- —.-

Patterns of

Ambulatory

General and

Practi~

Care in

Family

The National

Ambulatory Medical

Care Survey

United States, January 198&

December 1981

Data on the ambulatory medical care

provided during visits to office-based

general and family practice physicians are

presented. Individual practice profiles

are drawn for female and male physicians,

for different age groups of physicians,

for physicians in the four major geographic

regions, and for those in metropolitan

and nonmetropolitan areas. Descriptors of

practice include patient demographic

characteristics, prior visit status, and

patient condition. Data are also presented

on the patient management techniques

utilized, including diagnostic services,

medication therapy, and nonmedication

therapy.

DataFmmthe NationalHealthSurvey

Series13, No. 73

DHHS Publication No. (PHS] 83-1734

U.S. Department of Health and Human

Services

Public Health Service

National Center for Health Statistics

Hyattsville, Md.

September 1983
Cop*/right Information

Suggested Citation

Librar# dCongress Cataloging in PUIJIICMICCI-I Qars

Cypress, 13eulah K.

Patterns of ambulatory care

—
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 Analysis

and Epidemiology

Garrie J. Losee, Associate Director for Data Processing

and Services

Alvan O. Zarate, P1-I.D.,Assistant Director for International

Statistics

E. Ead Bryant, Associate Director for Interview and

Examination Statistics

Robert L. Quave, Associate Director for Management

Gail F. Fisher, Ph.D., Acting 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 Officer

Vital and Health Care Statistics Program

Peter L. Hurley, Associate Director

Gloria Kapantais, Assistant to the Director for Data Policy,

Planning, and Analysis

Division of Health Care Statistics

W. Edward Bacon, Ph. D., Director

Joan F. Van Nostrand, Deputy Director

James E. Delozier, ChieJ Ambulatory Care Statistics

Branch
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Scope ofthesuwey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Source and limitations ofthe data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

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

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

Visit rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Referral status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Sex ofthe patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Principal diagnosis andtherapeutic services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Principal diagnosis, duration, and disposition ofvisit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Listofdetailedtables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appendixes

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

II. Definitions ofterms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111. Survey instmments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. American Hospital Formulaiy Service classification system andtherapeutic category codes . . . . . . . . . . . . . . . . . . . . . . . .

List of figures

1. Percent distribution ofoffice visits by specialty: United States,January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . .

2. Percent of office visits to general and family practitioners, by age of patient and age of physician: United States.

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

3. Percent of oflice visits to general and family practitioners, by type of practice and age of physician: United States,

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

List of text tables

A. Number of office visits to general and family practitioners and percent distribution by type of practice, according to

location ofphysician”s practice: United States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

1

1

1

2

3

3

5

5

9

9

9

9

9

9

10

10

10

12

12

13

13

15

16

17

39

40

50

60

2

6

7

3

.,, Ill
B.

c.

D.

E.

F.

G.

Number of oflice visits to general and family practitioners, number and percent of drug visits, number of drugs mentioned, drug mention rate per visit, and drug intensity rate per drug visit, by type and location of practice: United

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

Average number of oflice visits per week and mean duration of visits to general and family practitioners, by age and

sex ofphysician: United States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number ofofflce visits to general and family practitioners, number andpercent ofdrugvisits, number ofdmgs mentioned, drug mention rate per visit, and drug intensity rate per drug visit, by age and sex of physician: United States,

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

Annual rate of ofTice visits to general and family practitioners, by age and sex of patient United States, 1975 and

1980-81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent of office visits to general and family practitioners, by 20 most frequent principal reasons for visit:

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

Number andpercent ofofice visits togeneral mdfmily practitioners, by20most frequent principal dia~oses: United

States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . ..” . . .. ~. . ..j . . . ..~... . . . . . . . . .

H.

J.

Number of oflicevisits to general and family practitioners, number and percent ofdrug visits, number of drugs mentioned, drug mention rate per visit, and drug intensity rate perdmgvisit byselected characteristics of patient: United

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

Mean duration of office visits to general and family practitioners, by prior visit status and principal diagnosis categories:

United States,Janua~ 1980-Decemberl 981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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 Iess than

500where numbers are roundedto

thousands

*

Figure does not meet standards of

reliability or precision

4

5

6

9

11

1

2

4

# Figure suppressed to comply with

confidentiality requirements

iv
Patterns of Ambulatory Care

in General and Family

Practice:

The National Ambulatory

Medical Care Survey

bv Beulah K. Cypress, Ph. D., Dwision of Health Care Statistics

Introduction

Purpose and background

This report is a presentation of national estimates of the

use of ambulatory medical care services provided by nonFederal. ofllce-based general and family practice physicians

in the conterminous United States during the calendar years

1980-81. It is the first in a planned series of reports based on

the visit characteristics of various medical and surgical specialties. The data were gathered by the National Center for

Health Statistics by means of the National Ambulatory Medical Care Survey. a sample survey of physicians’ office visits

conducted annually through 1981 by the Division of Health

Care Statistics. Data collection and processing for the 1980

and 1981 National Ambulatory Medical Care Surveys were

the responsibility of the National Opinion Research Center at

the University of Chicago. Sample selection was accomplished

with the assistance of the American Medical Association and

the American Osteopathic Association.

A brief report based on 1975 estimates of visits to general and family practitioners (GFP’s) was published in Advance Data from Vital and Health Statistics No. 15.’ However, because of the revision of the reason for visit coding system in use in 1977 and of the International C1assJ7cation of

Diseases in use in 1979. data from that report may not be

strictly comparable to those in this report. Summary statistics

for 1979. including selected characteristics of visits to GFP’s

among other specialists, were presented in Vi[a/ and HeaMz

Statistics, Series 13, No. 66.2

Dctailed information on the background and methodology of the survey was published in Vital and Health Statistics, Series 2, No. 61.3 A description of the 1980 and 1981

surveys, including statistical design, data collection and processing, and estimation procedures, may be found in appendix

I of this report. Technical details regarding reliability of estimates are also given in appendix I. Definitions of terms used

in the survey are provided in appendix II. Facsimiles of survey

instruments appear in appendix 111. Prior to data presentation.

the scope of the survey and limitations of the data are described

briefly to assist the reader in interpreting the estimates.

Scope of the survey

counter or visit. The current scope of NAMCS includes all

office visits within the conterminous United States made by

ambulatory patients to nonfederally employed. office-based

physicians as classified by the American Medical Association

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

radiologists, and physicians principally engaged in teaching,

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

Source and limitations of the data

The data in this report are based on information obtained

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

samples for the 1980 and 1981 NAMCS included 5,805 physicians, 1,124 of whom were ineligible because they were out

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

3,676 (78.5 percent) participated (see appendix I). There were

1,340 general and family practice physicians in the sample of

whom 289 were out of scope. Of 1,051 eligible GFP’s, 779

participated (74. 1 percent).

Sample physicians listed all office visits during a randomly assigned 7-day reporting period. During the 2-year period. information was recorded on Patient Records for a systematic random sample of 89.477 visits including 23,055 visits

to GFP’s.

The 1980 and 1981 NAMCS were conducted in identical fashion using the same instruments, definitions. and procedures. The 2 years of data were combined to provide more

reliable estimates. Therefore, the reader should note that estimates of number of visits and drug mentions contained in this

report are for a 2-year period, but ratios and rates represent

average annual estimates.

The information in this report is derived from a complex

sample survey. and the appendixes should be reviewed to insure a proper understanding and interpretation of the statistical

estimates presented. Because the statistics in this report are

based on a sample of oftice visits rather than on all visits. they

are subject to sampling errors. Therefore, particular attention

should be paid to the section entitled .’Reliability of estiThe basic sampling unit for the National Ambulatory mates..’ Charts on relative standard errors and instructions for

Medical Care Survey (NAMCS) is the physician-patient en- their use are also given.

1
Visits by specialty

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

The highest proportion of visits, about 33 percent, were made

to the offices of general and family practice physicians. This

proportion equals that of the next three ranking specialties combined. Although the volume of visits to GFP’s has been consistently greater than that of any other specialty, visits to

GFP’s declined from 41 percent of total visits in 1975 to 33

percent in 1980 while the proportions of the next three ranking specialties either remained constant or increased slightly.z

This decrease in the proportion of visits to GFP’s can be attributed largely to a corresponding decrease in the proportion of

these doctors in office-based practices. From 1975 through

1980, GFP’s decreased as a proportion of all non-Federal,

office-based physicians, from 22 percent in 1975 to 18 percent

in 1980.4

The foHowing sections of this report describe ambulatory

care provided by general and family practice physicians in

terms of physician and practice characteristics, patient characteristics, and patient condition and management. The profile is developed within the structure of the variables used in

the NAMCS Patient Record form and data collected in the

physician’s induction interview (see appendix III). Because

visits to GFP’s constitute the largest proportion of NAMC S

visits, many of the statistics presented in this report resemble

those in the summary of all NAMCS visits. It should be kept

in mind when reading this report that data are restricted to

general and family practice and should not be generalized to

the universe of all physicians.

Other All

meJical other

s~ecialties specialties

7.5

Obstetrics ,

/ !5.4

and IL

Figure 1, Percent distribution of office visits by specialty:

United States, January 1980-December 1981

2
Physician and practice

characteristics

Type of practice

The organization of medical practice has changed significantly in the United States. In 1975, The Center for Health

Services Research of the American Medical Association reported an 8 percent average annual growth rate in group’ medical practice over a 40-year periods A decline in the proportion of visits to physicians in solo practice since 1975 reflects

a continued trend towards multiple practice. In 1980–81 physicians in solo practice accounted for 64 percent of all visits

to GFP’s (table A), a decrease from the 73 percent reported

in NAMCS in 1975.1 However, there were regional differences in the distribution of visits by type of practice. Preference for solo practice is apparent in the Northeast and South

Regions where 74 percent and 69 percent of visits, respectively,

were made to such offices. But in the West and North Central

Regions less than average proportions of visits were to solo

practices (54 percent and 57 percent). In metropolitan areas

visits to physicians in solo practice or other practices were

about evenly divided, but in nonmetropolitan areas multiple

practice visits exceeded those of solo practice.

Selected characteristics of visits to GFP’s are distributed

by type of practice in table 1. Compared with patients visiting

solo practitioners, patients seen by physicians having other

practice arrangements were younger, more likely to be visiting

the physician for the first time, more likely to present acute

problems, and more likely to receive nonillness care.

Patients’ principal reasons for visits to GFP’s also differed based on the type of practice. In NAMCS patients’ reasons for visit, expressed as closely as possible in the patient’s

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

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

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

are coded and grouped in eight modules according to a classification system that is detailed in A Reason for Visit Classl@

cation for A mbulatoiy Care (RVC).6 These modules are listed

in table 1. (Specific reasons for visit are discussed in the section entitled “Patient condition and management.”) Patients

visiting solo practice physicians were more likely to describe

a symptom or give the name of a disease as their reason for

visit than those visiting group practice offices were. But a preaThe American Medical Association defines group practice as the provision of

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

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

more than one physician.

Table A. Number of office visits to general and family practitioners

and percent distribution by type of practice, according to location

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

Number of Type of practice

Location of practice visits in

thousands Total solo Otherf

Percant distribution

All visits . . . . . . . . . . . . . . . . . 381,710 100.0 63.5 36.5

Geographic region

Northeast . . . . . . . . . . . . . . . . 65,851 100.0 73.9 26.1

North Central . . . . . . . . . . . . . 118,772 100.0 57.0 43.0

South . . . . . . . . . . . . . . . . . . . 130,847 100.0 69.1 30.9

West . . . . . . . . . . . . . . . . . . . . 66,240 100.0 53.9 46.1

Area

Metropolitan . . . . . . . . . . . . . 230,141 100.0 50.8 49.2

Nonmetropolitan . . . . . . . . . . 151,569 100.0 31.4 68.6

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

ventive health care service was more likely to be the reason in

the latter type of practice than in the former.

The diagnostic tools used by GFP’s to evaluate patients”

symptoms or complaints are shown by type of service in table

1. These data do not measure the intensity of the physician’s

workup because NAMCS was designed to gather data on the

types of services ordered or provided during the current visit.

The Patient Record does not have the flexibility to probe

whether procedures were single or multiple. Differences in the

proportions of some diagnostic services provided by the two

groups of physicians appear to be related to case-mix. GFP’s

in solo practice. where the average patient was older than that

of GFP’s in other types of practice, used the general history

and examination proportionately more often than their counterparts in multiple practice did. However, the latter used the limited history and examination in proportionately more visits.

Solo physicians made proportionately more blood pressure

checks but were less likely to order clinical laboratory tests

and Pap tests. These firtdlngs are consistent with those usually

found in a practice serving older patients. It is not clear from

the data why solo physicians were less likely to order electrocardiograms than other physicians were.

The principal (first-listed) diagnoses rendered by physicians during visits are listed by categories based on the international Class l>cation of Diseases, 9th Revision, Clinical

iWodt@ation (ICD–9–CM)7 in table 1. Proportions of visits

to GFP’s in solo practice exceeded those in other types of
,, [icc when diagnoses were in the categories endocrine. nu-

:rl[ional find metabolic diseases, and immunity disorders; disc:isc~ of (he circulatory system; and diseases of the respiratory

systcm. Proportions of visits to physicians not in solo practice

were higher for diseases of the nervous system and sense organs, diseases of the genitourinary system, and supplementary

classification. The last three groups are usually relatively large

when the physician’s patient load is dominated by young patients. (Specific principal diagnoses are discussed in terms of

patient age in the section entitled “Patient condition and management.”)

The nonmedication therapy that physicians used to treat

these conditions is shown in table 1. Solo physicians provided

diet counseling during proportionately more visits than other

physicians did. but nonsolo physicians offered medical counseling proportionately more often. These data should be interpreted in the context of the case-mix profile. If the physician

treated many patients for obesity or diabetes mellitus, for example. visits that include diet counseling may be expected to

be correspondingly large. On the other hand, medical counseling may be an integral part of a family planning visit or a wellbaby examination. The more visits there are for these types of

care, the more medical counseling is likely to be used. Therefore, the services provided are likely to correlate with the

characteristics of the patient. Other nonmedication therapy

services, shown in table 1, were provided in about equal proportions by physicians practicing alone or in groups. However,

medication therapy was used with greater intensity by G FP’s

in solo practice than by others. About 18 percent of the visits

to solo physicians included three or more medications, compared with 14 percent with the same number to nonsolo physicians. Physicians in solo practice prescribed no drugs in 24

percent of their visits, compared with 31 percent with no drugs

prescribed by those in other types of practice.

Estimates of drug utilization in NAMCS are based on the

physicians’ entries on the Patient Record form. These entries

may be brandb or generic names of prescription or over-thecounter drugs, or a therapeutic effect. Drug mentions include

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

make up to eight such entries. The methodology used to collect and process this drug information is described in Vital

and Health Statistics, Series 2, No. 90.8

In addition to counting the number of drugs prescribed

during a visit, drug utilization may be measured by the percent of visits in which one or more drugs were ordered (drug

visits) and by two utilization rates. The drug mention rate is

the number of drug mentions divided by all visits; the drug

intensity rate is the number of drug mentions divided by the

number of drug visits. These rates are shown in table B. The

findings indicate that GFP’s in solo practice had a higher proportion of drug visits and a higher drug mention rate than other

GFP’s did. This is also a typical pattern for a practice with a

relatively large proportion of elderly patients.

Drug mentions are listed by the therapeutic effects they

are intended to produce in table 2. Therapeutic categories are

based on the American Hospital Formulary Service Classification System (AHFS) (see appendix IV).g In the NAMCS

drug file each drug entry was assigned to one AHFS category,

although for some drugs more than one therapeutic effect is

possible. There was a statistically significant difference by type

of practice in only one category. Serums, toxoids and vaccines, a group of drugs likely to be associated with young patients, was proportionately higher for physicians in multiple

practice than for those in solo practice. (Additional informaLq-he“se of brand or t~~denames does not implyendorsement by the public

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

Table B, Number of office visits to general and family practitioners, number and percent of drug visits, number of drugs mentioned, drug mention

rate per visit, and drug intensity rate per drug visit, by type and location of practice: United States, January 1980-December 1981

Type of practice and location

Number of Drug Percent Number of Drug Drug

intensity

visits visits 1 of drug mention

in in drug mentions in rate2 rate3

thousands thousands visits thousands per visit per drug

visit

Type of practice

Alltypes of practice . . . . . . . . . . . . . . . . . . . . . 381,710 281,101 73,6 532,065 1.39 1,89

solo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242,488 184,744 76,2 353,987 1.46 1.92

Othef i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139,222 96,356 69.2 178,078 1.28 1.85

Geographic region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . 65,851 52,171 79.2 100,329 1.52 1.92

North Central. . .,, . . . . . . . . . . . . . . . . . . . . . . 118,772 84,193 70.9 153,933 1.30 1.83

South . . . . . . . . . . . . . . . . . . . . . . . . . 130,847 101,622 77.7 200,630 1.53 1.97

West, ,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66,240 43,114 65.1 77$173 1.17 1.79

Area

Metropolitan, ,, . . . . . . . . . . . . . . . . . . . . 230,141 171,510 74.5 325,423 1,41 1,90

Nonmetropolitan, , ., . . . . . . . . . . 151,569 109,590 72.3 206,642 1,36 1,89

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

20rug mentions div!ded by number of wsits.

3Drug mentions divided by number of drug visits.

41ncludes partnership, group, and other types of practice

4
tion on the specific drugs used by GFP’s is provided in the

section “Patient condition and management.”)

Data on the duration and disposition of the visit were also

consistent with the average age of the patients likely to be

treated in a particular setting (table l). Relatively short visits

(less than 11 minutes) were proportionately more frequent in

the ofilces of physicians in practice arrangements other than

solo (51 percent) than in those of physicians in solo practice

(48 percent). On the other hand, relatively long visits ( 16 minutes or more) that are usually associated with an older group

of patients, were more common for solo physicians than for

the others (20 percent, compared with 17 percent). In general,

the duration of NAMCS visits increases with the increasing

age of the patients. Since GFP’s in solo practice tend to treat

many older patients, this result may be expected.

Physicians in solo practice were also more likely than other

physicians to schedule appointments for return visits; however,

physicians in other practice types were more likely to tell their

patients to return if needed. The instruction to return if needed is

usually associated with visits for acute, often self-limiting, problems that were shown previously to be associated with visits to

physicians in multiple practice.

Location of practice

Among the four major geographic regions, GFP’s in the

Northeast Region treated the highest proportion of patients over

44 years of age (49 percent); physicians in the North Central

Region treated the highest proportion of patients under 15 years

of age (17 percent). It is not possible to relate these statistics to

the distribution of the population because the distribution of

physicians confounds the issue.

The clinical profile of visits to GFP’s in the Northeast Region is typical of the medical practice in which patients are likely

to be over 44 years of age. Problems were more likely to be

chronic in nature in this region than those in other parts of the

country were. Also, blood pressure checks and general history

and examinations were more likely to be used for diagnosis.

Visits for endocrine, nutritional and metabolic diseases, and immunity disorders; and diseases of the circulatory system were

more common in this region than in other regions; and, similar to

the solo practice pattern, diet counseling was likely to be a

therapeutic measure. Except for the South Region, the percent of

drug visits and the drug mention rate in the Northeast exceeded

those of other regions (table B). It is known from NAMCS data

that drug utilization increases with patient age and such a result

may be expected in the Northeast where there was a high average

visit age. Anti-infective agents were used proportionately less in

the Northeast Region, but otherwise distributions of drug mentions by therapeutic category were similar for all regions (table 2).

Patients who visited physicians in the North Central Region were typically younger than those in the other regions, and it

was not unexpected that visits for nonillness care were proportionately higher. Also the reasons given by patients in this region

were more often for preventive care, with a correspondingly

higher frequency of visits in the supplementary classification of

diagnoses (table 1). The proportion of visits in which there was

no face-to-face encounter between patient and physician was

about 5 percent, which was higher than those in the other three

regions. Visits lasting less than 11 minutes were also more common there.

Patients in the South Region were more likely than those in

other regions to present acute problems. The percent of drug

visits and the drug mention rate for this region were similar to

those of the North Central Region, except that central nervous

system drugs were more likely to be prescribed in the South

Region. Proportions of visits lasting more than 16 minutes were

higher in the South and Northeast Regions than they were in the

North Central Region.

The highest proportion of visits that included no medication

was in the West Region where the percent of dmg visits and drug

mention rates were lower than in other regions.

Compared with GFP’s in metropolitan areas, those in nonmetropolitan areas saw proportionately more patients under 25

years of age. Thus the average visit pattern in the nonmetropolitan

areas was similar to others where patients were typically young.

Physician age and sex

The relationship of the physician’s age and sex to the content and organization of general and family practice is explored

in this section. It was postulated that if age is equated with the

year of graduation from medical school, it may be possible to

assess the influence of education and experience on the pattern of

ambulatory medical care. With the growth of nontraditional

practice organizations, such as health maintenance organizations

and multispecialty group practices, fewer graduates (among

whose number is an increasingly larger proportion of women

each year) choose solo practice, while older physicians remain in

established practices. It has been suggested that recency of education and experience also influence dmg prescribing patterns.

Therefore, in a constantly changing pharmaceutical environment, it is important to examine the effect, if any, ofphysician’s

age on prescribing patterns.

NAMCS data reveal a clear relationship between the numberofvisits per week and the age or sex ofthephysician (table C).

The oldest and youngest physicians had the smallest average

Table C. Average number of office visits per week and mean

duration of visits to generaI and family practitioners, by age and

sex of physician: United States, January 1980-December 1981

Average Mean

number of duration

Age and sex of physicianl visits per of visit

physician in

per week minutes

Age

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

Under 35 years . . . . . . . . . . . . . . . . . . .

35–44 years . . . . . . . . . . . . . . . . . . . . .

45–54 years . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . .

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

Sex

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

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

86.8

73.4

98.1

102.9

87.5

63.5

52.0

88.3

13.5

14.5

12.0

12.7

13.8

15.5

16.7

13.4

lDoes not include doctors of osteopathy.

5
number of’visits per week, and physicians 45–54 years of age

had the largest. The average number rose from about 73 visits

for physicians under 35 years of age to almost 103 for those

45-54 years of age, then decreased to a low of about 64 for

physicians 65 years and over. The average number of visits to

male physicians (88) significantly exceeded that to female

physicians (52). It was shown in a report on 1980 data that the

most professionally active physicians of both sexes were those

who graduated in 1951 –60 (about 45–54 years of age in

1980) but males saw more patients in a typical work-week

than females did regardless of the year of graduation. 10 Descriptions of studies of the reasons for the difference in the

productivity of female and male physicians abound in the

literature and will not be recapitulated here. However, the

practice characteristics provided by NAMCS data may offer

some additional insight into the subject. It can be seen in table C

that there is an inverse relationship between the average number of visits per week and the mean duration of the visit. The

two age groups with the highest average number of visits were

associated with the briefest duration, and the age groups with

the lowest number of visits were those with the longest duration. Women saw, on the average, fewer patients per week than

men did, but tended to spend more time with them.

Characteristics of visits to general and family practice physicians are shown for physician age and sex groups in table 3. and

drug mentions are listed by therapeutic categories in table 4. The

reader will note that in previous tables the rounded total of visits

was about 381.7 million and the number of drug mentions was

532.1 million; however, in tables 3 and 4 the comparable rounded

totals are 321.5 million and 445.0 million. This is because tables

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

doctors of osteopathy because data on the age of these physicians were unavailable. It is not likely that the distribution of

visits with the omission of the 60.3 million visits made in 1980–

81 to doctors of osteopathy would differ significantly from the

distribution that includes them. A separate profile of visits to

doctors of osteopathy was published in Advance Data No. 25.11

Patients

45 years and over

\\

\

Patients

under 25 years

‘\

\

\

\,

I I I I I

Under 35–44 45-54 55-64 65

35 and

over

Age of physician in years

NOTE: Ooes not Include doctors of osteopathy,

Figure 2. Percent of office visits to general and family practitioners,

by age of patient and age of physician: United States, January

1980-December 1981

Table D. Number of office visits to general and family practitioners, number and percent of drug visits, number of drugs mentioned, drug mention

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

All Drug Percent Number of Drug Drug

intensity

Age and sex of physiciarrl

visits visitsz of drug mention

in in drug mentions in rates

rate4

thousands thousands visits thousands per visit

per drug

wisit

Age

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321,454 236,117 73.5 444,961 1.38 1.88

Under 35 years . . . . . . . . . . . . . . . . . . . . . . . . . . . 27,963 18,326 65.5 30,670 1.10

35–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.67

56,563 38,440 68.0 68,216 1.21 1.77

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92,790 69,786 75.2 131,739 1.42

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.89

99,064 74,653 75.4 148,263 1.50

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

1.99

45,074 34,912 77.5 66,072 1.47 1.89

Sex

Female. ., . . . . . . . . . . . . . . . . . . . . . 7,477 5,555 74.3 10,577 1.41

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

1.90

313,977 230,562 73.4 434,384 1.38 1.88

10oesnot include doctors of osteopathy.

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

3Drug mentions divided by number of visits.

4Drug mentions dividad by number of drug visits.

6
On the average, GFP’s treat a more heterogeneous group of

patients than other physicians do, but the distribution of visits by

patient age varies with the age group of the physician. Proportions of visits by patients under 25 years of age decreased with

the increasing age of the physician, and proportions of visits by

patients 45 years of age and over increased (table 3). This tendency is illustrated in figure 2.

As is generally the case in NAMCS data, where there are

large proportions of visits by young patients there are also relatively high proportions of visits by new patients and visits for

nonillness care. About 23 percent of the visits to physicians

under 35 years of age were made by new patients, compared with

12 percent to physicians 35-44 years of age, 9 percent to those

45-64 years of age, and only 8 percent to the oldest group.

Nonillness care accounted for 18 percent of the visits to the

youngest physicians, compared with 8 percent of those to the

oldest (table l).

Diagnoses made by physicians under 35 years of age were

more likely than those of other physicians to be in the categories

of diseases of the nervous system and sense organs and supplementary classification (chiefly examinations). Physicians over

65 years of age were more likely to treat patients with endocrine,

nutritional and metabolic diseases, and immunity disorders; and

diseases of the circulatory and musculoskeletal systems.

Probably because of the relatively high proportion of visits

by older patients with endocrine and circulatory disorders,

diet counseling was given in 13 percent of the visits to the

oldest group of physicians. This proportion exceeded those of

other age groups.

Medication therapy was also proportionately more frequent when physicians were older. One or more drugs were

mentioned in 78 percent of visits to physicians 65 years of

age and over, compared with 66 percent of visits to the youngest group (table D). Drug intensity rates were analyzed by age

of the physician and age of the patient in an earlier report. 10It

was observed that drug intensity rates increased with increasing patient age regardless of the age of the physician, thus,

providing evidence that the rate of dmg use depends on the

age of the patient and not the age of the physician.

As may be expected when the age of the patient is correlated with the age of the physician, proportions of cardicrvascular drugs and diuretics increased with the increasing age

group of the physician (table 4). About 25 percent of drugs

mentioned by physicians 65 years of age and over were in

these two categories, compared with 21 percent, 18 percent,

16 percent, and 14 percent of each of the successively younger

groups.

The older the physicians the more likely they were to be

in solo practice (table 3). A clear trend towards practice arrangements other than solo by more recent medical school

graduates is demonstrated in figure 3.

Proportions of visits in metropolitan areas substantially

exceeded those in nonmetropolitan areas when physicians were

under 35 years or over 65 years of age. Only when visits were

to the offices of physicians 35–44 years of age were nonmetropolitan area visits proportionately higher.

A study of the characteristics of the medical practices of

females in various specialties based on 1977 NAMCS data

90

80

70

60

50

40

30

20

10

0

\

\

\

\

1 I 1 I 1

Under 35-44 45–54 55-64 65

35 and

over

Age of physician in years

NOTE: Does not include doctors of osteopathy.

Figure 3. Percent of office visits to general and family practitioners,

by type of practice and age of physician: United States, January

1980-December 1981

was published in Vital and Health Statistics, Series 13, No.

49.12 The number of females in non-Federal patient care increased by 40 percent from 1977 to 1980, but in the same

period the proportion of visits to female GFP’s declined. In

1977, visits to GFP’s accounted for 35 percent of the visits to

female physicians. This proportion decreased to an average of

21 percent in 1980–8 1, reflecting a general decline in visits to

all GFP’s during the period. Some shifi in the choice of specialty by female residents in medicinel~ may also have contributed to the decrease in visits because the comparable decline was smaller for male physicians (from 39 percent to 33

percent). It is important, therefore, to make a fresh examination of the practice profile of the female general and family

practice physician, and for the first time to include drug utilization.

7
One of the most striking differences between visits to female and male GFP’s is the proportion of visits by female

patients-72 percent of the average female GFP’s visits, compared with 59 percent of those to male GFP’s (table 3). Moreover, these proportions have changed very little since 1977

when the comparable figures were 75 and 59 percent, respectively.

Female physicians also treat younger patients than their

male counterparts do. About 44 percent of the female GFP’s

visits were made by patients under 25 years of age, compared

with 29 percent of the male GFP’s. Conversely, 45 percent of

the visits to males included patients 45 years of age and over,

while females saw that age group in 30 percent of their visits.

Proportions of visits by patients 25–44 years of age were about

the same for physicians of both sexes.

Female physicians treated proportionately more new patients than male physicians did, and provided more nonillness

care. They also ordered proportionately more Pap tests and

clinical laboratory tests, which is not surprising in view of the

higher proportion of visits by female patients. Differences between percents of other diagnostic services were not statistically significant.

As expected, diagnoses rendered by female and male physicians were related to the characteristics of the patients they

were likely to see. Male physicians, with an older case load,

treated proportionately more patients with circulatory diseases.

Female physicians, with a predominantly young and female

case load, had more visits by patients with diseases of the

genitourinary system. Visits with diagnoses in the supplementary classification (chiefly gynecological examinations)

were also proportionately higher for female physicians than

for males.

Women provided medical counseling in a larger proportion of their visits than men did, which is consistent with the

general pattern of the female and youth dominated patient load.

Drug utilization was similar for female and male physicians despite the differences in patients. There were no statistically significant differences in the proportions by the number

of drugs prescribed during a visit (table 3), in the percent of

drug visits, or in the drug utilization rates (table D). Data for

1980, which were presented in a previous report,io also indicated that there was little difference in drug utilization based

on the sex of the physician when the sex and age of the patient were also considered. The earlier report provides additional detailed information on drug utilization by the sex of

the physicians and by variables not considered in this report

that the reader may find useful.

The practice profiles of females and males in general and

family medicine also vary according to the duration and disposition of the visit, and the type and location of the practice.

The mean duration of visits to female practitioners was 16.7

minutes compared with 13.4 minutes for those to males

(table C). A more precise estimate of visit duration is shown

in table 3 where visits are distributed by time intervals. l[t can

be seen that 50 percent of the visits to male physicians lasted

less than 11 minutes (relatively short), compared with 39 percent of those to females; and visits of 16 minutes or more duration (relatively long) constituted 19 percent of the males’

visits compared with 31 percent of the females’.

No foilowup was planned in proportionately more of the

male physicians’ visits (16 percent) than of the females’ (5

percent), but females instructed patients to return if needed

more often (44 percent, compared with 30 percent of males’

visits).

Another noteworthy difference between the medical practices of female and male GFP’s occurred in the distribution of

visits by type of practice. Although the majority (62 percent)

of male physicians’ visits were to those in solo practice, the

majority of female physicians’ visits (55 percent) were to those

in partnership, group, or other types of practice.

The greater proportion of visits to all physicians was in

metropolitan locations, but visits to women in general and family practice were more likely to be in such areas (73 percent).

It has been suggested that women tend to select urban areas

for medical practice because of the location of medical schools

and because services are available that enable them to perform

their professional duties and also meet family obligations.

8
Patient characteristics

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

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

the physician. In this section, the emphasis is on the demographic characteristics and visit status of patients seen by general and family practice physicians. Statistics on the sex, race,

and ethnicity of patients are presented by age of the patient in

table 5. Visit rates are also shown in this table. Visits classified by the patient’s demographic characteristics are distributed

by referral status and prior visit status in table 6.

Age and sex

GFP’s see a broader range of patients than any other

grodp of physicians do. On the average, 14 percent of their

visits were made by patients under 15 years of age with about

5 percent in that group under 3 years of age. Of the 86 percent over 15 years of age, 15 percent were represented by patients 15–24 years of age, 27 percent were 25–44 years, 25

percent were 45–64 years, and 19 percent were 65 years of

age and over.

About 18 percent of the male patients were under 15

years of age, compared with 11 percent of the females. About

44 percent of the female group were in the child-bearing years

of 15–44, a statistic that is reflected by the high proportion of

visits for prenatal care. (Specific diagnosis is discussed in the

section entitled “Patient condition and management.”)

Age, race, and ethnicity

Black patients were less likely to be under 15 years of

age than white patients were. The differences between proportions of Hispanic and non-Hispanic age groups were not statistically significant, except for the group 25–44 years of age

where proportions by visits of Hispanics exceeded those by

non-Hispanics.

Visit rates

The visit rate was higher for children under 3 years of age

(90 per 100 in the population) than for other age groups under

15 years of age, probably because of frequent periodic checkups during infancy.

For patients of both sexes, visit rates increased with the

increasing age group of the patient beginning with those 6-10

years of age. However, the visit rates of all age groups of females over 14 years of age exceeded those of males.

Although visit rates increased with increasing age regardTable E. Annual rate of office visits to general and family practitioners,

by age and sex of patienti United States, 1975 and 1980-81

Wit rate per

100 persons in

Age and sex of patient population

1975 7980-81

Age

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . 113 86

Under 15 years . . . . . . . . . . . . . . . . . . . . . . 65 52

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . 96 69

25-44 years . . . . . . . . . . . . . . . . . . . . . . . . 108 82

45–64 years . . . . . . . . . . . . . . . . . . . . . . . . 152 109

65 years and over . . . . . . . . . . . . . . . . . . . . 194 151

Sex

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 100

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 71

less of the race of the patient, rates were higher for white patients under 45 years of age than for black patients the same

age. However, for patients 45 years of age and over, visit rates

were higher for black patients than for white patients.

The general rate of visits to GFP’s dropped from 113 per

100 persons in the population in 1975 to 86 in 1980–81 (table

E). For females, the rate fell from 130 to 100; for males, from

95 to71. The decline was apparent in all age groups.

Referral status

Patients were rarely referred to GFP’s. Only 1 percent

were referred by another physician, with no significant fluctuation in proportions based on age, sex. race, or ethnicity.

Prior visit status

As expected, the older the patients the more likely they

were to make return visits. About 75 percent of the visits by

patients over 65 years of age were for care of continuing problems presented by patients the physicians had seen before, compared with 65 percent, 51 percent. and 42 percent for the next

three younger groups. The return visit rate, which is the number of visits by old (returning) patients divided by the number

of \’isits by new patients. increased from 5 return visits for

each initial visit made by patients 15–24 years of age to 21

for patients 65 years of age and over. This rate was higher for

females than for males, for white patients than for black patients, and for non-Hispanic than for Hispanic patients.

9
Patient condition and

management

In this section, the clinical characteristics of visits are presented in relation to the age, sex, and prior visit status of patients. Condition of the patient is shown by means of patients’

reasons for visit and physicians’ diagnoses (tables 7–1 O). Statistics are presented on patient management exemplified by

the GFP’s use of diagnostic tools, nonmedication therapy, and

medication therapy (tables 11–1 3). In table 14, patients’ reasons for visit are analyzed by the diagnostic services ordered

or provided in their presence. The proportions of therapeutic

services ordered or provided for patients with certain diagnoses

are shown in table 15. To conclude the description of patient

management, statistics on the duration and disposition of the

visit appear in tables 16–17.

Sex of the patient

Proportionately more visits by female patients than by

males were for nonillness care, but acute problems and postwrgery or postinjury were more likely to be the major reason

‘or males’ visits (table 7). The principal reasons for visits exmessed by female patients were more likely to be in the diagnostic, screiming, and preventive module than those by males

were. However, male patients proportionately more often gave

‘easons in the injuries and adverse effects module and the administrative module. The high incidence of female visits with

reasons in the diagnostic, screening, and preventive module

was due in large part to visits for prenatal care and gynecological examinations. Examinations for employment, licenses, and

insurance contributed to the higher proportion of reasons in

the administrative module given by males.

The diagnostic procedures physicians used to evaluate patients’ problems differed depending on the sex of the patient.

Higher proportions of the visits by females than by males included clinical laboratory tests and blood pressure checks.

When patients were male, proportionately more visits included

X-rays, electrocardiograms, and vision tests. Only 5 percent

of all the visits by females included Pap tests (6 percent of

females 15 years of age and over).

Although NAMCS data do not necessarily provide a 1 to

1 relationship between reason for visit and diagnosis, the distribution of diagnostic categories reflects that of the reason for

visit modules. That is, among the diagnostic groups shown in

table 9, the supplementary classification (chiefly examinations)

was proportionately higher for female visits, and injury and

poisoning was higher for those by males. Female patients were

more likely to visit for chronic problems such as diseases of

the genitourinary system; and endocrine, nutritional and metabolic diseases, and immunity disorders. Males were more Iiiely

to visit for diseases of the respiratory system, which are largely

acute self-limiting conditions.

Statistics on nonmedication therapy were consistent with

the conditions likely to be associated with visits by female or

male patients. Physiotherapy and office surgery were more

commonly used when males visited, and family planning, therapeutic listening, diet counseling, and family or social counseling were proportionately higher during females’ visits (table 11).

Three or more medications were more likely to be ordered

or prescribed during females’ visits (18 percent) than during

those of males (14 percent). No medication was ordered in 28

percent of visits by male patients, compared with 26 percent

of those by female patients. Anti-infective agents accounted

for the largest proportion of drugs mentioned during visits by

male patients (20 percent) and central nervous system drugs

were the next largest (16 percent, table 12). For female patients, central nervous system drugs ranked first with 19 percent and anti-in fectives second with 16 percent. Central nervous system drugs, diuretics, vitamins, and hormones and synthetic substitutes were prescribed more often for female patients

than for males. The category of hormones and synthetic substitutes includes oral contraceptives. Males exceeded females in

mentions of antihistamine drugs, anti-infectives, cardiovascular drugs, skin and mucous membrane preparations, and spasmolytic agents.

The sex of the patient did not affect the duration of the

visit because differences between proportions of visits by time

intervals were not statistically significant. But patterns of visits

to GFP’s by female and male patients differed in the disposition of the visit (table 16). No followup plans were made in

17 percent of the visits by male patients, compared with 13

percent of those by females. Appointments for return visits

were made proportionately more often for females (53 percent)

than for males (48 percent), which may be one of the reasons

for the higher visit rate by female patients. The return visit

rate is about 9 to 1 for females, compared with about 7 to 1

for males (table 6).

Age of the patient

There were variations in the visit characteristics of the

various age groups of patients who visited GFP’s. The younger

the patients the more likely they were to have acute problems,

and the older the patients the more likely they were to have

10
chronic problems (table 7). Nonillness care was proportionately most frequent in visits by patients 15–24 years of age.

Patients sought health care for a wide variety of symptoms,

treatments, and services. The most frequent specific reasons

for aH visits to GFP’s are shown in table F, but the problems

presented by patients varied by age group (table S). As may

be expected, well baby examination was the leading principal

reason for the age group under 15 years, and prenatal examination ranked first for the age group 15–24 years. General

medical examination was among the top 10 reasons in every

age group and was the first ranking reason for patients 45

years of age and over; providing an indication of the average

patient’s interest in preventive health care.

Some diagnostic categories reflect the patients’ reasons

for making the visit (table 9). About 35 percent of the visits

by children under 3 years of age were in the supplementary

classification (chiefly examinations). About 29 percent were

for treatment of diseases of the respiratory system and 12 percent for diseases of the nervous system and sense organs (a

total of about 75 percent in these three categories). These categories also comprised the majority of visits by patients aged

3–5 years (67 percent). The three largest classes of diagnoses

for patients aged 11–14 years were diseases of the respiratory

system (21 percent), injury and poisoning (20 percent), and

supplementary classification (18 percent). The same three classes were predominant in visits by patients aged 15–24 years

with a total of 56 percent, and in those by patients aged 25–

44 years where they constituted 43 percent of the visits. Diseases of the circulatory system, diseases of the respiratory sysTabie F. Number and percent of office visits to general and family

practitioner, by 20 most frequent principal reasons for visit

United States, January 1980-December 1981

Number of

Principal reason for visit and RVC code~ visits

Percent

in

thousands

All visits. . . . . . . . . . . . . . . . . . . . . . . . . . . . 381,710 100.0

General medical examination . . . . . XI(X3 20,687 5.4

Symptoms referable to throat . . . . . . . . . S455 16,688 4.4

Blood pressure test . . . . . . . . . . . . . . . .. X320 12,468 3.3

Cough . . . . . . . . . . . . . . . . . . . . . . . . .,. .s440 11,516 3.0

Heed cold, upper respiratory infection

(coryza) . . . . . . . . .. . . . . . . . . . . . . . . . .. S445 10,764 2.8

Prenatal examination, routine . . . . . . . . X205 9,641 2.5

Back symptoms . . . . . . . . . . . . . ... . . .. S905 9,015 2.4

Chest pain and related symptoms

(not referable to body system) . . S050 7,507 2.0

Progress visit, not otherwise specified. ., T800 7,347 1.9

Headache, pain in head . . . . . . . . . . . . .. S210 7,163 1.9

Hypertension . . . . . . . . . . . . . . . ... . . .. D51O 6,925 1.8

Abdominal pain, cramps, spasms . . . . . . S550 6,418 1.7

Skin rash . . . . . . . . . . . . . . . . . . . . . . . . ..s860 6,323 1,7

Earache, or ear infection . . . . . . . s355 6,147 1.6

Vertigo-d izziness . . . . . . . . . . . . . . . . . .. S225 5,558 1.5

Fever . . . . . . . . . . . . . . . . . . . . . . . . . ..S01 O 5,224 1.4

Weight gain . . . . . . . . . . . . . . . . . . . . .. S040 4,497 1.2

Well-baby examination . . . . . . . . . . . . X105 4,228 1.1

Low back symptoms, . . . . . . . . . . . . . .. S910 4,176 1.1

Leg symptoms . . . . . . . . . . . . . . . . ... .. S920 4,155 1.1

1Baaed on A Reason for Visit Classification for Ambulatory Care (RVC).6

Table G. NumbH and percent of office visits to general and family

practitioners, by 20 most frequent principal diagnoses: United

States, January 1980-December 1981

Principal diagnosis and

ICD-9–CM codel

Number of

visits

Percent

in

thousands

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

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

Acute upper respiratory infection of multiple

or unspecified sites . . . . . . . . . . . . . . ...465

General medical examination . . . . . . . . . . V70

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

Diabetes mellitus . . . . . . . . . . . . . . . . . ...250

Obesity and other hyperalimentation . ...278

Acute pharyngitis . . . . . . . . . . . . . . . . . ...462

Bronchitis, not specified as acute or

chronic . . . . . . . . . . . . . . . . . . . . . . . . ...490

Suppurative and unspecified otitis

media . . . . . . . . . . . . . . . . . . . . . . . . . ...382

Health supervision of infant or child. . . . . V20

Neurotic disorders . . . . . . . . . . . . . . . . ...300

Chronic sinusitis . . . . . . . . . . . . . . . . . . ...473

Other and unspecified arthropathies. . ...716

Certain adverse effects, not elsewhere

classified . . . . . . . . . . . . . . . . . . . . . . ...995

Sprains and strains of other and unspecified

parts of back . . . . . . . . . . . . . . . . . . . . . ..847

Other forms of chronic ischemic heart

disease . . . . . . . . . . . . . . . . . . . . . . . . ...414

Other noninfectious gastroenteritis and

colitis . . . . . . . . . . . . . . . . . . . . . . . . . . ...558

Acute tonsillitis . . . . . . . . . . . . . . . . . . ...463

Other disorders of soft tissue . . . . . . . ...729

Allergic rhinitis (hay fever). . . . . . . . . . ...477

381,710 100.0

28,612 7.5

15,013 3.9

14,061 3.7

10,606 2.8

10,137 2.7

8,922 2.3

8,831 2.3

6,718 1.8

6,445 1.7

6,060 1.6

4,758 1.2

4,751 1.2

4,571 1.2

4,504 1.2

4,499 1.2

4,474 1.2

4,455 1.2

4,395 1.2

4,345 1.1

4,162 1.1

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

Modification, (ICD–9–CM). 7

‘Chiefly allergy, unspecified, 995.3.

tern, and diseases of the musculoskeletal system and connective tissue were the three leading categories of diagnoses treated

by GFP’s when patients were 45 years of age and over. They

accounted for 46 percent of visits by patients aged 45–64 years

and 56 percent of those by patients 65 years of age and over.

The 20 most frequent principal diagnoses rendered by

GFP’s are shown in table G.c Naturally, the rank order of

this list is afYected by the distribution of visits according to the

age of the patient. In table 10, it can be seen that the kind and

order of spec~lc diagnoses change within the five age groups.

These lists of diagnoses offer a rough measure of the health

status of the different age groups of patients who visit GFP’s,

and the degree to which age influences utilization.

The use of diagnostic procedures also changes with the

age of the patients served by general and family practice physicians. Blood pressure was rarely measured when children

under 11 years of age visited, but proportions of visits that included blood pressure checks increased with the increasing age

of the patient, rising tlom 25 percent of visits by patients aged

11–1 4 years to about 63 percent of visits by patients 65 years

cThe reader will note that normal pregnancy is listed fourth in table G. The

comparable diagnosis in 1975, prenatal care, was inadvertently omitted from

the 1975 publication.

11
Table H. Number of office visita to general and family practitioners, number and percent of drug visits, number of drugs mentioned, drug mantion

rate per visit, and drug intensity rate per drug visit, by selected characteristics of patients: Unitad Statas, January 1980-December 1981

All Drug Percent Number of Drug Drug

visits visits ~ of drug mention

intensity

in in drug mentions in rate2

rate3

thousands thousands visits thousands per visit

per drug

visit

Selected characteristic of patient

Sex

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

381,710

229,445

152,265

281,101

170,843

110,257

73.6

74.5

72.4

532,065

330,172

201,893

1.39

1.44

1.33

1.89

1.93

1.83

Age

Under 3yaars . . . . . . . . . . . . . . . . . . . . . . . . . . .

3–5 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

11–14 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

25–44 years, . . . . . . . . . . . . . . . .

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

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

18,377

9,297

11,492

13,715

56,230

103,275

95,458

73,867

13,330

7,366

8,419

8,403

36,515

72,004

74,308

60,756

72.5

79.2

73.3

61.3

64.9

69.7

77.8

82.3

22,038

11,764

12,504

12,719

58,485

124,633

149,707

140,215

1.20

1.27

1.09

0.93

1.04

1.21

1.57

1.90

1.65

1.60

1.49

1.51

1.60

1.73

2.01

2.31

Race

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

Black . . . . . . . . . . . . . . . . . . . . . . . . .

A[l other . . . . . . . . . . . . . . . . . . . . .

338,479

39,897

3,334

249,970

28,828

2,303

73.9

72.3

69.1

474,148

54,354

3,564

1.40

1.36

1.07

1.90

1.89

1,55

Ethnicity

Hispanic . . . . . . . . . . . . . . . . . . . . . .

Non- Hispanic . . . . . . . . . . . . . . . . . .

17,703

364,007

12,815

268,286

72.4

73.7

24,988

507,077

1.41

1.39

1.95

1.89

lVisits in which one or more drugs were ordered.

2Drug mentions divided by visits.

3Drug mentions divided by drug visits,

of age and over (table 11). Nonmedication therapy was more

likely to be not used than to be used because over 50 percent

of visits, regardless of age group of the patient, included no

such therapy. Medication therapy, however, was prescribed

on the average in 74 percent of patients’ visits (table H). The

oldest group had the highest proportion of drug visits (82

percent) and patients aged 11– 14 years had the lowest (61

percent).

It is not surprising to find that the largest proportions of

therapeutic categories of drugs mentioned by physicians were

related to the diagnoses most likely to be present in each age

group. For example, serums, toxoids and vaccines accounted

for 25 percent of the drugs mentioned in visits by children

under 3 years of age (table 12) and cardiovascular drugs accounted for 21 percent of drugs used in visits by patients 65

years of age and over. Central nervous system drugs were

mentioned in over one-fifth of the visits by patients between

the ages of 25 and 64 years. Table 13 contains the names of

specific drugs prescribed by GFP’s for the various age groups.

Age was clearly a factor in the duration of visits. Proportions of visits more than 10 minutes long increased with the

increasing age group of the patient (table 16). Disposition of

the visit was also age-related. Proportions of visits with no

followup planned decreased and those with scheduled appointments increased as the age of the patient increased. This finding is consistent with that of the National Medical Care Expenditure Survey in which it was observed that as the age of

the patient increased, physician-initiated visits increased. 14

Prior visit status

As it was with most specialists, the proportion of new patients visiting GFP’s was relatively low (11 percent, table 6).

Those specialties with higher than average proportions of new

patients are generally those with relatively high proportions of

referred patients, which is not the case with GFP’s. However,

patterns of care differ depending on the visit status of the patient. New patients, or patients the physician had seen before

but presenting new problems, tended to present proportionately

more acute than chronic problems, with the reverse true for

patients returning for care of an old problem (table 7). Nonillness care was proportionately more frequent when new patients visited than when old patients visited. This resulted in

differences in the classes of diagnoses likely to be rendered

for the groups (table 9). The old problems presented by returningpatients were proportionately more likely to be endocrine,

nutritional and metabolic diseases, and immunity disorders;

diseases of the circulatory system; and diseases of the musculoskeletal system and connective tissue than those of other patients were—a typical profile of patients over 44 years of age.

That age group constituted 55 percent of the visits by patients

the physician had seen before returning for care of an old problem. At the other end of the age range, visits by patients under

25 years of age constituted 41 percent of new patients’ visits.

Thus, the pattern of visits by new patients was consistent, with

that of young patients.

The physician’s workup was likely to be comprehensive

12
when new patients visited (table 11 ). The general history and

examination was used in 29 percent of such visits, compared

with 12 percent of those by patients with old problems. Clinical laboratory tests, X-rays, and vision tests were also included in proportionately more new patient visits than in others.

However, once a diagnosis was made, nonmedication therapeutic services differed minimally.

visits by new patients were, on the average, longer than

those by old patients reflecting the in-depth examination of

these patients by the physician (table 16). About 31 percent

of the visits by new patients lasted 16 minutes or more, compared with 17 percent of those by old patients with old problems.

Reason for visit and

diagnostic services

The relationship between patients’ reasons for visit and

thephysician’s workup is explored in table 14. Visits for acute

problems were more likely than those for routine chronic problems to include a limited history and examination (73 percent) or X-ray (9 percent). However, visits for chronic prob

lems were characterized by a higher proportion of blood pressure checks. Nonillness care inclided proportionately more

general history and examinations, Pap tests, and clinical laboratory tests than other types of care did.

Proportions of the various diagnostic services associated

with the reason for visit modules are also shown in table 14.

At least one-fourth of the visits included blood pressure

measurement or limited history and examination regardless of

the reason for visit. About 22 percent of \risits in the injuries

and adverse effects module included X-rays, and clinics!

laboratory tests were included in at least 20 percent of visits

in 5 of 7 modules.

Principal diagnosis and

therapeutic services

Visits with no therapeutic services ordered or provided

ranged from 37 percent where diagnoses were mental disorders or endocrine, nutritional and metabolic dis=ases, and immunity disorders to 73 percent of those for respiratory conditions (table 15). Where proportions of certain services were

higher than other services that were given for the same condition, those services were usually directly related to the problem. For example, physiotherapy was used in 1 of 4 visits

when a musculoskeletal condition was diagnosed, and in 1 of

5 when an injury was diagnosed. Office surgery was performed

in 15 percent of visits for skin diseases and in 17 percent of

those for injuries. Family planning was considered in 7 percent of the visits where examinations were made (supplementary classification). As expected, 26 percent of the visits classified as mental disorders included therapeutic listening and

12 percent included family or social counseling. The range of

mental disorders seen by GFP’s is narrow, resting mainly in

the group of neurotic disorders (table G). Therapeutic listening and counseling, therefore, are techniques likely to be used

for treating such patients. Diet counseling was the nonmedication therapy selected proportionately most often for patients

with endocrine, nutritional and metabolic diseases, and immunity disorders as well as diseases of the digestive system.

The first group includes such diagnoses as diabetes mellitus

and obesity.

However, drugs were the first choice of therapy for almost

all classes of diagnoses. The only exception was for visits in

the supplementary classification that were usually for preventive care where medication is not always indicated. Visits for

diagnostic groups are classified by the number of medications

associated with the visit in table 15. The complement of the

percent in the “none” category is the percent of drug visits, or

visits in which one or more drugs were continued or newly

prescribed. For example, only 7.5 percent of the visits for diseases of the respiratory system had no drugs indicated. Thus,

92.6 percent of visits for such conditions were drug visits (the

highest proportion of dmg visits for any of the diagnostic categories). One medication was the most likely number in visits

for all conditions where a drug was given. However, some conditions warranted the prescription of three or more drugs proportionately more often than others did. These included endocrine, nutritional and metabolic diseases, and immunity disorders (26 percent); diseases of the circulatory system (29 percent); and diseases of the respiratory system (24 percent). An

in-depth an~!ysis of the specific drugs utilized in visits by patients with selected diagnoses was published in Vital and

Health Statistics, Series 13, No. 71.15

Principal diagnosis, duration,

and disposition of visit

Yhe duration and disposition of the visit are important

parameters of practice management. If the financing of medical care is linked. as has been proposed, to the diagnosis of

the patient’s i!!ness, the amount of time used for examination

and treatment is a necessary economic variable. Disposition

of the visit is a tacior in the continuity of care and in estimating episodes of illness.

The mean duration of all visits to GFP’s was 13.5 minutes, but duration varied among diagnosis groups. The average

duration of a visit in which the patient was seen by the physician ranged from 11.8 minutes for patients with respiratory

conditions to 15.5 minutes for those with mental disorders

(table J). Some of the variation maybe attributed to the degree

of intensity of therapeutic services offered. Diseases of the respiratory system accounted for the highest proportion of visits

with no nonmedication services rendered, and it had the shortest average duration. In the same vein, proportionately more

therapeutic listening was associated with mental disorders than

with other conditions, probably lengthening the duration of the

visit accordingly.

In every disease category except one, visits by new patients were, on the average, more time consuming than those

made by returning patients were. These statistics may reflect

the additional time needed to gather historical data about the

new patient or to provide initial therapy. Among old patients,

the average duration of a visit was not very different for those

with new problems, compared with those presenting old prob13
Table J. Mean duration of office visits to general and family practitioners, by prior visit status and principal diagnosis categories: United States,

January 1980-December 1981

Old patients

Principal diagnosis categoy andlCD–9–CMcode J

All New

patients patients New Old

problem problem

Mean duration in minutes

All diagnoses,............,,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.5 15.8 13.3 13,2

Infectious and parasitic diseases ,, . ., .,, , .,, ., . ., .,.,,,... ,.. ,,, ,.. ,..001–139

Neoplasm, , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..140–239

Endocrine, nutritional andmetabolic diseases, andimmunity disorders, .,. .,.24 O-279

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

Diseases of the nervous system and sense organs . . . . . . . 320–389

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

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

Diseases of thedigestlve system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..520–579

12.6

15.2

13.5

15.5

12.3

13.8

11.8

14.5

3,6

9.0

4,6

9.7

4.9

9.2

3.2

7.6

2.2

6.6

2.8

4.7

1.7

4,8

1.2

4.1

2,8

4.3

3.5

5.2

2.2

3.4

1.8

4.2

Diseases of thegenitourinary system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, ,.580–629 14.6 17.6 14.4 14.1

Diseases of the skin and subcutaneous tissue. . . . . . . . . . . . .. 680-709 12.4 12.0

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

11.9 13.3

14.3 19.6 13.6 13.9

Symptoms, signs, and ill-defined conditions . . . . . . . . . . . . 780–799 14,8 19.6 14.5 13.7

lnjufy and poisoning, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,. .,.800–999 13.5 15.1

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

14.4 12.0

14.1 16.3 14.5 13.3

lBased onlnternationa/ Classification of Diseases, 9th Revision, Clirrical Modification (ICD–9–CM).7

lems. Thedisparity wasgreater between theduration of visits

by new patients and those by old patients, regardless of the

latter’s problem status. Thus, it may be assumed that the availability of basic data in the returning patient’s medical file reduced the average time spent with the patient.

Principal diagnosis categories areshown in table 17 with

visits distributed by proportions of duration intervals and the

mode of disposition. Visits in which there was no face-to-face

encounter between patient and physician, that is, the patient

was seen by a member of the physician’s staff, accounted for

only 3 percent of the visits in GFP’s offices. The only disease categories associated with higher than average proportions

of such visits were endocrine, nutritional and metabolic diseases, and immunity disorders (5 percent); and injury and poisoning (6 percent).

Relatively long visits (16 minutes or more) accounted for

31 percent of visits for neoplasms and 28 percent of those for

mental disorders.

GFPs arranged for continuity of care by scheduling return appointments or instructing patients to return if needed in

the majority of visits regardless of the patient’s diagnosis.

Followup care was particularly evident for patients with endocrine, nutritional and metabolic diseases, and immunity disorders; and for patients with diseases of the circulatory system

where 80 percent of each group were instructed to return at a

specified time. The physician’s initiative in scheduling appointments was probably the reason for the high rate of return visits

made by patients with these problems.

In general, only 3 percent of the visits to GFP’s culminated in referral to another physician, but visits for certain

categories of disease exceeded the average. About 13 percent

of the patients with neoplasms, 6 percent with diseases of the

nervous system and sense organs, 4 percent with diseases of

the digestive system, 6 percent with diseases of the genitourinary system, and 4 percent with musculoskeletal conditions

were referred for care. Except for patients with diseases of the

digestive system, of whom 6 percent were admitted to a hospital, such a disposition of a case was comparatively rare

among GFP’s.

14
Conclusion

A major, but not unexpected, finding in this study is that

the pattern of generaI and family practice evolves from the patient load of physicians in such practice, but that the patient

profile varies among physicians. That is, although the GFP

generally treats a heterogeneous group of patients, to some

degree the case-mix depends on the age or sex of the physician,

or the type and location of practice.

Two diverse patterns emerged from this analysis. One pattern characterized visits by relatively young patients, and the

other visits by relatively old patients. Where the physician’s

case load was dominated by one member of the dichotomy or

the other the physician’s practice typically included the characteristics briefly listed below.

“Old patient

Returning patients

Chronic problems

Reasons in the symptom and

disease modules

General history and examination, blood pressure checks

Circulatory diseases; respiratory diseases; musculoskeletal diseases; endocrine,

nutritional and metabolic

diseases, and immunity disorders

Diet counsehng

More than average drug theraPY

Longer than average visits

Scheduled appointments

These patterns

shown below.

“Young’’patient

New patients

Acute problems and nonillness care

Reasons in the diagnostic,

screening, and preventive

module

Limited hwtory and examination, clinical laboratow tests,

and Pap tests

Diseases of the nervous system and sense organs, diseases of the genitourlnary

system, and supplementary

classification

Medical counseling

Less than average drug therapy

Shorter than average wsats

Patient instructed to return if

needed

were typical of certain practices that are

“OICP pattern—Con. “Young’’pattern—Con.

Metropolitan areas Nonmetropolitan areas

Established (older) physicians Young physicians

Female physicians, except for

the characteristics related to

drugs, duration, location

Another pair of patterns were distinguishable by sex of

the patient. They are briefly described below.

Female patient

Nonillness care

Reasons in the diagnostic,

screening, and preventive

module

Clinical laboratory tests, Pap

tests, blood pressure checks

Diseases of the genitourinary

system; endocrine, nutritional and metabohc diseases, and immumty disorders

Family planning services,

therapeutic Iisten]ng, diet

counseling, family and soc[al counseling, 3 or more

medications

Central nervous system drugs,

anti- infectwes, vitamins, hormones

Scheduled appointments

Male patient

Acute problems postsurgery,

postinjury

Reasons in the injuries and

adverse effects module

X-rays, electrocardiograms,

vision tests

Respiratory diseases

Physiotherapy, office surgery,

visits with no medication

prescribed

Anti- mfectives, central nervous system drugs, antihistamines, cardiovascular drugs,

skm and mucous membrane

preparations, spasmolytic

drugs

No foliowup

One of the reasons the profile of the female physician did

not completely tit the pattern described for ‘-young” patients

was because of the relatively large proportion -. of visits by

women. The practice profile of the female physician is more

aptly described as the ‘byoung and female” pattern.

“OId” pattern “Young” pattern

Solo practice Nonsolo practice

Northeast Region North Central and South Regions

15
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and T. McLemore: A reason for visit classification for ambulatory

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

No. (PHS) 79–1 352. Public Health Service. Washington. U.S. Government Printing Oflice, Feb. 1979.

TNational Center for Hea]th Statistics: International Class~fication

of Diseases, 9th Revision, Clinical Modification. DHHS Pub. No.

(PHS) 80-1260. Public Health Service. Washington. U.S. GoveImment Printing Office, Sept. 1980.

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

processing of drug information, National Ambulatory Medical Care

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

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

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

gAmefican Society of HospitalPharmacists, Inc.: The American

Hospital Formulary Service. Washington. Jan. 1980.

loNationa] Center for Health Statistics, B. K. Cypress: Drug U~lization in general and family practice by characteristics of physicians

and otlice visits, National Ambulatory Medical Care Survey, 1980.

Advance Data from Vital and Health Statistics, No. 87. DHHS

Pub. No. (PHS) 81-1250, Public Health Service. Hyattsville, Md.

Jan. 1983.

1INational Center for Health Statistics, H. Koch: Office visits to doctors of osteopathy, National Ambulatory Medical Care Survey, United

States, 1975. Advance Data from VitaI and Health Statistics, No.

35. DHEW Pub. No. (PHS) 78-1250. Public Health Service. Hyattsville, Md. Mar. 22, 1978.

12National Center for Health Statistics, B. K. Cypress: Characteristics of visits to female and male physicians, The National Ambulatory Medical Care Survey, United States, 1977. Vital and Health

Statistics. Series 13, No. 49. DHHS Pub. No. (PHS) 80-1710.

Public Health Service. U.S. Government Printing Office, June 1980.

13Wunde~~, L. E.: Female physicians in the 1970’s, Their changing role in medicine, in G. L. Glandon and R. J. Shapiro (eds), Projile of Medical Practice 1980, Center for Health Services Research

and Development- American Medical Association. Chicago, Ill., 1980.

l’rNational Center for Health Services Research, L. F. Rossite~ Who

initiates visits to physicians? National Health Care Expenditures

Study. Data Preview 3. DHHS Pub. No. (PHS) 80–3278. Public

Health Service. Hyattsville, Md., Sept. 1980.

15National Center for Health Statistics, B. K. Cypress: Medication

therapy in oftlce visits for selected diagnoses, National Ambulatory

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

No. 71. DHHS Pub. No. (PHS) 82-1732. Public Health Service.

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

IsNational Center for Health Statistics, P. J. McCarthy: Replication,

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

Health Statistics. Series 2, No. 14. DHEW Pub. No. (HSM) 73-

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

17Nationa1 Center for Health Statistics, P. J. McCarthy Pseudoreplication, Further evaluation and application of the balanced halfsample technique. Vital and Health Statistics. Series 2, No. 31.

DHEW Pub. No. (HSM) 73–1 270. Health Services and Mental

Health Administration. Washington. U.S. Government Printing Office, Jan. 1969.

16
List of detailed tables

1. Number of ofice visits to general and family practitioners

and percent distribution by selected visit characteristics,

according to type and Iocation of physician’s practice:

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

2. Number of drugs mentioned in oflice visits to general and

family practitioners and percent distribution by therapeutic

categories, according to type and location of physician’s

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

3. Number of office visits to general and family practitioners

and percent distribution by selected visits characteristics,

according to age and sex of physician: United States,

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

4. Number of drugs mentioned in office visits to generai and

family practitioners and percent distribution by therapeutic

categories, accordkg to age and sex of physician: United

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

5. Number of office visits to general and family practitioners

and percent distribution and average annual rate of oftice

visits by age of patient, according to sex, race, and

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

6. Number of office visits to general and family practitioners

and percent distribution by referral status, prior visit

status, and return visit rate, accordhg to selected patient

characteristics: United States, January 1980-December

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

7. Number of ofiice visits to general and family practitioners

and percent distribution by visit status, according to sex

and age of patient and prior visit status: United States,

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

8. Number and percent distribution of office visits to general

and family practitioners by age of patient and 20 most

frequent principal reasons for visit United States, January

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

9. Number of ofllce visits to general and family practitioners

and percent dk.tribution by principal diagnosis categories,

according to sex and age of patient and prior visit status:

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

10. Number and percent distribution of office visits to general

and family practitioners, by age of patient and 20 most

frequent principal diagnoses: United States, January 1980-

18 December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11. Number of ot%ce visits to generaI and family practitioners,

percent of visits by diagnostic services and nonmedication

therapy, and percent distribution by number of medica20 tions, according to sex and age of patient and prior visit

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

12. Number of drugs mentioned in office visits to general and

family practitioners and percent distribution by thera21 peutic categories, according to sex and age of patient

and prior visit status: United States, January 1980-

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

13. Number and percent distribution of drugs mentioned in

23 ofilce visits to general and family practitioners, by age of

patient and most frequently named drugs: United States,

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

14. Number of office visits to general and family practitioners

24 and percent of visits, by diagnostic service, major reason

for visi~ and principal reason for visit module: United

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

15. Number of of?ice visits to general and family practitioners

and percent of visits by nonmedication therapy and

24 principal diagnosis categories, and percent distribution

by number of medications, according to principal diagnosis categories: United States, January 1980-December

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

25 16. Number of office visits to general and family practitioners

and percent distribution by duration and disposition of

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

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

26 17. Number of office visits to general and family practitioners,

percent distribution by duration of visit, and percent of

visits by disposition of visit, according to principal diagnosis categories: United States, January 1980-December

28 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

29

31

32

33

35

36

37

38

I

1

I

17
Table 1. Number of office visits to general and family practitioners and percent distribution by selected visit characteristics, according to type

and location of physician’s practice: United States, January 1980-December 1981

Selected visit characteristic

Type of practice Geographic region Area

All

North Metro- Nontypes of solo Otherl Northeast Central South West metropractice politan

politan

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

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

Sex of patient

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

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

Age of patient

Under 3 years . . . . . . . . . . . . . . .

3-5 years . . . . . . . . . . . . . . . . . . . . . . .

6–10 years . . . . . . . . . . . . . . . . . .

11–14 years . . . . . . . . . . . . . . . . . .

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

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

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

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

Prior visit status

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

Old patient, new problem. . . . .

Old patient, old problem. . . . . .

Referral status

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

Not referred by another physician . . . . .

Major reason for visit

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

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

Chronic problem, flare-up. . . . .

Postsurge~ or postinjury . . . . . . . . . .

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

Principal reason for visit

module and RVC codez

Symptom module . . . . . . . S001–S999

Disease module . . . . . . . . DOO1–D999

Diagnostic, screening, and preventive

module . . . . . . . . . . . . . . ..Xl 00-x599

Treatment module. ., . . T100-T899

Injuries and adverse effects

module . . . . . . . . . . . . . . .. JOOl —J999

Test results module . . . . . . RIOO– R7OO

Adminiatrative modu”le. ., Al 013-A140

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

Diagnostic service4

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

Limited history and/or examination .

General history and/or examination . . . .

Pap test . . . . . . . . . . . . ... . . . . . . . . . . . .

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

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

Blood prr?ssure check . . . . . . . . . . . . . . .

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

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

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

Mental status examination . . . . . . . . . . .

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

381,710

100.0

60.1

39.9

4.8

2.4

3.0

3.6

14.7

27.1

25.0

19.4

11.3

32.4

56.3

1.2

98.8

47.8

25.9

8.5

3.7

14.2

58.0

6.4

16.7

7.5

4.8

0.6

2.7

1.3

6.4

65.0

14.6

3.2

21.6

6.7

44.7

2.0

1.3

0.3

0.6

4.4

242,488

100.0

59.6

40.4

4.0

2.1

2.7

3.5

13.8

26.2

26.8

20.8

10.3

31.0

58.8

1.1

98.9

46.3

29.6

8.2

3.3

12.7

58.8

9.1

15.4

7.2

4.5

0.5

2.8

1.7

7.1

62.4

16.4

2.8

19.5

5.3

46.5

1.6

1.2

0.3

0.8

4.3

139,222

100.0

61.0

39.0

6,2

3,0

3,5

3.8

16.4

28.5

21.8

16.9

13.0

35.0

52.0

1.4

98.6

50.4

19.4

9.1

4.3

16.8

56.4

7.2

18.9

7.8

5.3

0.8

2.6

1.0

5.2

69.6

11.5

3.9

25.3

9.0

41.5

2.8

1,5

0.5

0,4

4.7

Number in thousands

65,851 118,772 130,847

Percent distribution

100.0

59.1

40.9

3.1

2.1

2.7

3.6

14.3

25.1

28.1

21.1

9.2

29.6

61.2

1.3

96.7

43.6

34.4

6.3

2.6

13.2

56.7

9.9

17.2

6.5

4.4

“0.3

2.8

2.2

6.0

60.8

20,4

2.2

16.1

5.0

54.8

2.4

1.1

*o. 1

1.0

4.4

100.0

59.6

40.4

6.5

3.1

3.8

3.7

15.5

26.0

23.1

18.4

9.4

34.0

56.6

1.0

99.0

45.9

22.7

9.0

4.1

18.4

55.4

7.1

19.9

7.5

4.3

0.8

3.4

1.6

7.4

66.3

11.6

3.7

23.5

7.0

42.0

1.9

1.5

“0.4

0.6

2.9

100.0

61.2

38.8

4.2

2.4

2.6

3.4

14.4

27.7

25.5

20.0

13.3

33.4

53.3

1.3

98.8

51.8

24.7

8.7

3.7

11.2

60.7

7.9

13.6

8.4

5.3

“0.4

2.5

1.2

5.4

65.4

16.7

2.7

22.9

6.6

46.0

1.8

1.1

“0.3

‘0.4

6.3

66,240

100.0

59.8

40.2

4.8

1.7

2.8

3.9

14.6

29.8

24.4

18.1

12.8

30.4

56.9

1.6

98.4

47.5

25.4

9.4

3.9

13.8

58.2

10.4

16.4

6.5

5.1

1.0

1.8

“0.6

7.1

66.2

10.3

4.3

21.3

8.1

37.0

2.5

1.6

“0.6

*0.7

3.6

230,141

100.0

60.2

39.8

3.7

2.1

2.9

3.5

14.1

28.9

26.5

18.4

11.6

32.5

55.9

1.5

98.5

48.1

27.8

8.6

3.2

12.3

59.9

9.1

14.4

7.6

4.7

0.6

2.4

1.3

6.7

63.9

14.9

3.1

20.4

6.9

47.0

2.4

1.3

0.4

0.6

4.8

151,569

100.0

60.0

40.0

6.5

3.0

3.2

3.7

15.7

24.2

22.8

20.9

10.9

32.3

56.8

0.9

99.1

47.3

23.0

8.3

4.4

17.0

55.1

7.4

20.0

7.2

5.0

0.7

3.2

1.4

6.1

66.6

14.2

3.5

23.4

6.4

41.2

1.5

1.3

“0.3

0.6

3.9

See footnotes at end of table.

18
,,. ,

Table 1. Number ofotice visits togeneral and family practitioners andpercent tistribtiion byselected visit characteristics, according totypc

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

Type of practice Geographic region Area

Selected visit characteristic All

types of S010 Orherl North Metro- jJon -Northeast Central South West metropractice politan politan

Principal diagnosis and

ICD-9-CM code5

Infectious and parasitic

diseases . . . . . . . . . . . . . . ...001-139

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

Endocrine, nutritional and metabolic

diseases, and immunity

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

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

Diseases of the netvous system

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

Diseases of the circulatory

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

Diseases of the respiratory

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

Diseases of the digestive

system . . . . . . . . . . . . . . . . . . 520–579

Diseases of the genitourinarf

system . . . . . . . . . . . . . . . . . . 580–629

Diseases of the skin and subcutaneous

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

Disaases of the musculoskeletal

system and connective

tissue . . . . . . . . . . . . . . . . . ..7l O-739

Symptoms, signs, and il!-defined

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

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

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

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

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

Nonmedication therapfl

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

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

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

Family planning . . . . . . . . . . . . . . . . . . . .

Psychotherapy or therapeutic

listening . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

Number of medications

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

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

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

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

4 ormore . . . . . . . . . . . . . . . . . . . . . . . . .

Duration of visit

O m inutesa . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

See footnotes at end of table.

3.3

1.2

6.2

2.6

5.1

13.1

17.3

5.6

5.3

4.0

7.6

3.8

9.8

13.0

1.1

1.2

56.8

5.5

5.5

1.3

2.5

10.3

1.9

22.5

1.4

26.4

34.7

22.5

9.5

6.9

3.1

13.3

35.7

28.8

17.3

1.9

3.1

1.0

7.3

2.5

4.5

14.4

18.2

5.4

4.8

3.7

7.9

3.9

9.4

11.5

1.0

1.4

57.7

5.6

5.2

1.1

2.6

11.2

1.9

21.3

1.1

23.8

35.5

23.0

10.1

7.6

3.3

12.8

35.1

28.6

18.1

2.1

3.7

1.6

4.5

2.7

6.0

10.9

15.7

5.8

6.1

4.5

7.0

3.6

10.5

15.5

1.2

0.9

55.4

5.4

6.1

1.7

2.3

8.6

2.0

24.5

1.8

30.8

33.4

21.7

8.4

5.7

2.9

14.2

36.7

29.0

15.8

1.4

Percent distribution

2.8

1.0

8.2

3.0

4.1

19.0

17.9

5.5

3.1

3.3

7.0

2.9

9.1

11.0

0.9

1.4

52.2

6.8

4.4

1.1

3.0

14.6

2.7

25.2

1.2

20.8

38.2

22.2

10.5

8.4

2.6

12.6

38.3

29.6

15.1

1.8

3.4

1.2

4.8

2.0

5.1

12.7

17.5

5.2

4.8

3.8

6.9

3.4

9.6

17.1

i .4

1.1

60.9

4.9

5.9

1.6

2.1

8.6

1.7

18.9

1.1

29.1

35.5

21.7

7.9

5.8

4.9

15.8

37.0

26.4

14.5

1.5

3.5

1.1

6.8

3.0

5.2

11.7

17.4

6.2

6.2

4.1

8.0

4.5

10.1

9.9

1.1

1.3

58.4

5.0

5.5

1.2

2.6

10.1

1.8

21.7

1.5

22.3

32.3

25.4

12.2

7.8

2.1

13.7

34.2

29.1

19.1

1.9

3.1

1.7

5.8

2.5

5.8

10.7

16.2

5.1

6.2

4.4

8.4

3.7

10.5

13.7

1.G

1.1

51.1

6.6

6.0

1.4

2.7

9.4

1.8

27.7

1.9

34.9

34.7

18.7

6.0

5.8

2.7

8.9

33.4

31.6

20.9

2.6

3.5

1.1

7.4

2.6

4.9

13.3

18.1

5.6

5.1

3.8

7.9

3.9

9.7

10.8

1.1

1.4

54.0

6.9

4.9

1.2

3.2

12.0

2.2

23.2

1.2

25.5

35.2

22.6

9.9

6.9

2.7

13.4

35.2

28.7

17.9

2.1

3.0

1.4

4.5

2.6

5.4

12.8

16.1

5.5

5.4

4.2

7.0

3.5

10.0

16.3

1.1

1.2

61.1

3.4

6.5

1.5

1.5

7.7

1.5

21.3

1.6

27.7

34.1

22.5

8.8

7.0

3.8

13.2

36.3

28.9

16.3

1.5

19
Table 1. Number of office viaits to general and family practitioners and percent distribution by selected visit characteristics according to WPe

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

Type of practice Geographic region Area

Selected visit characteristic All North MetroNontypes of solo Other! Northeast Central South West metropractice

politan politan

Disposition ofvisitT Percent distribution

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

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

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

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

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

Returned to referring physician . . . . . .

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

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

14.8 14.3 15.6 12.5

51.3 52.9 48,4 56.7

29.7 28.6 31.6 27.4

3.1 3.2 3.0 3.2

2.8 2.5 3.3 3.0

0.2 0.3 “0.2 “0.2

1,2 1,0 1.5 ‘0.7

0.2 “0.2 “0.2 *O. 1

15.7 15.7 13.6 13.7 16.3

47.4 51.3 52.8 52.4 49.5

30.6 30.6 28.4 28.8 31.0

4.5 1.8 3.1 3.6 2<3

2.7 2.6 3.2 3.1 2.3

“0.3 *0.2 “0.5 0.3 “0.2

1.2 1.6 1.0 1,1 1.4

“0.2 “0.1 “0.3 ‘0.2 *0.1

llncludes partnership, group, and other types of practice.

2Based onA Reasorr for Visit Classification forAmbulatory Care (RVC),6

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

4Percents will not total 100.0 because more than one aewice may have been rendered during a visit.

5Basedon hrternational Classification of Diseases, 9th Revision, C/inica/ Modification (lCD-9-CM).7

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

7Percents will not total 100. Obecause more than one disposition was possible.

Table 2. Number of drugs mentioned inoffice visits to general and family practitioners and percent distribution by therapeutic categories,

according totypeand location ofphysician’s practice: United States, January 1980-December 1981

Therapeutic catego~l

Type of practice Geographic region Area

All

North Nontypes of solo Othe# Northeast South West

MetroCentral metropractice politan

po~itan

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

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

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

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

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

Blood formation and coagulation. . . . . .

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

Central nenfous system drugs . . . . . . . .

Electrolytic, caloric, and water balance, . .

Expectorants and cough preparations. . .

Eye, ear, nose, and throat

preparations . . . . . . . . . . . . . . . . . . . . . .

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

Hormones and synthetic substitutes . . .

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

Skin and mucous membrane

preparations . . . . . . . . . . . . . . . . . . . . . .

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

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

Other, unclassified, or undetermined. . .

532,065

100.0

6.8

17.3

4,4

1.3

10.0

17.9

9.2

3.4

1.5

4.6

8.2

2.7

4,8

1.6

3.7

2.7

353,9B7

100.0

6.6

16.8

4.3

1.4

10.3

18.2

9.8

3.3

1.5

4.4

8.3

2.3

4.4

1.7

4.1

2.7

178,078

100.0

7.3

lB.1

4.5

1.1

9.5

17.1

8.2

3.5

1.6

5.0

7.8

3.6

5.5

1.6

3.0

2.8

Number in thousands

100,329 153,933 200,630

Percent distribution

100.0 100.0 100.0

6.8 7.2 6.7

13.0 18.1 18.7

4.6 3.6 4.6

1.6 1.4 1.0

12.1 10.3 8.7

17.9 15.8 19.9

10.8 9.8 7.8

3.5 3.4 3.4

1.6 1.8 1.4

3.9 4.2 5.4

8.1 7.5 8.8

3.2 3.7 1.6

3.9 5.3 4.5

1.9 1.4 1.6

4.7 4.3 2.8

2.4 2.2 3.1

77,173

100.0

6.6

17.3

5.3

1.1

10.2

16.8

9.9

3.3

1.3

4.1

8.0

2.8

5.5

1.8

3.6

2.4

325,423

100.0

7.0

16.6

4.6

1.2

9.8

18.2

9.4

3.7

1.5

4.5

8.3

2.6

4.7

1.6

3.7

2.6

206,642

100.0

6.6

18.3

4.1

1.4

10.4

17.4

9.0

2.9

1.5

4.7

7.9

2.8

4.8

1.7

3.8

2.7

lBased ontheclaasification system of the American Hospital Formulaw Sewice. g

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

20
Table 3. Number ofofice visits togeneral and family practitioners andpercent distribution byselected visit characteristics, according to age

and sex of physician: United States, January 1980-December 1981

Selected visit characteristic

Age of physician Sex of physician

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

ages

Female

years years years years

Male and over

Alivisitsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Sex of patient

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

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

Age of patient

Under 3 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3-5 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

65 years And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prior visit status

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

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

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

Referral status

Referred byanother physician . . . . . . . . . . . . . . . . . . . . . .

Not referred by another physician. . . . . . . . . . . . . . . . . . .

Major reason for visit

Acuta problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

Principal reason for visit module and RVC codez

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

Disease module . . . . . . . . . . . . . . . . . . . . . . . DOOI -D999

Diagnostic, screening, and preventive

module . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X1 OO-X599

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

Injuries and adverse effects module . . . . . . . JOOI-J999

Test rasults module . . . . . . . . . . . . . . . . . . .. R1OO–R7OO

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

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

Diagnostic service4

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

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

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

Pap test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

Mental status examination . . . . . . . . . . . . . . . . . . . . . . . . .

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

321,454

100.0

59.7

40.3

5.1

2.4

3.0

3.7

14.9

26.5

24.8

19.7

10.7

33.6

55.6

1.2

98.8

48.1

24.9

8.5

3.7

14.9

57.3

8.5

17.6

7.1

4.9

0.6

2.8

1.2

6.1

66.7

14.5

3.5

21.9

6.5

43.7

2.2

1.5

0.4

0.6

3.8

27,963

100.0

60.5

39.5

9.1

3.7

4.7

4.7

18.7

32.1

18.2

8.8

23.2

31.7

45.1

2.2

97.8

50.6

16.1

10.3

3.1

19.9

57.2

7.5

20.6

6.3

5.3

“1.0

1.9

‘0.2

4.5

70.7

15.2

4.7

28.2

7.8

40.9

*2.1

81.9

‘0.3

“0.8

3.3

56,563

100.0

60.7

39.3

8.7

3.2

3.5

4.1

16.6

30.0

19.1

14.9

11.7

33.8

54.5

“0.8

99.2

49.1

20.2

8.5

4.0

18.2

55.8

6.6

20.5

7.0

5.2

“0.8

3.6

80.5

5.8

69.5

12.8

3.3

21.9

7.2

34.7

1.6

1.4

“0.2

*0.8

2.5

Number in thousands

92,790 99,064

Percent distribution

100.0

60.4

39.6

4.4

2.8

3.4

3.8

15.0

26.3

24.9

19.5

9.4

35.5

55.1

1.4

98.6

49.0

24.3

8.5

3.4

14.8

56.6

8.5

17.3

8.6

4.7

“0.5

2.5

1.3

6.7

67.9

11.3

4.0

22.0

6.2

43.2

2.2

1.0

“0.4

“0.5

5.1

100.0

58.6

41.4

3.7

2.0

2.5

4.0

14.8

25.0

27.2

20.9

9.3

35.0

55.8

1.2

98.8

48.2

24.0

9.0

4.1

14.7

57.2

8.8

17.0

6.8

5.3

“0.4

3.0

1.5

5.6

62.9

18.9

3.7

23.1

7.8

49.9

2.6

2.0

“0.5

“0.5

3.9

45,074

100.0

59.0

41.0

2.2

1.0

1.8

2.0

10.5

22.2

30.4

29.9

7.7

27.8

64.5

1.1

98.9

42.9

39.1

6.4

3.4

8.4

60.9

11.0

13.6

5.4

4.0

“0.5

2.7

1.9

7.1

66.3

13.4

1.5

15.4

3.1

44.2

2.1

*1.2

“0.4

‘0.5

2.8

7,477

100.0

71.5

28.5

9.3

4.0

4.7

5.3

20.8

25.8

18.6

11.4

23.3

30.7

46.0

*1.5

98.5

47.4

17.6

10.0

“3.1

21.9

58.6

6.8

22.0

5.9

“2.0

“0.9

“3.0

0.8

7.6

66.8

18.6

10.9

27.8

8.3

43.7

“2.0

*1.9

“0.7

*0. I

“2.0

313,977

100.0

59.4

40.6

5.0

2.4

3.0

3.7

14.8

26.5

24.9

19.8

10.4

33.7

55.9

1.2

98.8

48.1

25.0

8.5

3.7

14.8

57.3

8.6

17.5

7.1

5.0

0.6

2.8

1.1

6.0

66.7

14.4

3.3

21.8

6.5

43.7

2.2

1.5

0.4

0.6

3.8

Sea footnotes at end of table.

21
Table 3. Number of office visits to general and family practitioners and percent distribution by selected visit characteristics, according to age

and sex of physician: United States, January 1980-December 1981 —Con,

Selected visit characteristic

Age of physician Sex of physician

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

ages years years years years

Female and overMale

Principal diagnosis and ICD–9–CM code5

Infectious and parasitic diseases. ., . . ...001-139

Neoplasm, . . . . . . . . . . . . . . . . . . . . . . . . . . ..140–239

Endocrine, nutritional and metabolic diseases,

and immunity disorders . . 240-279

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

Diseases of the nervous system and

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

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

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

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

Diseases of the genitourinary system . . . 580–629

Diseases of the skin 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. . . . . . . . . VO1–V62

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

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

Nonmedication therapy4

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

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

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

Family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychotherapy or therapeutic listening. . . . . . . . . . . . . . .

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

Famiiyor social counseling . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Number of medications

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

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

2

3 :::::::::;:::::::::;:::::::;;;; :::::::::;;;;;

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

Duration of visit

O minutes6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,

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

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

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

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

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

Disposition of visit7

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

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

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

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

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

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

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

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

See footnotes at end of table.

3.3

1.3

5.4

2,7

5.3

13.4

17.4

5.5

5.3

4.2

7.0

3.9

9.4

13.8

1,1

1.1

58.1

4.1

5.5

1.4

2.2

9.8

1.9

23,3

1.3

26.6

35.1

22.4

9.1

6.9

3.2

13.2

36.1

28.5

17.2

1.9

15.3

49.9

30.6

3.2

2.8

0.3

1.3

“0.2

3.7

“0.9

3.5

2,5

8.1

7.7

14.9

5.5

5.5

5.6

5.3

4.3

10.8

18,9

“1.7

*1.1

50.5

5.3

5.7

“1.3

4.1

8.9

3.0

31.2

*1.1

34.5

35.9

20.6

5.3

3.8

“1.8

8.9

35.9

31.6

19.2

2.7

8.6

48.4

39.4

4.6

4.0

“0.2

“0.6

“0.2

3.4

1.2

4,1

2,3

6.2

10.0

18.0

4.7

6.5

4.5

6.8

4.0

9.7

16.6

1.2

“0.8

66.4

4.0

5.3

2.1

1.3

7.2

1.8

15.9

1.5

32.0

34.9

20.8

7.2

5.0

3.3

18.7

40.7

23.4

12.6

1.3

19.7

45.2

29.4

2.8

2.8

“0.3

1.1

*0.1

Percent distribution

3.9

1.3

5.2

2.7

5.4

13.1

17.3

5.8

5.2

4,2

7.4

4.3

8.9

13.4

1.0

1.1

54.2

3.5

5.1

1.3

2.5

9.7

1.9

28.2

1.3

24.8

34.6

24.5

9.2

7.0

4.4

15.9

37.8

26.0

14.6

1.4

15.9

50.8

28.1

3.4

2.7

“0.1

1.8

“0.2

3.4

1.5

5.8

2,8

4.7

14.2

17.8

5.6

5.0

3.9

6.4

3.7

9.5

13.5

1.1

1.1

59.4

4.6

6.0

1.4

2.2

10.2

1.7

20.5

1.6

24.6

35.1

20.8

10.6

8.9

2.8

12.0

33.2

31.7

18.5

1.8

15.2

49.4

32.4

3.3

2.6

“0.2

1.2

“0.2

1.9

*1.2

7.7

2.8

3.7

19.9

17.5

5.6

4.7

3.7

8.5

3.0

9.0

8.8

“0.9

“1.1

57.5

3.4

5.2

“0.4

1.9

13.0

1.5

24.0

“0.7

22.6

35.8

24.4

10.5

6.8

2.2

6.2

33.4

31.0

24.1

3.1

13.3

55.8

28.0

2.4

3.0

*0.5

*1.1

“0.2

“4.0

“0.1

*4.4

“2.0

6.5

8.1

14.8

5.9

9.1

*4.5

*5.3

*5.3

8.6

20.1

“1.4

48.4

“3.3

“4.0

*4.2

*3.6

11.5

*3.5

31.6

*1.2

25.7

31.8

27.0

7.7

7.8

“1.0

7.0

32.2

29.0

24.7

6.0

*4.8

46.1

43.5

6.7

“2.0

“0.5

*0.7

*0.1

3.3

1.3

5.4

2.7

5.3

13.5

17.5

5.5

5.2

4.2

7.0

3.8

9.4

13.7

1.1

1.1

58.3

4.1

5.5

1.3

2.2

9.7

1.8

23.1

1.3

26.6

35.1

22.2

9.2

6.9

3.2

13.4

36.2

28.5

17.0

1.8

15.6

50.0

30.3

3.1

2.9

0.3

1.3

0.2

22
Tabla 3. Number of office visits to general and family practitioners and percent distribution by selacted visit characteristics, according to age

and sex of physician: Unitad States, January 1980-December 1981—Con.

Selected visit characteristic

Age of physician Sex of physician

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

ages years years years

Female

years and over

Male

Type of practice

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

Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Geographic region

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

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

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

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

Area

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

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

Percent distribution

61.5 25.5 31.4 65.5 72.7

38.5 74.5 68.7 34.5 27.3

15.7 8.7 7.2 17.5 14.4

30.3 30.4 43.8 26.1 30.6

35.1 26.2 31.8 46.2 31.8

18.9 34.9 17.2 10.2 23.2

56.9 69.6 42.2 58.4 56.1

43.1 30.4 57.8 41.7 43.9

88.5 45.0

11.5 55.0

29.8 15.3

21.8 25.3

29.0 34.1

19.4 25.3

66.5 73.1

33.5 26.9

61.9

38.2

15.7

30.5

35.1

18.7

56.6

43.5

1Does not include doctors of osteopathy.

2Baaad on A Reason for Visit Classification for Ambulatory Care (RVC).6

31ncludes blank; problems, complaints not elsewhere classified; entries of ‘“none”; and illegible entries.

4Percents will not total 100.0 becauae more than one service may have been rendered during a visit.

5Based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM).7

‘Represents visits in which there was no face-to-face encounter between patient and physician.

7Percents will not total 100.0 bacause more than one disposition was possible.

alncludes partnership, group, and other types of practice.

Table 4. Number of drugs mentionad in office visits to genaral and family practitioners and percent distribution by therapeutic categories,

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

Age of physician 1 Sex of physician 1

Therapeutic catego~2 All Under 35 35-44 45-54 55-64 65 years Female

ages years years years years and over

Male

All drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 444,961 30,670 68,216

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

Antihistamine drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.0 10.7 9.3

Anti-infective agents . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.4 17.6 21.0

Autonomic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4 5.5 4.4

Blood formation and coagulation . . . . . . . . . . . . . . . . . 1.3 “0.9 0.9

Cardiovascular drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.5 7.7 8.4

Central nervous system drugs . . . . . . . . . . . . . . . . . . . . 17.5 16.7 13.8

Electrolytic, caloric, and water balance . . . . . . . . . . . . 9.1 6.7 8.0

Expectorants and cough preparations . . . . . . . . . . . . . 3.4 2.9 3.5

Eye, ear, nose, and throat preparations . . . . . . . . . . . . 1.6 2.1 1.6

Gastrointestinal drugs . . . . . . . . . . . . . . . . . . . . . . . . . . 4.7 4.6 4.1

Hormones and synthetic substitutes . . . . . . . . . . . . . . 7.7 5.5 8.7

Serums, toxoids and vaccines. . . . . . . . . . . . . . . . . . . . 2.9 4.8 3.3

Skin and mucous membrane preparations. . . . . . . . . . 4.9 7.5 6.0

Spasmolytic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.7 2.4 1.1

Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5 2.6 3.1

Other, unspecified, or undetermined . . . . . . . . . . . . . . 2.4 1.8 2.8

Number In thousands

131)739 148,263

Percent distribution

100.0 100.0

6.4 6.1

17.9 16.2

4.2 5.0

1.3 1.6

10.2 10.9

18.5 18.2

8.0 9.9

3.7 3.1

1.8 1.3

5.3 4.7

7.5 8.2

3.0 2.5

4.6 4.2

1.8 1.8

3.3 4.0

2.5 2.3

66,072

100.0

5.8

15.3

3.2

1.2

13.5

18.4

11.5

3.8

1.6

4.4

6.9

2.4

4.7

1.2

3.9

2.2

10,577

100.0

7.5

15.9

*2.9

*1.8

6.0

16.1

8.8

4.6

“1.6

5.4

6.2

9.8

9.1

“0.4

*2.6

*1.3

434,384

100.0

6.9

17.4

4.5

1.3

10.6

17.6

9.1

3.4

1.6

4.7

7.7

2.7

4.8

1.7

3.6

2.4

1Does not include doctors of osteopathy.

‘Based on the classification system of the American Hospital Formulaw Serv!ce.g

23
Number of office visits to general and family practitioners and percent distribution and average annual rate of ofFice visits by age of

according to sex, race, and ethnicity: United States January 1980-December 1981

Table 5.

patient,

Sex Race Ethnicity

Age of patient Both Female Male White Black All Hispanic Nonsexes other Hispanic

Number of visits in thousands

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381,710 229,445 152,265 338,479 39,897 3,334 17,703 364,007

Percent distribution

100.0 100.0

4.8 4.5

2.5 1.9

3.1 2.3

3.6 3.0

14.7 15.4

27.0 26.6

24.8 26.9

19.5 19.5

100.0

*5.7

“4,0

“2.8

*9.2

“11.0

40.8

19.7

*6.8

100.0

3.8

3.4

4.9

3.0

15.9

32.7

22.8

13.6

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

3.9

2.0

2.4

3.0

15.7

27.9

25.0

20.1

100.0

6.1

3.1

4.0

4.5

13.3

25.8

25.0

18.2

4.9

2.4

2.9

3.6

14.7

26,8

25.1

19.6

Under 3 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3–5 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6–10 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

25–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

4.8

2.4

3.0

3.6

14,7

27.1

25.0

19.4

Visit rate per 100 population

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85.7 99.5 70,9 88.6 76.4 30.2 --- ---

Under 3 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90.2 91.1 89.3 98.9 57.1 *28.3 --- . . .

3–5 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48.8 48.0 49.5 54.3 25.8 “19.6 --- . . .

6-10 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34.3 33.1 35.4 38.0 18.1 “10.2 --- ..-

11–14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47,8 49.2 46.4 51.5 28.4 “40.6 --- . . .

15–24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89.1 87.1 50.5 72.6 56.7 “17.4 --- . . .

25-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82.4 99.6 64.3 84.6 77.1 .37.5 --- ---

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108.6 124.1 91.3 107.8 129.4 39.8 --- ---

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150.7 159.6 137.8 148.6 190.8 *36.7 --- . . .

Table 6. Number ofotice visits togeneraI and family practitionere andpercent distribution by referral status, prior visit status, and return visit

rate, according to selected patient characteristics: United States, January 1980-December 1981

Number of

Selected patient characteristic visits

in

Referral status Prior visit status

Return

Total Referred by Not referred

New Old patient, Old patiant, visit

another by another

patient new old rate 1

physician physician problem problem

Percent distribution

thousands

Sex

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

381,710

229,445

152,265

100.0

100.0

100.0

1.2 98.8 11.3 32.4 56.3

1,1 98.9 10.1 31.4 58.5

1.4 98.6 13.1 34.0 52.9

7.9

8.9

6.6

6.2

5.5

6.7

4.7

4.9

5.9

12.2

2CI.6

8.2

6.6

2.5

4.6

88.1

Age

Under 3 years . . . . . . . . . . . . . . . . . . . . . . . .

3–5 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

ll–14 years . . . . . . . . . . . . . . . . . . . . . . . . .

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

25–44 years . . . . . . . . . . . . . . . . . . . . . . . . .

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

66 years and over . . . . . . . . . . . . . . . . .

18,377

9,297

11,492

13,715

56,230

103,275

95,458

73,867

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

“1.1 98.9

*2.1 97.9

“1.0 99.0

*1.6 98.5

1.7 98.3

1,4 98.6

1.1 98.9

“0.6 99.4

13.9

15.4

13.0

17.7

17.1

14.5

7.6

4.6

39.4

48.6

49.4

48.0

41.0

34.8

27.2

20.1

46.7

36.0

37.6

34.3

42.0

50.8

65.3

75.2

Race

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

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Another.. . . . . . . . . . . . . . . .. . . . . . . . . . . .

338,479

39,897

3,334

100.0

100.0

100.0

1.2 98.8 10.9 32.5 56.6

“1.0 99.0 13.2 31.3 55.5

*3.O 97.0 28.2 34.1 37.7

Ethnicity

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-H ispanic . . . . . . . . . . . . . . . . . . .

17,703

364,007

100.0

100.0

*1.9 98.1 17.7 30.3 52.0

1.2 98.8 11.0 32.5 56.5

lAII old patients divided by new patients.

24
Table7. Number ofotice visketo general end family practitioners andpercent distribution byvisit status, according tosexand age of patient endprior visit status: United States,

Janua~ 1980-December 1981

Sex Age Prior visit status

Visit status

Both Under 3 3-5 6-10

Old

11–14

Old

Female Male

15-24 25-44 45-64 65 years New patient, patient,

sexes years years years years years years years and over patient new old

problem problem

Number in thousands

13,715 56,230 103,275

Percent distribution

All visits . . . . . . . . . . . . . . . . . . . . ,., 381,710 229,445 152,265 9,297

100,0

71.4

8,377 1,492 95,458

100.0

41.2

35.4

11.6

3.2

8.5

56.3

11.3

16.4

8.6

3.8

1.0

1.4

1.2

73,867

100.0

31.4

48.8

11.5

2.8

5.4

52.9

13.9

20.4

6.9

3,0

“0.6

‘0.3

“2.0

43,099

100.0

62.5

9.5

5.3

1.8

20.9

61.8

4.8

10.6

5.0

7.2

*0.3

9.2

1.1

123,752 214,859

100.0

27.7

40.7

12.3

4.9

14.4

48.4

11.7

23.2

10,3

2.7

0.9

1.1

1.7

100.0

64.8

9.3

3.4

5.4

17.1

58.9

6.0

4,9

8.0

11,2

10.0

*1.O

100!0 100.0

56.6 52.3

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

Major reason for visit

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

Chronic problem, rcrutine . . . . . . . . .

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

Postsurge~ or postinjury . . . . . . . . .

Nonil[ness care . . . . . . . . . . . . . . . . .

Principal reason for visit

module and RVC codel

Symptom module . . . . . S001-S999

Disease module . . . . .. DOO1-D999

Diagnostic, screening, and

preventive module. . . . Xl 00-X599

Treatment module. . . . . T100-T899

Injuries and advarse effects

module . . . . . . . . . . . .. JOOl -J999

Test results module . .. R1OO-R7OO

Administrative

module . . . . . . . . . . . . . Al 00-AI 40

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

00.0 100.0 100.0 100.0 100.0

47.8

25.9

8.5

3.7

14.2

100.0

45.5

26.6

8.5

2.9

16.5

51.2 57.5 68.8

24.8 2.6 5.8 12,5

8.5 2.5 5.5 5.1

4.8 1.4 1.9 4.6

10.7 36.1 15.4 8.9

77.6

5.7

3.0

2.1

11.6

9.4

8.5

4.2

5.7

9.0

3.7

5.0

25.7

58.0

8.4

57.5

7.8

58.6 55.9 69.0 69.6

9.3 3.4 *3.1 5.5

11.8 33.0 *6.2 *3.9

7.3 *2.5 *5.9 7.6

6.9 ‘2,4 7.3 8.1

0.6 ‘0.7

3.9 0.7 7.5 *3.8

1.6 *2.1 ‘1.0 *0.8

56.6 61.9 73.3

4.0

7.4

3,3

7.6

“0.3

3.4

0.7

4.9 5.8

18.6 14.3

5.7 8.6

6.7 4.9

“0.2 0.8

6.3 2.6

*1.O 1,1

16.7

7.5

19.9

7.5

4.8

0.6

3.4

0.6

2.7

1,3

2.0

1.3

1Based on A Reason for Visit Classification for Ambulatory Care [RVC).6

21ncludas blanks; problems, complaints natelsewherec lass! fied;entrresof “none”’;and illegiblaantrias.
Table8, Number andpercant distribution ofotice visits togeneral and family practitioners, by age of patient and20most frequent principal

reasons for visit: United States, January 1980-December 1981

Age andprincipalreason forvisit and RVCcodel

Number of

visits Percent

in distribution

thousands

Under 15 years

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

Well-baby examina~ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X105

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

Cough, , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . .. S440

Fever ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... .S010

Head cold, upper respiratory infection (coryza) . . . . . . . . . . . . . . . . . . . . . . . ... , . . . . . . . . . . . . . . . . . . . . . . .. S445

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

Skin rash..,,...........,,....,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, . . . . . . . . . . . . . . . . . . . . . . .. S860

General medical examination....,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . .. XI 00 . . .. XI00

Physical examination required for school. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Al10 . . . . . . . .. All O

Prophylactic innoculations, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X400

Physical examination required for extracurricular activities . . . . . . . . . . . . . . . . . . . . . . . . . Al 15

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

Nasal congestion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s400

Other symptoms referable to the ears, not elsewhere classified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S365

Vomiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S530

Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S595

Stomach pain, cramps and spasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S545

Abdominal pain, cramps, spasms, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s550

Suture-i nsertion, removal, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T555

Progress visit, not otherwise specified. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T800

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15–24 years

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

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

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

Head cold, upper respiratory infection (coryza) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S445

Skin rash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S860

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

Genera l medical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. XIOO

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

Abdominal pain, cramps, spasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s550

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

Physical examination required for school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. A11O

Physical examination required for employ merit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. AIOO

Physical examination required for extracurricular activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .AI15

Back symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S905

Pregnancy, unconfirmed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,.. .x2oo

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

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

Weight gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s040

Postpartum examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X215

Progress visit, not otherwise specified. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T800

Suture-insertion, removal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T555

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-44 years

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

Symptoms referable tothroat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S455

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

General medical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. XIOO

Back symptoms.,......,....,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S905

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

Head cold, upper respiratory infection (coryza) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S445

Headache, pain in head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S21O

Weight gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S040

Diet and nutritional counseling, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . .. T6oo

Chest pain and related symptoms (not referable to body system) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s050

Abdominal pain, cramps, spasms, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s550

Neck symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s900

Low back symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s91o

Pap smear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X365

52,880

4,228

3,744

3,506

3,189

2,969

2,578

1,722

1,716

1,352

1,080

1,077

1,046

971

875

747

669

567

517

514

507

19,306

56,230

5,244

4,797

1,423

1,377

1,360

1,293

1,200

1,187

1,010

985

946

923

815

728

616

616

593

548

520

518

29,531

103,275

4,593

4,223

3,878

3,153

3,058

2,747

2,715

2,687

2,522

2,518

1,825

1,734

1,636

1,607

100.0

8.0

7.1

6.6

6.0

5.6

4.9

3.3

3.2

2.6

2.0

2.0

2.0

1.8

1.7

1.4

1.3

1.1

1.0

1.0

1.0

36.5

100.0

9.3

8.5

2.5

2.4

2.4

2.3

2.1

2.1

1.8

1.8

1.7

1.6

1.4

1.3

1.1

1.1

1.1

1.0

0.9

0.9

52.5

100.0

4.4

4.1

3.8

3.1

3.0

2.7

2.6

2.6

2.4.

2.4.

1.8

1.7

1.6

1.6

I Baaed on A Reason for Visit Classification for Ambulatory Care ( RVC).6

26
Table 8. Number and percent distribution of office visits to general and family practitioners, by age of patient and 20 most frequent principal

reasons for visit United States, January 1980-December 1981 —Con.

Number of

Age and principal reason for visit and RVC code7

visits Percent

in distribution

thousands

25–44 years—Con.

Skin rash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S860

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

Progress visit, not otherwise specified. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. TBOO

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

Physical examination required for employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. AIOO

Stomach pain, cramps andapasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s545

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 yeara

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

General medical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. XIOO

8100d pressure test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X320

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D51O

Back symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S905

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

Progress visit, nototherwise specified. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T800

Vertigo-dizziness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S225

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

Head cold, upper respiratory infection (coryza) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S445

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

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D205

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

Headache, pain in head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S21O

Low back symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S910

Injections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T11O

Leg symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S920

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

Skin rash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S860

Shoulder symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s940

Diet and nutritional counseling.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T600

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65 years and over

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

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

Blood pressure test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X32r)

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D51O

Progress visit, not otherwise specified. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T800

Vertigo-dizziness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S225

Chest pain and related symptoms (not referable to body system) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...5050

Back symptoms, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s905

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

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D205

Head cold, upper respiratory infection (coryza) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s445

Leg symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S920

Gout, hyperuricemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s21o

Shortness of breath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s415

Arthritis . . . . . . . . . . .’. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D900

Abdominal pain, cramps, spasms.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s550

General weakness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S020

Foot and toe symptoms . . . . . . . .’. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s935

Shoulder symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s940

Knee symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S925

Tiredness, exhaustion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . sol 5

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,582

1,555

1,543

1,483

1,451

1,310

55,455

95,458

6,508

5.600

3,024

2,917

2,345

2,299

2,068

1,986

1,986

1,940

1,828

1,775

1,703

1,517

1,323

1,315

1,115

1,085

1,079

1,067

50,978

73,B67

7,292

5,090

2,875

2,478

2,248

2,025

1,943

1,651

1,649

1,639

1,411

1,327

1,25B

1,161

1,113

1,062

913

890

845

765

34,232

1.5

1.5

1.5

1.4

1.4

1.3

53.6

100.0

6.8

5.9

3.2

3.1

2.5

2.4

2.2

2.1

2.1

2.0

1.9

1.9

1.8

1.6

1.4

1.4

1.2

1.1

1.1

1.1

53.4

100.0

9.9

6.9

3.9

3.4

3.0

2.7

2.6

2.2

2.2

2.2

1.9

1.8

1.7

1.6

1.5

1.4

1.2

1.2

1.1

1.0

46.3

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

27
Table 9. Number of office visits to genersl snd femily practitioners and percent distribution by principal diagnosis categories, sccording to aex and age of patient and prior visit status:

United States, January 1980-December 1981

Sex Age Prior visit status

Principal diagnosis category and Old Old

ICD-9-CM code 1 Both

Female Male

Under 3 3-5 6–10 11–14 15–24 25–44 45–64 65 years New patient, patient,

sexes years years years years years years years and over patient new old

problem problem

Number in thousands

All visits . . . . . . . . . . . . . . . . . . . . 381,710 229,445 152,265 18,377 9,297 11,492 13,715 56,230 103,275 95,458 73,867 43,099 123,752 214,859

Psrcent distribution

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

Infectious and parasitic

disesses . . . . . . . . . . . . ..001 -l39 3.3 3.1 3.6

Neoplasms . . . . . . . . . . . ..l4O–239 1.2 1.2 1.3

Endocrine, nutritional and

metabolic diseases, snd immunity

disorders. . . . . .240-279 6.2 7.3 4.6

Mental disorders . . . . . . . 290–319 2.6 2.8 2.3

Diseases of the nervous system

and sense organs. . . . . . .320-389 5.1 4.8 5.5

Diseases of the circulatory

system . . . . . . . . . . . . . ..39 O–459 13.1 12.7 13.6

Diseases of the respiratory

system . . . . . . . . . . . . . ..46O-5l 9 17.3 16.2 19.0

Diseasas of the digestive

system . . . . . . . . . . . . . ..52 O–579 5.6 5.0 6.4

Diseases of the genitourinary

system . . . . . . . . . . . . . ..58 O–629 5.3 6.9 2.7

Diseases of the skin and

subcutaneous tissue . . . . 680–709 4.0 3.5 4.7

Diseasea of the musculoskeletal

system and connective

tissue . . . . . . . . . . . . . . ..7l O–739 7.6 7.8 7.2

Symptoms, signs, and ill-defined

conditions . . . . . . . . . 780–799 3.8 3.8 3.7

Injury and poisoning . . ...800-999 9.8 7.6 13.1

Supplementary classification . . . . . . . . . . . . . . . . VO1—V82 13.0 14.9 10.2

All other diagnoses . . . . . . . . . . . . . 1.1 1.3 0.8

Unknown diagnoses . . . . . . . . . . . . . 1.2 1.1 1.4

i Bssed on International Classification of Diseases, 9th Revision, Clinical Modification (I CD–9–CM).7

100.0 100.0 100.0 100.0 100.0

6.1

‘0.2

2.6

1.5

4.4

1.9

17.9

4.8

7.1

5.5

3.6

3.6

12.5

25.8

1.7

1.1

100.0 100.0 100,0 100.0 100.0 100.0

*5.8

“0.1

5.2

“0.3

8.0

‘1.5

7.3

“0.7

3.4

1.2

1.3 1.2

1.6 2.0

4.9 5.1

‘0.4 1.1

1.9

1.5

“0.2

*0.2

‘0.2

“0.5

“0.8

“0.4

“0.2

‘0.4

8.0

3.9

4.7

5.2

8.4 8.0

3.4 2.3

3.6 3.4

19.8 33.0

5,6 1.6

2.4 2.2

6.1 6.9

9.0

2.9

11.8 3.8

“0.5

17.0

“0.4

9.8

“0.5

9.1

“0.7 5.0 3.8 20.0

28.8 34.6 33.5 20.9 17.2 14.9 11.8 18.3 22.9 13.9

3.6 4.7

*1.6

*3.3

“4.1

*1.7

*3.2

*4.9

*1.7

*4.3

“3.7

6.3

6.9

6.0 5.6

5.6 3.4

5.0 7.2

4.5 6.6 4.6

7.0 5.0 4.0 3.5 3.0 5.3 5.7 2.7

“0.6 ‘0.3 *1.O *4.2 7.1 11.2 10.9 5.6 7.1 8.2

“3.1

3.9

*4.5

10.6

*4.1

15.8

*3.1

19.7

3.7

12.1

4.0 3.8

8.1 5.6

4.4 4.5

11.9 12.6

3.2

7.8

34.7

*1.2

*1.1

15.5

*1.4

“0.1

9.3

*1.O

“0.9

18.4

“0.7

*1.8

14.1

0.8

1.5

6.5 4.0

1.0 1.3

1.3 0.9

18.2 10.9

‘0.9 0.7

1.7 1.0

13.2

1.4

1.2
Table 10. Number and percent distribution of office visits to general and family practitioners, by age of patient and 20 most frequent principal

diagnoses: United States, January 1980-December 1981

Age, principal diagnosis. and ICD-9-CM codeq

Number of

visits Percent

in distribution

thousands

Under 15 years

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

Health supewision ofinfant orchild . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V20

Acute upper respirator infectionof multiple or unspecified sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...465

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

General medical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V70

Acute pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...462

Acute tonsillitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...463

Bronchitis, notspecified as acute or chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490

Other noninfectious gastroenteritis and colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 558

Need for prophylactic vaccination and inoculation against combinations of diseases. . . . . . . . . . . . . . . . . . . . . . . . . . V06

Other diseases dueto viruses and Chlamydiae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...078

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

Other open wound of haad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...873

Contact dermatitis and other eczema. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...692

Disorders ofconjunctiva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...372

Allergic rhinitis (hay fever) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...477

Nonsuppurative otitismedia and Eustachian tube disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..381

Acute nasopharyngitis (common cold). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...460

Acute bronchitis and bronchiolitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...466

Streptococcal sore throat and scarlet fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...034

Other disorders ofurethraandurina~ tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...599

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-24 years

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

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

General medical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V70

Acute upper respirator infectionof multiple orunspecified sites.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...465

Acute pha~ngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...462

Acute tonsillitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...463

Obesity andother hyperalimentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...278

Contact dermatitis and other eczema. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...692

Other noninfectious gastroenteritis andcohtis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...558

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

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

Chronic sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...473

bronchitis, notspecified as acute or chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490

InflammatoV disease ofcervix, vagina, and vulva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...616

Infectious mononucleosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...075

Other diseases duetoviruses and Chlamydiae. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...078

Disorders of external ear...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..38cJ

Sprains andstrains ofother and unspecified parts of back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...847

Allergic rhinitcs (hay fever) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...477

Disorders of menstruation and other abnormal bleeding from female genital tract . . . . . . . . . . . . . . . . . . . . . . . . . . ...626

Postpartum care and examination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V24

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-44 years

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

Obesity andother hyperalimentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...278

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

General medical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V70

Acute upper respiratory infectionof multiple or unspecified sites.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...465

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

Acute pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...462

Sprains andstrains ofother and unspecified parta of back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..847

Neurotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300

Chronic sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...473

Bronchitis, notspecified as acute or chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490

Allergic rhinitis (hay fever) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...477

Other noninfectious gastroenteritis and colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...558

Sprains andstrains of sacroiliac region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...846

Other disordera of soft tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...729

1Based on International Classification of Diseases, 9th Revision, Clinical Modification IICD-9-CMI. 7

52,880

5,811

4,599

4,006

2,512

2,227

2,146

1,613

1,061

792

698

679

675

626

588

574

569

549

515

502

498

21,640

56,230

6,059

4,260

2,764

2,303

1,220

894

886

761

732

721

685

620

616

615

606

582

577

566

556

547

29,660

103,275

5,555

4,373

4,194

3,870

3,283

2,628

2,238

2,201

1,788

1,678

1,504

1,444

1,430

1,402

100.0

11.0

8.7

7.6

4.8

4.2

4.1

3.0

2.0

1.5

1.3

1.3

1.3

1.2

1.1

1.1

1.1

1.0

1.0

0.9

0.9

40.9

100.0

10.8

7.6

4.9

4.1

2.2

1.6

1.6

1,4

1.3

1.3

1.2

1.1

1.1

1.1

1.1

1.0

1.0

1.0

1.0

1.0

52.7

100.0

5.4

4.2

4.1

3.7

3.2

2.5

2.2

2.1

1.7

1,6

1.5

1.4

1.4

1.4

29
Table 10. Number and percent distribution of office visits to general and family practitioners, by age of patient and 20 most frequent principal

diagnoses: United States, January 1980-December 1981 —Con.

Number of

Age, prirr cipal diagnosis, and ICD–9-CM code~ visits Percent

in distribution

thousands

25–44 years—Con.

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

Contact dermatitis and other eczema. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...692

Other andunspecified disorders of back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .724

Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . ...487

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

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,.......,....250

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45–64 years

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

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

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..25o

Acute upper respiratory infection ofmultiple or unspecified sites, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...465

Genera l medical examination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. ..,.,, V70

Obesity andother hyperalimentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...278

. . . . . . . . . . .

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

Bronchitis, notspecified asacute orchronic, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,, ...,,,,.....,,.,....,.,..490

Chronic sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...473

Other disorders ofsoft tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Osteoarthritis and allied disorders.,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . 729

. . . . . . . . . . . . 715

iJenopausa l and postmenopausal disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..627

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

Sprains andstrains ofother and unspecified parts of back, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 847

Acute pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . ...462

Other andunspecified disorders of back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..724

Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...487

Peripheral enthesopathies and allied syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...726

Chronic airway obstruction, not elsewhere classified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...496

Acute bronchitis and bronchiolitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...466

Sprains andstrains of sacroiliac region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...846

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65 years and over

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

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

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

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

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

Osteoarthritis and allied disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...715

Hypertensive heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...402

Acute upper respirato~ infection ofmultiple orusnpecified sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...465

Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428

Bronchitis, notspecified as acute or chronic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..49o

Chronic aimvayobstruction, not elsewhere classified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...496

General medical examination ...,.,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...v70

Other disorders of soft tissue, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...729

Neurotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...427

Acute bronchitis and bronchiolitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...466

111-defined descriptions and complications of heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...429

Peripheral enthesopathies and allied syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...726

Gastritis andduodenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..535

Other and unspecified anemias.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...285

Cystitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...595

Residual . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,291

1,255

1,246

1,153

1,095

1,058

58,589

95,458

12,945

4,352

2,279

2,224

2,076

1,871

1,662

1,550

1,501

1,490

1,388

1,325

1,217

1,167

1,045

1,043

1,003

995

984

963

52,378

73,867

12,005

4,436

3,350

2,191

2,125

1,582

1,500

1,177

1,145

1,121

871

756

745

714

694

638

631

620

591

577

36,398

1.3

1.2

1.2

1.1

1.1

1.0

56.7

100.0

13.6

4.6

2.4

2.3

2.2

2.0

1.7

1.6

1.6

1.6

I .5

1.4

1.3

1.2

1.1

1.1

1.1

1.0

1.0

1.0

54.8

100.0

16.3

6.0

4.5

3.01

2.9

2.1

2.0

1.6

1.6

1.5

1.2

1.0

1.0

1.0

0.9

0.9

0.9

0.8

0.8

0.8

49.3

7Based on International Classification of Diseases, 9th Revision, Clinical Modification (IC D–9-CM). 7

30
Table 11. Number of office visits to general and family practitioners, percent of visits by diagnostic sanfices and nonmedication therapy, and percent distribution by number of medications,

according to sex and sge of patient and prior visit status: United States, January 19S0.December 1981

Sex Age Prior visit status

Service or therapy

Old

Both Under 3 3-5

Old .

Female Male

6-10 11-14 15-24 25-44 45–64 65 years New

sexes years

patient, patient,

years years years years yaars years and over patient new old

problem problem

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

Diagnostic service’

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

Limited history and/orexaminetion. . .

General history and/or examination. . .

Pap test . . . . . . . . . . . . . . . . . . . . . . .

Clinical Iaboratoty test . . . . . . . . . . .

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

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

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

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

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

Mental status examination . . . . . . . .

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

Nonmedication therapyl

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

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

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

Family planning . . . . . . . . . . . . . . . . .

Psychotherapy or therapeutic

listening . . . . . . . . . . . . . . . . . . . . . .

Diet counseling............,.. ,,

Family or social counseling . . . . . . .

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

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

Number of medications

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

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

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

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

3 . . . . . . . . . ,,, ,. . . . . . . . . . . . . . . .

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

381,710

6.4

65.0

14.6

3.2

21.6

6.7

44.7

2.0

1.3

0.3

0.6

4.4

56.8

5.5

5.5

1.3

2.5

10.3

1.9

22.5

1.4

100.0

26.4

34.7

22.5

9.5

6.9

229,445

6.0

64.6

14.7

5.3

23.2

5.8

46.7

1.6

0.9

0.3

0.6

4.9

56.8

5.1

4.4

2.1

2.8

11.5

2.2

22.6

1.2

100.0

25.5

34.4

22.3

10.1

7.6

152,265

7.1

65.7

14.6

19.2

8.1

41.7

2.7

1.9

*0.4

0.7

3.7

56.B

6.3

7.2

“0.2

2.1

8.5

1.5

22.3

1.7

100.0

27.6

35.1

22.9

8.5

5.9

18,377

4.8

71.3

19.9

10,6

*1.9

4.6

“0.2

3.8

65.1

*1.O

3.8

“0.4

10,5

“2.7

20.9

“0.5

100.0

27.5

35.9

27.8

7.0

*1.8

9,297

8.0

72,7

13.4

16.8

*4.1

‘8.1

‘0.2

‘1.7

*3.4

68.2

*1.4

8.1

“1.5

“0.3

21,8

“0.3

100.0

20.8

41.9

28.8

7.2

“1.4

11,492

9.5

69.9

14,1

17.9

*2.7

8.7

“0.2

*1.0

*3.5

67.0

*2.4

8.3

*1.7

*2.3

“0.9

18.8

“0.3

100.0

26.7

43.6

24.1

5.2

“0.3

Number in thousands

13,715 56,230

Percent of visits

10.0 5.3

63.5 66.9

17.7 15.5

‘0.4 4.5

20.3 27.3

9.6 6.4

24.5 37.8

“0.3 “0.9

*3.9 2.0

‘0.2 ‘0.2

“0.5 “0.6

“2.7 *3.7

63.5 57.0

5.4 5.1

10.3 7.0

“0.4 4.1

‘0.4 1.9

*3.2 6.1

‘1.0 2.3

17.9 22.1

*2.4 1.7

Percent distribution

100.0 100.0

3B.7 35.1

37.3 37.1

17.3 19.3

5.7 6.2

“0.9 2.3

103,275

7.3

64.4

14.9

5.2

20.5

7,4

43.1

1.6

1.4

‘0.3

0.8

5.2

54.1

6.9

5.7

2,4

3.0

11.4

2.5

21.1

1.6

100.0

30.3

36.0

21.5

8.5

3.s

95,458

7.1

62.3

14.2

3.5

21.3

7.4

54.9

3.2

1.2

“0.5

0.7

4.3

54.5

6.8

4.8

‘0.2

3.1

13.3

1.8

23.6

1.6

100.0

22.2

33.4

24.0

11.3

9.2

73,867

4.2

65.0

12.6

1.4

23.5

6.8

62.9

3.5

“0.6

“0.5

“0.6

4.8

57.2

4.7

3.7

*0.1

2.9

11.7

1.3

25.2

1.0

100.0

17.8

29.8

23.2

13.3

16.0

43,099

“3.0

56.5

29.3

4.2

27.5

10.2

38.2

2.5

3.5

“0.2

“0.9

4.6

55.0

5.1

6.5

2,1

1.9

10,3

1,3

23.7

2.2

100.0

32.3

31.5

21,1

9.8

5.3

123,752

3.5

72.8

14.6

3.1

21.1

9.3

37.2

1.9

1.4

‘0.4

“0.4

3.8

59.0

5.7

6.9

1.3

1.8

5.7

1.6

22.1

1.8

100.0

25.7

37.1

23.9

8.9

4.4

214,859

8.8

62.2

11,7

3.1

20,8

4.5

50.3

2.0

0.8

0.3

0.7

4.7

56.0

5.6

4.5

1.2

3.0

12.9

2.2

22.5

0.9

100.0

25.5

34.0

22.0

9.8

8.7 —

i Percents will not total 100.0 because more than one service may have been rendered during a wsit.

6.)
Table 12. Number ofdrugs mentioned inofice visits togenaral and family practitioners andparcant distribution bytherapeutic categories, according tosexand ageofpatient and prior

visit status: lJnited Statea, January 1980 -December 1981

Therapeutic categoryl

All drugs.................,.,

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

Antihistamine drugs . . . . . . .

Anti-infective agents.

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

Blood formation and

coagulation . . . . . . . . . . . . .

Cardiovascular drugs. ., ., . . . .

Cantrsl nemous system drugs

Electrolytic, caloric, and water

balance . . . . . . . . . . . . . . . . . . . . .

Expectorants and cough

preparations . . . . . . . . . . . . . . . . .

Eye, ear, nose, and throat

preparations . . . . . . . . . . . . . . . . .

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

Hormones and synthetic

substitutes . . . . . . . . . . . . . . . . .

Serums, toxoids and vaccines

Skin and mucous membrane

preparation . . . . . . . . . . . . . . . . .

Spasmolytic agents. . . .

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

Other, unclassified, or

undertarmined . . . . . . . . . . . .

Sex Age Prior visit status

Both

Female Male

Under 3 3-5 6–10 19–14 15–24

sexes yeers years years years years

532,065

100.0

6.8

17.3

4.4

1.3

10.0

17.9

9.2

3.4

1.5

4.6

8.2

2.7

4.8

1.6

3.7

2.6

330,172

100.0

6.5

15.8

4.4

1.4

9.5

19.0

9.8

3.1

1,3

4.6

9.5

2.3

4.4

1.4

4.5

2.5

201,893

100.0

7.4

19.7

4.4

1.1

10.9

16.0

8.4

3.8

1.9

4.6

6.0

3.4

5.3

2.0

2.4

2.7

22,038

100.0

11.4

31.7

“0.9

‘0.9

“0.2

4.9

*1.2

5.8

2.9

3.4

*1.O

24.5

4.6

“0.9

*2.6

3.1

11,764

100.0

14.7

43.0

*2.1

“0.4

6.2

“0.0

7.7

3.6

3.2

*1.7

10.1

*4.9

*1.3

*O. 1

*1.O

12,504

100.0

18.6

40.2

*3.4

“0.3

‘0.4

6.0

‘0.2

6.7

“3.5

‘1.8

‘2.3

*4.7

8.6

“0.7

‘0.2

2.4

Number in thousands

12,719 58,485

Percent distribution

Old Old

25–44 45–64 65 years New patient, patient,

years years and over patient new old

problem problem

100.0

15.3

32.4

*3.7

“0.7

‘1.1

8.8

“1.0

7.5

*3.9

“3.0

*3.7

*4.4

8.3

*1.7

‘0.9

3.6

100.0

10.0

29.2

4.3

1.5

“0.9

14.4

1.8

5.0

2.2

3.7

8.1

2.5

7.9

0.4

5.8

2.3 2.7 3.3 2.1

24,633 1498707 140,215

100.0 100.0 100.0

8.5 5.1 2.5

20.1 12.1 7.4

5.8 4.7 3.7

0.9 1.1 2.0

3.4 12.6 21.0

21.9 20.7 17.6

5.9 12.2 15.8

4.2 2.4 1.7

1.7 1.1 0.8

4.9 4.6 5.3

8.7 10.2 8.2

1.1 1.2 1.5

5.8 3.7 2.9

0.8 1.8 2.9

3.6 3.2 4.6

53,957

100.0

8,1

25,1

4.7

‘0.4

3.5

16.7

6.2

5.0

2.0

3.4

8.1

2.6

6.6

1.7

2.5

3.4

161,523

100,0

8.8

25.9

4.8

0,6

4.3

16.9

3.7

5.2

2.4

5.7

5.8

3.1

7.2

1.0

2.1

2.5

316,586

100,0

5.6

11.5

4.1

1.7

4.1

8.6

2.6

2.2

1.9

4.2

9.4

2.5

3.2

2.0

4.8

2.5

.

‘Based on the classification system of the American Hospital Formula~Sewice.g
Table 13. Number and percent distribution of drugs mentioned in office visits to general and family practidoners, by age of patient and most

frequently named drugs: United States, January 1980-December 1981

Number of Number of

drug

Age of patient and name of drugl

Percent

mentions distribution

in

drug

Age of patient and name of drugl

Percent

mentions distribution

in

thousands thousands

Under 15 years

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

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

Diphtheria, tetanus toxoids, and pertussis

vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Poliomyelitis vaccine . . . . . . . . . . . . . . . . . . .

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

Amoxicillin . . . . . . . . . . . . . . . . . . . . . . . . . .

Dimetapp . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Allergy relief orshots . . . . . . . . . . . . . . . . . . .

E.E.S.(erythromycin) . . . . . . . . . . . . . . . . . . . .

Actifed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Keflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Amoxil(amoxicillin) . . . . . . . . . . . . . . . . . . . . .

Septra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenergan . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dimetane . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Benadryl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IIosone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

V-Cillin (penicillin) . . . . . . . . . . . . . . . . . . . . . .

Ceclor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Donnagel . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

M-M-R (measles, mumps, rubella virus

vaccine) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tylenol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pen-Vee K . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Donnatal . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E-Mycin (erythromycin) . . . . . . . . . . . . . . . . . .

Naldecon . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Larotid (smoxicillin) . . . . . . . . . . . . . . . . . . . . .

Neosporin . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tuberculin tine test . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15-24 years

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

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

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

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

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

Allergy relief or shots . . . . . . . . . . . . . . . . . . .

Actifed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Phenergan . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tetanus toxoid . . . . . . . . . . . . . . . . . . . . . . . . .

8enad@ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

V-Cillin (penicillin) . . . . . . . . . . . . . . . . . . . . . .

E.E.S.(erythromycin) . . . . . . . . . . . . . . . . . . . .

Ortho-novum . . . . . . . . . . . . . . . . . . . . . . . . . .

Prenatal vitamins . . . . . . . . . . . . . . . . . . . . . . .

Phenergan with cocaine . . . . . . . . . . . . . . . . .

Septra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pen-Vee K . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bactrim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E-Mycin (erythromycin). . . . . . . . . . . . . . . . . .

Amoxil(amoxicillin) . . . . . . . . . . . . . . . . . . . . .

Prednisone . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tylenol with codeine . . . . . . . . . . . . . . . . . . .

Dimetapp . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

59,026

3.047

2,815

2,779

2,230

2,096

2,069

1,598

1,454

1,289

1,208

1,061

959

927

876

83B

796

750

719

705

679

643

638

561

555

547

544

543

533

467

450

24,650

58,485

2,806

2,297

1,208

1,197

912

862

747

596

574

555

543

538

526

513

500

487

473

467

461

447

446

444

444

434

40,008

100.0

5.2

4.8

4.7

3.8

3.6

3.5

2.7

2.5

2.2

2.0

1.8

1.6

1.6

1.5

1.4

1.3

1.3

1.2

1.2

1.2

1.1

1.1

1.0

0.9

0.9

0.9

0.9

0.9

0.8

0.8

41.7

100.0

4.8

3.9

2.1

2.0

1.6

1.5

1.3

1.0

1.0

0.9

0.9

0.9

0.9

0.9

0.9

0.8

0.8

0.8

0.8

0.8

0.8

0.8

0.8

0.7

68.4

25–44 years

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

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

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

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

Allergy relief orshots . . . . . . . . . . . . . . . . . . .

Lasix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Tagamet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Motrin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Actifed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamin B-12 . . . . . . . . . . . . . . . . . . . . . . . . . .

Valium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E.E.S.(erythromycin) . . . . . . . . . . . . . . . . . . . .

Phenergan with codeine . . . . . . . . . . . . . . . . .

Chorionic gonadotropin2 . . . . . . . . . . . . . . . .

Inderal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Keflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tylenol with codeine . . . . . . . . . . . . . . . . . . .

Ionamin (phentermine) . . . . . . . . . . . . . . . . . .

Decadron . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E-Mycin (e@hromycin) . . . . . . . . . . . . . . . . . .

Phenergan . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrochlorothiazide . . . . . . . . . . . . . . . . . . . .

Pen-Vee K . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drixoral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ornade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terramycin . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dyazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tetanus toxoid . . . . . . . . . . . . . . . . . . . . . . . . .

Dawocet-N . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tylenol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Librax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrodiuril . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxil(amoxicillin) . . . . . . . . . . . . . . . . . . . .

Fastin(phentermine) . . . . . . . . . . . . . . . . . . . .

Norgesic . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Butazolidin . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prednisone . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Thyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Parafon Forte . . . . . . . . . . . . . . . . . . . . . . . . . .

Clinoril . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bead@. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Empirin with codeine . . . . . . . . . . . . . . . . . . .

Vtbramycin . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 yeare

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

Dyazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Inderal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lasix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Hydrodiuril (hydrochlorothiazide). . . . . . . . . .

Vitamin B-12. . . . . . . . . . . . . . . . . . . . . . . . . .

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

Motrin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrochlorothiazide . . . . . . . . . . . . . . . . . . . .

Valium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tagamet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hygroton . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

124,633

2,987

2,533

2,208

2,090

1,636

1,591

1,427

1,273

1,267

1,217

1,201

1,175

1,138

1,138

1,095

1,081

1,069

1,017

1,000

997

918

891

853

839

795

792

789

769

761

750

746

737

727

706

675

658

656

655

653

626

619

609

609

602

602

77,456

149,707

3,082

2,944

2,489

2,311

2,148

2,072

2,000

1,999

1,965

1,909

1,895

1,743

1,675

100.0

2.4

2.0

1.B

1.7

1.3

1.3

1.1

1.0

1.0

1.0

1.0

0.9

0.9

0.9

0.9

0.9

0.9

0.8

0.8

0.8

0.7

0.7

0.7

0.7

0.6

0.6

0.6

0.6

0.6

0.6

0.6

0.6

0.6

0.6

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

62.2

100.0

2.1

2.0

1.7

1.5

1.4

1.4

1.3

1.3

1.3

1.3

1.3

1.2

1.1

See footnotes at end of table.

33
Table 13. Number and percent distribution of drugs mentioned in office visits to general and family practitioners, by age of patient and moat

frequently named drugs: United States, January 1980-December 1981 —Con.

Number of Number of

drug drug

Age of patient and name of drug~ Percent

mentions Age of patient and name of drugl Percent

distribution

mentions

in

distribution in

thousands thousands

45–64 years—Con.

Aldomet . . . . . . . . . . . . . . . . . . . .

Tetracycline ., ., .,, . . . . . . . . . .

Lanoxin (digoxin). .,, ..,,,,... ., .,..,,.,

Lopressor. . . . . . . . . . . . . . . . . . . . . . . . .

Indocin. . ., . . . . . . . . . . . . . . . . . . . . . . . . .

Allergy relief orshots . . . . . . . . . . . .

Prednisone . . . . . . . . . . . . . . . . . . . .

Diabinese . . . . . . . . . . . . . . . . . . . . . . . . . . .

E.E.S.(erythromycin) . . . . . . . . . . . . . .

Clinoril . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Depo-Medrol . . . . . . . . . . . . . . . . . . .

Thyroid .,, . . . . . . . . . . . . . . . . . . . .

Estrogen, . . . . . . . . . . . . . . . . . . . . . . . . . .

Diuril ... ,.. . . . . .

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

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

Aldoril . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Premarin, ...,......,....,.. . . . . . . . . . .

Naprosyn . . . . . . . . . . . . . . . . . . . . . . . . . . .

Influenza virus vaccine, Type A, B . .

Butazolidin . . . . . . . . . . . . . . . . . . . . . . . . . .

Empirin with codeine, . . . . . . . . . . . . . . . .

Tranxene . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Darvocet-N . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Minipress . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ser-ap-es . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Benadfyl . . . . . . . . . . . . . . . . . . . . . . .

Phenergan . . . . . . . . . . . . . . . . . . . . . . . . . .

Tylenol with codeine . . . . . . . . . . . . . . . . .

Bactrim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ativan . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Librium . . . . . . . . . . . . . . . . . . . . . . . . .

Isordil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Libra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Slow-K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenobarbital . . . . . . . . . . . . . . . . . . . . . . . .

Phenergan with codeine. . . . . . . . . . . . . . . .

Tylenol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65 years and ovar

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

Lasix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lanoxin (digoxin). . . . . . . . . . . . . . . . . . . . . .

1,525

1,434

1,432

1,398

,272

,183

,135

,112

,027

,008

944

932

B91

889

876

870

870

857

833

823

794

793

7BI

781

763

743

741

730

729

724

724

643

639

637

627

622

614

606

602

86,871

140,215

5,169

4,677

1.0

1.0

1.0

0,9

0,8

O,B

0.8

0,7

0.7

0.7

0.6

0.6

0.6

0.6

0.6

0.6

0.6

0.6

0.6

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.4

0.4

0.4

0.4

0.4

0.4

0.4

0.4

58.0

I 00.0

3.7

3.3

65 years and over—Con.

Dyazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Indaral, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamin B-12 . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrodiuril (hydrochlorothiazide). . . . . . . . .

Aldomet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Motrin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dioxin., . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hygroton . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diabinese. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tagamet. ..,......,.,......,.. . . . . . . .

Valium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Slow-K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Influenza virus vaccine, type A, B . . . . . . . . .

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

Aldoril . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrochlorothiazide . . . . . . . . . . . . . . . . . . . .

Antivert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Clinoril . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Isordil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Naprosyn . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lopressor . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Nitroglycerin . . . . . . . . . . . . . . . . . . . . . . . . . .

Indocin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nitro-bid (nitroglycerin) . . . . . . . . . . . . . . . . .

Donnatal . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Coumadin . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ser-ap-es . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dalmane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diuril . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Persantine . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Elavil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aldactazide . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Nalfon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Prednisone . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Orinase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pavabid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Potassium . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,604

3,141

2,984

2,295

2,222

2,220

2,112

1,772

1,758

1,740

1,570

1,535

1,480

1,474

1,469

1,430

1,341

1,257

1,129

1,099

1,079

1,046

1,040

1,021

966

927

848

793

767

764

757

734

707

705

704

703

697

689

687

681

679

631

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75,112

2,6

2.2

2.1

1.6

1.6

1.6

1.5

1.3

1.3

1.2

1.1

1.1

1.1

1.1

1.0

1.0

1.0

0.9

0.8

0.8

0.8

0.7

0.7

0.7

0.7

0.7

0.6

0.6

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

53.6

1Based on the physician’s entry on the Patient Record form.

‘Constitutes 1.6 percent of mentions for this age group in 1980. There were no mentions of chorionic gonadotropin in 1981.

34
Table 14. Number of office visits to general and family practitioners and percent of visits, by diagnostic service, major reason for visit, end principal raason for visit module:

United States, January 1980-December 1981

Diagnostic service2

Number of

Major reason for visit and visits Limited General

principal reason for visit module~ in history histoiy Pap

Clinical Blood Mental

None laboratory X-ray Electro- Vision

thousands and/or and/or test

pressure Endoscopy cardiogram test

status Other

test

examination examination

check examination

Major reason for visit

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

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

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

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

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

Principal reason for visit

module and RVC code

Symptom module. . . . . S001-5999

Disease module. . . . . . DOOI-D999

Diagnostic, screening, and

preventive module . . . Xl 00-X599

Treatment module . . . . TI 00-T899

Injuries and adverse effects

module . . . . . . . . . . . .. JOOl-J999

Test results module. . . RI 00-R700

Administrative

module . . . . . . . . . . .. A100-Al4o

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

Percent of visits

182,430

98,734

32,405

13,966

54,175

221,209

32,078

63,602

28,421

18,292

2,334

10,390

5,384

3.5 73.3 13.1 1,4 19,5 8.8

10.1 58.2 10,9 1.4 19.8 2.8

5.5 69.8 12.0 1.9 21.6 8.3

12.8 69.4 4,9 “0.5 6.3 11.0

8.4 45.6 30.6 13.9 35.9 4.5

35.1

61.5

50.6

26.4

47.6

1.5 0.6

2.1 ‘0.5

3.7 “0.2

‘0.8 ‘0.4

3.2 6.3

0.4

“0.2

“0.6

‘0.5

“0.4

0.6 4.1

0.6 5.4

“0.9 3.8

“0.7 “0.7

‘0.7 5.0

4.5 71.6

5.1 67.5

13,0 1.6 19.5 7.5

11.0 “0.7 25.9 3.3

40.6

55.5

1.9 0.5

1.8 “0.5

0.3

“0.6

0.6

“0.5

4.2

3.6

3.8 51.3

30.3 47.8

20.9 12.1 32.8 3.7

8.6 *0.1 8.6 “2.1

61.0

39.2

3,4 1.8

‘0.8 “0.3

“0.4

“0.2

“0.3

“0.8

4.7

8.3

6.3 76.8

15.2 48.4

6.7 *0.O *2.7 21.7

“5.0 *5.3 33.5 *5.3

24.5

35.9

“0.3 ‘1,7

*2.8 ‘0.2

“0.6

“0.6

*2,4

“1.0 “8.0

0.5 38.1

*6.9 56.2

51.4 *2.2 50.8 7.0

15.5 *6.3 23.0 *4,6

50.9

48.4

“3.0 19.5

*4,6 *4.3

“0.4 “2.1

‘1.7

*3.3

*3.8

1Based on A Reason for Visit Classification for ..4rnLwlatowCare (RVC).8

‘Percents will not total 100.0 because more than one service may have baan rendered during a visit.

31ncludes blanks; problems not elsewhere classified; entries of “none”; and illaglble entries.
Table 15. Number of office visits to general and family practitioners and percent of visits by nonmedication therapy and principal diagnosis categories, and percent distribution by number

of medications, according to principal diagnosis categories: United States, January 1980-December 1981

Nonmedicetion therapy2 Number of medications

Number of

Principal diagnosis categow visits Psychoand ICD–9–CM code~ in

None

Physio- Office Family therapy or Diet Family

Medical 4

thousands therapy surge~ planning therapeutic counseling or social Other None 1 2 3

counseling

listening

or

counseling more

Percent of visits Percent distribution

22.1 41.0 25.5 7.5 4.0

56.4 23,3 10.0 *5.9 *4.4

Infectious and parasitic

diseases . . . . . . . ..001 –l39

Neoplasm . . . . . . . . 140–239

Endocrine, nutritional and

metabolic diseases,

and immunity

disorders. 240–279

Mental disorders . ..290-319

Diseaaea of the nervous

system and sense

organs . . . . . . . . . ..32 O-389

Diseases of the circulatory

system . . . . . 390–459

Diseaaes of the respiratory

system . . . . . . . . ..460–519

Diseases of the digestive

system . . . . . . . . ..520–579

Diseases of the genitourinaty

system . . . . . . . . . 580–629

Diseases of the skin

and subcutaneous

tiaaue . . . . . . . . . ..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 classificstion . . . . . . . . . .. VOl–V82

All other diagnoses . . . . . .

Unknown diagnoses . . . . . . . .

56.3

43.0

37.2

37.1

63.7

55.2

73.2

49.8

60.7

56.1

48.2

60.0

43.5

63.1

68.4

62.()

“2.0

*1.7

“0.5

*2.5

3.4

2.5

1.2

*1.2

*2.2

6.2

24.5

*1.7

21.1

*1.0

1.7

*6.2

10.4

27.5

“0.9

‘0.8

7.1

“1.9

‘0.7

*1.7

*3.4

15.3

4.0

“0.7

17.4

7.4

*2.4

*1 0.5

‘0.9

‘0.6

*1.1

“0.1

“0.2

‘0.2

“0.2

*2.6

“0.3

*O. 1

“0.2

*o 2

6.8

“4.0

*4.5

“0.8

*2.1

5.4

*3.9

●1.8

“0.9

26.3

25.5

‘0.7

*1.9

“0.7

*0.1

‘1.5

“0.7

“0.5

‘0.5

“0.9

*1.2

3.6

“0.5

5.2

‘0.4

0.7

‘4.4

12,503

4,660

23,797

9,909

19,334

49,943

66,022

21,192

20,050

15,074

28,920

14,370

37,518

49,576

4,210

4,633

*1.8

26.0

52.1

7.7

“0.7

12.3

19.9

27.8

19.3 33.1 21.6 13.1 12.9

19.3 40.2 26.6 8.8 5,1

“1.8

2.8

1.3

*2.3

*1.9

“2.1

17.6

2.8

23.6

5.7

*1.1

1.6

“0.7

*2.4

3.2

22.8

28.2

21.8

28.9

27.1

19.3 34.7 31.3 10.4 4.3

13.4 32.6 25.1 13.7 15,2

7.5 34.2 34.0 15.6 8.8

24.1 30.8 27.5 9.9 7.7

23.7 46.2 19.6 7.1 *3.4

*1.9 *3.5 “2.0 19.1 19.8 42.7 23.3 9.7 4,5

*1.4 3.9 ‘1.0 22.4 25.4 34.0 23.4 9.1 8.2

5.0

“1.1

1.7

“1.4

‘4.5

8.4

*1.2

8.5

8.7

*4.3

*2.2

“0.5

3.3

*2.7

*3.7

27.1

17.8

16.7

16.1

*1 2.3

32.8 34.0 18.8 9.9 4.5

42.1 39.2 13.4 3.4 1.9

60.3 27.9 8.6 1.9 “1.2

30.4 38.1 16.8 *7.2 *7.5

33.0 37.5 18.4 *5.2 *5.8

I Based on International Classification of Diseases, 9th Revision, Clinical Modification (ICO–9–CM).7

2Percents will not total 100.0 because more than one service may have been rendered during a visit.
Table 16. Number of office visite to general and family practitioner and percent distribution by duration and disposition of visit, according to sex and age of patient and prior visit ststus:

Unitad States, January 1980-Dacembar 1981

Sex Age Prior visit status

Duration and disposition of visit Both

Old Old

Femele Male

Under 3 3-5 6–10 11-14 15-24 25-44 45-64 65 years New petient, patient,

sexes years years years years years years years and over patient new old

problem problem

Numbar in thousands

All visits . . . . . . . . . . . . . . . . . . . . . . 381,710 229,445 152,265 18,377 9,297 11,492 13,715 56,230 103,275

100.0

*4.3

19.4

43.9

22.8

6.1

*1.4

23.1

30.5

39,6

*4.6

*4.1

“0.2

‘0.5

“0.3

95.458 73,867 43,099 123,752 214,859

Percent distribution

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

Duration of visit

Ominutesl . . . . . . . . . . . . . . . . . . . 3.1 3.1

l-5 minutes ., . . . . . . . . . . . . . . . . . 13.3 13.5

6-10 minutas . . . . . . . . . . . . . . . . . . 35.7 35.2

11–15 minutes . . . . . . . . . . . . . . . . . 28.8 29.1

16-30 minutes . . . . . . . . . . . . . . . 17.3 17.2

31minutes or longer . . . . . . . . . . . . . 1.9 1.8

3.2 *2.6

13.0 19.4

36.3 43.5

26.3 25.5

17.3 8.6

2.0 “0.4

*3.9

16.0

45.0

25.3

9.4

“0.4

4.7 1.9 3.3

18.1 17.3 13.5

34.2 35.3 36.2

26.3 27.0 26.5

15.8 16.8 18.4

“1.0 1.8 2.3

3.6

11.5

33.7

30.2

16.9

2.2

2.9 *1.O 1.7

8.7 9.2 13.4

33.7 30.9 37.4

34.1 28.2 29.1

18,9 26.9 17.0

1.8 3.8 1.5

4.4

14.1

35.6

28.7

15.5

1.7

Disposition of visitz Percent of visits

28.3 22,1 15.6

32.4 40.7 45.7

35.5 31.7 32.7

*2.5 3.5 4.1

*2.4 3.2 3.1

*0.5 ‘0.1 “0.4

*0.6 “0,9 1.3

‘0.2 “0.3 “0.1

No followup plannad . . . . . . . . . . . . .

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

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

Telephone followup planned . . . . . .

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

Returned to referring physician ,., .

Admit tohospitsl . . . . . . . . . . . . . . . .

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

14.8 13.4

51.3 53.4

29.7 29.2

3.1 3.1

2.8 2.7

0.2 “0.2

1.2 1.1

0.2 “0.1

16.8 19.1

48.1 48.5

30.5 31.4

3.1 *1.8

3.0 *1.1

“0.3 “0.4

1.3 “0.7

“0.2 “0.1

26.1

30.0

40.4

*4. 1

*0.5

10.8

58.6

26.9

2,5

3.3

“0.2

1.1

“0.2

6.8 26.2 20.0

67.8 37.8 35.4

23.1 26,1 38,6

2.3 3.8 4.2

2.0 3.4 3.5

‘0,2 0.9 *0. I

9.5

63.1

24.9

2.3

2.3

0.2

1.0

“0.1

‘0.2

“0.2 1.9 1.8 1,4

*0.3 *ocl “0.2 “0.2

1Represents visits in which there was no face-to-face encounter between patient and physician,

2percent~ will not total 100, Obecause more than onedispOsitiOn was Possible.
Table 17. Number ofofice visits togeneral and family practitionera, percent distribution byduration ofvisit, andpercent ofvisits by disposition

of visit, according to principal diagnosis categories: United States, January 1980 -December 1981

Number of Duration of visit

Principal diagnosis category and ICD–9–CM codel visits

in

Total o 1-5 6-10 11-75 16-30 3? minutes

thousands minutes2 minutes minutes minutes minutes or longer

Infectious and parasitic diseases. 001–139

Neoplasm. ,, . . . . . . . . . . . . . . . . . . . . ..140–239

Endocrine, nutritional and metabolic diseases,

and immunity disorders . . . 240-279

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

Diseases of the nervous system and sense

organs . . . . . . . . . . . . . . . . . . . . ., . . . . ..320–389

Diseases of the circulatory system 390–459

Diseases of the respiratory system 460–519

Diseases of the digestive system 520–579

Diseases of the genitourinary system ., 580–629

12,503

4,660

23,797

9,909

19,334

49,943

66,022

21,192

20,050

Diseases of the skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . ..680–709 15,074

Diseases of the musculoskeletal system and

connectwe tissue . . . . . . . . . . . . . . . . . ..710–739 28,920

Symptoms, signs, and ill-defined

conditions . . . . . . . . . . . . . . . . . . . . . . . ..780–799 14,370

lnjuryand poisoning ., . . . . . . . . . . . . . . ..8 OO-999 37,518

Supplementary classification. . VO1 –V82 49,576

Percent distribution

100,0 “2.7 14.6 39.0 27.9 14.7 *1.2

100.0 “3.2 8.9 30,5 26.7 27.6 “3.2

100,0 4.9 11.5 37.5 29.2 15.1 *1.8

100,0 “1,0 7.7 33,3 30.0 23.9 “4. 1

100.0 *0.9 15.3 42,0 28.2 11.8 *1.8

100.0 2.3 10.6 35.2 32.8 17.4 1.8

100.0 2.5 14.7 43,4 27.1 11.7 “0.6

100.0 “0.8 9.9 34.3 31.4 21.3 *2.4

100.0 3.2 11.3 29.2 32.7 21.8 *1.9

00.0 1.1 16.6 43,2 24.4 13.3 *1.3

00.0 2.7 9.1 33,4 33.5 19.3 *2.1

00.0 ‘2.7 8.9 33.2 31.0 22.1 “2.1

00.0 6.2 16,7 29.9 27.5 18.1 1.6

00.0 3.2 17,5 31.4 24.2 20.4 3.2

All other diagnoses . . . . . . . . . . 4,210 100.0 “7.5 16,2 29.5 25.7 19.7 *1.4

Unknown diagnoses . . . . . . . . . . . . . . . . . . . . . . 4,633 100.0 19.5 15.3 24.1 22.0 16.8 *2.2

Principal diagnosis category and

ICD–9–CM codel

Disposition of visits

No Return at Return Telephone Referred Returned to Admit

followup specified if followup to other referrin.q to Other

planned time needed planned physician ph ysici;n hospital

Percent of visits

Infectious and parasitic diseases . . . . . ,.001–139 17.1 37.1 39.0 5.6 *2.5 ‘0.5 “0.3 “0.1

Neoplasm.. . . . . . . . . . . . . . . . . . . . . . ..140–239 *1 0,4 58.5 13.7 *4,7 13.0 “0.4 *3.3 “0.4

Endocrine, nutritional and metabolic diseases,

and immunity disorders . . . .240–279 5.0 79.7 12.7 2.9 “1.0 “0.7 “o. 1

Mental disorders.....,.....,,.. . .,..290-319 8.7 48.3 39.1 *3.4 *3.4 “0.6

Diseases of the nervous system and sense

“1.6 “0.9

organs . . . . . . . . . . . . . . . . . . . , . . . . ...320-389 18.0 39.4 38.9 *1,5 5.6 “0.4 “0.3 “0.2

Diseases of the circulatory system. . 390–459 4.0 80.0 14.8 2.1 2.0 “0.1 1.5 “0.1

Diseases of the respiratory system . . . ..460–519 19.1 31.2 46.7 3.7 0.9 “0.3 “0.7 “0.0

Diseases of the digestive system. . 520–579 11.2 45.4 31.8 5.1 4.1 “0.4 6.0 “0.5

Diseases of thegenitourinary system , ..580-629 8.7 54.6 28.2

Diseases of the skin and subcutaneous

5.1 5.5 ‘0.3 *1.5 “0.5

tissue . . . . . . . . . . . . . . . . . . . . . . . ...,.680-709 18.9 39.2 38.2 *2,5 ‘3.1 “0.2 “0.3

Diseases of the musculoskeletal system and

connective tissue . . . . . . . . . . . . . . . . ..710–739 9.1 52.0 34.9 2.6 3.8 “0.2 “0.5 “0.1

Symptoms, signs, and ill-defined

conditions . . . . . . . . . . . . . . . .,.......780-799 11.2 45.6 33.3 6.5 4.9 *2.5 “0.5

Injury and poisoning . . . 800–999 15.6 49.0 31.9 2.4 2.8 “0.2 “0.6 ‘0.0

Supplementary classification . . . . . . . . . . VO1 –V82 30.4 51.2 16.5 1.6 1.7 “0.3 “0.2 “0.2

All other diagnoses . . . . . . . . . . . . . . . . . . . . . . . . *6.9 64.4 22.3 “3.6 *2.4 “0.2 *4.5 “0.2

Unknown diagnoses . . . . . . . . . . . . . . . . . . . . . . . 25.3 41.7 22.6 *3.1 *6.6 “0.3 “4.2

lBasedon lrrfernational Classification of Diseases, 9th Revision, Clinical Modification (lCD-9-CM).7

2Represents visits in which thare was no face-to- f.sce encounter batween patient and physician.

3Percents will nott0tal 100. Obecsuse m.methan cmedisposition was possible.
Appendixes

Contents

I. Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Statisticaldesign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Scope ofthe survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Sample design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Data collection andprocessing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Fieldprocedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Dataprocessing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Estimationprocedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Inflation by reciprocals ofprobabilities ofselection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Adjustmentfornonresponse.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Ratio adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Reliability ofestimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Estimates ofaggregates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Estimates ofpercents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Estimates ofrates where thenurnerator is not asubclass ofthedenominator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Estimates ofdifferences between two statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Tests ofsignificance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Population figures and rate computation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Roundingofnurnber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Systematicbias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

II. Definitions ofcertain terms used in this report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Terrnsrelatingto the survey... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Terms relatingtothe Patient Record Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

111. Survey instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Introductory letter from Director, NCHS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

PatientRecordForm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Induction Interview Form..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

IV. American Hospital Formulary Service classification system andtherapeutic category codes . . . . . . . . . . . . . . . . . . . . . . . . 60

Lk.tofappendix figures

I. Approximate relative stadademors forestimated numbers ofofice visits based onallphysicim specialties (A), md

individual specialties (l?), 1980–81 National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

II. Approxtiate relative stindard emorsfor estimated numbers oftigmentions based ondl physician specialties(A),

and individual specialties (B), 1980-81 National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Listofappendix tables

I. Distribution ofphysicians inthe 1980–81National Ambulatory Medical Care Survey sample and response rates, by

physician specialty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

II. Estimates of the civilian noninstitutionalized population ofthe United States used in computing annual visit ratesin

thisreport, byage, race, andsex: 1980-81.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

39
Appendix I

Technical notesd

This report is based on data collected during 1980 and

1981 in the National Ambulatory Medical Care Survey

(NAMCS), an annual sample survey of ofllce-based physicians conducted by the Division of Health Care Statistics of

the National Center for Health Statistics (NCHS). The two

surveys were conducted with identical instruments, definitions,

and procedures. Two years of data were combined to increase

the reliability of the estimates. The annual survey design and

procedures are presented in the following sections.

Statistical design

Scope of the survey

The target population of NAMCS includes office visits

made within the conterminous United States by ambulatory

patients to nonfederally employed physicians who are principally engaged in office-based patient care practice, but not in

the specialties of anesthesiology, pathology, or radiology. Telephone contacts and nonofflce visits are excluded from

NAMCS.

Sample design

The NAMCS utilizes a three-stage survey design that involves probability samples of primary sampling units (PSU’S),

physician practices within PSU’S, and patient visits within physician practices. The first-stage sample of 87 PSU’S was selected by the National Opinion Research Center (NORC) of

the University of Chicago, the organization responsible for

NAMCS field and data processing operations under contract

to NCHS. A PSU is a county, a group of adjacent counties,

or a standard metropolitan statistical area (SMSA). A modified probability-proportional-to-size procedure using separate

sampling frames for SMSA’S and for nonrnetropolitan counties

was used to select the sample PSU’S. Each fi-ame was stratified

by region, size of population, and demographic characteristics

of the PSU’S, and was divided into sequential zones of 1 million residents; then, a random number was drawn to determine

which PSU came into the sample from each zone.

The second stage consisted of a probability sample of practicing physicians, selected from the masterfiies maintained by

the American Medical Association (AMA) and the American

Osteopathic Association (AOA), who met the following criteria

● Oftlce-based, as defined by AMA and AOA.

. Principally engaged in patient care activities.

dpreparedby Thom~ M~hmore, Divisionof Health care statistics.

40

● Nonfederally employed.

● Not in the specialties of anesthesiology, pathology, clinical pathology, forensic pathology, radiology, diagnostic

radiology, pediatric radiology, or therapeutic radiology.

Within each PSU, all eligible physicians were sorted by

nine specialty groups: general and family medicine, internal

medicine, pediatrics, other medical specialties, general surgery,

obstetrics and gynecology, other surgical specialties, psychiatry, and all other specialties. Then, within each PSU, a systematic random sample of physicians was selected so that the

overall probability of selecting any physician in the United

States was approximately constant.

During 1980–8 1 the NAMCS physician sample included

5,805 physicians. Sample physicians were screened at the time

of the survey to ensure that they met the aforementioned criteria; 1,124 physicians did not meet the criteria and were,

therefore, ruled out of scope (ineligible) for the study. The most

common reasons for being out of scope were that the physician

was retired, deceased, or employed in teaching, research, or

administration. Of the 4,681 inscope (eligible) physicians, 3,676

(78.5 percent) participated in the study. Of the participating

physicians, 509 saw no patients during their assigned reporting

period because of vacations, illnesses, or other reasons for being temporarily out of office-based practice. The physician sample size and response data by physician specialty are shown

in table I.

The third stage was the selection of patient visits within

the annual practices of the sample physicians. This stage involved two steps. First, the total physician sample was divided

into 52 random subsamples of approximately equal size; then

each subsample was randomly assigned to 1 of the 52 weeks

in the survey year. Second, a systematic random sample of

visits was selected by the physician during the assigned reporting week. The visit sampling rate varied for this final step from

a 100 percent sample for very small practices to a 20 percent

sample for very large practices. The method for determining

the visit sampling rate is described later in this appendix and

I

in the Induction Interview form in appendix III. During 1980–

81, sample physicians completed 89,447 usable Patient Record forms.

Data collection and processing

Field procedures

Both mail and telephone contacts were used to enlist sample physicians for NAMCS. Initially, physicians were sent introductory letters from the Director of NCHS (see appendix

III). When appropriate, a letter from the physician’s specialty
Table 1. Distribution of physicians in the 1980-81 National Ambulatory Medical Care Survey samples and response rates, by physician specialty

Physician specialty Gross total Out of scope Net total Nonrespondents Respondents

Response

rate

All specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,805 1,124 4,681 1,005 3,676 78.5

General and family practice . . . . . . . . . . . . . . . . . . . . . . . . 1,340 289 1,051 272 779 74.1

Medical specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,695 296 1,399 298 1,101 78.7

Internal madicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 871 158 713 182 531 74.5

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414 83 331 42 289 87.3

Other medical specialties . . . . . . . . . . . . . . . . . . . . . . . . 410 55 355 74 281 79.2

Surgical specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,978 246 1,732 351 1,381 79.7

General aurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 521 75 446 115 331 74.2

Obstetrics andgynecolcgy . . . . . . . . . . . . . . . . . . . . . . 484 71 413 63 350 84.7

Other surgical specialties . . . . . . . . . . . . . . . . . . . . . . . . 973 100 873 173 700 80.2

Other specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 792 293 499 84 415 83.2

Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414 96 318 43 275 86.5

Other specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378 197 181 41 140 77.3

organization endorsing the survey and urging his participation

was enclosed with the NCHS letter. Approximately 2 weeks

prior to the physician’s assigned reporting period, a field representative telephoned the physician to explain briefly the study

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

via telephone or special explanatory letter and requested to

reconsider participation in the study.

During the personal interview the field representative determined the physician’s eligibility for the study, obtained his cooperation, delivered survey materials with verbal and printed

instructions, and assigned a predetermined Monday-Sunday

reporting period. A short induction interview concerning basic

practice characteristics, such as type of practice and expected

number of ofilce visits, was conducted. OffIce staff who were

to assist with data collection were invited to attend the instructional session or were offered separate instructional sessions.

The field representative telephoned the sample physician

prior to and during the assigned reporting week to answer questions that might have arisen and to ensure that survey procedures were going smoothly. At the end of the reporting week,

the participating physician mailed the completed survey materials to the field representative who edited the forms for completeness before transmitting them for central data processing.

At this point problems of missing or incomplete data were resolved by telephone followup by the field representative to the

sample physician; if no problems were found, field procedures

were considered complete regarding the sample physician’s participation in NAMCS.

Data collection

The actual data collection for NAMCS was carried out by

the physician, assisted by his ofllce staff when possible. Two

data collection forms were employed by the physiciu. the Patient Log and the Patient Record form (see appendix III). The

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

sampling frame to indicate the oflice visits for which data were

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

patient visit information permitted the physician to detach and

retain the listing of patients, thus, assuring the anonymity of

the physician’s patients.

Based on the physician’s estimate of the expected number

of ofilce visits and expected number of days in practice during

the assigned reporting week, each physician was assigned a

visit sampling rate. The visit sampling rates were designed so

that about 30 Patient Record forms would be completed by

each physician during the assigned reporting week. Physicians

expecting 10 or fewer visits per day recorded data for all visits.

Those physicians expecting more than 10 visits per day recorded data for every second, third, or fifth visit based on the

predetermined sampling interval. These visit sampling procedures minimized the physician’s data collection workload and

maintained approximately equal reporting levels among sample

physicians regardless of practice size. For physicians recording

data for every second, third, or fifth patient visit, a random

start was provided on the first page of the Patient Log so that

the predesignated sample visits recorded on each succeeding

page of the Patient Log provided a systematic random sample

of patient visits during the reporting period.

Data processing

In addition to followups for missing and inconsistent data

made by the field staff, numerous clerical edits were performed

on data received for central data processing. These manual

edit procedures proved quite efficient, reducing item nonresponse rates to 2 percent or less for most data items.

Information contained in item 6 (Patient’s problem or reason for visit) of the Patient Record form was coded according

to A Reason for Visit C[assl~cation for Ambulatoq~ Care

(RVC)$ Diagnostic information (item 9 of the Patient Record

form) was coded according to the International Class#ication

of Diseases, 9th Revision, Clinical Modl~cation (ICD–9–

CM).’ A maximum of three entries were coded from each of

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

into batches with approximately 650 forms per batch. Quality

control for the medical coding operation involved a two-way

5-percent independent verification procedure. Error rates were

defined as the number of incorrectly coded entries divided by

the total number of coded entries. The estimated error rates

for the 1980–8 I medical coding operation were 1.7 percent for

NOTE: A list of references follows tie text.

41
item 6 and 2.3 percent for item 9. Additionally, a dependent

verification procedure was used to review and adjudicate all

records in batches with excessive error rates. This procedure

further reduced the estimated error rates to 1.6 percent for item

6 and 2.1 percent for item 9.

The NAMCS medication data (item 11 of the Patient Record form) was classified and coded according to a scheme developed at NCHS based on the American Society of Hospital

Pharmacists’ Drug Product Information File. A description of

the new drug coding scheme and of the NAMCS drug data

processing procedures is contained in Vital and Health Statistics, Series 2, No. 90.8 A two-way 100 percent independent verification procedure was used to control the medication

coding operation. As an additional quality control, all Patient

Record forms with differences between drug coders or with

illegible drug entries were reviewed and adjudicated at NCHS.

Information from the Induction Interview and Patient Record forms was keypunched with 100 percent verification and

converted to computer tape. At this point, extensive computer

consistency and edit checks were performed to ensure complete and accurate data. Incomplete data items were imputed

by assigning a value from a randomly selected Patient Record

form with similar characteristics; patient sex and age, physician specialty, and broad diagnostic categories were used as

the basis for these imputations.

Estimation procedures

Statistics from NAMCS were derived by a multistage estimation procedure that produces essentially unbiased national

estimates and has three basic components: (1) inflation by reciprocals of the probabilities of selection, (2) adjustment for nonresponse, and (3) a ratio adjustment to f~ed totals. Each component is briefly described below.

Inflation by reciprocals of probabilities of selection.

Because the survey utilized a three-stage sample design,

three probabilities of selection existed: (1) the probability of

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

within the PSU, and (3) the probability of selecting an office

visit within the physician’s practice. The third probability was

defined as the number of office visits during the physician’s

assigned reporting week divided by the number of Patient Record forms completed. All weekly estimates were inflated by a

factor of 52 to derive annual estimates.

Adjustment for nonresponse

NAMCS data were adjusted to account for sample physicians who were inscope, but did not participate in the study.

This adjustment was calculated in order to minimize the impact of response on final estimates by imputing to nonresponding physicians the practice characteristics of similar responding

physicians. For this purpose, physicians were judged similar if

they had the same specialty designation and practiced in the

same PSU.

NOTE: A list of references follows the text.

42

Ratio adjustment

A poststratification adjustment was made within each of

nine physician specialty groups. The ratio adjustment was a

multiplication factor that had as its numerator the number of

physicians in the universe in each physician specialty group

and as its denominator the estimated number of physicians in

that particular specialty group. The numerator was based on

figures obtained from the AMA and AOA masterfiles, and

the denominator was based on data from the sample.

Reliability of estimates

As in any survey, results are subject to both sampling and

nonsampling errors. Nonsampling errors include reporting and

processing errors, as well as biases due to nonresponse and

incomplete response. The magnitude of the nonsarnpling errors

cannot be computed. However, these errors were kept to a minimum by procedures built into the survey’s operation. To eliminate ambiguities and encourage uniform reporting, carefhl

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

definitions. Also, extensive pretesting of most data items and

survey procedures was performed. The steps taken to reduce

bias in the data are discussed in the sections on field procedures and data collection. Quality control procedures and consistency and edit checks discussed in the data processing section reduced errors in data coding and processing. However,

because survey results are subject to sampling and nonsampling

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

ling variability alone.

Because the statistics presented in this report are based on

a sample, they differ somewhat from the figures that would be

obtained if a complete census had been taken using the same

forms, deftitions, instmctions, and procedures. However, the

probability design of NAMCS permits the calculation of samp

ling errors. The standard error is primarily a measure of

sampling variability that occurs by chance because ordy 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 21%times

as large.

The relative standard error of an estimate is obtainecl by

dividing the standard error by the estimate itself and is expressed as a percent of the estimate. For thk report, an asterisk (*) precedes any estimate with more than a 30 percent relative standard error.

Estimates of sampling variability were calculated using the

method of half-sample replication. This method yields overall

variability through observation of variability among random

subsamples of the total sample. A description of the development and evaluation of the replication technique for error estimation haa been published. 16,17Approximate relative standard

errors for aggregate estimates are presented in figures I and 11.
100

90

80

70

60

50

40

30

20

1:

:

6

5

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A 2 3 456789A 2 3 456789A 2 3 456789A 2 3 456789A 2 3 456789A

100 1,000 10,000 100,000 1,000,000 10,000,000

Size of estimate (in thousands)

EXAMPLE An estimate of 20 mdlion office visits to general surgeons [read from scale at bottom of chart) has a relative standard arror of 7.7 parcent (read from curve B on scale at left of chart) or a standard error

of 1,540,000 office visits (7.7 percent of 20 million visits).

Figure 1. Approximate relative standard errora for astimated numbers of office visits based on all physician specialties (A), and individual specialties (B), 1980-81 National Ambulatory Medical

&

W Care Survey
100

90

80

70

60

50

40

30

20

10

9

8

7

6

5

4

3

2

1

0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

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100

90

80

70

60

50

40

30

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10

9

8

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100 1,000 10,000 100,000 1,000,000 10,000,000

Size of estimate (in thousands)

EXAMPLE: An estimate of 60 million drug mentions (read from scele et bottom of chart) has a relative standard error of 5.1 percent [read from cuwe A on scale at left of chart) or a stenderd error of 3,060,000 drug

mentions (5.1 percent of 60 million drug mentions).

Figure Il. Approximate relative standard errors for estimated numbers of drug mentions based on ali physician apecialtiea (A), and individual apecielties (B), 1980-81Nationel Ambulato~ Medical

Care Survey
To derive error estimates that would be applicable to a wide

variety of statistics and could be prepared at moderate cost,

several approximations were required. As a result, the relative

standard errors shown in figures I and II should be interpreted

as approximate rather than exact for any specific estimate. Directions for determining approximate relative standard emors

follow.

Estimates of aggregates

Approximate relative standard errors (in percent) for aggregate statistics are presented in figures I and II. The approximate relative standard errors for aggregate estimates of office

visits are shown in figure I, and the approximate relative standard errors for aggregate estimates of drug mentions are shown

in figure II. In each figure, curve A represents the relative

standard errors appropriate for estimates based on all physician specialties, and curve B represents relative standard errors appropriate for estimates based on an individual physician

specialty. For the specific case where the aggregate estimate

of interest is the number of mentions of a specific drug, for

example, the number of mentions of Dyazide, figure I, curve

B should be used to obtain approximate relative standard

errors.

Instead of using figures I and II, relative standard errors

for aggregate estimates may be calculated directly using the

following formulae where x is the aggregate estimate of interest in thousands. For visit estimates based on all physician

specialties,

RSE(X) =

J

39.84195 0.001111+ x .100.0

For visit estimates based on an individual physician specialty,

For drug mention estimates based on all physician specialties,

R’E@)=~looJ’

For drug mention estimates based on an individual physician

specialty,

Estimates of percents

Approximate relative standard errors (in percent) for estimates of percents may be calculated from figures I and II as

follows. From the appropriate curve obtain the relative

standard error of the numerator and denominator of the

percents. Square each of the relative standard errors, subtract

the resulting value for the denominator from the resulting value

for the numerator, and extract the square root. This approximation is valid if the relative standard error of the denominator

is less than 0.05 or if the relative standard errors of the

numerator and denominator are both less than 0.10.

Alternatively, relative standard errors for percentages

may be calculated directly using the following formulae where

p is the percent of interest and x is the base of the percent in

thousands. For visit percentages based on all physician specialties,

RSE@) =

r

39.84195 .(1 –P) .1000

p.x

For visit percentages based on an individual physician specialty,

RSE(p) =

d

42.88175 .(1 ‘p) . ~ooo

p.x

For drug mention percentages based on all physician specialties,

-@)=m-looo

For drug mention percents based on an individual physician

specialty,

Estimates of rates where the numerator

is not a subclass of the denominator

100.0

Approximate relative standard errors for rates in which

the denominator is the total United States population or one

or more of the age-sex-race groups of the total population are

equivalent to the relative standard error of the numerator that

can be obtained from figures I or 11.

Estimates of differences between

two statistics

The relative standard errors shown in this appendix are

not directly applicable to differences between two sample estimates. The standard error of a difference is approximately the

square root of the sum of squares of each standard error considered separately. This formula represents the standard error

quite accurately for the difference between separate and uncorrelated characteristics, although it is only a rougl approximation in most other cases.

Teste of sign-ificance

In this report, the determination of statistical inference is

based on the t-test with a critical value of 1.96 (0.05 level of

significance). Terms relating to differences, such as “higher,”

and “less” indicate that the differences are statistically significant. Terms such as “similar” or “no difference” mean that

no statistical significance exists between the estimates being

compared. A lack of comment regarding the dtierence between

any two estimates dews not mean that the difference was tested

and found to be not significant.

45
Table Il. Estimates of the civilian noninstitutionalized population of the United States used in computing sverage annual visit rates in this repom,

by sex, race, and age: United States, 1980-81

Sex Race

Age of patient

Both

Male Female White Black All

sexes other

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

Under 3 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3-5 years...,.......,.....,.. . . . . . . . . . . . . . . . . . . .

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

11–14 years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

25–44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

222,674

10,191

9,529

16,759

14,354

40,710

62,658

43,963

24,512

Number of persons in thousands

107,429 115,244 191,052

5,231 4,961 8,284

4,826 4,703 7,764

8,568 8,190 13,785

7,351 7,002 11,860

20,076 20,634 34,229

30,487 32,171 53,973

20,849 23,114 38,993

10,042 14,470 22,165

26,107

1,572

1,427

2,511

2,117

5,430

6,870

4,143

2,039

5,515

335

339

463

377

1,052

1,816

828

308

I Figure may not add to total due to rounding.

NOTE Excludes Alaaka and Hawaii.

Population figures and rate

computation

The population figures used in computing annurd visit

rates are presented in table II. The figures are based on an

average of the July 1, 1980, and July 1, 1981, estimates of

the civilian noninstitutionalized population of the United

States provided by the U.S. Bureau of the Census. Because

NAMCS includes data for only the conterminous United

States, the original population estimates were modified to account for the exclusion of Alaska and Hawaii from the study.

For this reason, the population estimates should not be considered ofilcial and are presented here solely to provide denominators for rate computations.

Estimates of numbers of visits and drug mentions in this

report are for a 2-year period, but ratios and rates represent

average annual estimates. For example, the average annual

visit rates are calculated as follows. The numerator is obtained

by dividing the estimated number of of’flee visits for 1980-81

by 2 to obtain an average annual number of office visits. This

number is then divided by the appropriate population figure to

obtain an average annual visit rate. As previously discussed,

estimates of reliability for average annual visit rates may be

calculated from figure I and II.

Rounding of numbers

Estimates presented in this report are rounded to the nearest thousand. For this reason detailed figures within tables do

not always add to totals. Rates and percents are calculated on

the basis of the original, unrounded figures and may not necessarily agree precisely with percents calculated from rounded

data.

Systematic bias

No formal attempt was undertaken to determine or measure

systematic bias in the NAMCS data. But it should be noted

that there are several factors affecting the data which indicate

that these data underrepresent the total number of ofllce visits.

Some of these factors are briefly discussed below.

● Physicians who participated in NAMCS did a thorough

and conscientious job in keeping the Patient LQg however,

post survey interviews with participating physicians indicate that a small number of patient visits may have been

accidentally omitted from the Patient Lo% although this

number is quite small, such omissions would result in an

undercoverage of office visits.

The same post survey interviews indicate that the inclusion of patient visits that did not actually occur was

infrequent and would have a negligible effect on survey

estimates.

● As previously stated, the physician universe for the

1980–8 1 NAMCS included all nonfederal, ofice-based,

patient-care physicians on the AMA and AOA masteries.

The NAMCS was designed to provide statistically unbiased estimates of ofilce visits to this designated population. Not included in the universe were physicians who

were classified as federally employed or hospital-based,

or who were principally engaged in research, teaching, administration, or other nonpatient care activity. Consequently, ambulatory patient visits to these physicians in

an office setting would not be included in NAMCS estimates. In an attempt to measure the number of office visits

to physicians not in the NAMCS universe, a NAMCS

Complement Survey was conducted in 1980. This study

involved a sample of approximately 2,000 physicians

selected from among the 230,000 physicians in the AMA

and AOA masterl’iles who were not eligible (inscope) for

the 1980 NAMCS. Details of the Complement Survey

methodology and results are forthcoming. Preliminary results indicate that about 17 percent of the Complement

Survey physicians saw some ambulatory patients in an

office setting and that an estimated 69 million office visits

were made to these physicians in 1980.

46
Appendix II

Definitions of certain terms

used in the report

Terms relating to the survey

Oflce-Premises identified by physicians as location for

their arnbulato~ practices. The responsibility over time for

patient care and professional services rendered there generally

resides with the individual physician rather than with any institution.

Ambulatory patierzt-An individual seeking personal

health services who is neither bedridden nor currently admitted

to any health care institution on the premises.

Physician—Classified as eithe~

● In scope—Ail duly licensed doctors of medicine or doctors of osteopathy currently in practice who spend some

time caring for ambulatory patients at an ofilce location.

● Out of scope—Those physicians who treat patients only

indirectly, including physicians in the specialties of anesthesiology, pathology, forensic pathology, radiology, therapeutic radiology, and diagnostic radiology, and the following physicians:

c Physicians who are federally employed, including

those physicians in military service.

● Physicians who treat patients only in an institutional

setting, for example, patients in nursing homes and

hospitals.

● Physicians employed fill time in industry or by an

institution and having no private practice, for example,

physicians who work for the Veterans’ Administration or the Ford Motor Company.

. Physicians who spend no time seeing ambulatory patient, for example, physicians who only teach, are engaged in research, or are retired.

Patients—Classified as eithe~

. in scope—All patients seen by the physician or a staff

member in the ofllce of the physician.

● Out of scope—Patients seen by the physician in a hospital,

nursing home, or other extended care institution, or in the

patient’s home. (Note: If the physician has a private office, meeting the definition of “oflice,” located in a hospital, the ambulatory patients seen there are considered

in scope.) The following types of patients are considered

out of scope:

. Patients seen by the physician in an institution, including outpatient clinics of hospitals, for whom the

institution has primary responsibility over time.

. Patients who contact and receive advice from the

physician via telephone.

. Patients who come to the ofice only to leave a specimen, to pick up insurance forms, or to pay a bill.

. Patients who come to the office only to pick up medications previously prescribed by the physician.

Visit—A direct, personal exchange between an ambulatory patient and a physician or a staff member for the purpose

of seeking care and rendetig health services.

Physician specialty-Principal specialty, including general practice, as designated by the physician at the time of the

survey. Those physicians for whom a specialty was not obtained

were assigned the principal specialty recorded in the physician

master files maintained by the American Medical Association

or the American Osteopathic Association.

Regzon of practice location—The four geographic regions,

excluding Alaska and Hawaii, that correspond to those used

by the U.S. Bureau of the Census:

Region

Northeast . . . . . .

North Central . . .

South . . . . . . . . .

West . . . . . . . . . .

States included

Connecticut, Maine, Massachusetts, New

Hampshire, New Jersey, New York,

Pennsylvania, Rhode Island, and

Vermont

Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska,

North Dakota, Ohio, South Dakota, and

Wisconsin

Alabama, Arkansas, Delaware, District

of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi,

North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and

West Virgina

Arizona, California, Colorado, Idaho,

Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming

Metropolitan status of practice Iocation—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. Oftlce of

Management and Budget. The definition of an individual

SMSA involves two considerations: first, a city or cities of

specified ~pulation that constitute the central city and identifJ

the county in which it is located as the central county; second,

economic and social relationships with “contiguous” counties

that are metropolitan in character so that the periphery of the

specific metropolitan area may be determined. SMSA’S may

47
cross State lines. In New England, SMSA’S consist of cities

and towns rather than counties.

Terms relating to the

Patient Record Form

Age—The age calculated from date of birth was the age

at last birthday on the date of visit.

Race—White, Black, Asian or Pacific Islander, or American Indian or Alaskan Native. Physicians were instructed to

mark the category they judged to be the most appropriate for

each patient based on observation or prior knowledge. The

following definitions were provided to the physician:

●

●

●

●

White-A person having origins in any of the original

peoples of Europe, North Africa, or the Middle East.

Black—A person having origins in any of the black racial

groups of Africa.

Asian or Pac#ic Islander—A person having origins in

any of the original peoples of the Far East, Southeast

Asia, the, Indian subcontinent, or the Pacific Islands, including, for example, China, India, Japan, Korea, the

Philippine Islands, and Samoa.

Amen-can Indian or Alaskan Native—A person having

origins in any of the original peoples of North America

and who maintains cultural identification through tribal

afilliation or community recognition.

Ethnicity—Category judged by the physician to be the

most appropriate. The following definitions were provided

● Hispanic origin—A person of Mexican, Puerto Rican,

Cuban, Central or South American, or other Spanish culture or origin, regardless of race.

● Not Hispanic—Any person not of Hispanic origin.

Patient’s complaint(s), symptom(s), or other reason(s)

for this visit (in patient’s own words)—The patient’s principal

problem, complaint, symptom, or other reason for this visit as

expressed by the patient. Physicians were instructed to record

key words or phrases verbatim to the extent possible, listing

that problem first which, in the physician’s judgment, was

most responsible for the patient’s visit.

Major reason for this visit—The one major reason (selected from the following list) for the patient’s visit as judged

by the physician:

●

●

●

●

48

Acute problem—A visit primarily for a condition or illness having a relatively sudden or recent onset (within 3

months of the visit).

Chronic problem, routine—A visit primarily to receive

regular care or examination for a preexisting chronic

condition or illness (onset of condition was 3 months or

more before the visit).

Chronic problem, jlareup-A visit primarily to receive

care for a sudden exacerbation of a preexisting chronic

condition or illness.

Postsurgery orpostinjury-A visit primarily for followup

care of injuries or for care required following surgery, for

example, removal of sutures or cast.

. Nonillness care (routine prenatal, general exam, wellbaby)—General health maintenance examinations and

routine periodic examinations of presumably healthy persons, both children and adults, including prenatal and

postnatal care, annual physicals, well-child examinations,

and insurance examinations.

Diagnostic services this visit—Physicians were instructed

to check any of the following services that were ordered or

provided during the current visiti

●

●

●

●

●

●

●

●

Limited histo~ and/or examination—History or physical examination limited to a specific body site or system

or concerned primarily with the patient’s chief complaint,

for example, pelvic examination or eye examination.

General history and/or examination—History or physical examination of a comprehensive nature, including all

or most body systems.

Pap test—Papanicolaou test.

Clinical lab test—One or more laboratory procedures or

tests, including examination of blood, urine, sputum,

smears, exudates, transudates, feces, and gastric content,

and includiig chemistry, serology, bacteriology, and pregnancy test excludes Pap test.

X-ray—Any single or multiple X-ray examination for

diagnostic or screening purposes; excludes radiation

therapy.

Blood pressure check.

EKG—Electrocardiogram.

Vision test—Visual acuity test.

Endoscopy—Examination of the interior of any body

cavity except ear, nose, and throat by means of an endoscope.

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.

Princzjal diagnosis—The physician’s diagnosis of the

patient’s principal problem, complaint, or symptom. In the

event of multiple diagnoses, the physician was instructed to

list them in order of decreasing importance. The term “principal” refers to the first-listed diagnosis. The diagnosis represents the physician’s best judgment at the time of the visit and

may be tentative, provisional, or definitive.

Other significant current diagnoses—The diagnosis of

any other condition known to exist for the patient at the time

of the visit. Other diagnoses may or may not be related to the

patient’s reason for visit.

Have you seen patient before?—’’Seen before” means

provided care for at any time in the past. Item 10b refers to

the patient’s current episode of illness.

Medication therapy this visit—The physician was instructed to list, using brand or generic names, all medications,

including drugs, vitamins, hormones, ointments, and suppositories ordered, injected, administered, or provided this visit

including prescription and nonprescription drugs, vaccinations,

immunization, and desensitization agents. Also included are
drugs and medications ordered or provided prior to the visit

that the physician instructed or expected the patient to continue taking. Medications for the principal diagnosis are listed

in item 11a; all other drugs are listed in item 11b.

Nonmedication therapy-Physicians were instructed to

check any of the following services that were ordered or provided during the current visi~

●

●

●

●

●

●

●

●

Physiotherapy—Any form of physical therapy ordered or

provided, including any treatment using heat, ligh~ sound,

or physical pressure or movemen~ for example, ultrasonic,

ultraviolet, infrared, whirlpool, diathermy, cold, and

manipulative therapy.

Ofice surgery-Any surgical procedure performed in the

oftlce this visit, including suture of wounds, reduction of

fractures, application or removal of casts, incision and

draining of abscesses, application of supportive materials

for fractures and sprains, irrigations, aspirations, dilations,

and excisions.

Family planning—Services, counseling, or advice that

might enable patients to determine the number and spacing of their children, including both contraception and infertility services.

Psychotherapy or therapeutic listening—All treatments

designed to produce a mental or emotional response

through suggestion, persuasion, reeducation, reassurance,

or support, including psychological counseling, hypnosis,

psychoanalysis, and transactional therapy.

Diet counseling—Instructions, recommendations, or advice regarding diet or dietary habits.

Family or social counseling—Advice regarding problems

of family relationships, including marital or parent-child

problems, or social problems, including economic, educational, occupational, legal, or social adjustment tilcukies.

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 or social counseling are excluded.

Other—Treatments or nonmedication therapies ordered

or provided that are not listed or included in the preceding categories.

Was patient referredfor this visit by anotherphysician?—

Referrals are any visits that are made at the advice or direction of a physician other than the one being visited. The interest is in referrals for the current visit and not in referrals for

any prior visit.

Disposition this visit—Eight categories are provided to

describe the physician’s disposition of the case. The physician was instructed to check as many of the categories as

apply:

No follo wup planned—No return visit or telephone contact was scheduled for the patient’s problem.

Return at specl~ed time—Patient was told to schedule an

appointment or was instructed to return at a particular

time.

Return zf needed, P.R.N.—No future appointment was

made, but the patient was instructed to make an appointment with the physician if the patient considered it necessary.

Telephone followup planned—Patient was instructed to

telephone the physician on a particular day to report either

on progress, or if the need arose.

Referred to other physician—Patient was instructed to

consult or seek care from another physician. The patient

may or may not return to this physician at a later date.

Returned to refer.n”ngphysician—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

fiut.her oflice visits were expected prior to hospital admission.

Other—Any other disposition of the case not @eluded in

the preceding categories.

Duration of this visit—Time the physician spent with the

patient, not including time the patient spent wziiting 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 dld not see the physician during

the visit, the duration of visit was recorded as O minutes.

49
Appendix III

Survey instruments

Endorsing Organizations

American Academy

of Dermatology

American Academy of

Family Physicians

American Academy

of Neurology

American Academy of

Orthopaedic,Surgeons

American Academy

of Pediatrics

American Association of

Neurological Surgeons

American College of

Emergency Physicians

American College of

Obstetricians and

Gynecologists

American College

of Physicians

American College of

Preventwe Medic)ne

American Osteopathic

Association

American Society of

Colon and Rectal

Surgeons

American Psychiatric

Association

American Society of

Internal Medicine

American Society of

Plastic and Reconstructive

Surgeons, Inc.

American Urological

Association

Association of American

Medical Colleges

National Medical

Association

50

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

OFFICE OF HEALTH RESEARCH, STATIST ICSAND TECHNOLOGY

HYATTSVILLE, MARYLAND 207a2

NATIONAL AMBULATORY

MEDICAL CARE SURVEY

The National Center for Health Statistics, as part

of its continuing program to provide information on

the health status of the American people, is conducting

a National Ambulatory Medical Care Survey (NAMCS).

The purpose of this survey is to collect information

about ambulatory patients, their problems, and the

resources used for their care. The resulting published

statistics will help your profession plan for more

effective health services, determine health manpower

requirements, and improve medical education.

Since practicing physicians are the only reliable source

of this information, we need your assistance in the

NAMCS . As one of the physicians selected in our national

sample, your participation is essential to the success

of the survey. Of course, all information that you

provide is held in strict confidence.

Many organizations and leaders in the medical

have expressed their support for this survey,

those shown to the left. In particular, your

cialty society has reviewed the NAMCS program

this effort (see enclosure). They join me in

your cooperation in this important research.

profession

including

own speand supports

urging

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,

Dorothy P. Rice

Director

Enclosure
CNO.499932

PATIENTLOG

AS2URANCE OF cONFIDENTALITY-AII ,.lo, ma,,.” fih,, h .+UU!IIU,, IIM,ndenl,ltcatmn

of . . mdwcrual. a m.crxe, or . . wabhshm+m! W,II be hwi .imi,,i?ntmf. WI!l be used only

by !xrmm e.qqed m and for Ihe P. TDOSCS of m. NIr. eV and WA, ..! uc dmlosed or re

leased ,0 .,hcr 0,,s0”, w US@ 10, an” ah,, Ilurpofe

Dvmrm.z,, *I Health, Educ.l <””, d“<li%:el l.,,.

R.,,,,. H,.d!,h S.rv,,c

Olf,C, d H..,,. R.,’.ar, h. S,., <,,,.,, ,1”,,T,., tI,,,>,,,,,v

cNO.dg$)gsz

Nar,.ml C,”lvr 1$>,Hv,llh SI. !,,, S,,

1

PATlENT RECORD

Month ‘b” v,,? NATIONAL AMBULATORY MEDICAL CARE SURVEY T

4. COLOR OR RACE

1 ❑ WHITE

2 ❑ BLACK

3 ❑ ASIAN/pACIFIC

ISLANDER

4 QAMERICAN INDIAN(

ALASKAN NATIVE

As each patient arrives, rwordnsme and

tired of visit OR ttw log below. For the

pstient *nt9md on line #3, also cOmpltia th~ pstient record to the right.

I

5. ETHNICITY & PATI ENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER

REASON(S) FOR ~ VI S1 T /IM paritwr h UW?I wordsj

a. MOST IMPORTANT

b OTHER

1 l_JHISPANIC

ORIGIN

2 ❑NOT

HISPANIC

PATl ENT’S NAME TIME OF

VISIT

& DIAGNOSTIC SERVICES THIS VISIT

\Check all ordered or providedj

9, PHYSICIAN’S OIAGNOSES

a PRINCIPAL OIAGNOSISIPROLILEM A550cIATE0wITH ITEM G

I ❑ NOM 8 ❑ H(G

2 ❑ L,h41TE0HISTORYIEXAM. 9 ❑ VISION TEST. 1 ❑ACUTE PROBLEM

2 ❑cHRoNIC PROBLEM, ROUTINE

3 ❑cHRoNIC PROBLEM, FLAREUP

4 ❑P05TSURGERYIP0ST INJURY

5 ❑N0NILLNE5scARE{ R0uT,NE

PRENATAL. GENERAL EXAM .

WELL BABY. ETC I

3 ❑ GEt4ERAL H15TORYIEXAM ,0 ❑ ENOOsCOPY

4 ❑PAP TEST ,, ❑ k~;NT~LSTAT”S

5 ❑CLINICAL LAB TEST

6 ❑X.RAY

,, ❑ 0THER,.$,,K,,,,

b OTHER SIGNIFICANT CURRENT OIAGNOSES

7 ❑BLOOOPSiEKWRECHECK

11, MEDICATION THERAPY THIS VISIT ❑ NONE

3 /Usiy brand or setleric names, record all IICW, und cotrtim,ed medicwtium wdt,wd, ittjecrcd. udmi!tiswttf, ,Ir ,,rhwtri.w,

provided a r this vist. Include imrrmnizitt,q uttd destw$i ti: iu,q IWIN ts/

d. FOR PRINCIPAL OIAGNOSES IN ITEM 9.+ l). FOR ALL OTHER UEASCMW

1. 1

—

2. 2

3. 3

4. 4

I am

,DYES ,DNO

I

[F YES, FOR THE

CONOITION IN

ITEM 9d?

Record ,mm% 1 t 5

lo, th,s Patient I mm

I ❑ YES 2 ❑ NO

I

12, NON.MEDICATION THERA

[Check all services urdered or provided this visit/

13.Wgm&rw

FOR THIS VISIT

BY’ A~HER

PHYSICIAN?

14 DISPOSITION THIS VISIT

* /Check all thar apply]

1 ❑NO FOLLOW UP PLANNEO

2 ❑RETLJf7NAT5pEcIFIE0 TIME

3DRET”RNIF NEEIJEO,PR N

4 ❑TELEPHONE FOLLOwUPPLANNEO

5 ❑REFERFIEOTOOTHEFI PHYSICIAN

G ❑RETURNEO TO REFERRING rIHYSICIAN

7 ❑AIJMITTO HOSPITAL

8 ❑ OTHER ,,$,},, ,,, ,

15mOURATION

OF THIS

VISIT

I rim d<wuilr

,spt, nf wrh

/1/1lrf, lull/

I ❑ NONE

2 ❑ PHYSIOTHERAPY

6 ❑ OIETCOUNSELING

7❑F:$WLY&:;:L

8DME01cALcouh15EL.lNG

9n0THEfl (SLMWJW

3DOFFICE SURGERY

4 ❑ FAMILY PLANNING

5 ❑ psYcH0TH6RApy,

THERAPEUTIC LISTENING

CONTINUE LISTING PATIENTS

ON NEXT PAGE

m

P HS-61 06-C (9/79) oMB No. 6B-R149B
BEGIN DECK 3

*

iForm Approved I

CONFIDENTIALy’

NORC-4284

FOR OFFICE USE

ONLY:

OMB NO;-68R1498 I

NATIONAL AMBULATORY MEDTCAL CARE SURVEY

INDUCTION INTERVIEW

BEFORE STARTING INTERVIEW 1

1. ENTER PHYSICIAN I.D. NUMMR IN BOX TO

~

RIGHT. I

I

2. ENTER DATES OF ASSIGNED REPORTING WEEK IN “

Q. 2, P. 2. I

I J

Doctor, before I begin, let = take a minute to give you a little background about

this survey.

Although ambulatory medical care accounts for nearly 90 percent of all msdical care

received in the United States, there is no systematic information about the characteristics and problems of people who consult physicians in their offices. This kind

of information has been badly needed by medical educators and others concerned with

the medical manpower situation.

In response to increasing demands for this kind of information, the National Center

for Health Statistics, in close consultation with representatives of the udical

profession, has developed the National Ambulatory Fkdical Care Survey.

Your own task in the survey is simple, carefully designed, and should not take much

of your time. Essentially, it consists of your participation during a specified

7-day period. During this period, you simply check off a minimal amount of information concerning patients that you see.

Now, before we get into the actual procedures, I have a few questions to ask about

your practice. The answers you give me will be used only for classification and *

analysis, and of course information you provide is held in strict confidence.

1. F%rst, you are a

(ENTER SPECIALTY FROM CODE ON FACE SnET LA13EL.)”

Is that right? Yes . . . . . . . . .

No. . . . (ASK A) . .

A. IF NO: What is your specialty (including general practice)?

(Name of Specialty)

. . x

. . Y

Ill!

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 for refusing to answer any

question. All information collected is confidential and will

be used only to prepare statistical summaries. No information

which will identify an individual or a physician’s practice

will be released.

52
-2-

2. Now, doctor, this study will be concerned with the ambulatory patients you will

see in your office during the week of (READ REPORTING DATES ENTERED BELW).

(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 that week?

Yes. . . . . .(GO~Q. ’3).. X

No . . . . . . (ASKA) . . ..Y /’

IF NO: Why is that? RECORD VERBATI~ THEN READ PARAGRAPH BELW

Since it’s very important, doctor, that we include any ambulatory patients

that you & happen to see in your office during that week, I’d like to

leave these forms with you anyway--just in case your plans change. Itll

plan to check bacftwith your office just before (STARTING DATE) to make

sure, and I can explain them in detail then, if necessary.

GIVE DOCTOR THE ~ PATIENT RECORD FORMS AND GO TO Q. 9, P. 6.

53
-3-

3, A, At what office location will you be eee$

7-day period? RECORD UNDER A BELCM AND %?

ambulatory pattent$ during thtt

N CODE B.

B. FOR EACH OFFICE LOCATION ENTERED IN A, CODE YES OR NO TO “IN SCOPE.”

IN SCOPE (Yes) ] OUT OF SCOPE (No) [

Private offices Hospital emergency rooms

Free-standing clinics Hospital outpatient departments

(non-hospitalbased) College or university infirmaries

Groups, partnerships Industrial outpatient facilities

Kaiser, HIP, Mayo Clinic Family planning clinics

Neighborhood Health Centers Government-operated clinics

Privately operated clinics (VD, maternal & child health, etc.]

(except family planning)

IN CASE OF DOUBT, ASK: Is that (clinic/facility/institution)hospital based?

Is that (clinic/facility/institution)government

operated?

c. Is that @J of the office locations at which you expect to see ambulatory

patients during that week?

Yea. . . . . . . . . . . X

No . . . . . . . . . ..Y

IF NO: OBTAIN ADDITIONAL OFFICE LOCATION(S), ENI!ERIN “A” BELW, AND REPEAT.

A. 11- B.

Office Location In Scope?

Yea No

(1) 1 0

(2) 1 0

(3) 1 0

(4) 1 0

TOTAL IN-SCOPE LOCATIONS:

n 14/

IF ALL LOCATIONS ARE OUT OF SCOPE, THANKTHE DOCTORANDLEAVE.

54
-4- DECK 3

4. A. During that week (REPEAT DATES ),,how many ambulatory patients do you expect

to see in your office practice? (DO NOT CO~TT PATIENTS SEEN AT [OUT-OF-SCOPE

LOCATIONS] CODED IN 3-B.)

ENTER TOTAL UNDER “A” BELOW AND CIRCLE NUMBER CATEGORY ON API’ROFRTATE

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 CCLUMN UNDER “B” BELOW.

DETERMINE PROPER PATIENT LOG FORM-FROM CHART BELC%J. RZAD ACROSS

ON “TOTAL pATIENTS” LINE ~ER “A” AND CIRCLE LETTER IN APPROPRIATE

“DAyS” COL~ ~ER “B.tf

THIS LETTER TELLS YOU WHICH OF THE FOUR PATIENT LOG FORMS (A, B, C, D)

SHOULD BE USED BY THIS DOCTOR.

I A. I B. I

LOG FORM DESCRIPTION

A--Patient Record is to be

completed for ALL

patients liste~n Log. 15-17/

B--Patient Record is to be

completed for every

SECOND patient listed

on Log.

Expected total I

Total @ in practice

yatients during during week.

survey week.

1 I

ENTER TOTAL FROM I I

Q. 4-A.

m“ 11213~:151617

1- 12 PATIENTS A A A A“A A A

13- 25 “ BAAAAAA

26- 39 “ I CBAAAAA

40- 52 “ CBBAAAA

53- 65 “ DCBBAAA

66- 79 “ DCBBBAA

C--Patient Record is to be 80- 92 “ DDCBBBB

completed for every 93-105 “ DDCBBBB

THIfi patient listed 106-118 “ DDCCBBB

on Log.

119-131 “ DDCCBBB

I 132-145 “ ID DDCCBB

*D--Patient Record is to be

completed for every

FIFTH patient listed

on Log.

146-158 “ DDDCCBB

159-171 “ DDDCCCC

I 172-184 “ IDDDCCCC

185-197 “ DDDDDDD

198-210 “ DDDDDDD

211+ 11 DDDDDDD

*

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>raugh the Patient Record on every other page of the two folio pads,

starting with Page 1 of the pad. The physician then completes the Patient Log

on every page, but completes the Patient Record on every second page.

55
-5- DECK 3

5. FIND LOG FOLIO WITH AppRop~I.A.TE ~T’rE~ AND CIRCL’E LETTER, ENTER FIRST FOUR NUMBERS

OF THE FORM AND NUMBER OF LINES STAMPED “BEGIN ON NEXT LINE” FOR T~ B-C-D L~

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” forma completed.

A

B

c

\

19-23/

24-26/

6. HAND DOCTOR HIS FOLIO AND EXPLAIN H(XJFORMS ARE TO BE FILLED OUT. SHOW DOCTOR

INSTRUCTIONS ON THE POCKET OF FOLIO, ITEMS ~ AND 11 ON CAR@ IN POCKET

OF FOLIO AND ITEM DEFINITIONS ON THE BACK OF FOLIO, TO WHICH HE CAN REFER AFTER

YOU LEAVE.

EMPHASIZE THAT EVERY PATIENT VISIT EXCEPT ADMINISTRATIVE PURPOSE ONLY IS TO BE

RECORDED ON THE LOG FOR ENTIRE REPORTING PERIOD. FOR EXAMPLE, IF A MEDICAL

ASSISTANT GAVE THE PATIENT AN INOCULATION, OR A TECHNICIAN ADMINISTERED AN

ELECTROCARDIOGMM AND THE PATIENT DID Nm SEE THE DOCTOR TmS VISIT MUST STILL BE

LISTED ON THE LOG.

RECORD VERBATIM BEL~ ANY CONCERN, PROBLEMS OR QUESTIONS THE DOCTOR RAISES.

7. IF DOCTOR EXPECTS TO SEE AMBULATORY PATIENTS AT MORE THAN ONE IN-SCOPE LOCATION

DURING ASSIGNED WEEK, TELL HIM YOU WILL DELIVER THE FORMS TO THE OTHER LOCATION(S).

EM’ER THE FORM LETTER AND NUMBER(S) AND NUMBER OF LINES STAMPED “BEGIN ON NEXT

LINE” FOR THE B-C-D LOG FOR THOSE LOCATIONS BELOW, BEFORE DELIVERING FORM(S).

FOLIO No. Lines

1

‘FOR OFFICE USE ONLY:

Location Stamped “BEGIN ~umber Patient recor

Letter .Num~er ON NExT LINE” -forms completed

27-31/

32!-34/

35-39/

4CI-42/

43-47/

!

48-50/

.—

56
-6- DECK 3

8. During the survey week (REPEAT EXACT DATES), will anyone be available to help

you $n filling out these eecords (at each IN-SCOPElocation)?

Yes . . . . (ASKA) ...1

No . . . . . . . . . . .2

51/

A. IF YES: Wo would that be?

RECORD W, POSITION AND LOCATION.

I

NAME I POSITION 1 LOCATION I

PERSONALLY BRIEF EACH PERSON LISTED ABOVE.

EMPHAS12E THAT EVEW PATIENT VISIT DURING THE ENTIRE WEEK IS TO BE RECORDED ONTRE

LOG EXCEPT “ADMINISTRATIVE PURPOSE ONLY.”

+

9. Do you have a solo practice, or are you a8aociated with other physicians in a

partnership, in a group practice, or in some other way?

<---

IF PARTNERSHIP. GROUP. OR OTHER:

A. Is this 8 prepaid group practice?

[1] IF WSTOA: Whdt percent

of patients are

prepaid?

B. How many other physicians are

a880ciated with you?

solo. ● ● . . (GO ’10.Q.10) . . 1

Partnership . . (ASK A-C) . . . 2

Group

Other

Yes . . (ASK [1]) . . . 1 53/

No . . . . . . . . . .2

per cent 54-56/

NUMBER OF PHYSICIANS: 57-59/

c. What are the specialties of the other physicians associated with you?

(How many of these are there?)

Specialty Number of Physicians

(1)

(2)

(3)

(4)

(5)

D. CIRCLE ONE:

All physicians in this partnership/group practice

have thesamespecialty . . . . . . . . . . . . . . . . . . 1

More than one specialty in this partnership/group practice . . 2

60/

57
10. Now I have just one

IN

A.

B.

LARGE GR&JP, THE

-7- BEG’INDECK 4

more question about your practice. (NOSE: IF DOCTOR PIUXTICES

FOLLOWING INFORMATION CAN BE OBTAINED FROM SOMEONE ELSE.)

What is the total number of full-time (35 hours or more per week) employees of your (partnership/

group) practice? Include persons regularly employed who are now on vacation, temporarf& ill,

etc. Do not include other physicians. IWCORD ON BOTTOM LINE OF COLIJ’FNA BELW.

(1) H-—many of these full-time employees are a . . . (READ CATEGORIES BELCX4AS NECESSARY

AN13 RECORD NUMBER OF EACH IN COLUMN A.)

And what is the total number of part. tfme (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 BOITOM LINE OF COLUMN B BELOW.

(1) How many of these part-time etiployees are a . . . (RSAD CATEGORIES BELCM AS NECESSARY

AND RECORD NUMBER OF EACH IN COLUMN B.)

1

“A. B.

Employees ~F’ull-time Part-time

b (35 cm more hours/week) (Leee than 35 hours/week) I

(1)

(2)

(3)

(14)

(5)

(6)

(7)

Registered Nurse.... . . . . . . .

Licensed Ractical Nurse . . . . . . .

Nursing Aide . . . . . . . . . . . . .

Physician Aesistant* . . . . . . . . .

Technician . . . . . . . . . . . . . .

Secretary or Receptionist . . . . . .

Other (SPECIFY)

11-13/

14-16/

17-19/

20-22/

23-25/

26-28/

29-31/

32-34/

35-37J

38-40/

41-43/

44-46/

47-49/

50-52/

53-55/

56-58/

*

Phy8ician Assistant nust be a graduate of an accredited training program for Physician

Aasi.stants (F%ysician Extenders, %,dex, etc. ) or certified by theNational Board of Medical

Cxainers through the Certification Exam for Aasistmt to the Primary Care Fbyaician.

BEFORE YOU LEAVE, AGAIN STRESS THAT EACH AND EYEIW AM8UL&120RYPATIENT SEEN BY THE

DOCTOR OR HIS STAFF DURING THE 7-DAY PERIOD AT ALL IN-SCOPE OFFICE LOCATIONS (mEAT

THEM) IS TO BE INCLUDED IN THE SURVEY, THAT EAC~ATIENT IS TO BE RECORDED ON THE LOGj

AND ONLY THE APPROPRIATE NUMBER OF PATIENT RECORDS COMPLETED.

Thank you for your time, Dr. If you have any (more) questions,

please feel free to call me. My phone nu#er is written in the folio. 1’11

call ~ on Monday morning of your survey week just to remind you.

11. TIME INTERVIEW ENDED . . . . . . . . AM

PM

12. DATEOFINTERVIEW . . . . . . . . . . . . . . .

Ill Ill

(Month) (Day) (Year)

58
-8-

c(Mdfzmg:

DECK 4

INJ!ERVIEWERNUMBER

Ill Ill

INJ!ERVIEWER’S SIGNATURE

FOR OFFICE USE ONLY:

No. of Patients Seen: I I I I 59-61/

I

I I I

n

62/ Total.Da~.; in Practice duringWeek:

59
Appendix IV

American Hospital Formulary

Service classification system

and therapeutic category codes

AMERICAN HOSPITAL FORMULARY SERVICE CLASSIFICATION SYSTEM

AND THERAPEUTIC CATEGORY CODES (AHFS#)

(Cla.dkttions in parenthesesme protilonsl but maybe used in DPIF)

AMER3CAN

HOSPITAL

FORMULARY

SERVfCE

CLASSIFICATION

SYSTEM

04:00 ANTIHLSTAM2NEDRUGS

08:00 ANTI-INFECTIVEAGENTS

08:04 Amebacides

OS:08 Anthehnintics

OS:12 Antibiotics

08:12.02 Aminogfycosidm

08:12.04 Antifun@ Antibiotics

08:12.06 Cephafosporins

08:12.08 ChlOramDhenicOl

08:12.12 Erythrornycim

08:12.16 PenicifUm

08:12.24 Tetracyctines

OS:12.24 Other Antibiotics

08:16 Antitubercufosis Agents

08: 1S AILtiVidS

0020 Plasmodicides

08:24 Sulfonamides

0S26 .Wffones

0828 Treponemicides

08:32 Trichomonacides

08:36 Urinary Germicides

08:40 Other Anti-Infective

1000 A2TffNEOPLASTICAGENTS

12:00 AUTONOMfCDRUGS

12:04 Pamsympathomimetic Agents

12:08 ParasYznPatholYticAgents

1212 Sympathomimetic Agents

12:16 Sympatholytic A&nts

12:20 Skeletal MuscleRelaxants

16:00 BLOODDEPJVATIVES

20:00 BLOODFORMATIONANDCOAGULATION

2004 Andanemia Drugs

20:04.04 fron Preparations

20:04.0S Liver and Stomach

preparations

20:12 Coagulant-$and Anticoagulants

20:12.04 AnticOagukants

20:1208 Antiheparin Agents

20:12.12 Coagufants

2012.16 Hemostatic

20:40 Thrombolytic Agents

24:00 CARDIOVASCULARDRUGS

24:04 Cardiac DmSS

24:06 Andfipendc Agents

24:08 Hypotensive Agents

24:12 Vasoditatin8 Agents

24:16 Sclerosin8A8entS

28:00 CENTRAL NERVOUSSYSTEMDRUGS

28:04 Genem.1Anesthetics

28:08 Analgesicsand Antipyretics

28:10 Narcotic Antagonists

28:12 .hticontints

28:16 Psychotherapeutic Agents

28:16.04 Antidepressants

28:16.08 Tranquilizers

2S:16.12 OthH Psychotherapeutic

Agents

28:20 Respiratory and Cerebral

Stimulants

28:24 Sedativesand Hypnotics

36:00

36:04

36:08

36:12

36:16

36:18

36:24

36:2S

36:26

36:28

36:30

36:32

36:34

36:36

36:38

36:40

36:44

36:48

36:52

36:56

36:60

36:61

36:62

36:64

3666

36:6S

36:72

36:76

36:78

36:80

36:84

36:88

DIAGNOSTICAGENTS

AdrenocorticafInsufficiency

Amyloidosis

Blood Volume

BruceUosis

Cardiac Function

Circulation Time

(Cystic Fibrosis)

~betes Melfitus

Diphtheria

DmS Hypersensitivity

Fund

GaUbladdcrFunction

Gastric Function

intestinal Absorption

Kidney Function

Liver Function

Lymphogranuloma Vencreum

Mumps

Myasthenia Grati

bfyxedema

Pancreatic Function

Phenytketonmia

Pheociuomocytoma

Pituitary Function

Roent@tography

Scarlet FWer

sweating

(Thyroid Function)

Trichinosis

Tuberculosis

UrineContents

4000 ELECTROLYTIC,CALORfC,AND

WATERBALANCE

40:04 ACidifYin8Agents

40:OB AklfiId2iI18ABCnt$

40:10 Ammonia Detoxicants

40:12 Retdacement Solutions

4016

40:1s

020

40:24

4028

40:36

4040

44:00

48:00

52:00

So&m-Removing Resins

Potassium-RemovingResins

Caloric Agents

Salt and Sugar Substitutes

Diurctic$

Inigating Solutions

Uricosmic Agents

ENZYMES

EXPECTORANTSANDCOUGH

PREPARATIONS

EYE, EAR, NOSE ANDTHROAT

PREPARATIONS

52:04 Anti-Infectives

52:04.04 Antibiotics

S2:04.06 Antitiaf$

52:04.08 Sulfonamides

5204.12 Mi.scAnti-Infectives

52:08

52:10

52:12

52:16

52:20

52:24

52:28

52:32

52:36

S6:00

56:04

56:08

56:10

56:12

56:16

56:20

56:24

56:40

Anti-Inff2.mmatOryA8entS

Carbonic Anhydrase Inhibitors

Contact Lens Solutions

LOCIIAnesthetics

Miotics

Mydriatics

Mouth Washesand Gqfes

Vamconstrictors

UnclassifiedAgents

GASTROINTESTINALDRUGS

Antacids and Absorbents

Anti.Diarrhea Agents

Andffatulents

Cathartics and Laxatives

Digestants

Emetics and Anti-Emetics

Llpotropic Agents

Misc.Cl Drugs

60:00

64:00

68:00

68:04

68:08

6S:12

68:16

68:1B

68:20

GOLDCOMPOUNDS

HEAVYMETALANTAGONISTS

HORMONESANDsYNTHETIC

SUBSTITUTES

Adrenals

An&08enS

Contraceptives

F.stromns

Gom&opins

[nmlim and Anti-Dmtdc

Aeents

68:20.0S - Insulins

68:24 Pamthyroid

68:2S pituit~

68:32 Pmgestogens

6S:34 Other Corpus Luteum Hormones

6g:36 Thyroid and Antithyroid

72:00 LOCALANESTHETICS

76:00 OXYTOCICS

78:00 RADIOACTIVEAGENTS

8000 SERUMS,TOXOIDSANDvACCINES

80:@l Serums

80:0S Toxoids

80:12 Vaccines

84:00 SKIN ANDMUCOUSMEMBRANE

PREPARATION.-

84:04 Anti.Infectives

S4:04.04 Antibiotics

s4:04.0S Fungicides

84KM.12 %abicide~and Pediculicides

S4:04.16 Misc.Local Anti-lnfectives

s4:06 Anti-Infkmmatory Agents

S4:08 Antipmritics and Local

Anesthetics

B4:12 Astringents

s4: 16 CeflStimulants and Proliferants

84:20 Detergents

84:24 Emollients, Demulcenis and

Protestants

S4:24.04 BasicLotions and Lirdmcnts

84:24.08 BasicOds and Other Solvents

84:24.12 BasicOintments and

Pmtectants ... .. .

84:24.16 BasicPowders and Demulcents

84:2S Keratolytic A8entS

84:32 Keratoplastic A8entS

84:36 MkcelfaneousAgents

S4:50 Pigmenting& Depigmenting Agents

S4:50.04 DepigtnentingAgents

S4:50.06 Pigmenting Asents

84:80 Sunscreen A8ent5

86:00 SPASMOLYTICAGENTS

8S:00 VITAMINS

88:04 Vitamin A

88:08 Vitamin B Complex

88:12 Vitamin C

88:16 Vitamin D

88:20 Vitamin E

8B:24 Vitamin K Activity

s8: 28 Multivitamin Preparations

92:00 uNCLASSIFIED THERAPEUTICAGENTS

94:oo (DEVfCES)

96:00 (PHARMACEUTICSAIDS)

Copyright @1980. Drug Products Information File; American Society of Hospital Pharmacists, Bethesda, Maryland.

60

All rights re8erved. Reprinted with permission.

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Publlc Health Service

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