The Na$iomaI

Ambd@ory

Mdicd Care

tiN~:

United States, 1980

National Arn4u4tory Medicei Care

Complement Survey statistics on nonoffice-based physicians who see patients

in the private offiie setting are pceeented.

Data on visita to these phyaiciana we

comparad and contrasted with National

Ambulato~ Medical Care Survey data on

offtce visit%to office-based physicians.

The summary statistics used describe

patient demographic characteristics,

physician practice characteristics, patient

medical information, and the clinical

management of visits.

Data Fromthe NationalHeatthSurvey

Se&s 13, No. 77

DHHS Publication No. (PHS) 84–1 738

U.S. Dapanment of Health and Human

Services

Public Health Service

National Center for Health Statistics

Hyattaville, Md.

May 1984

———
.——

Copyright lnformationThe National Center for Health Statistics haa obtained permission

from tha copyright holders to raproduce certain quoted material in this

report. Further reproduction of this material is prohibited without

specific permission of the copyright holders. All other materisl

contained in the report is in the public domain and may be used and

reprinted without special permission; citation as to source, however,

is appreciated.

Suggested Citation

Nstional Center for Health Statistics, G. J. Gardocki, T. McLemore,

and J. E. DeLoziec The National Ambulatory Medical Care Complement

Survey, United States, 1980. Vital and Health Statistics. Series 13,

No. 77. DHHS Pub. No. (PHS) 84-1738. Public Health Service.

Washington. U.S. Government Printing Office, May 1984.

Library of Congrass Cataloging in Publication Data

Gardocki, Gloria J.

The national ambulato~ medical care complement survey

(Data from the national health survey. Series 13 ;

no. 77) (DHHS publication ; no. (PHS) 84-1 738)

Authors: Gloria J. Gardocki, Thomas McLemore, and

James E. DeLozier.

suPPkMefltS information collected in the National

AmbulatoV Medical Care Survey.

Includes bibliographical references.

Supt. of Dots. no.: HE 20.6209:1 3/77

1. Physician services utilization—lJnited State5—

Statmtics. 2. Ambulatory medical care—United States—

Statistics. 3. Health surveys-United States. 4. United

States—Statistics, Medical. 1. McLemore, Thomas.

Il. DeLozier, James E. Ill. National Center for Health

Statistics (U. S.) IV. Title. V. Series: Vital and health

statistics. Series 13, Data from the national health

survey ; no. 77. V1. Series: DHHS publication ; no. (PHS)

.’~4-l 738. [DNLM: 1. Ambulato~ care—United States—

Statistics. 2. OffIce visits—United States—Statistics.

3. Patients—United Statas—Statistics. 4. Physicians—

Manpower—United States—Statistics. W2 A N148vm no. 77]

RA410.7.G37 1984 362.1’0973 84-600996

IS8N 0-8406-0292-8 {pbk.)

For sale by the Superintendent of Documents, U.S. Go~ernment Printing 0t7ice, 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 Director for Anaiysis

and Epidemiology

Garrie J. Losee, Associate Director for Data Processing

and Services

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

Statistics

E. Earl BryanL Associate Directorfor 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 Haywood, Information Oflcer

Vital and Health Care Statistics Program

Peter L. Hurley, Associate Director

Gloria Kapantais, Assistant to the Director for Data Policy,

Planning and Analysis

Division of Health Care Statistics

W. Edward Bacon, Ph.D., Director

Joan F. van Nostrand, Deputy Director

James E. DeLozier, ChieJ Ambulato~ Care Statistics

Branch

Manoochehr K. Nozary, ChieJ Technical Services Branch
Section I. Background andpurpose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section II. Data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SectionII[. Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section IV. Physician data..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tables

1. Estinlated numbrmd percent distibution ofnon-office-based physician mdnumber ofsmple physicims, byfmd

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

2. Estimated number mdpercent distibution ofnon-offlce-bsed physician by scope, according totype of professional

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

3 Estimated number and percentdistribution ofoffice visits tenon-office-based physicians by type ofprofessional group:

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

4. Estimatednumberandpercentdistribution ofnon-oflice-basedphysiciansbyscope, accordingto major activity: United

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

5. Estimated number and percent distribution ofin-scope physicians by patient care activity status, accordingto typeof

profwsionalgr oup:UnitedSt ates,1980. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. Estimated number and percent distibution ofnon-office-basedphysiciansbyscope, accordingto specialty as listedby

the American Medical Association(AMA) ortheAmerican Osteopathic Association (AOA): United States, 1980 . . . .

Section ’4. Patient data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tables

7. Estimated number and percent distribution ofoffice visits to Complement Survey and National Ambulatory Medical

Care Survey (NAMCS) physiciansby selected patient characteristics: United Statesj 1980 . . . . . . . . . . . . . . . . . . . . . . . .

8. Estimated number mdpercent distribution ofofice visiW to Complement Survey and National Ambulatory Medical

Care Survey (NAMCS) physicians by selected physician and physician practice characteristics: United States, 1980 . . . .

9. Estimated number andpercent distibution ofo~cevisiS to Complement Suweymd National Ambulator Medical

Care Survey (NAMCS) physicians by major reason for visit, pnorvisit status, and referral status: United States, 1980...

10. Estimated number mdpercent distribution ofofice visiW to Complement Survey and National Ambulatory Medicrd

Care Survey (NAMCS) physicians by patient’s principal reason for visiti United States, 1980 . . . . . . . . . . . . . . . . . . . . . .

11. Estimated number adpercent distibution ofofflce visits to Complement Survey physicians bythe20 most common

principal reasons for visit in rank order for the Complement Survey with the comparable National Ambulato~ Medical

Survey (NAMCS) ranks: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12. Est~mated number mdpercent distribution ofofice visi@ to Complement Survey and National Ambulatory Medical

Care Survey (NAMCS) physicians by number and type of diagnostic services ordered or provided United States,

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13. Estimated number mdpercent distibution ofofice visiti to Complement Survey and National Ambulatory Medical

Care Survey (NAMC6) physicians by principal diagnosis: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14. Estimated number and percent distribution of office visits to Complement Survey physicians for the 15 most common

principal diagnoses in rank order for the Complement Survey with the comparable National Ambulato~ Medical Care

Survey (NAMCS) ranks: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15. Estimated number of drug visits and drug visits as a percent of all office visits, by physician specialty for the Complement

Survey and the National Ambulatory Medical Care Survey (NAMCS): United States, 1980 . . . . . . . . . . . . . . . . . . . . . . .

1

2

4

5

5

5

6

6

7

7

8

8

9

10

11

12

12

13

13

14

...

Ill

.
16. Estimated number of drug mentions, estimated number of drug mentions per oflice visit, and estimated number of drug

mentions per drug visit, by physician specialty for the Complement Survey and the National Ambulatory Medical Care

Survey (NAMCS): United States, 1980. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

17. Estimated number and percent distribution of drug mentions during Complement Survey and National Ambulatory

Medical Care Survey (NAMCS) visits by therapeutic category United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

18. Estimated number and percent distribution of olTice visits to Complement Survey and National Ambulatory Medical

Care Survey (NAMCS) physicians by number of nonmedication therapeutic services ordered or provided and type of

nonmedication therapy ordered orprovided: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

19. Estimated number and percent distribution of office visits to Complement Survey and National Ambulatory Medical

Care Survey (NAMCS) physicians by disposition and duration of visit United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . 17

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...”.” . . . . . ” ”” ”. - . ”” . . ” . - ” ” ”” ””””----” ‘ “””””-”-” 18

Appendixes

I. Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . ...”””.”””-”””-”””.””.” .- ”. ””” O””---””””” :

II. Survey instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ” . ” ”- ”” ’”.””.... .. ”-”” ””” ”-O””’

III. Definition ofterms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...””””””.””””. ““” ”””.””-”--””””-- 43

IV. American Hospital Fomula~ Sewice classification system andtherapeutic category codes . . . . . . . . . . . . . . . . . . . . . . . . 46

Symbols

..- Data not available

. . . Category nonapplicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500where numbers are roundedto

thousands

*

Figure doesnot meet standards of

reliability or precision

* Figure suppressed to comply with

confidentiality requirements

iv
The National Ambulatory

Medical Care Complement

Survey

by Gloria J. Gardocki, Ph. D., Thomas McLemore, M. S. P. H.,

and James E. De Lozier, M. S., Division of Health Care Statistics

Section I

Background and purpose

Since 1973, the National Center for Health Statistics

(NCHS) has conducted the National Ambulatory Medical

Care Survey (NAMCS) annually to assess the national volume

and characteristics of patient visits for medical care services

provided by ofice-based physicians in the office setting. The

NAMCS has been an invaluable and unique source of information on the demographic characteristics of patients visiting

these phys~cians and on the presenting problems encountered,

the diagnostic conclusions reached, and the treatment regimens

ordered or provided during these visits. In 1980, NCHS conducted the National Ambulatory Medical Care Complement

Survey to supplement the information collected through

NAMC S. The objective of the Complement Survey was to

measure the volume and characteristics of ambulatory patient

ofllce visits made to physicians not included in the NAMC S

physician universe.

The NAMCS universe in 1980 and prior years included

physicians on the American Medical Association (AMA) and

American Osteopathic Association (AOA) mastefiles who

were classified as nonfederally employed, principally engaged

in office-based practice, and not specializing in anesthesiology,

pathology. or radiology. In this report these physicians are referred to as “oflice-based” physicians. The employment, principal acti} ity, and specialty classifications used to define thk

group are based on data obtained by the AMA and AOA through

periodic mail surveys. In the AMA and AOA masteries used

for the 1’980 NAMCS, approximately 210,000 physicians

were eligible to participate in NAMCS. These rnasterllles also

included approximately 230,000 physicians who did not meet

the criteria for inclusion in NAMCS. These were physicians

whose principal activity was classified as teaching, research,

administration, or hospital-based patient care; physicians who

were inactive (including those who were retired); physicians

who were unclassified as to principal activity because information wm lacking physicians who were federally employed,

and physicians who specialized in anesthesiology, pathology,

or radiology. These physicians were defined as out of scope for

NAMCS and are referred to as “non-office-based” physicians

in this report. The non-oftlce-based physicians are of interest

because some of these physicians render office-based ambulatory patient care, that is, they provide health care services that

were otherwise in scope for NAMCS.

There are several circumstances under which this could

happen. First, in the time intervening between the most recent

AMA or AOA data collection efforts and the selection of the

NAMCS sample of physicians, some physicians may have

changed their principal activity to oflice-based patient care

from some other activity. Second, some physicians may have

been unclassified because of a lack of information, yet were in

fact principally engaged in oflice-based patient care. Third,

some physicians appropriately classified by the AMA or AOA

as not principally engaged in office-based patient care may see

ambulatory patients in an office, although that is not their principal professional activity. Because the AMA and AOA classifications are based on the activity that occupies the largest

proportion of each physician’s professional time, a substantial

proportion of a particular physician’s professional time could

be spent in providing oftlce-based patient care, yet the physician

would be classified in some other principal activity category.

Although the NAMCS physician universe of office-based

physicians included the bulk of office-based patient care, it has

not been possible to estimate the volume of ambulatory patient

ofllce visits to other physicians. How office visits to offlcebased physicians differed from office visits to other physicians

also was not known. The Complement Survey was designed to

fill the first information gap by providing a national estimate of

visits by ambulatory patients in the private ol%ce setting of

physicians not in the NAMCS universe. The Complement

Survey also collected demographic, diagnostic, and therapeutic

information on the patients making these visits. Thk information

can be examined to determine if the visits to the non-o fflcebased physicians included in the Complement Survey differed

from those to the ofice-based physicians included in NAMCS.

The Complement Survey data also may be used by NCHS

management to assess the possibility of redefining the NAMCS

physician universe.
Section II

Data collection

The procedures used to conduct the Complement Survey

involved three stages of data collection. In the first stage, a

sample of all non-office-based physicians was screened by

telephone to elicit information about the provision of offlcebased care to ambulatory patients. In the second stage, those

physicians who appeared to provide health care services in a

private ofllce setting were visited and interviewed using the

same induction interview procedures used for the National

Ambulatory Medical Care Survey (NAMCS). This visit was

designed to acquaint the physician with the purpose of the

suwey and the procedures to be used. It also served as a final

screening in determining physician eligibility. In the thkd stage,

those physicians who were judged to be in scope for the Complement Survey through the induction interview were asked to

complete Patient Log and Patient Record forms for a randomly

assigned week. These forms, the same as those used for

NAMCS, were designed to obtain selected information about

individual patient visits sampled from among all visita occuning

during the physician’s survey participation week.

This brief overview of the Complement Survey encompasses numerous detailed procedures that are summarized

below. A complete presentation of the technical procedures,

data collection instruments, definitions, and drug classification

system that were used can be found in appendixes I–IV.

The Complement Survey used a multistage probability design very similar to that of NAMCS. The first stage of sample

selection involved a probability sample of 87 primary sampling

units (PSU’S), the same as were used in the 1980 NAMCS

design. In the second stage, the physicians who were located

within each PSU (according to the American Medical Association and American Osteopathic Association masterfiles),

and who were defined by the National Center for Health Statistics (NCHS) as non-office-based, were stratified by NCHS

into 11 professional groups on the basis of the mastertle information. The groups were federally employed physicians;

anesthesiologists, pathologists, and radiologists; physicians

principally engaged in teaching, research, administration, or

hospital-based patient care; and physicians who were inactive,

retired, or unclassified as to principal activity. Any physician

who qualified for two or three of the professional groups was

assigned to the first-listed group for which he or she qualified.

Then a systematic random sample of approximately 5,000

physicians was selected such that the overall probability of

selection was approximately equal for all physicians. (See appendix I for a more detailed description of the sampling method

used.) These physicians were screened by telephone in random

sets of approximately 500 until about 400 physicians eligible

for participation in the Complement Survey were identified.

This telephone screening interview, the first stage of data

collection, consisted of a series of closed-ended questions that

attempted to identifi only those physicians who saw ambulatory

patients in the private oflce setting. On the questionnaire, the

physicians were asked first to select their major professional

activity from a preceded list (patient care, research, teaching,

administration, or something else); the questions became pr~

gressively more restrictive in focus. The purpose was to establish

whether the physician provided any direct patient care, whether

the patients seen were private patients who were ambulatory,

and whether the locations at which the patients were seen fit

the NAMCS and Complement Survey definition of a private

ot%ce. Locations defined as an oflice setting, and, therefore, in

scope for both the Complement Survey and NAMCS, were

private ofices, non-hospital-based freestanding clinics, groups

or partnerships, Kaiser and Mayo clinics, neighborhood health

centers, and non-family-planning privately operated clinics.

Locations considered out of scope for both the Complement

Survey and NAMCS included hospital emergency departments, hospital outpatient departments, college or university

infkmaries, industrial outpatient facilities, family planning

clinics, and government-operated clinics. The interviewer also

was to record survey administrative data. The Telephone

Screening Assignment questionnaire is reproduced in appendix II.

Physicians who appeared to be in scope for the Complement Survey on the basis of the telephone screening interview

were later visited by a field representative for a personal induction interview. During this interview, the second stage of

data collection, the field representative made a final determination of the physician’s eligibility to participate in the survey,

obtained information on basic practice characteristics (for example, type of practice and expected number of office visits),

enlisted the physician’s cooperation, delivered survey materials

with verbal and printed instructions, and assigned a random

predetermined Monday-Sunday reporting period. The Induction Interview form used for Complement Survey physicians

was identical to that used for NAMC S physicians and is reproduced in appendix II.

For the Complement Survey, attempts were made to telephone four groups of 502 physicians, or a total of 2,008 physicians” for the screening interview. Of these, 21 refused to be

interviewed, leaving a total of 1,987 physicians. Of this

number, 18 were deceased, 148 were retired, 32 had moved

2
out of the United States, 232 could not be located, and 48

could not be screened for other reasons. On the basis of the

screening interview, 1,118 physicians were found not to provide

ofllce-based patient care and were also ruled out of scope for

the Complement Survey. This left 391 physicians who appeared

to be in scope for the Complement Survey, based on the telephone screening interview. (See table 1 in section IV.) An

additional 63 physicians were ruled out of scope through the

personal induction interview, resulting in a final sample of 328

physicians in scope for the Complement Survey.

Physician weights were computed to inflate the physician

sample data to national estimates. The weights accounted for

the probabilities of selection for each physician, and included

an adjustment for nonresponse. They also included a ratio adjustment to insure that the nationrd estimates for five major

professional groups-Federal; hospital-base+ teaching, research, and administration; inactive, retired, and unclassified;

and anesthesiologists, pathologists, and radiologists-would be

in accord with national totals for those five groups computed

using the 1979 AMA and AOA mastefilles. A brief analysis

of these weighted physician estimates is the subject of

section IV.

The final stage of sampling involved the selection of patient

visits within the annual practices of the sample physicians.

This was accomplished using exactly the same tecluique as

was used for NAMCS. First, each in-scope sample physician

was randomly assigned to a 1-week data collection period

during the survey year. Second, using the Patient Log to record

a sequential listing of patients seen during the assigned week,

each physician selected a systematic random sample of visits.

The sampling rate for selecting visits varied from 100 percent

for very small practices to 20 percent for very large ones. For

each visit sampled, the physician completed a Patient Record

form, the NAMCS data collection instrument for recording

demographic, diagnostic, and therapeutic information. The

Patient Record form is reproduced in appendix II.

Of the 328 physicians judged to be in scope for the Complement Survey, 283, or 86 percent, agreed to submit visit information. Of these, 38 saw no patients during their assigned

week because of illness, vacation, attendance at a convention,

or some other reason. The remaining 245 physicians completed

Patient Record forms, yielding a total sample of 5,400 office

visits.

Visit weights were computed to intlate the raw data to

national estimates. The weights accounted for the probabilities

of selecting a visit, adjusted for nomesponse. The final weighted

estimates constitute the patient visit data summarized in

section V.

All comparisons among physician estimates in section IV

and among patient visit estimates in section V were tested for

statistical significance using the Bonferroni test for multiple

comparisons, a modification of the t-test. Unless otherwise

stated, all statements regarding differences between or among

statistics indicate that the test results showed a difference significant at the p<.05 level.

3
Section 1II

Highlights

From the Complement Survey, it is estimated that there

were 226,000 non-ofllce-based physicians in 1980. Of these,

an estimated 38,000 (16.7 percent) saw some patienta in an

ofilce setting, and so were eligible to participate in the Complement Survey. Of these eligible physicians, 37.0 percent

were categorized in the hospital-based patient care professional

group and 23.6 percent were in the group unclassified as to

professional activity.

An estimated 68.6 million office visits to Complement

Survey physicians occurred in 1980. This was 10.6 percent of

all office visits to physicians. Two-thirds (67.8 percent) of the

Complement Survey visits were to physicians with professional

group classifications of hospital-based patient care or “unclassified.” Compared with National Ambulatory Medical Care

Survey (NAMCS) visits, Complement Suwey visits included

higher proportions of minority group members, new patients,

and patients who had been referred by another physician.

Complement Survey visits also were more likely to be visits to

non-solo practitioners and to practitioners located in metr~

politam areas than were NAMCS visits. A larger proportion of

Complement Survey patients than of NAMCS patients was

returned to a referring physician, and a smaller proportion was

instructed to return if needed. In addition, the average Complement Survey visit lasted 17.9 minutes, or 2.5 minutes longer

than the average NAMCS visit.

In 35.7 million of the Complement Survey visits, the

physician ordered or provided at least one prescription or nonprescription drug for the patient. This was only 52.0 percent of

the visits, significantly less than the corresponding 63.1 percent

of the NAMCS visits. During Complement Survey visits, an

estimated 72.3 million drug mentions were made. This was an

average of 1.05 drugs for each visitor 2.03 drugs for each visit

involving at least one drug. The comesponding NAMCS averages were not significantly different.
Section IV

Physician data

Statistics on the characteristics of non-office-based physicians, as estimated horn the Complement Survey, are presented

in tables 1,–6. Based on Complement Survey data, there were

an estimated 226,000 non-ofilce-based physicians in 1980.

(See tabk 1.) An estimated 38,000, or 16.7 percent, saw

patients in an office setting and thus were eligible to participate

in the Complement Survey. Of the remaining 188,000, most

(134,000, or 59.1 percent of all non-office-based physicians)

were out of scope because they did not meet the Complement

Survey criteria defining the provision of office care to patients.

An estimated 55,000 were considered out of scope because

they were deceased or retired, had moved out of the United

States or could not be located, or because of some other reason.

The distribution of the in-scope and out-of-scope physician

estimates accordkg to professional group is displayed in

table 2. For both categories, physicians whose principal activity

was hospital-based patient care formed the largest group. Of

the in-scope physicians, 37.0 percent (14,000) were hospitalbased, as were 41.8 percent of the out-of-scope physicians.

The next largest groups of in-scope physicians were unclassified

physicians (9,000) and anesthesiologists and radiologists

(4,000). (No pathologists were in scope.) Ranking the remaining activity groups revealed no other significant differences

between groups.

The data in table 2 also demonstrate that the proportion of

physicians who were eligible for the Complement Survey ranged

Table 1. Estimated number and percent distribution of non-office-based physicians and number of sample physicians, by final disposition:

United States, 1980

Physicians

Final disposition Non-office-based Sample

Percent

Number distribution Number

Ail physician s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226,123 100.0 I ,987

In scope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37,805 16.7 328

0utofsco3e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188,318 83.3 1,659

Deceased . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,991 0.9 18

Retired . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.033 8.0 148

Moved cmtofthe United States.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,471 1.5 32

Cannot beloeated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25,795 11.4 232

Ruled out in interview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133,633 59.1 1,181

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,395 2.4 48

Table 2. Estimated number and percent distribution of non-office-based physicians by scope, according to type of professional group:

United States, 1980

Physicians

Professional group Total In scope Out of.wope

Number Percent Number Percent Number Percent

—— —

All physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

— —

226,123 100.0 37,805 16.7 188,318 83.3

Federal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,112 100.0 1,891 10.4 16,221 89.6

Hospital-based patient care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . 92,760 100.0 13,998 15.1 78,762 84.9

Teaching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,391 100.0 1,!385 31.1 4,406 68.9

Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,452 100.0 3,075 21.3 11,377 78.7

Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,197 100.0 1,946 19.1 8,251 80.9

Anesthesiologists, pathologists, and radiologists’ . . . . . . . . . . . . . . . . . . . . . . . . . 28,597 100.0 4,387 15.3 24,210 84.7

Unclassified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26,290 100.0 8,913 33.9 17,377 66.1

Inactive, other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29,324 100.0 1,610 5.5 27,714 94.5

1No pathologists wara in scope.

5
from a low of 5.5 percent of the inactive and other physicians

to a high of 33.9 percent of the unclassified physicians. When

ranked according to size, none of the proportions differed significantly from adjacent ranks, but two observations could be

made. The first is that the proportion of unclassified physicians

who were in scope for the Complement Survey was significantly

higher than the corresponding proportions of all other activity

groups except teaching and research. The second is that the

proportion of inactive and other physicians who were eligible

to participate in the Complement Survey was significantly

lower than the proportions of all other groups except federally

employed physicians.

The estimated number of office visits made to the physicians eligible for the Complement Survey is presented in

table 3. Unclassified and hospital-based physicians accounted

for approximately two-thirds of all office visits to non-offlcebased physicians. Despite the fact that the proportion of inscope physicians who were hospital-based signii5cant1y exceeded

the proportion who were unclassified, the frequencies and proportion of visits to these two groups did not differ significantly.

Of all visits to Complement Survey physicians, 23.9 million

(34.8 percent) were to unclassified ones and 22.6 million

(32.9 percent) were to hospital-based ones.

This lack of a difference in the number and proportion of

visits is the result of the relatively high estimated average

number of visits per year made to unclassified physicians.

Several observations imply that the professional group category

of unclassified physicians includes an unknown number of

office-based physicians excluded from the NAMCS physician

universe. The in-scope unclassified physicians had approximately 2,700 visits per physician during the survey year, while

all other in-scope physicians had approximately 1,500 per

physician. Because the ofilce-based physicians included in

NAMCS had an average of approximately 3,500 visits per

physician in 1980, there clearly is a possibility that the “unclassified” physicians include some who would have been

classified in the ofilce-based patient care professional group if

sufficient information had been available to the American

Medical Association (AMA) or the American Osteopathic

Association (AOA) for their classification of physicians according to primary professional activity.

The telephone screening interview principal activity data

indicate that the majority of all non-oi%ce-based physicians

(13 1,000, or 57.9 percent) was primarily engaged in patient

care (table 4). Only 40,000 non-ofilce-based physicians, or

17.6 percent of all, reported that they were mainly engaged in

other activities. Of the physicians primarily engaged in patient

care, 26.6 percent provided patient care in an office setting,

and thus were in scope for the Complement Survey. Of the

other non-o ftlce-based physicians, only 7.3 percent cared for

patients in an office setting and were in scope for the Complement Survey. As a result, an estimated 92.3 percent of all

in-scope physicians reported that their primary professional

activity was patient care.

A cross-tabulation of professional classification and the

telephone screening interview patient care variable for in-scope

physicians only is presented in table 5. A large majority of the

physicians in each professional group reported during the telephone screening interview that patient care was their main

activity. The percents ranged from a low of 65.5 percent of

Table 3. Estimated number and percent distribution of office visits to non-office-based physicians by type of professional group: United Slates,

1980

Professional group Office visits

Number in thousands Percent distribution

All physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68,556 100.0

3,192

22,576

3,281

4,621

1,567

8,179

23,872

1,269

4.7

32.9

4.8

6,7

2.3

11.9

34.8

1.9

‘Of these visits, 95 percent were to radiologists

Table 4. Estimated number and percent distribution of non-office-based physicians by scope, according to major activity: United States, 1980

Physicians

Major activity Total In scope Out of scope

Number Percent Number Percent Number Percent

All physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . .

— — — —

226,123 100.0 37,805 16.7 188,318 83.3

Patient care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130,946 100,0 34,694 26.6 96,052 73.4

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39,785 100,0 2,911 7.3 36,874 92.7

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55,392 100.0 55,392 100.0

NOTE: Oata from telephone screening intewiew.

6
Table 5. Estimated number and percent distribution of in-scope physicians by patient,care activity status, according to typa of professional

group: United States, 1980

Physicians

Telephone screening interview

Major activity Major activity is

Professional group Total is patient care nor patient care

Number Percent Number Percent Number Percent

Allin-scope physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

— —— —— —

37,805 100.0 34,894 92.3 2,911 7.7

Federal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,891

Hospital-based patient care.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13,998

Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,075

Teaching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,985

Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,946

Anesthesiologists and radiologists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,387

Unclassified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,913

Inactive, other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,610

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

1,574

13,768

2,613

1,630

1,274

4,130

8,403

1,502

83.2

98.4

85.0

82.1

65.5

94.1

94.3

93.3

317 16.8

230 1.6

462 15.0

355 17.9

672 34.5

257 5.9

510 5.7

108 6.7

Table 6. Estimated number and parcent distribution of non-otice-based physicians by scope, according to spacialty listed by the American

Medical Association (AMA) or the American Osteopathic Association (AOA): Unitad States, 1980

AMA orAOA~ specialty Total In scope Out of scope

All physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General ar,d family practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Internal medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Surgical specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Obstetrics and gynecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Other specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anesthesiology, pathology, and radioiogyz. . . . . . . . . . . . . . . . . . . .

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

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Parcent

Number distribution

226,123 100.0

18,968 100.0

60,231 100.0

38,731 100.0

11,764 100.0

9,736 100.0

39,335 100.0

16,146 100.0

8,839 100.0

14,350 100.0

102,549 100.0

15,787 100.0

53,571 100.0

33,191 100.0

5,040 100.0

Percent

Number distribution

37,805 16.7

4,537 23.9

10.008 16.6

6,387 16.5

1,583 13.5

2,038 20.9

8,476 21.5

1,752 10.9

2,436 27.6

4,288 29.9

13,556 13.2

4,195 26.6

5,297 9.9

4,064 12.2

1,228 24.4

Percent

Number distribution

188,318 83.3

14,431 76.1

50,223 83.4

32,344 83.5

10,181 86.5

7,698 79.1

30,859 78.5

14,394 89.1

6,403 72.4

10,062 70.1

88,993 86.8

11,592 73.4

48,274 90.1

29,127 87.8

3,812 75.6

lAMA or AOA = American Medical Association or American Osteopathic Association.

‘No pathologiata were in scope.

those in the administration group to a high of 98.4 percent of

those in the hospital-based patient care group. Despite this

variation, the differences between adjacent ranks were not

significant.

Finidly, the distribution of all non-office-based physicians

by AMA or AOA specialty and scope is presented in table 6.

The rank order of the major specialty types was the same for all

physicians and for just the in-scope ones. Among the in-scope

physicians, the most common type was other specialties

(14,000); of these, a substantial 39.1 percent (or 14.0 percent

of all in-scope physicians) was in the category entirely excluded ffom NAMC S—radiologists and anesthesiologists.

Signiflcnntly smaller than this were the numbers of medical

specialists (10,000) and surgical specialists (8,000). The

smallest groups were general and family practitioners (5,000)

and physicians with an AMA or AOA specialty classification

of unknown ( 1,000).

The percent of physicians in each AMA or AOA major

specialty type that was in scope for the Complement Survey

varied from 13.2 percent for other specialists to 24.4 percent

for those with an unknown specialty. Of general and family

practitioners, 23.9 percent were in scope, as were 21.5 percent

of surgical specialists and 16.6 percent of medical specialists.

Although this variation appeared, no difference between adjacent ranked percents was statistically significant.

7
Section V

Patient data

This section summarizes the data on patient visits obtained

through the 1980 Complement Survey. In addition, the information on Complement Survey visits is compared and contrasted with 1980 National Ambulatory Medical Care Survey

(NAMCS) visit information.

The demographic characteristics of the patients who made

office visits in 1980 are shown in table 7. There were an estimated 68.6 million visits to Complement Survey physicians, of

which the largest proportions were made by persons 25 –44

years of age (28.5 percent) and persons 45–64 years of age

(24.6 percent). The smallest proportions of visits were made

by persons 15-24 years of age ( 13.9 percent) and persons 65

years of age and over (14.4 percent). The age distribution for

visits included in the Complement Survey differed significantly

liom the age distribution for NAMCS visits in only one respect—

the proportion of Complement Survey visits made by persons

65 years old and older (14.4 percent) was smaller than the

corresponding proportion of NAMCS visits (17.5 percent).

For each survey, the proportion of visits made by females

was significantly greater than the proportion made by males.

Table 7. Estimated number and percent distribution of office visits to Complement Survey and National Ambulatory Medical Care Survey

(NAMCS) physicians by selected patient characteristics: United States, 1980

Office visits

Characteristic Complement Survey NAMCS

Number in

thousands

Percent

distribution

Number in

thousands

Percent

Both sexes distribution

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68,556

12,764

9,515

19,540

16,863

9,874

100.0

18.6

13.9

28.5

24.6

14.4

575,745

109,356

81,561

154,695

129,645

100.488

I 00.0

19.0

14.2

26.9

22.5

17.5

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

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

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

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

65yeara end over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female

40,077

5,601

5,851

13,037

9,953

5>634

58.5

8.2

8.5

19.0

14.5

8.2

346,106

50,503

54,879

103,562

76,385

60,777

60,1

8.8

9.5

18.0

13.3

10.6

Male

28,479

7,163

3,664

6,503

6,909

4>240

41.5

10.4

5.3

9.5

10.1

6.2

229,639

58,852

26,682

51,134

53,260

39,712

39.9

10.2

4.6

8,9

9.3

6.9

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

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

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

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

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

65vears and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rata

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Another, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...’. .

Asian or Pacific islander . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

American lndianor Alaakan Native. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

59,696

8,860

7,505

787

*569

87.1

12.9

11.0

1.2

‘0.8

516,616

59,129

52,872

4,133

2,124

89.7

10.3

9.2

0.7

0.4

Ethnicity

6,771

61,785

9.9

90.1

28,720

547,025

5.0

95.0

8
However, the two surveys did not differ significantly in the

proportion of visits made by each sex. The two surveys also did

not differ significantly in the proportion of visits made by each

age group within each sex, with one exception. In the Complement Survey, 8.2 percent of all visits were made by females

65 years old and older, compared with 10.6 percent in

NAMCS. This difference for elderly females accounts for the

earlier observation that the proportion of visits made by persons 65 years old and older was somewhat smaller for the

Complement Survey than for NAMCS,

The visits to Complement Survey physicians were more

likely to be made by minority group members than the visits to

NAMCS physicians were. Persons of all races other than

white made 12.9 percent of the visits to Complement Survey

physicians, an amount that was slightly, but significantly, greater

than the corresponding 10.3 percent of visits to NAMCS physicians. Most of this difference is accounted for by blacks, who

made a significantly higher proportion of the visits to Complement Survey physicians (11.0 percent) than of the visits to

NAMCS physicians (9.2 percent). Similarly, Hispanic persons

made 9.9 percent of the Complement Survey visits, but only

5.0 percent of the NAMCS visits.

The distributions of Complement Survey and NAMCS

visits accclrding to physician and physician practice characteristics are presented in table 8. The differing specialty distributions of the physicians participating in the two surveys led to

differing physician specialty distributions for the visits recorded

by the surveys. The most important difference is that visits to

the major specialty type of other specialists accounted for a

greater proportion of Complement Survey visits ( 18.7 percent)

than of NAMCS visits (6.0 percent). This is because the

Complement Survey included radiologists and anesthesiologists

in this catego~, but NAMCS excluded all practitioners with

these specialties. Of all Complement Survey visits, 13.2 percent,

or 9.1 million, were to these specialists. If these visits are

excluded from consideration, only 6.3 percent of the Complement Survey visits were to other specialists, a proportion that

did not differ significantly from that noted for NAMCS.

Another difference is that regardless of whether data on all

Complement Survey visits or only data on visits to those physicians who did not specialize in radiology or anesthesiology

are used, visits to Complement Survey physicians were less

concentrated in general and family practice than visits to

NAMCS physicians were. Visits to general and family practitioners accounted for a smaller proportion of all Complement

Survey visits (21.6 percent) than of NAMCS visits (33.3 percent). Excluding visits to radiologists and anesthesiologists

raises the proportion for Complement Survey physicians to

24.9 percent, but that amount is still significantly smaller than

the one noted for NAMC S physicians.

In addition, of all visits to Complement Survey physicians,

the proportions that were to medical specialists (33.4 percent)

Table 8. lEstimated number and percent distribution of office visits to Complement Survey and National Ambulatory Medical Care Survey

(NAMCS) physicians by selected physician and physician practice characteristics: United States, 1980

Office visits

Physician and physician practice characteristic Complement Survey NAMCS

Number in

thousands

Percent

distribution

Number in

thousands

Percent

distribution

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68,556 100.0 575.745 100.0

Physician specialty

General and family practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Internal medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Surgical specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Obstetrics and gynecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,,

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

Other specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychiat~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anesthesiology andradiologyl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

14,833

22,911

10,719

7,058

5,134

17,974

1,767

6,266

9,941

12,838

3,045

9,061

731

21.6

33.4

15.6

10.3

7.5

26.2

2.6

9.1

14.5

18.7

4.4

13.2

1.1

191,744

177,127

69,481

64,223

43,423

172,524

28,315

55,123

89,086

34,350

15,856

33.3

30.8

12.1

11.2

7.5

30.0

4.9

9.6

15.5

6.0

2.8

1

3:2”

‘.. .

18,494

Type of practitioner

Doctor of medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Doctor of osteopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65,275

3,281

95.2

4.8

539,593

36,152

93.7

6.3

Type of practice

34,000

34,557

49.6

50.4

313,963

261,783

54.5

45.5

Location of practice

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

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

57,356

11,200

83,7

16.3

439,721

136,024 ‘

76.4

23.6

lThe NAMCS sample of physicians excluded physicians with these specialties. In the Complement Survey, 95 percent of these visita were to radiologista.

9
and to surgical specialists (26.2 percent) did not differ significantly horn the proportions of NAMC S visits made to medical

specialists (30.8 percent) and surgical specialists (30.0 percent).

After excluding Complement Survey data on radiologists and

anesthesiologists, however, Complement Survey and NAMC S

physicians did differ in the proportion of visits made to medical

specialists-the Complement Survey proportion (38.5 percent)

was greater than the NAMCS proportion (30.8 percent).

The vast majority of visits in both surveys were made to

doctors of medicine rather than to doctors of osteopathy. Visits

to doctors of osteopathy, however, accounted for a slightly

smaller proportion of all Complement Survey visits (4.8 percent)

than of NAMC S visits (6.3 percent). Although the difference

is substantively small, it is statistically significant.

The distribution of visits according to type of practice differed for the two surveys. Visits to solo practitioners accounted

for a slightly smaller proportion of Complement Survey visits

(49.6 percent) than of NAMCS visits (54.5 percent), a difference that is, however, statistically significant.

The last physician practice characteristic compared for the

Complement Survey and NAMC S is the practice location.

Visits to physicians in metropolitan locations accounted for the

large majority of both Complement Survey visits (83.7 percent)

and NAMCS visits (76.4 percent). The proportion of visits

occurring in metropolitan areas was significantly greater for the

Complement Survey, however, than for NAMC S.

A comparison of several patient status variables for the

two surveys is shown in table 9. For the Complement Survey,

the most common major reason for visit was to obtain care for

an acute problem (26.0 million visits, or 38.0 percent of all

visits). Less common major reasons were a routine visit for

care of a chronic problem (19.8 million visits, or 28.8 percent),

and nonillness care ( 11.1 million visits, or 16.2 percent). The

least frequently cited major reasons for visit were to ob~?in postsurgery or postinjury care (5.9 million visits, or 8.6 percent)

and to obtain care for a flareup of a chronic problem (5.7 million

visits, or 8.3 percent). None of these percents differed significantly from those obtained for NAMCS, indicating that the

types of problems leading to office visits were quite similar for

both sets of physicians.

In both surveys, returning patients accounted for a much

larger proportion of visits than new patients did. Furthermore,

many more of the visits made by returning patients were made

for an old problem rather than a new one. Despite these similarities, however, there also was an important difference—

returning patients accounted for a significantly smaller proportion of the Complement Survey visits than of the NAMCS

visits (74.0 percent, compared with 85.1 percent). The larger

role played by new patients in the practices of Complement

Survey physicians may be explained by the observation that

patients who had been referred by another physician made a

larger proportion of the Complement Survey visits ( 14.6 percent) than of the NAMC S visits (4.4 percent).

The Patient Record form used in the Complement Survey

and NAMC S allowed for recording the patient’s description of

the most important and other complaints, symptoms, or other

reasons for visit. These reasons were coded according to “A

reason for visit classification for ambulatory care. ” 1This coding system includes major categories, such as symptoms or test

results, as well as specific reason for visit codes.

The similarity between the Complement Survey and

NAMCS data with respect to reason for visit categories is

striking, as the two surveys not only showed the same three

leading categories, but also did not show significant differences

in the proportion of visits recorded in any major category or

any symptom subcategory. (See table 10.) In both surveys,

Tabla 9. Estimatad number and percent distribution of office visits to Complement Survey and National Ambulatory Medical Care Survey

(NAMCS) physicians by major reason for visit, prior visit status, and referral status: United States, 1980

Office visits

Visit characteristic Complement Suwey NAMCS

Number in

thousands

Percent

distribution

Number in

thousands

Percent

distribution

Allvwits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68,556

Major reason for visit

Acuta problem.............,.. . . . . . . . . . . . . 26,023

Chronic problem, routine . . . . . . . . . . . . . . . . . . . . 19,772

Chronic problem, flareup ...,.... . . . . . . . . . . . . . . . . . . . . . . 5,721

Postsurge~, postinjury ...,..... 5,912

Non-illness camel . . . . . . . . . . . . . 11,128

Prior visit status

New patient . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,809

Old patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50,747

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . ...’.... 11,890

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38,857

Referral status

Referred by another physician . . . . . . . . . . . . . . . . . . . . 10,023

Notreferred by another physician. . . . . . . . . . . . . . . . . . . . . . . . . . 58,533

100.0

38.0

28.8

8.3

8.6

16.2

26.0

74.0

17.3

56.7

14.6

85.4

575,745

208,428

162,075

52,703

50,169

102.370

85,519

490,226

130,294

359,932

25,370

550,375

100.0

36.2

28.2

9.2

8.7

17.8

14.9

35.1

22.6

62.5

4.4

95.6

llncludes, for example, routine prenatal care, general examination, and well-baby examination.

10
Table 10. Estimeted number and percent distribution of office visits to Complement Survey and National Ambulatoy Medical Care Survey

(NAMCS) physicians by patient’s principal reason for visit United States, 1980

Office visits

Principal reason for visit and WC codef Complement Survey NAMCS

Number in

thousands

Percent

distribution

Number in

thousands

Percent

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

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

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S001-S099

Symptoms referable to psychological and mental disorders. . . . . . . . . . . . . . . S1 00-S1 99

Symptoms referable to nervous system (excluding sense organs) . . . . . . . . . . S200-S259

Symptoms referable to the cardiovascular and lymphatic systems. . . . . . . . . . S260-S299

Symptoms referable tothe eyes and ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S300-S399

Symptoms referable to the respiratory system. . . . . . . . . . . . . . . . . . . . . . . . . . S400-S499

Symptoms referable to the digestive system . . . . . . . . . . . . . . . . . . . . . . . . . . S500-S639

Symptoms referable to the genitourinary system. . . . . . . . . . . . . . . . . . . . . . . . S640-S829

Symptoms referable to the skin, nails, and hair. . . . . . . . . . . . . . . . . . . . . . . . . S830-S899

Symptoms referable to the musculoskeletal system . . . . . . . . . . . . . . . . . . . . . S900-S999

Disease module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. DD999D999

Diagnostic, screening, and preventive module. . . . . . . . . . . . . . . . . . . . . . . . . . . . Xl 00-X599

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

Injuriea andadverse effects module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. JOO1-J999

Test results module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. R1OO-R7OO

Administrative module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. A1OO-A14O

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. U990-U999

68,556

36,090

5,229

2,459

1,892

“402

3,903

5,807

4,829

3,102

2,745

5,722

6,650

11,594

7,706

3,441

*353

899

1,824

100.0

52.6

7.6

3.6

2.8

“0.6

5.7

8.5

7.0

4.5

4.0

8.4

9.7

16.9

11.2

5.0

“0.5

1.3

2.7

575,745

313,162

43,730

15,529

17,449

3,336

33,360

54,710

26,011

26,475

38,330

54,233

46,279

112,726

59,110

23,151

2,601

8,830

9,887

100.0

54.4

7.6

2.7

3.0

0.6

5.8

9.5

4.5

4.6

6.7

9.4

8.0

19.6

10.3

4.0

0.5

1.5

1.7

1Based on National Center for Health Statistic: D. Schneider, L Appleton, and T. McLemore: A reason for visit classification for ambulatory care [RVC]. V@/ andHeakh

.Wackfics.Series2, No. 78. DHEW Pub. No. (PHS) 79-1352. Publlc Health Service. Washington. U.S. Government Printing Office, Feb. 1979.

21ncludes blanks, entries marked “none”; illegible entries, and problems and symptoms not elsewhere classified.

symptoms were the most frequently cited reasons for visit,

accounting for approximately half of all visits (52.6 percent of

Complement Survey visits and 54.4 percent of NAMCS visits).

Diagnostic, screening, and preventive care was the second

most commonly given reason, appearing for 16.9 percent of the

Complement Survey visits and 19.6 percent of NAMCS visits.

Treatment, the third most commonly cited principal reason for

visit, was recorded for 11.2 percent of Complement Survey

visits and 10.3 percent of NAMCS visits.

The 20 most common specific reasons for Complement

Survey visits accounted for 41.2 percent of all visits and are

presented in table 11. (The ordering of these reasons may be

somewhat arbitrary because the frequencies and proportions

for adjacent ranks did not differ significantly.) Again, the similarity between the reasons for visits included in the Complement Survey and those for visits included in NAMCS is striking.

The first four reasons most frequently cited for Complement

Survey visits—general medical examinations; routine prenatal

examinations; postoperative visits; and progress visits, not

otherwise specified-were the same as the first four cited for

NAMCS visits. Furthermore, of the 20 reasons most frequently

cited for Complement Survey visits, 17 were among the 20

most common reasons for NAMC S visits.

Information on the ordering or provision of diagnostic

services during office visits is presented in table 12. Excluding

visits in which no diagnostic services were ordered or provided,

for both surveys the number and proportion of visits decreased

as the number of diagnostic services increased. The largest

number and proportion of Complement Survey visits involved

one diagnostic service (33.3 million visits, or 48.6 percent of

all visits), followed by visits in which two of these services

were ordered or provided ( 18.8 million, or 27.5 percent), visits

in which three or more services were ordered or provided

( 10.2 million, or 14.8 percent), and visits in which no such

services were involved (6.2 million, or 9.1 percent). The two

surveys did not differ significantly in the average number of

diagnostic services ordered or provided during visits. This

average was 1.5 for the Complement Survey and 1.6 for

NAMCS.

For both surveys, the most common diagnostic services

ordered or provided were a limited history or examination, a

blood pressure check, and a clinical laboratory test. However,

the proportion of visits involving a limited history or examination was smaller for the Complement Survey than for NAMC S

(53. 1 percent compared with 63.8 percent), as was the proportion of visits involving a clinical laborato~ test ( 17.8 percent

compared with 21.8 percent). An additional difference between

the two surveys was that X-rays were ordered or provided in

17.8 percent of the Complement Survey visits, but only

7.3 percent of the NAMCS visits. This last difference was

expected because radiologists were included in the Complement Survey, but not in NAMCS.

Diagnostic information for the Complement Survey and

NAMCS was coded according to the International Classz@

cation of Diseases, 9th Revision, clinical kfodzYication. 2 The

distribution of principal diagnoses according to the major

diagnostic classes for both surveys is presented in table 13. As

with the reason for visit distributions presented earlier, there

was little difference between the diagnostic distributions of the

two types of visit. The leadlng classes of principal diagnosis

were the same-supplementary classification of factors influencing health status and contact with health service, diseases

of the respiratory system, and diseases of the nervous system

and sense organs. (The rankhgs of diagnostic classes and

11
Table 11. Estimated number and percent distribution of office viaits to Complement Survey physicians by the 20 moat common principal

reasonafor visit in rank order for the Complement Survey with thecompareble National Ambulatory Medical Care Survey (NAMCS) ranks:

United States, 1980

Complement

IVAMCS Survey Complement Survey

rank rank Principal reason for visit and RVC codel office visits

1

2

3

4

15

8

19

6

5

10

16

7

12

14

11

20

13

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Allreasons for visit......,,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General medical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X1OO

Prenatal examination, routine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X2O5

Postoperative visit.........,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . .. T2O5

Progress visit, notothenvise specified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T800

Abdominal pain, cramps, spasms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S550

Well-baby examination, ,. ...,. . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, . . . . . . . . . . . . . .. XIO5

Vision dysfunctions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . .. S305

Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S440

Symptoms referable to throat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . .. S455

Head cold, upper respiratory infection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S445

Chest pain and related symptoms (not referable to body system). . . . . . . . . . . . . . . . . . . S050

8ack symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . .. S905

Earache, or ear infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . .. S355

Other diseases of blood and blood-forming organs. . . . . . . . . . . . . . . . . . . . . . . D255

Anxiety and nervousness . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . .. S100

Headache, pain in head, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . .. S210

Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S010

Eye examination..........,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X23O

Allergy medication, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. TIOO

Blood pressure test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X320

Another reasons forvisit. .,... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

68,556

3,030

2,830

1,972

1,906

1,727

1,716

1,462

1,214

1,179

1,168

1,156

1,145

1,078

1,071

1,067

982

979

894

851

849

40,281

Percent

distribution

100.0

4.4

4.1

2.9

2.8

2.5

2.5

2.1

1.8

1.7

1.7

1.7

1.7

1.6

1.6

1.6

1.4

1.4

1.3

1.2

1.2

58.8

1Based on National Center for Health Statistics: D. Schneider, L, Appleton, and T. McLemore: A reason for visit classification for ambulatory care [RVC]. Vita/ and Hea/th

Stadstics. Series 2, No. 78. DHEW Pub, No. (PHS) 79–1352. Public Health Service. Washington. U.S. Government Printing Office, Feb. 1979.

Table 12. Estimated number and percent distribution of office visits to Complement Survey and National Ambulatory Madical Care Survey

(NAMCS) physicians by number and type of diagnostic services ordered or provided: United States, 1980

Office visits

Number ofdiagnostic sewices and type ofdiagnostic setvice Complement Survey NAMCS

All visits ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of diagnostic services

Type of diagnostic servicel

Number in

thousands

Percant

distribution

Number in

thousands

Percent

distribution

68,566

6,231

33,297

18<844

10,184

6,231

36,427

11,878

2.471

12,187

11,637

20,638

1,737

4,078

*462

779

2,905

100.0

9.1

48.6

27.5

14.8

9.1

53.1

17.3

3.6

17.8

17.0

30.1

2.5

6.0

‘0.7

1.1

4.2

575.745

47,126

255,325

175(413

97,661

47,126

367,467

90,790

25,419

125,613

41,925

195,382

16,294

32,726

4,687

8,907

29,222

100.0

8.2

44.3

30.5

17,0

8.2

63.8

15.8

4.4

21.8

7,3

33,9

2.8

5.7

0.8

1.5

5.1

lDoes not add to 100,0 because more than one diagnostic serwce may have been ordered or provided during a visit

12
Table 13. Estimated number and percent distribution of office visits to Complement Survey and National Ambulato~ Medical Care Survey

(NAMCS) physicians by principal diagnosis: United States, 1980

Office visits

Principal diagnosis and ICD-9-CM code~ Complement Survey NAMCS

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

infectious and parasitic diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...001-139

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

Endocrine, nutritional, and metabolic diseases and immunity disorders . . . . . ...240-279

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

Diseasea of the nervous system and sense organs . . . . . . . . . . . . . . . . . . . . . . . ...320-389

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

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

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

Diseasea of thegenitourinarys .ystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...580-629

Diseases of the skin 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 of factors influencing health status and contact with health

service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..VO1 -V82

Another diagnosesz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown diagnoses3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

68,556

2,041

3,035

2,407

3,519

6,134

5,782

7,160

3,996

5,006

2,583

4,185

2,314

5,225

12,519

1,159

1,491

Percent

distribution

100.0

3.0

4.4

3.5

5.1

9.0

8.4

10.4

5.8

7.3

3.8

6.1

3.4

7.6

18.3

1.7

2.2

Number in

thousands

575,745

19,628

16,021

24,166

24,343

52,593

53,691

72,886

23,421

32,936

36,214

36,839

19,020

46,187

102,237

7,951

7,613

Percent

distribution

100.0

3.4

2.8

4.2

4.2

9.1

9.3

12.7

4.1

5.7

6.3

6.4

3.3

8.0

17,8

1.4

1.3

18ased on U.S. Public Health Service and Health Care Financing Administration: /ntenrat/ona/ C/ass/f/cation of Diseases, 9th Revision, C/inica/ Modification. DHHS Pub.

No. (PHS) 80-1260. Public Health Service, Washington. U.S. Government Printing Office, Sept. 1980,

‘Includes diaeasea of the blood and blood-forming organa (280-289); com~lications of pregnancy, childbirth. and the puerperium (630-676): congenital anomalies

(740-759); and certain conditions originating in the perinatal period (760-779).

31ncludes blank diagnosea, noncodable diagnoaes, and illegible dtagnosea.

specific diagnoses may be arbitrary, however, as the differences evaluation for suspected conditions, and normal pregnancy.

between numbers or percents of visits for adjacent ranks were Eleven of the 15 diagnoses also were among the 15 most comnot always significant, particularly for the Complement Survey.) mon principal diagnoses for NAMCS visits.

The 15 most common specific principal diagnoses asso- Drug visits for the Complement Survey and NAMCS are

ciated with visits to Complement Survey physicians, accounting tabulated according to physician specialty in table 15. A drug

for 33.9 percent of these visits, are tabulated in table 14. The visit is an office visit in which one or more therapeutic medicaIeading diagnoses were essential hypertension, observation and tions were ordered or provided: the medications involved may

Table 14. Estimated number and percent distribution of office visits to Complement Survey physicians for the 15 most common principal

diagnoses in rank order for the Complement Survey with the comparable National Ambulatory Medical Care Survey (NAMCS) ranks: United

States, 1980

Complement

NAMCS Survey Complement Survey

rank rank Principal diagnosis and ICD-9-CM code~ office visits

2

1

3

5

6

7

4

11

9

10

15

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

Nldiwnoses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Observation and evaluation for suspected conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V71

Normal pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V22

Health supervision ofinfant orchild . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V20

Acute upper respiratory infections of multiple or unspecified sites. . . . . . . . . . . . . . . . ...465

Suppurative andunspecified otitis media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...382

Neurotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..3oo

Disorders ofrefraction snd accommodation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...367

General medical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..v7o

Special investigations and examinations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V72

Renal failure, unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...586

Followup examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V67

Diabetea mellitus, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Other forms ofchronic ischemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...414

Other andunspecified arthropathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...716

All other diagnoses, . . . . . . . . . . . . .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, , . . . . .. Residual

Number in

thousands

68,556

2,837

2,580

2,487

2,306

1,814

1,742

1,580

1,286

1,229

1,111

1,056

1,030

923

“675

“608

45,292

Percent

distribution

100.0

4.1

3.8

3.6

3.4

2.6

2.5

2.3

1.9

1.8

1.6

1.5

1.5

1.3

1.0

0.9

66.1

1Based on U.S. Public Health Service and Health Care Financing Adminiatration: International Classification of Diseases, 9th Revision, Clinicel Modification. DHHS

Pub. No. (PHS) 80-1260. Public Health Sarvice. Washington. U.S. Government Printing Office, Sapt. 1980.

13
Table 15. Estimated number of drug visits and drug visits as a percent f all office visits, by physician specialty for the Complement Survey and

the National Ambulatory Medical Care Survey (NAMCS): United States, 1980

Drug visits

Complement Survey NAMCS

Number in As percent of Number in As percent of

Physician specialty thousands all office visits thousands all office visits

All specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35,650 52.0 363,489 63.1

General and family practice, ,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,816 72.9 ‘144,478 75.3

Medical specialties, , ...,,.... . . . . . . . . . . . . . . . . . . . . . . . . 16,896 73.7 131,775 74.4

Internal medicine, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,844 82.5 53,091 76.4

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,220 59.8 45,575 7’1.0

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,832 74.7 33,108 76.2

Surgical specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,033 33.6 67,912 39.4

General surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *340 *1 9.2 9,860 34.8

Obstetrics and gynecology, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,515 40.1 23,984 43.5

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,178 32.0 34,068 38.2

Other specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,905 14.8 19,325 56.3

Psych iatry . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,115 36.6 5,706 36.0

Anesthesiology andradiologyl, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *580 6.4

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “209 *28.6 13,6’1”9 73:6

lThe NAMCS sample of physicians excluded physicians with these specialties. In the Complement Survey, 95 percent of these visits were to radiologists.

have been either prescription or nonprescription dregs. The

distribution of drug visits among the major specialty types reflects the differing visit distributions across physician specialties

observed in table 8. For Complement Survey physicians,

medical specialists accounted for the largest number of drug

visits ( 16.9 million), and general and family practitioners accounted for the second largest number ( 10.8 million). This

order was reversed for NAMC S physicians. There were

144.5 million drug visits to general and family practitioners

and 131.8 million to medical specialists. Drug visits to surgical

specialists and other specialists accounted for smaller numbers

of drug visits in each survey.

Data on drug visits as a percent of all visits for both surveys are presented in table 15. These statistics indicate that the

proportion of visits in which one or more medications were

ordered or provided was significantly smaller for the Complement Survey (52.0 percent) than for NAMCS (63.1 percent).

This result is largely explained by the inclusion of radiologists

and anesthesiologists in the Complement Survey, but not

NAMCS. The Complement Survey recorded an estimated

9.1 million visits to these specialists, with one or more therapeutic medications ordered or provided in only 0.6 million of

them, or 6.4 percent. If visits to these specialists are excluded

from consideration, 58.9 percent of the remaining 59.5 million

Complement Survey visits involved the ordering or provision

of therapeutic medication. Although the difference between

this and the percent of NAMCS visits that were drug visits is

smaller than the original difference, it is still statistically

significant.

Statistics on drug mentions, according to the specialty of

the prescribing physician, are presented in table 16. A drug

mention is the order or provision of a specific therapeutic

medication, either prescription or nonprescription. The

NAMCS and Complement Survey data collection forms allowed for recording as many as eight such medications for each

visit sampled. There were an estimated 72.3 million drug mentions recorded by the Complement Survey. The largest numbers

of these were made by medical specialists (39.5 million) and

general and family practitioners (21.0 million). Although proportions are not shown in the table, the proportion of all drug

mentions made by Complement Survey physicians of each

major specialty type and of each specific specialty included in

table 16 did not differ significantly from the proportion made

by the comesponding type or specific specialty of NAMCS

physicians.

The number of drug mentions per ofi’ice visit (the drug

mention rate) for both surveys also is presented in table 16.

Complement Survey physicians made an average of 1.05 drug

mentions for each visit, which did not differ significantly from

the average of 1.18 for NAMCS physicians. Of the Complement Survey physicians, medical specialists, with a drug mention rate of 1.72, and general and family practitioners, with a

drug mention rate of 1.42, each prescribed more drugs per visit

than either surgical specialists (0.49) or other specialists (0.24).

Only one significant difference appeared between corresponding NAMCS and Complement Survey major specialty

types or specific specialties in the average number of drugs

provided or ordered during an oi%ce visit. Other specialists in

NAMCS had a higher drug mention rate than those in the

Complement Survey ( 1.08 compared with 0.24). This was the

result of the subcategory of other, which had a mention rate of

1.49 in NAMCS and 0.42 in the Complement Survey.

Data on the average number of drug mentions for drug

visits, or the drug intensity rate, according to physician specialty

are also given in table 16. There were even fewer significant

differences among these rates, within each survey and between

the two surveys, than there were among the dmg mention rates.

The Complement Survey overall drug intensity rate, major

specialty type rates, and specific specialty rates did not differ

significantly from the corresponding rates for NAMCS. The

overall drug intensity rate was 2.03 for the Complement Survey

and 1.87 for NAMCS. Within each survey, the rates for the

major physician specialty types did not differ significantly.

Within each major specialty type for the Complement Survey,

14
Tabla 16. Estimated number of drug mentions, estimated number of drug mentions per office visit, and estimated number of drug mentions

per drug visit, by physician specialty for the Complement Survey and the National Ambulatory Medical Care Survey (NAMCS): United States,

1960

Drug mentions

Complement Survey NAMCS

Number in Number in

Physician specialty thousands Per office visit Per drug visit thousands Per office visit Per drug visit

All specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72,296 1.05 2.03 679,593 1.18 1.87

General and family practice . . . . . . . . . . . . . . . . . . . . 20,991 1.42 1.94 279,186 1.46 1.93

Medical specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . 39,485 1.72 2.34 262,209 1.48 1.99

Internal medicine . . . . . . . . . . . . . . . . . . . . . . . . . . 23,884 2.23 2.70 118,943 1.71 2.24

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *5,928 0.84 1.40 72,825 1.13 1,60

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *9,673 *1 .88 2.52 70,442 1.65 2.13

Surgical specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,801 0.49 1.46 100,953 0.59 1.49

General surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . *523 “0.30 *1 .54 15,881 0.56 1.61

Obstetrics and gynecology. . . . . . . . . . . . . . . . . . . *3,5Q4 “0.56 ●1.39 33,026 0.60 1.38

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,774 0.48 1.50 52,047 0.58 1.53

Other specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,019 0.24 *1 .58 37,245 1.08 1.93

Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *1 ,596 0.52 *1 .43 9,655 0.61 1.69

Anesthesiology and radiology . . . . . . . . . . . . . . . “1,118 ‘0.12 *1 .93

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “304 ‘0.42 *1 .45 27,590 1:49 2:03

lThe NAMCS sample of physician excluded physicians with these specialties. In the Complement Survey, 95 percent of these visns were visits to radiologists.

the drug intensity rates of the specific specialties included in

table 16 did not differ significantly. For NAMCS, however,

significant differences did appear within the medical specialist

type. The drug intensity rates for specialists in internal medicine

(2.24) and other medical specialties (2. 13) did not differ, but

both were greater than that for pediatricians (1.60). This small

variation in the patterning of these rates by physician specialty

is the only noteworthy difference in dmg utilization that appeared between the surveys.

The frequency and percent distributions of dmg mentions

tabulated by the therapeutic categories of the dregs ordered or

provided are shown in table 17. The therapeutic categories are

groupings of drugs according to their desired effects, and are

based on the classification system used by the American Society

of Hospital Pharmacists (appendix IV). The categories of drugs

most frequently ordered or provided by Complement Survey

physicians were central nervous system drugs (with 12.5 million

mentions, or 17.2 percent of all mentions), cardiovascular drugs

(8.6 million, or 11.9 percent), and anti-infective agents

(8. 1 million, or 11.2 percent). This ranking of therapeutic categories may be arbitrary, however, as the frequencies and percents did not differ significantly among themselves.

Among NAMCS physicians, a very similar percent distribution appeared-central nervous system drugs (16.3 percent

of all dmg mentions) and anti-infective agents ( 15.4 percent)

were not ordered or provided significantly differently, but both

were ordered or provided significantly more frequently than the

third-ranked drug category of cardiovascular drugs (9.5 percent).

Consequently, it appears that the lack of statistically significant

differences among the therapeutic categories of the drugs

ordered or provided by the Complement Survey physicians

simply may be a result of the comparatively large relative

standard errors estimated for the statistics of that survey.

(NAMCS, based on a much larger sample, has comespondingly

smaller relative standard errors, and so comparatively small

diHerences between percents can attain statistical significance.)

This is supported by the observation that NAMCS and the

Complement Survey significantly differed in the percent of

drug mentions in the therapeutic categories for only one

category-anti-infective agents. The proportion of all drug

mentions that were in this category was significantly smaller

for the Complement Survey ( 11.2 percent) than for NAMCS

( 15.4 percent). This difference was due to different prescribing

patterns for the subcategory of antibiotics; for the Complement

Survey only 9.4 percent of all drug mentions were antibiotics,

compared with 13.3 percent for NAMCS.

The trend displayed in the distribution of visits according

to the number of nonmedication therapeutic services ordered

or provided was identical for the two surveys-the number and

percent of visits decreased significantly with each increase in

the number of these services. (See table 18.) In the Complement Survey, 39.8 million visits (58. 1 percent) involved no

therapeutic services other than medication, and a significantly

smaller 24.3 million visits (35.5 percent), involved one such

sewice. Two nonmedication therapeutic services were ordered

or provided in even fewer visits (3.9 million, or 5.7 percent),

and only 0.5 million visits (0.7 percent) involved three or more

of these services. Each survey averaged 0.6 nonmedication

therapeutic services per visit.

Despite the similarity between the Complement Survey

and NAMCS in the amount of therapeutic service other than

medication. there were two significant differences. The Complement Survey physicians displayed a greater tendency to

provide no nonmedication therapeutic services than did the

NAMCS physicians: they did so in 58.1 percent of visits,

compared with 52.6 percent of NAMCS visits. Similarly, a

larger proportion of NAMCS visits (39.6 percent) than of

Complement Survey visits (35.5 percent) involved one of these

services.

The numbers and percent of vishs in which specific therapeutic services other than medication were ordered or provided

are also shown in table 18. Again the similarity between Com15
Table 17. Estimated number end percent distribution of drug mentions during Complement Survey and National Ambulato~ Medical Care

Survey (NAMCS) visits by therapeutic catego~ United States, 1980

Drug mentions

Therapeutic c.3tegory1 Complement Survey NAMCS

All therapeutic categories .,..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antihistamine drugs, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Anti biotics, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

Central newous system drugs., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Analgesics andantipyretics, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychotherapeutic agents.,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

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

Adrenals, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Skin andmucous membrane preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Spasmolytic agenta, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Other therapeutic agents, pharmaceutics aids, and devices2 . . . . . . . . . . . . . . . .

Therapeutic categoy undetermined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

Percent

distribution

72,296

4,977

8,108

6,791

2,469

8,619

3,853

2,801

1,861

12,467

6,732

2,030

2,857

5,808

4,703

2,267

2,256

*3,832

4,869

1,787

“2,007

4,071

1,243

*4,482

3,356

* 1,464

100.0

6.9

11.2

9.4

3.4

11.9

5.3

3.9

2.6

17.2

9.3

2.8

4.0

8.0

6.5

3.1

3.1

5.3

6.7

2.5

2.8

5.6

1.7

“6.2

4.6

2,0

Number in

thousands

679,593

43,939

104,898

90,081

25,237

64,463

26,331

22,633

14,646

110,706

57,800

16,395

25,036

51,956

42,834

18,899

26,076

24,140

55,843

18,312

23,711

55,188

11,541

24,244

28,733

10,017

Percent

distribution

100.0

6.5

15.4

13.3

3.7

9.5

3.9

3.3

2.2

16.3

8,5

2.4

3,7

7.6

6.3

2.8

3.8

3.6

8.2

2.7

3.5

8.1

1.7

3.6

4.2

1.5

1Bssed on the pharmacologic-therapeutic classification of the American Society of Hospital Pharmacists; selected categories reproduced with the permission of the

Society (see appendix W),

‘Includes antineoplastic agents; blood derivatives; blood formation and coagulation; diagnostic agents; enzymes; gold compounds, heavy metal antagonists; local

anesthetics; oxytocics; radioactive agents; unclassified therapeutic agents; pharmaceutics aids: and devices.

Table 18. Estimated number and percent distribution of offica visits to Complement Survey and National Ambulatory Medical Care Survey

(NAMCS) physicians by number of nonmedication therapeutic services ordered or provided and type of nonmedication therapy ordered or

provided: United States, 1980

Office visits

Number of nonmedication therapeutic sewices and

type of nonmedication therapy Complement Survey NAMCS

Number in Percent Number in Percent

thousands distribution thousanda distribution

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68,556 100.0 575,745 100.0

Number of nonmedication therapeutic services

0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39,809 58.1 303,017 52.6

l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24,328 35.5 227,929 39.6

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,934 5.7 38,255 6.6

3 or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *485 ‘0.7 6,543 1.1

Type of nonmedication therapyl

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39,809 58.1 303,017 52,6

Physiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,790 2.6 29,281 5.1

Office surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,088 6.0 43,089 7.5

Family planning, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 889 1.3 12,828 2.2

Psychotherapy, therapeutic listening . . . . . . . . . . . . . . . . 3,897 5.7 29,024 5.0

Diet counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,852 7.7 48,886 8.5

Family, aocial counsel ing, ,. . . . . . . . . . . . . . . . . . . . . . . . 1,302 1.9 13,148 2.3

Medical counsel ing, ...,... . . . . . . . . . . . . . . . . . . . . . . . . . . 13,328 19.4 133,425 23,2

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,546 5.1 15,618 2,7

lDoes not add to 100.0 percent because more than one nonmedicatlon therapeutic sewice may have been ordered or provided during a visit.

16
Table 19. Estimated number and percent distribution of office visits to Complement Suwey and National Ambulatory Medical Care Suwey

(NAMCS) physicians by disposition and duration of visit: United States, 1980

Office visits

Disposition and duration of visit Complement Survey NAIWCS

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

Disposition

No follow-up planned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Telephone follow-up planned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

Duration

0rninutes2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

31minutes or more.......,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

Percent

distribution

Number in

thousands

Percent

distribution

68,556

7,062

38,731

12,705

1,749

2,044

7,070

1,726

“158

3,343

5,304

16,195

19,235

17,790

6,690

100.0

10.3

56.5

18.5

2.6

3.0

10.3

2.5

“0.2

4.9

7.7

23.6

28.1

26.0

9.8

575,745

67,442

346,414

131,404

19,955

15,157

3,677

13,088

1,380

13,813

71,894

175,660

157,619

120,900

35,858

100.0

11.7

60.2

22.8

3.5

2.6

0.6

2.3

0.2

2.4

12.5

30.5

27.4

21.0

6.2

1Does not add to 100.0 percent because more than one disposition may have been recorded for a vls!t.

2Repre~e”tS ~fflce vl$lt~ in which there was no face-to-face contact between the patient and the Phys!clan.

plement Survey and NAMCS physicians is notable, as precisely

the same trends appeared for both. Complement Survey physicians conducted medical counseling more frequently than any

other service ( 13.3 million visits, or 19.4 percent). The percents

of visits in which the remaining services (physiotherapy; office

surgery: family planning; psychotherapy, therapeutic listening,

diet counseling family, social counseling or other services)

were ordered or provided ranged from 1.3 to 7.1.

There were some significant differences between the two

surveys in the frequency with which particular services were

ordered or provided. Smaller proportions of Complement

Survey visits than of NAMCS visits involved physiotherapy

(2.6 percent compared with 5.1 percent), family planning

(1.3 percent compared with 2.2 percent), or medical counseling

(19.4 percent compared with 23.2 percent), and a larger proportion involved other nonmedication therapeutic services

(5. I percent compared with 2.7 percent). These differences are

substantively small, but statistically significant. A tabulation of

specific nonmedication therapeutic services according to major

specialty type (not presented here) shows that these differences

tend to remain even when controlling for specialty type.

A comparison of patient disposition in the two surveys is

displayed in table 19. In Complement Survey visits, by far the

most frequent disposition was an instruction to return at a

specified time, which occurred in 38.7 million visits, or

56.5 percent of all visits. This was followed by an instruction

to return if needed ( 12.7 million visits, or 18.5 percent), and

then by an instruction to return to the referring physician and

by no plaming of a follow-up (7. 1 million visits. or 10.3 percent,

each). Except for the relatively large proportion of visits returned to the referring physician, this distribution of dispositions

was quite similar to that observed for NAMCS visits.

The visits in each survey tended to fall into the same duration intervals (table 17). In the Complement Survey, the three

most common time intervals for visits were 11– 15 minutes

(19.2 million visits, or 28.1 percent of all visits), 16-30 minutes

( 17.8 million visits. or 26.0 percent). and 6-10 minutes

( 16.2 million visits, or 23.6 percent). Although the differences

in the frequencies and percents among these intervals were not

significant. all were significantly greater than the corresponding

statistics for the extreme time intervals.

The average duration of all Complement Survey visits was

17.9 minutes; it was 18.7 minutes with visits to radiologists

and anesthesiologists excluded. In contrast. the average

NAMCS visit lasted 15.4 minutes. A comparison of the average

duration for each major specialty type (with radiologists and

anesthesiologists excluded from the Complement Survey data)

showed that the duration was consistently higher for the Complement Survey visits. Consequently, the overall difference

cannot be attributed to the survey differences in physician

specialty distribution.

17
References

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

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

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

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

2u.s. public Hea]th Service and Health Care Financing Administration: International ClassJ7cation of Diseases, 9th Revision, Clinical

Modification. DHHS Pub. No. (PHS) 80-1260. Public Health

Service. Washington. U.S. Government Printing Office. Sept. 1980.

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

office-based practice, a summary of findings. Vital and Health Statistics. Series 13, No. 65. DHHS Pub. No. (PHS) 83-1726. Public

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

1982,

tory 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 OfYice, Mar.

1982.

5Nationa] Center for Health Statistics, P. J. McCarthy: Replicadon,

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 Office, Apr. 1966.

6National 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 Off]ce, Jan. 1969.

4National center for Health Statistics, H. Koch and W. H. Campbell:

The collection and processing of drug information: National Ambula18
Appendixes

Contents

I. Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Statistical design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Data collection andprocessing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Estimation procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Reliability ofestimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Tests ofsignificance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Roundingofnumbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

H. Survey instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Telephone screening introductory letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Complement Survey introductory letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Telephone ScreeningAssignment form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Induction Intemiew form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Patient Record form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

IH. Definition ofterms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Terms relatingto the surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Terms relatingto the Patient Record form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

IV. American Hospital Formulary Service classification system andtherapeutic category codes . . . . . . . . . . . . . . . . . . . . . . . . 46

Listofappendix tables

I. Distribution ofphysicians inthe Complement Survey sample by majorprofessional group: United States. 1980 . . . . . . . 21

H. Approximate relative standard errors of estimated numbers of drug mentions: National Ambulatory Medical Care

Complement Survey, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

19
Appendix 1

Technical notes

Background

This report is based on data collected in the National

Ambulatory Medical Care Complement Survey. The Complement Survey was conducted during 1980 by the Division of

Health Care Statistics of the National Center for Health Statistics (NCHS) to supplement data collected through the

National Ambulatory Medical Care Survey (NAMC S). The

NAMCS was designed to provide estimates of ofi-ice visits to

non-Federal, office-based, patient care physicians in the conterminous United States. Not included in the NAMCS universe

were visits to physicians who were federally employed, hospitalbased, or principally engaged in research, teaching, administration, or other nonpatient care activity. The purpose of the

Complement Survey was to estimate the number and characteristics of otlice visits made to physicians who had previously

been excluded from the NAMCS.

The Complement Survey was conducted in two phases. In

the first phase, a sample of non-office-based physicians was

screened by telephone to identify physicians in various professional activity groups who provided some office-based care. In

the second phase, sample otlice visit data were collected from

those physicians who provided some office-based care to

ambulatory patients. The design and methodology of the National

Ambulatory Medical Care Complement Survey are presented

in the following sections. The statistical design and methodology

of the 1980 National Ambulatory Medical Care Survey is described in another NCHS reports

Statistical design

Scope of the survey

The target population of the Complement Survey included

oftlce visits made within the conterminous United States by

ambulatory patients to physicians who were federally employed;

hospital-based; principally engaged in teaching, research, administration, or other nonpatient care activity: or specialized in

anesthesiology, pathology, or radiology. Telephone contacts

‘ and nonoffice visits were excluded from the Complement

Survey.

Sample design

The Complement Survey utilized a three-stage survey

design that involved probability samples of primary sampling

NOTE: A list of references follows the text.

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

of the University of Chicago, the organization responsible for

the NAMCS and the Complement Survey field and data

processing operations under contract to NCHS. A PSU was a

county, a group of adjacent counties, or a standard metropolitan

statistical area. A modified probability-proportional-to-size

procedure using separate sampling frames for standard metropolitan statistical areas 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 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 physicians, selected from

the masterflles maintained by the American Medical Association (AMA) and the American Osteopathic Association

(AOA) as of December 31, 1979, who were classified in any

of the following categories:

. Federally employed.

. Hospital-based.

● Principally engaged in teaching, research, or administration.

● Inactive, retired, or unclassified.

. In the specialties of anesthesiology, pathology, clinical

pathology, forensic pathology, radiology, diagnostic radiology, pediatric radiology, or therapeutic radiology.

The Complement Survey physician universe included

220.109 doctors of medicine and 5,669 doctors of osteopathy.

When combined with the 1980 NAMCS physician universe,

the two universes included all physicians in the conterminous

United States on the AMA and AOA mastertles.

Within each PSU, all eligible physicians were sorted into

11 professional groups: federally employed, hospital-based,

teaching, research, administration, inactive, retired, unclassified, anesthesiologists, pathologists, and radiologists. 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. A total of

5,018 physicians was thus selected and randomly divided into

10 groups of approximately equal size.

Sample physicians were sequentially screened by telephone

to identifi about 400 physicians eligible for the Complement

Survey. A total of 2,008 physicians, 4 of the 10 groups, were

actually included in the telephone screening sample. Twenty20
Table 1. Distribution of physicians in the Complement Survey sample by major professional group: United States, 1980

Gross Net

telephone Telephone telephone out Complement

screening screening screening of Survey

Professional group sample refusals sample scopel sample Nonrespondents Respondents

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,008 21 1,987 1,659 328 45 283

Federal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 3 163 143 20 3 17

Hospital-based patient care. . . . . . . . . . . . . . 848 7 841 721 120 22 98

Research, teaching, and adminiatration . . . . 287 4 283 224 59 8 51

Inactive, unclassified, and other . . . . . . . . . 481 5 476 381 95 11 84

Anesthesiologists, pathologists, and

radiologists . . . . . . . . . . . . . . . . . . . . . . . . . 226 2 224 190 34 1 33

10ut of scope indkcates physician does not provide office-based care to ambulatory patients.

one physicians refused to be interviewed, resulting in a net

sample of 1,987 physicians. Of these physicians, 18 were deceased, 148 were retired, 32 had moved out of the United States,

232 could not be located, and 48 were not interviewed for other

reasons. Based on the telephone interview, an additional 1,118

physicians were ruled out of scope for the Complement Survey.

The result was 391 physicians who were tentatively identified

as in scope for the study. At the induction interview conducted

prior to the physician’s assigned reporting period, a final determination of the physician’s eligibility was made. An additional 63 physicians were ruled out of scope at this point, resulting in a final physician sample of 328 physicians for the

Complement Survey. Of these physicians, 283 (86 percent)

agreed to submit visit information. Of the participating physicians, 38 saw no patients during their assigned reporting period

because of vacation, illness, or other reasons for being temporarily out of oflice-based practice. The physician sample size

and response data by major professional activity group are

shown in table I.

The third stage was the selection of patient visits within

the annual ol%ce-based practices of the sample physicians.

This stage involved two steps. First, the 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 off]ce 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 H.

Physicians participating in the Complement Survey completed

5.400 usable Patient Record forms.

Data collection and processing

Field procedures

The telephone screening interview involved mail and telephone contact with the sample physicians. Initially, sample

physicians were sent an introductory letter from the Director of

NCHS (see appendix II). Approximately 1 week later a field

representative telephoned and interviewed the sample physician

using the Telephone Screening Assignment form in appendix II.

The ultimate purpose of the interview was to identifJ physicians who saw ambulatory patients in an oi%ce setting. Physicians tentatively identified as seeing patients in an oftlce setting

were randomly assigned a weekly reporting period, contacted,

and inducted in the same reamer as sample physicians in

NAMCS. These procedures are described below.

Initially, each sample physician was sent an introductory

letter from the Director of NCHS (see appendix II). When

appropriate, a letter from the physician’s specialty organization endorsing the survey and urging his or her 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 the study briefly

and arrange an appointment for a personal interview. Physicians who did not initially respond were usually recontacted

via telephone or special explanatory letter and asked to reconsider participation in the study.

During the personal interview the field representative

made a final determination of the physician’s eligibility for the

study, obtained his or her 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 ofice visits,

was conducted. Oftlce 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 insure 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

thk 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 the Complement Survey.

Data collection

Data collection within the physician’s office was conducted

by the physician, assisted by his office staff when possible.

Two data collection forms were used by the physician: the

Patient Log and the Patient Record (see appendix II). The

21
Patient Log, a sequential listing of patients seen in the physician’s oftlce during the assigned reporting week, served as the

sampling frame to indicate the office visits for which data were

to be recorded. A perforation between the patient’s name and

patient visit information permitted the physician to detach and

retain the listing of patients, thus 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 rate was designed so

that about 30 Patient Record forms would be completed by

each physician during the assigned reporting week. Physicians

expecting 10 or fewer visits each day recorded data for all visits;

those expecting more than 10 visits per day recorded data for

every second, third, or fifth visit, based on the predetermined

sampling interval. These 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 fitlh patient visit, a random start was

provided on the first page of the Patient Log so that 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 performed

on data received for central data processing. The field and

manual editing procedures proved quite efficient, reducing item

nonresponse rates to 2 percent or less for most data items.

Information contained in item 6 (Patient’s complaints,

symptoms, or other reason for this visit) of the Patient Record

form was coded according to “A reason for visit classification

for ambulatory care.” 1 Diagnostic information (item 9 of the

Patient Record form) was coded according to the International

Classl~cation of Diseases, 9th Revision, ClinicaI Modlj7calion. 2 A maximum of three entries were coded from each of

these items. Prior to coding, Patient Record forms were grouped

into batches with approximately 650 Patient Record forms per

batch. Quality control for the medical coding operation involved

a tweway 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 medical coding operation were

1.9 percent for item 6 and 2.8 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

1.8 percent for item 6 and 2.5 percent for item 9.

The 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 drug data processing procedures is

NOTE: A list of referencesfollows the text.

contained in Vital and Health Statistics, Series 2, No. 90.4 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 insure

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

Estimation procedures were developed for each phase of

the Complement Survey. In the first phase, estimation pr~

cedures were developed to provide national estimates of physicians. In the second phase, estimation procedures, similar to

those used in the 1980 NAMC S, were developed to provide

national estimates of ofllce visits. For estimation purposes, the

original 11 professional groups were recombined into 5 groups

as follows: (1) Federally employe~ (2) hospital-based(3) teaching, research, and administration, (4) inactive, retired, unclassified, and othe~ (5) anesthesiologists, pathologists, and radiologists.

Physician estimation

Statistics from the first phase of the Complement Survey

were derived from a two-stage estimation procedure that pr~

duced national estimates and has three basic components. First,

data were inflated by the reciprocals of the two probabilities of

selection: the probability of selecting the PSU and the probability of selecting the physician within the PSU. Second, the

data were adjusted to account for nonresponding physicians by

imputing to nonresponding physicians the characteristics of

similar responding physicians. For this purpose, physicians

were judged similar if they were in the same PSU and major

professional group, An excess nonresponse adjustment was

added to adjust for those PSU and professional group combinations with sample physicians, but no responding physicians.

Third, a poststratification adjustment to fixed totals was made

within each of the five major professional groups. This ratio

adjustment was a multiplication factor that had as its numerator

the number of physicians in the universe in each professional

group and as its denominator the estimated number of physicians in that particular group. The numerator was based on

figures obtained from the AMA and AOA, and the denominator

was based on data from the sample.

Vkit estimation -

Statistics from the second phase of the Complement Survey

were derived by a multistage estimation procedure that produces essentially unbiased national estimates and has three

basic components: (1) inflation by reciprocals of the probabil22
ities of selection, (2) adjustment for nonresponse, and (3) a

ratio adjustment to fixed totals. Each component is described

briefly below:

● Injlation b]’ reciprocals of probabilities of selection—

Because the survey utilized a three-stage sample design.

three probabilities of selection existed: ( 1) the probability

of selecting the PSU, (2) the probability of selecting the

physician within the PSU, and (3) the probability of selecting an office visit within the physician’s practice. The third

probability was defined as the number of Patient Record

forms completed divided by the number of ofilce visits

during the physician’s assigned reporting week. All weekly

estimates were inflated by a factor of 52 to derive annual

estimates.

● Adjustment for nonresponse—Estimates from Complement Survey data were adjusted to account for sample

physicians who were in scope, but did not participate in

the study. This adjustment was calculated 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 were in the same PSU and professional group.

. Ratio adjustment—A poststratitication adjustment was

made within each of five major professional groups. The

ratio adjustment was a multiplication factor that had as its

numerator the number of physicians in the universe in

each professional group and as its denominator the estimated number of physicians in that particular group. The

numerator was based on figures obtained from the AMA

and AOA mastefiles. 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 or incomplete response. The magnitude of the nonsampling errors

cannot be computed. However, these errors were kept to a

minimum by procedures built into the operation of the survey.

To eliminate ambiguities and encourage uniform reporting,

careful attention was given to the phrasing of questions, terms,

and definitions. Also, extensive pretesting of most data items

and survey procedures was performed. The steps taken to

reduce bias in the data are discussed in the sections on field

procedures and data collection. Quality control procedures and

consistency and edit checks discussed in the data processing

section reduced errors in data coding and processing. However,

because survey results are subject to sampling and nonsarnpling

errors, the total error will be larger than the error due to sampling

variability alone.

Because the statistics presented in this report are based on

samples, they differ somewhat from the figures that would be

obtained if complete censuses had been taken using the same

forms, definitions, instructions, and procedures. However, the

probability design of the Complement Survey and NAMCS

permits the calculation of sampling errors. The standard error

is primarily a measure of sampling variability that occurs by

chance because only a sample rather than the entire population

is surveyed. The standard error, as calculated in this report,

also reflects part of the variation that arises in the measurement

process, but does not include estimates of any systematic biases

that may be in the data. The chances are about 68 out of 100

that an estimate from the sample would differ from a complete

census by less than the standard error. The chances are about

95 out of 100 that the difference would be less than twice the

standard error, and about 99 out of 100 that it would be less

than 21Atimes as large.

The relative standard error of an estimate is obtained by

dividing the standard error by the estimate itself and is expressed

as a percent of the estimate. For this report, an asterisk (*)

precedes any estimate with more than a 30-percent relative

standard error.

Estimates of sampling variability were calculated separately

for each survey using the method of half-sample replication.

This method yields overall variability through observation of

variability among random subsamples of the total sample.

Descriptions of the development and evaluation of the replication technique for error estimation have been published.s.d

Approximate relative standard errors have been calculated

for three types of estimate from the Complement Survey:

(1) estimates of physicians; (2) estimates of ot%ce visits; and

(3) estimates of drug mentions. They also were calculated for

the latter two types of estimate obtained from NAMCS. Pr&

cedures for calculating approximate relative standard errors for

aggregate and percent estimates are presented in the following

paragraphs. To derive error estimates that would be applicable

to a wide variety of statistics and that could be prepared at

moderate cost, several approximations were required. As a

result, the relative standard errors shown in this appendix should

be interpreted as approximate rather than exact for any specific

estimate.

Complement Survey estimates of aggregates

Approximate relative standard errors (in percent) for aggregate statistics may be calculated using the following formulas

in which x is the aggregate estimate of interest in thousands.

For physician estimates,

‘s’(x) =~’ooo

For visit estimates,

RSE(X) =

d

51.88312

0.0142323 + ~ “ 100.0

The approximate relative standard errors for aggregate estimates of drug mentions are presented in table II.

NOTE: A list of referencesfollowsthe text.

23
Table II. Approximate relative standard errors of estimated

numbers of drug mentions: National Ambulatory Medical Care

Complement Survey, 1980

Relative

standard

Estimated number of drug mentions in thousands error

For Complement Survey visit percents,

‘sE”’=/-R-’O””

For NAMCS visit percents,

Percent

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48.9

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36.9

2,000 . .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29.1

RSE@) =

d

36.36433 “(I –p) . ~Oo ~

p.x

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.2

10,000 ., .,, , . . . . . . . . . . . . . . . . . . . . . . .,, ...,,,,,. 20.9

20,000, ...,.,,......,,........,.. . . . . . . . . . . . . . 19,6

72,000, . . . . . . . . . . . . . . . . . . . . . . . . . . .,, .,, ,,, ,.. . 18.6

EXAMPLE OF USE OF TABLE: An aggregate estimate of B,000,OOO drug

mentions has a relative standard error of 21.8 percent or a standard error

of 1,744,000 visits (21 ,8 percent of 8,000,000 drug mentions).

NAMCS estimates of aggregates

Approximate relative standard errors (in percent) may be

calculated using the following formulas where x is the aggregate estimate of interest in thousands. For visit estimates,

‘SE(X) =

d

36.36433

0.00164987 + x “ 100.0

For drug mention estimates,

‘SE(X) =

d

0.00316979 +

71.26431

“ 100.0

x

Complement Survey and NAMCS estimates

of percents

Approximate relative standard errors (in percent) for estimates of percents may be calculated as follows: From the appropriate source, obtain the relative standard error of the numerator and denominator of the percent; 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. Alternatively, relative standard errors

(in percent) for percents may be calculated using the following

formulas where p is the proportion of interest and x is the base

of the percent in thousands. For Complement Survey physician

percents,

‘s’”) =-”lOO”

Estimates of rates where the numerator is not

a subclass of the denominator

Approximate relative standard errors for rates in which

the denominator is the total U.S. population or one or more of

the age-sex-race groups of the total population are assumed to

be equivalent to the previously provided relative standard error

of the numerator.

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, but 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 Bonferroni Test for multiple comparisons (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.

Rounding of numbers

Visit 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.

24
Appendix II

Survey instruments

F.ndorsing Organizations

American Academy

of Dermatology

Amer(can Academv of

Fam[ly Phwclans

American Academy

of Neurology

Amer!can Academy of

Orthopaed!c Surgeons

Amer]can Academy

of Pediatrics

American Assoc!atlon of

Neurological Surgeons

Amerrcan College of

Emergency Phwclans

Amerncan College of

Obstetrlclans and

Gynecologists

Amer(can College

of Phywclan$

Amertcan College of

Prevenwe Medlcme

Amer!can Osteopathic

Assoclatlon

American Society of

Colon and Rectal

Surgeons

Amer!can Psych latrtc

Assoclatlon

American SocIetv of

Internal Medic!ne

American Soc!ety of

Plastlc and Reconstructwe

Surgeons, Inc.

Amerman Urological

Assoc!a180n

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

OFFICE OF HEALTH RESEARCH, STATISTICS ANO TECHNOLOGY

HYATTSVILLE, MAR YLANO 20782

NATIONAL AMBuLATORY

ME OICAL 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

WS. A 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 NAMCSprogram and supports

this effort (see enclosure). They join me in urging

your cooperation in this important researth.

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.

Sincerely yours,

Assoc,at]on of American

Medical Colleges

National Medical

Association

Dorothy P. Rice

Director

Enclosure

25
@

.7* EDQC ~’,

~ $~””j

‘. “, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Jo “ ;“; ‘;+”’

PUBLIC HEALTH SERVICE

NATIONAL CENTER FOR HEALTH STATISTICS

HYATT SVILLE, MARYLAND 20782

Endorsing Organizations

American Academy

of Dermatology

American Academy of

Family Physicians

American Academy

of Neurology

American Academy of

Orthopedic Surgeons

American Academy

of Pediatrics

American Association of

Neurological Surgeons

American College of

Obstetricians and

Gynecologists

American College

of Physicians

American College of

Preventive Medicine

American Osteopathic

Association

American Proctologic

Society

American Psychiatric

Association

American Society of

Internal Medicine

American Society of

Plastic and Reconstructive

Surgeons, Inc.

American Urologic

Association

Association of American

Medical Col Ieges

National Medical

Association

NATIONAL AMBULATORY

MEDICAL CARE SURVEY

DearIbctor:

The NationalCenterfor HealthStatistics,as part of its

continuingprogramto provideinformationon the health

statusof the Americanpeople,is conductingthe National

AmbulatoryMedicalCareSurvey(NLVV!CS).The purposeof

the lUNICSis to collectinformationaboutambulatory

patients,theirproblems,and the resourcesused for

theircare. The resultingstatisticshelp the medical

connnunityplan formore effectivehealthservices,

determinehealthmanpowerrequirements,and improve

medicaleducation.

In an effortto provideinformationaboutoffice-based

ambulatorycare,we are contactinga randomsampleof

physicians,includingthoseengagedin office-based

practiceas well as thoseengagedin otheractivities.

As one of thephysiciansselectedin our national

sample,your assistanceis essentialto the successof

the study.

The NAMCSis authorizedby the HealthServicesResearch,

HealthStatisticsand HealthCareTechnologyAct of 1978

(PublicLaw 95-623). It is a voluntarystudy,and there

are no penaltiesfor decliningto participate.All informationcollectedin the studywill be held in confidence

andwill be used only to preparestatisticalsummaries.

Informationwill not be releasedthatwill identifyan

individualor a physician’spractice.

Withina few days, a surveyrepresentativefrom the

NationalGpinionResearchCenterwill telephoneto ask you

a few questionsconcerningyourprovisionof office-based

ambulatorycare. The questionnaireis very briefand

shouldtakeonly a few minutesof your time.

We greatlyappreciateand thankyou for your cooperation.

Sincerelyyours,

d

T

DorothyP. “ e

Director

26
OMB # 68-s79081 NATIONAL AMBULATORY M. ICAL CARE SURVEY NORC-4284

TELEPHONE SCREENING ASSIGNMENT

12/7’9

BEGIN DECK 01

(oF171cEusE ONLy)

01-05/

NORC CASE #:

(Intv. Name)

FINAL DISP. CODE:m ,07-09/

Phy. Business Telephone: ( ) Phy. Home Telephone: ( )

10-19/ 20-29/

IF ADDRESS ON LABEL IS CORRECT, CHECK BOX n.

Another Telephone #: ( )

IF NOT, ASK: What is your correct professional 30-39/

address? TIME ZONE:

East ...... 1

Central ... 2

(Street Address) (City) (State) (Zip)

Mountain .. 3

Pacific ... 4

40-69/ BEGIN DECK 02 07-26/ 27-28/ 29-33/

Day

of Week

Ho 1

Tu2Fc5

We3Sa6

lh4su7

Ho 1

h2Fr5

We3Sa6

Th4 SU7

no 1

Tu 2 Fr 5

We3Sa6

BEGIN m4 s“ 7

DK 03 :~.1

Tu 2 Fr 5

We3Sa6

Thk SU7

Mo 1

Tu2Fr5

we3 s*6

Th4 SU7

Month Date

34-35/ 36-37I

m m

45-46/47-481

m m

56-57/58-591

m m

07-08/09-10]

mlm

18-19/20-21/

m m

Time

38-41/

inn::

49-52/

m::

60-63/

Urn::

11-14/

m::

22-25/

m::

PENDING DISPOSITION CODES:

RSCOSD OF CA2.LS

DLSpOsLtiOn C-nts Internewer

Knt ‘ 1 ID #

42-44/

I

53-55/

[Ill m

64-66/

H m

15-17/

m

26-28/

m

Call Back ......................... CAB

Appointment . . (SPECIFY DATE AND TIME)

APT

No Answer ......................... NAN

Busy Signal ....................... BUS

Phy. Needs Tracing ................ NTR

Phy. Temporarily Unavailable

(SPECIFY DATE AVAILABLE) TUN

Temporary Refusal/Breakoff ........ TRB

Temporary Other (SPECIFY)

TOT

FINAL DISPOSITION CODES:

Out of Scope ...................... OUS

Deceased .......................... DEC

Retired ........................... RET

Moved out of USA .................. Mus

Moved/Can’t Locate ................ MCL

Refusal/Breakoff .................. FRB

Other (SpECIFy) 1

Supr.

FOSjonly

Completed Physician In Scope ...... CIS

27
DECK 03

RECORD OF CALLS

Day %nth Dam of Week “Time Dispocicion ~ncs

tntazwimmr

10C ‘L ID+

MO 1 29-30/ 31-32/ 33-36/ 37-39/

Tu2Fr5

’43

Th4

‘“6

5.7 m ‘m m:: Cml m

M 1 40-41/ 42-43/ 44-47/ 48-50/

h 2 Fr 5

‘“3sa’ m ml mm: m

Thf+ WJ7

m

30 1 51-52/ 53-54/ 55-58/ 59-61/

Tu2Fr5

‘e3sa’ m m ,=:: UEl

n14su71 m :+31 !62-63/~64-65/ 66-69/ 70-72/

Tu 2 Fr 5

,.~: ,,, !~i[-j !(~\i

!:: ml

i~

BEGIN:n ; ‘“7 I

12KdoPIo 1 lu7-u8/!09-10/ 11-14/ 15-17/

Tu2Fr5

;:::; m ‘m m:: CIIl m )s01 18-19/ 20-21/ 22-25/ 26-28/

h 1 ~:r j

::::: ml m m:: mu u!

ml 29-30/ 31-32/ 33-36/ 37-39/

lh2Fr5

‘e3sa’

Thksu7

ml m mm:: cm m !101 140-41/~42-43/ 44-471 48-50/

:U : fr 5

.! J

JT~lT- ~:; ~;

:04 su7\

t m .,

,!0 : \51-52/ 53-54/ 55-58/ 59-61/

Tu2Fr5

““a’

T?l~su7

m m m:: m m HO 1 62-63/ 64-65/ 66-69/ 10-72/

Tu2Fr5

‘e3

TI16SU7

‘a’ m ‘m m:: cm m

PENDING DISPOSITION CODES: FINAL DISPOSITION CODES:

Call Back ......................... CAB

Appointment (SPECIN DATE AND TIME)

APT

No Answer ......................... NAN

Busy Signal ....................... BUS

Phy. Needs Tracing ................ NTR

Phy. Temporarily Unavailable

(SPECIFY DATE AVAIMBLE) TUN

Temporary Refusal/Breakoff ........ TRB

Temporary Other (SPECIFY)

TOT

Out of Scope ...................... OUS

Deceased .......................... DEC

Retired .........................,. RET

Moved outof USA .................. MCJS

Moved/Can’t Locate ................ MCL

Refusal/Breakoff .................. FRB’

Other (SpECIFy)

)

Supr.

FOS

only

Ccn2pleted Physicia9 113Sccpe ...... CIS

28
-2-

TELEPHONE SCREENING FORM

Hello, Dr. (NAME). This is (YOUR NAME) of the National

(University of Chicago).

BEGIN DECK 05

Opinion Research Center

I’m representing the National Center for Health Statistics on the Ambulatory

Medical Care Survey. You have probably received a letter from Dorothy P. Rice,

director of the Center, telling you about the survey.

IF DOCTOR REMEMBERS LETTER, GO TO Q. 1

IF DOCTOR DOES NOT REMEMBER LETTER, EXPLAIN:

The National Ambulatory Medical Care Survey collects data on officebased ambulatory care. It is endorsed by the medical specialty organizations and is the source of many medical reports. I would like to ask

you a few questions about the extent of your own involvement in the

provision of office-based care. The questions are very brief and

should take only a few minutes of your time.

1. The first question concerns your major professional activity--that is,

the activity in which you spend the majority of your professional time.

Which one of the following categories best describes your present major

professional activity--patient care, research, teaching, administration,

or something else? CIRCLE ONE CODE.

Patient care ...... (SKIP TOQ. 3) ................ 1

Research ........... (GO TO Q. 2) ................. 2$

Teaching ........... (GOTOQ. 2) ................. 3

Administration ..... (GOTOQ. 2) ................. 4

Something else (SPECIFY AND GO TO Q. 2)

5

2. During your normal working week, do you provide ~ direct patient care?

Yes ........ (GO TOQ. 3) ............. 1

No ......... (AsKA) .................. 2

A. IF NO: Doctor, for this survey, direct patient care is

defined as seeing patients. Do you provide ~ direct

care during your normal working week, under this

definition?

Yes .......... (GO TO Q.3) ............. 1

No .. (GO TO TERMINATION

STATEMENT, P. 3) ............. 2

3. Are you currently in a residency training program?

Yes .................................... 1

No ..................................... 2

07/

08/

09/

lol

29
-3-

DECK 05

4. Are you currently employed by the federal government?

Yes ........ (AsK A) ............... 1 11/

No ....... (GOTOQ. 5) ............ 2

A. IF YES: In addition to your government practice, do YOU routinely

see any private patients?

Yes . . . . . . (READ STATEMENT IN B) ............... 1 12/

No ......fGOTO TERMINATION STATE~NT BELOW) ... 2

B. IF YES TO A: All of the questions that follow will be

concerned with these private patients .. (AsKQ. 5)

5. Doctor, we are concerned in this study with ambulatory patients--that is,

patients who are not admitted to a hospital, nursing home, or other institution

and are not bedri=n. With this definition in mind, do you provide care

to any ambulatory patients?

Yes . . . . . . . (GOTOQ. 6) ........... 1

No .........(ASKA) ................ 2

A. IF NO: Then all of your (private) patients are either hospitalized or

bedri=n in an institution?

Yes . . . . (GO TO TERMINATION STATEMENT BELOW) .. 1

No . . . . . (EXPLAIN BELOW, THEN GO TO Q. 6) ..... 2

TERMINATION STATEMENT

Thank you, Dr. (NAME), but since you do not (provide any direct

patient care/see any private patients/see any ambulatory patients),

our questions would not be appropriate for you. I appreciate your

time and interest.

13/

14/

30
-4- DECK 05

6. We are also concerned with office-based care, as opposed to care provided in

a hospital outpatient department or emergency room. Do you routinely see

~ ambulatory patients in an office?

Yes . . . . . (ASKA) .......... 1 15/

No ...... (ASKC) ....... . 2

A. IF YES: Is this your private office?

Yes ....(GOTO NEXT PAGE) .. 1 16/

No ...... (ASKB) ......... 2

B. IF NO TO A: What type of office is it? RECORD DESCRIPTION UNDER 7-A BELOW,

THEN CODE 7-B AND ASK 7-C.

7. A. RECORD DESCRIPTION B.

In scope?

Yes ~No

(1) 12 17/

(2) 12 18/

(3) 12 19/

B. FOR EACH LOCATION ENTERED IN A,

IN SCOPE (YES)

Private office

Free-standing clinic

(non-hospital based)

Groups, partnerships

Kaiser, HIP, Mayo Clinic

Neighborhood Health Center

Privately operated clinic

(except family planning)

IN CASE OF DOUBT, ASK: Is that

CODE YES OR NO TO “IN SCOPE?” ABOVE

OUT OF SCOPE (NO)

Hospital emergency room

Hospital outpatient department

College or university infirmary

Industrial outpatient facility

Family planing clinic

Government-operated clinic

(VD, maternal & child health, etc.)

(clinic/facility/institution)

hospital based.

Is that (clinic/facility/institution)

government operated?

IS that a private (industrial/corporation/

company) facility?

c. Do you routinely see (private) ambulatory patients at any other location?

IF YES, RECORD DESCRIPTION UNDER A ABOVE AND CIRCLE CODE UNDER B.

IF ALL LOCATIONS ARE OUT OF SCOPE, THANK THE DOCTOR AND TERMINATE THE INTERVIEW

IF ANY LOCATION IS IN SCOPE, ASK Q. 8, NEXT PAGE.
DECK 05 -5-

8. About how many ambulatory patients do you see during a typical week in

your private office practice?

Number of Patients: 1111 20-22/

9. Finally, doctor, what is your major specialty (including general practice)?

Major Specialty: 23-25/

Thank you for your time, Dr. (NAME).

10.

11.

12.

13.

DATE OF INTERVIEW: I I I I

Month Day Year

INTERVIEWER ID #: I

INTERVIEWER SIGNATURE:

WHO SUPPLIED THIS INFORMATION?

DOCTOR SUPPLIED ALL .....0. 1

SOMEONE ELSE SUPPLIED ALL . 2

BOTH ...................... 3

26-31/

32-36/

37/

32

d
-6-

REFUSAL/BREAKOFF REPORT

DAY : Mo 1 38/

Tu 2 Fr 5

We3Sa6

Th4 SU7

~lm:m:m H;

39-40/ 41-42/

43/

1. At what point did the refusal/

breakoff occur?

SPECIFY QUESTION #:

48-50/

2. Who refused? 51/

Doctor ......................... 1

Doctor through Nurse ........... 2

Nurse/Secretary (ANSWER A) ..... 3

Receptionist ................... 4

Office Manager/

Administrator (ANSWER A) ...... 5

Other office staff (SPECIFY) ... 6

A. SPECIFY NAME OF NURSE/

SECRETARY/OFFICE MANAGER:

3. What reasons were given for the

refusal/breakoff? RECORD VERBATIM,

THEN CIRCLE ALL THAT APPLY.

TOO busy ................... 1

Doesn’t like surveys ....... 2

Negative reaction to

HEW and government ....... 3

Not interested ............. 4

Concerned about

confidentiality .......... 5

No reason given ............ 6

Other ...................... 7

52/

52!

541

55/

56/

57/

58/

DATE: m

MONTH

m

DAY

44-45/ 46-47/

INTERVIEWER SIGNATURE:

4. How did you answer the reason(s)

for refusaljbreakoff?

5. FOR SUPERVISOR USE ONLY:

Conversion Assignment:

Date: m

MONTH

m

DAY

59-60/ 61-62/

Converter’s Name:

Interviewer ID #:

AND/OR

Letter sent:

H I I II

63-67/

mm

MONTH DAY

68-69/ 70-71/

No attempt to convert: ❑ 72/

6. TELEPHONE CONVERTER ASSIGNMENT

Record of Calls:

Date Time Result

I

7. What is the final disposition code?

33
BEGIN DECK 3

CONFIDENTIAL’t

NORC-4284

FOR OFFICE USE

ONLY:

m

5-6/

m

7-10/

NATIONAL AMBULATORY MEDICAL CARE

INDUCTION INTERVIEW

SURVEY

[

BEFORE STARTING INTERVIEW

!m

1. ENTER PHYSICIAN 1.D. NUMEER IN BOX TO 1-4/

RIGHT.

2. ENTER DATES OF ASSIGNED REPORTING WEEK IN

Q. 2, 1?. 2. TIME AM

BEGAN: PM

Doctor, before I

this survey.

begin, let me take a minute to give you a little background about

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 and problems of people who consult physicians in their office6. 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 sanountof information 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 all information you provide is held in strict confidence.

1. First, you are a

(ENTER SPECIALTY FROM CODE ON FACE SHEET LABEL.)”

Is that right? Yes . . . . . . . . .

No. . . . (ASKA) . .

A. IF NO: What is your specialty (including general practice)?

(Name of Specialty)

*

. . x

. . Y

I HI

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 physician’a practice

will be released.

34
-2-

2. Now, doctor: this study will be concerned with the ambulatory patients You will

see in your office during the week of (READ REPORTING DATES ENTERED

(that’s a (that’s a

/ Monday) through / Sunday)

month date month date

Are

A.

you likely to see ~ ambulatory patients in your office during

Yes. . . . . .(GOTOQ. 3).

BELti ).

that week?

.x

No . . . . . . (ASKA) . . ..y

IF NO: WIIyis that? RECORD VERBATIM, THEN READ PARAGRAPH BELCW

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. I’ll

plan to check bacl?with your office just before (STARTINGDATE) to make

sure, and I can explain them in detail then, if necessary.

GIVE DOCTOR I’HE~ PATIENT RXCORD FORMS AND GO TO Q. 9, P. 6.

35
-3-

3, A. A; what office locationwill you be eeei

7-day period? RECORD UNDER A BELW AND %

ambulatorypat%ents during that

N CODE B.

B. FOR EACH OFFICE LOCATIONENTERED IN A, CODE YES OR NO TO “IN SCOPE.”

10UT OF SCOPE (No)[

Private offices Hospital emergency rooms

Free-standingclinics Ho8pital outpatientdepartments

(non-hospitalbased) College or university infirmaries

Group8, partnerahipa Industrialoutpatientfacilities

Xaiser, HIP, Mayo Clinic Family planning clinics

NeighborhoodHealth Centers Government-operatedclinics

Privatelyoperated clinf.cs (VD,maternal & child health, etc.)

(exceptfamily planning)

IN CASE OF DOUBT, ASK: Is that (clinic/facility/institution)hospital based?

IS that (clinic/facility/institution)government

operated?

c. Is that all of the-officelocationaat which you expect to see ambulatory

patient=uring that week?

Yea. . . . . . . . . . . X

No . . . . . . . . . . .Y

IF NO: OBTAIN ADDITIONALOFFICE LOCATION(S),EN1’ERIN “A” BEL(AJ,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: I I 14/

IF ALL LOCATIONSARE OUT OF SCOPE, THANK THE DOCTOR AND LEAVE.

36
-4- DECK 3

4. A. During that week (REPEAT DATES), how many ambulatory patients do you expect

to see in your office practice? (DO NOT COUNT PATIENTS SEEN AT [OUT-OF-SCOPE

LOCATIONS] CODED IN 3-B.)

ENTER TOTAL UNDER “A” BELOW m CIRCLE NUMBER CATEGORY ON ATI’ROF~

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 COLUMN UNDER “B” BELOW.

DETERMINE PROPER PATIENT LOG FORM-FROM CI%4RTBELOW. READ ACROSS

ON “TOTAL PATIENTS” LINE UNDER “A” AND CIRCLE LETTER IN APPROPRIATE

“DAYS” COLUMN UNDER “B.”

THIS LETTER TELLS YOU WHT.CHOF THE FOUR PATIENT LOG FORMS (A, B, C, D)

SHOULD BE USED BY THIS DOCTOR.

LOG FORM DESCRIPTION

A. B.

Expected total Total @ in practice

patients during during week.

survey week. } I

ENTER TOTAL FROM 1

A--Patient Record is to be

completed for ALL

patients Iiste=n Log. 15-17/

B--Patient

completed

SECOND patient

Record

for every

is

listed

to be “J4QMz@ on Log.

C--Patient Record is to be

completed for every

THIRD patient listed

on Log.

*J3--Patient Record is to be

completed for every

FIFTH patient listed

on Log.

126-39’’ iCBAAA AA

I 40? 52 “ ICBBAA AA

I 53-65 “ ID CB BA AA

66- 79 “ DC BB BAA

80- 92 “ DDCBBBB

93-105 “ ID DC BBBB 1

106-118 “ I DDCCBBB

119-131 “ ID DC CBBB

132-145 “ DDDCCBB

146-158 “ DDDCCBB

159-171 “ DDDCCCC

t 172-184 “ IDD D C C C C

I 185-197 “ ID DDDDDD

I 198-210 “ ID DDDDDD

] 211+ ‘-”-“ ID DDDDDD

*

In the rare instance the physician will see more than 500 patients during

his assigned reporting week, give him two D Patient Log Folios and instruct him

to complete a patient record form for only every tenth patient. Then you are

to draw an X t;hroughthe 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.
-5-

5. FIND LOG FOLIO WITH APPROPRIATE LET’J’E~ AND CIRCLE LETTER, ENTER. FIRST FOUR

OF THE FORM AND NUMBER OF LINES STMED “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 EXPI.AINHCEJFORMS ARF TO BE FILLED OUT. SHOW DOCTOR

INSTRUCTIONSON THE POCKET OF FOLIO, ITEMS 8 AND 12 ON CARE IN POCKET

OF FOLIO AND ITEM DEFINITIONSON THE BACK OF FOLIO, TO WHICH HE CAN REFER AFTER

YOU LEAVE.

EMPHASIZETHAT EVERY PATIENT VISIT EXCEPT ADMINISTRATIVEPURPOSE ONLY IS TO ~

RECORDEDON THE LOG FOR ENTIRE REPO~ING PERIOD. FOR EXAMPLE, IF A MEDICAL

ASSISTANTGAVE THE PATIENT AN INOCULATION.OR A TECHNICIANADMINISTEREDAN

ELECTROCARDIOGW AND THE PATIEm DID N~=SEE THE D~TOR, THIS VISIT MUST STILL BE

LISTED ON THE LOG.

RECORD VERBATIM BELCTJANY CONCERN, PROBLEMS OR QUESTIONSTHE DOCTOR RAISES.

7. IF DOCTOR EXPECTS TO SEE AMBULATORY PATIENTSAT MORE THAN ONE IN-SCOPELOCATION

DURING ASSIGNEDWEEK, TELL HIM YOU WILL DELIVER THE FORMS TO THE OTHER LOCATION(S).

ENTER THE FORM LETTER AND NUMBER(S)AND NUMBER OF LINES STAMPED “BEGIN ON NEXT

LINE” FOR THE B-C-D LOG FOR THOSE LOCATIONS BEL~, BEFo~ DELIVERING FORM(S).

FOLIO No. Lines

1

v FOR OFFICE USE ONLY:

Location Stamped “BEGIN Number pat~ent recor

Letter .Num~er ON NEXT!LINE” forms completed

27-31/

32-34/

35-’39/

40-42/

43-47/

48-50/

..—

38
8. During the Surveyweek (RISPEA1’EXACT

you in filling out these recorde (at

-6- DECK 3

DATES), WiIl anyone be availableto help

●ach IN=SCOPE location)?

Ye8 . . . . (ASKA). .O1 51/

No . . . . . . . . . . .2

A. IF YES: Who would that be?

RECORD NAME, POSITIONAND LOCATION.

I

NAME I POSITION 1 LOCATION I

PERSONALLYBRIEF EACH PERMM LISTED MOW.

EMPNASIZETNATEVERY PATIENI!VISIT DURINGTHB ENTIRE WEEK IS TO BE RECORDED ONTNS

LOG EXCEPT “ADMINISTRATIVEPURPOSB ONLY.”

9. Do you have a 801o practice,or are you asaociatedtith other phystciane in ●

partnership,in a group practice, or in some other way?

<---

IF PARTNERSNIP.GROUP, OR OTHER:

A. IS thi8 a prepaid group practice?

[1] IF YES’N3A: What per cent

of patienta are

prepaid?

B. Now many other phyaicianaare

associatedwith you?

solo. , , . . (GO TO,Q. 10) . . 1 52/

Partnership , . (ASK A-C) . . . 2

Group . . . ..(ASKA-C) . ..3

Other (SPECIFYAND ASKA-C) . . 4

Yes . . (ASK [l]) . . . 1 53/

No . . . . . . . . . .2

per cent 54-56/

NUMBER OF PHYSICIANS: 57-59/

c. What are the epecialtieaof the other physicians aaaociatedwith you?

(Howmanyof these are there?)

Specialty Number of Physicians

(1)

(2)

(3)

(4)

(5)

D. CIRCLE ONE:

All physicians in this partnership/group practice

have the same specialty . . . . . . . . . . . . . . . . . . I 60/

More than one specialty in this partnership/group practice . . 2

39”
-7- BEGIN DECK 4

10. Now I have just

IN LARGE GROUP,

one

THE

more question about your practice. (NOTE: IF DOCTOR PRACTICES

FOLLOWING INFORMATIONCAN BE OBTAINED FROM SOMEONE ELSE.)

A. What is the total number of full-time (35 hours or more per week) employees of your (partner6hfp/

group) practice? Include persons regularly employed who are now on vacation, temporari~ ill,

etc. Do q include other physicians. RECORD ON BOTTOM LINE OF COLU’f.f4A BELOW.

(1) HOW many of these full-time emolovees are a . . .

●

(READ CATEGORIES BELW AS NRCESSARY

AND RECORD NUMBER OF EACH IN COLU’kNA.)

B. 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 physicians. RECORD ON BOTTOM LINE OF COLOMN B BELOW.

(1) HOW many Of these part-time eilployeesare a . . . (READ CATEGORIES BELCXJAS NECESSARY

AND RECORD NUMBER OF EACH IN COLUMN B.)

I

‘A. B.

Employees Amll-time Part-time

(35 ar more hours/week) (Less than 35 hnurslweek) I

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Registered Nurse.... . . . . . . .

Licensed Ractical Nurse . . . . . . .

Nursing Aide. . , . . . . . . . . . .

Physician Aasiatant* . . . . . . . . .

Technician . . . . . . . . . . . . . .

Secretary or Receptionist . . . . . .

Other (SFBCIFY)

~AL: n

11-13/

14-16/

17-19/

20-22/

23-25/

26-28/

29-31/

32-34/

‘35-37/

38-40/

41-43/

44-46/

47-49/

50-52/

53-55/

*AL: -j 56-58/

*

I%ysfclan Assistant mmt be a graduate of an accredited trslnfng program for ~ysfcian

Ataiotants (F%yaician Extendero, Medex, etc. ) or certiffed by the National Board of ?k?dical

Ex~iners through the Certification Exam for Assistant to the Primary Care Physician.

BEFORE YOU LEAVE, AGAIN STRESS THAT EACH AND EYERY AMBULATORY PATIENT SEEN BY THE

DOCTOR OR HIS STAFF DURING THE 7-DAY~~IOD A= IN-SCOPE OFFICE LOCATIONS (~EAT

THEM) IS TO BE INCLUDED IN THE SURVEY, THAT EAC~ATIENT IS TO BE RECORDED ON THE LOG,

AND ONLY THE APPROPRIATENUMBER OF PATIENT RECORDS COMPLETED.

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. 1111

call E on Monday morning of your survey week just to remind you.

11. TIME INERVIEW ENDED . . . . . . . . AM

PM

12. DATEOF INTERVIEW . . . . . . . . . . . . . .

dz13J33

(Month) (Day) (Year)

40
-8-

INl!ERVIEWERNUMEER

111111

I~ERVIEWER’ S SIGNATURE

FOR OFFICE USE ONLY:

No. of Patients Seen: rrrl 59-61/ L

I 1 1

Total Days in Practice during Week:

•1

62/

41
w

\

(

%9 399115 j

PATlENT;LOG

AS each patient arrives, rebord name and

time of visgt on the log ~elow. For the

patient entered on line #2, also comolete the oatient record to the riuht.

for tht, patce”l

——

1

1

1

I

!

I

I

1

I

I

I

I

1

1

1

I

1

1

I

1

!

(

I

[

1

1

1

1

1

CONTINUE LISTING ~ATIENTS

ON NEXT PAGE

ASSURANCE OF cONF, DE NT AL IT V-A I .,!,,, s>,.. u,, ,vti\<t>L.u. Ic, u,,,, w, ,0,. !>1,..,,..

,,1 ,!!, .,1, ,,, ,, ... . ,, ... ,...

D?.,rtr”en, .4 H..ltu, .md tl.m. %,.,.,.

‘,! . .. .,!.,, ,.”,, !!, >.. ,1 ., .,%, ‘.,., >,,?.,,,, ,.,,), t,. .,w,j “.,,

,,> ,?.,,.., e.w<,wf 1, ..’7 ,*? rh. LW.,?lw$ .?, J.. . . . . .. . and ,,,,, . . . b, d,,c,”,,ml ., ,.

Pub,,< H,, !,. S?r.,, . B O{i,c, c,, fi,.,,, R,,,.,’, s,.,, s,,., ..drpct, nn,.,,

,,”,.,, ,,, o,,, r ,,., {,,”, ,,, “$”,, ,0! ar), .,.. ! ,,,,,,,.,. w,!. ”., Q,l,, r l“, H,.l,, ! S,.,,., !..

fiJCJ ~gglltj

lm DATE OF VISIT

&

~

2.:;.;HOF 3m SEX

I ❑ FEMALE

2 t,tALE

t.”<> .,. Da, Y.,<

~, MAJORREASONFOR THIS

VISIT /CJ}r/kone/

, (-JAW PROBLEM

2 ❑ CHBONICPROBLEM, Rol.?rw,

3 ❑ CHRCJNIC PROBLEM. ,,ARE”,

. ❑ POST SURGERY Pow INJURY

5 ❑ N12N ILLNESS CARE ,ROUT,NE

PRENATAL, GENERAL EXA&l

WE LL8ABY, ETCI

~(). HAVE YOU SEEN

PATIENT BEFORE?

IF Y&. FOR THE

CONDITION IN

ITEM 9.7

,DYES ,UNO

PATlENT RECORD

NATIONAL AMBULATORY MEDICAL CARE SURVEY

4. COLOROR RACE [5= ETHNl121T~

I ❑ WHITE

2 ❑ 8LACK 1❑ HISPANIC

ORIGIN

3❑A&w&;Flc

2 ❑ .o.

HISPANIC

4 mAh4ERICAN INE21AN/

- ALAS KANNA1-IVE I

& DIAGNOSTIC SERVICES THIS VISIT

/C)wck all ordered or providedl

1 r-~ NONE ,UEKG

2 ~LIMITEO HISTORYEXANI 9 ❑ VIWJNTEST.

4 ❑PAP TEST ),@ MEJ&STAT”,

5 ❑ CLINICAL LAE3TEST

~cl””

,, ❑ omw+ ,Sf,!<!{,,

6, PATI ENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER

REASON(S) FOR ~ VISIT //,1 p~fl~),f ‘S<J$,,FI,,WliS/

a MCST IMPORTANT

b OTHER

9,PHYSICIAN’S OIAGNOSES

. PRINCIPAL D\ AGNOSIS!pRoBLEM ASSOCIATED WITH ITEM 6?

b OTHER SIGNIFICANT CURRENT DIAGNOSES

11. MEDICATION THERAPY THIS VISIT O NONE

[ Using brand w ge?wric names, record all new and c-ml rinued medico nom ordered. injecred, administered, or orherwrse

prowded a 1 this visl. Include immunizing and desensitizing agen cs/

d. FOR PRINCIPAL DIAGNOSES IN ITEM 9, b, FOR ALL OTHER REASONS

1 1

.—. .-—-.

2. 2.

3. 3.

.! 4.

72m NON-MEDICATION THERAPY

[Chzck a!l services ordered or prcwided tl*isvisit I

, ❑ NONE

2 ❑ PHY9CJTHERA.Y

3 ❑ OFFICE suRGERY

4DFAMILYFMNNING

5 (JFWCHOTHERAPYI

THERAPEUTIC LISTENING

6❑ OIET COUNSELING

7❑ FAMILY,sO.b4L

COUNSELING

8❑ MEDICAL COUNSELING

9❑ OTHER IsflrC,,,

PHS.61 05-B (9/79)

13. WAS PATlENT

REFERRED

FOR THIS VISIT

BY A~HER

PHYSICIAN?

, /--JYEs

14 DISPOSITIONTHIS VISIT

= [Chec$:all fhutt7FIply/

1 ❑ NO FC)LL.OVAJ.IPPLANNEO

2 fJ13ETURNATSpEC,F(ED T(ME

3 DRETUFIN [F NEE0EL3. p.R N

4DTELEPHONEFOLLOWUPP LANNE0

5 ❑ REFERREOTOOTHER PHYSICIAN

E. URETURNEDTOREFERR)NG physician

7 ❑ AOM(TTO HosP,TAL

B ❑ OTHER,SJWIJ,J

15. DURATION

CtF THIS

VISIT

[Time ocruoi[.v

spew ,%irh

physician/

Mm..,.,

* U S GOVERNMENT PRINTING OFFICE: 1980-721-502 3.1 OMB No. 68. R1498
Appendix III

Definition of terms

Because the design and execution cf the Complement

Survey and the National Ambulatory Medical Care Survey

were similar, most definitions of terms apply to the data obtained in both surveys. The definitions that pertain to only one

survey are labeled to that effect. When a term has different

meanings for the two surveys, separate definitions for each

survey are presented.

Terms relatingto the survey

Ofice-Premises identified by physicians as locations of

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. Private offices located within hospitals are included.

Ambulatory patient—An individual seeking personal health

services who is neither bedridden nor currently admitted to any

health care institution on the premises. This report uses the

term “patient” interchangeably with “ambulatory patient.”

Physician—All duly licensed doctors of medicine and

doctors of osteopathy:

●

●

●

●

Non-o fice-based-Physicians classified by the American

Medical Association (AMA) or the American Osteopathic

Association (AOA) as principally engaged in any professional activity other than office-based patient carq federally

employed; and/or specializing in anesthesiology, pathology,

clinical pathology, forensic pathology, radiology, diagnostic

radiology, pediatric radiology, or therapeutic radiology.

In scope for the Complement Survey-Non-o fice-based

physicians, with the following exclusions: physicians who

do not see patients and physicians who see patients only in

institutions (including hospitals and nursing homes), industrial clinics, family planning clinics, college or universi@

clinics, or government-operated clinics. Also excluded are

all physicians classified by the AMA or AOA as principally

engaged in ofllce-based patient care. This report uses the

terms “in scope for the Complement Survey” and “eligible

for participation in the Complement Survey” interchangeably.

Out ofscopefor the Complement Survey-All physicians

not judged to be in scope for the Complement Survey.

In scope for NAJ.fCS-Physicians who are classified by

the AMA or AOA as principally engaged in oi%ce-based

patient care and who currently see patients in private practice. Excluded are physicians who are classified by the

AMA or AOA as principally engaged in any professional

activity other than office-based patient care; physicians

who are classified by the AMA or AOA as federally employed, including those in military service; physicians who

do not see patients; physicians who see patients only in

institutions, industrial clinics, family planning clinics, college or university clinics, or government-operated clinics;

and physicians who specialize in anesthesiology, pathology,

clinical pathology, forensic pathology, radiology, diagnostic

radiology, pediatric radiology, or therapeutic radiology.

This report uses the terms “in scope for NAMCS” and

“oftlce-based physicians” interchangeably.

● Out of scope for NAhfCS-All physicians not judged to

be in scope for NAMCS.

Patients

● In scope—All patients seen by the physician (or a staff

member acting under the supervision of the physician) in

the physician’s office.

. Out of scope—All other patients of the physician, including inpatients and outpatients seen by the physician in an

institution (including a hospital, nursing home, or other

extended care facility); patients seen at their homes by the

physician; patients who contact and receive advice from

the physician by telephone; and patients who go to the

physician’s of’iice ordy to Ieave a specimen, to pick up insurance forms, to pay a bill,, or to pick up medications

previously prescribed by the physician.

Visit—A direct, personal exchange, at a physician’s office,

between an ambulatory patient seeking health care and the

physician (or a staff member acting under the supervision of

the physician) rendering health care services.

Ai14A/A OA ph-vsician specialty-The physician’s principal specialty, including general practice, as listed in the AMA

or AOA mastertles. This is used with the Complement Survey

physician data only.

Physician special@ —Pnncipal specialty, including general

practice, as designated by the physician at the time of the survey.

Those physicirms for whom a specialty was not obtained were

assigned the principal specialty recorded in the AMA or AOA

masterflles. This is used with both Complement Survey and

NAMCS patient visit data.

Region ofpractice location—The following four geographic

regions, excluding Alaska and Hawaii, that correspond to those

used by the U.S. Bureau of the Census:

Region States included

Northeast. . . . . . Connecticut, Maine, Massachusetts, New

Hampshire, New Jersey, New York,

Pennsylvania, Rhode Island, and Vermont.

43
Region—Con. States included—Con.

North Central, Illinois, Indiana, Iowa, Kansas, Michigan,

Minnesota, Missouri, Nebraska, North

Dakota, Ohio, South Dakota, and Wisconsin.

South . . . . . . . . . Alabama, Arkansas, Delaware, District of

Columbia, Florida, Georgia, Kentucky,

Louisiana, Marylend, Mississippi, North

Carolina, Oklahoma, South Carolina,

Tennessee, Texas, Virginia, and West

Virginia.

West. .,...,... 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 invo!ves two considerations: first, a city or cities of

specified population that constitute the central city and identifjr

the county in which it is located as the central county; second,

economic and social relationships with “contiguous” counties

that are metropolitan in character so that the periphery of the

specific metropolitan area may be determined. SMSA’S may

cross State lines. In New England, SMSA’S consist of cities

and towns rather than counties.

Terms relating to the Patient Record form

Age—The age at last birthday, as of the date of visit. This

is calculated from the date of birth.

Race—Vdhite, Black, Asian/Pacific Islander, or American

Indian/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:

●

●

●

●

W%ite-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/Paczj7cIslander—A person having origins in any of

the original peoples of the Far East, Southeast Asia, the

Indian subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the

Philippine Islands, and Samoa.

Amen-canIndian/AlaskanNative—A verson having origins

in any of the original peoples of North America and who

maintains cultural identification through tribal afflli ation

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

44

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 reasonfor 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 illness (onset of condition was 3 months or more

before the visit).

Chronic problem, ji’areup-A visit primarily to receive

care for a sudden exacerbation of a preexisting chronic

condition or illness.

Post surge~/post injzmy-A visit primarily for followup

care of injuries or for care required following surgery; for

example, removal of sutures or cast.

Non-illness care (such as routine prenatal, general, or

well-baby exams)—General health maintenance examinations and routine periodic examinations of presumably

healthy persons, both children and adults, including prenatal and postnatal care, annual physicals, well-child

examinations, and insurance examinations.

Diagnostic services this visit—Physicians were instmcted

to check any of the following services that were ordered or

provided during the current visifi

●

●

●

●

●

●

●

●

b

●

●

Limited history/exam-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/exam-History or physical examination

of a comprehensive nature, including all or most body

systems.

Pap test—Papanicolaou test.

Clinical lab test—One or more laboratory procedures or

tests, including examination of blood, urine, sputum,

smears, exudates, transudates, feces, and gastric content,

and including chemistry, serology, bacteriology, and pregnancy tes~ excludes Pap test.

X-ray—Any single or multiple X-ray examination for

diagnostic or screening purposes; excludes radiation

therapy.

Blood pressure check.

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.

Mental status exam—Any formal, clinical evaluation designed to assess the mental or emotional status of the

patient.

Other—All other diagnostic services ordered or provided

that are not included in the preceding categories.
PrincipaI 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.

New patient—The physician indicated in item 10 of the

Patient Record form that he or she had not seen the patient

before. This means that the physician had not provided care to

the patient at any time in the past.

Old patient—The physician indicated in item 10 of the

Patient Record form that he or she had seen the patient before;

that is, that he or she had provided care to the patient at some

time in the past.

Newproblem—The physician had not provided care in the

past for the principal diagnosis recorded for the current visit.

This applies to “old patients” only.

Old problem—The physician had provided care in the

past for the principal diagnosis recorded for the current visit.

This applies to “old patients” only.

Medication therap.v—All prescription or nonprescription

medications (including drugs, vitamins, hormones, vaccinations,

immunizations, and desensitization agents) listed by the physician as ordered, injected, or otherwise administered or provided

during the current visit. The physicians were instructed to use

either brand or generic names. Also included are medications

that were ordered or provided earlier and that the physician

instructed or expected the patient to continue taking as of the

end of the current visit. This report uses the terms “medication

therapy, “ “medication,” and “drug” interchangeably.

Drug visit-A visit during which the physician ordered or

provided one or more prescription or nonprescription medications.

Non-medication therapeutic services-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 therapies.

OJTzcesurgeq’—Any surgical procedure performed in the

office this visit, including suture of wounds, reduction of

fractures, application or removal of casts, incision and

draining of abscesses, application of supportive materials

for fractures and sprains, 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/therapeutic listening—AH treatments designed to produce a mental or emotional response through

su~estion, persuasion, reeducation, reassurance, or sup-

●

●

●

●

I

port, including psychological counseling, hypnosis. psyche

analysis, and transactional therapy.

Diet counseling—Instructions, recommendations, or advice regarding diet or dietary habits.

Familv/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—Instructions and recommendations

regarding any health problem, including-advice or counsel

about a change of habit or behavior. Physicians were instructed to check this category only if medical counseling

was a significant part of the treatment. Family planning,

diet counseling, and family/social counseling are excluded.

Other—Treatments or nonmedication therapies ordered or

provided that are not listed or included in the preceding

categories.

Referral status—Refemals are any visits that are made at

the advice or direction of a physician other than the one being

visited. The interest is in referrals for the current visit and not

in referrals for any prior visit.

Disposition this visit—Eight categories. areprovidedto

describe the physician’s disposition of the case. The physiciau --,

was instructed to check as many of the categories as apply:

●

●

●

●

●

●

●

●

No follow-up planned—No return visit or televhone contact was scheduled for the patient’s problem.

Return at speclj7ed time—Patient was told to schedule an

appointment or was instructed to return at a particular

time.

Return lY needed, P.R.N. —No future appointment was

made, but the patient was instructed to make an appointment

with the physician if the patient considered it necessary.

Telephone follow-up p[anned-Patient was instructed to

telephone the physician either on a particular day to report

on progress or if the need arose.

Referred to other physician—Patient was instmcted to

consult or seek care from another physician. The patient

may or may not return to this physician at a later date.

Returned to refem-ng phvsician-Patient was instructed

to consult again with the referring physician.

Admit to hospital—Patient was instructed that further

care or treatment would be provided in a hospital. No further

office 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.

45
Appendix IV

American Hospital Formulary

Service classification system

and therapeutic category codes

AMERICAN HOSPITAL FORMULARY SERVICE CLASSIF1CATION SYSTEM

AND THERAPEUTIC CATEGORY CODES (AHFS#)

(Classifications in parenthew are provisional but maybe used in DPIF)

—

AMER3CAN

HOSPITAL

FORMULARY

SERVtCE

CLASSIFICATION

SYSTEM

3600

36:04

36:08

36.12

36.t6

3618

36:24

36:25

36.26

36:28

36:30

36:32

36:34

36:36

36:38

36:40

36:44

3648

36:52

36:56

36:60

36:61

36:62

36:64

36:66

36:68

36.72

36:76

36:7S

36:80

36:84

36:8S

40:00

40:04

40:08

40:10

40:12

40:16

40:18

40:20

40:24

40:28

40:36

40:40

DIAGNOSTICAGENTS

Adrenocortwal [nsufticiency

Amyloidosis

Blood Volume

Brucetlow

CardMc Funcuon

C!rculatlon Time

(Cyst]c Fibros@

Dlatw tes Meltitus

Diph therm

Drug Hypersensitivity

Fun@

Gattbladder Funckm

Gastric Function

Intestinal Absorpu.n

Kidney Function

Lwer Function

60:00 GOLD COMPOUNDS

64:00 HEAVY METAL ANTAGONISTS

6B:00 HORMONES AND SYNTHETIC

SUBSTITUTES

68:C4 Adrenals

68:08 Androgens

6B: 12 Contraceptives

6B:16 Srtm8ens

68:18 Gcmadotropins

6S:20 Insulins and Anti-Diabetic

Azents

04:00 ANTIH3STAM3NE DRUGS

OB:00 ANTI-INFE~IVE AGENTS

08:04 Amebacides

08:08 .4nIhelmkmcs

08:12 Antibiotics

08:12.02 Anunogtycosides

08:12.04 Antifungal Antibioucs

08:12.06 Cephatosporins

08:12.08 Chloramphenicol

08:12,12 Eryttiomycins

OB:12.16 Penicittim

08:12.24 Tetracyctmes

08:12.24 Other Antibioucs

68. 20.OB” Insulins

68:24

6B:28

68:32

68:34

68:36

Parathyroid

Piwt.wy

ProSest0gen5

Other Corpus Luteum Iiormones

Thyroid and Antithymid

LOCAL ANESTHETICS

OXYTOCICS

RADtOACfIVE AGENTS

SERUMS, TOXOIDS AND VACCINES

Serums

Toxoids

Vaccines

SKIN AND MUCOUS MEMBRANE

PREPARATIONS

Anti-lnfectives

Lymphogzanuloma Venereum

Mumps

Myastheni8 Gravis

Myxedema

PancreaUc Funct]on

Phenylketonurn

Pheochronmcytonra

Pmutary Ftmct,.n

Roentgenogmphy

Scadct Ftver

Sweating

(Thyroid Function)

Tnchmosu

Tuberculosis

Urine Contents

72:oO

76:00

78:00

0S:16

08:18

08:20

08:24

OB:26

08:28

08:32

08:36

08:40

10:00

12:00

12:04

12:OB

12:12

12:16

12:20

16:00

20:00

Antituberc”tosls ASents

Amivirats

Ptasmodicides

Sulfonamides

S.UOnes

Treponerructdes

Trichomonamdes

Urinary Germicides

Other Anti-Infective

ANTINEOPLASTIC AGENTS

AUTONOMIC DRUGS

Parasympathomimetk Agents

F’aasympatholytic Agents

Symparhomimetic Agents

SympaLholy tic Agents

Skeletal Muscle Relaxanl$

BLOOD DERIVATIVES

So:oo

BO:&4

80:08

BO:12

84:00

ELECTROLYTIC, CALORIC, AND

WATER BALANCE 84:04

Acutifym8 Agents

Alkalinizin8 Agents

Ammonia Detoxicants

Replacement Solutions

Sodium-Remoting Resins

pOtass!um-Rem0vin8 Resins

Caloric Agents

Salt and SujW Substitutes

Diuretics

Irripting Solutions

Uricosuric A8ents

84:04.04 Antibiotics

84:04.08 Funsicide?

84:04.12 Scabicides and Ped!culicides

84:04.16 Misc. Local Anti-l nfectwes

84:06 Anti.inflammatory Agems

84:08 Antipruritics and Local

Amsthctics

84:12 Astringents

84:16 Cell Stimu lams and Prolifera”ts

84:20 Detergents

BLOOP FORMATION AND COAGULATION

84:24 Emol~ents, Demulcents and

Protestants

84:24.04 Bas]c Lofmns and Lmumcnts

84:24,08 Basic Oits and Other Sotvents

84:24.12 Basic Ointments and

PrO1ectants

84:24.16 Basic Powders and Demutcems

20:04 Antianemia Drugs

20:04.04 tron Preparations

20:04.08 Ltver and Stomach

Reparations

20:12 Coagulant and ,lntmmgulams

20:12,04 Anucoam.d.anrs

44:00 ENZYMES

48:00

52:00

EXPECTORANTS AND COUGH

PREPARATIONS

EYE, EAR, NOSE AND THROAT

PREPARATIONS

Anri-lnfectives

84:28 Keratolyttc Agents

84:32 Keratoplastic Agems

84:36 Miscettaneous A8ents

84:50 Pigmentin8 & DcpiSmenling Agents

S4: 50,04 Depigmeming Agents

84:50.06 Pizmentinz Am”ts

84:80

20:1208 Ant~hep”tin Agents

20:12.12 Coagu!ants

20:12.16 Hemostatic

52:04

52:84.04 Antibiotics

52; 04.06 Movuats

52:04.0S Sutfonanudes

20:40

24:00

24:04

24:06

24:08

24:12

24:t6

28:00

2B:04

28:08

Thrombolytic Agents

CARDIOVASCUMR DRUGS

Cd.iac Drugr

Antitipcndc Agents

Hypotensive Agents

Vasodi3aturg Agents

Sclerosmg Agents

CENTRAL NERVOUS SYSTEM DRUGS

General Anesthetics

Amh!esics and AntiDYrctlcs

52.04.12 Misc. Anti- lnfectivcs

52:08 Anti-lnftammatory Agents

52:10 Carbomc A“hydrasc Inhibitors

Suns&een Agh;

SPASMOLYTtC AGENTS

VITAMINS

Vitamin A

Vitomin B Complex

Vitamin C

Vitamin D

Vitamin E

Vitamin K Actiwty

Mult!mtamm Preparations

UNCLASSIFIED THERAPEUTIC AGENTS

(DEVICES)

(PHARMACEUTIC AIDS)

86:00

52:t2

52:16

52:20

52:24

52:28

52.32

52:36

Contact Lens Solutions

Local Anesthencs

Mlotlcs

Mydnatlcs

Mouth Washes and G.wgtes

Vasoconstnctars

Unclassified Agents

CASTRO] NTESTINAL DRUGS

AnlacvJs and Adsorbcnts

,%rtl-Durrhea Agents

Ant flatulents

Catharucs and Laxatwes

Dlgestants

Emetxs and .4nt!.EmelIcs

LIpotropIc Agents

Misc. Cl Drugs

88:00

88:M

8B:OB

88:12

BS:16

B8:20

B8:24

88:28

2B: tO Narc;tlc Antagonisms”

28:12 Anticonvwlmnts

2B: 16 Psychotherapeutic AgenLs

28:16.04 Antidepressants

28; 16.OB Tranquilizers

28:16.12 Other Psycho tJerapeutlc

Agents

28:20 Rmpuatory and Cerebral

Stlmulals

28:24 Se&twes and Hypnot]cs

56:oo

56:04

56:08

56:10

56:12

56:16

56:20

56:24

56:40

92:00

5’4:00

96:00

Copyright u 1980, Drug Proclucts Information File: American Society of Hospital Pharmacists, Bethesda, Maryland.

All ri~hts reserved. Reprinted with permission.

W. S. GOVER2W33NT PRINTING OFFICE : 1984 0-421-161/306

46
Vital and Health Statistics

series descriptions

SE RIES1.

SE RIES2.

SE RIES3.

SERIES4.

SERIES 5.

SERIES 10.

SERIES 11.

Programs and Collection Procedures-Reports describing

the general programs of the National Center for Health

Statistics and its offices and diwsions and the data collection methods used. They also include definitions and

other material necessary for understanding the data.

Data Evaluation and Methods Research-Stud!es 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 Epidomiological Studies-Reports preSeIStif19 analytical or interpretive studies bawd on vital

and health statistics, carrying the analysis further than

the expository types of reports in the other series.

Documents and Committoe 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

Reports-Analytical and descriptive reports comparing

U.S. vital and health statistics with those of other Coun.

tries.

Data From the National Health Interview Srsrvey-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 trms for (1) esttmates of rhe

medically defined prevalence of specific diseases in the

United States and the distributions of the population

with respect to physical, physiological. and psychological characteristics and (2) analysis of relationships

am0n9 the various measurements without reference to

an explicit fmlte universe of persons.

SERIES 12, Data From the Institutionalized Population Surveys-Discontinued in 1975. Reports from these surveys are included in Series 13.

SERIES 13. Data on Health Resources Utilization-Statistics on the

utilization of health manpower and facilities providing

long-term care, ambulato~ care, hospital care, and family

planning services.

SERIES 14. Data on Health Rasources: Manpower and FacilitiesStatistics on the numbers, geographic distribution, and

characteristics of health resources including physicians,

ckntists, nurses, other health occupations, hospitals,

nursing homes, and outpatient facilities.

SERIES 15. 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 Statlstlcs.

SERIES 20. Data on Mortality-Various statistics on mortality other

than as included in regular annual or monthly repotm.

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.

SERIES 21. Data on Natality, Marriage, and Divorrn-Various statistics cm natality, marriage, and divorce other than as

included in regular annual or monthly reports. Special

analyses by demographic variables; geographic and time

series analyses; studies of fertility; and statistics on

characteristics of births not available from the vital

records based on sample surveys of those records.

SERIES 22. Data From the National Mortality and Natality Surveys–

Discontinued in 1975. Reports from these sample surveys

based on vital records are included in Series 20 and 21,

respecthrely,

SERIES 23. Data From the National Survey of Family GrowthStatistics on fertdity, 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 repofls published in these series, write to:

Scientific and Technical Information Branch

National Center for Health Statistics

Publlc Health !%wce

Hyattswlle, Nd. 20782

or call 301.436 .NCHS
U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Service

National Center for Health Statistics

3700 East-West Highway

Hyattsville, Maryland 20782

OFFICIAL 8USINESS

PENALTY FOR PRIVATE USE, $300

DHHS Publmation No. (PHS) 84–1738, Series 13, No. 77