Medication Therapy

in Office Vkits for

Selected Diagnoses:

The National

Ambulatory Medical

Care Survey

United States, 1980

Data are presented on the drugs ordered,

prescribed, or administered by office-based

physicians to treat patients with principal

diagnoses that were among those most

commonly rendered during 1980. Diabetes

mellitus, hypertension, ischemic heart

disease, and certain respiratory conditions

are among the 15 illness-related diagnoses

selected. Drugs associated with visits for

three preventive care health services are

also included. For each diagnosis, percents

of visits in which one or more drugs were

provided, drug mention rates, and drug

intensity rates are reported by age, sex, and

race of the patient; problem status; and

major reason for visit. Drug mentions for

each diagnosis are also shown by therapeutic

category, physician’s entry mode, and

generic class.

Data From the National Health Survey

Series 13, No. 71

DHHS Publication No. (PHS) 83-1732

U.S. Department of Health and Human

Services

Public Health Service

National Center for Health Statistics

Hyattsville, Md.

January 1983
COPYRIGHT INFORMATION

The National Center for Health Stallstlcs has ohta]ned permlss!on from the

copyright holders 10 reproduce certa!n quoted material In th!s report. Ft)rthel

reproduction of thla material IS proh(bl ted without speclf!c permission of

the copyright holders, All other material contained In the reporl IS If7 the

publlc domatn and maybe used and reprinted w!thout spec Ia permtsslun,

cltatlon as to source, however, IS appreciated.

SUGGESTED CITATION

National Center for Health Statlstlcs, B, K, Cypress Medlcat!on therapy In

office watts for selected d+agnoses The National Ambulatory Med(cal Care

Survey, United States, 1980. Vita/ar)dHea/rhSfzrlsf)cs Series 13-No. 71

DHH$ Pub, No. (P HS)83–1732 Publlc Hedlth Serwce Washington

U.S. Government Prlnllng Off/ce, Janu~ry 1983.

Library of Congress Cataloging in Publication Data

Cypress, 8edah K

Medficat!on therapy In of flrewslls for selected (itagnoscs

(Vltaland health statlst,cs Serlesl 3, D,ilii[]l, t?e:tlth res(,(r:.(] lllt/]!l(],,

no, 71) (DHHS publication no (P HS)83–1732)

Data collected by the National Center for H?altt> St,i TIsIIcs

B! biography p. 63

Supt of Docs. no HE 20,6209 13:71

1. Drug utll!zat(on —Un]ted State s—Statlstlcs 2 Chernotht:rdpy -

Un)ted States— Statlst!cs 3 Physlclar~ sew]ces (Jtlllzatlorl— Unlt(>(l St]tesStatlst!cs, 4 Ambulatory medical care—United S\atcs-St~tlstlcs

5. Health surveys-United States 6 Un!ted States— Stattsl!cs MefhL4

1. National Center for Health Statlstlcs (U S ) II TIt Ic Ill Ser!cs IV Series

DHHSpubl(catlon ; no. 83–1732, [D NLM. 1 Arnt]datom care— Umted

State s—Statlst]c$ 2, Health surveys—United State s—St~tlstlcs 3 Drug

therapy -Un!ted State s—Statlstlcs 4 Drug !Jt(llz:it(on—Url!tecl States -

Stat(stlcs. W2AN148vm no 711

RM261 .3. U6C95 1983 6155’8’0973 82–600267

ISBN 0–8406-0266–9

—

F(Jrsal(, hytbe S(]I)(~rinten(l(’]ltof I)oc’t]nl(’nts.l J.S. Government Printing Office, Washington, D. C. 20402
National Center for Health Statistics

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

ROBERT A. ISRAEL, Deputy Director

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

Analysis and Epidemiology

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

Cooperative Health Statistics System

GARRIE J. LOSEE, Associate Directorfor Data

Processing and Services

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

International Statistics

E. EARL BRYANT, Associate Directorfor Interview

and Examination Statistics

ROBERT L. QUAVE, Associate DirectorforManagement

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

Research and Methodology

PETER L. HURLEY, Associate Directorfor Vital and

Health Care Statistics

ALICE HAYWOOD, Information Oflcer

Wal and Health Care Statistics Program

PETER L. HURLEY, Associata Director

GLORIA KAPANTAIS, Assistant to the Directorfor

Data Policy, Planning, and Analysis

Division of Health Care Statistics

W. EDWARD BACON, Ph. D., Director

JOAN F. VAN NOSTRAND, Deputy Director

JAMES E. DELOZIER, Chief Ambulatory Care

Statistics Branch
Contents

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

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

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

Source and limitations ofdata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Text table

A. Number and percent distribution of office visits and drug mentions by principal diagnosis: United States,’

Section l. General characteristics of medication therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Office visits and drug mentions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

980 . . . . .

. . . . . . . .

. . . . . . . .

Number of medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Entry status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prescription status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Composition status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Federal control status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Figure

1. Drug mention rates pervisitforselected diagnoses: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Detailed tables

1. Numberofofficevisits, numberand percentofdrugvisits,numberofdrug mentions,drugmention rate,and drug intensity

rate, by all diagnoses and selected principal diagnoses: United States,’1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Number and percent distribution of office visits by number of medications, according to all diagnoses and selected

principal diagnoses United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Percent distribution ofdrug mentions by entry status and prescription status, according to all diagnoses and selected

principal diagnoses: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Percent distribution ofdrug mentions bycomposition statusand Federal control status, accordingto all diagnosesand

selected principal diagnoses: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section ll. Selected endocrine and metabolic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Obesity and other hyperalimentation . . . . . . . . . . . . . . . . . . . . . . . . . . ..CO...................... . . . . . . . . . . . . . . . .

Texttables

B. Numberand percentdistribution ofselected anti-diabetic agents mentioned in officevisitsfordiabetes mellitusbyroute

of administration ofthe drug, according tosexand ageof the patient: United States, 1980 . . . . . . . . . . . . . . . . . . . . .

C. Numberand percentdistribution offederallycontrolled drug mentions in ofFicevisitsforobesityandotherhyperalimentationby control category: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

1

2

2

1

3

3

3

5

5

5

5

4

7

7

8

9

10

10

11

11

12

..

Ill
Figure

2. Drug mention rates per visit for selected diagnoses by sex of patient: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . 12

Detailed tables

5. Number of office visits for diabetes mellitus, number and percent of drug visits, number of drug mentions, drug mention

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

6. Number and percent distribution of office visits for diabetes mellitus by number of medications, according to selected

characteristics: United States, l 980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. Number, percent distribution, and rate per 100 visits of drug mentions in office visits for diabetes mellitus by therapeutic category, according to sex and age of the patient United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8. Number and percent distribution of drug mentions in office visits for diabetes mellitus by most frequently mentioned

specific drugs described by principal generic ingredient(s) and principal therapeutic category: United States, 1980 . . . . .

9. Number and percent distribution of drugs used in office visits for diabetes mellitus by form of use, according to moslfrequently used generic substances: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. Number of office visits for obesity and other hyperalimentation, number and percent of drug visits, number of drug

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

11. Number and percent distribution of office visits for obesity and other hyperalimentation by number of medications,

according to selected characteristics: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12. Number, percent distribution, and rate per 100 visits of drug mentions in office visits for obesity and other hyperalimentation by therapeutic categoty, according to sex and age of the patient: United States, 1980 . . . . . . . . . . . . . . . . .

13. Number and percent distribution of drug mentions in office visits for obesity and other hyperalimentation by most frequently mentioned specific drugs described by principal generic ingredient(s) and principal therapeutic category

United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...” .“”””

14. Number and percent distribution of drugs used in office visits for obesity and other hyperalimentation by form of use,

according to most frequently used generic substances: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13

14

14

15

15

16

17

17

18

18

Section ill. Neurotic disorders or depressive disorder, NEC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Text tables

D Drug mention rate per 100 office visits for neurotic disorders or depressive disorder, NEC, for all central nervous system

drugs and selected subcategories by sex and age of the patient United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . 19,

E. Number and percent distribution of federally controlled drug mentions in office visits for neurotic disorders or depressive

disorder, NEC, bycontrol catego~ United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Detailed tables

15. Number of office visits for neurotic disorders or depressive disorder, NEC, number and percent of drug visits, number of

drug mentions, drug mention rate, and drug intensity rate, by selected characteristics: United States, 1980 . . . . . . . . 20

16. Number and percent distribution of office visits for neurotic disorders or depressive disorder, NEC, bynumberof meclications, according to selected characteristics: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

17. Number and percent distribution of drug mentions in office visits for neurotic disorders or depressive disorder, NEC, by

most frequently mentioned specific drug described by principal generic ingredient(s) and principal therapeutic category:

United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

18. Number and percent distribution of drugs used in office visits for neurotic disorders or depressive disorder, NEC, by

form of use, according to most frequently used generic substances: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . 22

Section lV. Selected cardiovascular diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

, Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Ischemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Text table

F. Percent distribution of drug visits for essential hypertension by concomitance of two therapeutic categories, according

tosexand ageofpatient and problem status: United States, 1980..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

iv
Detailed tebles

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

Number of office visits for essential hypertension, number and percent of drug visits, number of drug mentions, drug

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

Number and percent distribution of office visits for essential hypertension by number of medications, according to

selected characteristics: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number, percent distribution, and rate per 100 visits of drug mentions in office visits for essential hypertension bytherapeutic catego~, according to sex and age of the patienti United Statesr 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of drug mentions in office visits for essential hypertension by most frequently mentioned specific drugs described by principal generic ingredient(s) and principal therapeutic catego~: United States,

1980 . . . . . . .. s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of drugs used in olfice visits for essential hypertension by form of use, according to

most frequently used generic substances: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of office visits for ischemic heart disease, number and percent of drug visits, number of drug mentions, drug

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

Number and percent distribution of ofFice visits for ischemic heart disease by number of medications, according to

se Iectedcharacteristics: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number, percent distribution, and rate per 100 visits of drug mentions in office visits for ischemic heart disease by

therapeutic category, according to sex and age of the patient: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of drug mentions in office visits for ischemic heart disease by most frequently mentioned specific drugs described by principal generic ingredient(s) and principal therapeutic catego~ United States,

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

Number and percent distribution of drugs used in office visits for ischemic heart disease by form of use, according to

most frequently used generic substances: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25

26

27

28

29

29

30

31

31

32

Section V. Otitismedia and selected respiratory diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Suppurative andunspecified otitis media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Acute upper respiratory infections of multiple or unspecified sites (acute URI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Acute pharyngitis or acute laryngitis andtracheitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Bronchitis, acute; or not specified asacute or chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Allergic rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Detailed tables

29. Number ofotice visits forsuppurative andunspecified otitismedia, number andpercent ofdrugvisits, number of drug

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

30. Number, percent distribution, andrate perl OOvisits ofdrugmentions inofice visits forsuppurative and unspecified

otitismedia bytherapeutic category United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31. Number andpercent distribution ofdrugmentions inoffice visits forsuppurative andunspecified otitismedia by most

frequently mentioned specific drugs described by principal generic ingredient(s) and principal therapeutic catego~

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

32. Number andpercent distribution ofdrugs used inoficevisits forsuppurative andunspecified otitismedia by form of use,

according tomostfrequently used generic substances: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

33. Number ofotice visits foracute upper respirator infections ofmultiple orunspecified sites (acute URl), number and

percent of drug visits, number of drug mentions, drug mention rate, and drug intensity rate, by selected characteristics:

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

34. Number and percent distribution ofotice visits foracute upper respirato~ infections ofmultiple or unspecified sites

(acute URI) by number of medications, according to selected characteristics: United States, 1980 . . . . . . . . . . . . . . . .

35. Number, percent distribution, andrate perl OOvisits ofdrugmentions inoticevisits forselected respirato~ conditions

bytherapeutic category United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

36. Number andpercent distribution ofdrugmentions inoffice visits forselected respirato~ conditions by most frequently

mentioned specific drugs described by principal generic ingredient(s) and principal therapeutic category: United

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

37. Number andpercent distribution ofdrugs used inotice visits foracute upper respirato~ infections ofmultipleorunspecified sites (acute URl)byform ofuse, accord ingtomostfrequently used generic substances: United States, l98O . . .

36

36

37

37

38

39

40

41

42

v
’38.

39.

40.

41.

42.

43.

44.

Number of office visits for acute phar-yngitis or acute laryngitis and tracheitis, number and percent of drug visits, number

of drug mentions, drug mention rate, and drug intensity rate, by selected characteristics: United States, 1980 . . . . . .

Number and percent distribution of drugs used in office visits for acute pharyngitis or acute laryngitis and tracheitis by

form of use, according to most frequently used generic substances: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . .

Number of office visits for bronchitis, acute; or not specified as acute or chronic, number and percent of drug visits,

number of drug mentions, drug mention rate, and drug intensity rate, by selected characteristics: United States, 198CI . . .

Number and percent distribution of drugs used in office visits for bronchitis, acute; or not specified as acute or chronic

by form of use, according to most frequently used generic substances: United States, 1980 . . . . . . . . . . . . . . . . . . . . .

Number of office visits for asthma, number and percent of drug visits, number of drug mentions, drug mention rate,, and

drug intensity rate, by selected characteristics: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of drugs used in office visits for asthma and allergic rhinitis by form of use, accordingto

most frequently used generic substances: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of office visits for allergic rhinitis, number and percent of drug visits, number of drug mentions, drug mention

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

Section V1. Diseases of sebaceous glands and selected musculoskeletal conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the sebaceous glands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Osteoarthritis and allied disorders or other and unspecified arthropathies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Intervertebral disc disorders or other and unspecified disorders of back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sprains and strains of sacroiliac region or other and unspecified parts of back. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Text tables

G.

H.

Number and percent distribution of federally controlled drug mentions in office visits for intervertebral disc disorders or

other and unspecified disorders of back by control categov: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of federally controlled drug mentions in office visits for sprains and strains of sacroiliac

region or other and unspecified parts of back by control category: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . .

Detailed tables

45.

46.

47.

48.

49.

50.

51.

52.

Number of office visits for diseases of sebaceous glands, number and percent of drug visits, number of drug mentions,

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

Number, percent distribution, and rate per 100 visits of drug mentions in office visits by selected diagnoses and therapeuticcategory: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of drug mentions in office visits for diseases of sebaceous glands by most frequently

mentioned specific drugs described by principal generic ingredient(s) and principal therapeutic category: United States,

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

Number and percent distribution of drugs used in office visits for diseases of sebaceous glands by form of use, accordingtomost frequently used generic substances: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of office visits for osteoarthritis and allied disorders orotherand’unspecif ied arthropathies, number and percent

of drug visits, number of drug mentions, drug mention rate, and drug intensity rate by selected characteristics: United

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

Number and percent distribution of drugs used in office visits for selected musculoskeletal conditions by form of use,

according to most frequently used generic substances: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of office visits for intervertebral disc disorders or other and unspecified disorders of back, number and percent

of drug visits, number of drug mentions, drug mention rate, and drug intensity rate, by selected characteristics: United

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

Number of office visits for sprains and strains of sacroiliac region or other and unspecified parts of back, number and

percent of drug visits, number of drug mentions, drug mention rate, and drug intensity rate, by selected characteristics:

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

43

43

44

44

45

46

47

48

48

48

49

49

49

49

50

51

51

52

52

.53

54

55

Section V1l. Selected preventive care services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Health supervision ofinfant or child. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Norma l pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

General medical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

vi
Detailed tables

53. Number of office visits for health supervision of infant or child, number and percent of drug visits, number of drug mentions, drug mention rate, and drug intensity rater by selected characteristics: United Statesr 1980 . . . . . . . . . . . . . . . 57

54. Number, percent distribution, and rate per 100 visits of drug mentions in office visits for selected health services by

therapeutic category : United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

55. Number and percent distribution of drugs mentioned in office visits for selected health services by most frequently

mentioned specific drugs described by principal generic ingredient(s) and principal therapeutic catego~ United

States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

56. Number of ofFice visits by women for normal pregnancy, number and percent of drug visits, number of drug mentions,

drug mention rate, and drug intensity rate, by selected characteristics: United States, 1980 . . . . . . . . . . . . . . . . . . . . . 59

57. Number of office visits for genaral medical examination, number and percent of drug visits, number of drug mentions,

drug mention rate, and drug intensity rate, by selected characteristics: United States, 1980 . . . . . . . . . . . . . . . . . . . . . 59

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Figures

3. Drug mention rates per visit for all-listed drugs and principal medication by age of patient United States, 1980 . . . . 60

4. Drug mention rates pervisitfor diabetes mellitus, essential hypertension, and ischemic heart disease by all-listed drugs

andprincipal medication and age ofpatienh United States, 1980. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

References, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Appendixes

1. Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Il. Definitions of terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

!11. Survey instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

IV. American Hospital Formula~Sewice classification system andtherapeutic catego~ codes . . . . . . . . . . . . . . . . . . . . . . 87

vii
Symbols

..- Data not available

. . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than 500

where numbers are rounded to thousands

*

Figure does not meet standards of

reliability or precision (more than

30-percent relative standard error)

# Figure suppressed to comply with

confidentiality requirements

VIII
Medication Therapy in

Office Visits for Selected

Diagnoses

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

Introduction Table A. Number and percent distribution of ofFice visits and drug mentions

by principal diagnosis United States, 1980

Purpose and background Principal diagnosis and ICD-9-CA4 codel

Office Drug

visits mentions

The purpose of this report is to provide information

about medication therapy in office visits for the 18

selected principal (first-listed) diagnoses shown in table A.

Diagnostic codes and groupings are based on the l’nternational Classij7cation of Diseases, 9th Revision,

Clinical Modification. 1 The data were collected in

1980 by the National Center for Health Statistics by

means of the National Ambulatory Medical Care Survey, a probability sample survey conducted annually by

the Division of Health Care Statistics.

Two brief reports on medication therapy in the

National Ambulatory Medical Care Survey have been

published. They highlighted the drugs most frequently

used in oi%ce-based practice, and drug utilization by sex

and age of the patient.z,s This report explores the statistical association between certain diagnoses and the

pharmacologic treatment modality, a fimdamental medical relationship. A brief report on medication therapy

in visits for hypertension has also been published.A The

conditions and health services shown in table A were

selected because they were among the most common

diagnoses rendered during office visits in 1980. They

accounted for 38 percent of all visits and 45 percent of

all drug mentions. Data on the general characteristics

and dimensions of drug therapy during visits for care

and treatment of these diagnoses are presented in section I. The drug parameters used in the National Ambulatory Medical Care Sumey include entry status (brand

namea or generic entity), prescription status (prescription or over-the-counter drug), composition status (single

ingredient or combination drug), and Federal control

status (drugs under the regulatory control of the Drug

aInclusion of brand or trade names is for identification only end does not

imply endorsement by the Public Health Service or the U.S. Department of

Health and Human Services.

All principal diagnoses . . . . . . . . . . . . . . . . . . . . . . .

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

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

Obesity and other hyperalimentation. . . . . ...278

Neurotic disorders or depressive disorder,

NEC2 . . . . . . . . . . . . . . . . . . . . . . . . . . .300, 311

Suppurative and unspecified otitis media . ...382

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

Ischemic heart disease. . . . . . . . . . . . ...410-414

Acute upper respirato~ infections of multiple or

unpacified sites (acute URI). . ..460. 461,465

Acute pharyngitis or acute laryngitis and

tracheitis . . . . . . . . . . . . . . . . . . . . . ...462.464

Allergic rhinitis . . . . . . . . . . . . . . . . . . . . . . . ...477

8ronchitis, acute; or not specified as acute

or chronic . . . . . . . . . . . . . . . . . . . . ...466.490

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

Diseases of sebaceous glands . . . . . . . . . . ...706

Osteoarthritis and allied disorders or other

and unspecified arthropathies. . . . ...715-716

Intervertebral disc disorders or other and

unspecified disorders of back . . . . ...722. 724

Sprains and strains of sacroiliac region or other

and unspecified parts of back . . . . ...846-847

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

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

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

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

Number in thousands

575,745 679,593

Percent distribution

100.0 100.0

1.7 2.6

1.4 2.2

2.4 1.8

2.0 2.7

4.4 6.8

1.8 3.9

2.9 4.8

1.8 2.4

1.5 1.5

1.4 2.4

1.0 1.7

1.8 3.1

1.4 2.1

1.1 1.1

1.3 1.0

3.0 2.4

4.6 1.6

2.8 1.0

61.7 54.9

‘1~a~ed on the ,nternations[ classification of Diseases, 9th Revision, Clinical MOdificsrion. See reference 1.

2NEC = not elsewhere classified.

Enforcement Agency ofthe U.S. Department ofJustice).

Sections II through VII describe drug utilization relative

to visits for speciilc diagnoses in terms of sex, age, and

race of the patien$ problem status; and major reason for

visit. In these sections drugs that were ordered or provided in the presence of these diagnoses are also categorized by therapeutic effect and listed by specific drug

1
names as well as generic substances. Therapeutic categories are based on the American Hospital Formulary

Service classification systems In the National Ambulatory Medical Care Survey drug file each drug entry

was assigned to one American Hospital Formulary

Service therapeutic category although for some drugs

more than one therapeutic effect is possible. In order to

report accurately what the physician prescribed, drug

mentions used in this report are based on the physicians’

entries on the Patient Record Form (see appendix III).

These entries may be brand or generic names of prescription or over-the-counter drugs, or a therapeutic

effect. “Drug mentions” include all new or continued

drugs listed in item 11, parts a and b, on the Patient

Record Form. Part 11b, it should be noted, may relate

to diagnoses other than the principal or first-listed diagnosis. Therefore, it is assumed that medications described in this report were ordered for patients with the

first-listed diagnosis but may not necessarily be therapeutic agents for that condition. The terms “medication” and “chug” are used interchangeably in this report.

The “prescriber” is assumed to be the reporting physician. While the verb “prescribe” usually indicates a

written formula or drug name to be dispensed by a

registered pharmacist, in the context of this report it is

used interchangeably with “ordered” or “provided.”

Therefore, it may also mean a recommendation by the

physician for an over-the-counter drug, or the administration of a substance during the visit.

The methodology used to collect and process this

drug information is described in Vital and Health Statistics, Series 2, No. 90.6 A detailed description of the

survey methodology was published in Vital and Health

Statistics, Series 2, No. 61.7 To assist the reader in

interpreting the statistics in this report, the scope of the

survey and the source and limitations of the data are

described briefly prior to data presentation. Detailed

technical notes, definitions of terms, and facsimiles of

survey instruments are presented in appendixes I–III.

Scope of the survey

The basic sampling unit for the National Ambulatory Medical Care Survey is the physician-patient encounter or visit. Within the current scope of NAMCS

are all office visits made in the conterminous United

States by ambulatory patients to nonfederally employed

ofi-lce-based physicians as classified by the American

Medical Association or the American Osteopathic Association. The National Ambulatory Medical Care

Survey physician universe excludes physicians practicing in Alaska and Hawaii and physicians in the specialties of anesthesiology, pathology, or radiology. Visits to

physicians principally engaged in teaching, research, or

administration, as well as telephone contacts and visits

made outside the physician’s ofilce, are excluded.

The definitions of office, physician, patient, and

visit in terms of eligibility for the National Ambulatory

Medical Care Survey are presented in appendix II.

Source and limitations of data

Estimates presented here are based on information

obtained through the completion of Patient Record

Forms (appendix III) for a sample of visits to a national

probability sample of office-based physicians. The

sample for the 1980 National Ambulatory Medical

Care Survey (NAMCS) included 2,959 physicians, of

whom 611 were found not eligible (out of scope) at the

time of the survey. Of the 2,348 physicians who were

eligible for participation in NAMCS, 1,869 (79.6 percent) actually participated in the survey (see appendix

T\

~).

Physicians who participated in the survey maintained a list of all office visits during a randomly assigned

7-day reporting period. For a systematic random sample

of these visits, information was recorded on the Patient

Record provided for that purpose. During 1980, responding physicians completed 46,081 Patient Record

Forms on which they recorded 51,372 drug mentions.

The appendixes to this report contain information

that is necessary for a proper understanding and interpretation of the statistics presented. Appendix I contains a general description of the survey methods, the

sample design, and the data collection and processing

procedures. Methods of estimation and imputation are

also presented. Because the statistics given here are

based on a sample of office visits rather than on all visits,

they are subject to sampling errors. Therefore, particular

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

and instructions for their use are also given in appendix I.

Definitions of terms used in this report and in the

survey operations are presented in appendix II. A facsimile of the Patient Record Form is reproduced in

appendix 111.Facsimiles of other survey materials such

as the introductory letter and Induction Interview Form

may also be found in appendix III.

2
Section L General

characteristics of

medication therapy

Office visits and drug mentions

A study of medication therapy by diagnosis begins

with the number of ofllce visits, number and percent of

visits in which one or more drugs were ordered or provided (drug visits), and number of drug mentions. These

basic data are shown in table 1. Two rates are also

provided. The drug mention rate is the number of drug

mentions divided by the number of all visits for a given

diagnosis. The drug intensity rate is the number of drug

mentions divided by the number of drug visits for a given

diagnosis.

On the average, medication therapy was used in 63

percent of all office visits in 1980, but this percent

varied greatly for various diagnoses. For the 18 diagnoses in this report, proportions of drug visits ranged

from a low of 29 percent for general medical examination to a high of 94 percent for certain respiratory conditions. Illness-related diagnoses in this group were

more likely to be associated with drug therapy than were

visits for preventive care. The highest drug mention rate

was for ischemic heart disease (2.54); the two lowest

were for general medical examination and normal pregnancy (0.41 each). The lowest illness-related drug mention rate (0.88) was for neurotic disorders or depressive

disorder, NEC (NEC = not elsewhere classified); followed by two musculoskeletal conditions; sprains and

strains of sacroiliac region or other and unspecified

parts of back (0.89) and intervertebral disc disorders

or other and unspecified disorders of back (1.18).

The variation in rates among diagnoses is illustrated in

figure 1.

Visits for some diagnoses were more drug intensive

than others. Therefore, rates representing the number of

drugs per drug visit may not vary indirect proportion to

drug mention rates. For example, the drug intensity rate

of 1.67 for neurotic disorders or depressive disorder,

NEC, was not the lowest illness-related drug intensity

rate, but averaging over all visits for this diagnosis drug

utilization was lower than it was for other conditions in

this report. Allergic rhinitis was less drug intensive than

neurotic disorders or depressive disorder, NEC, with a

drug intensity rate of 1.38. This underscores the interpretive distinction between the two rates. When drugs

were used for allergic rhinitis patients, the average

number per drug visit was 1.38; when the patient had a

neurotic disorder or depressive disorder, NEC, the average number per drug visit was 1.67, even though 52

percent of such visits included drugs compared with 90

percent of those for allergic rhinitis.

Number of medications

The proportions of visits according to the precise

number of medications for each listed diagnosis is shown

in table 2. The proportions shown in the “None” category are the complements of the percent of drug visits

shown in table 1. Proportions of drug visits according to

number of medications maybe calculated by omitting

this group. For example, 20.9 percent of all visits with

general medical examination, or 3,360,000, had one

drug entry. Dividing this number by total drug visits

shown in table 1 (4,732,000) yields an estimate of71

percent of drug visits with one medication. Visits were

more likely to fall in the “None” group when patients

visited for the preventive care services described in this

repo~, neurotic disorders or depressive disorder, NEC;

sprains and strains of sacroiliac region or other and

unspecfled parts of back; and intervertebral disc disorders or other and unspecified disorders of back. One

medication was the most common number in visits for

other diagnoses in table 2 except for ischemic heart

disease; acute upper respiratory infections of multiple

or unspecified sites (acute URI); bronchitis, acute; or

not specified as acute or chronic; and diseases of sebaceous glands, where two was the likely number of

drug mentions. Close to half (49 percent) ofthe visits for

ischemic heart disease were in the total of categories

three, four, or five or more drugs. Other diagnoses with a

relatively high total proportion of three, four, or five or

more drugs were diabetes mellitus (27 percent); obesity

3
Diabetea mellitua

Obesity and other hyperalimentation

Neurotic disorders or depressive

disorder, NEC1

Suppurative and unspecified otitis

medis

Essential hypertension

Ischemic heart disease

Acute upper respiratory infections of

multiple or unspecified sites

(acute URI)

Acute pharyngitis or acute laryngitis

snd tracheitis

Allergic rhinitis

Bronchitis, acute; or not specified ss

scute or chronic

Asthma

Diseases of sebaceous glsnds

Osteoarthritis and allied disorders or

other and unspecified arthropathies

intervertebral disc disorders or other

and unspecified disorders of back

Sprains and atrains of sacroiliac region

or other and unspecified parts of back

Health supervision of infant or child

Normal pregnancy

General medical examination

1NEC = not elsewhere classified,

Figure 1. Drug mention rates per visit for selected diagnosea: United States, 1980

and other hyperalimentation (36 percent); essential hy- The association between the number of medications

pertension (26 percent); asthma(31 percent); diseases ordered or provided in the presence of selected diagofsebaceous glands(32 percent); and osteoarthritis and noses and other variables, such as sex and age of the

allied disorders or other and unspecified arthropathies patient, is detailed in the remaining sections of this

(26 percent). report.

4
Entry status Composition status

On the average, 7 of 10 drug entries on the Patient

Record Form were identiiled by brand name (manufacturer’s product name). A convention adopted for this

report is that an entry name is spelled with an initial

capital letter. A higher than average use of brand names

occurred when the diagnoses were neurotic disorders or

depressive disorder, NEC (85 percent); intervertebral

disc disorders or other and unspecified disorders ofback

(85 percent); and sprains and strains of sacroiliac region

or other and unspecified parts of back (83 percent)

(table 3). Although proportions of brand name entries

exceeded genericb name entries, a higher than average

use of generic names was found with diabetes mellitus

(33 percent), obesity and other hyperalimentation (35

percent), acute pharyngitis or acute laryngitis and

tracheitis (34 percent), health supervision of infant or

child (75 percent), and general medical examination

(45 percent). The relatively high proportions of generic

entities mentioned with the last two diagnoses were

probably due to the large number of immunizations

given during their total visits. This is discussed in more

detail in section VII. Similarly, the proportions of entries

described by therapeutic effect when visits were for

allergic rhinitis (42 percent) and asthma (13 percent)

reflect the use of drugs, allergens, or other desensitizing

agents administered by injection without specific identification of the pharmaceutical agent. Drug therapy for

these two diagnoses is discussed in section V.

Prescription status

Brand name drugs may be prescription (a written

order from the physician to be filled by a registered

pharmacist) or nonprescription, also called “over the

counter. ” Drugs identified by the physician by generic

name usually require a prescription with some exceptions, notably aspirin and insulin. Eighty-three percent

of all drug mentions, regardless of diagnosis, were prescription drugs and 13 percent were over-the-counter

drugs (table 3). The higher than average proportion of

over-the-counter drugs mentioned in visits for diabetes

mellitus (25 percent) was due to the utilization of insulin

(other anti-diabetic agents are prescription drugs). Overthe-counter drugs were also more frequently mentioned

when acute URI (17 percent) and acute pharyngitis or

acute laryngitis and tracheitis (15 percent) were diagnosed, probably due to the availability of many overthe-counter drugs used for symptomatic relief of these

conditions. Another condition with a high proportion of

over-the-counter drugs, in this case due to vitamin mentions, was normal pregnancy. Specific drugs mentioned

with these diagnoses are discussed in subsequent sections of this report.

bFor some dregs the brand nae used by the manufacturer to market the

product is in fact the generic class of the substance. In NAMCS such drugs

were classified in the generic name category.

Composition status describes the drug entry according to whether it is a single ingredient drug, a combination drug, or a multivitamin. Single ingredient drugs

include all drugs with one active ingredient. Combination drugs consist of more than one active, principal

ingredient. On the average, 7 of 10 drugs mentioned

were single ingredient drugs (table 4). This number was

higher when the diagnoses were diabetes mellitus (85

percent); obesity and other hyperalimentation (83 percent); neurotic disorders or depressive disorder, NEC

(80 percent); essential hypertension (73 percent);

ischemic heart disease (88 percent); acute pharyngitis

or acute laryngitis and tracheitis (74 percent); and diseases of sebaceous glands (78 percent). Although for all

diagnoses, except normal pregnancy, single ingredient

drugs were more likely to be ordered than combination

drugs, higher than average proportions of combination

drugs were associated with suppurative and unspecified

otitis media (40 percent); acute URI (37 percent); bronchitis, acute; or not specified as acute or chronic (31

percent); sprains and strains of sacroiliac region or

other and unspecified parts of back (38 percent); and

health supervision of infant or child (37 percent). In

children’s health supervision visits the relatively large

proportion of mentions of combined vaccines (such as

diphtheria and tetanus toxoids and pertussis vaccine)

contributed to the total of combination drugs (see section VII). Multivitamins were prominent in visits for

normal pregnancy (60 percent).

If the physician entered a therapeutic effect rather

than a drug name, it was not possible to make certain

categorizations (this applies also to prescription status).

Proportions in the “undetermined” category with visits

for allergic rhmitis (44 percent) and asthma (15 percent) were due to the large number of entries marked

“allergy relief” with no further identification of the

pharmaceutical agents used (see section V).

Federal control status

Regulatory control of certain drugs rests, by law, in

the Drug Enforcement Agency of the U.S. Department

of Justice, which has assigned each regulated drug to

one of five categories. These classiilcations constitute a

scale based on two dimensions: potential for abuse,

ranging from high (I) to low (V); and psychological or

physical dependence, severe (I) to limited(V). All regulated drugs except those in schedule I have a currently

accepted medical use in the United States. Classifications and examples are as follows:

. Schedule I (Heroin, LSD, Marijuana). High potential for abuse. Lack of accepted safety for use under

medical supervision.

● Schedule II (Methaqualone, Meperidine, Amphetamines). High potential for abuse. Abuse may lead to

severe psychological or physical dependence.

5
● Schedule HI (Paregoric, Fiorinal, Phendimetrazine). Potential for abuse less than for drugs in

schedule II. Abuse may lead to moderate or low

physical dependence or high psychological dependence.

. Schedule IV (Diazepam, Flurazepam, Phentermine). Potential for abuse less than for drugs in

schedule III. Abuse may lead to limited physical or

psychological dependence.

● Schedule V (Lomotil, Cheracol Syrup). Potential

for abuse and dependence less than for drugs in

schedule IV.

About 87 percent of drugs mentioned in NAMCS

were uncontrolled and about 9 percent were controlled

(table 4). Higher than average proportions of controlled

drugs were found in visits for five diagnoses: obesity and

other hyperalimentation (32 percent); neurotic disorders

or depressive disorder, NEC (33 percent); bronchitis,

acute; or not specified as acute or chronic ( 13 percent);

intervertebral disc disorders or other and unspecit3ed

disorders of back (25 percent); and sprains and strains

of sacroiliac region or other and unspecitled parts of

back (26 percent). Controlled drugs used with these

diagnoses are detailed by schedule in the sections ofthis

report that deal with the individual diagnoses.

6
Table 1. Number of office visits, number and percent of drug visits, number of drug mentions, drug mention rate, and drug intensity rate,

by all diagnoaes and selected principal diagnoses United States, 1980

Principal diagnosis and ICD-9-CM codeq

Office visits Drug Drug Drug

mention mentions intensity

All visits Drug visits ratez rate3

Number in

thousands

Number in

Percent

Number in

thousands Rate per visit

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

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

Obesity andother hyperalimentation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 278

Neurotic disorders or depressive disorder, NEC4 . . . . . . . . . . . . . . . . ...300. 311

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

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

Ischemic haart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .410-414

Acute upper respiratory infections of multiple or unspecified sitea (acute

LJRI). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...460.461.465

Acute pharyngitis or acute laryngitis and tracheitis . . . . . . . . . . . . . . ...462. 464

Allergic rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...477

8ronchitis, acut~ or not specified as acute or chronic . . . . . . . . . . . ...466. 490

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

Oiseasea ofsebaceous glands... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...706

Osteoarthritis andallied disorders orotherand unspecified arthropathies. . ..715-716

Intervertebral disc disorders orotherand unspecified disorders of back. .. 722,724

Sprains and straine of sacroiliac region or other and unspecified parta of

back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...846-847

Health supewision ofinfant orchild . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V20

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

Genera l medical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V70

575,745

9,551

8,081

13,652

11,748

25,137

10,430

16,969

10,277

8,439

8,323

5,921

10,578

8,297

6,071

7,393

17,496

26,256

16,078

363,489

7,592

6,589

7,158

10,067

22,282

9,043

15,977

9,020

7,621

7.855

5,477

8,946

6,799

3,716

4,411

10,341

8.727

4.732

63.1

79.5

81.5

52.4

85.7

88.6

86.7

94.2

87.8

90.3

94.4

92.5

84.6

82.0

61.2

59.7

59.1

33.2

29.4

679,593

17,496

15,070

11,951

18,168

46,484

26,523

32,311

16,139

10,479

16,349

1?,655

20,981

14,251

7,138

6,586

16,502

10,755

6,624

1.18

1.83

1.86

0.88

1.55

1.85

2.54

1.90

1.57

1.24

1.96

1.97

1.98

1.72

1.18

0.89

0.94

0.41

0.41

1.87

2.30

2.29

1.67

1.80

2.09

2.93

2.02

1.79

1.38

2.08

2.13

2.35

2.10

1.92

1.49

1.60

1.23

1.40

1~a~ed on the /nternatjonaI C\a~sjfjc8t/onof D;seases, 9th Revision, Clinical Modification. See refarence 1.

2Drug mentions divided by number of visits.

3Drug ~e”tions divided by numberOfdmg visi~.

4NEC = not elsewhere classified.

Table 2. Number and percent distribution of office visita by number of medications, according to all diagnoaes and selected principal diagnose= United States, 1980

Number of medications

Principal diagnosis and ICD-9-CM code~ All visits

Total None 1 2 3 4

5

or more

Number in

Percent distribution

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

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

Obesity andother hyperelimentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...278

Neurotic disorders or depressive disorder, NE& . . . . . . . . . . . . . . . . ...300.311

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

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

Ischemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...410-414

Acute upper respirsto~ infections of multiple or unspecified sites (acute

URN). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...460.461.465

Acute pharyngitis or acute laryngitis and tracheitis . . . . . . . . . . . . . . ...462. 464

Allergic rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...477

Bronchitis, acute; or not specified as acute or chronic. . . . . . . . . . . . ...466. 490

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

Diseases of sebaceous glands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...706

Osteoarthritis andallied disorders orotharand unspecified arthropathies . ..715-716

lntewertebral disc disordera orotherand unspecified disorders of back. .. 722,724

Sprains and strains of sacroiliac region or other and unspecified pens of

back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...846-847

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

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

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

575.745

9,551

8,081.

13,652

11,748

25,137

10,430

16,969

10,277

8,439

8,323

5,921

10,578

8,297

6,071

7,393

17,496

26,256

16,078

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

100.0

100.0

100.0

100.0

100.0

100.0

36.9

20.5

18.5

47.6

14.3

11.4

13.3

5.8

12.2

9.7

5.6

7.5

15.4

18.1

38.8

40.3

40.9

66.8

70.6

30.9

31.1

29.3

28.8

37.2

35.5

14.5

33.8

41.1

68.9

24.8

39.4

15.7

36.8

26.3

37.4

31.2

26.3

20.9

18.2

21.5

16.6

15.6

33.5

27.4

23.4

36.0

31.1

12.9

49.7

22.0

37.4

19.4

21.1

15.9

21.4

6.3

6.2

8.1

10.5

20.7

5.6

10.6

14.2

20.0

15.7

9.2

6.3

12.6

17.4

18.1

13.3

8.2

5.6

6.0

‘0.6

*1.8

4.1

9.2

13.3

“1.8

3.6

8.1

18.3

6.6

5.9

*1.3

*4.5

9.6

13.2

8.8

*3.8

“0.8

“0.2

“0.1

“0.4

1.8

7.2

‘1.7

“0.8

“0.8

3.4

10.5

“2.0

“0.5

‘0.9

*2.8

‘4.0

“0.2

*3.8

1.7

“0.3

*o. 1

1Basedon the jnternatjona\ Classifjcario” of Diseases, 9th Revision, Clinical Modification. See reference 1.

2NEC = not elsewhere classified.

7
Table 3, Percent distribution of drug mentions by entry status and prescription status, according to all diagnoses and selected principal diagnosa= United States, 1980

Entry status Prescription status

Principal diagnosis and ICD-9-CA4 code~ Total

Brand Generic Therapeutic Prescription

NonUndetermined

name name effect drug

prescription Undetermined

drug

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

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

Obesity and other hyperalimentation . ..278

Neurotic disorders or depressive disorder,

NEC4 . . . . . . . . . . . . . . . . . . . . . ..3OO. 311

Suppurative and unspecified otitis

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

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

Ischemic heart disease ., . . . . . . . . 410–414

Acute upper respiratory infections of

multiple or unspecified sites

(acute URl) . . . . . . . . . . . . ..460.461 .465

Acute pharyngitis or acute laryngitis and

tracheitis. . . . . . . . . . . . . . . . . . 462, 464

Allergic rhinitis . . . . . . . . . . . . . . . . . . ...477

Bronchitis, acute: or not specified as

acute or chronic . . . . . . . . . . . . . . 466,490

Asthma . . . . . . . . . . . . . . . . . . . . . . . . ...493

Diseases of sebaceous glands. . . . . . ...706

Osteoarthritis and allied disorders

or other and unspecified

arthropathies . . . . . . . . . . . . . . ..715–716

lntewertebral disc disorders or other and

unspecified disorders of back. .722, 724

Sprains and strains of sacroiliac region or

other and unspecified parts

of back . . . . . . . . . . . . . . . . . . . ..846-847

Health supewision of infant or child . . V20

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

General medical examination V70

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

100.0

100,0

100,0

100,0

100,0

100,0

71.2

65,6

59,4

84.8

71,6

79.7

73,6

73.3

62.9

45.8

70.3

66.6

67.4

79.5

85.4

82.8

20.8

66.1

52.1

24.2

33.2

35.2

12.4

26.1

18.3

25.0

22.9

34.4

9.8

27.2

18.6

29.7

18.3

13.5

12.8

75.4

25.5

44.6

Percent distribution

3.2 1.5 82.6

“0.7 “0.5 73.8

3.4 “2.0 89.4

“0.9 “1.9 89.5

“2.0 “0.4 86.8

1.4 “0.6 91.8

“0.7 ‘0.7 90.6

1.8 2.0 79.7

2.3 “0.4 82.3

42.3 *2.1 49.9

‘1,2 “1.4 86.0

13.0 *1.8 79.1

“1.0 1.9 86.5

“0.6 *1.6 83.2

“0.3 “0.8 89.5

“1.7 *2,8 85.3

3.5 “0.4 91.5

8.2 “0.2 42.9

“2.0 “1.3 . 90.3

12.6

24.8

5.2

7.5

10.8

6.2

8.0

16.5

15.0

5.8

11.5

6.1

10.3

14.5

9.4

10.3

4.7

48.9

6.4

4.9

*1.4

5.4

*2.9

2.4

2.0

1.4

3.8

2.7

44.4

2.6

14.8

3.2

*2.4

*1.O

“4,4

3.9

8.4

*3,3

1 Based on the International Classification of Diseases, 9th Revision, Clinical Modification. See refarence 1.

2NEC = “Ot elsewhere classified

8
Table 4. Percent distribution of drug mentions by composition status and Federal control status, according to all diagnoses and

selected principal diagnoaes United Ststes, 1980

Composition status Federal control status

Principal diagnosis and

ICD-9-CM codel Total Single Combination Multi- Undetermined ingredient Controlled Uncontrolled vitamin Undetermined

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

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

Obesity and other

hyperalimentation. . . . . . . . . . . . . 278

Neurotic disorders or depressive

disorder, NEC2 . . . . . . . . ...300.311

Suppurative and unspecified

otitis media . . . . . . . . . . . . . . . ...382

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

Ischemic haart disease . . . ...410-414

Acute upper respiratory infections

of multiple or unspecified sites

(acute URI). ., . . . . ...460.461.465

Acute pharyngitis or acute laryngitis

and tracheitis . . . . . . . . . . . .462, 464

Allergic rhinitis . . . . . . . . . . . . . . . .. 477

8ronchitis, acute; or not specified

as acute or chronic. . . . . ...466. 490

Asthma . . . . . . . . . . . . . . . . . . . . . . . . 493

Diseases of sebaceous glands. . ...706

Osteoarthritis and allied disordera

or other and unspecified

arthropathies . . . . . . . . . . . . 715-716

intervertebral disc disorders or other

and unspecified disorders of

back . . . . . . . . . . . . . . . . . ...722.724

Sprains and strains of sacroiliac region

or other and unspecified parts

of back . . . . . . . . . . . . . . . . . 846-847

Health supervision of infant

or chid., . . . . . . . . . . . . . . . . . . ..VZO

Normal pregnancy. . . . . . . . . . . . . . . v22

General medical examination. , . . . . V70

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

100.0

100.0

100.0

100.0

100.0

100.0

69.0

84.9

83.1

79.7

57.0

73.2

88.0

59.1

73.9

35.1

66.3

69.5

77.7

80.9

65.9

57.2

54.2

18.7

60.8

24.4

12.6

10.3

15.9

40.4

23.8

9.9

36.7

23.3

20.5

30.8

15.7

19.2

16.2

31.6

38.2

36.7

13.3

34.4

2.0

*1.3

“1.2

*1.6

“0.3

1.1

“0.7

‘0.4

*O. 1

“0.1

“0.3

“0.0

“0.2

“0.7

*1.5

“0.2

5.3

59.6

*1.5

4.6

*1.2

8.6

4.2

86.5

94.4

4.9

*1.4

5.4 31.9 62.7 5.4

*2.8 32.5 64.6 *2.9

3.9

5.8

5.6

2.4

2.0

“1.4

93.8

92.3

93.0

2.4

2.0

*1.4

3.8 9.7 86.5 3.8

2.7

44.4

6.9

“1.1

90.5

54.6

2.7

44.4

2.6

14.8

2.9

12.5

4.6

“0.6

85.0

80.6

96.2

2.6

14.8

3.2

*2.2 9.7 88.0 2.4

*1.O 24.8 74.2 *1.0

*4.4 25.5 70.1 “4.4

“0.5

*1.2

7.4

3.9

8.4

*3.3

95.6

90.4

89.2

3.9

8.4

*3.3

1Based on the lnternationa\ classification of Diseases, 9th Revision, Clinicsl Modification. see reference 1.

2NEC = not ~l$ewhere classified.

9
Section II ■ Selected endocrine

and metabolic disorders

Diabetes mellitus

Patients with diabetes mellitus made about 9.6 million visits to office-based physicians in 1980 (table 5).

During these visits there were about 17.5 million mentions of drugs for an average of 1.83 drugs per visit. In

about 80 percent of all visits, one or more drugs were

utilized.

DiiTerences in drug rates between females and males

were not statistically significant. The drug mention rates

for members ofthe black and white races were identical.

However, the age of the patient was a significant factor

in drug utilization. Drug therapy was more likely to be

used in visits by patients 65 years of age and older (drug

mention rate = 2.18) than in those by patients 45 –64

years of age (1.71).

Rates were also higher when patients returned to the

same physician for continuing care (old problems) than

when they presented diabetes mellitus as anew problem.

Most visits for diabetes mellitus were characterized

by the physician as routine chronic problems (75 percent). However, in the 8 percent of visits described as

chronic problem, flareup, the drug mention rate was

2.53 compared with 1.82 in routine visits.

When visits were grouped by exact number of medications, as shown in table 6, the highest proportion was

in the category of one drug regardless of the patient’s

sex, age, or race. However, the proportion of visits with

only one medication decreased as the patient’s age

group increased, while proportions of visits in the categories of three, and four or more increased.

Drug mentions are distributed by therapeutic categories in table 7. (The American Hospital Formulary

Service classification system is shown in appendix IV.)

About 83 percent of drugs used were in four categories:

cardiovascular drugs; central nervous system drugs;

electrolytic, caloric, and water balance; and hormones

and synthetic substitutes. The last category constituted

the highest proportion (40 percent), followed by cardiovascular drugs with 19 percent. Drug mention rates,

which are also shown in table 7, indicate that hormones

and cardiovascular drugs were ordered proportionately

more frequently for patients 65 years of age and older

than for those in younger age groups.

The specific drugs entered most frequently on Patient Record Forms when diabetes mellitus was the

principal diagnosis are shown in table 8. Each entry is

described in this table by its principal generic ingredients and therapeutic category. Drug names are based

on the physicians’ entries and may be brand or generic

names. If only one generic ingredient is listed,, it maybe

because the physician ordered the drug by its generic

name or because the physician’s entry was a brand

name of a single ingredient drug. Not all ingredients are

listed for every combination drug. The NAMCS drug

file lists up to five active ingredients.

It is apparent that the hormones and synthetic substitutes group consisted chiefly of insulin, which had 3.2

million mentions. Diabinese ( 1.7 million), Orinase (0.8

million), and Tolinase (0.6 million) were also frequently

mentioned. Among cardiovascular drugs prescribed

during visits by diabetic patients, Aldomet (a.hypotensive agent), Lanoxin, and Digoxin (two cardiac drugs)

were predominant. Lasix and Dyazide were the leading

diuretics prescribed. These nine drugs, representing

three therapeutic categories, accounted for about 49

percent of all drug mentions with diabetes mellitus as

the principal diagnosis. The inclusion of hypotensive

agents, diuretics, and cardiac drugs in this list of drug

mentions reflects the two conditions frequently concomitant when diabetic patients visi~ hypertension and

ischemic heart disease.g According to NAMCS data,

an anti-diabetic agent without mention of a diuretic,

hypotensive agent, or cardiac drug was ordered in 46

percent of all drug visits (although other drugs may have

been mentioned). An anti-diabetic agent with a diuretic

but not a hypotensive agent or a cardiac drug was prescribed in 13 percent, an anti-diabetic agent with a

hypotensive agent but not the other two in 6 percent, and

an anti-diabetic agent with a cardiac drug alone in 5

percent. About 6 percent of visits included all four

drugs. Patients 25–44 years of age were more likely to

be treated with an anti-diabetic agent without one of the

other three types of drugs (72 percent) than were those

10
aged 45–64 years (47 percent) or 65 years of age and

older (37 percent).

Exogenous insulin accounted for 18 percent of all

drug mentions. Diabinese, Orinase, and Tolinase, which

are oral hypoglycemic, also accounted for 18 percent

of the total. The 6.3 million mentions of these four antidiabetic agents are distributed by route of administration and sex and age of the patient in table B. There were

no statistically signilcant differences by sex, but age

was a factor in the choice of drug therapy. Proportions

of oral hypoglycemic increased and those of insulin

decreased as the patient’s age group increased.

. Because in NAMCS the primary identification of a

drug was based on the physician’s entry, the specific

drugs in table 8 were listed by brand or generic name,

whichever the physician wrote and which may well have

been the same pharmaceutical agent. For example,

Lanoxin is a brand name and digoxin is a generic name,

but both are the same substance. Therefore, it is also

important to know the quantity of speciiic generic substances prescribed as single ingredients or extant in

combination with other substances. The most frequently

used generic substances in visits for diabetes mellitus

are listed alphabetically by form of use in table 9. It

should be noted that it is not possible to sum the number

of uses of generic substances and arrive at a total of 100

percent of drug mentions because many generic substances are found in combination with other drugs, thus

creating a duplicated count of mentions. In addition,

quantities in table 9 may not agree with those in table 8.

One reason for this discrepancy is that a single ingredient generic entity may be marketed under different

brand names. The totals in table 9 include all mentions

where the generic entity was an ingredient, whereas

table 8 shows only the most frequent entries. As may be

expected, the most frequent generic substance used was

insulin. It was followed by chlorproparnide (represented

in table 8 by Diabinese) and hydrochlorothiazide.

Control of food intake is important in the manageTable B. Number and percent distribution of selected anti-diabetic agents

mentioned in office visita for diabetea mellitus by route of administration

of the drug, according to sax and age of the patient United Statea, 1980

Number of

selected

Sex and age anti-diabetic Total Orall Injectionz

agents in

thousands

Sex Percent distribution

Female . . . . . . . . . . . . . . . . 3,740 100.0 51.2 48.8

Male . . . . . . . . . . . . . . . . . . 2,593 100.0 47.2 52.8

Age

25-44 yeara . . . . . . . . . . . . 716 100.0 21.9 78.1

45-64 yeara . . . . . . . . . . . . 2,476 100.0 48.8 51.2

65yeara and over . . . . . . . 2,873 100.0 60.5 39.5

1~abine~e (chl~~r~pamide], Orinase (tolbutamide), and Tolinase (tolazamide).

‘Insulin.

ment of diabetes mellitus, whether or not the patient

requires medication therapy. Diet counseling was included in 38 percent of visits by patients with diabetes

mellitus. Patients were more likely to be instructed

about diet when they were on medication, however,

than when drugs were not indicated during the visit.

About 42 percent of visits with medication therapy

included diet counseling compared with 26 percent of

visits without medication.

Obesity and other hyperalimentation

Basic data on office visits and drug mentions are

shown in table 10. There were about 8.1 million visits

for obesity and other hyperalimentation, yielding a drug

mention rate of 1.86. Most visits (83 percent) were

made by women, and their drug mention rate of 1.97

was significantly higher than that of men (1.37). This

was mainly because 85 percent of visits by women included one or more drugs compared with only 65 percent

of those by men. The widest gap in rates by sex of the

patient was associated with this diagnosis. The drug

mention rates by sex of the patient for obesity and for six

other diagnoses are illustrated in figure 2. Of those

plotted, differences in rates for two diagnoses were not

statistically signiilcan~ ischemic heart disease and neurotic disorders or depressive disorder, NEC (NEC =

not elsewhere classified).

Patients 25 years of age and over made 89 percent

of the visits and they were more likely to be given

medication therapy than were patients less than 25

years of age.

More than twice as many visits were made by patients returning for care of the same problem than by

those presenting new problems, but the drug rates were

higher for new problem visits. The drug mention rate for

new problems was 2.27 compared with 1.70 for old

problems. The same comparison for the drug intensity

rate was 2.77 and 2.09. These rates suggest an inverse

relationship between the number of drugs and visit status.

Of all new problem visits, 41 percent included three

drugs compared with 12 percent of old problem visits

with the same number. One drug was ordered in only 11

percent of new problem visits compared with 37 percent

of return visits (table 11).

Drugs utilized for obesity patients were chiefly in

three groups: central nervous system drugs, diuretics,

and hormones and synthetic substitutes (table 12). These

therapeutic categories constituted 81 percent of all drug

mentions, with central nervous system drugs accounting for 39 percent. The drug mention rate of 76 central

nervous system drugs per 100 visits for women was

higher than that for men (56). Patients 25–44 years old

were also more likely to be given central nervous system

drugs than were older patients.

Chorionic gonadotropin, a member ofthe hormones

and synthetic substitutes group, accounted for 10 percent of all mentions and, based on entry names, was the

11
Obesity and other hyperalimentation

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

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

Izl

%:.:.%: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:.:.:%..

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

... ....... ....... .............. ....... ................ ....... ....... ...... ●.*.* .

❑

%%..+

.......... Male :.:.:.:.:

Eaaential hypertension

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

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

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

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

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

Iachemic heart diaeaae

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

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

Neurotic disorders or depressive disorder,

NEC1 . . . . . . . . . . . .

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

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

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

Bronchitis, acute; or not specified as

acute or chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... . . ... . . ...

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

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

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

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

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

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

Allergic rhinitis

:.:.:.:.:.:.:. :.:.:.:.:.:.:.:.:.:.:.:.:.:.:.~.~

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

.:.:.:.:.:.:.:.:.:.:.:.:.:.:.~.~.~.%

Intervertebral disc disordera or other and

unspecified disorders of back . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

w ‘

I I 1 I I I I I I I

I

o 0.6 0.6 1.0 1.2 1.4 1.6 1.8 2.0 2.2 2.4 2.6 2.8

1NEC = not elsewhere classified. Drug mention rate per viait

Figure 2. Drug mention rates per visit for selected diagnoses by sex of patient United States, 1980

most frequently mentioned drug (table 13). This drug is (4.8 million) in visits for obesity were under the regulatory control ofthe Drug Enforcement Administration.

This group of mentions is distributed by Drug Enforcement Administration schedule in table C. About 20

usually a-dministered by intramuscular injection. It was

reported in the 1981 Physicians’ Desk Reference that

this hormone has not been demonstrated to be effective

in attaining weight loss or appetite control.g The American Drug Index, 1981 does not list obesity among the

uses described for this drug. 10

Two diuretics, Lasix and Hydrochlorothiazide, were

also among the most frequent specific drugs prescribed

for obesity patients (13 percent of mentions). Three

anorexients with brand names Ionamin, Fastin, and

Phentermine (all in the generic class phentermine) accounted for another 13 percent. Three of every four drug

visits included at least one drug that was a hormone or

an anorexient.

As shown in table 14, phentermine was the leading

generic substance used for treatment of obesity. When

entry names were listed in table 13, chorionic gonadotropin was the most frequent, but three separate brand

names for phentermine were listed. Thus, phentermine

was the leading generic substance used.

Table 4 showed that 32 percent ofthe drug mentions

Table C. Number and percent distribution of federally controlled drug

mentions in office visits for obesity and other hyperalimentation by control category United States, 1980

Federal control categofy’

Controlled drug

mentions

Number in thousands

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,804

Percent distribution

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

Schedule I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0

Schedule I l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.9

Schedule ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.2

Schedule IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66.4

Schedule V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5

1Based on the classification system of the Drug Enforcement Agency of the Depatiment of

Justice.

12
percent of the regulated drugs were in schedule II; 13 schedule ~ phendimetrazine, schedule ~, phentermine

percent in schedule 1~, and 66 percent, the largest and diethylpropion, schedule IV. There may have been

group, in schedule IV. (See section I for a description of

the schedules and the scale.) Among the drugs listed in

other regulated substances used in obesity visits, but

their numbers did not meet National Center for Health

table 14, four are controlled. Dextroamphetamine is in Statistics standards of reliability for reporting.

Table 5. Number of office visits for diabates mellitus, number and percent of drug vieite, number of drug mentions, drug mention rate, and drug intensity rate,

by selected characteristics United States, 1980

Office visits Drug

Selected characteristic Drug

Drug

mentions mention intensity

All visits Drug visitsl rate2 rate3

Number in Number in Number in

Sax thousands thousands Percent thousands Rate per visit

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49,551 7,592 79.5 17,496 1.83 2.30

Female, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,683 4,544 80.0 11,100

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

1.95 2.44

3,868 3,048 78.8 6,396 1.65 2.10

Age

Under 45 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,473 1,019 69.2 1,817

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

1.23 1.78

4,108 3,138 76.4 7,030

65yeara and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.71 2.24

3,971 3,435 86.5 8,650 2.18 2.52

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,923 6,226 78.6 14,545

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

1.84 2.34

1,510 1,290 85.4 2.774 1.84 2.15

Problem status

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 871 602 69.2 1,019

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.17 1.69

8,680 6,990 80.5 16,477 1.90 2.36

Mejor reason for visit

Acute problam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,087 879 80.9 1,831

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

1.68 2.08

7,122 5,660 79.5 12,962

Chronic problem, flereup .,....... . . . . . . . . . . . . . . . . . . .

1.82

805

2.29

689 85.5 2,034

Post surgery/post injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.53 2.95

*117 *39 *33.6 *95 *.81 *2.44

Non-illness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419 *324 “77.3 *674 *1 .37 *1 .77

1A “i~]t in ~hi~h one or more drugswere ordered or provided.

2DrUg ~ention5 divided by number Of visits.

3Drug ~entio”~ divided by numbar Of drug visits.

b,nclude~ ~aceS Oth~r than white and black not shown as sersarata cata90ries.

13
Table6. Number and percent distribution of office viaits for diabetea mellitus by number of medication, according to selected characteristics: United States, 1980

Number of medications

All visits

Total None 1 2 3

4

or more

Selected characteristic

Number in

Sex thousands

8othsexea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Age

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

45–64 yeara. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Race

White ., ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Problem status

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mejor reason for viait

Acute problem, ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Other reasons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent distribution

19,551

5,683

3,868

1,473

4,108

3,971

7,923

1,510

871

8,680

1,087

7,122

805

537

100.0

100.0

100.0

20.5

20.0

21.2

31.1

27.3

36.8

21.5 10.5

23.1 10.9

19.2 9.9

16.4

18.8

13.0

100.0

100.0

100,0

30.8

23.6

13.5

“17.2 “4.5

20.7 *8.7

23.9 14.5

*7.5

14.5

21.6

39.9

32.5

26.5

100.0

100.0

21.4

*1 4.6

30.3

35.1

20.5 11,0

28.4 *8.2

16.8

“13.7

“30.8

19.5

100.0

100.0

*38.5

30.4

“1 5.6 *12.8

22,1 10.2

*2.2

17.8

100.0

100.0

100.0

100.0

“19.1

20.5

*1 4.5

*32.3

‘30.4

31.1

“24.7

*43.4

“30.5 “9.0

20.8 11.5

*21 .3 “7.0

“1 2.4 “5.0

“11.0

16.0

*32.5

*6.9

1 Includes races other than white and black not shown as SeParat@ Cate90~es.

Table 7. Number, percent distribution, and rate per 100 viaita of drug mentions in office visits for diabetes mellitus by therapeutic category,

according to sex and age of the patient United States, 1980

Sex Age

Both

sexes

Female Male Under 45-64 65 years

45 years years and over

Therapeutic categoryl

Number of mentions in thousands

All therapeutic categories .,.... . . . . . . . . . . . . . . . . . . . . 17,496 Ii<loo 6,396 1,817 7,030 8,650

Percent distribution

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

Cardiovascular drugs.......,.,.. . . . . . . . . . . . . . . . . . . . . 18.5 17.8 19.8 “6.0 17.9 21.7

Central nervous system drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.4 9.7 “8,9 *8.8 *8.5 10.2

Electrolytic, caloric, and water belance. . . . . . . . . . . . . . . . . . . . 14.8 15.5 13.6 *6.7 15.4 16.1

Hormones and synthetic substitutes . . . . . . . . . . . . . . . . . . . . . . 39.8 38.0 42,8 57.9 38.3 37.2

Another therapeutic cetegoriea. . . . . . . . . . . . . . . . . . . . . . . 17.5 19.0 14.9 20.6 19,9 14.8

Drug mention rate per 100 visits

Cardiovascular drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 35 33 *7 31 47

Central newous system drugs.... . . . . . . . . . . . . . . . . . . . . . 17 19 15 “11 *15 22

Electrolytic, caloric, and water balance. . . . . . . . . . . . . . . . . . . . 27 30 23 “8 26 35

Hormones end synthetic substitutes. . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 74 71 71 66 81

1 Based ~“ the ~lsSSifi~ation System Of the American Hospital Formulav service. See reference 5

14
Table 8. Number and percent distribution of drug mentions in office visits for diabetes mellitus by most frequently mentioned specific drugs described by

principal generic ingredient(s) and principal therapeutic catego~ United States, 1980

Name of drugl Drug mentions Principal generic ingredient Principal therapeutic catego~

All drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diabinese . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Orinase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tolinase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lasix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dyazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aldomet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lanolin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dioxin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands distribution

17,496

3,192

1,728

792

621

621

491

479

“391

*322

8,858

100.0

18.2

9.9

4.5

3.5

3.5

2.8

2.7

*2.2

●1.8

50.6

. . .

insulin

chlorpropamide

tolbutamide

tolazamide

furosemide

triamterene, hydrochlorothiazide

methyldopa

digoxin

digoxin

. . .

. . .

insulin and anti-diabetic egents

insulin snd anti-diabetic agents

insulin and anti-diabetic agents

insulin and anti-diabetic agents

diuretics

diuretics

hypotenaive agents

cardiac druga

cardiac drugs

. . .

1 Bs~ed on the phy~i~ian-s .snt~ on ths Patient Record form. The entry may bes brand or 9eneric nsme.

Zlfo”lyo”e ~enefic i“gredie”t is li~ted, the Phy~i~ia”Js e“t~ isthege”aric drug ors brsnd name drug thst consistachieflyof a SiI’@ generic ingredient.fJaynot includeaIl ingredientsfor

evew combination drug.

3Based on the classification system of the American Hospitsl Formulary Service. See reference 5.

Table 9. Number and percent distribution of druga used in office visits for diabetes mellitus by form of use, according to most frequently used

generic substances United States, 1980

Generic substance

Form of use

Drugs

used

Total Single Combinations ingredient

Chlorpropamide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Furosemide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrochlorothiazida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Tolazamida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tolbutamide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Triamterene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

1,733

714

626

1,331

3,198

617

621

820

491

Percent distribution

100.0 100.0

100.0 100.0

100.0 100.0

100.0 33.7 66.3

100.0 100.0

100.0 83.7 16.3

100.0 100.0

100.0 100.0

100.0 100.0

15
Table 10. Number of office visits for obesity snd other hyperalimentatiom number and percent of drug visits, number of drug mentiOns, drug mention rste,

and drug intensity rate, by salected c.haractaristics United States, 1980

Office visits

Drug Drug Drug

Selected characteristic mention

mentions intensity

All visits Drug visitsq rate2 rate3

Sex

Both sexea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Age

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

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

45years snd over . . . . . . . . . . . . . . . . . . . . . . . . . . .

Race

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

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

Problem status

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major reason for visit

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

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

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

Post surgetylpost injuv . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-i llness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

Number in

thousands

48,08,

6,686

1,395

873

4,902

2,307

6,706

1,300

2,351

5,730

*293

5,886

*186

*33

1,682

6,589

5,681

908

528

4,202

1,859

5,495

1,019

1,923

4,666

“207

4,997

*156

1,229

Percent

81.5

85.0

65.1

60.5

85.7

80.6

81.9

78.4

81.8

81.4

“70.7

84.9

“63.7

73.1

Number in

thousands

15,070

13,152

1,918

1,128

9,346

4,596

12,655

2,272

5,336

9,734

“362

11,683

“290

2,735

Rate c%r visit

1.86 2.29

1.97 2.32

1.37 2.11

1.29 2.14

1.91 2.22

1.99 2.47

1.89 2.30

1.75 2.23

2.27 2,77

1.70 2.09

*1 .24 ‘1.75

1.98 2.34

*1 .56 “1 .86

1.63 2.23

1A “i~h in which one or more drugs were ordsrsd or provided.

.’2Drug ~e”tions divided by numbsr Of visits.

3Drug ~sntio”~ divided by number of drug visits.

41”c,udes ~aceS other thsn white and blsck not shown as separate cste90~es.

16
Table 11. Number and percent distribution of office visits for obesity and other hyperalimentation by number of medications, according to

selected characteristics United States, 1980

Number of medications

Selected characteristic All visits

Total None 1 2 3

4

or more

Number in

Sex thousands Percent distribution

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

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

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

18,081

6,686

1,395

100.0

100.0

100.0

18.5

15.0

34.9

29.3

29.7

*26.9

16.6

17.0

*14.7

20.7

21.9

*1 4.8

15.0

16.3

*8.7

Age

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

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

45 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

873

4,902

2,307

100.0

100.0

100.0

39.5

14.3

19.4

*24. 1

31.6

26.2

*14.8

17.8

*14.7

*11.6

22.8

19.6

*10.0

13.5

20.1

Race

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

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

6,706

1,300

100.0

100.0

18.1

*2 I .6

30.2

*23.1

16.0

“20.3

18.8

*28.9

16.9

“6.1

Problem statua

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,351

5,730

100.0

100.0

18.2

18.6

*11.0

36.7

*1 3.4

17.9

40.7

12.4

16.7

14.3

Major reason for visit

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

Non-illness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other reasons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5,886

1,682

513

100.0

100.0

100.0

15.1

26.9

*29.2

29.7

28.2

*27.5

14.2

*1 9.9

*33.6

25.7

*7.2

*6.5

15.3

*1 7.8

*3.2

1 ,nclude~ ~sce~ other thsn white and black not shown as separate cate90ries.

Table 12. Number, percent distribution, and rate per 100 visits of drug mentions in office visits for obesity and other hyperalimentation by therapeutic cate90V’,

according to aex and age of the patient United States, 1980

Sex Age

Both

sexes Female Male Under 25-44 45 years

25 years years and over

Therapeutic catego/

Number of mentions in thousande

1,918 1,128

Percent distribution

100.0 100.0

40.5 *48.3

*22.2 *22.8

*1 4.7 *1 3.0

*22.6 *1 5.9

Drug mention rate per 100 visits

56 *62

“30 *29

*2O “17

All therapeutic categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,070 13,152 9.346 4.596

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

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

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

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

Allothertherapeutic categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100.0

39.1

23.7

18.6

18.6

100.0

38.8

23.9

19.1

18.2

100.0

42.2

23.6

18.8

15.4

100.0

30.3

24.0

19.4

26.3

73

44

35

76

47

38

80

45

36

60

48

39

Central newoussyatem drugs... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

1 ~a~ed on the cla~~ification system of the American Hospital Formulav se~ice. sea refarence 5,

17
Tabla 13. Number and percent distribution of drug mentions in office viaita for obesity and other hyperalimentation by most frequently mentioned specific

drugs dascribed by principal generic ingredient(s) and principal therapeutic categow United States, 1980

Name of drug~ Drug mentions Principal generic ingrediant(s)z Principal therapeutic categor#

All drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chorionic gonadotropin . . . . . . . . . . . .

Lasix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ionamin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrochlorothiazide . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fasten. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Thyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamin B-l Z . . . . . . . . . . . . . . . . . . . . . . .

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

Didrex . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tenuata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dextroamphetamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenylpropanolamina . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

15,070

1,532

1,321

892

664

619

566

540

469

456

424

*393

“304

6,888

Percent

100.0

10.2

8.8

5.9

4.4

4.1

3.8

3.6

3.1

3.0

2.8

*2.6

*2.O

45.7

chorionic gonadotropin

furosemide

phentermine

hydrochlorothiazide

phentermine

thyroid

Vttamin B-12

phentermine

benzphetamine

diathylpropion

dextroamphetamine

phenylpropanolamine

. . .

gonadotropin

diuratics

respiratory and cerebral stimulants

diuretics

respiratory and cerebral stimulants

thyroid and antithyroid

vitamin B complex

respirato~ and cerebral stimulants

respirato~ and cerebral stimulants

respirato~ and cerebral stimulants

respirato~ and cerebral stimulants

sympathomimetic agents

1 Based on the phy~i~ian,~ ~ntv On the Patiant Record Form. The entry maY be a brand or 9eneric ‘ame.

21f ~“ly ~“e genaric i“9redient is listed, the phy~icia”.~ e“tw is the ~e”etic drug ora brand name drug that consists chieflyofa sin91e9eneric ingredient.May notincludeall in9redientsf0r

every combination drug.

3Ba~ed on the ~las~ificatj~” ~y$tem of the American Hospital FormularySe~ice. See referenca 5.

Table 14. Number and percent distribution of drugs used in office visits for obesity and other hyperalimentation by form of use, sccording to most frequently

used generic substances United States, 1980

Form of use

Generic substance

Drugs

used

Total

Single

Combinations

ingredient

Number in

thousands Parcent distribution

Benzphetamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chorionic gonadotropin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dextroamphetamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diethylpropion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Furosemide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrochlorothiazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phendimetrazine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phentermina . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Thyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamin B-12, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

456

1,546

675

627

1,321

1,167

426

2,196

566

609

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

66.1

100.0

100.0

70.4

100.0

100.0

100.0

100.0

33.9

29.6

18
Section IIL Neurotic disorders

or depressive disorder, NECC

This pair of diagnoses (ICD-9-CM 300 and 3 11),

representing 13.7 million visits, had the lowest illnessrelated drug mention rate (0.88) (table 15) compared

with others shown in table 1. Only 52 percent of visits

included one or more drugs (table 15), with no statistically significant difference between proportions of

drug visits or rates for women and men. However, the

proportions of drug visits increased with each advancing age group ranging from 33 percent of visits by patients under 25 years of age to 85 percent of those 65

years of age and older. Drug visits were also proportionately more frequent when patients presented new

problems (66 percent) than when they returned for care

of an old problem (49 percent). Drug visits were also

more common when the major reason for visit was an

acute problem (65 percent) or a flareup of a chronic

problem (65 percent) than when it was a routine visit for a

chronic problem (45 percent). These findings suggest a

conservative use of drugs during ambulatory care ofilce

visits.

Psychotherapy or therapeutic listening was used in

proportionately more visits (69 percent) than drug therapy was (52 percent). When psychotherapy was used,

59 percent of those visits did not include medication

therapy.

For all drug visits, one was the most likely number

of medications since the 29 percent of visits in this

category was the highest proportion in the categories

greater than zero (table 16). One drug was also preeminent in new problem visits (42 percent). The relatively high proportion of visits with no medication prescribed when the major reason for visit was a routine

chronic problem suggests a decreased use of medication

as the course of treatment progressed.

In 87 percent of all drug visits the prescribed drugs

were in one or both of two central nervous system therapeutic categories: psychotherapeutic agents or sedatives

and hypnotics. The drug mention rates of these two

groups are detailed by sex and age ofthe patient in table D.

cNot elsewhere classified.

Table D. Drug mention rate per 100 ofFice visits for neurotic disorders or

depressive disorder, NEC,l for all central nervous system drugs and

selected subcategories by sex and age of the patient United States, 1980

All central Psycho- Sedatives

Sex and age nervous system therapeutic and

drugs2 agents hypnotics

Sex Rate per 100 visits

Female . . . . . . . . . . . . . . . . . 66 33 27

Male . . . . . . . . . . . . . . . . . . . 52 26 22

Age

Under 25 years . . . . . . . . . . *32 *17 *11

25-44 years . . . . . . . . . . . . 46 23 20

45-64 years . . . . . . . . . . . . 79 44 30

65 years And over . . . . . . . . 112 41 51

1 ~EC= not .gsewhere classified.

Z]ncludes analgesics and LiINiPYMk

Female patients were more likely to receive central

nervous system drugs than male patients. The rate of

sedatives and hypnotics (for example, tranquilizers)

increased with the patient’s advancing age group, but

differences among age groups using psychotherapeutic

drugs (for example, mood altering drugs) were not statistically significant.

Eight specific drugs in these two categories accounted for 36 percent of all drug mentions (table 17),

Valium (9 percent), Tranxene (4 percent), Ativan (4

percent), and Librium (3 percent) were the leading

drugs in the sedatives and hypnotics class. Elavil (7

percent), Sinequan (4 percent), Triavil (3 percent), and

Tofranil (3 percent) were the most commonly prescribed

psychotherapeutic agents. The list of generic substances

in table 18 directly reflects these eight drugs. The

amount of the generic substance used is higher than the

number of mentions of the entry in table 17 by that

generic name. That may be because another brand name

drug with the same generic ingredient used singly or in

combination with other ingredients was less frequently

prescribed, or because infrequently the physician en19
tered the name of the generic substance. In both instances the substance would be included in table 18 but

not in table 17. As has been evident in previous tables,

this tends to change the ranking somewhat. In table 17

the number of mentions of Valium (diazepam) is higher

than that of Elavil (amitriptyline), but in table 18 amitriptyline leads diazepam. These data provide alternative

approaches to analysis depending on the research needs.

It was shown in table 4 that federally regulated

drugs accounted for about one third of the drugs prescribed in the presense of neurotic disorders or depressive disorder, NEC. Of these 3.9 million mentions, 92

percent were in schedule IV (table E, see section I for a

description of the Drug Enforcement Administration

scale). Of the drugs listed in table 17, those in the

therapeutic category of sedatives and hypnotics are in

schedule IV; the others are not federally regulated.

Table E. Number and percent distribution of federally controlled drug

mentions in office visits for neurotic disorders or depressive disorder,

NEC1, by control cstegow United States, 1980

Federal control category2 Controlled drug

Number in thousands

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,880

Percent distribution

TotsI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

Schedule I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0

Schedule 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6

Schedule ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5

Schedule IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91.7

Schedule V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2

1 NEC = not elsewhere classified.

2Based ~nthe ~lassification system of the Drug Enforcement Agency of the Department Of

Justice,

Table 15, Number of office visits for neurotic disorders or depressive disorder, NEC,l number and percent of drug visits, number of drug mentions,

drug mention rate, and drug intensity rate, by selected characteristics United States, 1980

Office visits Drug Drug Drug

Selected characteristic mention mentions intensity

All visits Drug visits2 rate3 rate4

Sex

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

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

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

Age

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

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

45–64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Race

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

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

Problem statua

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major reason for visit

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

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

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

Poatsurgery/post injuw . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-illness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

513,652

9,029

4,623

1,233

7,185

3,609

1,424

12,B68

734

2,895

10,757

3,478

8,120

1,738

*21

*295

Number in

thousands Percent

Number in

thousands Rste per visit

7,158

5,010

2,148

407

3,039

2,500

1,212

6,639

46B

1,918

5,240

2,259

3,646

1,123

*9

“121

52.4

55.5

46.5

33.0

42.3

65.6

85.1

51.6

66.5

66.3

48.7

65.0

44.9

64.6

*43.4

“40.6

11,951

8,477

3,474

*495

4,383

4,352

2,721

11,088

820

3,068

8,883

3,376

6,175

2,147

*9

*244

0.88 1.67

0.94 1.69

0.75 1.62

“0.40 *1 .22

0.61 1.44

1.14 1.74

1.91 2.25

0.86 1.67

1.12 1.68

1.06 1.60

0.83 1.70

0.97 1.49

0.76 1.69

1.24 1,91

“0.43 *1 .00

‘0.83 ‘2.02

1 NEC = not elsewhere classified.

2A “i~it in which one or more drugs were ordered or provided.

3Drug mentions divided by number of visits.

4Drug mentions divided by number of drug visits.

Slncludes ~a~e~ other than white and black not shown as separate cate90tieS.

20
Table 16. Number and percent distribution of office visits for neurotic disordera or depressive disorder, NEC,l by number of medicetiona,

according to selected characteristics United States, 1980

Number of medications

Selected characteristic All visits

Total None 7 2 3

4

or more

Number in

Sex thousanda Percent distribution

Both sexea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213,652 100.0

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,029 100.0

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,623 100.0

47.6

44.5

53.5

67.0

57.7

34.4

14.9

4B.4

*33.5

33.7

51.3

35.0

55.1

35.4

“59.0

28.8

29.B

26.7

*26.9

28.0

31.0

2B.3

28.6

*31 .2

41.6

25.3

43.4

23.3

26.8

*1 9.3

15.6

16.7

13.3

“5.0

10.6

24.9

“24.7

14.B

*28.6

*1 3.0

16.2

14.0

14.7

24.2

*7.5

5.6 *2.5

B.3 *2.6

*4,1 *2.4

*1.1

*3.2 “0.5

*6.2 *3.5

*1 9.6 *12.6

5.6 *2.6

*5.1 *1.4

*8.6 *2.8

4.7 *2.5

*4.8 *2.8

5.1 *1.8

*B.5 5.2

“11.1 “3.0

Age

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

25-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

1,233

7,185

3,809

1,424

100.0

100.0

100.0

100.0

Race

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

black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12,B6B

734

100.0

100.0

Problem atatua

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,B95

10,757

100.0

100.0

Major reason for visit

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

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

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

Other reaaona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,47B

8,120

1,738

*316

100.0

100.0

100.0

100.0

1~Ec= not .gI$ewhere classified.

zrnclude~ ~aces Other than white and black not shown as sermrata cate90ries.

Table 17. Number and percent distribution of drug mentions in office viaits fbr neurotic disorders or depressive disorder, NEC,l by most frequently

mentioned specific drug described by principal generic ingredient(a) and principal therapeutic catego~ United States, 1960

Name of dru$ Drug mentions Principal generic ingredient Principal therapeutic catego@

Number in

thousands

Percent

distribution

All druga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,951 100.0 . . . . . .

Valium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Elavil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tranxene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sinequan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ativan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Triavil :

tibrium: ::::::::::::::::::::: :::::::::::::::::::::

Tofranil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,040

805

50B

441

420

402

*351

*322

7,661

B.7

6.7

4.3

3.7

3.5

3.4

*2.9

*2.7

64.1

diazepam

amitriptyline

clorazepate

doxepin

Iorazepam

perphenazine, amitriptyline

chiordiazepoxide

imipramine

sedatives and hypnotics

psychotherapeutic agents

sedatives and hypnotics

psychotherapeutic agenta

sedativea and hypnotics

psychotherapeutic agents

sedatives and hypnotics

psychotherapeutic agenta

1 NEC = not elsewhere classified.

z~a~ed on the phy~i~i~n<s ~ntv on the Patient Record Form. The entrf maybe a brand Or 9anaric name.

31f ~“lyone ~e”eric i“9redient is ]i=ted, tha Phy~ieian.s .S”tw is the genefic drug LXa brand name drug that consists chiefly of a single gi3WriC ingredient. May not include all ingredients for

ava~ combination drug.

‘t~ased ~“ the ~la~~ification system Of the American Hospital FormuW SeNice. See reference 5.

21
Table 18. Number and percent dwtribution of drugs used in office visits for neurotic disorders or depressive disorder, NEC,l by form of use,

according to moat frequently used generic substance: United States, 1980

Form of use

Generic substance

Drugs

used

Total

Single

Combinations

ingredient

Number in

thouaanda Percent distribution “

Amitriptyline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,513 100.0 68.3 31.7

Chlordiazepoxide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 664 100.0 58.3 41.7.

Clorazepate. .,,.........,.,.,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 599 100,0 100.0

Diazepam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,060 100,0 100.0

Doxepin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 607 100.0 100.0

lmipramine, . ., . . . . . . . . . . . . . . . . . . . ...,,,,,.,,,........,.,,,,,,,,, , .,,,,,,,, 454 100.0 100.0

Lorazepam, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425 100.0 100.0

Perphenazine, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503 100.0 4.4 95.6

1 NEC = “O? elsewhere classified.

22
Section IV. Selected

cardiovascular diseases

Essential hypertension

Patients with this diagnosis made 25.1 million visits,

the highest number of visits for an illness-related diagnosis in 1980. During these visits there were about 46.5

million mentions of drugs for an average of 1.85 drug

mentions per visit (table 19).

The drug mention rate for women (1.92) was significantly higher than that for men (1.72), and drugs

were more likely to be used for patients 45 years of age

and older than for younger patients. However, the difference between rates for patients 45–64 years of age

(1.84) and older patients (1.9 1) was not statistically

significant.

Almost all visits were made by patients the physician had treated previously for the same problem (91

percent), and 9 of 10 such visits included medication

therapy. When hypertension was presented as a new

problem, drugs were less likely to be used, since about

79 percent of such visits included medication therapy

compared with 90 percent in old problem visits. There

was little variation in drug intensity rates among the

variables listed in table 19 with averages hovering

around 2.0.

It is shown in table 20 that one drug ordered or

provided was the most likely event with 36 percent of

the visits in that category. In another 27 percent of

visits, two drugs were mentioned. Proportions of visits

decreased as the number of drugs prescribed during a

visit increased.

Drug mentions are shown by therapeutic categories

in table 21. The majority of drug mentions were in two

classes: hypotensive agents (24 percent) and diuretics

(30 percent). Another 8 percent were cardiac drugs.

Some beta-adrenergic blocking agents classified as cardiac drugs by the American Hospital Formulary Service (for example, propranolol and nadolol) are used to

treat angina pectoris and other heart conditions as well

as hypertension, thus increasing the proportion of cardiac drugs used with hypertension.

Among all therapeutic categories, only the difference between the drug mention rates of women and men

who were prescribed central nervous system drugs was

statistically signiilcant. The small differences in rates of

other categories were probably due to sampling variability.

A wide variety of drugs were used in hypertension

visits. The 30 drugs listed in table 22 accounted for

about 60 percent of all drug mentions. The reader is

cautioned that the ranking may be somewhat artificial

because some estimates do not differ significantly from

other near estimates due to sampling variability. Of the

30 listed drugs, 10 are hypotensive agents, 9 are diuretics, 4 are cardiac drugs, and 2 are potassium replacement solutions. Only one is a tranquilizer. Dyazide

(6 percent) and Hydrochlorothiazide (5 percent) were

the most frequently prescribed drugs. Aldomet was the

leading hypotensive agent (5 percent). Inderal (propranolol), a cardiac drug often used as an antihypertensive, also accounted for 5 percent. There were also

415,000 mentions of influenza virus vaccine and 303,000

mentions of Vitamin B-12, which suggests that preventive medicine was practiced during visits by at-risk

patients.

The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure recommends a “stepped-care” approach to drug therapy. In

their four-step sequence, step 1 is a diuretic and step 2 is

the addition of an adrenergic inhibiting agent (classified

as hypotensive agents in this report).11 The degree of

compliance with steps 1 and 2 of the committee’s recommendation may be estimated from National Ambulatory Medical Care Survey (NAMCS) data. Visits for

hypertension were examined to determine how many

included a diuretic without a hypotensive agent (although

other drugs may have been listed), a hypotensive agent

without a diuretic, both types of drugs in one visit, or

neither one. The results are shown in table F. In about

one quarter of all visits, neither of these therapeutic

categories was mentioned. The proportionately largest

group, about 29 percent, included a diuretic only, 24

percent had a hypotensive agent only, and 22 percent

23
Table F. Percent distribution of drug visits for essential hypertension by concomitance of two therapeutic categories, according to sex and age of patient

and problem status: United Statas, 1980

Therapeutic categoryl

Sex, age, and problem status Total

No diuretics Diuretics

or Diuretics

Hypotensive and

hypotensive agants2 hypotensive

agents2 agents2

Sex

8oth sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

Age

Under 45 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

45–64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

Problem status

New problem, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

25.6

25.6

25.8

22.7

23.6

28.7

21.5

26.0

Percent distribution

28.7 23.7

29.8 23.9

26.7 23.4

32.5 21.3

30.3 23.2

25.8 24.9

35.3 21.8

28.1 23.9

22.0

20.7

24.3

23.5

22.9

20.6

21.4

22.0

1 Based on the c{assificstio” system of the Americsn Hospital Formulaw seWiCe. see referenca 5.

21”clUde~propra”oIoI,which is classified s cardiac drug by the American Hospital Fo~uW ‘emice

included both a diuretic and a hypotensive agent. Women

patients were more likely to use a diuretic alone than a

diuretic with a hypotensive agent, but the difference

between these two categories for men was not statistically significant. A higher proportion of visits fell in

the diuretics only group than in the dual category when

patients visited for new problems. This suggests a degree of compliance with the recommendation to use a

diuretic without other drugs in the early stage of treatment. The predominance of the diuretic only category

did not change for different age groups.

It is apparent from the repetition of generic descriptors shown with the drug entries listed in table 22 that

some brand name drugs consist of the same generic

substances as others. The most frequently utilized generic substances are shown in table 23. Hydrochlorothiazide (10.5 million uses) was clearly the most frequently used generic ingredient.

Ischemic heart disease

There were 10.4 million visits for ischemic heart

disease (table 24). The number of visits by men (59

percent) exceeded those by women(41 percent). This is

one of the few conditions not related to the sex of the

patient found in NAMCS where the visit rate of male

patients exceeded that of female patients. However,

higher visit rates do not necessarily portend higher drug

mention rates since there was no statistically significant

difference betwen the rates of the two sexes. But the

drug mention rate of 2.54 and the drug intensity rate of

2.93, regardless of sex, were higher than any other rates

in this report.

Age of the patient was a more influential variable in

the use of medication therapy than the sex ofthe patient.

24

Patients 65 years and over were more likely to have

drugs prescribed than younger patients were, and the

average number of drugs per drug visit was also higher

for older patients.

About 88 percent of all visits were made by patients

returning for care of old problems, and their drug mention rate of 2.62 was signiilcantly greater than the rate of

2.00 for patients with new problems. When the return

visit was caused by a flareup of a chronic problem rather

than a routine return visitor an acute problem, medication therapy was proportionately more frequent. About

95 percent of visits due to a flareup of a chronic condition includeddrugs compared to 86 percent of visits of

a more routine nature. The mean number of medications during drug visits necessitated by the ir~tensification of a chronic problem was 2.89, higher than the

average number for all visits.

me high drug rates associated with this diagnosis

were due to the relatively large proportions of visits with

three, or four or more drugs (table 25). On the average,

20 percent of the visits included three drugs and 29

percent included four or more, a total of 49 percent in

the highest categories of drug mentions. This total exceeded that of any other diagnosis in this report. This

was particularly evident in the oldest age group with a

total of52 percent of the visits in the two highest medication categories.

Predictably, 53 percent of all medications used with

ischemic heart disease were cardiovascular drugs (table

26). This therapeutic category constituted a larger proportion of visits by male patients (56 percent) than by

female patients (48 percent), but the differences by age

were not statistically significant. Diuretics were also

prominent among therapeutic categories and accounted

for 13 percent of drug mentions. This class of drugs con-
stituteda largershareof mentionsfor patients65 years

of age andolder thanit did for youngerpatients.

Table 27 shows that 15 drugs enteredon Patient

Record Forms by physicians whose patients had

ischemic heartdisease constituted57 percent of their

mentions.Three cardiacdrugs-Inderal, Lanoxin, and

Digoxin-accounted for21 percent.As mentionedpreviously,thebeta-blockerInderaliswidelyusedfor both

essentialhypertensionandischemicheartdisease.This

is substantiatedintables22 and27. Another20 percent

comprised the vasodilatingagents—Isordil,Nitroglycerin, Nitr-bid, Nitrostat,and Sorbitrate.Lasix, Dyazide, and Hydrochlorothiazidewere the most prominentdiuretics,totalingabout9 percentof drugmentions.

Aspirin,Vaiium, andCoumadin(2 percenteach) were

alsoamongthedrugsmostfrequentlyprescribed.About

1 percentof mentionswere influenzavirusvaccine.

Nitroglycerin(about 3 millionuses) andisosorbide

(2.7 million)werethegenericsubstancesmostfrequently

usedas singleingredientvasodilatingagents(table28).

Propranolol(2.8 million)anddigoxin(2.9 million)were

the leadingsubstancesused in cardiac drugs.

Table 19. Number of office visits for essential hypertension, number and percent of drug visits, number of drug mentions, drug mention rate,

and drug intensity rata, by selected characteristics United States, 1980

Office visits

Selected characteristic Drug Drug Drug

mentions mention

All visits

intensity

Drug visitsl rate2 rate3

Sex

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

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

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

Age

Under 45 yeare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Race

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

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

Problem status

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major reason for visit

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

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

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

Post surgery/pOst injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-illness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

425,137

15,787

9,350

3,019

11,458

10,660

22,048

2,940

2,155

22,981

1,985

19,209

2,114

*81

1,748

Number in

thousands

22,282

14,203

8,079

2,532

10,361

9,388

19,507

2.637

1,692

20,590

1,611

17,339

1,946

*63

1,322

Percent

Number in

thousands

88.6

90.0

86.4

83.9

90.4

88.1

88.5

89.7

7_8.5

89.6

81.2

90.3

92.1

*78.6

75.6

46,484

30,365

16,119

5,068

21,096

20,320

40,965

5,245

3,380

43,103

3,218

36,471

4,376

“197

2,221

Rate per visit

1.85 2.09

1.92 2.14

1.72 2.00

1.68 2.00

1.84 2.04

1.91 2.16

1.86 2.10

1.78 1.90

1.57 2.00

1.88 2.09

1.62 2.00

1.90 2.10

2.07 2.25

*2.43 *3.1 3

1.27 1.68

1A “i~it in which one or more drugswere ordered or provided.

2Drug ~antions divided by numberOfvisits.

3Dmg ~a”tion$ divided by numberof dru9 visits.

41”c[ude~ra~esother than white and black flOt shown as Separate cste90ries

25
Table 20. Number and percent distribution of office visits for’essential hypertension by number of medication, according to selected characteristics

United States, 1980

Number of medications

Selected characteristic All visits

Total None 1 2 3

4

or more

Sex

Both aexea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Age

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

45–64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Race

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

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

Problem atatua

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major reason for visit

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

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

Chronic problem, flareup . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . .

Post surge~/poat inju~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-i llneas care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousanda Percent distribution

‘25,137 100.0 11.4 35.5 27.4

15,787 100.0 10.0 34.6 28.0

9,350 100.0 13.6 36.8 26.5

3.019 100.0 16.1 37.6 25.0

11 ;456

10,660

22,048

2,940

2,155

22,981

1,985

19,209

2,114

“81

1,748

00.0 9.6 36.0 27.9

00.0 11.9 32.3 27.6

00.0 11.5 35.8 26.4

100,0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

*1O.3 33.1 35.2

21.5 31.4 27.7

10.4 35.9 27.4

*18.8 36.5 23.3

9.7 35.2 28.9

“6.0 32.4 27.2

. . . . . . ,.,

24.4 43.0 ‘17.8

14.2 11.5

14.2 13.1

14.1 9.2

*9.7 “11.6

14.2 10.4

15.4 12.7

14.2 12.1

13.7 “7.7

“1O,2 *9.2

14.5 10.8

*11.3 *1O.1

13.9 12.3

21.3 *11.2

. . . . .

*11.9 *2.9

1 ,nclu~es raceS other than white and black not shown m separate cate90~=.

26
Table 21. Number, percent distribution, end rate per 100 visits of drug mentions in office visits for essential hypertension by therapeutic category,

according to sex and age of the pstiene United States, 1980

Therapeutic categoryl

Sex Age

Both

sexes

Female Male Under 45-64 65 yeara

45 years years end ovar

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

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

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

Hypotenaive agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiac druga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vesodilating agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Central netvoua system drugs, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Analgeaica andantipyretica . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Diuratics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Replacement solutiona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Hormonea andsynthetic substitutes . . . . . . . . . . . . . . . . . . . . . . . . . .

Another therapeutic categories.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Hypotansive agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Analgesics andantipyretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Electrolytic, caloric, and watar balance. . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Hormonea andsynthetic aubatitutes . . . . . . . . . . . . . . . . . . . . . . . . . .

46,464

100.0

34.8

23.9

6.0

2.5

12.5

5.6

4.1

1.9

34.2

29.6

4.1

2.6

4.0

11.7

35

44

15

5

23

10

7

“3

63

55

●8

5

7

30,365

100.0

33.2

23.7

6.7

2.6

13.6

6.4

4.2

“2.0

32.8

26.6

4.0

2.9

4.7

12.6

64

46

13

5

26

12

8

●4

63

55

●8

6

9

Number of mentions in thousands

16,119 5,068

Percent distribution

100.0 100.0

37.7 32.5

24.2 24.4

10.5 ●7.1

●2.3 “0.8

10.5 6.5

“4.2 ●1.9

●3.8 “3.5

*1.7 *1.5

36.8 41.7

31.5 34.4

“4.3 ●5.6

●2.5 ●2.5

●2.6 “3.2

9.9 *1 1.6

Drug mention rate per 100 visits

65 55

42 41

18 12

4 ●1

18 ●14

7 ●3

6 *6

“3 ‘3

63 70

54 58

*7 *9

●4 ●4

●5 *5

21,096

100.0

33.3

23.3

8.3

“1.6

13.2

5.3

4.4

“2.4

36.5

32.1

4.1

*2.2

4.2

10.6

61

43

15

*3

24

10

8

*4

67

59

8

●4

8

20,320

100.0

36.8

24.3

7.9

*3.8

12.8

6.9

*3.8

*1.5

29.9

25.8

*3.8

“3.4

*3.9

13.2

70

46

15

*7

24

13

*7

*3

57

49

*7

●6

“7

1 Ba$~d on the ~la~aificati~n system Of tha American Hospital FormulawService. sea rafar.nce 5.

27

.. ..
Table 22, Number and percent distribution of drug mentions in office visits for essential hypertension by moat frequently mentioned specific drugs

described by principal generic ingredient(s) and principel therapeutic categow United States, 1980

Name of drugl Drug mentions Principal generic ingredient Principal therapeutic catego$

Number in

thousands

46,484

2,583

2,449

2,284

2,090

1.836

1;779

1,569

1,325

910

869

787

786

730

650

644

619

588

578

557

529

479

447

415

402

402

*362

*353

*344

*319

“303

18,496

Percent

distribution

100,0

5.6

5.3

4.9

4.5

4.0

3.8

3.4

2.9

2.0

1.9

1.7

1,7

1.6

1.4

1.4

1.3

1.3

1.2

1.2

1.1

1.0

1.0

0.9

0.9

0.9

*0.8

“0.8

80.7

“0.7

“0.7

39.8

. . .

triamterene, hydrochlorothiazide

hydrochlorothiazide

methyldopa

propranolol

hydrochlorothiazide

chlorthalidone

metoprolol

furosemide

methyl dopa, hydrochlorothiazide

chlorothiazide

reserpine, hydralazine, hydrochlorothiazide

apironolactone, hydrochlorothiazide

reserpine

hydralazine

potassium replacement solution

potassium replacement solution

hydrochlorothiezide

diazepam

ibuprofen

prazosin

nadolol

digoxin

influenza virus vaccine

methyclothiazide

clonidine

aspirin

digoxin

methyclothiazide, deserpidine

chlorpropamide

vitamin B-1 2

. .

. .

diuretics

diuretics

hypotensive agents

cerdiac drugs

diuretics

diuretics

hypotensive agenta

diuretics

hypotensive agents

diuretics

hypotensive agents

diuretics

hypotensive agents

hypotensive agents

replacement solution

replacement solution

diuretics

sedatives or hypnotics

hypotensive agenta

hypotensive agents

cardiac drugs

cardiac druga

vaccines

diuretics

hypotensive agents

analgesics and antipyretics

cardiac drugs

hypotenaiva agenta

anti-diabetic agents

vitamin B complex

. . .

1 Based on the phy~ieia”,~ ~ntv On the patient Record Form. The entry maY be a brand Or 9erieric ‘ame,

21f only ~“e ~e”eric ingredient is listed, the ~hY~i~ia”,s ~ntw is the genetic drug ora brand name drug that consists chiefly Of a 6in91e 9eneric ingredient. Mw not includeall in9redientsf0r

every combination drug.

3Ba~ed on the classification system of the American Hospital Formulaw Service. See reference 5.

28
Table 23. Number and percent distribution of drugs used in office visits for essential hypertension by form of use, according to most frequently

used generic substances United Ststes, 1980

Generic substance

Form of use

Drugs

used

Total Single Combinations

ingredient

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

Chlorothiazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chlorthalidone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Clonidine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diazepam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Furosemide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydralazine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrochlorothiazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ibuprofen, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Metoprolol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Methyclothiazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Metolazone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nadolol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prazosin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Proprsnolol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rauwolfia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reserpine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Spironolactone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Triamterene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

1

730

1,304

2,435

737

588

800

1,325

1,763

0,536

557

1,583

784

3,410

405

479

542

2,379

437

2,665

847

2,612

Percent distribution

100.0 66.6 33.4

100.0 69.2 30.8

100.0 78.5 21.5

100.0 62.4 37.6

100.0 100.0

100.0 100.0

100.0 100.0

100.0 44.5 55.5

100.0 46.8 53.2

100.0 100,0

100.0 100.0

100.0 53.8 46.2

100.0 68.2 31.8

100.0 100.0

100.0 100.0

100.0 100.0

100.0 94.1 5.9

100.0 61.2 38.8

100.0 30.7 69.3

100.0 7.1 92.9

100.0 1.1 98.9

Table 24. Number of office visits for iachemic heart disease, number snd percent of drug visits, number of drug mentions, drug mention rate,

and drug intansity rate, by selected characteristics United States, 1980

Selected characteristic

Office visits Drug Drug Drug

mention

All visits

mentions

intensity

Drug visitsl rate2 rate3

Sex

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

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

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

Age

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

45-64 yaara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Race

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

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

Problem status

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major reaaon for visit

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

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

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

POstsurgery/pOat injuw . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-illness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

41 (343(3

4,249

6,181

*329

4,071

6,030

9,955

427

1,280

9,151

1,3B0

6,668

1,506

*362

514

Number in

thousands

9,043

3,787

5,256

*245

3,360

5,437

8,655

“340

995

8,048

1,201

5,705

1,437

*308

391

Percent

Number in

thousands Rate Der visit

86.7

- 89.1

85.0

*74.5

82.6

90.2

86.9

79.5

77.8

88.0

87.1

85.6

95.4

85.1

76.0

26,523

10,940

15,583

*698

9,374

16,452

25,402

967

2,565

23,958

2,948

17,212

4,345

1,021

998

2.54 2.93

2.57 2.89

2.52 2.96

*2.1 2 *2.85

2.30 2.79

2.73 3.03

2.55 2.93

2.26 2.84

2.00 2.58

2.62 2.98

2.14 2.45

2.58 3.02

2.89 3.02

*2.82 *3.31

1.94 2.55

1A “i~it in which one or more drugswere ordered or provided.

2Drug ~ention~ divided by numberOfvisi~,

3Drug ~ention~ divided by numberof drug visits.

41nclude~ra,.es Otherthan ~hits a“d black n~I shown as separate Categories, I

29
Table 25. Number and percent distribution of office visits for ischemic heart diseese by number of medications, according to selected characteristics

United Ststea, 1980

Number of medications

Selected characteristic All visits

Total None 1 2 3

4

or more

Number in

Sex thousands Percent distribution

Both saxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110,430 100.0 13.3

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,249 100.0 10.9

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,181 100.0 15.0

Age

Under 45yesra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45–64yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65yeara andovar . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Race

White, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Problem status

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major raason for viait

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

Chronic pmblem,m urine . . . . . . . . . . . . . . . . . . . . . . .

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

POatsurgery/post in jury . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-ill ness care. . ., ., .,.,..... . . . . . . . . . . . . . . . .

*329

4,071

6,030

9,965

427

1,280

9,150

1,380

6,668

1,506

*362

514

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

*25.6

17.5

9.8

13.1

“20.5

*22.2

12.1

*1 2.9

14.4

*4.6

. . .

“24.0

4.5

8.5

1.7

“14.9

17.0

12,8

14.9

“6.0

“22.1

13.4

*21 .8

11.5

“1 9.0

. . .

*20.9

23.4

23.2

23.5

*1 6.6

21.6

25.0

22.9

“30.6

*1 8.5

24.1

28.5

23,6

*1 9.8

*I;:9

20.0 28.9

18.2 29.2

21.2 28.6

*21.1 “21 .9

18.6 25.3

20.8 31.6

19.7 29.4

*28.5 *14.5

*15.9 *2 I .3

20.5 29.9

*21 .2 *1 5.6

20.7 29.7

“20.1 36.6

. . .

*1 6.6 “20.6

1 ,nc,udas races ~~har ~hsn whita snd bhck not shown ss sapsrate cata90rias

30
Table 26. Number, percent distribution, and rate per 100 visits of drug mentions in office visits for ischemic heart disease by therapeutic category,

according to aex and age of the patient United States, 1980

Therapeutic categoryl

sex Age

Both

sexes

Female Male Under 45-64 65 years

45 years years and over

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

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

Cardiovascular druga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Hypotensive scents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vasodilating agenta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Analgesics andantipyretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sedatives and hypnotica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Hormones andsynthetic aubatitutes. . . . . . . . . . . . . . . . . . . . . . . . . . .

Allothertherapeutic categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiovascular druga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiac druga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hypotensive agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Central nervoua aystem druga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Analgesics andantipyretica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Hormones andaynthetic substitutea. . . . . . . . . . . . . . . . . . . . . . . . . . .

26,523

100.0

52.9

25.6

4.0

23.0

11.7

5.3

4.4

16.1

12.9

4.0

15.3

135

65

10

58

30

13

12

41

33

10

Number of mentions in thousanda

10,940 15,583 *698

100.0

48.3

22.2

*3.8

22.3

12.8

*5.8

*4.4

16.8

12.7

*5.5

16.6

Percent distribution

100.0 100.0

56.1 “68.0

26.1 *24.4

*4, 1 4.0

23.4 *33.8

11.0 “11.0

*4.9 *5.4

*4.4 *5.4

15.6 *9.6

13.0 *8.1

*2.9 *1.9

14.4 *9.5

Drug mention rate per 100 visits

124 141 *144

57 71 *52

*lo *lo *13

57 59 “72

33 28 *23

*15 *12 *1 1

*11 *1 1 *1 1

43 39 “20

33 33 “17

*14 *7 *4

9,374

100.0

56.9

28.1

*3.4

24.9

11.1

*4.5

*5.8

13.2

9.6

*4.7

14.1

131

65

*8

57

26

*1 o

“13

30

22

“11

16,452

100.0

50.0

24.3

*4.2

21.4

12.1

5.7

*3.5

18.0

15.0

“3.7

16.2

136

66

*12

58

33

16

“10

49

41

*lo

1Basedon the classificationsystem of the American Hospital Formularysewice. see refarence 5.

Table 27. Number and percent distribution of drug mentions in office visita for ischemic heart disease by most frequently mentioned specific drugs

described by principal generic ingredient(s) and principal therapeutic catego~ United States, 1980

Name of drugl Drug mentions Principal generic ingredient Principal therapeutic catego$

All drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Inderal ,Sordil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . .

. . . . . ..- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nitroglycerin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lanolin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lasix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Dyazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nitro-bid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Valium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nitrostat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Coumadin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sorbitrate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

influenza virus vaccine, type A,B. . . . . . . . . . . . . . . . . . .

Hydrochlorothiazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...!”” . .

Number in Percent

distribution

26,523

2,739

2,188

1,835

1,665

1,295

1,201

708

607

516

419

*394

“390

*366

*366

*316

11,517

100.0

10.3

8.3

6.9

6.3

4.9

4.5

2.7

2.3

1.9

1.6

*1.5

*1.5

*1.4

“1.4

*1.2

43.4

. . .

propranolol

isosorbide

nitroglycerin

digoxin

furosemide

digoxin

triamterene, hydrochlorothiazide

nitroglycerin

aspirin

diazepam

nitroglycerin

warfari n

isoaorbide

influenza virus vaccine

hydrochlorothiazide

. .

,..

cardiac drugs

vaaodilating agenta

vasodilating agents

cardiac drugs

diuretics

cardiac druga

diuretics

vasodilating agents

analgesics and antipyretics

sedatives and hypnotics

vasodilating agents

coagulents and anticoagulants

vasodilating agents

vaccines

diuretics

. . .

1 ~a~ed on the phy~i~ian.s entv On the Patient Record Form. The entry may be a brand or 9eneric name.

21fonlyo”e ~ener~ in9radient is ,i~ted, the phy~i~ian~ entv is the ge”e~c drug ~ra brand name drug that con.$i$ts chiefly of a single generic ingredient. May not include al[ ingredients for

every combination drug,

3Ba~ed ~n the ~la~~ifi~atio” system of the American Hospital Formularf SeNice. See reference 5.

31
Table 28, Number and percent distribution of drugs used in office visits for ischemic. heart disease by form of use, according to most frequently used

generic substances: United States, 1980

Generic substance

Form of use

Drugs

used

Total Single Combinations ingredient

Number in

thousands

766

435

2,866

1,295

1,583

2,652

2,956

648

2,841

Percent distribution

100,0 83.7 16.3

100.0 100.0

100.0 100.0

100.0 100.0

100.0 65.0 35.0

100.0 100.0

100,0 100.0

100.0 96.6 3.4

100.0 99.9 0.1

00.0 100.0

00.0 4,8 95.2

00.0 100.0

32
Section V. Otitis media and

selected respiratory diseases

Suppurative and unspecified otitis media

Children under 3 years of age were the patients in 43

percent of the estimated 11.7 million visits for otitis

media, and children 3– 14 years of age accounted for 37

percent—a total of 80 percent of visits by patients under

15 years of age (table 29).

The drug mention rate for the youngest group ( 1.56)

was not significantly higher than that of patients 3– 14

years of age ( 1.46); however, ifthe patient was 15 years

of age or older, the drug mention rate ( 1.67) was higher

than that of patients 3– 14 years.

Visits were about evenly divided between new and

old problems, but 94 percent of new problem visits

included drugs compared to only 78 percent of return

visits. Some of the latter group were probably followup

visits in which medication was discontinued.

In most of the visits the diagnosis shown on the

Patient Record Form did not indicate whether the patient’s case of otitis media was acute or chronic (that is,

almost all were coded as ICD-9–CM 382.9, unspecified). However, table 29 shows that in about 77 percent

the major reason for the visit was described as an acute

problem, and 90 percent of those visits included medication therapy.

Five therapeutic categories incorporated about 90

percent of the drug mentions (table 30). The majority

were anti-infective agents (51 percent). These were

chiefly antibiotics. The next largest group used were

antihistamine drugs (19 percent). Skin and mucous

membrane preparations accounted for 8 percent eye,

ear, nose and throat preparations were named in 6 percent and expectorants and cough preparations in 5

percent.

The entry names of 14 drugs that accounted for 86

percent of the total mentions are listed in table 31. The

most frequently named antibiotics were Amoxicillin

(15 percent), Ampicillin (10 percent), Amoxil (6 percent), Penicillin (6 percent), Ceclor (4 percent), and

Larotid (4 percent). The leading antihistamine drugs

ordered were Dimetapp (12 percent) and Actifed (4

percent). Cortisporin, a topical anti-inflammatory

agent, was the fourth most frequently used drug (7 percent). Amoxicillin, with over 3 million uses, ranked fust

among the generic substances used to treat otitis media

as shown in table 32.

Acute upper respiratory infection of

multiple or unspecified sites (acute URI)

Three ICD–9–CM codes (460,461, and465) were

combined to form this diagnostic grouping because the

diseases they represent present very similar symptoms

and thus medicinal use of drugs differs minimally

among them.

There were close to 17 million visits for acute URI

(table 33), and in 94 percent of them an average of 2.02

drugs were utilized (table 33). Patients 45–64 years of

age made only 12 percent of the visits, but had a higher

drug mention rate (2.54) than did patients under 15

years of age (1.65) who made 45 percent of the visits.

About 50 percent of visits by members of the older age

group included three, or four or more drugs, whereas

only 13 percent of visits by the younger group included

the same numbers (table 34).

As in most acute, self-limiting illnesses, initial

visits exceeded return visits. Visits for new problems

were about twice as many as those for old problems.

Drug rates, however, did not differ significantly in these

two situations.

The 32 million drug mentions with acute URI were

mainly (80 percent) in four therapeutic categories: antihistamine drugs, anti-infective agents, central nervous

system drugs, and expectorants and cough preparations

(table 35). Abroad spectrum of drugs from each therapeutic group was used. The relatively long list of drug

names in table 36 covers only 54 percent of all mentions. When sampling error is considered, many estimates in this table do not differ significantly from other

near estimates. The antibiotics Penicillin, Tetracycline,

and E. E. S., which head the list, were ordered with

33
almost equal frequency, and together accounted for 11

percent of mentions. Actifed (4 percent) and Dimetapp

(3 percent) were predominant among antihistamines.

Phenergan expectorant with codeine accounted for 3

percent of drug mentions with this diagnosis.

It was noted in section I that a higher than average

proportion of over-the-counter drugs was associated

with visits for acute URI. Among these nonprescription

drugs were Aspirin, Dimetane, Tylenol, Novahistine,

Robitussin, Sudafed, and Triaminic.

Generic substances are listed in table 37. Phenylephrine, phenylpropanolamine, and pseudoephedrine

are found in many drugs identified by a wide variety of

trade names. Therefore, it is not surprising to find over 3

million uses of each of these substances in medication

therapy for acute URI. This table reflects the principal

ingredients of the most frequently named drugs in table

36, but provides a more complete total use of generic

substances.

Acute pharyngitis or acute laryngitis

and tracheitisThis diagnostic group was formed from ICD–9–

CM codes 462 and 464. Table 38 shows that about half

ofthe 10.3 million visits for this condition were made by

children under 15 years of age. Only 13 percent were

made by patients 45 years of age and over, but the drug

mention rate for the oldest group (1.99) was higher than

the drug mention rate for the youngest group (1.5 1).

New problem visits (6.8 million) exceeded old

problem visits (3.5 million), and almost all visits were

for acute problems (9. 3 million). However, drug rates

did not vary appreciably based on the type of visit.

Anti-infective agents accounted for 54 percent of

drug mentions. An additional 30 percent were divided

about equally among antihistamine drugs, central nervous system drugs, and expectorants and cough preparations (table 35). Table 36 shows that, by entry name,

Penicillin (11 percent) and Ampicillin (7 percent) were

the most frequently mentioned antibiotics. Aspirin was

the chief central nervous system drug used (5 percent).

Antihistamines and expectorants and cough preparations are not listed among the most frequent drug mentions because the diversity of entry names in these

categories precluded high frequency for any one.

Table 39 shows that over 3.4 million drug mentions

were of the generic substance penicillin. Because table

36 shows that there were 1.8 million entries called

“Penicillin,” it is apparent from table 39 that there were

entries of various brand name drugs that used this same

generic substance.

Bronchitis, acute; or not specified

as acute or chronic

When acute bronchitis was specified on the Patient

Record Form as the principal diagnosis it was coded

ICD–9–CM 466, but when it was not qualified as to

acute or chronic, it was coded ICD–9–CM 490. However, there are indications that the physician intended

the diagnosis to mean acute bronchitis because the

major reason for visit in these unqualified cases was

almost always classified by the physician as an “acute

problem.” For this reason the two codes were cc~mbined

for this analysis.

Of the 8.3 million visits for bronchitis, 53 percent

were made by female patients and 47 percent by imales—

approximately the distribution of the population used

in the National Ambulatory Medical Care Survey

(NAMCS). The drug mention rate for female patients

(2.09) was higher than that of male patients (1.82).

Among age groups, proportionately more visits included

patients under 15 years of age. But the drug mention rate

of the youngest group (1.72) was the lowest of those

associated with the age groups shown in table 40.

Drugs in the therapeutic categories of anti-infective

agents (42 percent) and expectorants and cough preparations (20 percent) were the most frequently used medications (table 35). Antihistamine drugs accounted for 9

percent of drug mentions and spasmolytic agents for 6

percent. The most common treatment regimens consisted of an antibiotic alone, or an antibiotic with an

expectorant or cough preparation. About33 percent of

the visits with an antibiotic noted did not include antihistamines or expectorants and cough preparations (although other drugs may have been ordered). Both an

antibiotic drug and an expectorant or cough preparation were prescribed in 30 percent of drug visits. Treatment varied depending on the age group of the patient. If

the patient was under 25 years or over 64 years of age,

an antibiotic alone was the most likely therapy. If the

patient was from 25 to 64 years old, then an antibiotic

plus an expectorant or cough preparation were likely to

be prescribed.

By entry name, the frequencies of the antibiotics

Arnoxicillin, Ampicillin, Penicillin, Tetracycline, and

Erythromychi were not very different when sampling

error was taken into account (table 36). Together they

accounted for 20 percent of drug mentions. Phenergan

and Dimetane (an over-the-counter drug) were the most

commonly named antihistamines, and totaled 7 percent. Although expectorants and cough preparations

accounted for 20 percent of the drug mentions, only

Phenergan Expectorant with Codeine (prescription, 4

percent) and Robitussin (nonprescription, 2 percent)

are included in table 36. A wide variety of prescription

and over-the-counter drugs were mentioned in this category. Thus, some individual estimates did not meet

National Center for Health Statistics standards of reliability. This probably reflects the availability of different drugs in this therapeutic category. The large residual of 65 percent, which includes many drugs with

estimates of less than 300,000, attests to the diversity of

physicians’ choices.

The generic substances most often used in drugs

34
prescribed for patients with bronchitis are shown in

table 41. Except for the antibiotics, these substances

were for the most partingredients in combination drugs.

It was shown in table 4 that about 13 percent of

drugs invisits for bronchitis were under Federal control.

Of these approximately 2 million mentions of controlled

drugs, 74 percent (or 1.5 million) were in schedule V

(the leastpotentialfor abuse and dependence). This was

due chiefly to the various antitussive drugs thatincluded

a relatively small amount of codeine as a secondary

ingredient. Table 41 shows that codeine was an ingredient in 1.4 million drug mentions, 96 percent of which

were in combination drugs.

Asthma

Patients under 15 years of age accounted for the

largest proportion of visits for asthma(39 percent of the

5.9 million visits assigned this principal diagnosis), but

theirdrug mention rate of 1.50 was the lowest of the age

groups shown in table 42. The drug mention rate increased as the patient’s age group increased up to age

group 45-64 years with a rate of 2.70.

The large proportion of visits by patients returning

for care of old problems (80 percent) is characteristic of

chronic diseases. However, problem status was not a

factor in the rate of drug mentions since the difference

between new and old problem rates was not statistically

significant.

Table 35 shows that one fourth of the drugs mentioned were spasmolytic agents. The most frequently

mentioned specific drugs in this group were Theo-dur,

Slo-phyllin, and Marax, which together accounted for

about 10 percent of drugmentions (table 36). Autonomic

drugs (17 percent, chiefly sympathomimetic) constituted

the next largesttherapeutic category prescribed. Representative of this group were Alupent (5 percent) and

Brethine (4 percent). Although there were 1.6 million

total mentions of antihistamine drugs, there were no

specific drugs in this category that were predominant.

The adrenals, Prednisone and Vanceril, accountedfor9

percent of drugs used.

“Allergy relief or shots” was noted on about 10

percent of the Patient Record Forms, but it was not

possible to identify the allergens used.

The relatively frequent use of the generic spasmolytic agent theophylline in treating patients with

asthmais underscored by the data in table 43. About71

percent of the 2.3 million uses was as a single ingredient

drug and 29 percent in combination drugs. Slo-phyllin

and Theo-dur are examples of the former use; Marax,

the latter. Metaproterenol and terbutaline, which are

syrnpathomimeticagents,arerepresented among specific

drugs shown in table 36 by Alupent and Brethine, respectively.

Allergic rhinitis

The 8.4 million visits for allergic rhinitis shown in

table 44 were equally divided between female and male

patients, but the drug mention rate of females was

higher than that of males. Two age groups, under 15

years and 25–44 years, accounted for 30 percent and

33 percent of visits, respectively, andtheirdmg mention

rates were about the same. The highest drug mention

rate was associated with age group 45–64 years.

The major reason for two of three visitswas aroutine

chronic problem with a drug mention rate of 1.14. But if

the major reason was an acute problem, the drug mention rate rose to 1.51.

About 90 percent of the visits included medication

therapy and one drug only was mentioned in 76 percent

of those drug visits.

Drugs in the therapeutic category of antihistamines

accounted for 62 percent of total mentions (table 35).

As discussed previously, antihistamines are used in

such awide variety of prescription and over-the-counter

drugs and offer so many choices to both physician and

patient that specific drug entries do not accumulate in

sufficient frequency in NAMCS to provide reliable

data. The largest number of such mentions was for

Dimetapp (table 36).

Similar to asthmavisits, allergy relief or shots without fimther qua.liilcation was entered as medication

therapy in 41 percent of mentions. However, ragweed

and related pollen allergens was named in 4 percent of

mentions.

Generic substances most frequently found in drugs

used to treat allergic rhinitisare detailed by form of use

in table 43.

.

35
Table 29. Number of office visits for suppurative and unspecified otitis media, number and percent of drug visits, number of drug mentions,

drug mention rate, and drug intensity rate, by selected characteristics United States, 1980

Office visits Drug Drug

Selected characteristic Drug

mention mentions intensity

All visits Drug visitsl rate2 rate3

Number in Number in

Sex

Number in

thousands thousands Percent thouaanda Rate per viait

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411,748 10,067 85.7 18,168 1.55 1.80

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,562 4,842 87.1 8,868 1.59 1.83

Male, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,185 5,225 84.5 9,299 1.50 1.78

Age

Under 3yeers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,032 4,405 87.5 7,851 1.56 1.78

3-14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,315 3,597 83.4 6,316 1.46 1.76

15yeara and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,402 2,066 86.0 4,001 1.67 1.94

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,019 9,511 86.3 17,005 1.54 1.79

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 518 397 76.7 877 1.69 2.21

Problem status

New problem . . . . . . . . . . . . . . . . . . . . . 5,797 5,430 93.7 10,218 1.76 1.88

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,951 4,636 77,9 7,950 1.34 1.71

Major reaaon for visit

Acute problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,031 8,126 90.0 15,144 1.68 1.86

Chronic problem, routine . . . . . . . . . . . . . . . . . . . . . . . . . 951 556 58.4 813 0.85 1.46

Chronic problem, flareup . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,214 1,064 87.7 1,731 1.43 1.63

Post surgery/pOst in jury. ,., .,.,. . . . . . . . . . . . . . . . . . . . *154 *19 “12.2 *19 “0.1 2 *1 .00

Non-i llness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *398 “302 “75.8 “461 “1.16 *1 .53

1A “iSit in which one m more drugs were ordered or prOvided.

2Drug ~ention~ divided by number Of visits.

3Drug ~entionS divided by number Of drug visits.

41ncludeS rKeS other than white and black not shown as SePSr8te C2.teEOries.

Table 30. Number, percent distribution, and rate per 100 visits of drug mantiona in officie visita for suppurative and unspecified otitis media

by therapeutic category United Statea, 1980

Therapeutic categoryl Drug mentions

Number in Percent Rate per

thousands distribution 100 visits

All therapeutic categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,168 100.0 155

Antihistamine drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,429 18.9 29

Anti-infective agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,265 51.0 79

Expectoranta and cough preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 919 5.1 8

Eye, ear, nose and throat preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,147 6.3 8

Skin andmucous membrane preparations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,493 8.2 13

Another therapeutic categories.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,915 10.5 16

1 Based on the classification system of the American Hospital Formulary Service. See reference 5.

36
Table 31. Number and percent distribution of drug mentions in office visits for auppurative and unspecified otitis media by most frequently mentioned

specific drugs described by principal generic ingredient(s) and principal therapeutic category: United Ststes, 1980

Name of drugl Drug mentions Principal generic ingredient Principal therapeutic catego$

All drugs . . . . . . . . . . . . . . . . . . . . .

Amoxicillin . . . . . . . . . . . . . . . . . . .

Dimetapp . . . . . . . . . . . . . . . . . . . .

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

Cortisporin . . . . . . . . . . . . . . . . . . .

Amoxil . . . . . . . . . . . . . . . . . . . . . .

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

Septra . . . . . . . . . . . . . . . . . . . . . . .

Actifed . . . . . . . . . . . . . . . . . . . . . .

Ceclor . . . . . . . . . . . . . . . . . . . . . . .

Larotid . . . . . . . . . . . . . . . . . . . . . .

Vitamin B-1 2 . . . . .. . . . . . . . . . . . .

Gantrisin . . . . . . . . . . . . . . . . . . . . .

E.E.S. . . . . . . . . . . . . . . . . . . . . . . .

Auralgan . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . .

Number in Percent

thousands distribution

11,748 100.0

1,786 15.2

1,414 12.0

1,209 10.3

870 7.4

750 6.4

687 5.9

550 4.7

520 4.4

480 4.1

457 3.9

407 3.5

*355 ‘3.0

*326 *2.8

“306 *2.6

1,830 13.9

,..

amoxicillin

brompheniramine, phenylephrine, phenylpropranolamine

ampicillin

polymixin B, bacitracin, neomycin, hydrocortisone

emoxicillin

penicillin

sulfamethoxazole, trimethoprim

triprolidine, pseudoephedrine

cefaclor

amoxicillin

vitamin B-1 2

sulfiaoxazole

erythromycin

antipyrine, benzocaine, glycerin

. . .

. . .

antibiotics

antihistamine druga

antibiotics

anti-inflammatory agents

antibiotics

antibiotics

sulfonamides

antihistamine drugs

antibiotics

antibiotics

vitamin B complex

sulfonamides

antibiotics

local anesthetics

. . .

1 ~a$ed on the phy~i~ian,~ entV on tha Patient Racord Form. The ent~ may ba a brand Or9eneric ‘ame.

21fon[yo”e generic ingredientis li~ted,the physi~ia”,~~“t~ isthe genericdrugora brand name drug that consists chiefly of a single generic ingredient May not include all ingredients for

avery combination drug.

s~a~ed ~“ the ~la~~ifi~ati~” system of the American Hospital Formulaw Samice. See reference 5.

Table 32. Number and percent distribution of drugs used in office visits for auppurstive and unspecified otitis media by form of use,

according to moat frequently used ganeric substances United States, 1980

Generic substance

Form of use

Drugs

used

Total

Single Combinations ingredient

Numbar in

thousands Percent distribution

Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Antipyrine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Benzocaine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Cefaclor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chlorpheniramine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Guaifeneain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrocortiaone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neomycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Phenylephrine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phanylpropranolamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Pseudoephedrine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sulfamethoxazole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sulfisoxazole ., .,.,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,756

3,078

1,520

410

404

1,558

480

1,013

1,140

556

988

1,140

1,256

2,521

2,347

1,129

1,136

989

563

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

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

5.6

2.5

100.0

6.3

82.5

3.6

82.7

9.6

0.8

23.6

1.3

64.5

100.0

100.0

94.4

97.5

93.7

17.5

96.4

100.0

100.0

17.3

90.4

100.0

99.2

76.4

98.7

35.5

37
Table 33. Number of office visits for scute upper respiratory infections of multiple or unspecified sites (scute URI), number end percent of drug visits,

number of drug mentions, drug mention rate, and dwg intensity rste, by selected characteristics United States, 1980

Office visits Drug Drug Drug

Selected characteristic mentiOn

mentions

intensity

All visits Drug visitsl rate2 rate3

Sex

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

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

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

Age

Under 15 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

25-44 vears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousattds

Number in

thousands Percent

416,969

9,112

7,857

7,677

2,295

3,594

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,058

65yeera and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,345

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,901

Beck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,860

Problem status

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,405

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,564

Major reason for viait

15,977

8,634

7,343

7,152

2,113

3,463

94.2

94.8

93.5

93.2

92.1

96.4

Number in

thousands

32,311

16,002

14,309

12,654

4,264

7,169

Rate per visit

1.90 2.02

1.98 2.09

1.82 1.95

1.65 1.77

1.86 2.02

1.99 2.07

1,941 94.3 5,222 2.54 2.69

1,309 97.3 3,001 2.23 2.29

4,064 94.4 28,597 1.92 2.03

1,735 92.3 3,351 1.78 1.93

0.697 93.8 21,207 1.86 1.98

5,280 94.9 11,104 2.00 2.10

Acute problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,706 14,866 94.7 29,926 1.91 2.01

Chronic problem, routine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414 *366 *88.5 “694 *1 .68 *1 .90

Chronic problem, flareup . . . . . . . . . . . . . . . . . . . . . . . . . . 594 554 93.3 1,431 2.41 2.58

Non-illness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ●255 “192 *75.2 *259 *1 .02 *1.35

1A “i~h i“ which one or more drugs were ordered or prOvided.

2Drug ~e”tiona divided by number of ViSita.

3Drug ~entio”S divided by number of drug visits.

41 “clude~ ~acea other than white and black not shown as separate cate90ries.

38
Table 34. Number and percent distribution of office visits for acute upper respiratory infections of multiple or unspecified sites (acute URI)

by number of medications, according to selected characteristics United States, 1980

Number of medications

Selected characteristic All visits

Total None 7 2 3

4

or more

Number in

Sex thousands Percent distribution

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116,969 100.0 5.8 33.8 36.0

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,112 ~00.0 5.2 32.0 36.6

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,857 100.0 6.5 36.0 35.3

Age

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,677 100.0 6.8 38.9 40.9

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,295 100.0 *7.9 33.8 33.7

25-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,594 100.0 *3.7 33.7 34.4

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,058 .100.0 *5.7 20.1 24.6

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,345 100.0 *2.7 26.4 33.5

Race

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

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

Problem status

4,901 100.0 5.6 34.1 35.2

1,880 100.0 “7.7 32.8 41.2

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,405 100.0 6.2 34.2 36.4

Oldpmblem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,564 100.0 *5.1 33.2 35.2

Major reason for visit

Acute problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,706 100.0 5.4 33.8 36.5

Chronic problem, rcwtine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414 100.0 “11 .5 *31 .1 *40.2

Chronic problem, flareup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 594 100.0 *6.7 *31.1 “24.1

Non-ill ness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *255 100.0 . . . . . . . . .

15.7 8.7

15.9 11.2

15.6 6.5

9.6 *3.7

14.9 “9.6

19.7 *8.6

27.0 22.7

*24.1 *1 3.2

16.1 8.9

“11.7 *6.6

15.4 7.8

16.3 10.2

16.2 8.2

*13.7 *3.5

*1O.9 *27.2

. . . . . .

1,nclude$ races Otherthan white snd blsck not shown aa separate cate90ries.

39
Table 35. Number, percent distribution, and rate per 100 visits Of dru9 mentiOna in office visits for selected resPiratW conditions

by therapeutic category United States, 1980

Respiratory condition and therapeutic categow’ Drug mentions

Acute UR1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antihistami ne drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anti-infective agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Central netvous aystem drugs.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Expectorants andcough preparatiOna . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allothar therapeutic categories.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Acute pharyngitia or acute laryngitis andtracheitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antihistamine druga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anti-infective agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Expectoranta and cough medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Another therapeutic categories.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bronchitis, acute; or not specified aa acute or I

Antihistamine druga . . . . . . . . . . . . . . . . .

Anti-in fective agenda . . . . . . . . . . . . . . . .

Expectorants and cough preparations . . . . .

Spaamolytic agents . . . . . . . . . . . . . . . . . . . . .

All other therapeutic categories. . . . . . . . . . .

Number in

thouaanda

32,311

6,180

11,943

2,311

5,361

6,516

16,139

1,747

8,713

1,492

1,648

2,539

16,348

1,469

6,909

3,187

895

3,689

11,655

1,620

1,443

1,970

1,289

2,909

2,424

108479

6,442

873

3,164

Percent

distribution

100,0

19.1

37.0

7.2

16.6

20.1

100.0

10.8

54.0

9.3

10.2

15.7

100.0

9.0

42.3

19.5

5.5

23.7

100.0

13.9

12.4

16.9

11.1

25,0

20.7

100.0

61.5

8.3

30.2

Rate per

100 visita

190

36

70

14

32

. . .

157

17

85

15

16

196

18

83

38

11

. .

197

27

24

33

22

49

. . .

124

76

10

,..

1 Based on tha classification system of the American Hospital Formulaty Service. See reference 5.
Table 36. Number and percent distribution of drug mentions in office visits for selected respiratory conditions by most frequently mentioned

specific drugs described by principal generic ingredient(s) and principal therapeutic categow United Statea, 1980

Principal diagnosis and name of drugq Drug mentions Principal generic ingredient Principal therapeutic caregory3

Acute upper respiratory infections of

multiple or unspecified sites

(acute URl) . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

E.E.’S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Actifed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dimetapp . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenergan expectorant with codeine . . . . . .

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

Phenergan . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxicillin . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dimetane . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Rondec . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terramycin . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Naldecon . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Novahistine . . . . . . . . . . . . . . . . . . . . . . . . . .

Benylin Syrup . . . . . . . . . . . . . . . . . . . . . . . .

E-mycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tylenol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drixoral . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Robitussin . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sudafed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vibramycin . . . . . . . . . . . . . . . . . . . . . . . . . . .

Triaminic . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Acute pharyngitis or acute laryngitis

.

andtracheltls . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Pen-Vee-K. . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

V-cillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E.E.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Celestone . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxicillin . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rasidual . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Acute bronchitis and bronchiolitis or

bronchitis, not specified as acute

or chronic . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxicillin . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenergan . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Phenergan expectorant with codeine. . . . .

Etythromycin . . . . . . . . . . . . . . . . . . . . . . . . .

Dimetane . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E.E.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Robitussin . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

32,311

1,353

1,191

1,124

1,121

1,107

1,022

9.78

878

767

746

674

650

615

529

523

465

446

428

407

*374

*359

*341

*329

“323

’308

“305

‘14,947

16,139

1,779

1,160

750

555

553

452

447

430

“377

*342

“304

8,990

16,349

759

747

740

678

615

583

432

421

*368

*342

10,664

Percent

distribution

100.0

4.2

3.7

3.5

3.5

3.4

3.2

3.0

2.7

2.4

2.3

2.1

2.0

1.9

1.6

1.6

1.4

1.4

1.3

1.3

“1.2

“1.1

“1.1

*1.0

“1.0

“1.0

‘0.9

46.3

100.0

11.0

7.2

4.6

3.4

3.4

2.8

2.8

2.7

*2.3

*2.1

*1.9

55.7

100.0

4.6

4.6

4.5

4.1

3.8

3.6

2.6

2,6

*2.3

*2.1

65.2

. . .

penicillin

tetracycline

erythromycin

triprolidine, pseudoephadrine

brompheniramine, phenylephrine,

phenylpropanolamine

promethazine, codeine, phenylephrine,

guaiacolsulfonate

ampicillin

promethazine

amoxicillin

brompheniramine

amoxicillin

erythromycin

carbinoxamine, pseudoephedrine

oxytetracycline

aspirin

phenylpro~anolamine, phenylephrine,

phenyltoloxamine, chlorpheniramine

phenylpropanolamine, chlorpheniramine

diphenhydramine

erythromycin

cephalexin

acetaminophen

pseudoephedrine

guaifenesin

pseudoephedrine, chlorpheniramine

doxycycline

phenylopropanolamine, pheniramine,

pyrilamina

. . .

. . .

penicillin

ampicillin

aapirin

penicillin

erythromycin

tetracycline

penicillin

erythromycin

cephalexin

betamethasone

amoxicillin

. . .

amoxicillin

promethazine

ampicillin

penicillin

tetracycline

promethazine, codeine, phenylephrine,

potassium guaiacolsuifonate

erythromycin

brompheneramine

erythromycin

guaifenesin

. . .

antibiotics

antibiotics

antibiotics

antihistamine drugs

antihistamine druga

expectorants and cough preparations

antibiotics

antihistamine drugs

antibiotics

antihistamine drugs

antibiotics

antibiotics

antihiatamine drugs

antibiotics

analgesia and antipyretics

antihistamine drugs

antihistamine drugs

antihistamine drugs

antibiotics

antibiotics

analgesics and antipyretica

antihistamine drugs

expectorants and cough preparations

sympathomimetic drugs

antibiotics

antihistamine drugs

. . .

antibiotics

antibiotics

analgesia and antipyretics

antibiotic

antibiotics

antibiotics

antibiotics

antibiotics

antibiotics

adrenala

antibiotics

. .

. . .

antibiotics

antihistamine drugs

antibiotic

antibiotics

antibiotics

expectorants and cough preparations

antibiotics

antihistamine drugs

antibiotics

expectorants and cough preparations

. . .

See footnotes at end of table.

41
Table 36, Number and percent distribution of drug mentions in office visits for selected respirato~ conditions by most frequently mentioned

specific drugs described by principal generic ingredient(s) snd principal therapeutic catego~ United States, 1980—Con.

Principal diagnosis and name of drugl Drug mentions Principal generic ingredient Principal therapeutic categor#

Asthma, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allergy relief orshots4, .,.,..... . . . . . . . .

Alupent, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prednisone . . . . . . . . . . . . . . . . . . . . . . . . . . .

Theo- dur . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vanceril . . . . . . . . . . . . . . . . . . . . .

Brethine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Slo-phyllin . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mars . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allergic rhinitia . . . . . . . . . . . . . . . . . . . . . . . .

A[lergy relief orshots4 . . . . . . . . . . . . .

Ragweed and related pollen sllergens .

Dimetapp . . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in Percent

thousands distribution

11,655 100.0

1,141 9.8

546 4.7

505 4.3

486 4.2

441 3.8

431 3.7

*354 “3.0

“301 *2.6

7,450 63.9

10,479 100.0

4,249 40.6

444 4.2

*328 *3.1

5,457 52.1

undetermined

metaproterenol

prednisone

theophylline

beclomethasone

terbutaline

theophylline

hydroxyzine, ephedrine, theophylline

.

allergy relief, unspecified

aympathomimetic drugs

adrenals

spasmolytic agenta

adrenala

sympathomimetic drugs

apasmolytic agenta

spasmolytic agents

.

undetermined

pollen antigens

brompheniramine, phenylephrine,

phenylpropranolamine

,.,

allergy relief, unspecified

unclassified therapeutic agents

antihistamine drugs

.

1 Based on the physicia”,s ~nt~ O“ tha F%tiant Record Form. The entry msy be s brand or 9eneriC name, Or a therapeutic ‘ffect.

2.1fonlyo”e generic i“gredie”t is listed, the physicians antw is the genetic drug ma brsnd name drug that consists chiafly Of a SiI191a 9eflariC ingredient. MaY nOt include all ingredients fOr

every combination drug.

?’~ased on the classification system Of the American Hospital Formulsry Sawica. Sae refsrence 5,

4Thi~ WaS the most common mode of entry for allergy treatment.

Table 37, Number and percent distribution of druga used in office visits for acute upper respirato~ infections of multiple or unspecified sitea (acute URI)

by form of use, according to most frequently used generic substances United Statea, 1980

Generic substance

Form of use

Drugs

used

Total Single Combinations

ingredient

Number in

thousanda

774

3,517

1,831

1,145

714

1,853

623

2,461

2,053

1,156

669

2,777

1,892

529

2,189

430

3,188

3,937

1,758

1,900

3,124

504

767

1,686

1,301

Percent distribution

100,0 70.4 29.6

100.0 100.0

100.0 100.0

100.0 100.0

100.0 74.1

100.0 9.2

100.0 1.3

100.0 11.0

100.0 4.2

100.0 4.5

100.0 100.0

100.0 97.4

100.0 0.8

100.0 100.0

100.0 94.9

100.0

100.0 2.9

100.0 0.3

100.0

100.0 8.1

100.0 12.5

25.9

90.8

98.7

89.0

95.8

95.5

2,6

99.2

5.1

00.0

97.1

99.7

00.0

91.9

87.5

100.0 100.0

100.0 100.0

100.0 100,0

100.0 100.0

42
. Table 38. Number of office visits for acute pharyngitia or acute laryngitis and tracheitis, number and percent of drug viaits, number of drug mentions,

drug mention rate, and drug intensity rate, by selected characteristics United States, 1980

Office visits

Drug Drug Drug

Selected characteristic mention

mentions

intensity

All visits Drug visits; ratez rate3

Number in Number in Number in

thousanda

16,139

8,949

7.190

Percent Rate per visit

1.57 1.79

1.58 1.82

1.56 1.75

Sex

Both sexea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

410,277

5,669

4,608

9,020

4,916

4,104

87.8

86.7

89.1

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

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

Age

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

15-24 yea rs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

45 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.51 1.78

1.45 1,61

1.56 1.72

1.99 2.13

5,229

1,646

2,113

1.288

4,428

1,483

1,906

1,203

84.7

90.1

90.2

93.4

7,801

2,392

3,286

2,560

Rata

14,980

972

1.57 1.78

1.56 2.00

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

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

9,524

625

8,418

486

88.4

77.7

Problem status

6,756

3,521

5,845

3,075

88.0

87.3

10,089

6,050

1.49 1.70

1.72 1.97

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major reason for visit

14,620

*488

831

“200

1.56 1.77

*1.81 “2.06

1.63 1,95

*1.31 *1 .69

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

Chronic problam, routine . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Non-ill neaa care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9,345

“269

509

*153

8,237

“237

427

*IIB

88.2

88.2

83.8

“77.5

1A vi~jt in which one or more drugs were ordered or Provided.

2Dr”g ~ention~ divided by number Of visits.

3Dr”g ~e”tion~ divided by number Of drug visits.

‘+ncl”des WICeS other than white and black not shown as Separatecate90ries.

Table 39. Number and percent distribution of drugs used in office visits for acute pharyngitis or acute laryngitis and tracheitis by form of use,

according to most frequently usad generic substances: United States, 1980

Form of use

Drugs

used

Total

Single Combinations ingredient

Generic substance

Number in

thousands

902

766

1,533

862

882

669

1,448

677

3,421

854

1,249

“367

509

796

512

Percent distribution

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

100.0

100.0

100.0

100.0

100.0

87.0

6.7

100.0

13.0

93.3

100.0

1.0

3.0

6.0

95.6

100.0

100.0

72.1

88.4

100.0

Codeine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Guaifenesin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Phenylephrine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenylpropanolamine . . . . . . . . ..-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Potassium guaiacolsulfonate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Promethazine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pseudoephedrine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

99.0

97.0

94.0

4.4

27.9

11.6

100.0

Triprolidine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “380

43
Tabla 40. Number of office visits for bronchitis, acute; or not specified ss acute or chronic, number snd percent of drug visits, number of drug mentions,

drug mention rate, and drug intensity rate, by selected characteristics United States, 1980

Office visits Drug Drug

Selected characteristic

Drug mention mentions intensity

All visits Drug visitsl rate2 rate3

Number in Number in

Sex thousands thousands Percent

Both aexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48,323 7,855 94.4

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,382 4,237 96.7

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,940 3,618 91.8

Age

Undar15yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,101 2,911 93.9

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 818 783 93.2

25-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,312 1,293 98.5

45-64 yaars, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,075 1,787 95.3

65yeara and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,216 1,102 90.7

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,246 6,909 95.3

black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 916 850 92.8

Problem status

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,012 4,837 96.5

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,311 3,018 91.2

Major reason for visit

Acute problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,203 6,941 96.4

Chronic problam, routine . . . . . . . . . . . . . . . . . . . . . . . . . . . 587 447 76.1

Chronic problem, flareup . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413 *364 88.0

Post surge@ p&stinju~ . . . . . . . . . ..c . . . . . . . . . . . . . . . . “12 “12 *1 00.0

Non. illness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “108 *91 *84.9

Number in

thousands Rate per visit

16,349 1.96 2.08

9,179 2.09 2.17

78170 1.82 1.98

6,328 1.72 1,83

1,559 1.91 2.04

2,682 2.04 2.07

3,797 2.03 2.12

2,883 2,45 2.71

14,103 1.95 2.04

2,086 2.28 2.45

9,850 1.97 2.04

6,499 1.96 2.15

14<094 1.96 2.03

1,277 2.18 2.86

“771 *1 .87 “2.1 2

*24 82.00 “2.00

’183 *1 .69 “2.01

1A visit in which o“e or more drugs were ordered or provided.

213ru9 mentions divided by number of Vi$itS.

3Drug ~enlio”~ divided by number of drug visits.

alnclude~ ~aceS Other than white and black not shown as separste Cate90ries

Table 41. Number and percent distribution of drugs used in office visits for bronchitis, acute; or not specified as acute or chronic by form of use,

according to most frequently used generic substances United States, 1980

Form of use

Drugs

used

Total

Single Combinations ingredient

Number in

thousands Percent distribution

1,622

1,132

1,023

590

966

1,363

454

1,566

1,287

1,040

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

16.9

0.4

3.7

0.9

91.4

12.2

93.2

100.0

83.1

99.6

96.3

99.1

8.6

87.8

6.8

,421 100.0 10.3 89.7

,265 100.0 100,0

,056 100,0 100,0

,330 100,0 21.6 78,2

650 100,0 7.1 92.9

952 100.0 96.1 3.9

590 100.0 35.0 65.0

44
Table 42. Number of office visits for asthma, number and percent of drug visits, number of drug mentions, drug mention rate, and drug intensity rate,

by selected characteristics United States, 1980

Office visits Drug Drug

Selected characteristic

Drug

mention mentions intensity

All visits Drug visitsl rate2 rate3

Number in Number in Number in

Sex thousands thousands Percent thousands Rate per visit

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45,921 58477 92.5 11,655 1.97 2.13

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,262 2,999 91.9 6,738 2.07 2.25

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,659 2,478 93.2 4,917 1.85 1.98

Age

Under 15 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,335 2,126 91.0 3,495 1.50 1.64

15-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 737 716 97.2 1,262 1.71 1.76

25-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,106 1,031 93.2 2,271 2.05 2.20

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,065 989 92.8 2,876 2.70 2.91

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 678 616 90.8 1,750 2.58 2.84

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,234 4,830 92.3 10,441 1.99 2.16

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 648 607 93.8 1,134 1.75 1.87

Problem status

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,204 1,148 85.3 2,616 2,17 2.28

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,717 4,328 91.8 9,039 1.92 2.09

Major reason for viait

Acute problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,653 1,518 91.9 3,243 1.96 2.14

Chronic problem, routine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,812 2,561 91.1 5,036 1.79 1.97

Chronic problem, flareup . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,214 1,169 96.3 2,976 2.45 2.55

Non-illneaa care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “241 *228 *84.6 *401 *1 .66 *1.76

1A “i~it in Whichone or more drugs were ordered or provided.

2Drug ~sntions divided by number of visits.

3Drug ~e”tion~ divided by number Ofdrug ‘isita.

41ncIUde~~ace~o~he~than white .md black not shown as separate cate90ries.

45
Table 43. Number and percent distribution of drugs used in office viaita for aathma and allergic rhinitis by form of use,

according to most frequently used ganeric au balances: United Statea, 1980

Form of use

Diagnosis and genaric substance

Drugs

used

Total

Single

Combinations

ingredient

Number in

thousands

478

493

*297

417

542

“306

812

531

*263

616

2,315

407

528

834

“331

’244

733

720

453

652

*284

Percent distribution

100.0 100.0

100.0 99.4 0.6

100.0 “100.0

100.0 100.0

100.0 7.6 92.4

100.0 “1.6 *98.4

100.0 100.0

00.0

00.0

00.0

00.0

00.0

00.0

00.0

00.0

100.0

*7.8 *92.2

100.0

70.7 29.3

100.0

25.0 75.0

29.8 70.2

*1 00.0

100.0 *100.0

100.0 100.0

100.0 100.0

100.0 100.0

100.0 21.0 79,0

100.0 “100,0

1About , o% of drug ~e”tion~ ,“ “isit~ for ~~thma could not be identified by generic substance becsuse the physician’s entW was a11er9Y relief ‘r shots.

2AbOut ~,% of drug ~e”tiO”~ i“ “i~it~ for ~llargic rhi”itis m“ld mt be identified by generic substance because the physician’s entrY was aller9Y relief or shots.

46
Table 44. Number of office visits for allergic rhinitis, number and percent of drug visits, number of drug mentions, drug mention rate, and drug intensity rate,

by selected characteristics United States, 1980

Office visits Drug Drug

Selected characteristic Drug

mention mentions intensity

All visits Drug visits~ rate2 rate3

Number in Number in Number in

Sex thousands thousands Percent thousands Rste per visit

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48,439 7,621 90.3 10,479 1.24

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,236 3,954 93.4 5,9B4 1.41

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,204 3,666 87.2 4,495 1.07

Age

.38

.51

.23

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

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

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

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

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

2,552

986

2,754

1,556

592

2,340

880

2,496

1,361

544

91.7

89.3

90.6

87.4

92.0

2,861

1,133

3,282

2,332

871

1.12

1.15

1.19

1.50

1.47

1.22

1.29

1.31

1.71

1.60

Race

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

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

7,986

“374

7,188

365

90.0

97.4

9,837

“540

1.23

*1 .44

1.37

*1 .48

Problem status

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,669

6.770

1,454

6,167

87.1

91.1

2,265

8,214

1.36

1.21

1.56

1.33

Major reason for visit

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

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

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

Non-illness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,368

5,626

1,150

*296

1,268

5,176

927

“250

92.7

92.0

80.7

●84.5

2,070

6,426

1,715

●268

1.51

1.14

1.49

80.91

1.63

1.24

1.85

*1 .07

1A “i~it in Whichone or more drugs were ordered or provided.

2Drug mentions divided by number Of visits.

3Drug mentions divided by number Of drug visits.

41”clude~ raceS other thsn white and black not shown as Separate Cata90ries.

.

47
Section VI. Diseases of

sebaceous glands and selected

musculoskeletal conditions

Diseases of sebaceous glands

Two forms ofthis condition were commonly reported

in NAMC S: acne (other than varioliformis), 8.1 million

visits, and sebaceous cyst, 2.2 million visits. As maybe

expected, 72 percent of patients visiting for acne were

under 25 years of age. When sebaceous cyst was the

specific diagnosis, 84 percent ofthe visits were made by

patients over 24 years of age. This distinction should be

kept in mind when interpreting the data.

Beginning with age 15 years, proportions of visits

and drug mention rates decreased as the patient’s age

group increased, reflecting the type of condition likely to

be presented (table 45). Young patients who predominantly had acne were more likely to have medication

therapy than were older patients who were likely to have

sebaceous cysts, which usually require surgery but not

necessarily drugs. (Thirty-seven percent of all visits for

diseases of sebaceous glands included office surgery).

Patients 15–24 years of age accounted for48 percent of

the visits and used an average of 2.29 drugs per visit.

The group aged 25–44 years had a drug mention rate of

1.80, and those 45 years of age and over had the lowest

rate (0.93). Only 54 percent of the visits by patients

over 45 years of age included one or more drugs compared with 94 percent of those by patients in the 15-24

year old group. When drugs were provided, two was the

typical number since 44 percent of such visits included

two mentions.

Drugs were more likely to be prescribed during

continuing care for an old problem (drug mention

rate = 2.11) than when a new problem was presented

(1.58). If the major reason for the visit was aflareup of a

chronic problem, patients were given drugs at the rate of

2.39 per visit compared with 1.57 per visit for acute

problems. The relatively low rate of 0.43 when the visit

was post surgery supports the previous suggestion that

drug therapy was not commonly associated with visits

for excision of sebaceous cysts.

Table 46 shows that about 77 percent of drugs

prescribed were in four therapeutic categories—antibiotics (43 percent), keratolytic agents (21 percent),

anti-inflammatory agents (9 percent), and cell stimulants

and proliferants (5 percent).

Tetracycline (15 percent) and Cleocin ( 12 percent)

48

were the most frequently named antibiotics as shown in

table 47. Other antibiotics entered on Patient Record

Forms were Minicin (4 percent), Erythromycin (3 percent), and Achromycin (3 percent). Among the many

keratolytic agents named were Desquam-X (4 percent),

Benzac (4 percent), Panoxyl (3 percent), Persa,-gel (3

percent), and Benzagel (2 percent). (The principal ingredient in the last five drugs is benzoyl peroxide.)

Retin-A, from the group of cell stimulants and proliferants, appeared in 5 percent of drug mentions.

The leading generic substance used was tetracycline

with 4.2 million mentions (table 48). Benzoyl peroxide,

which was the principal ingredient in at least five frequently used brand name drugs, was the second most

frequent generic substance with 3.6 million uses. The

generic substance tretinoin was exclusively represented

in oi%ce visits by the brand name drug Retin-A, which

was shown in table 47.

Osteoarthritis and allied disorders

or other and unspecified arthropathies

Women made 69 percent, and patients over 45

years of age, 89 percent, of the visits for this diagnosis;

but drug mention rates did not differ significantly by sex

or age (table 49).

Similar to visits for other chronic conditions made

predominantly by the elderly, 72 percent ofthe visits for

osteoarthritis were return visits for care of an old problem, and drugs were more likely to be used as therapy

than when patients presented the condition as a new

problem. It was pointed out in section I that some of the

drugs may have been prescribed for conditions other

than the principal diagnosis. This is particularly true of

visits by elderly patients who tend to have multiple

chronic conditions.

One or more drugs were mentioned in 82 percent of

the visits. Of this group, 45 percent had one drug mention, 24 percent had two, and 16 percent had three

(number of visits with a specific number of prescriptions divided by the number of drug visits).

Table 46 shows that41 percent of drug mentions

were in the category of analgesics and antipyretics.

Cardiovascular drugs, probably used for such conditions as ischemic heart disease and hypertension, which
are frequently concomitant with arthropathies, accounted for 12 percent.

All of the generic substances listed in table 50,

except reserpine and hydrochlorothiazide, are categorized as analgesics and antipyretics. Aspirin was the

most frequently used drug with 1 million uses. Other

frequently mentioned anti-inflammatory drugs were

ibuprofen, indomethacin, naproxin, and sulindac. The

brand name entries that represented these substances as

single ingredient drugs, in the same order, were Motrin,

Indocin, Naprosyn, and ClinoriL

Intervertebral disc disorders or

other and unspecified disorders of back

Drugs were used in only61 percent of visits for disc

and other back problems, a relatively low proportion.

Visits were evenly divided between women and men,

but the women’s drug mention rate was 1.38 compared

to 0.97 for men (table51 ). This was because about 66

percent of women’s visits included drug therapy compared with 57 percent of those by men. On the average,

43 percent of drug visits had one drug mentioned, and

34 percent had two.

Patients were likely to be 25-64 years old (80

percent), and rates did not differ signitlcantly for specific

age groups.

The largest category of drugs used was analgesics

and antipyretics, which accounted for41 percent of all

mentions (table 46). Skeletal muscle relaxants constituted another 14 percent. In the first group, aspinn,

acetaminophen (with and without codeine), and phenacetin were the most commonly used generic substances

(table 50). In the second group, methocarbamol and

orphenadrine were the most frequent.

Tylenol with Codeine was the entry name for the

388,000 single-ingredient uses of acetaminophen with

codeine. Robaxin, with 360,000 mentions, represented

the 89 percent of use of methocarbamol listed as a single

ingredient.

About 25 percent of mentions were federally controlled drugs. Table G shows that of these 1.8 million

mentions, 15 percent were in schedule II, 42 percent

were in schedule III, and 43 percent in schedule IV.

Physiotherapy was provided in 34 percent of visits

for disc and back disorders. Medication therapy was also

ordered in about 64 percent of such visits.

Sprains and strains of sacroiliac region

or other and unspecified parts of back

Characteristics of drug therapy forsprains and strains

closely paralleled those of intervertebral disc disorders

or other and unspecified disorders of back (except that

drug mention rates did not differ by sex of the patient).

Only 60 percent of the 7.4 million visits for back sprains

and strains included medication therapy (table 52), and

physiotherapy was likely to be used. With this diagnosis

53 percent of the visits included physiotherapy and in

Table G. Number and percent distribution of federally controlled drug mentions in office visits for intervertebral disc disorders orotherand unspecified disorders of back by control category United States, 1980

Federal control category’

Controlled drug

mentions

Number in thousands

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,769

Percent distribution

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

Schedule I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0

Schedule 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.6

Schedule ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.8

Schedule IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43.4

Schedule V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2

1 ~a~ed on the ~la~sification system of the Drug Enforcement .4gencv of the Depanment

of Justice.

about half of such visits medication was also prescribed.

About 78 percent of the visits were made by patients

25–64 years of age. The relatively low drug rates were

similar for specitlc age groups. However, problem status

made a difference in the provision of drugs. The drug

mention rate for patients with new problems was 1.08

compared with 0.76 for those with old problems, suggesting a decrease in drug utilization as treatment

progressed.

When patients were treated with drugs, 63 percent

of such visits had one drug mentio~ only 24 percent had

two. Drug intensity rates did not vary significantly by

sex, age, or problem status.

Drug therapy consisted mainly of the two classes of

drugs shown in table 46: analgesics and antipyretics (43

percent) and skeletal muscle relaxants (21 percent).

The classes of generic substance used to treat this condition were very similar to those listed with the back

diagnosis described previously.

The 1.7 million federally regulated drug mentions

for this diagnosis are distributed by control schedule in

table H, which shows that 90 percent were in schedules

111and IV.

Table H. Number and percent distribution of federally controlled drug mentions in office visits for sprains and strains of sacroiliac region or othar

and unspecified parts of back by control category United States, 1980

Federal control catago~i

Controlled drug

mentions

Number in thousands

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,678

p~rcent distribution

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

Schedule I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0

Schedule 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.8

Schedule ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.7

Schedule IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52.1

Schedule V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4

1~a~edon~h~~ja~~ification system of the Drug Enforcement A9encY of the Department

of Justice.

49

“
Table 45. Number of office visits for diseases of sebsceous glands, number and percent of drug visits, number of drug mentions, drug mention rste,

snd drug intensity rate, by selected characteristics United States, 1980

Office visits Drug Drug

Selected characteristic

Drug

mention

mantions

,intensity

All visits Drug visitsl rate2 rate3

Number in

thousanda

Number in Number in

Percent thousands Rate per visit

410,578

6,171

4,408

8,946

5,341

3,604

84.6

86.6

81.8

20,981

12,959

8,022

1.98 2.35

2.10 2.43

1.82 2.23

Age

Under 15 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

45 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,242

5,086

3,157

1,083

1,165

4,782

2,404

595

93.7

84.0

76.1

54.4

2,656

11,623

5,689

1,014

2.14 2.28

2.29 2.43

1.80 2.37

0.93 1.70

Race

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

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

9,998

430

8,493

*344

85.0

“80. 1

20,129

*667

2.01 2.37

*1 .55 “1 .94

Problem statua

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,553 1,833

8,025 7)1 13

71.8

88.6

4,021

16,960

1.58

2.11

2.19

2.36

Major reaaon for visit

.

1,832 1,342 73.2 2,881 1.57 2.15

5,590 5,100 91.2 11,956 2.14 2,34

2,423 2,275 93.9 5,794 2.39 2.55

582 *154 *26.4 *252 “0.43 “1 .64

“150 *76 50.3 *98 “0.65 *1 .29

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

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

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

Post surge~/post injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-illness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1A “i~it in which me or mors drugs were ordared Or provided.

2Drug ~entio”~ divided by number Of visits.

?.Drug ~e”tIonS divided by number of drug visits.

41ncludes races other than white and black not shown as separate categories.

50

,.
Table 46. Number, percent distribution, and rate per 100 visits of drug mentions in office visits by selected diagnoses and therapeutic category

United States, 1980

Diagnosis and therapeutic categoryl Drug mentions

Diseases ofsebaceous glands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anti biotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Cell stimulants andproliferants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Another therapeutic categories.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Osteoarthritis and allied disorders or other and unspecified arthropathies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Analgesics andantipyretica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Allothertherapeutic categories.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Intamartebral disc disorders or other and unspecified disorders of back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skeletal muscle relaxanta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Analgesics andantipyretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allothertherapeutic categories.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sprains and strains of sacroiliac region or other and unspecified parts of back. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Analgesics andantipyretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allothertherepeutic categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

Percent

distribution

20,981

9,018

1,777

1.080

4,350

4,756

14,251

1,666

5,807

944

885

4,949

7.138

1,016

2,952

3,170

6,586

1,370

2,618

2,398

100.0

43.0

6.5

5.2

20.7

22.6

100.0

11.7

40.8

6.6

6.2

34.7

100.0

14.2

41.4

44.4

00.0

20.8

42.8

36.4

Rate per

100 visits

198

43

17

10

41

. . .

172

20

70

11

11

. . .

118

21

49

. . .

89

19

38

. . .

1 ~asad on ,he ~l~~~ifi~ation ~y=tem of the American Hospital Formulaw se~ice. saa reference 5.

Table 47. Number and percent distribution of drug mentions in office visits for diseases of sebaceous glands by most frequently mentioned specific drugs

described by principal generic ingredient(s) and principal therapeutic category United States, 1980

Name of drugl Drug mentions Principal ganeric ingredient Principal therapeutic catego~

Number in

thousends

Percent

distribution

All drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Cleocin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Retin-A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Minocin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Desquam-X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Benzac . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Panoxyl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Persa-gel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Achromycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E-mycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Benzagel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Kenalog . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Staphylococcus toxoid . . . . . . . . . . . . . . . . . . . . . . . . . .

Sumycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrocortisone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prednisone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Cordran . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Zinc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20,981

3,108

2,511

1,072

836

789

787

715

595

572

527

508

467

*362

*346

*323

“320

*315

*314

*298

*288

5,928

100.0

14,8

12.0

5.1

4.0

3.8

3.7

3.4

2.8

2.7

2.5

2.4

2.2

*1.7

*1.6

“1.5

*1.5

*1.5

*1.5

*1.4

*1.4

28.3

tetracycline

clindamycin

tretirmin

minocycline

benzoyl peroxide, disodium edetate

benzoyl peroxide

erythromycin

benzoyl peroxide

benzoyl peroxide

tetracycline

erythromycin

benzoyl peroxide

triamci nolone

staphylococcus toxoid

tetracycline

hydrocortisone

prednisone

salicylic acid

flurandrenolide

zinc topical agent

. . .

antibiotics

antibiotics

cell stimulants and proliferants

antibiotics

keratolytic agents

keratolytic agents

antibiotics

keratolytic agents

keratolytic agents

antibiotics

antibiotics

keratolytic agents

anti-inflammatory agents

toxoida

antibiotics

anti-inflammatory agents

adrenals

keratolytic agents

anti-inflammatory agents

unclassified

. . .

1sassd on the phy~i~ian,~~“tw o“ the Patient Record Form.The entry maY be a brand or 9eneric ‘ame.

21f only one ~O”eric ingredient i= listed, the ~hYsi~ian.~ ~n~v is the generic drug ma brand nsme drug that consists chiefly of a Singlegeneric ingredient.May nOtincludeall ingredientsfor

evary combination drug.

Ssased ~“ ths classification system of the American Hospital Formulary SetViCa. See reference 5.

51
Table 48. Number and percent distribution of drugs used in office visits for diseases of sebaceous glsnds by form of use, according to most frequently

used genaric substance: United Statea, 1980

Form of use

Generic substance

Drugs

used

Total

Single Combinations ingredient

Number in

thousands Percent distribution

Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,903 100.0 100.0

Benzoyl peroxide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,587 100.0 47.1 52.9

Clindamycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,575 100.0 100.0

Edetate diaodium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 719 100.0 100.0

Erythromycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,364 100.0 100.0

Hydrocortiaone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 878 100.0 61.2 38.8

Minocycline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 844 100.0 100.0

Predniaone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *315 100.0 “100.0

Salicylic acid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 862 100.0 3.0 97.0

Sulfur (cathartic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 677 100.0 100.0

Tetracycline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,168 100.0 99.6 0.4

Tretinoin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,072 100.0 100.0

Triamcinolone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 479 100.0 100.0

Zinc topical agenta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “326 100.0 *88.3 “11.7

Table 49. Number of office viaits for oateoarthritia and allied disorders or other and unspecified arthropathies, number and percent of drug visits,

number of drug mentions, drug mention rate, and drug intensity rate by selected characteristic: United States, 1980

Office visits Drug Drug

Selected characteristic

Drug

mention mentions intensity

All visits Drug visitsl rate2 rate3

Sex

8oth sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Age

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

45-64 yeara . . . . . . . . . . . . . . . .

65yeara andcwer . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rata

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

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

Problem atatua

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oldprobiem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major reaaon for viait

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

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

Chronic problem, flaraup . . . . . . . . . . . . . . . . . . . . . . . .

POatsurgepr/post injury, .,.,..... . . . . . . . . . . . . .

Non-ill ness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousanda

Number in

thouaanda Percent

Number in

thousanda Rate per viait

48,297

5,733

2,564

934

3,457

3,906

7,225

1,038

2,286

6,010

2,041

3,565

1,970

“304

417

6,799

4,793

2,006

686

2,773

3,340

5,902

864

1,687

5,112

1,786

3,042

1,657

*46

*267

82.0

83.6

78.2

73.4

80.2

85.5

81.7

83.2

73.8

85.1

87.5

85.3

84.1

15.3

“64.0

14,251

10,139

4,112

1,055

5,379

7,816

12,394

1,801

3,339

10,912

3,563

6,728

3,355

*8 I

522

1.72 2.10

1.77 2.12

1.60 2.05

1,13 1.54

1.56 1.94

2.00 2.34

1.72 2.10

1.74 2.08

1.46 1.98

1.82 2.13

1.75 1.99

1.89 2.21

1.70 2.02

‘0.27 *1 .76

*1 .25 *1 .96

1A “i~j~ i“ which one or more drugs were ordered or provided.

2Drug ~entio”$ divided by numbarof visits.

3orug ~entio”s divided by numberof drugvisits.

41ncrudes~ace~Otherthan white and black not shown as separate cate90rias

52
Table 50. Number and percent distribution of drugs used in offtca visits for selected musculoskeletal conditions by form of use, eccording to most frequently

used generic substances United States, ?980

Diagnosis and generic substance

Form of use

Drugs

used

Total Single Combinations ingredient

Osteoarthritis and allied disorders or other and unspecified arthropathies

Acetaminophen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Fenoprofen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrochlorothiazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ibuprofen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

lndomethacin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Naproxen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Raserpine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Intatvertebral disc disorders or other and unspecified disorders of back

Acetaminophen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Acetaminophen and codeine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Caffeine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Codeine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ibuprofen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Methocarbamol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Orphenadrine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenacetin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sprains and strains of sacroiliac region or other and unspecified parts of back

Acetaminophen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Acetaminophen and codeine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Caffeine . . . . . . . . . . . . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chiorzoxazone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Codeine . . . . . . . . . . . . . . . . ,., .,.., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ibuprofen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Methocarbamol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Orphenadrine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenacetin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Propoxyphene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in

thousands

715

1,008

“308

712

918

663

720

*333

569

613

*388

704

488

“245

*276

406

“309

488

753

*21 o

1,200

730

“247

’210

*247

537

370

713

*288

Parcent distribution

100.0 34.5 65.5

100.0 86.9 13.1

100.0 *1 00.0

100.0 39.6 60.4

100.0 100.0

100.0 100.0

100.0 100.0

100.0 *1 8.6 *81 .4

100.0 100.0

100.0 22.3 77.7

100.0 100.0

100.0 33.8 66.2

100.0 100.0

00.0 *9.8 *90.2

00.0 100.0

00.0 88.7 11,3

00.0 “57.4 *42.6

00.0 100.0

100.0 10.9

100.0 100.0

100.0 30.3

100.0

100.0

100.0

100.0 100.0

100.0 70.6

89.1

69.7

00.0

00.0

00.0

29.4

100.0 29.7 70.3

100.0 100.0

100.0 *5.2 “94.8

53

.
Table 51. Number of off!ce visits for intervertebral disc disorders or other and unspecified disorders of back, number and percent of drug visita,

number of drug mentions, drug mention rate, and drug intensity rate, by selected characteristics United States, 1980

Office visits

Drug Drug Drug

Selected characteristic mention mentions intensity

All visits Drug visitsl rate2 rate3

Number in

thouaanda

Number in

thousands Percent

Number in

thousands Rate per visit

1.18 1.92

1.38 2.11

0.97 1.71

46,071

3,035

3,036

3,716

1,987

1,729

61.2

65.5

57.0

7,138

4,189

2,949

Age

Under 25 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

65veara and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

*323

1,512

1,391

491

53.1

58.8

61.5

78.0

“487

2,640

2,855

1,155

“0.80 “1.51

1.03 1.75

1.26 2.05

1.84 2.35

607

2,571

2,264

629

Race

5,276

786

3,150

562

59.7

71.6

6,046

1,088

1.15 1.92

1.38 1.94

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

black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Problem status

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,462

4,676

1.06 1.78

1.25 2.00

2,318

3,753

1,384

2,333

59.7

62.2

Major reason for viait

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

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

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

post surgery/pOat in jury . . . . . . . . . . . . . . . . . . . . . . . .

Non-ill nesa care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,274

1,479

1,391

810

*118

1,527

836

941

*356

“57

67.2

56.5

67.7

*43.9

*48.2

3,030

1,507

1,925

*595

*8O

1.33 1.98

1.02 1.80

1.38 2.05

“0.73 *1 .67

*0.68 *1 .40

1 A “i~it in which one or more druga were ordered or providad.

2Drug ~antions divided by numbar Of visits.

3Drug ~entio”~ dividad by number Of drug visits.

41”cl”de~ ~ace~ other than ~hita a“d black not shown as separate cate90ries.

54
Table 52. Number of office visits for sprains and strains of sacroiliac region or other and unspecified parts of back, number and percent of drug viaita,

numbar of drug mentions, drug mention rate, and drug intensity rate, by selected characteristics United Statea, 1980

Office visits Drug Drug

Selected characteristic

Drug

mention mentions intensity

All visits Drug visitsl rate2 rate3

Sex

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

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

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

Age

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

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

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

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

Race

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

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

Problem status

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major reason for visit

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

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

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

POstaurge~/pOat injure . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-illness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Numbar in

thousands

47,393

3,755

3,637

962

3,523

2,273

635

6,147

1,093

2,938

4,455

3,758

1.473

1,118

938

*105

Number in

thousands

4,411

2,158

2,252

522

2,125

1,287

478

3,713

583

2,074

2,337

2,590

587

748

442

*44

Percent

Number in

thousands Rate Der visit

59.7

57.5

61.9

54.2

60.3

56.6

75.3

60.4

53.4

70.6

52.5

68.8

39.9

67.0

47.1

“42.1

6,586

3,193

3,393

749

3,007

1,996

834

5,620

833

3,181

3,404

3,927

818

1,062

*718

*59

0.89 1.49

0.85 1.48

0.93 1.51

0.78 1.43

0.85 1.42

0.88 1.55

1.31 1.74

0.91 1.51

0.76 1.43

1.08 1.53

0.76 1.46

1.04 1.52

0.56 1.39

0.95 1.42

“0.77 *1 .62

“0.56 “? .34

1A “iSit in which one or more drugswere ordered or provided.

2DW9 ~en~ion$ divided by numberOfvisits.

3Drug ~e”tio”S divided by numberOfdrugvi$it$.

41ncludeSraceSotherthan white and black IIOt shown as SePSratacSte90ries.

55
Section VI 1. Selected

preventive care services

The three preventive care services presented in this

report accounted for 10 percent of all visits to oflicebased physicians in 1980, but only 5 percent of drug

mentions. Because, as the term implies, current illness

is usually absent during preventive care visits, low drug

mention rates may be expected. However, it is also

worthwhile to examine the preventive measures taken

with such care and to note by inference what medication is not routinely prescribed for patients visiting for

non-illness care.

Health supervision of infant or child

There were an estimated 17.5 million visits by children, of which 12.5 million, or 71 percent, were for

examination of children under 3 years of age (table 53).

About 59 percent of visits by children included

medication therapy, with a drug mention rate of 0.94.

One drug was used in53 percent of the 10.3 million drug

visits; two drugs in 36 percent. The drug intensity rate

of 1.60 reflects this pattern.

Immunization is a primary concern during early

childhood visits and it is seen in the National Ambulatory Medical Care Survey (NAMCS) that 67 percent

of all drug mentions were in the therapeutic category of

serums, toxoids, and vaccines (table 54). The Tuberculin

tine test, a diagnostic agent, accounted for 15 percent. It

is seen in table 55 that the most frequently mentioned

biologics were Diphtheria and tetanus toxoids and pertussis vaccine (26 percent); Diphtheria and tetanus

toxoids, unspecified (2 percent); Poliomyelitis vaccine,

unspecified (27 percent); Vaccination, unspecified (3

percent); M-M-R (measles, mumps, rubella virus vaccines, 3 percent); and Rubella virus vaccine, live (2

percent).

These data provide information on the number of

single or combination immunizing agents administered,

but it is possible that more than one type was provided

during a visit. Also, the same child maybe immunized

against disease by a series of “shots. ” NAMC S does

not provide data on such episodes; therefore, the number of immunizations should not be interpreted as the

number of immunized children.

Only one vitamin was reported with more frequency

than others. Poly-vi-flor, also used for caries prophylaxis,

was indicated in 2 percent of drug mentions.

Normal pregnancy

The estimated 26.3 million visits for prenatal care

was the highest number of visits for any one diagnosis

reported in NAMCS. The drug mention rate of 0.41 is

the lowest of those in this report (table 56). Medication

therapy was mentioned in only one of every three visits,

and one drug was the likely number prescribed since it

was indicated in 79 percent of those visits in which a

drug was mentioned.

On the average there were about six return visits for

prenatal care for each visit in which pregnancy was first

diagnosed by the physician. Drug therapy was more

likely to be used in the latter, new problem, visits(53

percent) than in return visits (30 percent). This maybe

due in part to the prescription of drugs to relieve nausea

and vomiting in the early stage of pregnancy. Bendectin,

an antihistamine drug used for this purpose, was entered

in 3 percent of drug mentions.

Vitamins, which accounted for 67 percent of drug

mentions, were the most commonly prescribed therapy

for pregnant women (table 54). Antianemia drugs were

noted in 13 percent. The vitamin preparations most

frequently named by physicians are listed in table 55. In

some cases the physician simply recorded “vitamins”

(8 percent of mentions). The most frequently named

multivitamins were Prenatal Formula (17 percent),

Matema (13 percent), Stuartnatal 1 i- 1 (7 percent),

Pramet FA (5 percent), and Natalins (5 percent).

General medical examination

As table 57 shows, only 29 percent ofthe 16 million

visits for general medical examination included medication therapy, a not unexpected finding. A higher propor56
tion of visits by female patients (34 percent) than by

male patients (24 percent) included drugs. The relatively low drug mention rate of 0.41, matched only by

the rate for normal pregnancy, may also be attributed to

the fact that only one drug was mentioned in71 percent

of drug visits.

Serums, toxoids, and vaccines (consisting chiefly of

poliomyelitis vaccine and diphtheria and tetauus toxoids

and pertussis vaccine) were used in 27 percent of mentions. The Tuberculin tine test accounted for 17 percent.

Use of these biologics was associated mainly with patients under 25 years of age. Contraceptives constituted

14 percent of all mentions with general medical examinations (20 percent of women’s mentions). Putting

this statistic into perspective requires information on

the use of contraceptives when other diagnoses were

present. Of the 7.8 million mentions of contraceptives

during women’s visits for all diagnoses, 65 percent were

found with six diagnoses: 12 percent were associated

with general medical examination; 8 percent with postpartum care; 13 percent with contraceptive management 22 percent with gynecological examination; 5

percent with inflammatory disease of cervix, vagina,

and vulvrq and 5 percent with dkorders of menstruation.

Table 53. Number of office visits for health supervision of infant or child, number and percent of drug visits, number of drug mentions, drug mention rate,

and drug intensity rate, by selected characteristic.% IJnited States, 1980

Office visits Drug Drug

Selected characteristic Drug

mention mentions intensity

All visits Drug visits~ rate2 rate3

Number in

Sex thousands

Number in

thousands Percent

Number in

thousands Rate oer visit

Age

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

3-5 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Race

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

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

Problem status

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major reason for visit

Non-illness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other reaaon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

417,496

8,240

9,257

12,499

2,238

2,204

555

15,401

1.809

4,393

13,104

17,066

431

10,341

5,067

5,275

7,642

1,231

1,194

“275

9,259

933

2,312

8,030

10,165

“177

59.1

61.5

57.0

61.1

55.0

54.2

*49.5

60.1

51.6

52.6

61.3

59.6

*4 I .3

16,502

8,158

8,344

12,214

2,300

1,578

*4 I o

14,732

1,539

4,090

12,413

16,203

“300

0.94

0.99

0.90

0.98

1.03

0.72

“0.74

0.96

0.85

0.93

0.95

0.95

“0.70

1.60

1.61

1.58

1.60

1.87

1.32

“1 .49

1.59

1.65

1.77

1.55

1.59

*1 .69

1A “i~it in which ww or mors drugs wsrs ordered or Provided.

2Drug mentions di”ided by numbsr Of visits.

3Drug Mentions di”ided by number Of drug visits.

alnclude~ ~acSS Other than white snd blsck not shown ss ssparate cats90ries.

57
Table 54. Number, percent distribution, and rate per 100 viaits of drug mentions in office viaits for selected health services by therapeutic catego~

United States, 1980

Health serv;ce and therapeutic categoyl Drug mentions

Number in Percent Rate per

thousands distribution 100 visits

Heaithsupewision ofinfant orchild . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,502 100.0 94

Diagnostic agents (for tuberculosis). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,416

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

14.6 14

11,087 67.2 63

Another therapeutic categories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,985 18.2 . . .

Normal pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,755 100.0 41

Antianemia drugs .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,370 12.7 5

Vitamins ., ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,208 67.0 27

Another therapeutic categories.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,177 20.3 .,.

Genaral medical examination, ...,.... ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,,,,,,,,,,,,,,,,,,, 6,624 100.0 41

Diagnostic agents (for tuberculosis).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,154 17.4 7

Contraceptives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 899

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

13.6 6

1,778 26.8 11

Another therapeutic categories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,793 42.2 . . .

1 Based ~“ the ~lasslflcation system of the Arnencan Hospnal Formulay Sewice. See reference 5.

Table 55. Number and percent distribution of drugs mentioned in office visits for selected health services by most frequently mentioned specific drugs

described by principal generic ingredient(s) and principal therapeutic category United Statea, 1980

Principal diagnosis and name of drugq Drug mentions Principal ganeric ingredient Principal therapeutic categoryz

Health supewision of infant or child . . . . . . . . . . ., .,

Poliomyelitis vaccine, unspecified. ., . . . . . . ., ., .,

Diphtheria and tetanua toxoids and pertuasis vaccine .,

Tuberculin tine test,........,., . . . . . . . .

M- M-R,.,.,.,............,.,,, . . . . . . . .

Vaccination, unspecified, ,, . . . . . . . . . . . . . . .

Diphtheria and tetanus toxoids, unspecified ., ., . . . . . .

Rubella virus vaccine, live, . . . . . . . . . . . . . . . . . .

Poly-vi-flor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Normal pregnancy, , ., .,.,..... . . . . . . . .

Prenatal formula (vitamins), .,.,.,. . . . . . . . . . . . . .

Materna l..,,,...,........,.. . . . . . . . . . . . . . . . .

Vitam!n(s), unspecified, ,,, .,.,. . . . . . . . . . . . . . . .

Stuartnatal l+ l . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pramet FA, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Natal ins, , . . . . . . . . . . . . . . . . . .

8endectln. . . . . . . . . . . . . . . . . . .

Filibon . . . . . . . . . . . . . . . . . . . . . .

Natabec, ,,, ,,, . . . . . . . . . . . . . . .,.,.,.,,,,,,,,,,.

Residual, . . . . . . . . . . . . . . . . . . . ,, ., ., .,, ,,, ,., .,...

Number in

thousands

16,502

4,480

4,335

2,416

555

407

*372

*369

’327

3,241

10,755

1,801

1,387

819

728

565

549

“358

*347

*336

3,866

Percent

distribution

100,0

27,1

26,2

14.6

3.4

2.5

*2.3

“2.2

“2.0

19.6

100.0

16.7

12.9

7.6

6.8

5.3

5.1

*3.3

*3.2

“3.1

36.0

poliomyelitis vaccine, unspecified

diphtheria and tetanus toxoids

and pertussis vaccine

Old Tuberculin

measlea, mumps, rubella virus

vaccines

undetermined

undetermined

rubella virus vaccine

multivitamins, general

.

.

multivitamins, prenatal

multivitamins, prenatal

undetermined

multivitamins, prenatal

multivitamins, prenatal

multivitamins, prenatal

doxylamine, pyridoxine

multivitamins, general

multivitamins, prenatal

vaccines

toxoids

tuberculosis diagnostic agent

vaccinea

vaccines

toxoids

vaccines

unclassified therapeutic agents

,..

,..

multivitamin preparations

multivitamin preparation

vitamins

multivitamin preparations

multivitamin preparations

multivitamin preparation

antihistamine drugs

multivitamin preparations

multivitamin preparations

. .

1 Based ~“ the physi~ta”~ ~“tv on the Pat,e”t Record Form. The entry may be a brand or generic name, or a therapeutic effect

2Ba~ed ~“ tha ~la~scflcallo” SySW- Of the American Hospital Formulary Senme. see reference 5.

58
Table 56. Number of office visits by women for normal pregnancy, number and percent of drug visits, number of drug mentions, drug mention rate,

end drug intensity rate, by selected characteristics: United States, 1980

Office visits Drug Drug

Selected characteristic

Drug

mantion

All visits

mentions intensity

Drug visits~ rate2 rate3

Number in Number in Number in

Age thousands thousands Percent thousands Rate per visit

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

426,256 8.727 33.2 10,755 0.41 1.23

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *333 *186 *55.8 “308 “0.92 *1 .66

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,880 4,255 35.8 5,308 0.45

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

1.25

13,940 4,277 30.7 5,130 0.37

45years’and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.20

*103 *9 *8.7 *9 *0.09 *I .00

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22,923 7,551 32.9 9,185 0.40 1.22

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,868 1,014 35.4 ?,383 0.48 1.38

Problem status

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,814 2,003 52.5 2,672 0.70

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.33

22,441 6,724 30.0 8,084 0.36 1.20

Major reason for visit

Acute problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,074 *374 *34.8 *532 *0.50 *I .42

Non-illness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24,879 8,208 33.0 10,054 0.40

Other reason . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.22

“303 *145 “47.9 *169 “0.56 “1.17

1A “i~it in which Onem more drugswera ordered or provided.

2Drug mentiOn~divided by number Of visits.

3Dmg mentiOn~divided by number Of drug visits.

qlnc[ude$ ~aceS C,ther than white and black not shown as sepsrate cste90rie$.

Table 57. Number of office visits for general medical examination, number and percent of drug visits, number of drug mentions, drug mention rate,

and drug intensity rate, by selected characteristics: United States, 1980

Office visits Drug

Selected characteristic Drug Drug

mention

All visits mentions intensity

Drug visitsl rate2 rate3

Number in Number in

Sex

Number in

thousands thousands Percent thousands Rate per visit

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416,078 4.732 29.4 6,624 0.41 1.40

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,350 3,134 33.5 4,440

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

0.47 1.42

6,727 1,598 23.8 2,184 0.32 1.37

Age

Under 15yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,288 1,575 47.9 2,171 0.66

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

1.38

4,159 1,163” 28.0 1,644

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

0.40 1.41

4,638 861 18.6 983 0.21

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

1.14

2,612 761 29.1 1,283 0.49

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

1.69

1,381 *372 ‘27.0 *544 ‘0.39 *1 .46

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,313 4,459 31.2 6,175 0.43

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

1.38

1,536 *219 “14.3 *372 “0.24 *1 .70

Problem status

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,756 1,746 22.5 2,646 0.34

Old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.52

8,322 2,986 35.9 3,978 0.48 1.33

Major reason for visit

Chmnicp roblem,r outing. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,241 411 33.1 *61 5 0.50

Non-illness care

1.50

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,221 4,158 29.2 5,667 0.40

Other reason . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.36

615 *163 *26.5 *342 “0.56 *2.1 o

1A “i$it i“ which one Ormore dregs were ordered or provided.

2Drug ~e”,io”s divided by number Of visits.

3Drug mentions divided by number of drug ViSits.

41”~ludeS ~aceS other than white and black nOt shown as separate cate90ries.

59
Discussion

All of the drug data used in this report were derived

from the information provided by physicians in item 11

of the National Ambulatory Medical Care Survey

(NAMCS) Patient Record. Part a of this item was

designed to elicit the medication prescribed for the principal diagnosis assigned to the patient’s visit. Part b was

provided to list medication ordered for all other reasons.

In order to describe the total pharmacologic environment of patient care, both parts of item 11 were used to

compute total drug mentions and to describe specific

drugs prescribed in the presence of a specific diagnosis.

As the data with the highest frequencies were tabulated,

it became apparent that what emerged were chiefly the

drugs that produced the appropriate therapeutic effects

for the principal diagnosis under study. That is, medications ordered most frequently for hypertensive patients

were antihypertensive drugs or diuretics, those for diabetic patients were anti-diabetics, and so forth. In some

tables drugs were listed that are used for conditions

often concomitant with the principal diagnosis of interest, such as cardiovascular drugs with diabetes mellitus

and osteoarthritis. In other cases the aggregation of all

available drug data provided information about preventive care during illness visits. Noteworthy in this

respect was the provision of vitamin B-12 to patients

with hypertension and the administration of influenza

virus vaccine to at-risk patients with hypertension and

ischemic heart disease. This is not to say, however, that

this is the only appropriate analytic method. The twopart structure of the medication therapy item has the

flexibility of serving different research needs.

Increasing age was a significant factor in the utilization of drugs with many of the diagnoses discussed in

this report. In fact, regardless of diagnosis and on the

average, drug mention rates increased with each advancing age group beginning with age group 15–24

years (figure 3). Similarly, proportions of visits that

included one or more drugs increased as did the average

number per drug visits However, because these rates

were calculated from data in both parts of item 11, it

could be argued that medication for concomitant conditions often associated with visits by elderly patients

60

1.7

1.6

1.5

1.4

All-listed drugs

1.3

1.2

1.1

1.0

\

\

\

0.9

NJ

h-d

Principal medication

:“~

Under 15-24 25–44 45-64 65 and

15 over

Age in years

Figure 3. Drug mention rates per visit for all-listed druga and principal

medication by age of patient United Ststes, 1980

caused the rise in the rate (that is, elderly patients were

given more drugs because they had more problems).

Therefore, rates based on only part 11a (medication for
the principal diagnosis) were calculated and are also

plotted in figure 3. As expected, rates for the principal

medication were lower than those for all-listed (parts

11a and 11h) drugs, but both curves exhibit a similar

pattern of increase, suggesting that rising rates were not

necessarily a function of drug use for conditions other

than the principal diagnosis. Similar dual curves were

plotted for diabetes mellitus, essential hypertension,

and ischemic heart disease (figure 4). Patients visiting

with these three diagnoses tended to have interrelated

concomitant conditions for which additional therapeutic

classes of medication were ordered. For each diagnosis

the two curves increase with increasing age groups,

demonstrating that given one of these conditions, as

patients age increases they are increasingly likely to

have drugs prescribed for that condition.

It has been reported that no statistically significant

differences were found between the drug rates of female

and male patients in the 1980 NAMCS when data for

all diagnoses were examined.s Of the 18 diagnoses in

this report, the drug mention rate for female patients was

higher than that of male patients for five diagnoses:

obesity, hypertension, bronchitis, allergic rhinitis, and

intervertebral disc disorder. Although no drug mention

rates among the groups in this report were higher for male

patients, there are other diagnoses where this may occur.

NAMCS drug data reflect physicians’ choices

among many therapeutically equivalent pharmaceutical

_ All-listed drugs

-- Principal medication

.

Under 45 45–64 65 and

over

Disbetes mellitus

Disgnosis st?d sge in years

/“’’””-

I

I I 1 I I

Under 45 45-64 65 and Under 45 45–64 65 and

over over

Essential hypertension Ischemic heart disease

Figure 4. Drug mention rates per visit for diabetes mellitus, essential hypertension, and ischemic heart disease by all-listed drugs and principal medication

and age of pstient United States, 1980

61

,
products. In some parts of this report selections from

available drugs were so diverse that it was not possible

to list any one with good statistical reliability. In others,

a limited number of individual drugs described almost

the entire range of drug mentions. It is not known whether

this was due to the number of drugs available in the

pharmaceutical market, to the number of acceptable

and approved generic drugs developed to treat a disease, or to physician preference for a particular brand

name drug. NAMCS data indicate that physicians were

most likely to order brand name drugs, since 71 percent

ofthe drugs used were entered by manufacturer’s product

name. But what influenced a physician to select one

brand of drug rather than an equivalent one produced by

another manufacturer cannot be inferred from these

data.

Finally, this report reflects drug utilization for the

year 1980. These statistics should not be generalized to

other time periods because pharmacology is an evolving

science and the production of pharmaceuticals is a dynamic industry.

62
References

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No. (PHS) 80–1 260. Public Health Service. Washington. U.S.

Government Printing Oflice, Sept. 1980.

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United States, 1977. Advance Data From Vital and Health Statktics, No. 57. DHEW Pub. No. 79– 1250. Public Health Service.

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9Charles E. Baker, JC Physicians’ Desk Reference, 35th ed.

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10Norman F. Billups, and Shirley M. Bilh.zps:The American Drug

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63
Appendixes

Contents

1. Technical Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Statistical design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Data collection and processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Estimation procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Reliability of estimates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

Tests of significance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Population figures and rate computation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Rounding of numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Systematic bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Il. Definition ofterms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..73

Terms relating to the survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Terms relating to the Patient Record Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ?4

Ill. Survey instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

introductory Letterfrom Director, National Center for Health Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Patient Record Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Induction Interview Form.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

IV. American Hospital Formulary Service classification system and therapeutic category codes. . . . . . . . . . . . . . . . . . . . . . 87

List of appendix tables

1. Distribution ofphysicians inthe1980National Ambulatory Medical Care Survey universe andsampleand response rates

by physician specialty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Il. Estimatesofthe civilian noninstitutionalized population ofthe UnitedStatesused in computing annualvisit ratesin this

report byage, race, sex, geographic region, and metropolitan and nonmetropolitan area: Julyl, 1980 . . . . . . . . . . . 72

Listof appendix figures

1. Approximate relative standard errorsforestimated numbers ofofficevisits based onallphysician specialties(A)and individualspecialties(/3), 1980 National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Il. Approximate relative standard errors for estimated numbers of drug mentions based on all physician specialties (A) and

individual specialties(B), 1980 National Ambulatory Medical Care Survey... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

64
Appendix L Technical notes

@

This report is based on data collected during 1980

in the National Ambulatory Medical Care Survey

(NAMCS), an annual sample survey of office-based

physicians conducted by the Division of Health Care

Statistics of the National Center for Health Statistics

(NCHS).

Statistical design

Scope of the survey

The target population of NAMCS encompasses

oflice 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.

Sample design

The NAMCS utilizes a multistage probability design that involves probability samples of primary sampling units (PSU’S), physician practices within PSU’S,

and patient visits within physician practices.

The first-stage sample of 87 PSU’S was selected by

the National Opinion Research Center 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-tosize procedure using separate sampling frames for

SMSA’S and for nonrnetropolitan counties was used to

select the sample PSU’S. After sorting and stratifying

by size, region, and demographic characteristics of the

PSU’S, each frame was divided into sequential zones of

1million residents, then a random number was drawn to

determine which PSU came into the sample from each

zone.

The second stage of the survey consisted of a probability sample of practicing physicians, selected from

the master files maintained by the American Medical

Association (AMA) and the American Osteopathic

Association (AOA)asofDecember31, 1979, who met

the following criteria:

● OffIce based, as defined by AMA and AOA.

● Principally engaged in patient care activities.

● Nonfederally employed.

● Not in the specialties of anesthesiology, pathology,

clinical pathology, forensic pathology, radiology,

diagnostic radiology, pediatric radiology, or therapeutic radiology.

The 1980 NAMCS physician universe included 217,500

doctors of medicine and 10,058 doctors of osteopathy

(see table I).

Within each PSU, all eligible physicians were arranged 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 the NAMCS physician sample included 2,959 physicians. Sample physicians were

screened at the time of the survey to insure that they met

the aforementioned criteri~ 611 physicians did not

meet all the criteria and were, therefore, ruled out of

scope (ineligible) forthe study. The most common reasons

for being out of scope were that the physician was retired; deceased or employed in teaching, research, or

administration. Of the 2,348 in-scope (eligible) physicians, 1,869 (79.6 percent) participated in the study.

The physician sample size and response data by physician specialty are shown in table I.

The final stage was the selection of patient visits

within the annual practices of the sample physicians.

This stage involved two steps. First, the total physician

65
Table 1. Distribution of physicians in the 1980 National Ambulato~ Medical Care Survey universel and sample and response rates by physician specialty

Physician specialty

All specialties . . . . . . . . . . . . . . . .

Genera land family practice . . . .

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

Internal medicine......,.,.,.,., .

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

Other medical specialties . . . . . . . .

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

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

Obstetrics and gynecology.....,..

Other surgical specialties ..,.....

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

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

Other speciakies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sample

Universe

Gross out of

Net total Non respondents Respondents

Response

total stop e rate

Number Percent

-—

227,558 2,959 611 2,348 479 1,869 79.6

53,147 676 155 521 133 388 74.5

66,692 864 172 692 138 554 80.1

35,198 458 92 366 85 261 76.8

16,043 204 46 158 19 139 88.0

15,450 202 34 168 34 134 79.8

77,625 1,002 131 871 164 707 81.2

21,486 269 39 230 60 170 73.9

18,246 247 36 211 27 184 87,2

37,893 486 56 430 77 353 82.1

30,094 417 153 264 44 220 83.3

16,662 223 55 168 22 146 86.9

13,432 194 98 96 22 74 77.1

1 ,“cludes d~~tors Of medicine and doctors Of ostewath~.

sample was divided into 52 random subsarnples of approximately equal size, and each subsample was randomly assigned to 1 of the52 weeks in the survey year.

Of the participating physicians, 249 saw no patients

during their assigned reporting period because of vacations, illnesses, or other reasons for being temporarily

out of ofllce-based practice. Second, a systematic random

sample of visits was selected by the physician during the

assigned week. The sampling rate varied for this final

step from a 100-percent sample for very small practices

to a 20-percent sample for very large practices. The

method by which the sampling rate was determined is

described later in this appendix and in the Induction

Interview Form in appendix III. During 1980,46,081

usable Patient Record Forms were completed by physicians participating in NAMCS.

Data collection and processing

Field procedures

Both mail and telephone contacts were used to enlist sample physicians for NAMCS. Introductory Letters from the Director of NCHS (see appendix III) were

sent to physicians first. When appropriate, a letter from

the physician’s specialty organization endorsing the

survey and urging 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 to arrange an appointment for a personal interview.

Physicians who did not respond initially 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 the cooperation of the physician, delivered

survey materials with verbal and printed instructions,

and assigned a predetermined Monday-Sunday reporting period. A short induction interview concerning basic

practice characteristics, such as type of practice and

expected number of oflice visits, was conducted. IOfflce

staff who were to assist with data collection were invited

to attend the instructional session or were offered separate instructional sessions.

Before the beginning and again during the week assigned for data collection, the field representative telephoned the sample physician to answer questions that

might have arisen and to insure that survey procedures

were going smoothly. At the end of the reporting week,

the participating physician mailed the completed suryey

materials to the field representative, who edited the

forms for completeness before transmitting them for

central data processing. At this stage, problems of missing or incomplete data were resolved by telephone

followup by the field representative to the sample :physician; if no problems were found, field procedures were

considered complete regarding the sample physician’s

participation in NAMCS.

Data collection

The actual data collection for NAMCS was performed by the physician, assisted by ofllce staff when

possible. Two data collection forms were employed by

the physician: the Patient Log and the Patient Record

(see appendix III). The Patient Log, a sequential listing

of patients seen in the physician’s office during the

assigned reporting week, served as the sampling frame

to indicate the ofl-lce visits for which data were to be

recorded. A perforation between the patient’s name and

patient visit information permitted the physician to detach and retain the listing of patients, thus protecting the

confidentiality of the physician’s patients.

Based on the physician’s estimate of the expected

66
number of office visits and expected number of days in

practice, each physician was assigned a patient sampling

rate. The patient sampling rates were designed so that

about 30 Patient Record Forms would be completed by

each physician during the assigned reporting week.

Physicians expecting 10 or fewer visits each day recorded data for all visits, those expecting more than 10

visits per day recorded data for every second, third, or

fifth visit, based on the predetermined sampling interval.

These patient sampling procedures minimized the physician’s data collection workload and maintained 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 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 procedures proved quite efilcient,

reducing item nonresponse rates to 2 percent or less for

most data items.

Information contained in item 6 (Patient’s complaint(s), symptom(s), or other reason(s) for this visit)

ofthe Patient Record was coded according to “A reason

for visit classl~cation for a7nbulato7y care” @7C].~z

Diagnostic information (item 9 of the Patient Record)

was coded according to the Intematz”onal Classl@ation

ofDiseases, 9th Revision, ClinicalModl~cation (ICD–

9–CM).1 A maximum of three entries were coded from

each of these items. Prior to coding, Patient Record

Forms were grouped into batches with approximately

650 Patient Record Forms per batch. Quality control

for the medical coding operation involved a two-way 5-

percent independent verification procedure. Error rates

were defined as the number of incorrectly coded entries

divided by the total number of coded entries. The estimated error rates for the medical coding operation were

1.9 percent for item 6 and 2.8 percent for item 9. An

additional dependent procedure was used to review and

adjudicate all records in batches with excessive error

rates. This procedure IWher reduced the estimated

error rates to 1.8 percent for item 6 and 2.5 percent for

item 9.

The NAMCS medication data (item 11 of the Patient Record) was classified and coded according to a

scheme developed at NCHS based on the American

Society of Hospital Pharmacists’ Drug Product Information File. Detailed descriptions of the development

of the new drug coding scheme and of the NAMCS

NOTE: A list of references follows the text.

drug data processing procedures are contained in Vital

andHealth Stat’ish”cs,Series 2, No. 90.6A twsway 100-

percent independent veritlcation procedure was used to

control the medication coding operation. All Patient

Record Forms with differences between drug coders or

with illegible drug entries were reviewed and adjudicated at NCHS.

Information from the Induction Interview and Patient Record Forms was keypunched with 100 percent

verification and converted to computer tape. At this

point, extensive computer consistency and edit checks

were performed to insure complete and accurate data.

Incomplete items were imputed by assigning a value

from a randomly selected Patient Record Form with

similar characteristics; patient sex and age, physician

specialty, and broad diagnostic categories were used as

the basis for these imputations.

Estimation procedures

Statistics from the 1980 NAMCS were derived by a

multistage estimation procedure that produces essentially unbiased national estimates and has three basic

components: (1) inflation by reciprocals of the probabilities of selection, (2) adjustment for nonresponse,

and (3) a ratio adjustment to fixed totals. Each component is briefly described in this section.

Inflation by reciprocals of the

probabilities of selection

Because the survey utilized athree-stage sample design, three probabilities of selection existed: (1) the

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

selecting the physician within the PSU, and (3) the

probability of selecting a patient visit within the physician’s practice. The last probability was defined as the

exact number of ofllce visits during the physician’s

assigned reporting week divided by the number of Patient Record Forms completed. All weekly estimates

were inflated by a factor of 52 to derive annual estimates.

Adjustment for nonresponse

Estimates for NAMCS data were adjusted to account for sample physicians who did not participate in

the study. This adjustment was calculated to minimize

the impact of response on final estimates by imputing to

nonresponding physicians the practice characteristics

of similar responding physicians. For this purpose, physicians were judged similar ifthey had the same specialty

designation and practiced in the same PSU.

Ratio adjustment

A poststratilcation adjustment was made within

each of nine physician specialty groups. The ratio ad67
justment 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 master files, and the

denominator was based on data from the sample.

Reliability of estimates

As in any survey, results are subject to both sampling and nonsampling errors. Nonsampling errors include reporting and processing errors, as well as biases

due to nonresponse or incomplete response. The magnitude of the nonsampling errors cannot be computed;

however, these errors were kept to a minimum by survey

procedures. To eliminate ambiguities and encourage

uniformity of reporting, careful attention was given to

the phrasing of the questions, terms, and definitions,

and, in addition, extensive pretesting 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

sampling variability alone.

Because the statistics presented in this report are

based on a sample, they differ somewhat from the figures

that would be obtained had a complete census been

taken using the same forms, definitions, instructions,

and procedures. However, the probability design of

NAMCS permits the calculation of sampling errors.

The standard error is primarily a measure of sampling

variability that occurs by chance because only a sample

rather than the entire population is surveyed. The standard error, as calculated in this report, also reflects part of

the variation that arises in the measurement process. It

does not include estimates of any systematic biases that

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

that an estimate from the sample would differ from a

complete census by less than the standard error. The

chances are about 95 out of 100 that the difference

would be less than twice the standard error, and about

99 out of 100 that it would be less than 2% times as

large.

The relative standard error of an estimate is obtained by dividing the standard error by the estimate

itself and is expressed as a percent of the estimate. For

this report, an asterisk (*) precedes any estimate with

more than a 30-percent relative standard error.

Estimates of sampling variability were calculated

using the method of half-sample replication. This method

yields overall variability through observation of variability among random subsamples of the total sample. A

description of the development and evaluation of the

replication technique for error estimation has been published. 1311Approximate relative standard errors for aggregate estimates are presented in figures I and II. To

derive error estimates that would be applicable to a wide

variety of statistics and could be prepared at moderate

cost, several approximations were required. As a result,

the relative standard errors shown in figures I and II

should be interpreted as approximate rather than exact

for any specific estimate. Directions for determining

approximate relative standard errors follow.

Estimates of aggregates

Approximate relative standard errors (in percent)

for aggregate statistics are presented in figures I and II.

Figure I presents approximate relative standard errors

for estimates of ofi-lce visits, while figure II presents

approximate relative standard errors for estimates of

drug mentions. (Figure I should also be used to obtain

the relative standard error of a speczfic drug mention

such as Dyazide: Figure II should also be used to obtain

the relative standard error of a group of drug mentions

such as all drugs prescribed for hypertension.) In each

figure, curve A represents the relative standard errors

appropriate for estimates based on all physician specialties, and curve 1? representa relative standard errors

appropriate for estimates based on an individual physician specialty.

Alternatively, relative standard error (RSIE) for

aggregate estimates maybe calculated directly using the

following formulas, where x is the aggregate of interest

in thousands. For visit estimates (or for mentions of a

specific drug) based on all physician specialties,,

RSE(X) =

d

0.00164987 +

36.36433.1000

x

For visit estimates (or for mentions of a specific drug)

based on an individual physician specialty,

RSE(X) =

d

0.00434821 +

36.97024

“100.0

x

For grouped drug mention estimates based on all physicial specialties,

RSE(X) =

d

71.26431

0.00316979 + ~ “100.0

For grouped drug mention estimates based on an individual physician specialty,

RSE(X) =

d

69.54527

0.00827256 + ~ “100.0

Estimates of percents

Approximate relative standard errors (in percent)

for estimates of percents maybe calculated from figures

NOTE: A list of references follows the text.

68
UI

w

100

90

80

70

60

50

40

30

20

10

9

8

7

6

5

4

3

2

:.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

60

50

40

30

20

1:

8

7

6

5

4

3

2

&9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

A 2 3 456789A 2 3 456789A 2 3 456789A 2 3 456789A

100 1,000 10,000 100,000 1,000,000

Size of estimate (in thousands)

Examp/e of use ofchati.’An estimete of 20 million office visits to general surgeons (read from scale at bottom of chart) has a relative standard error of 7.9 percent (read from curve B on acaleat Ieftofchati)

or a standard error of 1,580,000 office visita (7.9 percent of 20 million office visits).

Figure 1. Approximate relative standard errora for estimated numbers of office visits based on all physician specialties (A) and individual specialties (B), 1980

National Ambulatory Medical Care Survey
1gg

80

70

60

50

40

30

20

1$1

8

7

6

5

4

3

2

1

0,9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

I ,

,

I

I

1

, I r r7

r I r

F , * +-it J— ~ I

1 r

I

I

I I 1 I ! ,

I f

+ - ‘ -“-

-

J . p----- ~ _ . _ ~ . J _ I_ _ . . . - J.

1

r r- – – - - - - - - - - - — — — — — — r – – r 1---- -1 I 1

-

II I I I I I I I 111! 111111

111111 Hlllllllrlllll I I I I 1111111

1l):

60

70

60

50

40

30

20

1:

8

7

6

5

4

3

2

&9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

A 2 3 456789A 2 3 456789A 2 3 456789A 2 3 456789A

100 1,000 10,000 100,000 1,000,000

siZc3 Of estimate (in thousands)

ExamP/e of use of chart: An estimata of 60 million drug mentions to general practitioners (read on scale at bottom of chart) has a relative standard error of 9.7 percent (read from cume B On scale at left

of chart) or a standard error of 5,820.000 drug mentions (9.7 percent of 60 million drug mentions).

Figure Il. Approximate relative standard errors for estimated numbers of drug mentions based on all physician specialties (A) and individual specialties (B), 1980

National Ambulatory Medical Care Survey
I and II. The relative standard error of the numerator

and denominator of the percent is obtained from the

appropriate curve; each of the relative standard errors is

squared; the resulting value for the denominator is subtracted from the resulting value for the numeratoq and

the square root is extracted. This approximation is valid

if the relative standard error of the denominator is less

than 0.05 percent or ifthe relative standard errors of the

numerator and denominator are both less than 0.10

percent.

Alternatively, relative standard errors for percents

may be calculated directly using the following formulas,

wherep is the percent of interest and x is the base of the

percent in thousands. For visit percents (or percents of a

specific drug) based on all physician specialties,

RSE(p) =

d

36.36433 “(1 –p) .1000

p“x

For visit percents (or percents of a specific drug) based

on an individual physician specialty,

For grouped drug mention percents based on all physician specialties,

RSE(p) =

d

71.26431 o(1 –P). ~ooo

p“x

For m-ouped drug mention percents based on an individu~l physician <pecialty, -

Estimates of rates where the numerator

is not a subclass of the denominator

Approximate relative standard errors

100.0

for rates in

which-he denominator is the total United States population or one or more of the age-sex-race groups of the

total population are equivalent to the relative standard

error of the numerator that can be obtained from figures

I and II.

Estimates of differences

between two statistics

The relative standard errors shown in this appendix

are not directly applicable to differences between two

sample estimates. The standard error of a difference is

approximately the square root of the sum of squares of

each standard error considered separately. This formula represents the standard error quite accurately for

the difference between separate and uncorrelated characteristics, although it is only a rough approximation in

most other cases.

Tests of significance

In this repo~ the determination of statistical inference is based on the t-test with a critical value of 1.96

(0.05 level of significance). Terms relating to differences, such as “higher” and “less,” indicate that the

differences are statistically significant. Terms such as

“similar” or “no difference” mean that no statistical

significance exists between the estimates being compared. A lack of comment regarding the difference between any two estimates does not mean that the difference was tested and found to be not significant.

Population figures and rate computation

The population figures used in computing annual

visit rates are presented in table II. The figures are based

on provisional Bureau of the Census estimates of the

civilian noninstitutionalized population of the United

States as of July 1, 1980. 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 oi%cial and are presented here solely to provide denominators for rate computations.

Rounding of numbers

Estimates presented in this report have been rounded

to the nearest thousand. For this reason detailed figures

within tables do not always add to totals. Rates and

percents were calculated on the basis of the original,

unrounded figures and may not necessarily agree pre~

cisely with percents calculated from rounded data.

Systematic bias

No formal attempt was undertaken to determine or

measure systematic bias in the NAMCS data. But it

should be noted that there are several factors affecting

the data which indicate that these data underrepresent

the total number of office visits. Two of these factors are

briefly discussed:

● Physicians who participated in NAMCS did a thorough and conscientious job in keeping the Patient

Log however, post survey interviews with participating physicians indicate that a small number of

patient visits may have been accidentally omitted

from the Patient Log although this number is quite

small, such omissions would result in an undercoverage of oi%ce 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 universe for the 1980

NAMCS included all non-Federal, ofilce-based,

patient-care physicians in the AMA and AOA mas71
Table Il. Estimates of the civilian noninstitutionalized population of the United Statesl used in computing annual visit rates in this reporl by age, race, sex,

geographic region, and metropolitan and nonmetropolitan area: July 1, 1980

Age

Selected characteristic All ages Less

than 15

15-24 25-44 45-64 65 years

years

years years years and over

Race

Geographic region

Area

Metropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,

Nonmetropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,

216,580

104,490

112,090

186,513

90,343

96,170

25,422

11,845

13,577

4,644

2,301

2,343

48,240

57,508

71,358

39,475

148,203

68,377

49,542

25,292

24,251

40,792

20,873

19,918

7,542

3,804

3,738

1,209

615

595

. . .

. . .

,.,

Population in thousands

39,760

19,562

20,197

33,622

16,657

16,966

5,229

2,438

2,791

908

467

441

.

. .

. . .

.

. . .

. . .

60,140

29,111

31,029

52,080

25,490

26,590

6,520

2,877

3,643

1,540

744

796

. . .

. .

. . .

. . .

43,318 23,820

20,716 9,809

22,602 14,011

38,455 21,564

18,457 8,867

19,999 12,697

4,117 2,015

1,890 835

2,226 1,179

746 241

369 107

378 135

. . . . . .

. . . .. .

. . . . . .

. . .

. . . . .

. . . . .

1 Excludes Alaska and Hawaii,

NOTE: Figures may not add to totals dua to rounding.

ter files. The NAMCS was designed to provide

statistically unbiased estimates of office visits to

this designated population. Not included in the universe were physicians classified in such categories

as federally employed, hospital-based, research,

teaching, administration, or other nonpatient care

activity. Consequently, any ambulatory patient

visits to these physicians in an office setting are not

included in NAMC S estimates. In an attempt to

measure the number of office visits to physicians not

in the NAMCS universe, a NAMCS Complement

Survey was conducted in 1980. This study involved

a sample of approximately 2,000 physicians selected

from among the 226,000 physicians in the AMA

and AOA master files who were not eligible (in

scope) for the 1980 NAMCS. Details of the Complement Survey methodology and results are forthcoming. Preliminary results indicate that about 17

percent of the Complement Survey universe saw

some ambulatory patients in an office setting. An

estimated 69 million ofllce visits were made to these

physicians in 1980. This indicates that the total

number of oflice visits to all physicians during 1980

was about 645 million (69 million plus 576 million).

72
Appendix 11. Definition of

Terms

Terms relating to the survey

0j71ce.-Premises identified by physicians as location for their ambulatory practices. The responsibility

over time for patient care and professional services

rendered there generally resides with the individual

physician rather than with any institution.

Ambulatory patient.—An individual seeking personal health services who is neither bedridden nor currently admitted to any health care institution on the

premises.

Physician. —Classified as either:

● In scope.—All duly licensed doctors of medicine or

doctors of osteopathy currently in practice who

spend some time caring for ambulatory patients at

an office location.

● Outofscope. —Those physicians who treat patients

only indirectly, including physicians in the specialties of anesthesiology, pathology, forensic pathology, radiology, therapeutic radiology, and diagnostic radiology, and the following physicians:

●

●

●

●

Physicians who are federally employed, including those physicians in military service.

Physicians who treat patients only in an institutional setting for example, patients in nursing

homes and hospitals.

Physicians employed full time in industry or by

an institution and having no private practice; for

example, physicians who work for the Veterans’

Administration or the Ford Motor Company.

Physicians who spend no time seeing ambulato~ patients; 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 office 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 ofilce, meeting the definition of

“office,” located in a hospital, the ambulatory patients seen there are considered in scope.) The following types of patients are considered out of scope:

●

●

●

●

Patients seen by the physician in an institution,

including outpatient clinics ofhospitals, 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 oi%ce only to leave a

specimen, to pickup insurance forms, or to pay

a bill.

Patients who come to the ofilce only to pick UP

medications previously prescribed by the ph~-

sician.

Visit.—A direct, personal exchange between an

ambulatory patient and a physician or a staff member

for the purpose of seeking care and rendering health

services.

Physicianspecialty. -l?rincipal specialty, including

general practice, as designated by the physician at the

time of the survey. Those physicians for whom a specialty was not obtained were assigned the principal

specialty recorded in the physician master files maintained by the American Medical Association or the

American Osteopathic Association.

Region ofpractice location.—The four geographic

regions, excluding Alaska and Hawaii, that correspond

to those used by the U.S. Bureau of the Census:

Region States included

Northeaat . . . . . . Connecticut, Maine, Massachusetts, New

Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont

North Central . . Illinois, Indiana, Iowa, Kansas, Michigan,

Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin

73
Reg/On— COn. States )ncluded— Con Rican. Cuban. Central or South American. or other

South ... Alabama, Arkansas, Delaware, District of

Columhm, Flor!da, Georg!a, Kentucky, Lou-

[stana, Maryland, Mlsslssippl, North CaroI!na, Oklahoma, South Carolina, Tennessee,

Texas, Virginia, and West V!rglnia

West. . . . Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah,

Washington, and Wyom!ng

Metropolitan status ofpractice location. —A physician’s practice is classified by its location in a metropolitan or nonrnetropolitan area. Metropolitan areas

are standard metropolitan statistical areas (SMSA’S) as

defined by the U. S. Office of Management and Budget.

The definition of an individual SMSA involves two

considerations: first, a city or cities of specified population that constitute the central city and identify the

county in which it is located as the central county;

second, economic and social relationships with “contiguous” counties that are metropolitan in character so

that the periphery of the specific metropolitan area may

be determined. SMSA’S may cross State lines. In New

England, SMSA’S consist of cities and towns rather

than counties.

Terms relating to the

Patient Record Form

Age. —The age calculated from date of birth was the

age at last birthday on the date of visit.

Color or race. —White, Black, Asian/Pacific Islander, or American Indian/Alaskan Native. Physicians

were instructed to mark the category they judged to be

the most appropriate for each patient based on observation or prior knowledge. The following definitions were

provided to the physician:

White. —A person having origins in any of the original peoples of Europe, North Africa, or the Middle

East.

B[ack. —A person having origins in any of the black

racial groups of Africa.

Asian/Pacz~c Islander. —A person having origins

in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific

Islands. This area includes, for example, China,

India, Japan, “Korea, the Philippine Islands, and

Samoa.

Amen-can Indian/A laskan Native.—A person having origins in any of the original peoples of North

America and who maintains cultural identification

through tribal affiliation or community recognition.

Ethnicity. —Category judged by the physician to be

the most appropriate. The following definitions were

provided:

@ Hispanic origin. —A person of Mexican, Puerto

74

Spanish culture or origin, regardless of ra~e.

Not Hispanic. —Any person not of Hispanic origin.

Patient’s complaintisj, sym~tom(sl other reason(s)

for this visit (;npatie;t ;w; words)~–The patien~’~

principal problem, complaint, symptom, or other

reason for this visit as expressed by the patient.

Physicians were instructed to record key words or

phrases verbatim to the extent possible, listing that

problem first which, in the physician’s judgment,

was most responsible for the patient’s visit.

Major reason for this visit.—The one major reason

(selected from the following list) for the patient’s visit as

judged by the physician:

● Acute problem. —A visit primarily for a condition

or illness having a relatively sudden or recent onset

(within 3 months of the visit).

● Chronic problem, routine. —A visit primarily to

receive regular care or examination for a preexisting

chronic condition or illness (onset of condition was

3 months or more before the visit).

o Chronic problem, jlareup. —A visit primarily to

receive care for a sudden exacerbation of a preexisting chronic condition or illness.

● Post surge~/post irzj”ury.—A visit primarily for

followup care of injuries or for care required following surgery; for example, removal of sutures or cast.

● Non-illness care (routine prenatal, general exam,

well-baby, etc.).—General health maintenance examinations and routine periodic examinations .of

presumably healthy persons, both children and

adults, 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 visit:

●

●

●

●

●

Limited histo~/exam.—History or physical examination limited to a specific body site or system

or concerned primarily with the patie’nt’s chief complaink for example, pelvic examination or eye examination.

General history/exam. —History or physical examination of a comprehensive nature, including all

or most body systems.

Pap test.—Papanicolaou test.

Clinical lab test.—One or more laboratory procedures or tests, including examination of blood, urine,

sputum, smears, exudates, transudates, feces, and

gastric content, and including chemistry, serology,

bacteriology, and pregnancy test excludes Pap

test.

X-raj~.—Any single or multiple X-ray examination
for diagnostic or screening purposes; excludes radiation therapy.

Blood pressure check.

EICG.-Electrocardiogram.

Vision test.—Visual acuity test.

l?rzdoscopy.-Exarnination of the interior of any

body cavity except ear, nose, and throat by means

of an endoscope.

Mental statusexan2.-Any formal, clinical evaluation designed to assess the mental or emotional

status of the patient.

Othex—All other diagnostic services ordered or provided that are not included in the preceding categories.

Principal diagnosis. -The physician’s diagnosis of

the patient’s principal problem, complaint, or symptom.

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 maybe 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 mayor

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 therapythisvisit.—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.

Non~medication therapy.—Physicians were instructed to check any of the following services that were

ordered or provided during the current visit:

● Physiotherapy.—Any form of physical therapy ordered or provided, including any treatment using

heat, light, sound, or physical pressure or movemen~ for example, ultrasonic, ultraviolet, infrared,

whirlpool, diathermy, cold, and manipulative

therapy.

● 0~7ce surgery.—Any surgical procedure performed

in the ofilce this visit, including suture of wounds,

reduction of fractures, application or removal of

casts, incision and draining of abscesses, application ofsupportive materials for fi-actures and sprains,

irrigations, aspirations, dilations, and excisions.

●

●

●

●

●

●

Familyplanning.—Services, counseling, or advice

that might enable patients to determine the number

and spacing of their children, including both contraception and infertility services.

Psychotherapy/therapeutic listening.—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/socialcounseling. —Advice regarding problems of family relationships, including marital or

parent-child problems, or social problems, including economic, educational, occupational, legal, or

social adjustment dit%culties.

Medical counseling.—lkstructions and recommendations regarding any health problem, including advice or counsel about a change of habit or

behavior. Physicians were instructed to check this

category only if medical counseling was a significant part of the treatment. Family planning, diet

counseling, and family/social counseling are excluded.

Othez—Treatments or non-medication therapies

ordered or provided that are not listed or included in

the preceding categories.

Waspatient referredfor thisvisitby 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 appIy:

Nofollowupplanned—No return visitor telephone

contact was scheduled for the patient’s problem.

Return at specijied time. —Patient was told to

schedule an appointment or was instructed to return

at a particular time.

Return l~neede~ P.RN.—No future appointment

was made, but the patient was instructed to make an

appointment with the physician if the patient considered it necessary.

Telephone follow-up planned. —Patient was instructed to telephone the physician on a particular

day to report either on progress, or if the need arose.

Refeiredto otherphysician.—Patientwas 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 referringphysician. —Patient was in75
strutted to consult again with the referring physician.

. Admit to hospital. —Patient was instructed that

further care or treatment would be provided in a

hospital. No further office visits were expected prior

to hospital admission.

● Other.—Any other disposition of the case not included in the preceding categories.

Duration of this visit.—Time the physician spent

with the patient, not including time the patient spent

waiting to see the physician, time the patient spent receiving care from someone other than the physician

without the presence of the physician, and time the physician spent in reviewing such things as records and test

results. If the patient was provided care by a member of

the physician’s staff but did not seethe physician during

the visit, the duration of visit was recorded as O min.

76
Appendix IIL Survey

instruments

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

OFFICE OF HEALTH RESEARCH. STATISTICS AND TECHNOLOGY

HYATTSVILLE, MARYLAND 207S2

NATIONAL AMBULATORY

MEDICAL CARE SURVEY

Endorsins Organi’’ations

Americsn Academj’

of Dermatology

American Academv of

Familv Physicians

American Academy

of Neurology

The NationalCenterforHealthStatistics,as part

of its continuingprogramto provideinformationon

the healthstatusof theAmericanpeople,is conducting

a NationalAmbulatoryMedicalCare Survey(NAMCS).

Americsn Academy of

Orthopedic Surpons

American Academv

of Pediatrics

American Association of

Neurological Surgeons The purposeof this surveyis to collectinformation

aboutambulatorypatients,theirproblems,and the

resourcesused for theircare. The resultingpublished

statisticswill help yourprofessionplan for more

effectivehealthservices,determinehealthmanpower

requirements,and improvemedicaleducation.

American College of

Emergencv Physicians

American College of

Obstetricians and

Gynecologists

Sincepracticingphysiciansare the only reliablesource

of this information,we need your assistancein the

WS. As one of the physiciansselectedin our national

sample,yourparticipationis essentialto the success

of the survey. Of course,all informationthatyou

provideis held in strictconfidence.

American College

of Physicians

American Collnge of

Preventive Medicine

American Osteopathic

American Society of

Colon and Rectal

Surgeons

Many organizationsand leadersin the medicalprofession

have expressedtheirsupportfor this survey,including

thoseshownto the left. In particular,your own specialtysocietyhas reviewedthe NAMCSprogramand supports

thiseffort(seeenclosure).They joinme in urging

your cooperationin this importantresearch.

American Psychiatric

Association

American Society of

Internal Medicine

Withina few days,a surveyrepresentativewill telephone

ive you for an appointmentto discussthe detailsof your

participation.We greatlyappreciateyour cooperation.

American Society of

Plastic and Reconstruct

Surgeons, Inc.

American Urological

Association Sincerelyyours,

Association of American

Medical Colleses

National Medical

Association

DorothyP. Rice

Director

Enclosure

77
D 749612

ASSURANCE OF CONFIDENTALITY–AI1 ,nlorm!so,a *h,ch would Derm,t ,dent,lucat, m &I?w,m”t .1 Healthmd Hu,rw” S?rvmces

01 an ,.dwsd. al. a “r.c,, ce. or an ,S, ablt,hmwn, wdl be htld c.nf,de”t ml. w811be used .“1” P.b ,. HmlthS!,v,ce

b, .mc.ns e.wed ,“ ad [., me wm.- of the $.,.ev a.d w,! I ..t b, d,scl.-d ., f*- Oflm .1 HealthR/ %wh. S,,,8,,,<$ andTe,hn.!ww D 749612

,..,,. ,.other 0,, s0”, o, .s?d for 2“. o!her .“r.me Na,, ooal -“w for H,,l, h S,,,>,,,.,

PATlENT LOG

~ “-””--- “-

1 ,

PATlENT RECORD

NATIONAL AMBULATORY MEDICAL CARE SURVEY

As each patient arrives, record nama and

time of visit on the log below. For the

pstinnt entamd on Iina *, also cam.

plete the patient record to the right.

I

PATlENT’S NAME TIME OF

VISIT

1. DATE OF VISIT

&

- =

!’] 5 I INON. ILLNESS CARE [ROUTINE

~. COLOR OR RACE

1 QwH,TE

2 ❑ BLAcK

3❑A:AN.A:FIC

4 ❑ AMER,cAN INDIAN,

ALASKAN NATIVE

5, ETHNICITY

1 ❑ HISPANIC

ORIGIN

2 ❑ NOT

HISPANIC

B. DIAGNOSTIC SERVICES THIS VISIT

[Check all orden?d or provided!

I ❑ NONE 8 H EKG

2 ❑ LIMITED HK.TORY/EXAM. 9 ❑ V1510N TEST.

3 ❑ GENERAL HISTfJRYIEXAM. IO ❑ ENOOSCOPY

4 ❑PAP TEST ,, ❑ M:::fl,LSTATUS

5 ❑ C.LINICAL LAB TEST

6 ❑ X.RAY

,, ❑ oTHER(speciJ,,

7 lJBLOOOPRESS”FiE cHEcK

11, MEDICATION THERAPY THIS VISIT

am PATIENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER

REASON(S) FOR ~ VISIT [In patient k own words]

a. MOST IMPORTANT

b. OTHER

S. PHYSICIAN’S DIAGNOSES

,. PRINCIPAL DIAGNOSISIPROBLEM ASSOCIATED WITH ITEM 60

b. OTHER SIGNIFICANT CURRENT DIAGNOSES

[ Using brand or generic names, recoti all new and continued medications otiered, injected, administered, or otherwise

provided at this visr. Include immunizing and desensitizing agen ts]

a. FOR PRINCIPAL DIAGNOSES IN ITEM%. b. FOR ALL DTHER REASONS.

1. 1.

2. 2.

3. 3.

4. 4.

provided

5

J-.---j

I HNONE 6 QDIETCOUNSEL,NG

2❑ PHYSIOTHERAPY 7 QFAM,LY,sDciAL

a.m. COUNSELING

3❑ OFFICE SURGERY

4❑ FAPAILYPLANNING

8❑ MED,cALcOUNsEL,NG

5❑ psYcH0THE17*PY,

9❑ OTHER MWLIJY,

Rmord ,tem, 1-15

f., ths wmnt. Dm

THERAPEUTIC LISTENING

.

CONTINUE LlsTING pATIENTS

ON NEXT PAGE

P HS-61 05-0 (9/79)

13. WAS PATlENT

REFERRED

FOR THIS VISIT

BY A~HER

PHYSICIAN?

I ❑ YES

2DN0

1❑ NO FOLLOW.UP PLANNED

2 ❑ RETURNAT5PECIFlED T,ME

3 ❑ RETuRN IF NEEDED. P.R.N.

a j_JTELEpHONEFOLLOW.UppMNNED

5 ❑REFERREOTOOTHER pHYs,c,AN

6 ❑RETURNE070 REFERRING PHYSICIAN

7 ❑ ADMIT TO HOSPITAL

15. ::~y

VISIT

[Time actually

spent with

ph.vsician/

Mm”,,,

OMB No. 68-R1498
CONFIDENTIAL*

NORC-4284

BEGIN DECK 3

~

FOR OFFICE USE

ONLY:

m

5-61

m

7-10/

NATIONAL MULATORY MEDICAL CARE SURVEY

INDUCTION INTERVIEW

I

BEFORE STARTING INTERVIEW I

\Phy~. I~N~er/

1. ENTER PHYSICIAN I.D. NUMEER IN BOX TO ~

I

1-4/

RIGHT.

2. ENTER DATES OF ASSIGNED REPORTING WEEK I__i

Q. 2, P. 2.

h

Doctor, before I begin, let me take a minute to give you a little background about

this survey.

Although ambulatory medical care accounts for nearly 90 percent of all medical care

received in the United States. there is no systematic information about the characteristics and problems of peo~le who consult-physicians in their”offices.

——

ThiS kind

of information has been badly needed by medical educators and others concerned with

the medical manpower situation.

In response to increasing demands for this kind of information, the National Center

for Health Statistics, in close consultation with representatives of the medical

profession, has developed the National Ambulatory Medical Care Survey.

Your own task in the survey is simple, carefully designed, 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 mount of informs.

tion concerning patients that you see.

Now, before we get into the actual procedures, I have a few questions to ask about

your practice. The answers you give me will be used only for classification and *

analysis, and of course information you provide is held in strict confidence.

1. First, you are a

(ENTER SPECIALTY FROM CODE ON FACE SHEET LABEL.)”

Is that right? Yes . . . . . . . . . . .X

No. . . . (ASK A) . . ..Y

A. IF NO: What is your specialty (including general practice)?

(Name of Specialty)

[111 11-13/

The National Ambulatory Medical Care Survey is authorized by

Congress in Public Law 93-353, section 308. It is a voluntary

study and there are no penalties fcr refusing to answer any

question. All information collected is confidential and will

be used only to prepare statistical summaries. NO information

which will identify an individual or a physician’s practice

will be released.

79
-2-

(that’s a (that’s a

/ Monday) through / - Sunday)

month date month date

you likely to see ~ ambulatory patients in your office during

Yes. . . . , .(GOTOQ. 3).

BELOW).

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 ENTBRED

Are

A. . ●

that week?

.A .

NO .’. . . . . (ASK A). . . . Y

IF NO: WhY is that? RECORD VERBATIM. THEN READ PARAGRAPH BELCKJ

Since it’s very important, doctor, that we include any ambulatory patients

that you do happen to see in your office during that week, I’d like to

leave the= forms with you anyway--just in case your plans change. 1’11

plan to check bacl?with your office just before (STARTING DATE) to make

sure, and I can explain them in detail then, if necessary.

GIVE DOCTOR ‘THE~ PATIENT RECORD FORMS AND GO TO Q. 9, P. 6.

8CI
-3-

3, & M what office location will you be #eet

7-day period? RECORD UNDER A BELW AND %

mbulato?y

N CODE B.

pstieaw dwin$ thw

B. FOR EACH OFFICE LOCATION ENTERED IN A, CODE YES ORNO TO “IN SCOPE.”

~ OUT OF SCOPE {No)j

Private offices Hospital emergency rooms

Free-standing clinics Hospital outpatient departments

(non-hospital based) College or university infirmaries

Groups, partnerships Industrial outpatient facilities

Kaiser, HIP, Mayo Clinic Family planning clinics

Neighborhood Health Centers Government-operated clinics

Privately operated clinics (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 ~ of the office locations at which you expect to see ambulatory

patients during that week?

Yes. . . . . . . . . . . X

No . . . . . . . . . . . Y

IF NO: OEZAIN ADDITIONAL OFFICE LOCATION(S), ENIER IN “A” BELOU, AND REPEAT.

A. B.

Office Location In Scope?

Yes I

No

(1) 1 0

(2) 1 0

(3) 1 0

(4) 1 0

TOTAL IN-SCOPE LOCATIONS:

u

14/

IF ALL LOCATIONS ARE OUT OF SCOPE, THANK THE DOCTOR AND LEAVE.

81
-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 coum PATIENTS SEEN A’r [OUT-OF-SCOPE

LOCATIONS] CODED IN 3-B.)

ENTER TOTAL UNDER “A” BELOW AND CIRCLE NUMBER CATEGORY QN APT’.ROF&QITE L=

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 BELOW. READ ACROSS

ON “TOTAL PATIENTS” LINE UNDER “A” AND CIRCLE LETTER IN APPROPRIATE

“DAYS” COLUMN UNDER “B.”

THIS LETTER TELLS YOU WHICH OF THE FOUR PATIENT LOG FORMS (A, B, C, D)

SHOULD BE USED BY THIS DOCTOR.

LOG FORM DESCRIPTION

A--Patient Record is to be

completed for ALL

patients Iiste=n Log.

B--Patient Record is to be

completed for every

SECOND patient listed

on Log.

C--Patient Record is to be

c~,leted for every

THIRD patient listed

ng .

*D--Patient Record is to be

completed for every

FIFTH patient listed

=g .

15-17/

A. B.

Expected total

J

Total ~ in practice

patients during during week.

survey week.

ENTER TOTAL FROM

Q. 4-A.

m“ 11213Y:151617

1- 12 PATIENTS AAAAAAA

13- 25 “ B AAAAA~ r

26- 39 “ CBAAAA7

40- 52 “ ICBBAA AA

53- 65 “ [D CB BA AA

66- 79 “ tD C B B B AA

80- 92 “ DDCBBBB

93-105 “ D D C B B B’~

106-118 “ D “D C C B By

119-131 “ DDCCBBB

132-145 “ DDDCC B=_ &

146-158 “ DDDCCBB

159-171 “ DDDCCCC

172-184 “ DDDCCCC

185-197 “ DDDDDDD

,

198-210 “ I DDDDDDD

211+ 11 ID DDDDDD

*

In the rare instance the physician will see more than 500 patients during

his assigned reporting week, give him two D Patient Log Folios and instruct him

to complete a patient record form for only every tenth patient. Then you are

to draw an X :lhrough the ?atient 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.

82
-5-

5. FIm LOG FOLIO WITH APPROPRIATE LETTER.AND CIRCLE LETTER, ENTER FIRST FOUR

OF THE FORM AND NUMBER OF LINES STAMPED “BEGIN ON NEXT LINE” FOR THE B-C-D

FORMS (if no lines are stamped, enter “O”) BELOW.

\

v

FOLIO “No. Lines FOR OFFICE USE ONLY

Stamped “BEGIN Number patient record

Letter .Numb.er ON NEXT LINE” forma completed.

A

B

c

D

DECK 3

NUMBERS

LOG

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.

EMPHAS12E 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 THliPATIENT AN INOCULATION, OR A TECHNICIAN ADMINISTERED AN

ELECTROCARDIOGRAM AND THE PATIENllDID NUI SEE THE DOCTOR. THIS VISIT mST STILL BE

LISTED ON THE LOG.

RECORD VERBATIM BEL@l ANY CONCERN, PROBLEMS OR QUESTIONS THE DOCTOR RAISES.

7. IF DOCTOR EXPECTS TO SEE AMBULATORY PATIENTS AT FS3RETHAN ONE IN-SCOPE LOCATION

DURING ASSIGNED WEEK, TELL HIM YOU WILL DELIVER THE FORMS TO THE OTHER LOCATION(S).

ENTER THE FORM LETTER AND NUMBER(S) AND 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

v FOR OFFICE USE ONLY:

Location Stamped “BEGIN Number Patient recor

Letter .Num~er ON NEXT LINE” fores completed - -.

27-31/

32-34/

35-39/

40-42/

43-47/

48-50/

83
-6- DECK 3

8. During the surveyweek (REPEAT EXACT DATES), will anyonebe availableto help

you in fill$agout theee records (at each IN.SCOPElocation)?

Yes . . . . (ASKA) ...1 ,51/

No . . . . . . . . . . .2

A. IF YES: Who would that be?

RECORDNAME, POSITIONAND LOCATION.

I

NAMS 1 POSITION i LOCATION J

PERSONALLYBRIEF EACN PERSON LISTED ABOVE.

EMPHASIZETHAT EVERY PATIENIVISIT DURING THE ENTIRE WEEK IS TO BE RECORDBDONTNE

LOG EXCEPT “ADMINISTRATIVE PURPOSE ONLY. ”

9. Do you have a 801o practice,or are you aamociatedwith other phy6icienmin a

partnership,in a group practice,or in 80UW other way?

solo. , , . . (m TO.Q. 10) . . 1

Partnership. . (ASKA-C) . . . 2.

Group . . . ..(AC)A-C) . ..3

<--- Other (s~c~~ AND AsKA-C) , . 4

IF PARTNERSHIP,GROUP,OR OTHER:

A. 16 this a prepaidgroup practice? Yea . . (AsK [l]) . . . 1

[1] IF YES TO A: What per cent

No . . . . . . . . . .2

of patientaare

prepaid? per cent

B. How many other phyeicianeare

ammciated with you? NUMBER OF PHYSICIANS:

c. What are the specialtiesof the other physiciansassociatedwith y~u?

(Nowmany of these are there?)

(1)

(2)

(3)

(4)

(5)

Specialty Number of Physicians

D. CIRCLE ONE:

All physicians in this partnership/group practice

have the same specialty . , . . . . . . . . . . . . . . . . I

More than one specialty in this partnership/group practice . . 2

52/

53/

54-56/

57-59/

60/

84
-7- BEGIN DECK 4

10. Now I have just one more question about vour Dractice. (NOTE: IF DOCTOR PRACIXCES

IN

A.

B.

LARGE GROUP, THE FOLLtiING INFORMATIO~ 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, temporari& ill,

etc. Do not include other physicians. RECORD ON BOTTOM LINE OF COLW A BELON.

(1) H~—many of these full-time employees are a . . . (READ CATEGORIES BELUJ AS NECESSARY

AND RECORD NUMBER OF EACH IN COLUMN A.)

And what is the total number of part-time (less than 35 hours per week) employees of your

(partnership/group) practice? Again, include persons regularly employed who are now on vacation,

ill, etc. Do not include other physicians. RECORD ON B(YTTOMLINE OF COLW B BELOW.

(1) How many of these part-time ei,ployees are a . . . (RBADCATEGORIBS BELCWAS NECESSARY

AND sscom mER oF EACH IN COLUMN B.)

1

B.

Employees \mli-l&s Part-time

(35 or -re hours/week) (tiss than 35 hours/week)I

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Registered Nurse.... . . . . . . .

Licensed Ractical Nurse . . . . . . .

Nursing Aide . . . . . . . . . . . . .

physician Assistant* . . . . . . . . .

Technician . . . . . . . . . . . . . .

Secretary or Receptionist . . . . . .

Other (SPECIFY)

) (

11-13/

14-16/

17-19/

20-22/

23-25/

26-28/

29-31/

32-34/

35-37./

38-40/

41-43/

44-46/

47-49/

50-52/

53-55/

56-58/

*

physician Assistant must be ● graduate of en ●ccredited training program for Physician

Aeefetants (Fhyeician Extenders, Nedex, etc. ) or certified by the National Board of Medical

Ihcdners through the Certification EXU for Aaaiatant to the Rimary Care physician.

BEFORE YOU LEAVE, AGAIN STRESSTHAT EACH AND EYERY AMBUIAW3RYPATIENT SEEN BY THE

DOCTOR OR HIS STAFFDURING THE 7-DAYyiiiIODAm IN-SCOPEOFFICE LOCATIONS (mEAT

THEM) IS TO BE INCLUDEDIN TNE SURVEY,THAT EAC~ATIENT IS TO BE RECORDEDON THE LOG,

AND ONLY THE APPROPRIATENUMBER OF PATIENT RECORDSCOMPLETED.

Thank you for your time, Dr. If you have any (more) questions,

please feel free to call me. My phone n~er is written in the folio. I’ll

call E on Monday morning of your survey week just to remind you.

11. TIME INTERVIEWENDED . . . . . . . . AM

PM

12. DATEOFINTERVIEW . . . . . . . . . . . . . . .

I I II I I

(Month) (Day) (Year)

55
-8- DECK 4

INl!ERVIEWERNUMBER

111111

I~ERVIEWER’ S SIGNATURE

FOR OFFICE USE ONLY:

No. of Patients Seen: IIH 59-61/

u

62/

Total- Day.j in Practice during Week:

86
Appendix IV. American

Hospital Formulary

Service classification

system and therapeutic

category codes

AMERICAN HOSPITAL FORMULARY SERVICE CLASSIFICATION SYSTEM

AND THERAPEUTIC CATEGORY CODES (AHFS#)

(Clsssitkati.ms in parentheses sfe provisional but maybe used in DPIF) —

AMERICAN

HOSPITAL

FORhiULARY

SERVICE

CLASSIFICATION

SYSTEM

04:00 ANTIHLSTAMLNEDRUGS

0S:00 ANTI-INFECTIVEAGENTS

0804 Anwbacides

0S:08 Anthelndntics

08:12 Antibiotics

08:12.02 Aminoglycosides

08:12.04 Antifungal Antibiotics

08:12.06 Cephalosporins

08:12.08 Ctdoramphcnicol

08:12.12 Erythromycins

08:12.16 Penicillins

08:12.24 TCf13CYdillCS

08:12.24 Other btibiotics

08:16

08:18

08:20

0S:24

0826

0s 2s

08:32

08:36

08:40

10:00

12:00

1204

1208

12:12

12:16

12:20

16:00

20:00

2004

htitUb51CU10SiS A&IltS

Antiviral

Phmodicides

Sulfonamides

.%lfones

Treponendcides

Trichomonacides

Urinary Germicides

Other Anti-Infective

ANTINEOPLAST2CAGENTS

AUTONOMLCDRUGS

Parasympathomimctic A&nts

Parasympatholytic Agents

Sympathomimetic Agents

Sympatholytic Agents

SkcIetal Muscle Relaxants

BLOODDERLVATIVZS

BLOODFORMATIONAND COAGULATION

Antianemia Drum

2004.04 fxonpreparations

2004.08 Liver and Stomach

Reparations

2012 Coagulant and Anticoagulants

201204 Anticoagulants

201208 Antiheparin Agents

20:12.12 Coagufants

2012.16 Hemostatic

20:40 Thrombolytic Agent!

2400 CARD1OVASCULARDRUGS

24:04 Cdiac Drugs

24:06 Antilipendc Agents

24:0S Hypotensive Agents

24:12 Vasdilating Agents

24:16 SclerosingAgents

28:00 CENTRAL NERVOUS SYSTEMDRUGS

2S:04 General Anesthetics

2S:08 Analgesicsand Antipyretics

28:10 NucOtiC AntaK0ni5t5

2812 Anticonvufsants

28:16 Psychotherapeutic Agents

28:16.04 Antidepressants

28:16.08 Tranquilizers

28:16.12 Other Psychotherapeutic

Agents

28:20 Respiratory and Cerebral

Stimulants

2S:24 Sedativm and Hypnotics

36:00

36:04

36:08

36:12

36:16

36:18

36:24

36:25

36:26

36:28

36:3o

36:32

36:34

36:36

36:38

36:40

36:44

36:48

36:52

36:56

36:60

36:61

36:62

36:64

36:66

36:68

36:72

36:76

36:78

36:80

36:84

36:8S

4000

40:04

40:08

40:10

40:12

4016

4CX18

4J3:20

4024

4028

4036

40:40

44:00

48:00

5200

DIAGNOSTICAGENTS

Adrenocortiul Insufficiency

.knyloidosis

Blood Volume

Bmcellosis

Cd&c Function

Circulation Time

(CYsticFibrosis)

i)idxtesMeRit&

Diphtheria

Drug Hypersensitivity

Fungi

Gallbladder Function

Gastric Function

Intestinal Absorption

Ridney Function

Liver Function

Lymphogranu!oma Venereum

Mumps

Mya.stheniaGrwis

hlyxedema

Pancreatic Function

Phenylketonuria

Pheochromocytoma

pituitary Function

Roentgwbagmphy

Scmlet Fciwer

sweating

(Thyroid Function)

Trichinosis

Tutcrculosis

Urine Contents

ELEC7fROL}TfC,CALORfC, AND

WATZRBALANCE

Acidifying Agents

AOmOnizingAgents

Ammonb Dctoxicants

Replacement Solutions

Sodium-RemovingResin!

Potmsium-Removing Resins

C410ricAgents

Salt and Sugar Substitutes

Diuretics

Lrr@ing Solutions

Uricostic Agents

ENZYMES

EXPECTORANTSANDCOUGH

PREPARATIONS

S2:04

52:0434 Antibiotms

EYE, EAR, NOSE ANDTHROAT

PREPARATIONS

An&lnfectives

52:04.06 AIditiclh

52:04.08 SuIfontidcs

52x34.12 & Anti-Infectivcs

S208

52:10

52:12

52:16

S220

5224

52:28

52:32

52:36

56:00

56:o4

56:08

56:10

56:12

S6: 16

56:20

56:24

56:40

.Mti-htlmunatOry Agents

Cd@dc Anhydrase Inhibitors

Contact Lens Solutions

Local Anesthetics

Miotics

Mydrhtics

Mouth Washesand Ga@es

Vasoconstrictors

UnclassifiedAgents

GASTROINrSSTINAL DRUGS

Anticids and Absorbents

Anti-Di.mrheaAgents

Antiftatulents

Cathartics and Lmatives

Digestants

Emetia and Anti-Emetics

Lipotropic Agents

Misc.GI Drugs

60:00 GOLDCOMPOUNDS

64:00 HEAVYhK_TALANTAGONISTS

68:00 HORMONESANDSYNTHETIC

SUBSTITUTES

6g:04 Adrcnrds

68:0S Androgcm

68:12 Contraceptives

68:16 Estmgcns

68:18 Gonadotropms

68:20 Insulins and Anti-Di*betic

Agent%

68:20.08 Insulins

68:24

68:28

68:32

68:34

68:36

72:00

76:00

7s:00

So:oo

80:(S4

80:0s

SO:12

84:00

84:e4

Parathyroid

Pituitory

Progcsmgens

Other Corpus Lulcum Normoncs

Thyroid and Antlthyrmd

LOCALANESTHETICS

0.XYT(X3L2S

RADIOACTIVEAGENTS

SEELP.IS,TOXOIDS AND v4CC1NES

Smums

To..oxds

Vaccmm

84:C+ Anti.lntl:unrmmn .4c@.

84:108 .4nt1Frurmc. .md L,xd

.4m<11Cllc%

84:12 Aztimgcnt!

S4:16 Celf StLmLmt~ zn.1 Prohtcmm,

84:20 fktergcrm

84.24 EnmIhcnt$,Dcnml cm-m .“d

PTotccrmts

84:24.(u B.wc Lotwr. and LmmncnI.

84:24.WI Ram 011.and Other %lwnl..

S6:00 SPASMOLYfIC AGENTS

88:00 VITAMINS

88:04 Vnamin A

S8:08 Vnamin B Complex

88:12 Vitamin C

S8:16 ViWmmD

8B:20 Vitamm E

88:24 Vnamin K Actmty

88:28 Mulmmumm Preparations

92:00 UNCLASSIFIEDTNERAPEUTIC AGENTS

94:00 (DEVICESI

96:00 (PHARh!ACEUTICAIDS)

Copyright @1980. Drug Products Information FiIe: American Society of Hospital Pharmacists. Bethesda. Ma~land.

All rights reserved. Reprinted with permission.

87
Vital and Health Statistics series descriptions

SERIES 1

SERIES 2

SERIES 3.

SERIES 4

SERIES 10

SERIES 11,

SERIES 12

SERIES 13

Programs and Collection Procedures —F?eor, rt< i.~scr(blrg SERIES 14

the g~, neral programs of the National CerTTer r,-rr He-, l!h, S*;Jr Istlcs and its nff]ces and ,~)wwons and lhe rf:,l,+ ,c,llecwn

methods usnd The}, also !nclucfc cief!ntt, ons(n(i ,,thermater,.+1

necessa~ for understanding th~ ,dala

Data Evaluation and Methods Research —St{,d,.s of r={, SERIES 15

statlsllcal methuduloqs, [rjclfidlnq e.per(me r,, ,1 te,,t,< r,f r,el.,.

SUIVEVmethods, studies of v]tal stattstlcs ,:ctllwhon r-oet hods,

new analytical techniques Oblcctlve evaluat!~os nf rellahfl,t;

of colleclerf data, and ‘contr!butrons to SIA?ISTI,::CI thyor; SERIES 20

Analytical and Epidemiological .Studies —Re~r)rts :]resent, n~l

analytical or Interpretive studies based on wtal ~n,l health sla -

t!st!cs, carry!ng the analys!s further than thee.posllon{r~l]esof

reports tn the other series

Documents and Committee Reports, -F(rlal r,p,r?. of m:,lor

committees concerned wtlh vltr[l and h~allh >l?TI??ICS arl C SERIES 27

documents such asrecommenrfed model ,,!t.alreg, s! at, on Ia\,s

and revised birth and death certificates.

Data From the National Health Interview Survey —Sra IIst Ics

on Illness accldent,al ]n[ur]es cflsablll r’, ,,JF ,,f )7~,~pl~31

medical, dental, and other sen,lces and oth?r k$e~lth. rela, e,o

topics, all based on data coll$, cted In the cent, nwng nat!on?l

household rntervlew surve; SERIES 22

Data From the National Health E::aminatjon Survey and the

National Health and Nutrition Examination Survey .—Data

from direct exam! nation, testtng, and measurement cf nattonal

samples of the crvlllan non!nst ]t!utlonallzed po~mlat, on pro,,, de SERIES 23

the baslsfor(l ) estimates of fhs medlcallv ciefit,ed Fre.aler!ce

of spectflc diseases In the Llnlled St,ates and the dlslrliutlor,s

of the population w!th respect to ph~slc al, ph~;slolog$csl artd

psychological characteristics and 12) anaivsis of reldtlonshps

among the ~sar!o$us measurements withoul reference tc, an

expllclt flnlte tunlkmrse of persons

Data From the Institutionalized Population Surveys —EJ, scontlnued In 1975. Reports from these surveys are lncl,lderi ,n

Data on Health Resources: Manpower and Facilities. —

SI~II:W:s on lb,? rlLIITIberS geogrsph!c d[stnbut]on, and char-

+c!~r[st!,:s of health r~sources Includrng ph,; sw!ans, dentists,

r!,Jr; ,Ks, ,C,ther he. dth occupat!orts, hosp!tals, nurs[ng lhom~s,

and outpatient facllttles

Data From Special Surweys. -Stat !st]cs on health and healthr+?ed +C>CIICS cdlect?d !n spec!al s!uwe~;s that arc not a Parr of

rr, e ~cont!r, wng dala SY+-t e ms of the ]N,=!tronal Center for Health

Starlsrlcs

Data on Mortality —I{aric,s statistics on mortaltt,f othsr than

xs mcludeti In regular annual c,r mnnthly reports. Specral

aral;ses bv cause of death age, and other demography

variables geographic and time series anal,;ses: and statlstjcs

an ,characl,zrrstw; of ~deallks not at,a!l able from the v!tal records

ha?~!C c,r, sample sur. e,:s of those records

Data cm Nata!ity, Marriage, and Diwrce. -Var[ous stat[st!cs

or! Natalie,,,, marrt age, and diuarce other than as Included !n

reg,~lar anvual or monthl~; reports. Specml analyses by demographic ,:?r!ables g,eographlc and t[me series analyses: stucf)es

SI,f fer?,l (t;, an,i s!xrIstIcs on ,ch?iracterrsf[cs of b!rths not

a~a,l.~hle fmm tt-,,s v,t,sl records based on sample sun, ew of

those recor!ds

Data From the National Monthly and Natality Surveys. —

D!sc,ont!nued n 1975 Reports from these sample surve)+s

tt~;ed @n ,;)ral recctrds are incl!uded [n Series 20 and 21,

Wspectl, .’el$;

Data From the National Survey of Family Growth.-Statlsh!:s or! ferrl\lt&; km, ($, fc,rmat!on and d(ssolut!un, famll~;

plannlr, g arid relatwf maternal and Infant health topics derived

fr,lm a periodic s,urve; o f a nat!on,.vtde probability sample of

e~ver-m.amed women 15–W ,;ears of age.

Sertes 13 FQr a hzt of tttles ,of r~ports pfubl!shed in these series, ,.vnte to:

Data on Health Resources Utilization. —St+1lst!c< or, lhe ,ATI,- Sz, entlflc and T~chnl,:al In fwmat(on Branch

zatton of health manpower and fac[l)t!es pm.wd[ng h>ng- term ?d,~t]c,nal Center for Health Stat! st!cs

care, ambulatory care, huspltal care, and familv plannlng P!Ihl Ic Health Sen.’!cc

serwces. H,, at Isv]lle, :L’ld 20782
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Publtc Health Service

National Center for Health Statmcs

3700 East-West Highway

Hyattswlle, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

POSTAGE AND FEES PAID

U.S. DEPARTMENT OF HHS r=

I

A

Third Class A

m

DHHSPublication No. (PHS)83–1732, Seties 13, No. 71

For a listing of publications in the VITAL AND HEALTH STATISTICS aenes call 301 -436-NCHS

--l