Office Visits

to Psychiatrists

unitedS?ats 1985

Descriptive informationon offiosvisitsto

ofk@Msed psychiatristsin 19S5 is

pntd. Trend data for 1975-s5 are

itwluded.Emphasis is plaoed on patient

diagnoses,factors related to the utilization

of medkath and psychdkrapy, and typas

of -t&n utilized.Ad&ions I information

on visit&waowwXispwented*

i~l@w ~ i-~,

expected source of payment patient

disposMon,and visitduration.

lxIta Fromthe Ndiond Hedhsurvey

slM’ie81&No.94

DHHS PutMoatbn No. (PHS) SS-1755

U.S. Department of Health and Human

Public Health Servke

centers for Disea8e control

National center for Health statistics

Hyatlsville, M(I.

May 19S8
.,

‘1

Copyright Informath

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

reproduced or copied without parmiseicq citation as to source, however, IS

appreciated.

suggested txation

National Center for Health Statistics, G. J. Gardocki. 1988. Office visits to

psychiatrists: United States, 1985. Vita/ and +/ea/th Statistics. Series 13, No. 9$

DHHS Pub. No. (PHS) 88-1755, Pubhc Health service. Washington: U.S.

Government Printing Office.

Library of Congraee Catalogk@n-PMioatbn Data

Gardocki, Gloria J.

OffiCOvisits to psychiatrist: Unitad States, 1985.

p. cm.—(Vltal & health statistics. Series 13, Data from the National Health

Survey; no. 84) (DHHS publication ; no. (PHS) 88-1755)

Author: Gloria J, Garaocki.

r Bibliography: p.

ISBN 0+340S+3904

1. Mental health earvicea-Unitad Statee-Utilization-Stat@lcs.

2. Psychotherapy patiente-United Statee-Statistics. 3. Mental health

suweys—Unitad States. 1. National Canter for Health Statistics (U.S.) 11.Title.

Ill. Series. IV. Series: DHHS publication ; no. (PHS) 88-1755.

[DNLM: 1. Mental Health Sarvices+tilizatiinitad States—statistics.

2. (MC8 Visite-utilizatkxI-lJnitad Statea-etat@cs. W2 A N148vm no. 94]

RA790.8.G37 1988 382.20425-dc 19 88-1435

DNLMIDLC

for Library of Congress CIP

For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20+02

,

\
National Center for Health Statistics

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

Robert A. Israel, Deputy Director

Jacob J. Feldman, Ph. D., Associate Director for Analysis

and Epidemiology

Gail F. Fisher, Ph. D., Associate Director for Planning and

Extramural Programs

Peter L. Hudey, Associate Director for Vital and Health

Statistics Systems

Stephen E. Nieberding, Associate Director for Management

George A. Schnack, Associate Director for Data Processing

and Services

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

and Methodology

Sandra S. Smith, Information 0f17cer

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
Introduction . ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4.

Datasourceandlimitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .

Findings . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Demographics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patients’ diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Visitcharacteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drugmentions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Listofdetailedtables . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .

Appendixes

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

II. Definitionsofterms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111.PatientLogandPatientRecordform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

List oftextfigures

1. Rate ofvisits tooffice-based psychiatrists bysexand ageofpatient: United States, 1985 . . . . . . . . . . . . . .

2. Percent distribution of secondary diagnoses in visits to office-based psychiatrists by diagnostic group:

UnitedStates, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Percent distribution ofpsychotherapy admedication invisits tooffice-bmed psychiatrists: United States, 1985 . . .

4. Average number of drug mentions per visit in visits to office-based psychiatrists by age of patient:

UnitedStates, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .

List of text tables

A.

B,

c.

D.

E.

F.

G.

H.

Number, percent distribution, and rate of visits to office-based psychiatrists by age and sex of patient:

UnitedStates, 1975-~6, 1980-81,and 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number, percent distribution, and rate of visits to ot%ce-based psychiatrists by geographic region:

1975-76, 1980-81, and1985, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of visits to office-based psychiatrists by principal diagnosis:

1975–76, 1980-81, and1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . .

United States,

. . . . . . . .

United States,

. . . . . . . .

Number and percent distribution of visits to office-based psychiatrists by detailed principal diagnosis:

UnitedStates, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of visits to office-based psychiatrists by principal diagnosis, according to sex of

patient: UnitedStates, 1985... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of the most common specific principal diagnoses in visits to office-based

psychiatristsby sexandageofpatient: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number mdpercent ofvisits tooffice-based psychiatrists byexpected source ofpayment: United States, 1985 . . .

Number and percent of visits to office-based psychiatrists by selected characteristics: United States, 1975–76,

1980-81, and1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

1

1

2

3

3

4

6

11

14

15

28

36

40

4

8

10

12

3

4

5

6

6

7

8

9

..

Ill
J. Percent distribution of visits to office-based psychiatrists by use of psychotherapy and medication, according to, age

andsexof patient: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

K. Number and percent distribution of visits to office-based psychiatrists by use of medication, according to patient

referral status, visit status, and metropolitan status: United States, 1985 . . . . . . . . . . . . . . . . . . . . .

L. Percent distribution of visits to office-based psychiatrists by use of medication, according to principal diagnosis:

UnitedStates,1985 . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

M. Percent distribution of visits to office-based psychiatrists by visit duration, according to use of medication:

UnitedStates,1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

N. Number and percent distribution of drug mentions in visits to office-based psychiatrists by selected characteristics:

UnitedStates, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0. Number and percent distribution of drug mentions in visits to office-based psychiatrists by therapeutic category:

UnitedStates, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

P. Number and percent of visits to office-based psychiatrists involving the most common generic drug ingredients:

UnitedStates,1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . .

Q. Number, percent distribution, and average number per visit of drug mentions in visits tooffice-based psychia,trists

byprincipaldiagnosis: United States, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

R. Number and percent distribution of drug mentions in visits to office-based psychiatrists by therapeutic category,

according to principal diagnosis: United States, 1985 . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . ,

10

10

11

11

11

12

12

12

13

Symbols

--- Data not available

. . . Category nonapplicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are roundedto

thousands

*

Figure does not meet standard of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements

iv
Office Visits to

Psychiatrists

by Gloria J. Gardocld, Ph. D., Division of Health Care

Statistics

Introduction

Purpose

In this report, national information on the characteristics

of visits to office-based psychiatrists is presented. The information is based on the 1985 National Ambulatory Medical Care

Survey (NAMCS), a sample survey of the medical care provided in the office setting by physicians primarily engaged

in office-based practice. Trend analyses based on the 1975–76,

1980-81, and 1985 ambulatory care surveys also are included

in this report. A report describing NAMCS information on

the visits made to psychiatrists in 1975 and 1976 has been

published (NCHS, 1978).

Data source and limitations

NAMCS was conducted annually by the National Center

for Health Statistics (NCHS) from 1973 through 1981 and

again in 1985. Detailed information on the background and

methodology of the survey has been published (NCHS, 1974).

In brief, the basic sampling unit for the survey is the physicianpatient encounter or visit. The scope of NAMCS includes

all office visits within the conterminous United States made

by ambulatory patients to nonfederally employed, office-based

physicians, excluding anesthesiologists, pathologists, and

radiologists. Thus the design of NAMCS excludes all telephone

contacts with office-based physicians, all contacts with officebased physicians conducted outside the physician’s office,

all contacts with physicians in the three specialties mentioned,

and all contacts with physicians principally engaged in other

professional activities, such as teaching, research, or

administration.

The data collected on sample patient visits include patient

demographic and medical characteristics (for example, age

and significant diagnoses) and information on the conduct

of the visits (for example, diagnostic tests ordered or provided

and duration of physician-patient contact). The latter information includes prescription and nonprescription therapeutic

medications ordered or provided during each visit (that is,

drug mentions). Data from individual sample visits were inflated to produce national estimates.

NAMCS data reflect considerable duplication of persons

because the unit of measurement used is the patient visit

and because the average member of the civilian noninstitutionalized population makes mtdtiple visits each year.

This is particularly true for NAMCS data on visits to psychiatrists, since psychiatric patients usually make multiple visits

during an episode of illness. For this reason, use of the term

“patient” in discussing the characteristics and treatment of

the persons who made the visits examined in this report is

avoided wherever practicable. When needed for clarity, the

term “patient” is used. It refers to the person who made

a particular visit, rather than to a person who may receive

continuing care by making a number of visits.

The trend data presented in this report include annual

averages for 1975–76 and 1980-81, as well as data from

the 1985 survey. Each year’s NAMCS was conducted using

the same definitions of the physician universe and an office

visit. The survey designs also were very similar, although

two major changes did occur. First, a larger physician sample

was utilized for the 1985 survey than for earlier surveys (approximately 5,000, compared with approximately 3,000). Second, the method of stratifying the physician universe according

to specialty was changed, along with the attendant sampling

fractions. The overall effect of these changes was to increase

the precision of estimates. The most obvious differences that

appear among the surveys, however, revolve around changes

in the Patient Record form and the coding of patients’ reasons

for visits and diagnoses. Although the 1975 and 1976 surveys

were conducted in an identical manner, as were the 1980

and 1981 surveys, numerous changes in the collection and

coding of NAMCS data were made over the years, These

changes mean that the analysis. of longitudinal trends is quite

limited. Wherever trend data are presented in this report,

the discussion includes an explanation of relevant limitations.

For further clarification the reader is urged to consult the

detailed information that has been published on each survey

(NCHS, 1979a and 1983).

Because of the complexity of the survey design and estimation procedures, appendixes 1–111should be reviewed to ensure

accurate understanding and interpretation of the statistical estimates presented. Appendix I presents a description of the

1985 survey, including the survey design, data collection and

processing procedures, and estimation procedures. Guidelines

for judging the precision of estimates also are included in

this appendix. Appendix H contains definitions of terms used

in the survey. F]nally, a facsimile of the Patient Record form—

the survey instrument used to report visit information-appears

in appendix 111.

1
*

●

●

●

●

●

There were 18.0 million visits to office-based psychiatrists

in 1985. This was 1 of every 35 physician visits. and

77 visits per 1,000 population.

More than half of the visits were made by persons 2544

years of age, and three-fifths were made by females.

There were no statistically significant changes between

1975–76 and 1985 in the numbers, percents, or rates

of visits to psychiatrists for the total population, either

sex, or any age group.

The 1985 regional rates of visits to psychiatrists ranged

from 47 visits per 1,000 population in the South to 127

in the Northeast.

The most common principal diagnosis in 1985 was depression, which was reported for 29.4 percent of the visits.

Both the number and percent of visits with a principal

diagnosis of depression increased significantly between

1975–76 and 1985 (from 3.0 to 5.3 million visits, and

from 19.6 percent to 29.4 percent). Also between 1975-76

and 1985, the proportion of visits with nonpsychiatric

principal diagnoses decreased from 14.4 percent to 7.1

percent.

In 1985, the most common principal diagnoses in the

group of depressive disorders were neurotic depression

(13.2 percent of all visits to psychiatrists) and major

depressive disorder, single episode (9.3 percent). The

most common neurotic disorders, excluding neurotic depression, were anxiety states exclusive of generalized anxiety disorder (8.7 percent). Adjustment reaction (9.2 percent of all visits) was the largest component of visits

in the residual group of other psychiatric disorders and

psychiatric examinations. No other group of principal

diagnoses had a statistically significant leading

component.

Females made more visits with a principal diagnosis of

depression than males did (3.5 million, compared with

1.8 million).

The most frequently reported expected sources of payment

were self-payment (reported for 57.1 percent of visits),

other commercial insurance (29.0 percent), and Blue Cross

or Blue Shield (16.1 percent). (Note that these expected

sources of payment were not mutually exclusive. )

Almost three-fourths of all visits were made to solo

practitioners.

Checking patients’ blood pressures dropped significantly

●

●

s

●

●

●

●

●

●

between 1975–76 and 1985 (from 5.4 percent of visits

to 2.3 percent), but ordering or providing one or more

clinical laboratory tests remained constant, with 3.3 percent of the visits in 1985 involving these tests.

Patients were instructed to return at a specified time in

91.4 percent of the visits.

The median visit duration was 45 minutes. More than

half of the visits lasted 4 1–50 minutes, and almost one-fifth

lasted 21-40 minutes.

The use of medication increased steadily between 1975–76

and 1985. One or more medications were ordered or

provided in one-fourth of the 1975–76 visits, one-third

of the 1980–8 I visits, and almost half of the 1985 visits.

Medication was ordered or provided most often in the

visits made by persons 45 years old and cJder-62.9

percent. In contrast, it was used in only 40.9 percent

of the visits made by persons 2544 years of age and

in 33.1 percent of the visits made by persons under 25

years of age.

Medication was used primarily as an adjunct to

psychotherapy. Psychotherapy alone was used in almost

half of the visits, and psychotherapy and medication were

both used in another four-tenths of the visits.

Medication was ordered or provided in six of every seven

visits in which the principal diagnosis was a psychosis—

more than for any other principal diagnosis.

Almost half of the visits in which medication was used

lasted 0-40 minutes, but only one-seventh clf the visits

with no medication use were that short.

There were 14.8 million drug mentions in the 1985 visits

to office-based psychiatrists. Of these, 28.8 percent were

antidepressants, 28.8 percent were anxiolytics, sedatives,

and hypnotics, 16.9 percent were major tranquilizers (that

is, antipsychotic medications), and 6.1 percenlt were antimanic agents.

The average number of drug mentions per visit rose with

patient age, from 0.31 per visit for patients 14 years

of age and younger to 1.81 per visit for patients 65

years of age and older.

The average number of drug mentions per visit also varied

with principal diagnosis. Highest were the averages for

visits with principal diagnoses of psychoses (1.76 per

visit) and depressive disorders (1. 02 per visit).
Findings

Demographics

In 1985 there were 18.0 million visits to office-based

psychiatrists, or 77 per 1,000 civilian noninstitutionalized

population. This was 2.8 percent of all visits to physicians

that year. Although the median patient age in visits to psychiatrists of 38.0 is essentially equal to that in visits to all other

physicians (38. 1), the distribution of visits according to age

differs markedly. As table A shows, most of the visits to

psychiatrists were made by young and middle-aged adults.

Persons 2544 years of age made more than half of the visits

(56.2 percent), and those 45-64 years of age made almost

one-fourth of the visits (23.1 percent). All other persons (that

is, those under 25 years of age and those over 64 years

of age) together accounted for only one-fifth of all visits

to psychiatrists.

The age differences in the utilization of psychiatrists’

services can be seen most clearly in the visit rates. The rates

for the group 25-44 years of age (141 per 1,000 population)

and the group 45-64 years of age (94) did not differ significantly, but were greater than the rates for those 15–24 years

of age (45) and those 65 years old and older (44). Not surprisingly, children 14 years of age and younger had the lowest

rate of visits (16).

Visits to psychiatrists also varied significantly with patient

sex. In 1985, three-fifths of the visits (59.4 percent) were

made by females and only two-fifths by males (40.6 percent).

The female rate of 89 visits per 1,000 population was a

fullthird higher than the male rate of 65.

Despite these differences, by far the most striking observation to be made regarding the statistics presented in table A is that there were no significant longitudinal trends

at all. The 1975–76 and 1980-81 annual averages and the

1985 annual statistics showed no statistically significant

changes over time in the visit frequencies, percent distributions, or rates for the total or for any age or sex group.

It should be noted, however, that the relatively small frequencies, by NAMCS standards, resulted in relatively large standard

errors. This may have contributed to the negative findings

of the statistical tests here, or in some of the other analyses

presented in this report.

The 1985 age-specific rates of visits for each sex are

shown in figure 1. The difference between the male and

female rates is not significant for any of the five age groups.

The rise and fall of the rates through the age range, however,

is somewhat different for the two sexes. For the males, a

sharper peak emerges. The rates for the two youngest age

Tabte A. Number, pement cfratribution, and rate of visits to o~ed

psychiatrists by age and sex of patient: United Stateq 1975-76,

1960-61, and 1965

Age and sex of patient 1975-761 1980-61 ‘ 1965

Number in thousands

All visits . . . . . . . . . . . . . . . . . . . . 15,308 15,905 17,989

Age

Under 15 years . . . . . . . . . . . . . . . . 1,316 652 821

15-24 years . . . . . . . . . . . . . . . . . 2,331 1,792 1,730

25-44 yeare . . . . . . . . . . . . . . . . . 8,081 8,653 10,114

4.5-6-t years . . . . . . . . . . . . . . . . . 3,114 3,946 4,149

65 years And over . . . . . . . . . . . . . . ’486 663 1,175

sex

Male . . . . . . . . . . . . . . . . . . . . . 6,105 6,651 7,308

Female . . . . . . . . . . . . . . . . . . . . 9,203 9,254 10,661

Percent distribution

All visits, . . . . . . . . . . . . . . . . . . . 100.0 100,0 100.0

Age

Under 15 years ., ...,...., . . . . . 8.6 5.4 4.6

15-24 years . . . . . . . . . . . . . ,,. . 15.2 11,3 9.6

2E-44 yeara . . . . . . . . . . . . . . . . . 52.8 %.4 56.2

45-&years . . . . . . . . . . . . . . . . 20,3 24.8 23.1

65years and over.....,.,.. . . . . 3.0 4.2 6.5

sex

Male . . . . . . . . . . . . . . . . . . . . , 39.9 41.8 40.6

Female, . . . . . . . . . . . . . . . ,.. , 60,1 58.2 59.4

Rate per 1,000 civilian

noninstitutionalized population

All visits . . . . . . . . . . . . . . . . .,, , 73 71 77

Age

Under 15 years . . . . . . . . . . . . . . . . 25 17 16

15-24 years . . . . . . . . . . . . . . . . M 44 45

25-44 years . . . . . . . . . . . . . . . . . 153 136 141

45-64 years . . . . . . . . . . . . . . . . 72 90 94

65years Andover.......,.. . . . . “22 27 44

sex

Male . . . . . . . . . . . . . . . . . . ... 61 62 65

Female . . . . . . . . . . . . . . . . . . . . 85 60 89

lSlatMics are averageannualasiimstes

groups do not differ significantly, but are smaller than the

rate of 122 visits per 1,000 population for the 254.4 year

age group. The rates for the oldest age groups also do not

differ significantly and also are smaller than the rate for the

3
160- 2

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Under 15 15-24 26-44 45-64 65 and over

Age of patient in years

Fiiurel. Rate ofvisita tooffice-based psychiatrists bysexand age of

patient United States, 1985

middle age group. In contrast, the rates for the females show

somewhat more complexity. The rate for girls 14 years of

age and younger is significantly smaller than that for young

women 15-24 years of age, and both are significantly lower

than the rate of 160 per 1,000 population for women 25-44

years of age. The rate of 117 for women 45-64 years of

age, however, is not significantly lower. For females, the

significant rate drop comes with the group 65 years of age

and older.

Information on regional patterns in the use of psychiatrists’

services is shown in table B. In 1985, the Northeast had

more visits to psychiatrists than any other region-6.3 million,

or 35.2 percent of the total. The Northeast’s rate of 127

visits per 1,000 population, however, was higher than the

rates of only two regions, the Midwest and the South (with

rates of 67 and 47, respectively). The rate of 90 visits per

4

Table B. Number, percent distribution, and rate of visits to office-based

psycfriatrista by gaographm region: United Statesj 197%76, 1980-S1,

and ~965

Geographic region 1975-761 1980-81 ‘ 1965

Allvisite . . . . . . . . . . . . . . . . . . . .

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

Midwest . . . . . . . . . . . . . . . . . . . .

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

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

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

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

Midwest . . . . . . . . . . . . . . . . . . . .

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

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

AllVisits . . . . . . . . . . . . . . .’. . . . .

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

Midwest . . . . . . . . . . . . . . . . . . . .

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

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

Number in thousands

15,308 15,905 17,989

5,751 5,313 6,337

2,728 2,351 3,945

3,690 4,439 3,763

3,139 3,802 3,945

Percent distribution

i 00.0 100.0 100.0

37.6 33.4 35.2

17.6 14.6 21.9

24.1 27.9 20.9

20.5 23.9 21.9

Rate per 1,000 civilian

noninstitutionalized population

73 71 77

116 108 127

49 40 67

55 61 47

86 93 90

‘Statistics are average annual estimatea,

1,000 population in the West did not differ significantly from

the Northeast’s rate.

Neither the regional frequencies nor the regional rates

changed significantly between the 1975–76 and 1985 time

periods. A slight shift in the regional percent distribution

of visits did appear, however, between 1980-81 and 1985.

During that period, the percent of all visits that took place

inthe Midwest increased (from 14.8 percent to21.9 percent),

and the percent that took place in the South decreased correspondingly (from 27.9 percent to 20.9 percent).

Patients’ diagnoses

Thedistributionof principal diagnoses invisitstopsychiatrists in 1975–76, 1980-81, and 1985 is shown in table C.

Two different, although related, coding systems were used

overthe yearsto organize thedlagnoses reportedly participating physicians. The Eighth Revision, International Classification of Diseases, Adapted for Use in the United States (ICDA)

(NCHS, 1967) wasused tocodethe 1975 and1976 diagnostic

data, and the International Classijkation of Diseases, 9th

Revision, Clinical Modijkation (ICD-9-CM) (PHS and

HCFA, 1980) was used to code the 1980, 1981, and 1985

diagnostic data. Fortheanalyses in this report, specific diagnostic codes have been aggregated into diagnostic groups.

(The exact contents of each diagnostic group under each coding

system can be found in appendix II.) Although the ICDA

and ICD–9-CM are closely related, they are not identical,

so meaningful diagnostic groups that are perfectly comparable

could not be constructed. Consequently, trends that appear

must be viewed with caution; there is some possibility that

they may reflect changes in the coding systems used, rather

than changes in the diagnostic patterns displayed by patients.
Depressive disorders were the most common principal

diagnosesin 1985 visits topsychiatrists, accounting for29.4

percent of the visits. Alltheother diagnostic groups related

to mental disorders accounted for essentially equal proportions—neurotic disorders were listed as the principal diagnosis

in 17.6 percent of thevisits, psychoses in 16.3 percent, personality disorders in 14.4 percent, andallother psychiatric disorders and psychiatric examinations in 15.2 percent. Principal

diagnoses not directly indicative of mental disorders accounted

for the smallest proportion of visits, only 7.1 percent.

The 1975–76, 1980-81, and 1985 statistics presented in

table C reveal that two significant trends occurred. First,

both the number and percent of visits in which the principal

diagnosis was a depressive disorder increased between 1975–

76 and 1985. Depressive disorders accounted for 5.3 million

visits in 1985, or 3 of every 10 visits, but only an average

of 3.0 million visits, or 2 of every 10, in 1975 and 1976.

Second, the proportion of nonpsychiatric diagnoses decreased

from 14.4 percent in 1975–76 to 8.9 percent in 1980-81,

then essentially remained constant at 7.1 percent in 1985.

Although NAMCS data cannot be used to pinpoint the underlying sources of these changes, several possibilities can be

suggested. Modifications of the diagnostic coding system,

which were rather extensive for depressive disorders, may

have contributed to these statistical changes, despite efforts

to make the diagnostic groups comparable over time. Also,

because of changes in the knowledge base used in the practice

of psychiatry, psychiatrists in 1985 may have assigned mental

disorder diagnoses, particularly depression, to cases which

they would have classified differently 10 years earlier. Finally,

knowledgeability regarding the causes and treatment of depression and/or the definition of mental illness may have increased

in the public, spurring a larger number of depressed persons

to seek treatment and/or inhibiting persons whose problems

do not warrant psychiatric diagnoses from visiting

psychiatrists.

A more detailed presentation of the 1985 frequency and

percent distributions of the diagnoses included in the diagnostic

groups can be seen in table D. Several noteworthy tindings

emerge from this table. In the group of principal diagnoses

that were depressive disorders, neurotic depression and major

depressive disorder (single episode) were the most common,

accounting for 13.2 percent and 9.3 percent of all visits to

psychiatrists, respectively. Second most common were depressive disorders not elsewhere classified (4.9 percent), and least

common was major depressive disorder (recurrent episode),

which accounted for 2.0 percent. In the neurotic disorder

group, which excludes neurotic depression, the largest diagnostic subgroup was anxiety states other than generalized anxiety

disorder (8.7 percent of all visits). Generalized anxiety disorder

and all other neurotic disorders accounted for essentially equal

proportions of psychiatrists’ visits (4.0 percent and 4.9 percent,

respectively). Finally, a majority of the visits included in

the residual category of other psychiatric disorders and psychiatric examinations had the principal diagnosis of adjustment

reaction; these visits accounted for 9.2 percent of all visits

to psychiatrists in 1985.

The distribution among diagnostic groups of the visits

made by each sex in 1985 is presented in table E. Only

one significant difference between the visit distributions of

males and females was found: Females made significantly

more visits for depression than males did (3.5 million compared

with 1.8 million). The proportion of visits made by females

in which depression was the principal diagnosis, although

appearing notably larger than the proportion of visits made

by males with that diagnosis, did not differ significantly from

it (32.8 percent and 24.4 percent, respectively).

The most common specific principai diagnoses for all

visits, each sex, and each age group are shown in table F.

It is important to note that, although these specific diagnoses

have been rank ordered, differences among the frequencies

and percents are not always significant. For all visits, the

most common specific diagnoses were neurotic depression,

major depressive disorder (single episode), unspecified anxiety

state, depressive disorder not elsewhere classified, unspecified

adjustment reaction, generalized anxiety disorder, unspecified

personality disorder, borderline personality disorder, compulsive personality disorder, and unspecified bipolar affective

disorder. Together these 10 diagnoses accounted for approximately half (53.6 percent) of all visits to psychiatrists in

1985.

The statistics presented for each sex and for each age

group show all the specific diagnoses named as the principal

diagnosis often enough to attain statistical reliability. Particular

TabIe C. Number and percent dwtnbutiin of waits to office-based psychiatrkts by principsi dhgnoak Lfritad Stat- 197%76, 1960-61, and 1965

197$76 ‘ 1980-81 ‘ 196.5

Number in Percent Number in Percent Number in Perc8rrt

Principal diagnosis 2 thousands distribution thousands distribution thousands distributkm

All visits.............,,. . . . . . . . . . . . . . . . . . . . . . . 15,308 100.0 15,905 100.0 17,989 100.0

Psychoses (including affective psychoses, except major

depressive disorder) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,497 16.3 2,471 15.5 2,928

Depressive disorders (including major depressive disorder) . . . . . , . . . . .

16.3

2,994 19,6 4,288 26.8 5,287

Neurotic disorders (excluding neurotic depression) . . . . . . . . . . . .

29.4

3,597 23.5 3,264 20.5 3,165

Personality disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17.6

2,059 13.4 2,477 15.6 2,587

Other psychiatric disorders and psychiatric examinations . . . . . . . .

14.4

1,960 12.8 2,019 12,7 2,743

Another principal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . .

15.2

2,201 14.4 1,406 8.9 1,279 7.1

%tatistics are average annual esbmates.

‘In the 1975 and 1976 surveys, based on Egfrfb Rewm, /nfernafmra/ Chss(ficafcm of Dseases, Adapted for Use m h? Lfmted States {lCDA). In the 19S0, 19S1. and 1985 surveys, based on

/nternafim8/ Ck?ssfkation of Diseases, 9ffI Rev;son, Cfmicd Modfkafmn (ICO-9-CM),

5
Table D. Number and percent distribution of visits to office-based psychiatrists by detailed principaldiagnosis United States, 1985

Principal diagnosis and ICD-%CM code’ Number in thousands Percent distribution

All visits. . . . . . . .

Psychoses (including affective psychoses, except major depressive

disorder) . .290–295, 296.0, 296.1, 296.4–296.9, 297-299

Paranoid typeschizophrenia, . . . . . . . . . . . . . . . . . . . . . ...295.3

Otherschizophrenic disorders.. . 295.0–295.2, 295.4-295.9

.Elipolaraffective disorders,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...296.4-296.7

Other affective psychoses (excludng major depressive disorder) . . 296,0, 296.1, 296.6, 296.9

Otherpsychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-294.297-299

Depressive disorders (including major depressive disorder) . 296.2, 296.3, 300.4, 311

Majordepressivedisorder, single episode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . ...296.2

Majordepressivedisorder, recurrent episode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..296.3

Neurotic depression.....,,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..300.4

Depressivedisorder, notelsewhere classified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...311

Neurotic disorders (excluding neurotic depression) . . . . . 300.0-300.3, 300.5-300.9

Generalizedanxietyctisorder.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300.02

Otheranxietystates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300.00.300.01. 300.09

Other neuroticdisorders . . . . . . . . . . . . . . . . . . . . . . . . . . 300.1–300.3, 300.5-300.9

Personalitydisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...301

Compulsive personalitydisorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..301.4

Borderline peffionalitydisorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 301,83

Otherpersonalitydisorders . . . . . . 301.0-301.3, 301 .5–301 .7, 301.81, 301.82, 301.84, 301.89, 301.9

Other psychiatric disorders and psychiatric examinations . . . 302–31 O, 312-316, V67.3, V70.1, V70.2, V79.0, V79.I

Adjustmentreaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...309

Remaining psychiatric disorders and examinations . . 302–308, 310, 312–316, V67.3, V70.1, V70.2, V79.0, V79.I

Allotherdiagnoses . . . . . . . . . . . . . . . . . . Residual

17,989

2,928

467

983

673

425

379

5,287

1,665

355

2,383

884

3,165

712

1,567

687

2,587

473

535

1,579

2,743

1,658

1,085

100.0

16.3

2.6

5.5

3.7

2.4

2.1

29.4

9.3

2.0

i 3,2

4,9

17.6

4.0

8.7

4.9

14.4

2.6

3.0

8.8

15.2

9.2

6.0

1,279 7.1

1Based on hterrrafiorrd C/assiflcs/ion of Diseases, 9th Revision, C/irrica/ A.fodificatim (ICO-9-C M),

Table E. Number and percent distribution of visits to office-based psychiatrists by principal diagnosis, according to sex of patienh United Stsdes, 1985

Both Both

Princ@al diagnosis’ sexes Male Female sexes (Male Female

Number in thousands Percent distribution

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . ...17.989 7,308 10,661

Psychoses (including affective psychoses, except major depressive disorder) . . . . . . . 2,928 1,246 1,682

Depressivedisorders (including major depressive disorder). . . . . . . 5,287 1,781 3,506

Neuroticdisorders(excludingneurotic depression) . . . . . . . . . . . . . . . . 3,165 1,309 1,857

Personalitydisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,587 1,238 1,350

Otherpsychiatricdisordersandpsychiatric examinations . . . . . . . . . . . 2,743 1,203 1,541

Allotherdiagnoses ...,.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,279 533 746

100,0 “100.0 100.0

16.3 17.0 15.8

29.4 24,4 32.8

17.6 17.9 17.4

14.4 16.9 12.6

15.2 16.5 14.4

7,1 7.3 7.0

}Based on /nfernatiorra/ Classification of Diseases, 9th Revision, C/irricsl Modification (lCC%-CM),

diagnoses appear inthese listings with remarkableconsistency.

For each sex and for the three middle ,age groups (25–34

years, 35-44 years, and 45–64 years), neurotic depression

was always the most common principal diagnosis. Major depressive disorder (single episode) and unspecified anxiety state,

not always in that order, were the next most common diagnoses

foreachsex andage group with atleast two orthree diagnoses

that reached the level of statistical reliability. No single specific

principal diagnosis was made often enough to reconsidered

reliable intheyoungest andoldestage groups.

The final aspect of. diagnoses to be considered is the

question of secondary diagnoses. In the 1985 visits to psychiatrists,6.4 million secondary diagnoses were reported, anaverage of 0.36 per visit. As figure 2 shows, the least common

diagnostic group was psychoses, as only 4.9 percent of these

diagnoses were so classified. The remaining diagnostic groups

accounted for proportions ranging from 13.0 percent to 28.7

percent, with no noteworthy pattern emerging.

Visit characteristics

The 1985 NAMCSincluded, forthe first time, aquestion

on the sources from which payment for physician visits was

to be expected. Participating physicians were asked to indicate

on a checklist which of the nationally most common payment

sources was expected to pay all or part of the charges incurred

during each sample visit. The accuracy of these reports thus

depends on the extent of physicians’ knowledge regarding

the precise status of patients’ insurance coverage, as well

as on completeness of reporting. For this reason, NAMCS

6
Table F. Number and percent diatnbution of the moat common apecifk principal diagnoses in vials to oflioa-baaed psych@rfsta by sex and age of

patienk United States, 1985

Principal diagnosis and ICD-9-CM code,’ and sex and age of patient Number in thousands Percent disfributkwr

Both sexes

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

Neurotic depression .,...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..300.4

Major depressive disorder, single epiaode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...296.2

Anxietystate, unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . ...300.00

Depressivedisorder, notelsewhere classified ...’.........”.. . . . . . . . . . . . . . . . . . . . . . . ...311

Unspecifiedadjustmentreaction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...309.9

Generalized anxiety disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300.02

Unspmified pereonalitydisorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...301.9

Borderlinepereonalitydisorder.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...301.83

Compulsive personalitydisorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...301.4

Bipolaraffecfivedisorder,unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...296.7

Allotherprincipaldiagnoses... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Residual

Male

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

N&roticdepression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300.4

An~ie~ystate, unspecific . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300.00

Majordepressivedisorder, singleepisode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..296.2

Depressivedisorder, notelsewhere classified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...311

Allotherprincipaldiagnoses... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Residual

Female

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neuroticdepression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300.4

Majordepressivedisorder, singleepisode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..296.2

Anxietystate, unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300.00

Unspecifiedadjustmentreaction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...309.9

Depreeaivedk.order, notelsevhere classified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...311

Borderline personalitydisorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...301.63

Generalizedanxietydisorder.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300.02

Allotherprincipal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Residual

Under 25 years of age 2

Allvisik . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yearn of age

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neuroticdepression . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allotherprincipaldiagnoees... . . . . . . . . . . . . . . . . . . . .

35-44 ~ears of age

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

Neuroficdepression . . . . . . . . . . . . . . . . . . . . . . . . . . .

Majordepressivedisorder, single episode . . . . . . . . . . . . . . . .

Anxietystate, unspecified . . . . . . . . . . . . . . . . . . . . . . . .

Generalized anxietydkorder . . . . . . . . . . . . . . . . . . . . . . .

Allotherprincipaldiagnoses... . . . . . . . . . . . . . . . . . . . .

4%64 years of age

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neuroticdepression . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major depressive disorder, single episode . . . . . . . . . . . . .

Allotherprincipaldiagnoses... . . . . . . . . . . . . . . . . . . .

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

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

. . . . . . . . . . . . . . . . . . . . . . . . 300.4

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

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

. . . . . . . . . . . . . . . . . . . . . . . . 300.4

. . . . . . . . . . . . . . . . . . . . . . . . 296.2

. . . . . . . . . . . . . . . . . . . . . . . 300.00

. . . . . . . . . . . . . . . . . . . . . . . 300.02

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

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

. . . . . . . . . . . . . . . . . . . . . . . . 300.4

. . . . . . . . . . . . . . . . . . . . . . . . 296.2

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

65 years of age and overz

Allvisils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17,969

2,383

1,569

1,220

864

799

712

607

535

473

436

8,352

7,306

846

4s’t

465

353

5,164

10,681

1,537

1,123

739

560

532

363

376

5,431

2,552

4,640

563

4,077

5,473

607

428

412

387

3,460

4,749

589

501

3,059

1,175

100.0

13.2

8.8

6.8

4.9

4.4

4.0

3.4

3.0

2.6

2.4

46.4

100.0

11.6

6.6

6.4

4.8

70.7

100.0

14.4

10.5

6.9

5.2

5.0

3.6

3.5

50.6

100.0

100.0

12.1

87.9

100.0

14.7

7.6

7.5

6.7

63.2

100.0

14.2

12.1

73.7

100,0

lBasedon /nfemstbna/ C/asifimfbn oJDiseases, 9ti Revisim, C/fnti/Wifkation (lCUWM).

‘For this age group, no specific diagnosis had a frequency large enough to meet the NCHSstandard of srstistksl reiiabilii.

7

.
Table G. Number andpercent ofvisits tootice-based payctiatristsby

expected source of payment United States, 1985

Psychoses (including affective

psychoses, except major

depressive disorder)

4.90/.

Neurotic disorders

(excluding neurotic \

depression)

13,0”/.=

Depressive

disorders

(including

major

depressive

f

disorder

15,30/o

Figure2. Percent distribution ofsecondary diagnoses invisits to officebased psychietnsts bydiagnostic group: United States, 1985

information on the expected source of payment was not expected to attain the level of completeness and accuracy reached

for other types of information collected, such as diagnoses

or the use of therapeutic services. Nevertheless, this information should provide valuable insight into the relative importance

of each payment source in reimbursing physicians for officebased patient care.

Table G shows that self-payment and private insurance

predominate in paying for psychiatric services. By far the

most common expected source of payment was self-payment,

which was reported for 57.1 percent of the visits. This included

both the visits in which all of the charges were to be paid

by the patients and those in which only part of the charges

were to be paid by the patients. The second and third most

coammon expected sources of payment were other commercial

insurance (29.0 percent of the visits) and Blue Cross or Blue

Shield (16. 1 percent). All other expected sources of payment

were mentioned significantly less frequently, in a range of

0.2–6. 1 percent of the visits.

Information on several other variables directly concerned

with the characteristics of patient visits has been collected

in NAMCS since its inception. Trend statistics for those items

are presented in table H.

Visits to solo practitioners strongly predominated in 1985,

with almost three-fourths of all visits to psychiatrists (72.5

percent) being made to these physicians. Although visits to

solo practitioners also strongly outweighed those to other psychiatrists in 1975–76 and 1980-81, there was a significant

change. The proportion of all visits that was made to psychiatrists in solo practice increased significantly between 1975–76

and 1980-81 (from 77.9 percent to 88.8 percent), then dropped

significantly to the 1985 level. The underlying reasons for

these changes cannot be determined from the available data.

Two diagnostic services relevant to psychiatric practice

on which data were collected between 1975–76 and 1985

were blood pressure measurements and clinical laboratory

Number in

Expected source of payment thousands Percent

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

Self-pay . . . . . . . . . . . . . . . . . . . . . . . .

Medicare . . . . . . . . . . . . . . . . . . . . . . . .

Medicaid . . . . . . . . . . . . . . . .

Blue Cross or Blue Shield . . . . . . . . . . . . . . .

Other commerical insurance . . . . .

HMOorother prepaid plan..... . . . . . . . . . .

No charge..,,,........,.. . . . . . . . . .

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

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

17,989!

10,271

1,001

1,106

2,897

5,219

846

*,225

668

’31

100.0’

57.1

5.6

6.1

16.1

29.0

4,7

“1.3

2..7

‘0.2

‘Sums of categories do not equal the totals because more than one expected source of

payment was recorded for some visits,

tests. Checking patients’ blood pressures dropped significantly

between 1975–76 and 1985 (from 5.4 percent c)f visits to

2.3 percent), although the intervening changes involving the

1980–8 1 period were not significant. In contrast, ordering

or providing clinical laboratory tests remained essentially constant over the entire period, with 3.3 percent of the visits

in 1985 involving one or more of these tests. It is important

to note that no significant change occurred despite changes

in the survey instrument which, if anything, encouraged more

complete reporting of these tests.

The disposition of patients at the end of visits and the

duration of visits also were remarkably stable over time, as

no significant differences appeared between 1975–76 and

1985. In the vast majority of the 1985 visits (91.4 percent),

the patients were instructed to return at a specified time.

The remaining visits were essentially equally distributed among

the other categories of patient disposition: return if needed

(4.7 percent); no followup planned (2.8 percent); and all other

patient dispositions (2.9 percent). Similarly, a large majority

of the 1985 visits (68.0 percent) lasted 3 1–60 minutes. This

was followed by the visits that lasted 16-30 minutes (19.4

percent). All other visit durations accounted for small, essentially equal, proportions of visits: 6.6 percent lasted 11–15

minutes, 3.2 percent lasted 61 minutes or mone, and 2.9

percent lasted 10 minutes or less. The median duration of

all visits was 45 minutes.

A very different picture revealing a great deal of change

emerges when the information on the use of medications is

inspected. In 1975 and 1976, only otie-fourth of all visits

to psychiatrists (27.1 percent) involved ordering or providing

one or more medications to the patient. By 1980-81, this

had increased to one-third (36.2 percent), and by 1985 it

had increased again, to almost one-half (46.3 percent). At

first glance, it appears that the initial increase could be the

result of a major change in the method utilized in NAMCS

to report the use of medication. In 1975 and 1976, physicians

indicated the use of medication by simply checking one or

more of three items in a list of therapeutic sewices ordered

or provided; in 1980 and 1981, physicians listed specific

drugs ordered or provided. The greater specificity of the questions used in the later period, as well as the obviously greater

emphasis on the item, could have increased the responsiveness

of participating physicians. However, no change of such a

8
Table H. Number and percent of visits to office-based psychiatrists by selected characteristics: United States, 1975-76, 1980-61, and 1965

1975-761 1980-61~ 1985

Number in Number in Number in

Characteristic thousands Percent thousands Percent thousands Percent

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,308

Type of practice

SOIL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...11.924

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,385

Selected diagnostic servicesz

Bloodpressurecheck . . . . . . . . . . . . . . . . . . . .

Clinical lab!es~ . . . . . . . . . . . . . . . . . . . . . . .

Use of medication

Medication used4 . . . . . . . . . . . . . . . . . . . . . . .

No medication used . . . . . . . . . . . . . . . . . . . . .

Patient disposition

Nofollowupplanned . . . . . . . . . . . . . . . . . . . . .

Return atspacifiadtime . . . . . . . . . . . . . . . . . . .

Return ifneeded . . . . . . . . . . . . . . . . . . . . . .

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

Visit duration

0-10minutes5 . . . . . . . . . . . . . . . . . . . . . . . .

11-15 mingles . . . . . . . . . . . . . . . . . . . . . . . .

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

31-60 minutes . . . . . . . . . . . . . . . . . . . . . . . .

610rmoreminutes . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . 819

. . . . . . . . . . . . . . . . . . . . . . ●376

. . . . . . . . . . . . . . . . . . . . . . 4,148

. . . . . . . . . . . . . . . . . . . . . . 15,308

. . . . . . . . . . . . . . . . . . . . . 632

. . . . . . . . . . . . . . . . . . . . ., 13,607

. . . . . . . . . . . . . . . . . . . . 924

. . . . . . . . . . . . . . . . . . . . . 923

. . . . . . . . . . . . . . . . . . 826

. . . . . . . . . . . . . . . . . . . . . ’598

. . . . . . . . . . . . . . . . . . . . 2,717

. . . . . . . . . . . . . . . . . . . . . 10,590

. . . . . . . . . . . . . . . . . . . . . “577

100.0

77,9

22.1

5.4

“2.5

27.1

72.9

4.1

68.9

6.0

6.0

5.4

3.9

17.7

69.2

3.8

15,905

14,124

1,781

529

’259

5,759

10,146

433

14,401

900

489

482

528

3,026

11,519

’350

100.0

88.8

11.2

3.3

‘1.6

36.2

63.8

2.7

90.5

5.7

3.1

3.0

3.3

19,0

72.4

“2.2

17,989

13,051

4,939

418

592

6,324

9,665

501

16.442

840

522

527

1,179

3,487

12,226

571

100.0

72.5

27.5

2.3

3.3

46.3

53.7

2.8

91.4

4.7

2.9

2.9

6.6

19.4

68.0

3.2

1Statistics are average annual estimates,

‘More than one wss recorded for some visits,

‘In the 1975, 1976, 1980, end 1981 surveys, m+asurad by the physicim checking “cfinical lab tes~ m a Ihstof dlagnosfc aarvwes ordered or prowdsd In the 1985 suwey, measuredby h

physician cheddng “urinalysis,” ‘“hematology,” “bbcd chemistry,” andor “other lab test” in a [[s1of diagr?ostii aarwces ordered or prowdad

41nthe 1975 and 1976 surveys, measured by the physician checking “drug prescribed,” “’inption,” and or “tmmun!zatmn desena!bzalmm- m a Ihatof tharapeutw sawms orderad w pra+ded In the

1980, 1881, and 1985suweys, meesured bythephysician recordingoneor rmxespac!fffimed!caltons,!wwor mtlnwd, asor~rtiorprotiti

‘Duration of zero mmules waa recorded for visits m wh(ch there was no face-to-face contact between the patient and the physman

magnitude was made in the questions between 198&81 and extreme importance. For this reason, the remainder of this

1985, yet the reports of using medication increased just as portion of this report is devoted to investigating different

much. During the total 1975–85 period, the development of aspectsofthe useofmedication and psychotherapy.

psychotropic drugs, clinical knowledge regarding advanta- As table J shows. the use of psychotherapy is related

geous applications of psychotropic drugs, and emphasis on to patient age, and the use of medication is related to both

health care cost-cutting measures all increased dramatically. patientageandpatient sex. OveraH. psychotherapy washeavily

Together, these observations lead to the conclusion that the utilized. as it was ordered or provided in 88.7 percent of

statistical increases noted here are not artifacts created by all visits. It was used significantly more often with persons

methodological changes, but instead are reflections of actual between theages of25and44 (91. 8percent) than with persons

changes inpsychiatric treatment. 45 years of age andolder(83.O percent), Its use with persons

Since medication therapy and psychotherapy are the two under 25 years of age (88.3 percent), however, did not differ

principal methods of treating mental disorders, they are of significantly from its use with either of the two older age

Age ot patient

Both sexes Under 25-44 45 years

Sex of Peflent

Use of psychotherapy and medication all ages 25 years years and over Male Female

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 1000 100.0 100.0

Psychotherapy orderad or provided

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88,7 66.3 91.8 83.0 89.2 88.4

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.3 11.7 8.2 17.0 10.8 11.6

Medication ordered or provided

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46.3 33.1 40.9 62.9 40.6

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

50.2

53,7 66.9 59.1 37,1 59.4 49.8

9
groups. Furthermore, psychotherapy was used equally often

with males (89.2 percent of visits) and females (88.4 percent).

In contrast, medication was utilized more in the visits made

by persons 45 years of age and older (62.9 percent) than

in the visits made by persons 25-44 years of age (40.9 percent)

‘or in the visits made by persons under25 years of age (33. I

percent). In addition, it was ordered or provided in 50.2

percent of the visits made by females but in only 40.6 percent

of the visits made by males. The latter finding may be at

least partly due to the larger number of visits for depression

made by females, since depression is one of the mental disorders relatively amenable to treatment with medication.

The extent to which the use of psychotherapy and medication overlapped is illustrated in figure 3. This shows that

medication was used primarily as an adjunct to psychotherapy.

In almost half of the visits (48.9 percent), only psychotherapy

was ordered or provided. In another four-tenths (39.8 percent),

both psychotherapy and medication were ordered or provided.

Only in very small proportions of visits were only medication

used (6.4 percent), or neither psychotherapy nor medication

used (4. 8 percent).

As table K shows, the use of medication was also related

to both the visit status and the population density of the

geographic area in which the visit took place, but not to

the referral status of the visit. Medications were used substantially more often in return visits than in initial visits (47.7

percent, compared with 29.8 percent), and also substantially

more often in visits in nonmetropolitan areas than in visits

in metropolitan areas (71.5 percent, compared with 45.4 percent). They were used at essentially equal rates, however,

in visits for which the patient had been referred (39.7 percent)

and in those that were not referrals (46.5 percent).

The type of principal diagnosis influenced the use of

medication, but not as clearly as expected (table L). Medication

was utilized by far the most often in the visits in which

the principal diagnoses were psychoses (85.6 percent). The

corresponding proportions among the remaining diagnostic

groups ranged from 20.1 percent of the visits in which the

principal diagnoses were personality disorders to 54,8 percent

of the visits in which the principal diagnoses were depressive

disorders. Although there were some significant differences

among these statistics, no clear pattern emerged. Given the

Neither psychotherapy nor medication

ordered or provided

4,8%

Only medication \

ordered or provided

6.40/o~

Psychotherapy

and medication

Fgure 3. Percent distribution of psychotherapy and medication in visits

to office-based psychiatrists: United States, 1985

broad range that appeared in the proportions, this relative

lack of statistically significant findings undoubtedly was at

least partly due to the small frequencies involved, with the

consequent large relative standard errors.

The final aspect of medication usage to be considered

here is its clear relationship with length of visit. As table

M shows, visits in which medication was ordered clrprovided,

compared with all other visits, were significantly more likely

to last 0-20 minutes (18.9 percent, compared with’7.0 percent)

or 21J40 minutes (30.6 percent, compared with 7.2 percent),

and significantly less likely to last 4 1–50 minutes (40.4 percent, compared with 68.7 percent) or 51 minutes or longer

(10. 1 percent, compared with 17.1 percent). Several possible

explanations could account for this. First, although we have

seen that medication usually was used in conjunction with

psychotherapy, it sometimes may have been used as a partial

substitute. That is, some psychiatrists, in some cases, may

have felt that when medication was used extended

psychotherapy sessions were unnecessary. Second, some of

the visits may have been brief follow-up visits made for the

Table K. Number and percent distribution of visits to office-based psych~tnsts by use of medication, according to patient referral status, visit statu% and

metropoliin status: United States, 1985

Patient was referred Visit status Metropolitan status

All for this visit New Return Metropolitan Nonmetropolitan

Medication ordered or provided visits Yes No patient visit area area

Number in thoussnds

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,989 615 17,374 1,408 16,581 1.7,383 606

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,324 “244 8,079 419 7,905 7,891 433

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,665 371 9,294 989 8,677 9,493 *173

Percent distribution

Allvisite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46.3 39.7 46.5 29.6 47.7 45,4 71.5

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.7 60.3 53.5 70.2 52.3 54.6 ‘28.5

10
Table L. Percent distribution of visits to offiie-based psychiatrists by use of medication, according to priIw@d diagnosis United States, 1985

Prmcpal diagnosis 1

Other

psychiatnb

All disorden and All other

principal Depressive Neurotic Personality psychiatric principal

Mediation ordered or provided diagnoses Psychoses 2 disorders 3 disorders4 disorders examinations diagnoses

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100,0 100.0 100.0

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46.3 85.6 54.8 41.7 20.1 25.0 30.8

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.7 14.4 45.2 58.3 79.9 75.0 69.2

‘Basedon /nfemaf/ona/C/ass/fi&t/onof Diseases,9th R?bmmn,C/inica/Mtiificafion (lC&WM)

‘Includes affective psychoses, except major depresswedkorder.

%cludes major depresswe drsorder.

4Excludes neurotic depression,

Table M. Percent distribution ofvisits tooffiie-baaed psychiatnstsby

visit duration, according to use of medication: United Ststea, 1985

Medication ordered

or provided

Visit duration All visits Yes No

All visits . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0

0-20minutes’ . . . . . . . . . . . . . . . . 12,5 18.9 7.0

21-40 minutes . . . . . . . . . . . . . . . 18.0 30.6 7.2

41-50 minutes . . . . . . . . . . . . . . . . 55.6 40.4 68.7

51 minutesormore . . . . . . . . . . . . 13.9 10.1 17.1

‘Duration of zero minutes was recorded forv! sits m which there was no face-to-face contact

between the patient and the phystcian.

purpose ofcontinuing maintenance medication therapy. Third,

psychiatric patients who need medication often, althou.gh not

always, are the sickest patients. In some of the visits made

by these patients, the psychiatrists may have decided that

the patients were unable to benefit from extended

psychotherapy sessions andso may have limited the duration

of the visits. The final pmsibility also isrelated to the seventy

of patients’ disorders. Since insurance coverage of treatment

for mental disorders often is much more limited than coverage

for other disorders, some of psychiatrists’ sickest patients

may have exhausted much or all of their insurance coverage

and consequently may have been unable to afford longer

psychotherapy visits.

Drug mentions

This portion of the report explores various aspects of

the particular drug mentions that appeared in visits to psychiatrists. rather than the characteristics of the visits in which

medication was ordered or provided.

There was a total of 14,8 million drug mentions in the

1985 visits to office-based psychiatrists. As shown in table N, most of the drugs were ordered using trade names

(81.5 percent), were available to patients only with a prescription (95.9 percent), and were composed of a single active

ingredient (94.2 percent). Two-thirds of the drug mentions

(66.4 percent) were drugs not subject to the control regulations

of the Drug Enforcement Administration, but almost one-third

(30.8 percent) were controlled dregs. Most of the drug mentions (87.7 percent) were continuing medications; only 11.5

percent were newly ordered or provided. Undoubtedly the

Tabfe N. Number and percent ddributii of drug mentions in visits to

oftice-baaed psych~nsts by selected charactensW United State~ 1985

Number in Percent

Characteristic thousands distribution

All drug mentions . . . . . . . . . . . . . . . . . .

Entry status

Generic name . . . . . . . . . . . . . . . . . . . .

Trade name . . . . . . . . . . . . . . . . . . . . .

Undetermined . . . . . . . . . . . . . . . . . . . .

Prescription status

Prescription drug . . . . . . . . . . . . . . . . . .

Nonprescription drug . . . . . . . . . . . . . . .

Undetermined . . . . . . . . . . . . . . . . . .

Composition status

Single ingrechent drug . . . . . . . . . . . .

Combmation drug . . . . . . . . . . . . .

Undetermined . . . . . . . . . . . . . . . . . . . .

Conlrol status

Controlled drug . . . . . . . . . . . . . . . .

Uncontrolled drug . . . . . . . . . . . . .

Undetermined . . . . . . . . . . . . . . . .

Use status

New medication . . . . . . . . . . . . . . . .

Continuing mechcatim . . . . . . . . . . . . . . .

Undetermined . . . . . . . . . . .. . . . . . .

Diagnostic relevance

Madicatlon is forpnnclpal diagnoses .

Madicatlon isnotfor prmcipaldlagnosis .

Undetermined . . . . . . . . . . . . . . . . . . .

14,826 100.0

2,325 15.7

12,087 81.5

’414 ●2.8

14,213 95.9

“174 ‘1.2

“439 ‘3.0

13,973 94.2

“439 “3.0

’414 ‘2.8

4,5e4 25.8

9,838 86.4

“424 “2.9

1,703 11.5

12,896 87.7

“126 “0.9

13,191 89.0

1,522 10.3

“112 “0.8

high proportion of return visits to psychiatrists was largely

responsible for this predominance of continuing medications.

Finally, most of the drug mentions (89,0 percent) were for

treatment of the condition reflected in the principal diagnosis

and only 10.3 percent were ordered for the treatment of other

conditions,

The NAMCS data files also contain American Hospital

Formulary Service (American Druggist Blue Book Data Center, 1985) information as to the expected therapeutic effects

of drugs mentioned. The therapeutic categories associated with

the drugs ordered or provided by psychiatrists are shown

in table O. As expected, most of the medications (85.4 percent)

were central nervous system drugs; all other types of drugs

11
Table O. Number and percent distribution of drug mentions in visits to

office-baaed psychiatrists by therapeutic category United States, 1985

Number in Percent

Therapeutic category 1 thousands distribution

Alldrug merrtions . . . . . . . . . . .

Central nervous system drugs . .

Psychotherapeutic agents . . . .

Antidepressants . . . . . . . . . . . . . . .

Major tranquilizers . . . . . . . . . . .

Anxiolytics, sedatives, and hypnotics

Benzodiazepines . . . . . . . . . . . . . . . .

Other anxiolytics, sedatives, and hypnotics

Antimanic agents......,,.. . . . . . . .

Other central nervous system drugs . . .

Another drug mentions ..,,... . . . . . . . .

14,826

12,665

6,777

4,267

2,510

4,276

3,966

“306

910

“702

2,161

100.0

85.4

45.7

26.6

16.9

28.8

26.6

.2.1

6.1

4.7

14.6

lBased on American Hospital FormularyService ClassificationSystem, Drug Product

hrfomratiorr Fi/e, The American Druggist Blue Book Data Center, San Bruno, Calif,, 1985

Tabte P. Number and percent of viaite to office-based psychiatrists

involving the most common generic drug ingredients United Statea, 1985

Number in

Generic drug ingredient’ thousands Percent

All visita . . . . . . . . . . . . . . . . . . . . . . . . . . 17,969 100.0

Alprazolam . . . . . . . . . . . . . . . . . . . . . . . . 1,622 9.0

Lithium . . . . . . . . . . . . . . . . . . . . . . . . . . 910 5.1

Amitriptyline . . . . . . . . . . . . . . . . . . . . . . . . 881 4.9

Imipramine . . . . . . . . . . . . . . . . . . . . . . . 837 4.7

Desipramine . . . . . . . . . . . . . . . . . . . . . . . 685 3.8

Diezepam . . . . . . . . . . . . . . . . . . . . . . . . . 58~ 3.2

Thioridszine . . . . . . . . . . . . . . . . . . . . . . . . 557 3.1

Doxepin . . . . . . . . . . . . . . . . . . . . . . . . . 440 2.4

Chlordiazepoxide . . . . . . . . . . . . . . . . . . . . . 360 2.0

‘More than one generic drug ingredient may have been ordered or provided during a single

visit.

accounted for only 14.6 percent of all drug mentions. The

central nervous system dmgssubclassified aspsychotherapeutic agents were dlvidedbetween antidepressants (28.8 percent

ofall drug mentions) and major tranquilizers (16.9 percent),

statistics which did not differ significantly. Of the central

nervous system drugs classified as anxiolytics, sedatives, and

hypnotics, the vast majority were benzodiazepines

(26.8 percent of all drug mentions). Only 2.1 percent were

other anxiolytics, sedatives, and hypnotics. Finally, antimanic

agents accounted for 6.1 percent of all drug mentions and

other central nervous system drugs for 4.7 percent.

A tabulation of the number of visits in which each of

the most common generic substances was used is presented

in table P. The nine generic ingredients presented in this

table are the only ones that appeared in statistically reliable

numbers of visits. Of these, four were antidepressants—amitriptyline (utilized in 4.9 percent of the visits), imipramine

(4.7 percent), desipramine (3.8 percent), and doxepin

(2.4 percent). Three were anxiolytics—alprazolam (utilized

in 9.0 percent of visits), diazepam (3.2 percent), and chlordiazepoxide (2.0 percent). Only one ofthe generic substances

was an antipsychotic major tranquilizer (thioridazine, used

in 3.1 percent of the visits), and one was the antimanic agent

lithium (5. 1 percent).

Theaverage number ofdrugs utilized in individual visits

rose with patient age, as shown in figure 4. There were

~d over

Age of patient in years

F~ure4. Average number ofdrugmentions pervisit invisits to officebased paychmtnsts byageofpatierk United States, 1985

Table Q. Number, percent dstnbution, andaverage number pervisitof

drug mentions in visits to office-based paychiatriets by principal

diagnosis United States, 1985

Average number

Number in Percent of drug mentions

Principal diagnosis’ thousands distribution per visit

Alldrugmentions . . . . . . 14,826 100.0 0.82

Psychoses (including affective

psychoses, except major

depressive disorder). . . . . 5,165 34.8 1.76

Depressive disordera (including

major depressive ctisorder) 5,391 36.4 1.02

Neurotic disorders (excluding

neurotic depression) . . . . 1,924 13.0 0.61

Personality disorders . . . . . 806 5.4 0.31

Other psychiatric disorders

andpsychiatric examinationa . . 909 6.1 0.33

Another principal diagnoses . . ’631 “4.3 0.49

‘Based on /ntemationalCkrssificationof Diseasea,9tfJRevision,ClinicalMcdWcation

(ICD-9-CM).

no significant differences among the averages for the three

youngest groups (0.31 drug mentions per visit fior patients

under 15 years of age, 0.59 per visit for those 15–24 years

of age, and 0.65 for those 25-44 years of age). All, however,

were smaller than the average of 1.16 drug mentions per

visit forages 45-64. This inturn,was smaller than lhe average

of 1.8 I for visits made by patients 65 years of age and older.

Similar statistics on drug mentions according to principal

diagnosis are displayed intable Q. Most drug merKions were

associated with principal diagnoses of depressive disorders

or psychoses (36.4 percent and 34.8 percent, respectively).

This distribution reflects the intensity of drug utilization during

visits. Visits with psychoses as the principal diagnoses had

the highest intensity—an average of 1.76 drug mentions per

12
visit—and visits with depressive disorders as the principal

diagnoses had the second highest—1 .02 per visit. The averages

for the remaining diagnostic categories ranged from only 0.33

per visit (for the residual category of other psychiatric disorders

and psychiatric examinations) to 0.61 per visit (for neurotic

disorders).

Finally, there is a clear relationship between the principal

diagnosis and the types of medication used, but there is no

simple correspondence between the two (table R). In visits

in which psychoses were the principal diagnoses, major tranquilizers were the most commonly utilized medications, accounting for 34.1 percent of all drug mentions. All other

drug types accounted for statistically equal proportions of

the drug mentions. In visits with depressive disorders as the

principal diagnoses, antidepressants and anxiolytics, sedatives,

and hypnotics constituted almost three-fourths of all medications used (41.0 percent and 30.9 percent, respectively). The

remaining three drug groups accounted for small and essentially

equal proportions of the total. In the visits with principal

diagnoses of neurotic disorders, which include anxiety disorders, more than half of all drug mentions (56.8 percent) were

anxiolytics, sedatives, and hypnotics. An additional one-fourth

of all drug mentions (29.8 percent) were antidepressants. All

other drug mentions accounted for only very small proportions

of the total. Lastly, in the group of visits with all other

principal diagnoses, no one type of drug was utilized significantly more often than the other types. The limited nature

of the relationship between the principal diagnosis and medications utilized undoubtedly reflects the multifaceted nature of

many psychiatric disorders and variations in psychiatrists’ style

of medical practice, as well as the limitations on data analysis

imposed by the influence of secondary diagnoses.

Table R. Number and percent distribution of drug mentiins in visits to office-based psychatnste by therapeutic category, aeeording to prineipsl diagnosis:

United Ststes, 1985

Principal diagnosis’

All All other

principal Depressive Neurotic prirrcipl

Therapeutic category2 diagnoses Psychoses 3 disordera 4 disordas= diagnoses

Numberin thousands

All drug mentions.......,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major tranquilizers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anxiolyfics, sedatives, andhypnolics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Another centrsl nervous system drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Another drug mentions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

All drug mentions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Majortranquilizers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anxiolytics, sedatives, andhypnolics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allothercentral nervoussystemdrugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allotherdrug mentions. .,... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14,826

4,267

2,510

4,276

1,612

2,161

100.0

28.8

16.9

28.8

10.9

14.6

5,165 5,391 1,924

884 2,209 “573

1,759 “463 ’41

834 1,865 1,092

’753 “385 %3

955 “670 “156

Percent distribution

100.0 100.0 100.0

16.7 41.0 28.8

%.1 ‘8.6 “2. 1

16.2 30.9 56.6

14.6 “7.1 “3.3

18,5 12.4 ‘8.1

2,346

“621

“248

“6a5

“412

’381

100.0

26.5

‘1O.6

29.2

“17.6

“16,2

lBa*don /ntematmfla/C/ass//natmnof O(seases,WrReworr. C//nJca/MtiIfiatIon (lC&WM)

2Basedon Americsm Hospttal Formulafy Serv!ce Classlfmatlon System, Drug Product /nfarmatfon Fl/e, The Amer!ean Druggst Blue Book Data Center. San Bruno, Cafii., 1965.

31ncludesaffect!ve psychows, except maprdepresswe diwder

41ncludes major depressive d!snrder.

5Excludes nsurotic depression.

13
References

American Druggist Blue Book Data Center. 1985. American Hospital

Formulary Service Classification System. Drug Producl Information

File. San Bruno, Calif.

Miller, R. G. 1966. Simuhaneous Sra~isticu/ Jnference. New York:

McGraw-Hill.

National Center for Health Statistics, P. J. McCarthy. 1966. Replication: An approach to the analysis of data from complex surveys.

Viral and Health SfaMics. Series 2, No. 14. PHS Pub. No. 1000.

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

Office.

National Center for Health Statistics. 1967. Eigh/h Revision /n?ernational Classification of Diseases, Adapted for Use in the United

States. PHS Pub. No. 1693. Public Health Service. Washington:

U.S. Government Printing Office.

National Center for Health Statistics, P. J. McCarthy. 1969.

Pseudoreplication: Further evaluation and application of the balanced

half-sample technique. Viral and Healrh S/aristics. Series 2, No.

31. DHEW Pub. No. (HSM) 73-1270. Health Services and Mental

Health Administration. Washington: U.S. Government Printing

Office,

National Center for Health Statistics, J. B. Tenney, K. L. White,

and J. W. Williamson. 1974. National Ambulatory Medical Care

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

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

74-1335. Health Resources Administration. Washington: U,S. Government Printing Office.

National Center for Health Statistics, B. K. Cypress. 1978. Office

visits to psychiatrists, 1975-76. Advance Data from Vital and Health

Matistics. No. 38. DHEW Pub. No. (PHS) 78-1250. Public Health

Service. Hyattsville, Md.

National Center for Health Statistics, B. K. Cypress. 1979a. Office

visits for diseases of the respiratory system, the National Ambulatory

Medical Care Survey: United States, 1975–76. Vital and Health

.Warisrics. Series 13, No. 42. DHEW Pub. No. (PHS) 79-1793.

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

office.

Nation?l Center for HeaIth Statistics, D. Schneider, L. Appleton,

and T. McLemore. 1979b. A reason for visit classification for ambulatory care. Vital und Health Statistics. Series 2, No. ’78. DHEW

Pub. No. (PHS) 79–1352. Public Health Service. Washington: U.S.

Government Printing Office.

National Center for Health Statistics, H. Koch and W. H. Campbell.

1982. The collection and processing of drug information, National

Ambulatory Medical Care Survey: United States, 1980. Vital and

Hea//h Statistics. Series 2, No. 90. DHHS Pub. No. (PHS) 82-1364.

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

Office.

National Center for Health Statistics, B. K. Cypress. 19:33.Patterns

of ambulatory care in general and family practice, the National

Ambulatory Medical Care Survey: United States, January 1980-

December 1981. Vital and Health Statistics. Series 13, No. 73.

DHHS Pub. No. (PHS) 83-1734. Public Health Service. Washington:

U.S. Government Printing Office.

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

and J. E. DeLozier. 1984. The National Ambulatory Medical Care

Complement Survey: United States, 1980. Vital and Health Statistics.

Series 13, No. 77. DHHS Pub. No. (PHS) 8+1738. Public Health

Service. Washington: U.S. Government Printing Office.

Tompkins, L., and I. M. Shimizu. 1985. Sample design research

for the 1985 National Ambulatory Medical Care Survey. 1985 Proceedings of the Section on Survey Research Methods of the American

Statistical Association. Las Vegas, Nev.

U.S. Public Health Service and Health Care Financing Administration. 1980. International Classification of Diseases, 9th Revision,

Clinical Modj$cation, DHHS Pub. No. (PHS) 80-1260. Public Health

Service. Washington: U.S. Government Printing Office.

14
List of detailed tables

1.

2.

3.

4.

5.

6.

7.

8.

9.

Number, percent distribution, and rate of visits to officebased psychiatrists by sex and age of patient: United

States, 1985 . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of visits to office-based

psychiatrists by selected characteristics, according to age

of patient: United States, 1985 . . . . . . . . . . . . . .

Number and percent distribution of visits to office-based

psychiatrists by selected characteristics, according to sex

of patient: United States, 1985 . . . . . . . . . . . . . .

Number and percent distribution of visits to officebased psychiatrists by metropolitan status: United States,

1975-76, 1980-81, and 1985 . . . . . . . . . . . . , .

Number of visits to office-based psychiatrists by

geographic region and selected characteristics: United

States, 1985 . . . . . . . . . . . . . . . . . . . . . . .

Percent distribution of visits to office-based psychiatrists

by selected characteristics, according to geographic

region: United States, 1985 . . . . . . . . . . . . . . .

Number and percent distribution of visits to office-based

psychiatrists by selected characteristics, according to type

of practice: United States, 1985 . . . . . . . . . . . . .

Number and percent distribution of visits to office-based

psychiatrists by principal diagnosis, according to age of

patient: United States, 1985 . . . . . , . . . . .,. . . .

Number and percent distribution of visits to office-based

psychiatrists by principal diagnosis, according to

geographic region: United States, 1985 . . . . . . . . .

10.

16

11.

17

12.

18

13.’

18

14.

19

15.

20

Number and percent distribution of secondary diagnoses

in visits to office-based psychiatrists by type of diagnosis,

according to age of patient: United States, 1985 . . . . . 22

Number and percent distribution of secondary diagnoses

in visits to office-based psychiatrists by diagnosis,

‘according to sex of patient: United States, 1985 . . . . . 23

Number and percent distribution of visits to office-based

psychiatrists by use of medication, according to expected

source of payment: United States, 1985 . . . . . . . . . 23

Number and percent distribution of visits to office-based

psychiatrists by treatment method and principal diagnosis,

according to sex of patient: United States, 1985 . . . . . 24

Number of visits to office-based psychiatrists by principal

diagnosis and selected characteristics: United States,

1985 . . . . . . . . . . . . . . . . . ., . . . . ...24

Number and percent distribution of visits to office-based

psychiatrists by selected characteristics, according to use

of medication: United States, 1985 . . . . . . . . . . . 25

16. Number and percent distribution of visits to office-based

psychiatrists by visit duration, according to age of

21 patien~ United States, 1985 . . . . . . . . . . . . . . . 25

17. Average number of drug mentions per visit for visits to

office-based psychiatrists, by age of patient: United

22 States, 1985 . . . . . . . . . . . . . . . . . . . . ...25

18. Number and ~rcent distribution of drug mentions in

visits to office-based psychiatrists by therapeutic category,

22 according to age of patient: United States, 1985 . . . . 26

15
Table 1. Number, percent distribution, and rate of visits to office-based paychiatriats by sex and age of patient United States, 1985

Rate per 1,000

civilian

Number in Percent noninstitutionalized

Sex and age of patient thousands distribution population

All ages .

Under 15 years

15-24 years .

25-34 years

35-44 years

45-54 yeara

55-64 yeara .

65years And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17,989

7,308

541

737

1,914

2,332

800

651

●334

10,681

’280

993

2,727

3,141

1,491

1,208

100.0

40.6

3.0

4.1

10.6

13.0

4.4

3.6

1.9

59.4

‘1.6

5.5

15,2

17.5 ‘

8.3

8.7

4.7

77

65

21

39

97

154

74

63

“30

89

“11

51

132

196

130

103

53

16
Table 2. Number and percent dmribution of vis”ti to office-based psychtinsta by se&cted characterie~ according to age 01 pa6ent:

United Stateq 1985

All Under 15-24 2L%34 35-44 45-64

Characteristic

66 years

ages 15 years years years years years and over

Number in thousands

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

Visit status

Newpatient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Returnvisit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Metropolitan status

Metropolitanarea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Type of practice

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

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

Psychotherapy ordered or provided

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . .5....... . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medication ordered or provided

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patientinstrucfed to returnatspacified time

Yes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . .

Visit status

Newpatient . . . . . . . . . . . . . . . . . . . . . . . . . . .

Retumvisit . . . . . . . . . . . . . . . . . . . . . . . . . .

Metropolitan status

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

Nonmelropolitan area . . . . . . . . . . . . . . . . . . . . .

Type of practice

solo, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Psychotherapy ordered or provided

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medication ordered or provided

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

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

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

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

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

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

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

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

Patient instructed !0 return at specified time

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17,989

1,408

16,581

17,383

606

13,051

4,939

15,960

2,029

8,324

9,665

16,442

1,548

100.0

7.8

92.2

98.6

3.4

72.5

27.5

88.7

11.3

46.3

53.7

91,4

8.6

821

’93

728

812

“1 o

840

’182

698

’123

“208

614

776

“46

1CQ.o

●11.3

68.7

98.8

“1.2

77,9

22.1

85.0

“15,0

●25.3

74.7

94.4

“5.6

1,730

“178

1,552

1,703

“27

1,326

404

1,555

“175

636

1,094

1,549

“181

4,640

381

4,259

4,537

“103

3,394

1,246

4,262

378

1,828

2,812

4.278

“363

5,473

“342

5,131

5,310

●163

4,136

1,337

5,027

446

2,306

3,167

5.136

%35

Percentdkdrilndion

100.0 100.0 lCQ.O

‘1O,3 8.2 6.3

89.7 91.8 93.7

98.5 97.8 97.0

●1.5 “2.2 “3.0

76,6 73.1 75.6

23.4 26.9 24.4

69.9 91,8 91.9

“1O,1 8.2 8.1

343.7 39.4 42.1

83.3 80.6 57.9

89.5 92.2 93.9

“1O.5 7.8 6.1

4,149

’325

3,824

3,837

’212

2,810

1,339

3,534

615

2,409

1,740

3,670

479

100.0

7.8

82.2

84.9

“5. 1

67.7

32.3

85.2

14.8

58.1

41.9

66.5

11.5

1,775

●89

1,087

1,063

’92

745

430

884

“s2

938

“238

I,wl

’145

100.0

“7,6

92.4

92.2

“7.8

63.4

38.6

75.2

24.8

79.8

‘20.2

87.7

“12.3

17
Table 3. Number and percent distnbutiin of visits to office-based psychmtrists by selected chsractenstics, according to sex of patient

United States, 1985

Both Both

Characteristic sexes Male Female sexes M.sle Female

Number in thousands Percent distribution

Allvisits. . . . . . . . . .

Ethhicity and race

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

White, notliispani c...,,,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherraces, notHkpanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Visit status

Newpstient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Retumvisit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Geographic region

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

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Metropolitan status

Metropolitanarea . . . . . . . . . . . . . . . . . . . . . . . ...’... . . . . . . . . . . . . . . . . .

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

Type of practice

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

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

. Visit duration

C-20minutes1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21-40minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

41-50minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

510rmoreminutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patient instructed to return at specified time

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .’ . . . . . . . . . . . .

17,989

615

16,524

851

1,408

16,581

6,337

3,945

3,763

3,945

17,383

606

13,051

4,939

2,251

3,242

10,003

2,494

16,442

1,548

7,306

’288

6,715

“305

559

6,750

2,421

1,786

1,472

1,626

7,074

“234

5,401

1,907

922

1,211

4,203

973

6,635

674

10,681

*327

9,809

546

850

9,832

3,916

2,157

2,291

2,317

10,310

372

7,650

3,031

1,329

2,032

5,800

1,521

9,807

874

100.0 . ... - --- -

3.4

91.9

4.7

7.8

92.2

35.2

21.9

20.9

21.9

96.6

3.4

72.5

27.5

12.5

16.0

55.6

13.9

91.4

8.6

IUU.U

“3.9

91,6

“4.2

7.6

92.4

:33.1

24.5

:20.1

22.3

‘96.8

“3.2

73.9

26.1

12.6

16.6

57.5

13.3

9116

9.2

3.1

91.9

5.1

8.0

92.0

36.7

20.2

21.4

21.7

96.5

3.5

71.6

26.4

12.4

19.0

54.3

14.2

91.6

8.2

‘Durationof zem minuteswas recordedforviaitainwhichtherewea no face-to-facecontactbetweenthe patientandthe physician.

Table4. Numbarandpercentdistnbutionofvisitsto Office-bsaed peychmtnetsby metropolitan ststus United States, 1975-76, 19M-81,and1985

1975-76’ 1980-81’ 1985

Number in Percent Number in Percent Number!n Percent

Metropolitan status thousands distribution thousands distribution thousancfs distribution

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,306 100.0 15,905 100.0 17,969 100.0

Metropolitan area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,358 93.6 14,936 93.9 17,363 96.6

Nonmetropolitsn area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 951 6.2 970 6.1 606 3.4

1Statisticsare averageannualestimatea.

18
Table 7. Number and Dercent distribution of @zits in nffir-.=+ .-w.M.+A.*- A. -.+..+.A —- .--A-- --- - —

Tabfe 5. Number of visits to office-based psychiatrists by geographic region and selected characteristic United Stste~ 1965

Characteristic All regions Northeast Midwest .%uth West

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

Age of patient

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

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

25-34years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.5-44years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

65yearsand over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Visit status

Newpatient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Return visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Metropolitan status

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

Nonmetropolitan area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ; . . . . . . . . . . . . . . . . . . .

Typeofpractice

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

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

Patient instructed to return at specified time

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Visit duration

0-20minutes1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21-40minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

41-50minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

51 minutesormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychotherapy ordered or provided

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medication ordered or provided

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17,989

821

1,730

4,640

5,473

2,290

1,859

1,175

1,408

16,581

17,383

606

13,051

4,939

16,442

1,548

2,251

3,242

10,003

2,494

15,960

2,029

8,324

9,665

6,337

‘175

567

1,942

1,812

805

691

“346

“348

5,989

6,104

’233

5,115

1,222

6,030

’307

661

755

4,359

563

5,685

652

2,695

3,642

3,945

390

318

962

1,227

421

437

“191

513

3,432

3,666

●279

2,401

1,544

3,362

583

683

778

1,755

729

3,599

“346

1,749

2,196

3,763

“124

535

714

1,088

506

366

429

“263

3,500

3,691

●7I

2,366

1,397

3,309

454

583

951

1,642

586

3,135

627

2,027

1,736

3,945

*133

311

1,023

1,347

558

365

’209

“284

3,661

3,922

●23

3,169

776

3,741

’204

’324

759

2,246

615

3,540

405

1,854

2,091

~Durationof zero minutes was recorded for visits in which there was no face-to-fats contact between the patient and the physician

19
.,—

Tabb6. Poroenf dbwbu6m ofvkitatodb4maed w~tw~ ~eocwdh9tofJewwhk re@omunited 6tatas+ 1966

Characteristic A# ragbrrsNortheast MMwat south West

Allvisifs . . . . . . . . . . . . . . . . .

Age of patient

Undar15years . . . . . . . . . . . . .

15-24yeers . . . . . . . .

25-34years . . . . . . . . . . . . . .

36-4yeere . . . . . . . . . . . . . . . . . . . . . . . .

45-54yaar$ . . . . . . . . . . . .

56-64yeaf’a . . . . . . . . . . . . . . . .

86yaareandover . . . . . . . .

Visit status

Nawpetient. . . . . .

Fletumvisit . . . . . . . . . . . . . .

Metropolitan status

Metropoliianarea . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonmetropofiinarea . . . . . . . . .

Type of practice

sob . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ofher . . . . . . . . . . . . . . . . .

.

Patient instructed to return at specifii time

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . .

Visit duratiin

0-20minutee’ . . . . . . . . . . . .

21-iOminutaa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

41-50minutee . .’ . ...’.... . . . . . . . . . . . . . . . .

51 minutesormore . . . . . . .

Psychotherapy ordered or provided

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Madicationordered orprovidad

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,

No . . . . . . . . . . . . . . . . . .

100.0

4.6

9.6

25.8

30.4

12.7

10.3

6.5

7.8

92.2

96.6

3.4

72.5

27.5

91.4

6.6

12.5

18.0

55.6

13.9

68.7

11.3

46.3

53.7

100.0

‘2.8

8.9

30.6

28.6

12.7

10.9

.5.5

5.5

94.5

96.3

.3.7

60.7

19.3

95.2

“4.6

10.4

11.9

66.8

8.9

89.7

10.3

42.5

575

100.0

9.9

8.0

24.4

31.1

10.7

11.1

.4.8

13.0

67.0

92.9

.7.1

60.9

39.1

85.2

14.8

17.3

19.7

44.5

16.5

91.2

8.8

44.3

55.7

100.0

‘3.3

14.2

19.0

28.9

13.4

9.7

11.4

.7.0

93.0

98.1

‘1.9

62.9

37.1

67.9

12.1

45.5

25.3

43.6

15.6

83.3

16.7

53.9

46.1

‘DurafiiOfzerO minusaawasracordsd fc+viaiiinwhich fherawaanoface-to-faca mntacfbatwasm fhepalintand tha~ysician

too.o

“3.4

7.9

25.9

34.1

14.1

9.2

‘5.3

‘7.2

92.8

89.4

.0.6

80.3

19.7

94.8

“5.2

8.2

19.2

68.9

15.6

89.7

10.3

47.0

53.0

*
Both Both

pracfice solo Other type practice sob Other type

CharacteMic types practka Otpractlce fypes practice of practice

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Referred for fhii visit

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Visit status

Newpatienf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Retumvisl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Metropoliianstatus

Metropalitanar e a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonmetropoliianarea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patient in+ttcfed to return at specified time

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Visit duration

O-20minutes’ . . . . . . . .

21--40 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

41–50 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

51 minutesormore. . . . .:. . . . . . .

Psychotherapy ordered or provided

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medication ordered or provided

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Principal diagnosis

Psychoses (includingatfective psychoses, except majordepfesaiva dwrdar)

W~e*ivedWW~ti~m~Apre*ive disorder). .

Neurotic disorders (excluding neurofic ctepression)

Parsonaliidisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherpsychiidisordersandpsychiatricexaminafiins

Allotfrerprincipatdiagnosaa... . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Numtrer inthousands

17,989

615

17,374

1,408

16,561

17,2$3

605

16,442

1,546

2,251

3,242

10,003

2,494

15,960

2,029

8,324

9,665

2,928

5,287

3,165

2,587

2,743

1,279

13,051

429

12,622

856

12,195

12,471

560

12,163

868

1,266

1,949

8,011

1,622

11,637

1,414

5,598

7,452

1,721

3,529

2,807

2,1M

2,093

707

4,939

“*87

4,752

552

4,386

4,912

*26

4,259

680

962

1,293

1,992

672

4,324

615

2,725

2,214

1,207

1,756

359

393

850

571

Percent distribution

100.0 ---- .-..

3.4

96.6

7.6

92.2

96.6

3.4

91.4

8.6

12.5

18.0

55.6

13.9

88.7

11.3

46.3

53.7

16.3

29.4

17.6

14.4

15.2

7.7

1W.(I

3.3

96.7

6.6

93.4

95.8

4.4

93.3

6.7

9.7

14.9

61.4

14.0

89.2

10.6

42.9

57.1

13.2

27.0

21.5

16.6

16.0

5.4

1U(J.O

●3.8

96.2

11.2

88.8

99.5

“0.5

88.2

13.8

19.9

26.2

40.3

13.6

67.5

12.5

55.2

44.8

24.4

35.6

7.3

8.0

13.2

11.8

‘Durafbmofzerominubs wss recordedforvisifsin whichrherewas no fsce-bface~~ffw pdenrandfhs physician

2b&onlntem~l~~tiofD&~, SfhRebiskm, CWr&a/hbd&afkwr(fCD-S-CM).

v

21

‘\
Table 8. Number and percent distribution of visits to office-based psychiatrists by principal disgnosis, according to age of patient United States, 1985

Under 75–24 25–34 3$44 45-64 65 years

Principa/ diagnosis’ A// ages 15 years years years years years and over

Number in thousands

All visits . . . . . . . . . . . . . . . . . . . . . . . . 17,989 821 1,730 4,640 5,473 4,149 1,175

,Psychoses (including affective psychoses, except major depressive disorder)

Depressive disorders (including major depressive disorder)

Neurotic disorders (excluding neurotic depression)

Personality disorders . . . . . . . .

Otherpsychiatricdisordersandpsychiatric examinations

Allotherprincipal diagnoses . . . . . . . . . . . . . . . .

2,928

5,287

3,165

2,587

2,743

1,279

’30 ’293 700 690 935

410 1,101 1,618 1,541

’229 886 1,214 524

“195 1,023 940 387

423 673 707 468

“180 “276 “305 ’293

“279

550

“169

’67

“163

“42

394

’126

“79

“99

Percent distribution

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100,0 100.0 100.0 100.0 100.0 100.0

Psychoses ~ncluding affective psychoses, except major depressive disorder)

Depressive @sorders (including major depressive dsorder)

Neurotic disorders (excluding neurotic depression)

Personalitydisorders . . . . . . . .

Otherpsychiatricdisordersandpsychiatric examinations .

Another principal diagnoses . . . .

16.3

29.4

17.6

14.4

15.2

7.1

“3.6

“8.1

‘19.8

“5.1

48.0

“15.3

17.0 15,1 12.6 22.5

23.7 23.7 29.6 37.1

“13.2 18.7 22.2 12.6

“11.3 22.0 17.2 9.3

24.4 14.5 12.9 11.3

“1O.4 ‘5.9 ‘5.6 ●7.1

23.7

46.8

‘1 4.3

“6.7

“8.4

‘Based on/nfemationa/ Classificationof Disease.%9ffr Revision, C/irrica/Modification (lCO-9-CM)

—

Table9. Numkrand percent d~nbutmn ofvisks tooffice+ased paychmtrists byprintipal dmgnoaie, according togeogrsphic region:

United States, 1985

Principal diagnosis 1 A//regions Northeast Midwest south, West

Number in thousands

6,337 3,945 3,763

939 543 556

1,345 1,374 1,273

1,167 870 60EI

1,462 ’214 40C)

855 735 579

569 ’209 ’346

Percent distribution

100.0 100,0 100,()

14.8 13.8 14.8

21.2 34.8 33.13

18.4 22.0 16.2

23.1 ●5.4 10.(3

13.5 18,6 15.4

9.0 “5.3 9.2

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

Psychoses (including affective psychoses, except major depressive disorder) . . . . . .

Depressivedisorders (including major depressive disorder). . . .

Neuroticdisorders (excluding neurotic depression) .

Personalitydisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,,.

Other psychiatricdisordersand psychiatric examinations . . . . . .

Allotherprincipal diagnoses . . .

17,989

2,928

5,287

3,165

2,587

2,743

1,279

100.0

16.3

29.4

17.6

14.4

15.2

7.1

3,945

890

1,294

520

511

574

‘155

100.0

22.6

32.6

13.2

13.0

14.6

‘3.9

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychoses (includng affective psychoses, except major depressive &sorder)

Depressivedisorders (including major depressive disorder). . . . .

Neuroticdisorders (excluding neurotic depression) . .

Personelitydisorders . . . . . . . . . . . . . . . . . . . . . . . . .

Otherpsychiatricdisordersandpsychiatric examinations . . . . . . . . . . . .

Allotherprincipal diagnoses . . . . . . . . . . .

‘Sasedon /i?fernationa/Classificationof Diseases, 9ffr Revisiorr,C/inica/Modification (lCD-e-CM).

Table IO. Number andpercent dffitribution ofaeanda~d~noses invietia toofice4aaed p~cMatiats by~peofdagnosi$ according toage of patient

United Stetee, 1985

Under 15–24 2544 35-44 45-54 55-64 65years

Type of secondary diagnosis All ages 15 years years years years yeara yeara and over

Number in thousands

All secondarydiagnoses . . . . 6,428 *268 521 1,331 2,151 734 898 525

Mentaldisorderdiagnoses . . . . . . . . . . . . . . . . . 4,586 ’194 416 1,013 1,683 518 517 ’243

Allothersecondarydiagnoses. . . . . . . . . . . . . 1,843 ●74 “105 *3I 8 467 ’216 3[11 ’282

Percent distribution

All secondarydiagnoses . . . . . . . . 100.0 100.0 100.0 100.0 100.0 100.0 100,0 100.0

Mental disorderdiagnoses . . . . . . . . . . . . . . . . . 71.3 72.5 79.9 76.1 78.3 70.6 57.5 46.3

Allothersecondary diagnoses.. . . . . . . . . . . . . . . . . . . . 28.7 ‘27.5 “20.1 23.9 21.7 ‘29,4 42!.5 53.7

22
Tablell. Num&rand perceot dstribution ofswonda~@agnoses invistis toofficAased psych@t&ts bytiagwis -tingtosexofptieti

United Stsrteq 1985

Diagnosis’ Seth sexes Male Female

All secondary diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychoses fincluding affective psychoses, except major depressive dsorder) . . . . . . . . . , . , . . . . . . . . .

Depressivedisorders (including major depressive disorder). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neuroticdisorders (excluding neurotic depression) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Personalitydisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ofherpsychiatricdisordersandpsychiatric examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allothersecondarydiagnoses.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allsecondarydiagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychoses (including affective psychoses, except major depressive disorder) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Depressivedisorders (inckrding majordepressive disorder). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neuroticdisorders (excluding neurotic depression) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Personalitydisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherpsychiatricdisordersandpsychiatricexaminations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allothersecondarydiagnoses.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number in thousands

6,428 2,419 4,009

“312 “104 ’208

983 357 626

836 “306 530

1,145 470 675

1,309 663 646

1,843 520 1,323

Percent distribution

100.0 100.0 100.0

4.9 “4.3 ‘5.2

15.3 14.7 15.6

13.0 12.6 13.2

17.8 19.4 16.8

20.4 27.4 16.1

28.7 21.5 33.0

lBasedOn /nfemafiona/ C/8ssiftitbn of Diseases, 91h Revision, c/inti/M&ification (lC&WM).

Tabie 12. Nmberand ~rmntdstnbtimn ofvitis totiAasd psychmttists byuseof m~hn, -rdngto ex~4*uwof~~enk

United States, 1985

Expected source of payment

All Blue HMO

expected Cross or Other or other

sources of Self Blue commercial prepaid No

Medication ordered or provided payment’ payment Madibere Medicaid Shield insurance plan charge Other Unkrmwn

Number in thousands

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . 17,989 10,271 1,001 1,106 2,897 5,219 648 “225 664 ’31

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . 8;24 4,074 845 866 1,600 2,267 :334 “113 “301 ‘lo

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,665 6,197 ●157 “140 1,397 2,952 512 “112 367 ●2O

Percent distribution

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . 46.3 39.7 84.4 87.3 51.8 43.4 39.4 “50.1 45.0 “s.3

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.7 60.3 “15.6 ‘12.7 48.2 56.6 60.6 “49.9 55.0 ●66.7

lTotalsdo not equal aumsof sources because more than one expected aourceof payment wasindicated for$ome visits

23
Tsble 13. Number andpercent dsttibMon ofviatis tooffice-based psycMatnsts bytreatment method andpnncipaI tiagnosiq accordng tosexofpatienk

United States, 1985

Both Both

Treatment method and principal diaanosis sexes Male Female sexes Male Female

Number in thousands

17,989 7,308 10,681

Percent distribution

Allvisits . . . . . . . . . . . . . . . 100.0 1Ocl.o 100.0

Psychotherapy ordered or provided

Yes . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . .

No, . . . . . . . . . . . . . . . .

15,960 6,515 9,445

2,029 793 1,236

88.7 89.2 88.4

11.3 10.6 11.6

8,324 2,964 5,360

9,665 4,345 5,321

46.3 40.6 50.2

53.7 5!3.4 49.8

Principal diagnosis’

Psychoses ~ncludng affective psychoses, except major depressive dsorder) . . . .

Depressive &sorders ~ncludng major depressive disorder). . . . . . .

Neuroticdisorders(excludingneurotic depression) . . . .

Personalitydisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherpsychiatricdisordersandpsychiatricexaminations . . . . . . .

Allotherprincipal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,928 1,246 1,662

5,287 1,781 3,506

3,165 1,309 1,857

2,587 1,238 1,350

2,743 1,203 i ,541

1,279 533 746

16.3 1‘7.0 15.6

29,4 24.4 32.8

17.6 17.9 17.4

14.4 16.9 12.6

15.2 16.5 14.4

7.1 7.3 7,0

~Basedon /nferrrafiorra/Classificationof Diseases, 9tfrffevisiorr, C/irrics/Modifiostlon (lCD-9-CM).

Table 14. Number oftisik tooffice-based psycMat*ts bypnncipal dagnosis andselected characteristics Unked States, 1985

Principal diagnosis 1

Other

psychiatric

All disorders and Another

princ@al Depressive Neurotic Personality psychiatric principal

Characteristic dia.qnoses Psvchoses2 disorders disorders4 disorders examinatio,m diagnoses

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychotherapy ordered or provided

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.

Medication ordered orprovided

Yea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17,969 2,928 5,287 3,165 2,587 2,743 1,279

15,960 2,484

2,029 444

4,710

577

2,982

‘183

2,400

’188

2,493

’250

892

387

8,324 2,507

9,665 421

2,896

2,391

1,320

1,845

521

2,066

686

2,057

394

885

Patient instructed to return at specified time

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vkit duration

C-20minutes5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21=10minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

41-50 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

51 minutesorm0rs. . . . . . .

16,442 2,732

1,548 ‘197

4,996

“291

3,008

*159

2,466

’121

2,314

430

928

’351

’290 *3I o

‘164

696

“109

2,251 727

3,242 1,063

10,003 937

2,494 ’200

593

1,151

2,810

733

●223

371

2,073

498

“108

’114

2,027

“339

380

1,460

614

.

‘Baaed on /nterrratior?a/C/assificsfionof Diseases, 9tfr Revision, C/inicsl Modificafiorr (ICD-2-CM)

21ncludes affective psychoses, except major depressive disorder.

%cludes maior depressive disorder.

4Excludes net!rotic”depression.

‘Duration of zero minutes waa recorded for visits in which there was no face-to-face contact between the patient and the physician

24
Table 15. Number atipement dmtribWbn oftisfis toofice4asd psychmtri* bysdectd char%eris~ a~rdngtoweofm~atin

Unitad State& 1985

Medication orderad M&icaiion orderad

or providd or provided

Characteristic All visits Yes No All visits Yes No

Allvisik . . . . . . . . . .

Yes . . . . . . . . . . . .

No . . . . . . . . . . . . .

Yes . . . . . . . . . . . .

No . . . . . . . . . . . . .

O-20minutes’ . . . . . .

2140minutes . . . .

41-50 minutes . . . . .

51 minutesormore. . .

. .

. .

. .

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

Psychotherapy ordered or provided

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

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

Patient instructed to return at specified time

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

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

Visit duration

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

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

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

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

Number in thousands

17.989 8,324 9,885

15,960 7,167 8,793

2,029 1,157 872

16,442 7,?99 8,643

1,540 525 1,022

2,251 1,572 679

3,242 2,548 694

10,003 3,365 6,638

2,494 839 1,655

Percent distribution

100.0 100.0 100.0

68.7 86.1 91.0

11.3 13.9 9.0

91.4 93.7 89.4

8.6 6.3 10.6

12.5 18.9 7.0

18.0 30.6 7.2

55.6 40,4 68.7

?3.9 10,1 17.1

1Duratiom of zero minutes was recorded for visits in which there was no face-to-face contact b%lween the patient snd the phyaiman

Table 16. Number and percent dmtnbutionof viaits to offwe-basad psychisttista by visit duration, accordii to age of patient Uniied StateS 1985

Under 26-34 35-44 45-64 6.5 years

Visit duraiion All ages 25 years years years years and over

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

O-20 minutes’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2140 minutes, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

41-5J3 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

510rmoreminutes .,,..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allvisits . . .

&20 minutes’

21-40minules

41-50 minutes

510rmoreminutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17,989 2,552

2,251 “273

3,242 ’286

10,003 1,616

2,494 388

100.0 100.0

12.5 “1O.7

18.0 11.6

55.6 83.3

13.9 14.3

Number m thousands

4,640 5,473

501 475

695 774

2@3 3,307

614 917

Percent dstnbubom

100.0 100.0

10.8 8.7

15.0 14.1

61.0 80.4

13.2 16.8

4,149

598

1,074

1,933

544

100.0

14.4

25,9

48.6

13.1

1,175

404

403

“316

“52

100.0

34.4

34.3

26.9

“4,4

lDuratiinof zero minutes was recorded for visita m whlchthere wsanoface-to.face mrWsctMweenthepa tiintendlhephya~n.

Table 17. Average numbarof dnsgrnantiins per Wfor Mtoo~ PsY~fVs9e of@’@ftt:Mdwe% 1=

Averaganumbarof

Age of patient drvgmenfbnsper visit

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 0.82

Under 15years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,.,.,. ‘0.31

15-24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,,,,. 0.59

2544years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.65

45-84years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,, ,, ., .,, ...,....,

65yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.16

1.81

25
Table 18. Number andpercent datribution ofdmgmentiona inviaits tooWce-based psycMatnsts bytherapeutic @t~o~, accoting toageof patienti

United States, 1985

Under 25-44 45-64 65 years

Therapeutic category’ A// ages 25 years years years and over

Number in thousands

Alldrugmentions. . .

Antidepressants . . . . . . . . . . . .

Majortranquilizers . . . . . . . . . . . . . . . . . . . . . . .

Anxiolytics, sedatives, andhypnotics . . . . . . . . . . . . . . . .

Allothercentral nervoussystem drugs . . . . . . . . . . . . . . . . . . . . . . . .

Allotherdrug mentions...,.. . . . .

All drug mentions ...,,.... . . . . . . . . . . . . . . .

Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Majortranquilizers ...,.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

‘Anxiolytics, sedatives, andhypnotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allothercentral nervoussystem drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allotherdrug mentions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14,826

4,267

2,510

4,276

1,612

2,161

100.0

28.8

16.9

28,8

10.9

14.6

1,277 6,608

’342 1,919

“280 1,110

“226 1,961

’283 777

“147 620

Percent distribution

100.0 100.0

*26.7 29.0

’21.9 16.8

‘17.7 30.0

“22.1 11.8

“11.5 12.4

4,812

1,435

850

1,405

’410

’712

100.0

29.8

17.7

29.2

‘8.5

14.8

2,129

“571

*270

’664

’142

’481

100.0

26.6

‘1 2.7

31.2

‘6.7

‘22,6

~BasedcmAmerican Hospital FormularySewice ClassificationSystem, Drug Product information File, The American DruggiatBlue Book Data Center, San Bruno, Calif., 1985.

26
Appendixes

Contents

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

Statistical design, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Datacollectionandprocessing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimation procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reliabilityofestimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Testsofsignificance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Population figures andratecomputation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Roundingofnumbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Systematic bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

H. Definitions ofterms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Termsrelatingtothe survey. . . . . . . . . . . . . . . . . . . . . . . . . . ;. . . . . . . . . . . . . . . .

Termsrelatingtothe Patient Record . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111.Patient Logand Patient Record form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Listofappendixfigures

1. Approximate relative standarderrors forestimated numbers ofoffice visits based on aHphysicians (A)andon individual

physician groups (B-D) :National Ambulato~Medical Care Suney, 1985 . . . . . . . . . . . . . . . . . . . . .

H. Approximate relative standmdemors forestimated numbers ofdmgmentions based onallphysicians (A)andon individual

physician groups (B–D): National Ambulatory Medical Care Survey, 1985 . . . . . . . . . . . . . . . . . . . . .

Listof appendix tables

I.

II.

m.

28

28

29

30

30

34

34

34

34

36

36

37

40

32

33

Number of physicians in the universe, total sample and sample response categories, and response rates, by physician

strata: National Ambulatory Medical Care Survey, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Coefficients appropriate for determining relative standard errors by type of estimate and physician groups: National

Ambulatory Medical Care Survey, 1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...31

Population used in computing annual visit rates shown in this report by selected demographic characteristics:

July 1,1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

27
Appendix I

Technical notes

This report is based on data collected during the period

March 1985 through February 1986 in the National Ambulatory

Medical Care Survey (NAMCS), a sample survey of officebased physicians conducted by the Division of Health Care

Statistics of the National Center for Health Statistics (NCHS).

The NAMCS survey design and procedures are presented

in the following sections.

Statistical design

Scope of the survey

The target population of the 1985 NAMCS includes oftlce

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 nonoffice visits are excluded from

the NAMCS.

Sample design

The NAMCS utilizes a three-stage survey design that

involves probability samples of primary sampling units

(PSU’S), physician practices within PSU’S, and patient visits

within physician practices. The first-stage sample of 84 PSU’S

was selected jointly by the National Opinion Research Center

of the University of Chicago and the Survey Research Center

of the University of Michigan. The National Opinion Research

Center was 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 metropolitan

statistical area (MSA). The U.S. Bureau of the Census designations of MSA’S, including the U.S. Office of Management

and Budget additions of July 1981, were used. A modified

probability-proportional-to-size procedure using separate sampling frames for MSA’S and for nonmetropolitan counties

was. used to select the sample PSU’s independently within

each of the four census regions. The 1980 census figures

of the number of occupied housing units were the basis for

calculating the probability of selecting the PSU’s.

The second stage consisted of a probability sample of

practicing physicians, selected from the masterfiles maintained

by the American Medical Association (AMA) and the American Osteopathic Association (AOA), 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 and subspecialties of anesthesiology,

pathology, and radiology.

The 1985 NAMCS physician universe included 27(5,430 doctors of medicine and 11,776 doctors of osteopathy (see table 1).

Eligible physicians were stratified into 15 groups within

metropolitan/nonmetropolitan status. Doctors of medicine were

stratified into 14specialty groups as follows:

Cardiovascular disease

Dermatology

General and family practice

General surgery

Internal medicine

Neurology

Obstetrics and gynecology

Ophthalmology

Orthopedic surgery

Otorhinolaryngology

Pediatrics

Psychiatry

Urological surgery

All other specialties.

Doctors of osteopathy were included as a separate stratum.

The number of physicians selected from each stratum was

based on optimum sample design research for the 1985

NAMCS conducted by the NCHS Office of Research and

Methodology (Tomkins and Shimizu, 1985).

The 1985 NAMCS physician sample included 5,032 physicians. Sample physicians were screened at the time of the

survey to ensure that they met the aforementioned criteria,

928 physicians did not meet the criteria and were, therefore,

ruled out of scope (ineligible) for the study. The most common

reasons for being out of scope were that the physician was

retired or employed in teaching, research, or administration.

Of the 4,104 in scope (eligible) physicians, 2,879I (70.2 percent) participated in the study. Of the participating physicians,

397 saw no patients during their assigned reporting period

because of vacations, illnesses, or other reasons for being

temporarily out of office-based practice. The physician universe, sample size, and response data by physician strata

are shown in table 1.

The third stage was the selection of patient visits within

the annual practices of the sample physicians. The stage involved two steps. Fhst, the total physician sample was divided

into 52 random subsamples of approximately equal size; then

each subsample was randomly assigned to 1 of thle52 weeks

NOTE A list of references follows the text.

28
Table 1. Number of physicians in the universe, total sample and aarnpk response categories, and response rate% by physician strata National

Ambulatory Medical Care Survey, 1985

Sample

outof Non- Response

Physician strata Universe’ Total scope In swpe respondents Respondents rate

Number Percent

All strata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..288.206 5,032 928 4,104 1,225 2,879 70

Cardiovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,684 220 27 193 96 97 50

Dermatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,116 131 15 116 39 77 66

General and family practice . . . . . . . . . . . . . . . . . . . . . . . . . . . 51,611 749 144 605 204 401 66

General surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,577 290 54 236 78 158 67

Internal medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39,077 381 82 299 101 196 86

Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,478 113 16 97 34 63 65

Obstetricsandgynecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22,509 322 36 284 74 210 74

Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,835 510 49 461 121 340 74

Orthopedicsurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,574 318 40 278 70 20s 75

Otorhinolaryngology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,593 142 20 122 44 78

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

64

21,499 205 56 149 26 123 63

Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,061 235 57 176 47 131 74

Urological surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,893 268 26 262 63 199 76

All otherspecialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45,903 617 220 397 95 302 76

DoctorsofOsteopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,776 511 64 427 133 294 69

‘These data were derived lrom the American Medical Association and the American Osteopathi cAssociation masterliles and represent thetotalnumtx+rof physicians eiigible for the National

Ambulatory Medical Care Survey.

in the survey year. Second, a systematic random sample of

visits was selected by the physician during the assigned reporting week. The visit sampling rate varied for this final step

from a 100-percent sample for very small practices to a 20-

percent sample for very large practices. The method for determining the visit sampling rate isdescnbed later inthisappendix. The 1985 NAMCSresponding sample physicians completed71,594Patient Records.

Datacollection and processing

Field procedures

Both mail and telephone contacts were used to enlist

sample physicians for NAMCS. Initially, physicians were sent

introductory letters from the Director of NCHS. When appropriate, a letter from the physician’s specialty organization

endorsing the survey and urging his participation was enclosed

with the NCHS letter. Approximately 2 weeks prior to the

physician’s assigned reporting period, a field representative

telephoned the physician to briefly explain thestudyandarrange an appointment for a personal interview. Physicians

who did not initially respond were usually recontacted via

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

During the personal interview, the field representative

determined the physician’s eligibility for the study, obtained

his cooperation, delivered survey materials with verbal and

printed instructions, and assigned a predetermined Monday–

Sunday reporting period. A short induction interview concerningbasic practice characteristics, such as type of practice

and expected number of office visits, was conducted. Office

staff who were to assist with data collection were invited

to attend the instructional session or were offered separate

instructional sessions.

The field representative telephoned the sample physician

prior to and during the assigned reporting week to answer

questions that might have arisen and to ensure that survey

procedures were going smoothly. Attheend of the reporting

week, theparticipating physician mailed the completed survey

materials to the field representative, who edited the forms

for completeness before transmitting them for central data

processing. Problems ofmissing or incomplete data were resolved through telephone followupby the field representative

to the sample physicians.

Data collation

The actual data collection for NAMCS was earned out

by the sample physicians, often assisted by their office staff.

Two data collection forms were employed by the physicians:

the Patient Log and the Patient Record (see appendix III).

The Patient Log was used to sequentially list all patients

seen in the physician’s office during the assigned reporting

week and served as the sampling frame to indicate the office

visits for which data were to be recorded on the Patient

Records. A perforation between the patient’s name on the

Patient Log and patient visit information on the Patient Record

permitted the physician to detach and retain the listing of

patients, thus assuring the anonymity of the patients.

Based on the physician’s estimate of the expected number

of office visits and expected number of days in practice during

the assigned reporting week, each physician was assigned

a visit sampling rate. The visit sampling rates were designed

so that about 30 Patient Records would be completed by

each physician during the assigned reporting week. Physicians

expecting 10 or fewer visits each day recorded data for all

visits, while those expecting more than 10 visits per day

recorded data for every second, third, or fifth visit based

on the predetermined sampling interval. These visit sampling

procedures minimized the physician’s data collection workload

and maintained approximately equal reporting levels among

sample physicians regardless of practice size. For physicians

29
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

edit procedures proved quite efficient, reducing item nonresponse rates to 2 percent or less for most data items.

Information contained in item 8 (Patient’s complaint,

symptom, or other reason for visit) of the Patient Record

was coded according to “A Reason for Visit Classification

for Ambulatory Care” (RVC) (NCHS, 1979). Diagnostic information (item 11 of the Patient Record) was coded according

to the International Classljication of Diseases, 9th Revision,

Clinical Modification (ICD-9-CM). A maximum of three

entries were coded from each of these items. Quality control

for the medical coding operation involved a two-way 100-

percent independent verification procedure. A dependent verification procedure was used to review and adjudicate all

records with coding discrepancies.

The NAMCS medication data (item 14 of the Patient

Record) was classified and coded according to a scheme developed at NCI-IS based on the Drug Product Information

File maintained by the American Druggist Blue Book Data

Center. A description of the drug coding scheme and of the

NAMCS drug data processing procedures is contained in Vital

and Health Statistics, Series 2, Nt). 90 (NCHS, 1982). A

two-way 100-percent independent verification procedure was

used to control the medication coding operation. As an additional quality control, all Patient Records with differences

between drug coders or with illegible drug entries were reviewed and adjudicated.

Information from the Induction Interview and Patient

Records was keypunched with 100 percent verification and

converted to computer tape. Extensive computer consistency

and edit checks were performed to ensure complete and accurate data. Incomplete data items were imputed by assigning

a value from a randomly selected Patient Record 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 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) ratio adjustment to fixed totals. Each

component is briefly described below.

Inflation by reciprocals of probabilities of selection

Because the survey utilized a three-stage sample design,

three probabilities of selection existed: (1) the probability

NOTE A list of references follows the text

30

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

physician within the PSU, and (3) the probability of selecting

the office visit within the physician’s practice. The overall

probability of including a physician in the sample was the

product of the probability of the PSU being selected times

the probability of the physician being selected. The probability

of selecting the physician within a PSU was 1.0 for physicians

in nonmetropolitan areas and was the PSU weight divided

by the sampling interval for physicians in metropolitan areas,

The probability of selecting the office visit was defined as

the number of office visits during the physician’s assigned

reporting week divided by the number of Patient Records

completed. All weekly estimates were inflated by a factor

of 52 to derive annual estimates.

Adjustment for nonresponse

Estimates from NAMCS data were adjusted to account

for sample physicians who were in scope but did not participate

in the study. This adjustment was calculated to minimize

the impact of response on final estimates by imputing to

nonresponding physicians the practice characteristics of similar

responding physicians. For this pu~ose, physicians were

judged similar if they had the same specialty designation

and practiced in the same PSU.

Ratio adjustment

A poststratification adjustment was made within each of

the 15 physician strata. The ratio adjustment was a multiplication factor that had as its numerator the number of physicians

in the universe in each physician specialty strata and as its

denominator the estimated number of physicians in that particular specialty strata. The numerator was based on figures obtained from the AMA and AOA master files, amd the denominator was based on data from the sample.

Reliability of estimates

As in any survey, results are subject to both sampling

and nonsampling errors. Nonsampling errors include reporting

and processing errors, as well as biases due to nonresponse

or incomplete response. The magnitude of the nonsampling

errors cannot be computed. However, these errors were kept

to a minimum by procedures built into the operation of the

survey. To eliminate ambiguities and encourage uniform reporting, careful attention was given to the phrasing of questions, terms, and definitions. Also, extensive pretesting of

most data items and survey procedures was performed. The

steps taken to reduce bias in the data are discussed in the

sections on field procedures and data collection. Quality control

procedures and consistency and edh checks discussed in the

data processing section reduced errors in data coding and

processing. 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 if a complete census had been taken using the

same forms, definitions, instructions, and procedures. How- ‘

ever, the probability design of NAMCS permits thle 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 calctrlat,ed in this report, also reflects part

of the variation that arises in the measurement process, but

does not include estimates of any systematic biases that may

be in the data. The chances are about 68 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

of 100 that the difference would be less than twice the standard

error, and about 99 of 100 that it would be less than 2 1/2

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. In 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 (NCHS, 1966, 1969).

Approximate 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

Figure I presents approximate relative standard errors for

aggregate estimates of office visits, and figure H presents

approximate relative standard errors for a$gregate estimates

of drug mentions. In each figure, curve A represents the

relative standard errors appropriate for estimates based on

all physicians, and curves B–D represent relative standard

errors appropriate for estimates based on the individual physician group indicated.

Alternatively, relative standard errors (RSE’S) for aggregate estimates may be calculated using the following general

formula, where x is the aggregate of interest in thousands,

and A and B are the appropriate coefilcients from table II.

RSE(X) = dA + : x 100.0

Estimates of percents

Approximate relative standard errors (in percent) for estimates of percents may be calculated from figures I and 11

as follows. From the appropriate curve, obtain the relative

standard error of the numerator and denominator of the percent.

NOTE: A list of references follows the text.

Table IL Coefkienta appropriate for determining relativeatendard errora

by type of estimateand phy.sidan groups: Natiinal Ambulatory Mediil

Care Survey, 1985

Coefficient

Type of estimafe and physician group A B

Wits

All physician groups . . . . . . . . . . . . . . . . 0.001493373 28.258848

Ophthalmology, orthopedic surgery, urological

surgery . . . . . . . . . . . . . . . . . . . . . . 0.003343029 10.785509

Cardiovascular disease, dermatology, geqeral and

family practice, internal medicine, neurology,

obstetrics and gynecology, Doctors of Osteopathy,

otorhinolaryngology, psychiatry, and all other

specialties . . . . . . . . . . . . . . . . . . . . . 0.005780329 29.680397

General surgery and pediatrics . . . . . . . . . 0.010470160 40.657939

Drug mentions

All physician groups . . . . . . . . . . . . . . . . 0.001864167 46.903471

Ophthalmology and urological surgery . . . . . 0.006309863 9.381846

Dermatology, general and family practice,

neurology, obstetrics and gynecology, Doctors of

Osteopathy, orthopedic surgery, and

otorhinolaryngology . . . . . . . . . . . . . . . 0.006777398 37.687413

Cardiovascular disease, general surgery, internal

medicine, pediatrics, psychiatry, and all other

specialties . . . . . . . . . . . . . . . . . . . . . 0.011745980 80.088822

Square each of the RSE values, subtract the resulting vah.te

for the denominator from the resulting value for the numerator,

and extract the square root. This approximation is valid if

the RSE of the denominator is less than 0.05 or if the RSE’S

of the numerator and denominator are both less than O.10,

Alternatively, RSE’S for percents maybe calculated using

the following general formula, where p is the percent of

interest and x is the denominator of the percent in thousands,

using the appropriate coefficient from table 11.

v’B*(l–p)

RSE@) =

“p”x x 100.0

Estimates of rates where numerator is not a

subclass of denominator

Approximate relative standard errors for rates in which

the denominator is the total United States population or one

or more of the age-sex-race groups of the total population

are equivalent to the relative standard error of the numerator

that can be obtained from figures I or H.

Estimates of dfierences 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.

31
(

I 00

90

80

70

60

50

40

30

20

10

9

8

7

6

5

4

3

2

100

90

80

70

60

50

40

HUH r ( , # , ,

I++f+l -t

L. . .L. L. L J 30

1 1 - 1 - -i- 1 4. =i

20

10

9

8

7

6

Hu+f 5

, 1 1 1 1 1 1 I

I I I I I II

1

4

3

t

, 1 , , , , , , , 1 , ,

I I I I I Ilmtttitm I 1 I 1 I Iltmitttm I 1 I II Illtmmttt 1 1 I I I Illllittttm I I I I IIl[m

2

1

;.9

08

07

0.6

05

0.9

08

07

0.6

0.5

0.4

I

1 I Curve 6: Ophthalmology, orthopedic surgery, and urological surgery

Curve C: Cardiovascular disease, dermatology, general and family mactice. 04

=FfR ‘-” internal medicine, neurology, obstetric; and gynecology; Doctors of Osteopathy,

otorhinolaryngology, psychiatry, and all other specialties

Curve L?.’General surgery and pediatrics Ill

0.3 03

0.2 02

01 01

A 2 34

100

56789A 2 34

1.000

56789A 2 3 456789A 2 34

10.000 100.000

56789A

1,000,000

‘\

8ize of eafimate (in thousands)

~~Ati~L~ ~~ WE 6? CHART: An e~~.-P=*D ,=.-., n+ ! O mi!h?n Office visits to rleneral and familv Dracfice Dhvsicians [read on scale at bottom of chart) has a relativa standard error of 9.4 Dercent (read from curva C on scsle at Iaft of chatt) or a

standard error of 940,000 office visits (9.4 percent of 10 million office visit=).

,.

Figure L Approximate relative standard errors for estimated numbers of office visits based on all physicians (A) and on individual physician groups (B+ National Ambulatory Medicsl Care Survey, 1985
01

A 2 345678

100

50

40

30

20

If)

9

8

?

6

5

4

3

2

1

!?:

07

06

05

04

03

02

01

1A 2 34567E

000

9A 2 3 456789A 2 3 456789A

0000 100,000 1.000,000

Stze of estimate (in thousands)

EXAMPLE OF USE OF CHART An esrimale of 20 mtllmn drug mentnns to general surgeons (reacf on scale at botfom of chari) has a relative standard error of 12 I perwnt (read from cunre D cmscs[e at Ieti of chafl) or a standard error of

2.420000 drug ITWIIICSIS(12 1 perceru of 20 mdlion drug rnentmns)

. .

f% ~kl&* Il. APWxknate Aa6ve sWcferd errors for esthnatad numbers of drug IfIWMiOn8 based on all physicians (A) and on individual physician groups (B+: National Ambulatory Mediil Care Sutvay,
Tests of significance

In this report, the determination of statistical inference

is based on the t-test. The Bonferroni inequality was used

to establish the critical value for statistically significant differences (0.05 level of significance) (Miller, 1966). Terms relating to differences, such as ‘~higher,” “less,“ and so forth,

indicate that the differences are statistically significant. Terms

such as “similar” or “no difference” mean that no statistical

significance exists between the estimates being compared.

A lack of comment regarding the difference between any

two estimates does not mean that the difference was tested

and found to be not significant.

Population figures and rate computation

The population figures used in computing annual visit

rates are presented in table III. The figures are based on

the July 1, 1985, estimates of the civilian noninstitutionalized

population of the United States. Because NAMCS includes

data for only the contenninous United States, the original

population estimates were modified to exclude Alaska and

Hawaii. For this reason, the population estimates should not

be considered official and are presented here solely to provide

denominators for rate computations

Rounding of numbers

Estimates presented in this report are rounded to the nearest

thousand. For this reason detailed figures within tables do

NOTE A list of references follows the text.

not always add to totals. Rates and percents are calculated

on the basis of the original, unrounded figures and may not

agree precisely with percents calculated from rounded data.

Systematic bias

No formal attempt was undertaken to determine or measure

systematic bias in the 1985 NAMCS data. It should be noted,

however, that there are several factors affecting the data which

indicate that these data underrepresent the total number of

office visits. Some of these factors are briefly discussed below:

● Physicians who participated in NAMCS did a thorough

and conscientious job in keeping the Patient Log; however,

a postsurvey evaluation study conducted a~on,g a random

sample of participating physicians indicat~s that a small

number of patient visits may have been accidentally omitted from the Patient Log; although this ntrmber is quite

small, such omissions would result in an undercoverage

of office visits. The same postsurvey study indicates that

the inclusion of patient visits which did not actually occur

was infrequent and would have a negligible effect on

survey estimates.

. As previously stated, the physician universe for the 1985

NAMCS included all non-Federal, office-based, patientcare physicians on the AMA and AOA masterfiles. The

NAMCS was designed to provide statistically unbiased

estimates of office visits to this designated population.

Not included in the universe were physicians who were

classified as federally employed or hospital-based, or who

were principally engaged in research, teaching, administrable Ill. Population used in computing snnual visit rates shown in this report by seleoted demographic chsracteristiorx July 1, 1985

All Less than 15-24 25-34 3L%f4 45-54 55-64 65 years

Characteristic ages 15 years years years years years years and over

Race

All races . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

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

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

Other races . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Region

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

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Metropolitan status of area

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

Nonmetropolitan, . . . . . . . . . . . . . . . . . . . . . .

232,175

112,112

120,062

198,020

96,191

101,829

27,959

12,992

14,966

6,196

2,929

3,267

49,756

58,601

80,129

43,688

176,349

53.625

51,373

26,283

25,090

41,906

21,570

20,336

7,876

3,964

3,892

1,591

729

862

. . .

---

. . .

..-

..-

---

38,141

18,836

19,305

31,772

15,761

15,991

5,322

2,521

2,801

1,047

534

513

. . .

---

..-

---

-..

. . .

40,337

19,702

20,635

34,244

16,954

17,290

4,838

2,165

2,673

1,255

564

672

-..

..-

.-.

..-

.-.

. . .

31,141

15,142

15,999

26,889

13,237

13,652

3,266

1,451

1,815

986

454

532

---

-..

---

---

..-

..-

22,243

10,764

11,479

19,258

9,394

9,864

2,357

1,053

1,304

627

316

311

.-.

---

,-.

..-

. . .

-..

22;006

10,826

11,680

19,602

9/247

10,855

2:049

919

1,130

356

161

195

-..

.-.

-..

.-.

.-.

..-

26,934

11,060

15,874

24,349

10,009

14,341

2,250

698

1,352

334

153

161

-..

-..

. . .

---

---

---

34
tration, or other nonpatient care activity. Consequently,

ambulatory patient visits to these physicians in an office

setting would not be included in NAMCS estimates. In

an attempt to measure the number of office visits to

physicians not imthe NAMCS universe, a NAMCS Complement Survey was conducted in 1980. This study involved a sample of approximately 2,000 physicians

selected from among the 230,000 physicians in the AMA

and AOA masterfiles who were not eligible (in scope)

for the 1980 NAMCS. Details of the Complement Survey

methodology and results are presented in Series 13,

No. 77 (NCHS, 1984). Results indicate that about 17

percent of the Complement Survey physicians saw some

ambulatory patients in an office setting and that an estimated 69 million office visits were made to these physicians in 1980.

NOTE A list of references follows the text.

35
Appendix II

Definitions of terms

Terms relating to the survey

Ojj$ce-Premises identified by physicians as locations for

their ambulatory practices, customarily including consultation,

examination, or treatment spaces the patients associate with

a particular physician.

Ambulatory patient—An individual seeking personal

health services who is neither bedridden nor currently admitted

to any health care institution on the premises.

Physician—A duly licensed doctor of medicine or doctor

of osteopathy. For purposes of this NAMCS, physicians are

classified as in scope or out of scope as follows:

. In scope—Physicians currently in practice who spend

some time caring for ambulatory patients in office locations except as excluded below.

● Out of scope

—Physicians in the specialties and subspecialties of anesthesiology, pathology; and radiology.

—Physicians who are federally employed, including those

physicians who work for the Veterans’ Administration

or who are in military service.

—Physicians who treat patients only in institutional settings, such as nursing homes and hospitals.

—Physicians employed full time in industry or by institutions and having no private practice, for example, physicians who work for the Ford Motor Company.

—Physicians who spend no time seeing ambulatory patients, for example, physicians who only teach, are engaged in research, or are retired.

Patient—A person under a physician’s care for health

reasons. For purposes of this NAMCS, patients are defined

as in scope or out of scope as follows:

. In scope—A patient seen by an in-scope physician or

a staff member in the physician’s office, except as

excluded below.

9 Out of scope

—Patients seen by the physician in a hospital, nursing

home, or other extended care institution, or in the patient’s

home. If the physician has a private office located in

a hospital that meets the definition of “office,” the ambulatory patients seen there are considered in scope.

—Patients seen by the physician in an institution, including outpatient clinics of hospitals, for whom the institution

has primary responsibility over time.

—Patients who contact and receive advice from the physician via telephone,

—Patients who come to the office only to leave a specimen, to pickup insurance forms, or to pay a bill.

—Patients who come to the office to pick up medications

previously prescribed by the physician.

Visit—A direct, personal exchange between an ambulatory

patient and a physician or a staff member working under

the physician’s supervision for the purpose of seeking care

and rendering personal health services.

Drug mention—The physician’s entry of a pharnnaceutical

agent prescribed or provided—by any route of administration––

for prevention, diagnosis, or treatment. Generic names as

well as brand name drugs are included, as are nonprescription

as well as prescription drugs. Along with all new drugs,

the physician also records continued medications, if the patient

was specifically instructed during the visit to continue the

medication.

Physician specialty-Principal specialty, including general practice, as designated by the physician at the time of

the survey. Those physicians for whom a specialty was not

obtained were assigned the principal speciahy recorded in

the physician masterfiles maintained by the American Medical

Association or the American Osteopathic Association.

Region of practice location—One of the four geographic

regions, excluding Alaska and Hawaii, that correspond to

those used by the U. S. Bureau of the Census:

Region

Northeast . . .

Midwest . . . . . .

South . . . . . . .

West ..,....

States included

Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania,

Rhode Island, and Vermont

Illinois, Indiana, lowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio,

South Dakota, and Wisconsin

Alabama, Ar~ansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma,

South Carolina, Tennessee, Texas, Virginia, and

West Virginia

Arizona, California, Colorado, Idaho, Montana,

Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming

Metropolitan status of practice location—A physician’s

practice is classified by its location in a metropolitan or nonmetropolitan area. Metropolitan areas are metropolitan statistical

areas (MSA’s) as defined by the U.S. Office of Management

and Budget. The definition of an individual MSA, 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 metro36
politan in character, so that the periphery of the specific

metropolitan area may be determined. MSA’s may cross State

lines. In New England, MSA’S consist of cities and townships

rather than counties.

Terms relating to the Patient Record

Age—The age calculated from date of birth was the age

at last birthday on the date of visit.

Race—White, Black, Asian or Pacific Islander, or American Indian or Alaskan Native. Physicians were instructed to

mark the category they judged to be the most appropriate

for each patient based on observation or prior knowledge.

The following definitions were provided to the physician:

White—A person having origins in any of the original

peoples of Europe, North Africa, or the Middle East.

Black—A person having origins in any of the black racial

groups of Africa.

Asian or Pacific Islander—A person having origins in

any of the original peoples of the Far East, Southeast

Asia, the Indian subcontinent, or the Pacific Islands, including, for example, China, India, Japan, Korea, the

Philippine Islands, and Samoa.

American Indian or Alaskan Native—A person having

origins in any of the original peoples of North America

and who maintains cultural identification through tribal

affiliation or community recognition.

Ethniciq4ategory judged by the physician to be the

most appropriate. The following definitions were provided:

●

●

the

Hispanic origin—A person of Mexican, Puerto Rican,

Cuban, Central or South American, or other Spanish culture or origin, regardless of race.

Not Hispanic—A person not of Hispanic ongin.

Expected source(s) of payment—The source(s) that to

best of the physician’s knowledge describes how charges

incurred this visit will be paid:

●

●

●

●

●

●

Se~ pay-Charges billed directly to the patient which

will not be reimbursed by a third party.

Medicare-Charges paid in part or in full by a Medicare

plan, including payments made directly to the physician,

as well as payments rei~bursed to the patient.

Medicaid<har,ges paid in part or in full by a Medicaid

plan, including payments made directly to the physician,

as well as payments reimbursed to the patient.

Blue CrosslBlue Shield-Charges paid by Blue Cross or

Blue Shield either directly to the physician or reimbursed

to the patient.

Other commercial insurance-Charges paid by a private

insurance company, including payments made directly

to the physician, as well as payments reimbursed to the

patient.

HMO/prepaid plan-Charges included under a health

maintenance organization (HMO) plan or other prepayment plan, including independent practice associations

(IPA’s) and preferred provider organizations (PPO’S).

●

●

●

No charge—Visits for which no fee is charged (not including visits paid for as part of a total care package; for

example, pregnancy visits for which a flat fee was

charged).

Other—All other sources of payment not in the preceding

categories; for example, workman’s compensation programs and Civilian Health and Medical Programs of Uniformed Services (CHAMPUS).

Unknown—This category indicates that none of the previous source of payment categories was checked.

Was patient referred for this visit by another physician?—

Referrals are any visits that are made at the advice or direction

of a physician other than the one being visited. The interest

is in referrals for the current visit and not in referrals for

any prior visit.

patient’s complaint(s), symptom(s), or other reason(s)

jlor this visit (in patient’s own words)-The patient’s 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. “Most important”

refers to that problem which in the physician’s judgment was

most responsible for the patient’s visit.

Glucose tests this visit—Any test(s) ordered, provided,

or specimen taken to measure the patient’s glucose level,

including test for diagnosis, screening, or patient evaluation.

Other diagnostic services this visit-Physicians were instructed to check any of the following services that were

ordered or provided during the current visit:

●

●

●

●

●

●

●

●

●

●

●

●

●

Breast exam—Examination of breast.

Pelvic exam—Self-explanatory.

Rectal e.ram—Any manual or proctoscopic examination

of the rectum.

Visual acuity tesl—Self-explanatory.

Urinalysis—Any physical,- chemical, or microscopic

examination of urine.

Hematology—Any laboratory examination of blood, including counts, clotting studies, and tests.

Blood chemist~-chemical analysis or test of blood.

Pap rest—Papanicolaou test.

Other lab test—Any other laboratory test, except glucose

test.

Bloodpressure check—Self-explanatory.

EKG—Electrocardiogram.

Chest x ray—Single or multiple x ray examination for

diagnostic or screening purposes.

Other radiology—Any single or multiple x ray examination for diagnostic or screening purposes, excluding chest

x rays, includhg computed tomography and any diagnostic

nuclear medicine imaging procedure.

Ultrasound—Any single or multiple ultrasound imaging

examination.

Other service—Any other diagnostic services not included

or listed in the preceding categories.

Physician’s 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

37
list them in order of decreasing importance. The term “principal” refers to the first-listed diagnosis. The diagnosis represents

the physician’s best judgment at the time of the visit and

may be tentative, provisional, or definitive.

Other significant current diagnoses—The diagnosis of

any other condition known to exist for the patient at the

time of the visit. Other diagnoses may or may not be related

to the patient’s reason for visit.

Diagnostic groups—Principal diagnoses and secondary

diagnoses in visits to psychiatrists were each classified in

the following groups:

All psychiatric diagnoses—For 1975–76 data, includes

ICDA codes 290-309, YOO.1, and Y03.4 (that is, all

ICDA psychiatric diagnoses listed below). For 1980-81

and 1985 data, includes ICD–9-CM codes 290-316,

V67.3, V70. 1, V70.2, V79.0, and V79. I (that is, all

ICD-9-CM psychiatric diagnoses listed below).

Psychoses, including aflective psychoses—For 1975–76

data, includes ICDA codes 290-295,296. 1–296.3, 296.8,

296.9, and 297–299 (that is, senile and presenile dementia;

alcoholic psychosis; psychosis associated with intracranial

infection; psychosis associated with other cerebral condition; psychosis associated with other physical conditions;

schizophrenia; manic-depression psychosis, manic type;

manic-depressive psychosis, depressed type; manic-depressive psychosis, circular type; other affective psychosis;

unspecified affective psychosis; paranoid states; other

psychoses; and unspecified psychosis). For 1980-81 and

1985 data, includes ICD-9-CM codes 290-295, 296.0,

296.1, 296.4-296.9, and 297–299 (that is, senile and

presenile organic psychotic conditions; alcoholic psychoses; drug psychoses; transient organic psychotic conditions; other chronic organic psychotic conditions; schizophrenic conditions; manic disorder, single episode; manic

disorder, recurrent episode; bipolar affective disorder,

manic; bipolar affective disorder, depressed; bipolar affective disorder, mixed; bipolar affective disorder, unspecified;, manic-depressive psychosis, other and unspecified; other and unspecified affective psychoses;

paranoid states; other nonorganic psychoses; and psychoses with origin specific to childhood).

Depressive disorders, inc[uding major depressive disorder—For 1975–76 data, includes ICDA codes 296.0 and

300.4 (that is, involutional melancholia and depressive

neurosis). For 198&8 1 and 1985 data, includes

ICD-9-CM codes 296.2, 296.3, 300.4, and 3 I I (that

is, major depressive disorder, single episode; major depressive disorder, recurrent episode; neurotic depression;

and depressive disorder, not elsewhere classified).

Neurotic disorders, excluding depression—For 1975 data,

includes ICDA codes 300.0-300.3 and 300. 5–300.9 (that

is, anxiety neurosis; hysterical neurosis; phobic neurosis;

obsessive-compulsive neurosis; neurasthenia; depersonalization syndrome; hypochondriacal neurosis; other

neurosis; and unspecified neurosis). For 1980-81 and 1985

data, includes ICD–9-CM codes 300.0-300.3, and 300.5–

300.9 (that is, anxiety states; hysteria; phobic disorders;

obsessive-compulsive disorders; neurasthenia; depersonalization syndrome; hypochondriasis; other neurotic

disorders; and unspecified neurotic disorder).

Personality disorders—For 1975–76 data, includes ICDA

code 30 I (that is, personality disorders). For 1980-81

data, includes ICD–9–CM code 301 (that is, personality

disorders).

Other psychiatric disorders and psychiatric examinations-For 1975–76 data, includes codes 302–309, YOO.1,

and Y03.4 (that is sexual deviation; alcoholism; drug

dependence; physical disorders of presumably

psychogenic origin; special symptoms, not elsewhere classified; transient situational disturbances; behavior disorders of childhood; mental disorders not specified as

psychotic associated with physical conditions; general psychiatric examination; and follow-up psychiatric examination not needing further psychiatric care). For 1980-81

and 1985 data, includes ICD–9–CM codes 302–3 10, 3 12–

316, V67.3, V70.1, V70.2, V79.0, and V79. 1 (that is,

sexual deviations and d]sorders; alcohol dependence syndrome; drug dependence; nondependent abuse of drugs;

physiological malfunction arising from mental factors;

special symptoms or syndromes, not elsewhere classified;

acute reaction to stress; adjustment reaction; specific nonpsychotic mental disorders due to organic brain damage;

dkurbance of conduct, not elsewhere classified; disturbance of emotions specific to childhood and adolescence;

hyperkinetic syndrome of childhood; specific delays in

development psychic factors associated with diseases

classified elsewhere; follow-up examination following

psychotherapy and other treatment for mental disordeq

general psychiatric examination, requested by the authority; general psychiatric examination, other and unspecified, special screening for depression; and special

screening for alcoholism).

All other diagnoses— For 1975–76 data, includes all residual ICDA codes and diagnoses. For 1980-81 and 1985

data, includes all residual ICD-9–CM codes and

diagnoses.

Have you seen patient before ?—’’Seen before” means

provided care for at any time in the past. Item 12b refers

to the patient’s current episode of illness.

Nonmedication therapy—Physicians were instructed to

check any of the following services that were ordered or

provided during the current visit:

● Physiotherapy—Any form of physical therapy ordered

or provided, includlng any treatment using heat, light,

sound, or physical pressure or movement; for example,

ultrasonic, ultraviolet, infrared, whirlpool, diathermy,

cold, and manipulative therapy.

. Ambulatory surgery-Any surgical procedure performed

in the office or ordered to be performed elsewhere on

an outpatient basis, includlng suture of wounds, reduction

of fractures, application or removal of casts, incision

and draining of abscesses, application of supportive materials for fractures and sprains, irrigations, aspirations,

dilations, and excisions.

38
Radiation therapy—Therapeutic use of x rays and other

high energy modalities, radium, cobalt, and brachytherapy

for surface, intracavity, or interstitial applications, including nuclear medicine therapeutic procedures.

Psychotherapy—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.

Family planning—Services, counseling, or advice that

might enable patients to determine the number and spacing

of their children, includlng both contraception and infertility services.

Diet counseling—Instruction, recommendations, or advice

regarding diet or dietary habits.

Other counseling—Instructions and recommendations regarding any health problem, including advice or counsel

about a change of habit or behavior. This also includes

instruction on the proper use of drugs and devices and

their possible adverse effects.

Corrective fenses—Provision, ordering, or prescription

for glasses or contact lenses.

Other—Treatments or nonmedication therapies ordered

or provided that are not listed or included in the preceding

categories.

Medication therapy this visit—The physician was instructed to list, using brand or generic names, all medications

including drugs, vitamins, hormones, ointments, and suppositories ordered, injected, administered, or provided this

visit including prescription and nonprescription drugs, vaccinations, immunizations, 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.

. New medication ?—Indicates whether the medication was

newly prescribed for the patient at the time of the visit.

. For Dx in item 1la?—Indicates whether the medication

was ordered or provided for

item 11a of the Patient Record.

the principal diagnosis in

Disposition this visit-Eight categories are provided to

describe the physician’s disposition of the case. The physician

was instructed to check as many of the categories as apply:

●

●

●

●

●

●

●

●

No followup p[anned—No return visit or telephone contact

was scheduled for the patient’s problem.

Return at specified time—Patient was told to schedule

an appointment or was instructed to return at a particular

time.

Return if needed, P. R. N.—No future appointment was

made, but the patient was instructed to make an appointment with the physician if the patient considered it

necessary.

Telephone followup planned—Patient was instructed to

telephone the physician either on a particular day to report

on progress, or at any time if the need should arise.

Referred to other physician—Patient was instructed to

consult or seek care from another physician. The patient

may or may not return to this physician at a later date.

Returned to referring physician—Patient was instmcted

to consult again with the referring physician.

Admit to hospitai—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 \’isit—Time the physician spent with

the patient, not including time the patient spent waiting to

see the physician, time the patient spent receiving care from

someone other than the physician without the presence of

the physician, and time the physician spent in reviewing such

things as records and test results. If the patient was provided

care by a member of the physician’s staff but did not see

the physician during the visit, the duration of visit was recorded

as Ominutes.

39
*

0

D 779329 boumnca cd &m14mU91KY-AN infcmmtkm nldch would twmlt ldentiflcalicm 01 an

ndividuaI, a practice, or an establishment *N ~ hard cOnflden!iar. rnll be used ‘nly CWartment 01 Heallh and Human Sewices

w PWOns WP3ti in and fOr the PUW024S of the survey and wII not ba disclosed or

Public Health Service

National Canter for Health Statistics D 779329 nleawd toother persons or used for anY other purpose

1. mTE OF VI$IT OMB No. 0937-0141

Expkes 9/30/8(

(PHS)6105-[

4S6-23i

PATlENT RECORD

. AMBULATORY MEDICAL CARE SURVEY PATIENT LOG

-

7. :&::g*

FOR~

VISIT BY

ANUTHER

PHYSICIAN?

1(--J YES 2QN0

As each pa fieni arrives, re

time of visit on the 109

pafiant entered on line t15

the patient record to the rig

d name and

IW. For the

30 complete

Tl~:l~F

a.m.

n

p.m.

a.m.

p.m.

&m.

p.m.

am,

Q,m

~

p.m

,❑ WPAJIC

2❑ NOI HISPANIC

PATlENT’S NAME

+1 2 U MALE AMERICAN lNOIANf

4 ❑ALASKAN NATtVE

TIENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER 8. ~AsoN(s)FORTHISVISIT II. p.tienti own wordsl

—

1

$SE 10m OTHER DIAGNOSTIC SERVICES THIS ‘

flsrr

[Check all ordered or provided)

1❑ NONE SD URINALYSIS I, DwJOOF%ESWFIECHECK

2 ❑ BREAST EXAM 7D ttEMATOLWV 12HEI(G

3 ❑ FfLW EXAM 806L000CHEMISTRY 130 CHEST X-RAY

4DRECTALEXAM 9DPAPTEST 14❑ OTHER RAOK3LOGY

5 ❑VISUAL ACUITY IODOTHE17LAELTEST 15H”LTRASWND

16DoTHERSERWCElSDecifY,

[ Check all

a MOST IMWRTAN1

ordered or

provided~

I ❑ NONE

2 ❑ BLOfJO

2

b. OTHER

3 ❑ URINE

4 ❑ ORAL

11. FHVSICIAN’S OIAGNOSES 12. ~~E$&s&~ 13, NON-MEDICATION THERAPY

[Check all services ordered or provided fhis visit) 3

5❑ PSYCHOTHERAW 9❑CORRECTIVE LENSES

a. ~CJR& ~aAGNOSIS/FROBKM ASSOCIATE

2 ❑ PHYSIOTHERAPY 6 ❑ FAMILYPMNNING ,ODOTHER,SPecify,

3 ❑ AMBULATORY SURGERY 7 ❑ OIET COUNSELING

\

IF YES, FOR

b. OTHER SIGNIFICANT CURRENT ofAGNOSES THE WNOiTiON IN

ITEM 1la?

4 20N0 I

4 H RADIATION THERAPY 8❑ OTHER CWNSEUNG

1

14s ~:~’;: h

TION THERAFY [Record all new or continued medications ordered or provided at this

e t e same bfind name or generic name entered on my Rx or office medical record. I 15“ &EMME!’!)%Ysm

I ❑ NOFaLW-UPWNNEO IF WISE, CHECK HERE U

a

I

b.

NEW FOR OX

MEDICATION? IN ITEM 1la?

YES NO

I

YES NO

‘cl 20 I ‘cl 20

‘cl 20 I ‘n 20

‘cl 21-J ~ In ,H

lCI ZD I la 2H

‘0 2rJ I la ,U

2 ❑ RETURN AT SFZCIFIEO TIME

3 ❑ RETURN IF NEEOEO. F!R.N.

4DTELEFl+O+4EFoLLow.”Pm..ANNED

5

Record items 1.16

Ior this Went

+

I

2

,

3

4

5

5 ❑REFERREo TO OTHER Fi+YB,c,AN

6 ❑ ‘~RNED TO REFERRING FWSICIAN

7 ❑AOMIT TO HOSFiTAL

8 ❑ OTHER l.Tpecifyl

Mhdas

CONTINUELISTINGPATIENTS A., MEW-TDAP.C “L. l.t-r. ! . n..-
Vital and Health Statistics

series descriptions

SERIES1.

SERIES 2.

sERm 3.

SE FtlES .1

SERIES 5

SERIES 10

SERIES 11

SERIES f2.

SERIES 13.

SERIES 1-1.

SERIES 15

sEi=ilKl20

~~R[~~al

SERIES 22.

SERIES 23.
U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Serv!ce

Centers for Disease Control

National Center for Health Statistics

3700 East-West Highway

Hyatfswlle, fvlaryland 20782 m

I I

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

DHHSPubl!cation No. (PHS)8S-1755, Sews13, No.94