope:

● Patients seen by the physician in an institution, including outpatient clinics of hospitals, for whom the

institution has primary responsibility over time.

. Patients who contact and receive advice from the

physician via telephone.

. Patients who come to the office only to leave a specimen, to pick up insurance forms, or to pay a bill.

● Patients who come to the oftlce only to pickup medications previously prescribed by the physician.

Visit—A direct, personal exchange between an ambulatory patient and a physician or a staff member for the purpose

of seeking care and rendering health services.

Physician specialty-Principal specialty, including general practice, as designated by the physician at the time of the

survey. Those physicians for whom a specialty was not obtained

were assigned the principal specialty recorded in the physician

master files maintained by the American Medical Association

or the American Osteopathic Association.

Region of practice location—The four geographic regions,

excluding Alaska and Hawaii, that correspond to those used

by the U.S. Bureau of the Census:

Region

Northeast . .

North Central .

South, . . . . . . . .

West. .,.......

States included

Connecticut, Maine, Massachusetts, New

Hampshire, New Jersey, New York,

Pennsylvania, Rhode Island, and

Vermont

Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska,

North Dakota, Ohio, South Dakota, and

Wisconsin

Alabama, Arkansas, Delaware, District

of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi,

North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and

West Virgina

Arizona. California, Colorado, Idaho,

Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming

Metropolitan status of practice location—A physician’s

practice is classified by its location in a metropolitan or nonmetropolitan area. Metropolitan areas are standard metropolitan

statistical areas (SMSA’S) as defined by the U.S. OffIce of

Management and Budget. The definition of an individual

SMSA involves two considerations: first, a city or cities of

specified population that constitute the central city and identify

the county in which it is located as the central county; second,

economic and social relationships with “contiguous” counties

that are metropolitan in character so that the peripherj of the

specific metropolitan area may be determined. SMSA’S may

48
cross State lines. In New England,

and towns rather than counties.

Terms relating to the

Patient Record Form

SMSA’S consist of cities

Age—The age calculated from date of birth was the age

at last birthday on the date of visit.

Race—White, Black, Asian or Pacific Islander, or American Indian or Alaskan Native. Physicians were instructed to

mark the category they judged to be the most appropriate for

each patient based on observation or prior knowledge. The

following definitions were provided to the physician:

● White-A person having origins in any of the original

peoples of Europe, North Africa, or the Middle East.

● Black—A person having origins in any of the black racial

groups of Africa.

. Asian or Pacific Islander—A person having origins in

any of the original peoples of the Far East, Southeast

Asia, the Indian subcontinent, or the Pacific Islands, including, for example, China, India, Japan, Korea, the

Philippine Islands, and Samoa.

● American Indian or Alaskan Native—A person having

origins in any of the original peoples of North America

and who maintains cultural identification through tribal

affiliation or community recognition.

Ethnicity-Category judged by the physician to be the

most appropriate. The following definitions were provided:

● Hispanic origin—A person of Mexican, Puerto Rican,

Cuban, Central or South American, or other Spanish culture or origin, regardless of race.

● Not Hispanic—Any person not of Hispanic origin.

Patient’s complaint(s), symptom(s), or other reason(s)

for this visit (in patient’s own 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 visit—The one major reason (selected from the following list) for the patient’s visit as judged

by the physician:

● Acute problem—A visit primarily for a condition or illness having a relatively sudden or recent onset (within 3

months of the visit).

. Chronic problem, routine—A visit primarily to receive

regular care or examination for a preexisting chronic

condition or iliness (onset of condition was 3 months or

more before the visit).

● Chronic problem, jlareup-A visit primarily to receive

care for a sudden exacerbation of a preexisting chronic

condition or illness.

● Postsurgeq orpostinjury-A visit primarily for followup

care of injuries or for care required following surgery, for

example, removal of sutures or cast.

●

to

Nonillness care (routine prenatal, general exam, wellbaby) —General health maintenance examinations and

routine periodic examinations of presumably healthy persons, both children and adults, iricluding prenatal and

postnatal care, amual physicals, well-child examinations,

and insurance examinations.

Diagnostic services this visit—Physicians were instructed

check any of the following services that were ordered or

provided during tie current visiti

●

●

●

●

●

●

●

●

●

●

●

Limited history and/or examination-History or physical examination limited to a specific body site or system

or concerned primarily with the patient’s chief complaint,

for example, pelvic examination or eye examination. ,

General history and/or examination-History or physical examination of a comprehensive nature, including all

or most body systems.

Pap test—Papanicolaou test.

Clinical lab test—One or more laboratory procedures or

tests, includlng examination of blood, urine, sputum,

smears, exudates, transudates, frees, 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 screening purposes; excludes radiation

therapy.

Blood pressure check.

EKG—Electrocardiogram.

Vision test—Visual acuity test.

Endoscopy—Examination of the interior of any body

cavity except ear, nose, and throat by means of an endoscope.

Mentai status exam—Any formal, clinical evaluation designed to assess the mental or emotional status of the patient.

Other—All other diagnostic services urde d or provided

that are not included in the preceding categories.

Pn’ncipal 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 decreasing importance. The term “principal” refers to the first-listed diagnosis. The diagnosis represents the physician’s best judgment at the time of the visit and

may be tentative, provisional, or definitive.

Other signz#7cant current diagnoses—The diagnosis of

any other condition known to exist for the patient at the time

of the visit. Other diagnoses may or may not be related to the

patient’s reason for visit.

Have you seen patient before?—’’Seen before” means

provided care for at any time in the past. Item 10b refers to

the patient’s current episode of illness.

Medication therapy this visit—The physician was instructed to list, using brand or generic names, all medications,

including drugs, vitamins, hormones, ointments, and suppositories ordered, injected, administered, or provided this visit

including prescription and nonprescription drugs, vaccinations,

immunization, and desensitization agents. Also included are

49
drugs and medications ordered or provided prior to the visit

that the physician instructed or expected the patient to continue taking. Medications for the principal diagnosis are listed

in item 11a; all other drugs are listed in item 11b.

Nonmedication therapy—Physicians were instructed to

check any of the following services that were ordered or provided during the current visit:

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.

Oflce surge~—Any surgical procedure performed in the

oflice this visit, including suture of wounds, reduction of

fractures, application or removal of casts, incision and

draining of abscesses, application of supportive materials

for fractures and sprains, irrigations, aspirations, dilations,

and excisions.

Family planning—Services, counseling, or advice that

might enable patients to determine the number and spacing of their children, including both contraception and infertility services.

Psychotherapy or therapeutic listening—All treatments

designed to produce a mental or emotional response

through suggestion, persuasion, reeducation, reassurance,

or support, including psychological counseling, hypnosis,

psychoanalysis, and transactional therapy.

Diet counseling—Instructions, recommendations, or advice regarding diet or dietary habits.

Family or social counseling—Advice regarding problems

of family relationships, including marital or parent-child

problems, or social problems, including economic, educational, occupational, legal, or social adjustment difficulties.

Medical counseling–Instmctions and recommendations

regarding any health problem, including advice or counsel

about a change of habit or behavior. Physicians were instructed to check this category only if medical counseling

was a significant part of the treatment. Family planning,

diet counseling, and family or social counseling are excluded.

Other—Treatments or nonmedication therapies ordered

or provided that are not listed or included in the preceding categories.

Was patient referred for this visit by another physician?—

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 refemals for

any prior visit.

Disposition this visit—Eight categories are provided to

describe the physician’s disposition of the case. The physician was instructed to check as many of the categories as

apply:

No followup planned—No return visit or telephone contact was scheduled for the patient’s problem.

Return at specl~ed time—Patient was told to schedule an

appointment or was instructed to return at a particular

time.

Return 1~ needed, sP.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 follo wup planned—Patient was instructed to

telephone the physician on a particular day to report either

on progress, or if the need arose.

Referred to other physician—Patient was instructed to

consult or seek care from another physician. The patient

may or may not return to this physician at a later date.

Returned to referring physician—Patient was instmcted

to consult again with the referring physician.

Admit to hospital—Patient was instmcted that further

care or treatment would be provided in a hospital. No

further otllce” visits were expected prior to hospital admission.

Other—Any other disposition of the case not included in

the preceding categories.

Duration of this visit—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 such things as records

and test results. If the patient was provided care by a member

of the physician’s staff but did not see the physician during

the visit, the duration of visit was recorded as O minutes.

50
Appendix II1

Survey instruments

Endorsing Organizations

American Academy

of DermalologV

American Academy of

FamllY Physicians

Amertcan Academy

of Neurology

American Academy of

0rthopaed6c Surgeons

American Academy

of Pedlatrlcs

American Association of

Neurological Surgeons

American College of

Emergency Physicians

American College of

Obstetricians and

Gynecologlsrs

American College

of Physmlans

American Collpge of

Preventw Medictne

American Osteopathic

Association

American Socwtv of

Colon and Rectal

Surgeons

American Psvchiatrlc

Assoclatann

American Socletv of

Internal Med#cine

American Society of

Plastlc and Reconstructwe

Surgeons, Inc.

American Urological

Association

Association of American

Medical Colleges

National Mr?dicnl

Aswclation

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

OFFICE OF HEALTH RESEARCH. STATISTICS AND TECHNOLOGY

HYATTSVILLE, MARYLAND 207B2

NATIONAL AMBULATORY

MEDICAL CARE SURVEY

The National Center for Health Statistics, as part

of its continuing program to provide information on

the health status of the American people, is conducting

a National Ambulatory Medical Care Survey (NAMCS).

The purpose of this survey is to collect information

about ambulatory patients, their problems, and the

resources used for their care. The resulting published

statistics will help your profession plan for more

effective health services, determine health manpower

requirements, and improve medical education.

Since practicing physicians are the only reliable source

Of this information, we need your assistance in the

NAMCS . As one of the physicians selected in our national

sample, your participation is essential to the success

of the survey. Of course, all information that you

provide is held in strict confidence.

Many organizations and leaders in the medical profession

have expressed their support for this survey, including

those shown to the left. In particular, your own specialty society has reviewed the NAMCS program and supports

this effort (see enclosure). They join me in urging

your cooperation in this important research.

Within a few days, a survey representative will telephone

you for an appointment to discuss the details of your

participation. We greatly appreciate your cooperation.

Enclosure

Sincerely yours,

Dorothy P. Rice

Director

51
Ln

t+

CNO.499932

PATIENTLOG

As each patient arrives, record nsme and

tim.a of visit on the log beiow. For the

patient entered on line #3, a1s0 cOmolme the Datient record to the right.

PAT I ENT’S NAME TIME OF

VISIT

3

}

a.n

Remrd ,tem, 1.15

h, ,h, s Oalmnl. I P.m

CONTINUE LISTING PATIENTS

ON NEXT PAGE

ASSURANCE OF COUFIDENTALITV-A, I ,nlmma,,.n ,.,.,cI,w,o.wI .,, w,, ,IIe.,,,, ca,,. tx Oeud,,mml., He.’th Ed...,,,,,, ,,,,,, wJ,,.,

.1 a. ,.d, v,d.a, a 0,.,,,.,, Q, a“ ,,, atl,,shmen, u,,,, 0, held .0.1,,,,.,,., ~,11b. ,,,,, J”.1, P.m.< . ..1.}. S,...,c,

Lm IX,$OOSe.mq:d .. ..d l.. !h@ o.mme$ .1 the wr. ev ..(I s.!!1 not !,@ d!xlowd ., w oflc@’o! H.A81. R?,.ar<h s!. ?,,,,., ,,,,%,7,.,,, ,,,,,,

CNOC499932

!,, s,0 10 o!h, r 0?!s0”s or “sW for .“, ah, ! 0., ”0,, twx.ona’ c?”,., f“. Hv. >,r>s,.,,,,,.,

PATlENT RECORD

NATIONAL AMBULATORY MEDICAL CARE SURVEY

1. DATE OF VISIT

&

___uJ h!.., h Da, ,,,,:::AULE

1“

7. MAJOR REASON FOR THIS

VISIT /ChFck O,le]

1 ❑ A.”,, PROS,EM

2 ❑ CHRONIC PROBLEM. ROUT,NE

3❑ CHRONIC PROBLEM, FLAREUP

4 nPOSTSuRGERYIPOST INJURY

5 ❑ NON-ILLNESS CARE {ROUTINE

PRENATAL, GENERAL ExAM

WELL 8AEIY. ETC J

10. HAVE YOU SEEN

PATl ENT BEFORE?

,D,ES ,DNO

I

IF YES, FOR THE

CONDITION IN

ITEM 9, ~

4. COLOR OR RACE

1❑ wHITE

2 ❑ BL...

3 HA51AN/PACIFIC

IS LANOER

4 ❑AMERICANlND,AN/

ALASKAN NATIVE

5, ETHNICITY

1 ❑ HISPAN,C

ORIGIN

2 ❑ NOT

HISPANIC

Sm DIAGNOSTIC SERVICES THIS VISIT

/Check all ordered or provided/

I ❑ NONE 8 l_J EKG

2 ❑LIMITEO HISTORY/EXAM 9 ❑ VISION TEST.

3 @GENERAL HISTORY/EXAM 10 ❑ ENOOSCOPY

4 ❑PAP TEST 11 ❑ MENTAL STATUS

5 ❑ CLINI12AL LAB TEST

ExAM

6 ❑ X. RAY

,2 ❑ OTHER ,.s,,,(,,,

7 @BLO&PRESSUFIE CHECK

& PATl ENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER

REASON(S) FOR ~ VISIT //,, ,Iar[,,II[ ‘s,,,,,?] w,)rds/

, MOST 1MPORT4NT

b OTHER

9mPHYSICIANS DIAGNOSES

a PRINCIP4L D, A’NoSls PROBLEM bSSOCI ATED WIT I+ ITEM hi

1 !3THEfl SIGNIFICANT c“RREVT OIAGNOSES

11. MEDICATION THERAPY THIS VISIT ❑ NONE

\ Using brand or ~eneric names, record all n<,%,und wnti,twd ,,,t-dicanon, ,,,-d,wd, r,r,?cr?d, od,n!u;xnwd, ,,r g,rl,rr,tiw

provided a r this uiss Include immunizing and desensiti: ing a.gen rs/

a. FOR PRINCIPAL OIAGNOSES IN ITEM9, b. kOR AL LOTHEIi HE ASoNS

1. I

—

2, 2

3 3

4 4

12. NON-MEDICATION THERAPY

lCheck all services ordered or provided this .isit/

1❑ NOEWE 6❑ CIIET COUNSELING

2 ❑ PHYSIOTHERAPY 7❑FAM,LY,SOCIAL

3UOFF,CESURGERY

COUNSELING

4 ❑ FAMILY PLANNING

8 ❑ MEOICAL COUNSELING

5❑ P5YCHOTHERApY(

9 QOTHER (Sp.<,,v,

THERAPEUTIC LISTENING

13. WAS PATIENT

REFERRED

FOR THIS VISIT

BY A~HER

PHYSICIAN?

, ❑ YES

,/-JN.

14mDISPOSITION THIS VISIT

/Check all rhaf appl,l

I ❑ NO FOLLOW UNPLANNED

z ❑ RETURN AT SPECIFIECI TIME

.?❑ RET”ITN IF NEEOECJ.PR N

4 (_JTELEpHONE FOLLOW UfIPLANNEO

5 ❑ REFERREL7 TOOTHERPHYs,CIAN

G ❑ RETURNEII TO REFERRING PHYSICIAN

7 ❑ ADMIT TO HOSPITAL

8 ❑ OTHER ,.s,,,., ,,, ,

15. DURATION

OF THIS

?.1 !O,, !..’

PHS-61 OE-C (9/79) 0M8 No. 6S-R1498
cONFIDENTIAL*

NORC-4284

FOR OFFICE USE

ONLY:

m

5-61

m

7-10/

BEGIN DECK 3

~

NATIONAL AMBULATORY MEDICAL CARE SURVEY

INDUCTION INTERVIEW

BEFCRE STARTING INTERVIEW 1.ENrER PHYSICIAN 1.D. NUMEER IN BOX TO

jm 1-4/

RIGI-KC.

2. ENTER DATES OF ASSIGNED REPORTING WEEK IN

Q. 2, P. 2.

.M

Doctor, before I begin, let me take a minute to give you a little background about

this survey.

Although ambulatory medical care accounts for nearly 90 percent of all medical care

received in the United States, there is no systematic information about the characteristics dnd problems of people who consult physicians in their offices. ThiS kind

of information has been badly needed by medical educators and others concerned with

the medical manpower situation.

In response to increasing demands for this kind of information, the National Center

for Health Statistics, in close consultation with representatives of the medical

profession, has developed the National Ambulatory Medical Care Survey.

Your own task in the survey is simple, carefully designed, @ should not take much

of your time. Essentially, it consists of your participation during a specified

7-day period. During this period, you simply check off a minimal =Ount of infonzation concerning patients that you see.

Now, before we get into the actual procedures, I have a few questions to ask about

your practice. The answers you give me will be used only for classification and *

analysis, and of course information you provide is held in strict confidence.

1. First, you are a

(ENTER SPECIALTY FROM CODE ON FACE S~ET LABEL.)”

Is that right? Yes . . . . . . . . . . .X

No...”. (iisKA) . . ..Y

A. IF NO: What is your specialty (including general practice)?

(Name of Specialty)

1111

11-13/

*

The National Ambulatory Medical Care Survey is authorized by

Congress in Public Law 93-353, section 308. It is a voluntary

study and there are no penalties fcr refusing to answer any

question. All information collected is confidential and will

be used only to prepare statistical summaries. No information

which will identify an individual or a physicians practice

will be released.

53
-2-

2. Now, doctor, this study will be concerned with the ~bulatory patients you will

see in your office during the week of (R&W REPORTING DATES ENTERED BELCW).

(that’s a (that’s a

f Monday) through I Sunday)

month date

Are you likely to see ~

A. IF NO: Why is that?

month date

ambulatory patients in your office during that week?

Yes. . . . . .(GOTOQ. 3).. X

NO .’. . . . . (ASK A). . . . Y

RECORD VERBATI~ THEN READ PARAGRAPH BR?XXJ

Since it’s very important, doctor, that we include any ambulatory patients

that you do happen to see in your office during that week, I’d like to

leave the= forms with you anyway--just in case your plans change. 1’11

plan to check back with your office just before (STARTING DATE) to make

sure, and I can explain them in detail then, if necessary.

GIVE DOCTOR “THE~ PATIENT RECORD FORMS AND GO TO Q. 9, P. 6.

54
-3-

3, A, At what office location will you be

7-day period? RECORD UNDER A BELCW

B. FOR EACH OFFICE LOCATION ENTERED IN A, CODE YES OR NO TO “IN SCOPE.”

~ OUT OF SCOPE (No)!

Private office8 Hospital emergency rooms

Free-standing clinics Hospital outpatient departments

(non-hospital based) College or university infirmaries

Groups, partnerships - Industrial outpatient facilities

Kaiser, HIP, Mayo Clinic Family planning clinics

Neighborhood Health Centers Government-operated clinics

Privately operated clinics (VII,mate~al & child health> etc.)

(except family planning)

IN CASE OF DOUBT, ASK: Is that (clinic/facility/institution)hospital baaed?

IS that (clinic/facility/institution)government

operated?

co Is that all of the office locations at which you expect to see ambulatory

patient=uring that week?

Yea. . . . . . . . ● . . x

No . . . . . . . , . . . Y

IF NO: OBTAIN 4DDITIONAL OFFICE LOCATION(S), ENi’ERIN “A” BELOW, AND REPEAT.

A. B.

Office Location In Scope?

.

Yes I

No

(1) 1 0

(2) 1 0

(3) 1 0

(4) 1 0

TOTAL IN-SCOPE LOCATIONS: II 14/

IF ALL LOCATIONS ARE OUT OF SCOPE, THANK THE DOCTOR AND LEAVE.

55
-A- DECK 3

4. A. During that week (REPEAT DATES),, how many ambulatory patients do you expect

to see in your office practice? (DO NOT COUNT PATIENTS SEEN AT [OUT-OF-SCOPE

LOCATIONS] CODED IN 3-B.)

ENTER TOTAL UNDER “A” BELOW AND CIRCLE NUMBER CATEGORY ON API’ ?

B. And during those seven days (REPEAT DATES IF NECESSARY), on how many @ do

you expect to see any ambulatory patients? COUNT EACH DAY IN WHICH DOCTOR

EXPECTS TO SEE ANY PATIENTS AT AN IN-SCOPE OFFICE LOCATION.

CIRCLE NUMBER OF DAYS IN APPROPRIATE CCLUIV!NUNDER “B;’ BELOW.

DETERMLNE PROPER PATIENT LOG FORM FROM CHART BELOW. READ ACROSS

ON “TOTAL pATIENTS” LINE ~ER “A” AND CIRCLE LETTER IN APPROPRIATE

“DAYS” COLUMN UNDER “B.”

THIS LETTER TELLS YOU WHICH OF THE FOUR PATIENT LOG FORMS (A, B, C, D)

SHOULD BE USED BY THIS DOCTOR.

A. B.

LOG FORM DESCRIPTION Expected total Total ~ in practice

patients during dur~ng week.

survey week. i I 1

ENTER TOTAL FROM I

A--Patient Record is to be

completed for ALL

patients liste=n Log. 15-17/ m“ +bly++ ,

1- 12 PATIENTS AAAAAAA

13- 25 “ B AAAAAA

B--Patient Record is to be

completed for every

SECOND patient listed

on Log.

C--Patient Record is to be

completed for every

THI~ patient listed

on Log.

*D--Patient Record is to be

completed for every

FIFTH patient listed

on Log.

26- 39 “ CBAAAAA

40- 52 “ CBBAAAA

53- 65 “ DCBBAAA

66- 79 “ DCBBBAA

80- 92 “ DDCBBBB

I 93-105 “ ID DC BBBB

106-118 “ DDCCBBB

119-131 “ DDCCBBB

132-145 “ DDDCCBB

I 146-158 “ lDDDCCBi

159-171 “ DDDCCCC

172-184 “ DDDCCCC

185-197 “ DDDDDDD

198-210 “ DDDDDDD

211+ II D D D D-D D D—

*

In the rare instance the physician will see than 500 patients during

his assigned reporting week, give him two D Patient Log Folios and instruct him

to complete a patient record form for only every tenth patient. Then you are

to draw an 1 throug~l the Patient Record on every other page of the two folio pads,

starting with Page 1 of the pad. The physician then completes the Patient Log

on every page, but completes the Patient Record on every second page.

56
-5-

5. FINTILOG FOLIO WITH APPROPRIATE LETTER AND CIRCLE LETTER, ENTER FIRST FOUR

OF THE FORM AND NUMBEi OF LINES STAMPED “BEGIN ON NEXT LINE” FOR THE B-C-D

FORMS (if no lines are stamped,enter “o”) BELOW.

*

FOLIO No. Lines FOR OFFICE USE ONLY

Stamped “BEGIN Number patient record

Letter .Number ON NEXT LINE” forms comPleted.

A

B

c

D

DECK 3

NUMBERS

LOG

19-23/

24-26/

6. HAND DOCTOR HIS FOLIO AND EXPLAIN HC%lFORMS ARE TO BE FILLED OUT. SHOW DOCTOR

INSTRUCTIONSON THE POCti OF FOLIO, ITEMS ~ AND 11 ON CAl@ IN POCKET

OF FOLIO AND ITEM DEFINITIONSON THE BACK OF FOLIO, TO WHICH HE CAN REFER AFI’ER

YOU LEAVE.

EMPHASIZE THAT EVERY PATIENTVISIT EXCEPT ADMINISTRATIVEPURPOSEONLY IS TO BE

RECORDEDON THE LOG FOR ENTIRE REPORTINGPERIOD. FOR EXAMPLE, IF A MEDICAL

ASSISTANTGAVE THE PATIENTAN INOCULATION.OR A TECHNICIANADMINISTEREDAN

ELECTROCARDIOGRAMAND THE PATIENl!DID N~’SEE THE DOCTOR, THIS VISIT MST STILL BE

LISTED ON THE LOG.

b RECORDVERBATIMBELCXJANY CONCERN,PROBLEMSOR QUESTIONSTHE DOCTOR RAISES.

7. IF DOCTOR EXPECTSTO SEE AMBULATORYPATIENTSAT FIIRETHAN ONE IN-SCOPELOCATION

DURING ASSIGNEDWEEK, TELL HIM YOU WILL DELIVERTHE FORMS TO THE OTHER LOCATION(S).

ENTER THE FORM LETTERAND NUMBER(S)AND NUMBER OF LINES STAMPED “BEGINON NEXT

LINE” FOR THE B-C-D LOG FOR THOSE LOCATIONSBELOW, BEFORE DELIVERINGFORM(S).

FOLIO No. Lines

.1

‘FOR OFFICE USE ONLY: ,—

Location Stamped “BEGIN Number patient recor

Letter .Number ON NExT LINE” -forms completed -

27-31/

32-34/

35-39/

40-42/

43-47/

48-50/

57
-6- DECK 3

8. During the surveyweek (REPEATEXACT DATES),will anYone be available to help

you in fillingout theee secords (at each IN-SCOFB location)?

Ye8 . . . . (ASKA) ...1

No . . . . . . . . . . .2

51!

A. IF YES: Who would that be?

RECORDNAME, POSITIONAND LOCATION.

i

NAME I POSITION 1 LOCATION I

PERSONALLYBRIEF EACN PERSON LISTED ABOVE.

EMPHASIZETHAT EVERY PATT.ENIVISIT DURING THE ENTIRE WEEK IS TO BE RECORDEDONTEB

LW EXCEPT“ADMINISTRATIVEPURPOSEONLY.”

9. Do you have a solo practice,or are you amaociatedwlth other phycician8in ●

partnership,in a grouppractice,or in some other way?

solo. , . . . (m TO. Q. 10) . . I

Partnership. . (ASKA-C) . . . 2

Group . . . ..(AC)A-C) . ..3

<--- Other (s~(jI~ ~ ASKA-C) . . 4

IF PARTNERSHIP.GROUP.OR OTHER:

A. 18 thiu a prepaidgroup practice? Yes . . (ASK [II) . . . 1

[1] IF YESTOA: What per cent

No . . . . . . . . . .2

of patientsare

prepaid? per cent

B. How many other phyaiciana are

aanociated with you? NUMBER OF PHYSICIANS:

c. What are the specialtiesof the other phyaicianaamociatedwith you?

(Hovmany of these are there?)

(1)

(2)

(3)

(4)

(5)

Specialty Number of Physicians

D. CIRCLE ONE:

All physicians in this partnership/group practice

have the same specialty . . . . ; . . . . . . . . . . . . . 1

More than one specialty in this partnership/group practice . . 2

52/

531

54-56/

57-59/

60/

58
-7-

10. Now I have just one more question about vour Dractice. (NOTE: IF

IN

A.

B.

BEGIN DECK 4

DOCTOR PRACTICES

LARGE GROUP, THE FOLLtiING INFORMATION CAN’BE OBTAINED FROM SOMEONE ELSE.)

Uhat is the total number of full. time (35 hours or more per week) eqloyees of your (partaerabip/

group) practice? Include persons regularly employed who are now on vacation, temporari~ ill,

etc. Do not include other physicians. RSCORD ON BOITOMLINR OF COLU’IW A BELUJ.

(1) H~—many of these full-time employees are a . . . (READ CATEGORIES BELUJ”AS NECESSARY

AHD RECORD NUMBER OF EACH IN COLUMN A.)

And what is the total number of part-time (less than 35 hours per week) employees of your

(partnership/group ) practice? Again, include persons regularly employed who are now on vacation,

ill, etc. Do not include other phyaiciana. RECORO ON BO1’TOM LINE OF COLU?4J B BhOW.

(1) How many of these part-time etiployees are a . . . (READ CATEGORIES BELUJ AS NECESSART

AHD RECORD NUMBER OF EACH IN COLUW B.)

I

Employees

1(

Full-time Part-time

35 ar more houra /week) (Leas than 35 hours/week) I

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Registered Nurse . . . . . . . . . . . 11-13/

Licensed Ractical Nurse . . . . . . . 14-16/

NuraingAide. . . . . . . . . . . . . 17-19/

fiysician AsBiatant* . . . . . . . . . 20-22/

Technician. . . . . . . . . . . . . . 23-25/

Secretary or Ibsceptioniat . . . . . . 26-28/

Other (SPECIFY) 29-31/

=.: n 32-34/

35-37/

38-40/

41-43/ ‘

44-46/

47-49/

50-52/

53-55/

~: m 56-58/

*

Phyaiciau Asaiatant wst be a graduate of an accreditedtrainiq progrn for Physician

Asaiatanta (Wysiciao Extenders, ~dex, etc. ) or certified by the Uational Board of lbdical

kinera through the Certification Ex= for Assistant to the Rx Care Physician.

BEFORE YOU LEAVE, AGAIN STRESS THAT EACH AND EYERY AM8UI&!ORYPATIENT SEEN BY THE

DOCTOR OR HIS STAFF DURING THE 7-DAYyiiiIODA- IN-SCOPEOFFICE LOCATIONS (mEAT

THEM) IS TO BE INCLUDEDIN TNE SURVEY>THAT EAC~ATIENT IS TO BE RECORDEDON THE LOG,

AND ONLY TNE APPROPRIATENUMBER OF PATIENT RECORDSCOMPLETED.

Thank you for your time, Dr. If you have any (more) questions,

please feel free to call me. My phone n~er is written In the folio. I’ll

call g on Monday morning of your survey week just to remind you.

11. TIME INTERVIEWENDED . . . . . . . . AM

PM

12. DATEOFINTERVIEW . . . . . . . . . . . . . . . 11111 I

(Month) (Day) (Year)

59
-8- DECK 4

NUMBER

111111

FOR OFFICE USE ONLY:

No. of Patients Seen:

m 5’-’”

Total I)aYj in Practice during Week: ❑

62/

INTERVIEWER’S SIGNATURE

60
Appendix IV

American Hospital Formulary

Service classification system

and therapeutic category codes

AMERICAN HOSPITAL FORMULARY SERVICE CLASSIFICATION SYSTEM

AND THERAPEuTIC CATEGORY CODES (AHFS#)

(Classifications in parentheses are provisional but maybe used i. DPIF) —

AMERICAN

HOSPITAL

FORMULARY

SERV3CE

CLASSIFICATION

s SYSTEM

04:04 ANTIHISTAMINEDRUGS

08:C4 ANTI-INFECTIVEAGENTS

0.9:04 .bebmides

08:08 .4rkhehnintics

08:12 Antibiotics

08:12.02 kninoglyco!idcs

08:12.04 Antifungal Antibiotics

08:1206 Cephalo$porins

08:1108 Chloramphenicol

08:12.12 Erytluomycins

08:12.16 &NdiM

08:12.24 Tetmcyclims

08:12.24 Other Antibiotics

08:16

08:18

08:20

08:24

08:26

08:28

08:32

08:36

08:40

10:00

12:00

12:04

12:08

12:12

1216

12:20

16:Oi7

20:00

20:04

20:04.04 bon Prepar8ti0ns

20:04.08 Liver and Stomach

Antituberculmis Agents

AntiviIaks

Phmodicides

Sulfonamides

Stdfones

Trcpcmemicides

Trichomomcides

Urinary Germicides

Other Anti-Infective

ANT1NEOP3,STkC AGENTS

AfRONOMIC DRUGS

Parasympathomimetic ASCntS

Pansy mpatholytic Agents

Sympathomimetic Agents

Sympatholytic Agcnt$

Skeletal MuscleRelaxznk

BLCX3DDERIVATIVES

BLOODFORMATION ANDCOAGULATION

Anrianemia Drum

Reparations

20:12 Cagtdants and Amicmgulants

20:12.04 Anticoagulants

20:1208 Antibeptin Agentt

20:12.12 C.mguhntt

2012.16 Hemostatic

20:40 Thromboly+icAgents

24:00 CARD1OVASCULARDRUGS

24:04 Cardiac DrusJ

24:06 Antilipemic Agmts

24:08 Hypotemive Agents

24:12 VasodikatingAgents

24:16 SclerosingAgents

28:00 CENTRAL NERVOUS SYSTEMDRUGS

28:04 General Anmthetics

28:08 Amlgetics and A.tipyrctics

28:10 t+ucOtiC Ant2@sts

28:12 Anticonvulsants

28:16 psychotherapeutic Agents

28:16.04 Antidepre$smm

28:16.08 Trznquilizcrs

28:16.12 Other Psychotherapeutic

Agents

28:20 Resptiatory and Cerebral

Stimulants

28:24 Sedatives and Hypnotics

36:00

36:04

36:08

36:12

36:16

36:18

36:?A

36:2-3

36:26

36:28

36:3o

36:32

36:34

36:36

36:38

36:40

36:44

36:48

36:52

36:56

36:6o

36:61

36:62

36:64

36:66

36:68

36:72

36:76

36;78

36:80

36:S4

36:88

4000

40:M

40:08

40:10

40:12

40:16

40:18

40:20

40:24

40:28

40:36

40:40

4:00

48:00

S2:W

DIAGNOSTkCAGENTS

Adrenocortical Insufficiency

Amyloidosis

Blood Volume

Brumklosfi

Cardi?c Function

Circulation Time

(Cystic Fibrosis)

L3izbctesMcllitus

Diphtheria

Dmg Hypersensitivity

Fungi

Gdlbl~dder Function

Gastric Function

Intestinal Absorption

Kidney Function

LiverFunction

Lymphogranuloma Venercum

Mumps

Myistbenia Gratis

Myxedcma

Fhncreatic Function

PhcnyIketmturia

Phedlronx.cytom

Pituitary Function

Romtgenognphy

Scaiet Fkvcr

Swuting

(Thyroid Function)

Trichinosis

Tuberculosis ~

Urim C0ntenr5

EL3KPROLYTfC, CALORIC, AND

WATZRBALANCE

Acidifying Agenu

. .

Alkdmmw Agents

Ammonia Detoxiunts

Rcplwtnmt solution!

SodiuIWRemotirU R=im

Potwium-Renwving Resins

C410ricAgcntt

Salt and SuW Sulxtitute$

Diurclict

fmiglring solutions

Uricowric Agents

ENZYME-S

EXPECTORANTSANDCOUGH

PREPARATIONS

SYE, EAR, NOSE ANDTHROAT

PREPARATIONS

52:04 Ant+Infectives

52:04.04 Antibiotics

S2:04.06 Antitials

52:04.08 Sukfommida

5204.12 MisGAnti-lnfectives

5208

52:10

52:12

S2: 16

52:20

52:24

S2:28

52:32

52:36

56:00

56:04

56:08

56:10

56:12

56:16

S6:20

56:24

56:40

hti-lldlmrunatory Agentt

Carbonic Anhydrase Inhibitors

Contact L.enJSolutions

Local Armtthetics

Miotics

MYtitics

Mouth Washesand Gargles

Vmoconstrictors

Unclmifkd Agentt

GASTR01NTEST3NALDRUGS

Antacids and Ad!or&nts

Anti-Dhrrhea Agents

Antiflamlents

C@hardcsand Laxative$

Digestantt

Emetics and AntI.Emetics

LJpotropic Agents

Misc.GI Drugs

60:00 GOLDCOMFOUNDS

64:00 HEAVYMETALANTAGONISTS

68:00 HORMONESAND SYNTHET[C

SUBST3TUTLS

68:04 Adremls

6608 Acdmgem

68:12 Contraceptives

68:16 Estrogens

68:18 Gonadotropin

68:20 Insulins and Anti-Dtibctic

Agents

68:20.08 Insulins

68:24

68:28

68:32

68:34

68:36

72:00

76:00

78:00

80:00

80:tt4

80:08

80:12

S4:oo

S4:M

Pamrhyroid

Pindtaly’

Rogestogem

Other Cotpm Luteum Hormones

Thyroid and Antithyroid

LOCALANESTHETICS

OXYTOCICS

RADIOACTIVEAGENTS

SERUMS,TOXOIDS ANDVACCINES

.%ums

Toxoids

Vaccines

SKIN AND MUCOUSMEMBRANE

PREPARATIONS

Anti+fcclives

S4:04.04 Antibiotics

S4:04.08 Ftmgicidm

84:04.12 Sabicides and Pediculicidcs

P4:04. 16 Mix. Loml Anti-lnfectn’es

S4:06 Anti-lntlammatory Agents

64:08 Antipruritics and Local

.h--khetics

S4: 12 Astringents

S4: 16 Cell Stimulants and Pmhfermt$

S4:20 Detergents

S4:24 Emolkmtts, Demulccnts and

Rotectants

S4:24.04 Bane Lmons and L]mments

S4:24.08 BasicOLISmid Other Solvents

S4:24.12 ltanc Ointments and

Rotectants

S4:24. 16 Bs.c Powders and Demulcents

84:28 Keratolytlc Agents

S4:32 Kerttoplmt!c Agents

S4:36 f4isceUane0usAgents

S4:S0 Pigmenlmg & Dcplgmcntmg Agents

S4:50.04 CWpUMemingAgents

S4:50.06 Rgmenting Agents

S4:80 Sumcreen Agents

86:00 SPASMOLYTICAGENTS

88:00 VITAMINS

88:04 Vitamin A

88:08 Vitamin B Complex

88:12 Vitamin C

88:16 Vitamin D

88:20 Vitamin E

88:24 Vitamin K Activity

88:28 Multivitamin preparations

92:00 UNCLASSIFIEDTHERAPEUTIC AGENTS

94:oO (DEVICES)

96:00 (PHARMACEUTICSAIDS)

Copyright 01980. DrtJg Products Information File: American Societv of Hos~ital Pharmacists. Bethesda. Marvland.

A1l-righ-fireserved. Re~rinted with permission.

,.

e

61

-,, .
Vital and Health Statistics

series descriptions

SERIES 1.

SERIES 2.

SE RIES3.

SERIES4.

SERIES 5.

SERIES 10.

SERIESI1.

SERIES 12.

SERIES 13.

Programs and Collection Procedures-Reports describing

the general programs of the National Center for Health

Statistics and its offices and divisions and the data collection methods used. They also include definitions and

other material necessary for understanding the data.

Data Evaluation and Methods Resaarch-Studies of new

statistical methodology including experimental tests of

new survey methods, studies of vital statistics collection

methods, new analytical techniques, objective evaluations

Of reliability of collected data, and contributions to

statistical theory. Studies also include comparison of

U.S. methodology with those of other countries.

Analytical and Epidemiological Studies-Reports presenting analytical or interpretive studies based on vital

and health statistics, carrying the analysis further than

the expository types of reports in the other series.

Documents and Committee Reports-Final reports of

major committees concerned with vital and health statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

Comparative International Vital and Health Statistics

Repo~s-Analytical and descriptive reports comparing

U.S. vital and health statistics with those of other Coun.

tries.

Data From the National Health Interview Survey-Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other

health-related topics, all based on data collected in the

continuing national household interview survey.

Data From the National Health Examination Survey and

the National Health and Nutrition Examination Survey–

Data from direct examination, testing, and measurement

of national samples of the civilian noninstitutional ized

population provide the basis for (1) estimates of the

medically defined prevalence of specific diseases in the

United States and the distributions of the population

with respect to physical, physiological, and psycho.

logical characteristics and (2) analysis of relationships

among the various measurements without reference to

an explicit ftnite universe of persons.

Data From the Institutionalized Population Surveys-Discontinued in 1975. Reports from these surveys are included in Series 13.

Data on Haalth Resoursas Utilization–Statistics on the

utilization of health manpower and facilities providing

long-term care, ambulatory care, hospital care, and family

planning services.

SERIES

SERIES

4,

5.

SERIES 20.

SERIES 21.

SERIES 22,

SERIES 23.

Data on Health Resources: Manpower and FacilitiesStatistics on the numbers, geographic distribution, and

characteristics of health resources including physicians,

dentists, nurses, other health occupations, hospitals,

nursing homes, and outpatient facilities.

Data From Special Surveys–Statistics on health and

health-related topics collected in special surveys that

are not a part of the continuing data systems of the

National Center for Health .$tatisti=.

Data on Mortality-Various statistics on mortality other

than as included in regular annual or monthly reports.

Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses;

and statistics on characteristics of deaths not available

from the vital records based on sample surveys of those

records.

Data on Natality, Marria~, and Divorca-Various sta.

tistics on natal ity, marriage, and divorce other than eS

included in regular annual or monthly reports. Special

analyses by demographic variables; geographic and time

series analyses; studies of fertility; and statistim on

characteristics of births not available from the vital

records based on sample surveys of those records.

Data From the National Mortality ●nd Natality SurveysDiscontinued in 1975. Reports from these sample suweys

based on vital records are included in Series 20 and 21,

respectively.

Data From tha National Survey of Family GrowthStatiStiCS on fert!lity, family formation and dissolution,

family planning, and related maternal and infant health

topics derived from a periodic survey of a nationwide

probability sample of ever-married women 1544 years

of age.

For a list of titles of reports published in these series, write to:

or call

Scientific and Technical Information Branch

National Center for Health Statistics

Public Health Service

Hyattsville, Md. 20782

301-436-NCHS
U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Publlc Health Service

National Center for Health Stat! stlcs

3700 East-West Highway

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

THIRD CLASS MAIL

BULK RATE

POSTAGE & FEES PAID

PHS/NCHS

PERMIT No. G-281

DHHS Publication No. (PHS) 84-1740, Series 13, No. 79