Data from the

NATIONAL HEALTH SURVEY

Office Visits by Women

The NationalAmbulatory

MedicalCare Survey

United States, 1977

Statistics obtained from a national probability sample of otficebased physicians are presented on the utilization of ambulatory

care by women 15 years and over. Visits are described in terms of

patient age, sex, and race, patient condition, and management of

the patients’ problems. Selected comparisons are made with similar

data on visits made by men. Family planning visitsby women aged

15-44 years are described according to patient characteristics,

reason for visit, and services rendered.

DHEW Publication No. (PHS) 80-1796

Series 13

Number 45

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service

Office of Health Research, Statistics, and Technology

National Center for Health Statistics

Hyattsville, Md. March 1980
/

t

.>

.,

Library of Congress Cataloging in Publication Data

C>prcss, Beulah K

Of ficc tisits b~ women.

(Vital tmd health statistics:

“D;ttLL were collected in the

ducted }ewlv by the Division

Series 13 ; n{). 45) (DH!EW publication ; no. (PfIS) 80-1976)

National ambulator} medical arc survey (NAMCS) . . . conof HcaIth Rcw)urces Utilization Statistics (DHRUS) of the

Xati{>na~ Ccn’ter for Health Statistics (NCHS).”

Includes bibliographical rcfcrcncxs.

sLlpt. Of DO(X. no.: HE 20.6209-1 3/40

1. Women-Diseases-United Statrs-Statistics. 2. Ph>sician stwices utili~atio~l-United

States-Statistics. 3. Anlbtllator>” medical care-lJllitcd States-Utilizat ion-Statistics.

4. \V{)mcn’s health scr\iccs-Uni~cd States–Utilization–St atistics. 5. IIcalth stlrvcys–

united States. 6. United States-Statistics, hlcdiczl. 1. United States. Na[ional Center for

Health Statistics. Division of Hc:dth Resources Utilization Statistics. National ambulatory

medical care survey. II. “[itle. 111. Series: United States. National Center for Health Statistics. Vital and health statis~ics : Series 13, Data from the National IIealth S\~rvc>, Datii

on health rcsoLtrces utilization ; no. 45. 11~. Series: United St~ttes. Dept. (If Health, Educ:ition, and Wcli’~irc. DHE~V publication ; no. (PIiS) 80-1 791. [DLNLXI: 1. Anlbulatorj” c:iR’-

Cnitcd S[atcs–Statistics. 2. Health sur\e}s-United States-Statistics. 3. \Vonlcl~-United

St:ttes–Statistics. \V2 A N148Yn1 no. 40]

RA407.3. A349 no. 45 362.1’ 1’0973s 79-607171

[RAM) 8.W65]

ISBX ()-8406 -0182-4

1362.1]
NATIONAL CENTER FOR HEALTH STATISTICS

DOROTHY P. RICE, Director

ROBERT A. ISRAEL, Deputy Director

JACOB J. FELDMAN, Ph.D., Associate Director for Analysis

GAIL F. FISHER, Ph.D., Associate Director for the Cooperative Health Statistics System

ROBERT A. ISRAEL, Acting Associate Director for Data Systems

ROBERT M. THORNER, SC.D., Acting Associate Director for International Statistics

ROBERT C. HUBER, Associate Director for Management

MONROE G. SIRKEN, Ph.D., Associate Director for Mathematical Statistics

PETER L. HURLEY, Associate Director for Operations

JAMES M. ROBEY, Ph.D., Associate Director for program Development

GEORGE A. SCHNACK, Acting Assoctite Director for Research

ALICE HAYWOOD, Information Officer

DIVISION OF HEALTH RESOURCES UTILIZATION STATISTICS

SIEGFRIED A. HOERMANN, Director

JAMES E. DELOZIER, C/ziej Ambulatory Care Statistics Branch

SIEGFRIED A. HOERMANN, Acting Chief Hospital Care Statistics Branch

MANOOCHEHR K. NOZARY, Chief Technical Services Branch

STEWART C. RICE, Chief Family Planning Statistics Branch

JOAN F. VAN NOSTRAND, Chief Long-Term Care Statistics Branch

Vital and Health Statistics Series 13-No. 45

DHEW Publication No. (PHS) 80-1796

Library of Congress Catalog Card Number 79-607171
CONTENTS

htroduction ............................................................................................................................................ 1

Back@oun& ....................................................................................................................................... 1

Scope of the Survey ........................................................................................................................... 1

Source and Limitations of the Data ................................................................................................... 2

Patient Characteristics ............................................................................................................................. 2

Patient Condition ....................................................................................................................................

Psincipal Reason for Visit ..................................................................................................................

PrincipaI Reason for Visit and Age of the Patient ..............................................................................

Principal Reason for Visit and Race of the Patient .............................................................................

Principal Reason for Visit and Sex of the Patient...............................................................................

Principrd Reason for Vkit and Time Since Onset of Complaint or Symptom .....................................

Principal Reason for Vkit and Physician Specialt y.............................................................................

Principal Diagnosis .............................................................................................................................

Principrd Diagnosis and Age of the Patient .........................................................................................

Principal Diagnosis and Principal Reason for Vkit .............................................................................

Principal Diagnosis and Race of the Patient .......................................................................................

Principal Diagnosis and Sex of the Patient .........................................................................................

Principal Diagnosis and Return Visit Rate ..........................................................................................

Seriousness of Condition ....................................................................................................................

Seriousness of Condition and Sex of the Patient ................................................................................

3

3

3

4

5

5

6

6

7

8.

9

10

13

14

16

Patient Management ................................................................................................................................ 16

Diagnostic and Therapeutic Services .................................................................................................. 16

Diagnostic and Therapeutic Services and Age, Race, and Sex of the Patient ...................................... 16

Diagnostic Services and Patient’s Principal Reason for Visit ............................................................... 17

Therapeutic Services and Principal Diagnosis ..................................................................................... 17

Disposition of Visit ............................................................................................................................ 18

Referral .............................................................................................................................................. 18

Duration of Visit ................................................................................................................................ 18

Family Planning ...................................................................................................................................... 19

Patient Age and Race ....................................................................................... ................................. 20

Physician Specialty ............................................................................................................................ 21

Patient’s Reason for Visit ................................................................................................................... 21

Diagnostic and Therapeutic Services .................................................................................................. 22

References ............................................................................................................................................... 23

List of Detailed Tables ............................................................................................................................ 25

Appendixes

I. Technical Notes .......................................................................................................................... 45

II. Definitions of Certain Terms Used in This Report ..................................................................... 53

III. Survey Instruments .................................................................................................................... 57

LIST OF TEXT FIGURES

1. Annual rate of office visits with patient’s principal reason for visit gynecological examination, by

age of patien~ United States, 1977 ............................................................................................. 4

...

Ill
2.

.3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

A.

B.

c.

D.

E.

F.

G.

H.

J.

K

Annual rate of office visits with Pap smear as one of the reasons for visit, by age of patient:

United States, 1977 ......................................................................................................................

Annual rate-of office visits for prenatal care (Y06), by age of patient: United States, 1977 ...........

Annuaf rate of office visits for disorders of menstruation (626) and menopausal symptoms

(627), by age of patient: United States, 1977 ..............................................................................

Annual rate of office visits for medical and surgical aftercare (Y IO), by age and sex of patient:

United States, 1977 ......................................................................................................................

Armuaf rate of office visits for acute upper respiratory infection of multiple or unspecified sites

(462) and acute pharyngitis (465), by age and sex of patient: United States, 1977 .....................

Annual rate of office visits for diabetes mellitus (250), by age and sex of patient: United States,

1977 ................................................................................................................................. ............

Annuaf rate of office visits for obesity (277), by age and sex of patient: United States, 1977 .......

Annuaf rate of office visits for hypertension (401), by age and sex of patient: United States,

1977 .................................................................................................................................. ...........

Annual rate of office visits for arthritis and rheumatism (7 12-715, 717-7 18), by age and sex of

patient: United States, 1977 ........................................................................................................

Annuaf rate of office visits for heart dkease (410-413, 427), by age and sex of patient: United

States, 1977 ..................................................................................................................................

Annual rate of office visits for neuroses (300), by age and sex of patient: United States, 1977 .....

Percent of office visits that included Pap test and blood pressure check, by age of patient: United

States, 1977 ..................................................................................................................................

LIST OF TEXT TABLES

Median visit age and standard error of the median in years, by sex and race of patient: United

States, 1977 ..................................................................................................................................

Percent distribution of office visits made by patients 15 years and over by principaf reason for

visit module, according to sex of patient: United States, 1977 ....................................................

Number and percent of new problem office visits made by women 15 years and over, by selected

principal reasons for visit and selected physician specialties: United States, 1977 .......................

Rate of all-listed operations for female patients dkcharged from short-stay hospitals, by age of

patient and selected surgical categories: United States, 1977 .......................................................

Number and percent distribution of office visits made by women 15 years and over with pnncipaf

reason for visit lump or mass of breast (S805), by principaf diagnosis: United States, 1977 ........

Number and percent distribution of office visits made by women 15 years and oveT with principaf

reason for visit vision dysfunction (S305), by principal diagnosis: United States, 1977 ...............

Prevalence rate by race of patient with percent of difference, and visit rate by race of patient

with percent of difference, according to pnnciprd diagnoses diabetes mellitus and hypertension:

United States, 1977 ......................................................................................................................

Number and percent dktribution of office visits made by patients 15 years and over for medical

and surgicaf aftercare (Y 10) by principal 4-digit diagnosis, according to sex of patient: United

States, 1977 ..................................................................................................................................

Prevalence rate by sex of patient with percent of difference, and visit rate by sex of patient with

percent of difference, according to selected principal diagnoses: United States, 1977 .................

Number and percent of office visits made by patients 15 years and over, by sex of patient-and

selected principal reasons for visit: United States, 1977 ..............................................................

4,

7

7

10

11

11

12

12

13

14

14

17

3

5

6

8

9

9

10

10

13

15

iv
L

M.

N.

o.

P,

Q.

R.

s.

T.

u.

v.

w.

Number and percent of office visits made by patients 15 years and over for selected principal

reasons for visit, by selected diagnostic groups and sex of patient: United States, 1977 ..............

Return visit rate for women 15 years and over, by seriousness of condition: United States,

1977 .............................................................................................................................................

Percent of office visits made by women 15 years and over that included a Pap test, by selected

principal reasons for visifi United States, 1977 ............................................................................

Percent of office visits made by women 15 years and over that included X-ray, by selected

principal reasons for visit: United States, 1977 ............................................................................

Number and percent of office visits made by patients 15 years and over, by sex of patient and

disposition of the visiti United States, 1977 ................................................................................

Mean contact duration of office visits made by women 15 years and over, by selected principal

diagnoses: United States, 1977 ....................................................................................................

Number of fsmily planning office visits made by women 15-44 years and percent distribution by

whether family planning was a stated reason for the visit or a therapeutic service was given,

according to age and race of patient: United States, 1977 ...........................................................

Number, percent dktribution, and annual visit rate of office visits made by women 15J44 years

for family planning, by age and race of the patient: United States, 1977 ....................................

Number and percent distribution of family planning office visits made by women 15-44 years by

most visited physician specialty, according to age and race of patient: United States, 1977 ........

Number and percent distribution of office visits made by women 15-44 years with a family

planning reason for visit, by reason category: United States, 1977 ..............................................

Number and percent distribution of office visits made by women 15-44 years that included a

family planning therapeutic service but not a family planning reason for visit, by most common

pticipal reason for visit: United States, 1977 .............................................................................

Number and percent of National Ambulatory Medical Care Survey (NAMCS) visits and number

and percent of family planning visits made by women 15-44 years, by most common dmgnostic

and therapeutic services: United States, 1977 ..............................................................................

SYMBOLS

Data not available .-.

Category not applicable—— . . .

Quantity zero .-—.. ——.—.- .

Quantity more than O but less than 0.05— 0.0

Figure does not meet standards of

reliability or precision *

15

16

17

17

18

19

20

21

21

22

22

22

v
OFFICE VISITS BY WOMEN

THE NATIONAL AMBULATORY MEDICAL CARE SURVEY

Beulah K. Cypress, Ph.D., Division of Health Resources Utilization Statistics

INTRODUCTION

Background

The need for research on women’s health

was documented in the proceedings of a conference sponsored by the National Center for

Health Services Research in 1975.1 A wide

variety of concerns for women’s health issues

were discussed. About 79 percent of women in

the civilian noninstitutionalized population of

the United States saw a physician at least once

during 1977,2 therefore, basic data concerning

physician services used by women are fundamental to research designed to address many of these

concerns.

This report presents national estimates of

“ the number and characteristics of visits to

office-based, nonfeder~ly employed physicians

by women aged 15 years and older during 1977.

These statistics represent an objective set of data

on physician utilization. This report is not intended to provide answers to the many questions raised about women in the health care

system, but in some instances the dispassionate

nature of the estimates reveal reIat.ionships (or

lack of relationships) among variables that are

often hypothesized in research projects.

The patently different physiology of women

and men affects their use of medical practitioners and thus precludes certain comparisons

between them. However, this report does include data for men’s visits where comparisons by

the patient’s sex are a logical consequence of

presenting the data for women’s visits. For

example, if the data show that women tend to

visit physicians proportionately more often for

care of one non-sex-related condition than for

another, it seems appropriate to consider

whether men exhibit a similar health care seeking pat tern.

The data were collected in the National

Ambulatory Medical Care Survey which is a

sample survey conducted yearly by the Division

of Health Resources Utilization Statistics of the

NationaJ Center for Health Statistics. Detailed

information regarding the background and methodology of the survey were published in Vital

and Health Statistics, Series 2, No. 61.s Summary data for 1977 were published in Aduance

Data from Vital and Health Statistics, No. 48,4

and again with greater detaiI in Vital and Health

Statistics, Series 13, No. 44.5

Data collection and processing for the 1977

National Ambulatory Medical Care Survey were

the responsibility of the University of Chicago’s

National Opinion Research Center. Sample selection was accomplished with the assistance of the

American Medical Association and American

Osteopathic Association.

Scope of the Survey

The basic sampIing unit for the National

Ambulatory Medical Care Survey was the physician-patient encounter or visit. The current

scope of the NAMCS includes all office visits

within the conterminous United States made by

ambulatory patients to non federally employed

office-based physicians as classified by the

American Medical Association or the American

Osteopathic Association. The NAMCS physician

1
universe excluded physicians practicing in

Alaska and Hawaii and anesthesiologists, pathologists, and radiologists. Visits to physicians principally engaged in teaching, research, or administration; telephone contacts; and visits conducted

outside the physician’s office were also excluded.

The definitions for office, physician, patient,

and visit used to determine eligibility for the

National Ambulatory Medical Care Survey are

presented in appendix IL

Source and Limitations of the Data

The estimates in this report are based on

information obtained from Patient Records (see

appendix III) for a sample of visits provided by a

national probability sample of office-based physicians. The sample for the 1977 National

Ambulatory Medical Care Survey included 3,000

physicians, 507 of whom were not eligible (out

of scope) at the time of the survey. Of the 2,493

physicians who were eligible, 1,932 (77.5 percent) actually participated (see appendix I).

Sample physicians listed all office visits

during a randomly assigned 7-day reporting

period. Information was recorded on the Patient

Record, or encounter form, which supplied data

on a systematic random sample of 26,553 visits

by women aged 15 years and older and 16,137

visits by men of the same age.

Readers are urged to review the appendixes

to this report as information provided is necessary for proper understanding and interpretation

of the statistics presented. Appendix I contains a

general description of the survey methods, the

sample design, and the data collection and processing procedures. Methods of estimation and

imputation are also presented. The statistics in

this report are based on a sample of office visits

rather than on all visits and are subject to

sampling errors. Therefore, particular attention

should be paid to the “Reliability of Estimates”

section in appendix I. Charts of relative standard

errors and instruction for their use are also given

in appendix I.

Definitions of the terms used in this report

and in the survey operations are presented in

appendix H. Facsimiles of survey materials, such

as the introductory letter, the Patient Record

and Induction Interview forms, are furnished in

appendix 111.

By means of another program of the NCHS,

The Health Interview Survey (HIS) data were

collected on the utilization of physician services

through a household interview survey. These

estimates may differ from those in the National

Ambulatory Medical Care Survey because of

differences in the collection procedures, population sampled, and definitions. The Health Interview Survey are published in Series 10 of Vital

and Health Statistics.

PAT lENT CHARACTERISTICS

During 1977 an estimated 295 million visits

to office-based physicians were made by women

aged 15 years and older, which is an average of

3.5 visits per person per year (table 1). About 9

out of 10 visits were made by white women; 1

visit in 10 was made by women of black and

other races. The visit rate for white women, (3.6)

exceeded that for women of all other races

(2.7).

This rate increased with the advancing age of

the patient. Women aged 65 years and oIder

visited at the highest rate (4.4 visits per person

per year). This proportion reflected the high rate

of return visits for elderly women with chronic

diseases (table 12).

Table A shows that the median visit age’ of

white women (37.0 years) was higher than that

of black and all other women (33.1 years), but

that it did not differ significantly from that of

white men (36.7 years).

Women visited at a higher rate than did men

aged 15 years and older (the rate for men was

2.3 per person per year); rates were higher for

women than for men regardless of age (not

shown in table A).

Data on visits by men and other demographic information are found in the 1977

National Ambulatory Medical Care Survey summary.s Demographic data on visits according to

aMedian visit age should not be confused with

median path t age. The median visit age is based on

initial and return visits some of which can be by the

same patient. Calculation of median visit age includes

visits by patients under age 15 years.

2
Table A. Median visit age and standard error of the median in

years, by sex and race of patient: United States, 1977

Standard

Sex and race of patient Vgi;’g’l error of the

median

Ail visits ........ ...........................

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

E+-

~Wh ite ........... .............................. .... 37.00 0.56

Black and all other ........................ 33.11 1.12

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

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

Black and all other ..... ................... M .

lInc]ude~ visits by patients under 1s Years.

the location of the physician’s practice can also

be found in the same report,

PATlENT CONDITION

Principal Reason for Visit

Information obtained from item 6 of the

Patient Record represents a literal record of the

patients’ reasons for visiting physicians’ offices.

These data have been classified and coded

according to A Reason for Visit Classification

for Ambulatory Care (RVC), which has been

published in Series 2 of Vital and Health Statistics.6 The RVC was not used prior to 1977; the

National Ambulatory Medical Care Survey

Symptom Classij7cation7 was used instead to

code these data. Therefore previous data on the

reasons for women’s visits to physicians are not

comparable to data in this report.

The RVC uses a modular structure with the

basic categorizations of patients’ reasons for

visits represented by the following seven modules: (1) symptom; (2) disease; (3) diagnostic,

screening, and preventive care; (4) treatment; (5)

injuries and adverse effects; (6) test resuIts; and

(7) administrative.

The RVC6 contains a more complete

description of the various moduIes, their development, and application.

The expressed reason for the visit, which in

the physician’s judgment was most responsible

for the visit, was entered on the Patient Record

as the principal (first-listed) reason. The physician also listed additional reasons that are not as

important as the principal reason.

Women visited physicians for a broad spectrum of reasons. The 57 reasons shown in table

2 accounted for 67 percent of their total visits.

Routine prenatzd examinations and gynecological examinations primarily account for 10 percent of all reasons. When these visits are added

to visiti for blood pressure tests (3 percent),

general medical examinations (about 3 percent),

family planning, not otherwise specified, and

contraceptive device. (1 percent), and Pap smears

(about 1 percent), at least 18 percent of

women’s visits were shown to be for preventive

care. M of the separate reasons in the family

planning category are not incIuded in table 2.

However, family planning is discussed in greater

detail in a later section of this report.

Principal Reason for Visit and

Age of the Patient

The order and kind of the principal reasons

given for women’s visits change when listed by

the patient’s age. Table 3 shows 20 reasons most

frequently expressed by patients in each of the

four age groups. Prenatal and postpartum examinations, listed among the leading reasons given

by patients aged 15-44 years, are understandably

not among the reasons shown for older patients.

On the other hand, hypertension and diabetes

mellitus are prominent on the list for women

aged 45 years and older, but not for those less

than age 45.

Hypertension, arthritis, heart examination,

general weakness , and shortness of breath are

among those reasons given by patients aged 65

years and oIder and reflect the gerontological

conditions generally associated with women.

Request for a blood pressure check ranks

first among reasons given by women aged 45

years and older and accounts for 5 percent of aII

visits by women aged 45-64 and 7 percent of

those by women aged 65 and older, which

correlates with increased hypertension rates for

women of that age.

Gynecological examination is included

among the leading reasons for visits for al age

3
groups. Figure 1 illustrates the annual rate of

gynecological examination visits by the patient’s

age.

A Pap smear ceases to be a leading reason for

a visit after age 44 years. In an estimated 3.7

million visits, Pap smear was given as a principil

reason for the visit. However more than 30

million visits included a Pap test as a diagnostic

service (regardless of the patient’s reason for

visit). The latter visits are discussed in a later

section of this report. However, the reason for

the visit shows the intent of women regarding

preventive care. The age curve in figure 2 illustrates the annual visit rate in which Pap smear

was one of the reasons for the visit. For this

I I I I I I

15.24 25-34 35.44 45.54 55.64 65and

over

AGE IN YEARS

I

Figure 1. Annual rate of office visits with patient’s principal

reason for visit gynecological examination, by age of

plot, rates were based on the number of visits in

which the test was listed on the survey form

either as the principal reason or as an additional

reason. The latter were included because

patients may have also requested a Pap smear

during visits for other principal reasons, and

those visits are also a rough measure of the

patient’s intent regarding health care. Visit rates

for Pap tests declined after age 34, which corresponds to the decreasing rates of childbearing,

and suggests that women tend to neglect this

test when gynecological and pregnancy examinations are no longer routine.

Principal Reason for Visit and

Race of Patient

The principal reasons for visits by the

patient’s race are listed in table 4 according to

the subgroups of the RVC modules, that is, the

seven modules are categorized at the “upper

level” of specificity (see reference 6, p. 6).

Proportions of visits did not vary appreciably by

race except for symptoms referable to the eyes

and ears where proportions of visits by white

women were. significantly higher than those of

women of all other races.

120 r

, ~J

15-24 25.34 3544 45.54 65-64 65and

over

AGE IN YEARS

Figure 2. Annual rate of office visits with Pap smear as one of

patient: United States, 1977 the reasons for visit, by age of patient: United States,, 1977
Principal Reason for Visit and

Sex of the Patient

The symptom module of the RVC

accounted for about 69 percent of all reasons

for visits by both sexes aged 15 years and over

(table B). Women visited physicians more frequently for diagnostic, screening, and preventive

care than men did, chiefly for prenatal and

gynecological examinations and for family planning. A larger percent of visits by men were

classified in the injuries and adverse effects

group than were those by women. Examinations

for employment, licenses, and insurance (not

shown in table B) contributed to the higher

proportion of administrative reasons, given by

men than by women, a fact that reflects the

composition of the work force.

Principal Reason for Visit and Time

Since Onset of Complaint or

Symptom

One indicator of heahh care attitudes is the

relative amount of time that elapses between the

onset of a complaint or symptom and the visit

to the physician. However, this period can often

be influenced by factors not under the patient’s

controL Availability of a particular specialist,

scheduling, transportation, patient perception of

certain symptoms as inevitable, economics, or

other problems may contribute to postponement.

To estimate how long women waited before

seeing the physician, new problem visits were

separated from return visits. New problem visits

were either initial visits or visitsby patients that

the physician had previously seen for a different

problem.

The number of new problem visits (according to the subgroup classification in the symptom module) is itemized by the time since onset

of the symptom in table 5. Predictably, patients

with acute conditions, chiefly respiratory complaints, were more likely to visit the physician

within 1 week of symptom onset than those

with other symptoms were.

Table 6 shows the number of visits for

selected specific reasons and their proportion

according to the time since onset of symptom.

This table clearly shows that patients with problems, which are generally acute, such as a head

cold, sore throat, and cough, were more likely to

visit their physicians within a week than they

were to wait longer.

If the new problem visit for a prenatzd “

examination was the patient’s first visit for

suspected pregnancy, then 69 percent of the

women waited at least a month before making a

medical visit, which is not unusual. The data ako

indicate that the time of the first visit since

Table B. Percent distribution of office visits made bv uatients 15 vears and over bv wincipal raason for visit module, according to sex of

- patient: United Statas, 1977

Reason for visit module and RVC codel

:..

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

Symptom module ...................................................................................................................................... S001 -S888

Diseasemodula ..................................................................................................................................... .... DOO1-D088

Diagnostic, screening and preventive module ............................................................................................ X1 OO-X588

Treatment moduie ..................................................................................................................................... T100-T889

Injuries and adverse effects module .......................................,,, ,..,,,., .,,. ..,... ............................................... VOO1-V888

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

Administrative mdule ........................... ........ ............ ...................... ......................................................... A1OO-A14O

Other and uncodable entries ..................................................................................................................... UBB04J889

Sex of patient

EEIEI

Percent

distribution

100.0

W.6

5.1

15.2

2.9

3.7

0.6

2.1

0.8

100.0

69.0

5.8

5.9

E

0.3

6.4

0.8

lReason for visit codes are based on A Reason for VL?itClassification for Ambulatory Care (RVC).
onset of pregnancy for 34 percent of the 3.3

million visits was more than 3 months. (These

and other data are taken from source materials

and are not shown in tables or charts. )

Table 7 shows the time since onset of the

symptom or complaint by the patient’s age. The

highest proportions of new problem visits for all

ages fell in the time frame of 1-6 days. (Examination of the source data revealed a similar

pattern for men’s visits. )

Principal Reason for Visit and

Physician Specialty

About 40 percent of women’s visits to physicians were to generaI and farrdy practitioners

(GFP’s), 17 percent were to obstetrician-gynecologists (OBG’S), and 13 percent were to

internists. These three specialties accounted for

about 70 percent of the total number of visits

(table 8). White women were more likely to visit

psychiatrists than black women and other

women were, but additional differences in the

utilization of various specialties by women of

different races were not statistically significant.

Examination of the data on the most common symptoms and complaints by women to

the three most frequently visited specialties is

instructive. Data anaIysis focused on new problems as an indication of how a woman selects

her physician when faced with a new condition.

The data in table C provide a contrast between

the GFP and internist group and the OBG group.

The OBG’S treated 41 percent of patients who

presented symptoms referable to the genitourinary system. About the same proportion of

such symptoms were seen by GFP’s and internists. GFP’s and internists, who together

accounted for the majority of women’s visits

(about 52 percent), treated 73 percent of

women with general symptoms, 69 percent with

digestive complaints, and 65 percent with musculoskeletal complaints. Very small percents of

visits for these reasons were made to OBG’S.

Most women went to GFP’s or internists for

general examinations (80 percent). On the other

hand, about two out of three special examinations (chiefly prenatal and gynecological) were

conducted in OBG’S offices. FamiIy pIanning

was also clearly considered the domain of the

OBG by most patients.

Principal Diagnosis

The 58 most common principal diagnoses

associated with visits by women aged 15 and

older are shown in table 9. These diagnoses

accounted for 66 percent of women’s visits.

Table C. Number and percent of new problem office visits made by women 15 years and over, by selected principal reasons for visit and

selected physician specialties: United States, 1977

principal reason for visit and FIVC codel

General symptoms .......................................................................................sool.so99

Symptoms referable to the digestive system .....................................o..........S5OO.S639

Symptoms referable to the genitourinary system .........................................S64O.S829

Symptoms referable to the musculoskeletel system .....................................s900-s999

General examinations ............................................................................. ... x1oO-XI99

Special examinations ........................................................................ ......... X200-X299

Diagnostic tests .......... ........................................................................... ..... X300-X399

Family planning ......................................... .................................... .. .......... X500-X599

Preoperative and postoperative care ............................................................ T2O&T299

Number

of new

problem

visits in

thousands

8,048

8,050

12,343

11,300

2,522

8,709

2,529

2,123

1,159

Physician specialty

E

Percentz

72.8 * 5.Q

68.6 8.3

4? ,9 40.8

64.5 *2.8

79.8 * 8.0

18.9 67.0

79.3 * 15.9

36.6 62.3

*30.6 41.9

1Reason for visit codes are based on A Reason for Visit Classification for Ambulatory care (RVC).

Zpercents ~ill not add to 100.o btxause allphysician spwialtiea are not shows in the ~dble.

6
Prenatal care and medical or special examinations constituted 13 percent of the total. At

least 13 percent of the patient visits were for

disorders unique to women. (Although a one-toone correlation between reason for the visit and

the diagnosis was not expected, a positive connection was found in the data. )

Figure 3 illustrates annual visit rates for

prenatal care by age groups. Visit rates for

disorders of menstruation and menopausal

symptoms are plotted in figure 4. Understandably, visit rates for menopausal symptoms rise

with advancing age and those for disorders of

menstruation fall, The curves intersect within

the group aged 35-44 years.

01 I 1 1 I

15.19 20.24 25.34 35-44

AGE IN YEARS

Figure 3. Annual rate of office visits for prenatal care (Y06),

by age of patient: United States, 1977

Essential benign hypertension, neuroses, and

diabetes mellitus were the three Ieading morbidity-related diagnoses which accounted for 10

percent of the total visits.b

Principal Diagnosis and Age of

the Patient

Table 10 shows how the predominance of

certain diagnoses changed with advancing age as

the principal reason for the visit did. Prenatal

bThe reader is cautioned that the rank order of

numbers of visits may be somewhat artificial because

many estimates are not statistically different from other

near estimates because of sampling variabilityy.

i

/

j’

Disorders of menstruation

/f

/

/J

/1

/1

[1

i

I

1

I

I

I

I

1

I

I

I

\

1

I I I i I

15.24 25.34 35’44 45.54 55 and

AGE IN YEARS

over

Figure 4. Annual rate of office visits for disorders of menstruation (626) and menopausal symptoms (627), by age of

patient: United States, 1977

7
care accounted for 18 percent of visits in the

group aged 15-24 years and declined to 11

percent in the group aged 25-44 years. Vkits for

hypertension increased from a low of about 1

percent for women aged 25-44 years to a high of

11 percent for those aged 65 years and over.

The importance to women to maintain good

health is demonstrated by the fact that medical

or special examinations continued to be the

second leading diagnosis for visits until age 65

years at which age these examinations placed

ninth. At age 65 years, however, visits for

chronic conditions, with their relatively high

rate of return visits, were more common than

those for younger age groups. The most frequent

diagnoses for elderly patients included chronic

ischemic heart disease and symptomatic heart

disease (about 10 percent); osteoarthritis and

allied conditions plus arthritis, unspecified (7

percent); cataract and glaucoma (about 3 percent) (table 10).

The need for surgical aftercare persisted

throughout all age groups, but was probably

caused by dissimilar categories of surgery

depending on the age group. Unpublished data

from the 1977 Hospital Discharge Survey

(HDS), a survey conducted by the Division of

Health Resources Utilization Statistics, The

National Center for Health Statistics, show that

the rates of some surgical procedures varied

considerably by age group.8 Table D shows that

rates per 10,000 women were higher for women

aged 65 years and over than they were for all

other age groups for ophthalmological surgery

(197.1), vascular and cardiac surgery (129.6),

abdominal surgery (288 .8), urological surgery

(72.8), and orthopedic surgery (278.3). However, women aged 25-44 years had more gynecological surgery (818.7 per 10,000) than other

women did. Obstetrical procedures were highest

among patients aged 15-34 years (348. 1 for each

10,000 in that age group). Rates for breast

surgery were not as high and did not vary among

age groups as much as the rates for other

procedures did. The rates ranged from a low of

19.0 per 10,000 for patients aged 15-24 years to

a high of 64.2 for women aged 45-54 years.

Principal Diagnosis and Principal

Reason for Visit

The NAMCS data cannot be examined retrospectively and statistically to “predict” i~ relationship between a reason for a visit and the

final diagnosis. However, data on symptoms that

can result in diagnoses of varying degrees of

gravity, such as “lump or mass of breast” and

“vision dysfunction, ” can be evaluated in terms

of the distribution of their visits by diagnosis.

Table E shows that of the 2 million visits in

which a lump or mass of breast was the :reason

for the visit, chronic cystic disease of breast or

Table D. Rate of all-listed operations 1 for female patients discharged from short-stay hospitals, by a9e of Patient and selectedl surgical

categories: United Statesr 1977

Age of patient

Surgical category and ICDA Code2

15-24 25-34 35-44 45-54 55-64 6!5 yeers

years years years years years and over

Neurosurgery ..........................................................................................ol.o5

Ophthalmology ................................................................................. ......O6.l4

Vascular and cardiac surgery ..................... ................. ....................... ......24.3O

Abdominal surgery .................................................................................38.48

Urological surgery ............ .......................................................................54.6l

Breast surgery ..............................................................................................65

Gynecological surgery ...................... ..................... ............................... ...67.72

Obstetrical procedures ............................................................................74.78

Orthopedic surgery ............................... ....................................... ...........8O.9O

5.8

0.9

7.5

92.8

20.8

19.0

259.0

327.9

82.1

Rate per 10,000 population

16.1 19.9 6.8 36.5

8.6 28.8 35.0 68.1

17.2 35.3 60.9 90.5

149.4 150.2 174.5 218.4

36.2 49.2 42.5 62.1

42.2 62.3 64.2 46.6

827.0 807.3 558.4 266.3

372.7 91.0 3.8 0.4

88.5 136.9 185.4 92.4

21.1

197.1

128.6

288.8

72.8

44.8

152.1

278.3

——

Icalc”]ated from unpublished data collected in the Hospital Discharge Suwey, 1977.

2Based on the Eighth Revision International Classification of Diseases, Adapted for Use in the United States (ICDA).
other diseases of the breast was diagnosedin 46

percent with a decision of malignant neopIasm

in only 6 percent. Benign neoplasms or those of

an unspecified nature were found in about one

of three visits.

Table F shows that visits prompted by vision

dysfunction (3.9 milIion) resulted mainly in a

diagnosis of refractive error (46 percent). Cataracts accounted for 17 percent, and gIaucoma

was diagnosed in about 6 percent.

Principal Diagnosis and Race

of the Patient

Proportions of visits for selected principal

diagnoses are shown in table 11 by race of the

patient. White women visited office-based physicians proportionately more often for neuroses

and medical or special examinations than other

women did. The relative frequency of visits by

women of black and other races exceeded that

of white women for diabetes mellitus and

hypertension. Other differences were not statistically significant.

Prevalence rates for diabetes mellitus and

hypertension are also higher among women of

black and other races than among white

women.g J10 A higher prevalence disease rate for

a specific group might resuIt in increased visits

for medicaI care for that disease by that group.

However, table G shows that the percents of the

difference in rates by race were disproportionate, that is, physician visit rates for women other

than white were not as high as expected considering the differences in prevalence rates.

Although the prevalence rate for women of

bIack and other races for diabetes mellitus was

39 percent higher than that of white women,

their visit rate was only 27 percent higher.

SimilarIy, the prevalence rate of hypertension

for women of races other than white exceeded

that of white women by 82 percent, but their

visit rate was only about 1 percent higher. These

data indicate that black women and women of

other races either are not seeking care for their

problems with the same frequency as white

women, or are obtaining care in settings other

than the office of the private physician. The

reason couId be a combination of both factors.

Data from HIS show that about 9 percent of

ambulatory medical care visits by white persons

Table E. Number and percent distribution of office visits made

by women 15 years and over with principal reason for visit

lump or mass of breast (S805),1 by principal cfiagnosis: United States, 1977

Principal diagnosis and ICDA code2

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

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

Chronic cystic disease of breast or other

disease of breast ....................................61 0-611

Neoplasm of unspecified nature of breast .......233

8enign neoplasm of breast ....... .......................217

Malignant neoplasm of breast or other

secondary malignant neoplasm3 ........ ...174. 198

Other diagnoses .........................................residual

All

visits

Number in

thousands

2,023

Percent

distribution

100.0

45.8

24.6

‘8.0

*5.9

15.7

lReaSon for ~jsjt codes are based on A Reason for Visit

Classification for Ambulatory Care (RVC).

p~ased on the Eighth Revision International t%@..ct7tI”on of

Diseases, Adopted for Use in the United States (ICDAJ

3Thjs diagnosis relates only to those visits where the princiPaI

reason for visit was coded “Iump or mass of breast.” A total of

987,328 visits were estimated where %mdignant neoplasm of

breast” was the principal diagnosis. Those visits included “lump

or mass of breast” plus other reasons.

Table F. Number and percent distribution of office visits made

by women 15 years and over with principal reason for visit

vision dysfunction (S305),1 by principal diagnosis: United

States, 1977

Principal diagnosis and ICDA code2 I

AlI

visits

Number in

thousands

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

I

3,887

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

Refractive errors ........... ..................................370

Cataract .................... .................... ..................374

Glaucoma ...........................v ...........................375

Other diagnoses .........................................residual

Percent

distribution

100.0

45.5

17.1

*5.5

37.9

lRexon for vj5it codes are based on A Reason for Visit

Classification for Ambulatory Cart! (RVC).

2Based on the Eighth Revision Internan.orud @Wific@.on of

Diseases, Adapted for Use in the United States (ICDA).

9
Table G. Prevalence rate by race of patient with percent of

difference, and visit rate by race of patient with percent of

difference, according to principal diagnoses diabetes

mellitus and hypertension: United States, 1977

Principal diagnosis and

ICDA codel

Diabetes mellitus (250)

Prevalence rate . ................

Visit rate ............................

Hypertension (401 )

Prevalence rate4 ... ..............

Visit rate ............................

Rate per 1,000

population

White Black and

all other

33.6 46.7

73.4 92.9

157.0 I

286.0

183.2 185.7

Percent of

difference

39.0

26.6

82.2

1.4

1~a~e-J on the Eighth Revision International Classification of

Diseases, Adapted fo; Use in the United States (ICDAj. -

2Visit rates are based on data from the 1977 National

Ambulatory Medical Care Survey (NAMCS). Prevalence rates

from the Health Interview Survey (HIS) and the Health and

Nutrition Examination Survey (HANES) are based on prior-year

surveys. However, few statistically significant differences in

NAMCS visit rates since the inception of the Survey have been

observed.

3Ba~ed on unpublished data from the 1976 StJPPlement to

the HIS. See reference 9.

4Based on data on women aged 18-74 Years ‘rem the

HANES. See reference 10.

were to hospital clinics or emergency rooms,

whereas 21 percent of visits by members of

other races were in a simiIar setting. 11

Principal Diagnosis and Sex

of the Patient

Women visited physicians proportionately

more often than men did for medical and

surgical aftercare which reflects the higher rate

of surgery performed on women (120.2 operations per 1,000 women versus 77.8 per 1,000

men).1 Z Fi~re 5 illustrates visit rates for

medical and surgical aftercare by patient age.

The highest visit rate for women occurred

between ages 45 and 64 years; the visit rate for

men rose to its highest point at age 65 years and

older. Table H shows that men visited the

physician proportionately more often than

women did for orthopedic aftercare, reflecting a

higher rate of orthopedic surgery for men (14.5

per 1,000) than for women (12.4 per 1,000

women). 12 About 81 percent of women’s visits

200

r

180 —

Male

i

/’

160 —

/’

z

g

~ ,40 _

~

.

g

?j. 120 –

K

t

L

~ lLW —

k

~

>

60 —

\

,~J15.24 25.34 35.44 45.54 55.64 65 and

over

AGE IN YEARS

Figure 5. Annual rate of office visits for medical and surgical

eftercare (YIO), by age and sex of patient: United States, 1977

Table H. Number and percent distribution of office visits made

by patients 15 years and over for medical and surgical

aftercare (Y IO) by principal 4-digit diagnosis, according to

sex of patient: United States, 1977

Principal diagnosis and ICDA codel

Sex of patient

v

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

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

Orthopedic aftercare ......... ................. YlO.4

Other surgical aftercare ...................... YlO.5

Other medical aftercare ...................... YlO.6

Other aftercare ............YlO.O. ‘f10.3, YIO.9

Number in

thousands

9,906 I 7,275

Percent

distribution

T

100.0 100.0

9.4 16.6

81.4 73.7

6.2 6.3

‘3.0 *3.3

l~ased on the Eighth Revision In temational Ckzwifimr”cvr‘f

Diseases, Adapted for Use in the United States (lCDA).

10
were because of other surgical aftercare compared with about 74 percent of the men’s visits.

Figure 6 vividly illustrates the contrast in

visit rates for women and men diagnosed with

acute upper respiratory infections and acute

pharyngitis. Women and men visited the physician at about the same rate when patients were

aged 25-34 years and over 54 years, but rates

varied considerably at other ages.

Visit rates by sex and age of the patient for

diagnoses of diabetes mellitus, obesity, hypertension, and arthritis and rheumatism are

plotted in figures 7-10. If the extent of physician utilization reflects attitude towards health

care, then NAMCS data for these four conditions provide evidence that women with certain

diseases tend to seek heaIth care proportionately

more often than men with the same conditions

do. Examining visit and prevalence rates for

these diagnoses demonstrates that the percent of

difference in the visit rates between the two

sexes was disproportionately larger than the

corresponding percent of difference in prevalence rates. Table J shows that the prevalence

rate for fern ales with diabetes mellitusg was 19

percent greater than that for men, but their visit

rate was 27 percent higher. Arthritis and rheumatism caused women to visit the physician at a

rate 67 percent higher than that for men

although their prevalence rate was only 26

percent higher than that of men. 13 Even more

startling is the extent of visits by women with

obesity and hypertension. Although the prevalence of obesity among women was 70 percent

higher than among men, 14 their visit rate was

over 300 percent higher than that of their male

counterparts. The hypertension prevalence rate

is the only one shown in table J in which the

male prevalence rate* 0 exceeds the female

prevalence rate, yet the female visit rate is 27

percent higher than that of the correspondkg

rate for males.

Heart disease tends to afflict more men than

women. The visit rate curves in figure 11 reflect

160

r

401-

,~

65 and

over

AGE IN YEARS

Figure 6. Annual rate of office visits for acute upper respiratory

infection of multiple or unspecified sites (462) and acute

pharyrsgitis (465); by age “and sex of patient: United

States, 1977

Af3E IN YEARS

over

Figure 7. Annual rate of office visits for diabetes mellitus

(260), by age and sex of patient: United States, 1977

11
120

r

100 —

z

: 80 -

5

3

i?

300 —

~.

u

E ~.

r

~

/

~.. 1-

g

%,

/

\

> 20 — ---

-------

Mole

,0

0

I I I

16.24 25.34 3s.44 45.54 s5.64 65 and

owr

AGE IN YEARS

Figure 8. Annual rate of office visits for obesitv (277). bv aaa

and sax of patient: Unitad States, 1977 - -

this fact because the visit rates for men exceeded

those of women. Both curves rise steadily with

advancing age. Detailed utilization data on visits

for coronary heart disease and symptomatic

heart disease can be found in an earlier NCHS

publication based on NAMCS data that describes

visits for diseases of the circulatory system.1 5

Visit rates for neuroses are graphed by age

and sex of the patient in figure 12. On the

average, women clearly visited the physician

more often than men did for this problem. The

highest rate for both sexes occurs between age

25 and 34 years. However, the rate for women’s

visits at that point (161 per 1,000) is almost

twice as high as that of men (about 85 per

1,000).

Conflicting reports regarding the validity of

interpretation of symptoms presented by

women abound. Some researchers theorize that

women’s symptoms are diagnosed as neuroses or

psychoses more often than those symptoms

presented by men are. 16 Unpublished data from

the Psychological Mental Health Index (PMHI),

a portion of the General Well-Being Schedule

(GWB) in HANES,l 7 show that on the average

women responded positively to having symp550 r Female

AGE IN YEARS

over

Figure 9. Annual rate of office visits for hypertension 1[401), by

age and sex of patiant: United States, 1977

toms of psychological stress more often than

men did. The PMHI has been shown to discriminate mental health clinic patients from population samples. 1s Another study supported the

capability of the GWB to measure psychcdogical

distress. 19 However, some researchers suggest

that differences in reporting “neurotic” symptoms may be related to the relative willingness

of women and men to report such symptom s.]

The NAMCS data show that proportions of

symptoms expressed by patients, whiclh were

likely to be associated with neuroses m- psychoses as diagnosed in visits to office-based

physicians, did not vary significantly by sex.

These reasons are detailed in table 1<. The

category “general symptoms” may include, for

example, tiredness or exhaustion, general weakness, and general ill feeling. Symptoms referable

to psychological and men&.1

anxiety and nervousness,

dis&ders allude to

depression, anger,

12
450 r

Table J. Prevalence rate by sex of patient with percent of

difference, and visit rate by sex of patient with percent of

difference, according to selected principal cfiagno400

350

10+I

50

0

Figure 10. Annual rate of office visits for arthritis and rheumatism (71 2-715, 71 7-718), by age and sex of patient: United

States, 1977

problems with identity and self-esteem, behavioral disturbances, and so forth. SociaI problems

counseling ingludes such reasons as maritaI

problems, other problems of family relationship,

occupational, and social adjustment problems.

Table L presents information regardkg the

number of visits made by women and men that

included the symptoms listed in table K, and the

proportionate assignment of those symptoms to

the psychoses and neuroses diagnostic groups.z 0

For exampIe, the 9,150,000 visits made by

women with symptoms referable to psychological and mental disorders represented 3 percent

of their total visits (table K). Of this group,

about 12 percent were diagnosed in the psychoses group and 59 percent in the neuroses

group (table L). Men made 5,365,000 visits for

the same reason, also representing 3 percent of

their total visits (table K). Proportions of the

psychoses and neuroses diagnostic groups for

men were 14 and 66 percent, respectively. No

statistically significant differences were found

between women and men, either in the proporses: United States, 1977

Principal diagnosis, ICDA

code,l and rate

.

Diabetes mellitus (250)

Prevalence rate3 ....................I

Visit rate ...... ..................... .....

Obesky (277)

Prevalence rate . ........... .........

Visit rate ................................

Hypertension (401 )

Prevalence rate . ....................

Visit rate ............................ ....

Arthritis and rheumatism

(712-15,717-718)

Prevalence rate’

Visit rate ................................

Rate per 1,000

population

Male

29.6

59.6

140.0

15.5

192.0

127.8

124.4

79.2

Female

35.2

75.9

237.2

64.3

171.0

162.4

156.3

132.3

Percent of

difference

18.9

27.3

69.9

314.8

612.3

27.1

25.6

67.0

lFja~ed on the Eighth ~evjs”on I)h?r71dS-0r3d ck@ica*kWs ‘f

Diseases, Adapted for Use in the United States (ICDA).

2Vi~it rates are based on data from the 1977 National

Ambulatory Medical Care Survey (NAMCS). Prevalence rates

from the Health Interview Swey (HIS) and the Health and

Nutrition Examination Survey (HfiES) are based on prior-year

surveys. However, few statistically significant differences in

NAMCS viait rates since the inception of the Survey have been

obs rved.

5Based on unpublished data from the 1976 supplement to

the HIS. See reference 9.

4Based on data from the HANES for persons aged 20-74

year . See reference 14.

2Based on data from the HANES for persons aged 18-74

years, See reference 10.

6’fhe msde prevalence rate exceeds the female Prevalence

rate.

7C&~lated from data in the 1976 HIS. See reference 13.

tions of symptoms presented or in the diagnoses

rendered.

Principal Diagnosis and Return

I/kit Rate

The return visit rate is the ratio of return

visits to new probIem visits. This ratio is an

indicator of an attitude toward heaIth care as

weIl as a measure of physician utilization and

provides an index of the patient’s willingness to

return for medical care after a condition has

been diagnosed.

13
;

700 — 1’

Male\

650 —

I

/

/

603 — 1’

1’

/

550 —

i

/

500 — ;

z

g

~ 450

.

3

5m.

~ 400

s

:. /

m 350 /1

&

/1

L

< /{

E 300

* /’

~

5

/

250 — /

/

/

200 —

/

/

150 —

100 — /

/{

//

50 — /’

o .

15.24 25.34 35.44 45.54 55.64 65.74 75 and

over

AGE IN YEARS

Figure 11. Annual rate of office visits for heart disease (410-

413, 427), by age and sex of patient: United States, 1977

Return visit rates well above the average of

1.76 (table 12) tended to be associated with

chronic conditions such as diabetes mellitus,

chronic ischemic heart disease, hypertension,

and hay fever. Except for visits for menopausal

symptoms, patients with other female disorders

were not likely to make return visits because the

return visit ratio for each diagnosis is less than

one. On the average, pregnant women made

about four return visits for each initial visit for

prenatal care.

o~~1

15.24 25.34 55.64 65 and

over

AGE IN YEARS

Figure 12. Annual rate of office visits for neuroses (300}, by age

and sex of patient: United States, 1977

Seriousness of Condition

“Seriotisness” refers to the physician’s clinical judgement regarding the extent of the

patient’s impairment that might result if care

were unavailable. With this criterion, physicians

were requested to rate the patient’s condition on

a four-point scale ranging from “not serious” to

“very serious. ” This measure of seriousness is

highly subjective, and data should be viewed in

this context.

Table 13 shows that in 82 percent of all

women’s visits the physician evaluated the condition as not serious or slightly serious with the

balance considered serious or very serious. These

proportions varied according to the patient’s

age. Problems were more likely to be judged

serious or very serious when women were aged

14
Table K. Number and percent of office visits made by patiants 15 years and over, by sex of patient and selected principal reasons for

visit: United States, 1977

I

Sex of patient

Famale Male

Principal reason for visit and RVC codel

, Number Percent Number Percent

in of in of

thousands visits 2

thousands visits 2

All reasons ........ ................................................ ............................................. 294.958- 100.0 171,338 100.0

General symptoms ........................................................................................soo5.so95 21,531 7.3 11,712 6.8

Symptoms referabla to psychological and mental dtsorders .............. ........ ....S100-S165 9,150 3.1 5,365 3.1

Symptoms referable tothe nervous system (excluding sanseorgans) .. ......... ..S2OO-S24O 12,077 4.1 5,791 3.4

Psychotherapy ............................................ ...... ......... ....... ......................... ........... T410 1,272 0.4 1,011 0.6

Social problems counseling ..........................................................................T7W.T73O 1,468 0.5 1,031 0.6

1Reason for visit codes are based on A Reason for Visit Classification for Ambulatory Care (RVC).

2percent5 ~]1 not add to 100.o because all reasons fOr Visit are not listed.

Tabla L. Number and percent of office visits made by patients 15 yaars and over for selected principal reasons for visit, by selected

diagnostic groups and sax of patient: United States, 1977

Principal reason for visit, RVC code,l and sex of patient

General symptoms (S005-S095):

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

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

Symptoms referable to psychological and mental disorders (S100-S1 65):

Famale ............................. ...................................................... ...............................

Male .............!..... ......................................... .................................................... ......

Symptoms referable to the nervous system (excluding sense organs) (S200-S240):

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

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

Psychotherapy (T410):

Famale ........ .......................... ...... .............. ......... ......................... ..........................

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

Social problems counseling (T700-T730):

Famale ................................................................................................... ..... ..........

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

Reason for visit

Number in

thousands

21,531

11,712

9,150

5,365

12,077

5,791

1,272

1,011

1,468

1,031

Parcent

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Diagnostic group and

ICDA codez

m

Percant3

*0.3

‘0.4

11.6

13.7

*0.5

“0.6

*26.9

*18.O

*9.0

*I 0.1

4.3

4.5

59.4

66.1

12.6

8.o

64.5

77.5

75.5

82.0

lReeaon for visit codes are based on A Reason for Visit Classification for Ambulatory Care (RVC).

2~ased on the ~igh th Revin-on International C[msificafion of Di~mes, Adapted for Use in the United stcl@S (ICDA).

3F’ercents will not add to 100.0 because all diagnostic groups are not listed.
Table M. Return visit rate for women 15 years and over, by

seriousness of condition: United States, 1977

Return

Seriousness of condition visit

rate 1

Not serious ................................................................ 1.41

Slightly serious ................................ .............. ....... ... 1.79

Serious .......................................................... ............. 3.48

Very serious .......................................................... ..... 4.05

lThe return “i5it rate is the ratio of retUrn visits to new

problem visits.

45 years and over, thus reflecting the high

proportions of visits made by older women for

chronic conditions. The lesser proportions of

serious or very serious problems in groups aged

15-24 years and 25-44 years reflect visits associated with the reproductive years that are

considered mainly routine and are generally

evaluated as not serious.

Table M relates the seriousness of women’s

problems to their return visit rate. As would be

expected, the more serious the condition, the

higher was the rate of return.

Seriousness of Condition and Sex of

the Patient

Problems were proportionately more often

described as slightly serious or not serious than

serious or very serious regardless of the sex of

the patient. For both women and men this

tendency declined with advancing age (table 13).

The lesser degree of seriousness for younger

women can easily be attributed to the preponderance of routine prenatal visits, although the

increased seriousness of the condition for older

groups of both sexes is probably because of the

onset of chronic problems such as heart disease.

In every age <group the problems of men

were, on the average, evaluated as serious or very

serious proportionately more frequently than

those of women were.

PATl ENT MANAGEMENT

Diagnostic and Therapeutic Services

The Patient Record contains a checklist of

types of diagnostic and therapeutic services.

However, for some services it is not possible to

estimate the intensity of the workup (e.g.,

X-ray) or the extent of therapeusis (e.g., drugs)

because the number of tests or prescriptions at

each visit are not recorded. The proportions of

these services ordered or provided during office

visits are shown in table 14 by age of the

patient, and in table 15 by race and sex of the

patient. Table 16 provides data relating diagnostic services to selected principal reasons for the

visit to the physician. Table 17 offers information on therapeutic services rendered with corresponding selected diagnoses.

Diagnostic and Therapeutic Services

and Age, Race, and Sex of the Patient

As in most NAMCS visits, the limited history

and/or examination was the most widely used

diagnostic service. More than half of the visits by

patients in all age groups of women included this

service (table 14). Blood pressure measurernents

also were taken during a large proportion of

visits made by all age groups. At least one in

four visits included one or more clinical laboratory tests. Pap tests were more common for

patients aged 25-34 years, which comprised 31

percent of the visits by that age group in

comparison with 2-16 percent for other age

groups. (These proportions represent visits in

which the Pap test was a diagnostic service

regardless of the patient’s reason for visit. )

Figure 13 shows that Pap tests tend to

decline as the patient’s age increases. Thle increasing proportions of blood pressure checks

with advancing age are also evident in figure 13.

The prescription of drugs increased from 46

percent of visits by women aged 25-34 years to

68 percent by those aged 75 years and older, but

other forms of therapy did not vary appreciably

by patient’s age (table 14). (As expected proportions of family planning services rendered to

patients between ages 15 and 34 years more

than doubled those of other age groups.)

Blood pressure was more likely to be ]measured and drugs were more likely to be ordered

during visits by black women and women of

other races than during white women’s visits

(table 15).

Men were more likely than women to have

X-rays and EKG’s, probably because they have a

16
60 —

50 -

./--

~

“.’4

/’ Cj do _

>

u

/“

Blocd prel$ure

;

30 -

check

g

2

20 -

‘0 -’apt”>

o

15.24 25.34 35.44 45.s4 5s.84 65.74 75 and

AGE IN YEARS over

Figure 13. Percent of offtce visits that included Pap test and

blood pressure check, by age of patient: Unitad Stetes, 1977

higher rate of injuries and heart problems.

However, visits by women were more likely than

those by men to include a clinical laboratory

test or a blood pressure check. (Additional data

on diagnostic and therapeutic services provided

female and male patients visiting a physician for

treatment of hypertension and heart disease may

be found in an earlier publication “Office Visits

for Diseases of the Circulatory System.”)1 b

Correlating with their higher proportions of

visits for injuries and adverse effects, men also

had proportionately more physiotherapy and

office surgery than women did (table 15).

Diagnostic Servicesand Patient’s

Principal Reason for Visit

The relationship of diagnostic services to the

patient’s principal reason for visit is shown in

table 16. Except for depression, vision dysfunction, and symptoms referable to the throat,

physicians made higher than average numbers of

blood pressure checks when the symptoms listed

in table 16 were presented. (BIood pressure

checks were made in 34 percent of all NAMCS

visits.)5 Clinical Laboratory tests were highly

represented in visits caused by painful urination

and vaginal problems. Pap tests were included in

33 percent of visits caused by vaginaI discharge

and in 43 percent of those where uterine and

vaginal bleeding was the principal reason for visit

(table N). X-rays were most commonly used

when the reasons shown in table O were

presented.

Therapeutic Servicesand Principal

Diagnosis

Table 17 shows that drug therapy ranged

from 34 percent of visits for hay fever to over

80 percent for those involving hypertension. At

Ieast 50 percent of the visits for neuroses,

obesity, diabetes meIlitus, chronic ischemic

heart disease, asthma, and eczema and other

dermatitis included drugs. Patients with menopausal problems visiting a physician were treated

with drugs about 78 percent of the time (not

shown in table). As expected, about three of five

visits by patients with neuroses included psychotherapy. Medical counseling was given to

patients with disorders of menstruation ‘ (30

percent) and menopausal symptoms (23 percent), as well as to those with the conditions

shown in table 17. Hay fever patients received

desensitization or immunotherapy during 63

Table N. Percent of office visits made by women 15 years and

over thet included a Pap test, by selacted principal reasons

for visit: United States, 1977

Principal reason for visit and RVC coda 1

I

Total I

Percant

Abdominal pain, cramps, and spasms..S56O 100.0 14.3

Uterina and vaginal bleeding..,,,.,, t......S756 100.0 42.8

Vaginal dlacharga,,O,.,,,.,.,....................S780 100,0 33.3

Other vaginal symptoms .....................S765 100.0 23.2

lReason for visit codes are based on A Reason for Wit

CIamiffcation for Ambulatory Care (RVC).

Table O. Parcent of offica visits made by women 15 years and

over that included X-ray, by selected principal reasons for

visit: United States, 1977

I 1

Reason for visit and RVC code 1

I

Total Percent

1 1

Beck symptoms ..................................S905 100.0 17.1

Low back symptoms ...........................S9lO 100.0 19.4

Chest pain and related symptoms (not

referable to body system) ................S050 100.0 22.6

Cough .................................................S440 100.0 12.8

lReeson for visit codes are based on A Reason for Visit

Class[37cationfor Ambuk7tory Care (RVC).

17
percent of their visits. Patients with problems of

obesity were given diet counseling in an estimated 68 percent of their visits.

Disposition of Visit

Continuity of care is an important aspect of

patient management. The intent of the physician

regarding the patient’s need for ongoing care is

reflected by the disposition of the visit. Most

visits concluded with instructions to the patient

to return at a specified time (table P). This

tendency was more pronounced when women

visited than when men did.

Referral

Of the 41 million women making an initial

visit to a physician (visits by new patients are

shown in table 19), 11.1 million, or 27 percent,

were the result of referral by another physician.c

Table 18 shows the distribution of these 11.1

cThe reader will notice an apparent discrepancy

between the number of visits designated as “referred

to other physician” (table P) and those referred from

another physician (table 18). Largely, this discrepancy

is because referrals can be made by physicians not in

the scope of the survey or by telephone or by other

means.

Table P. Number and percent of office visits made by patients

15 years and over, by sex of patient and disposition of the

visit: United States, 1977

Sex of patient

Disposition

Female I Male

Number in

thousands

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

I

294,958 I 171,338

\ Percentl

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

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

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

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

Refarred to other physician .....................

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

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

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

8.2

66.2

20.7

2.9

2.5

0.9

2.0

1.3

11.8

60.8

21.2

2.7

2.8

0.9

2.3

1.3

lPercents will not add

disposition was possible.

to 100.0 because more than one

million visits according to principal diaemosis.

Two groups of conditions were responsible for

about 22 percent of referred visits: diseases of

the nervous system and sense organs (11 percent) and diseases of the genitourinary system

(11 percent).

Duration of Visit

Visit duration, as estimated by the physician, is the amount of time spent in direct

encounter with the patient. Although some visits

require and consume much of the physician’s

time, others do not. This fact does not imply,

however, that care was not rendered. l[n the

framework of the NAMCS definition, therefore

visits could conceivably consume more physician’s time because treatment could have been

appropriately delegated to the physician’s staff.

Physicians also devote time to patient care that

is not necessarily performed in the presence of

the patient, such as evaluating test results,

reading X-rays, reviewing histories, and consulting with other physicians. Duration estimates,

therefore, are presented mainly for comparative

purposes and not as the total time spent in care.

Table 19 shows the proportions of physician

visits estimated in discrete time categories by

selected patient characteristics and seriousness

of the patient’s condition. Regardless of the

patient’s race, age, or status, the majority of

visits lasted 15 minutes or less. (Examination of

the source data indicated that no significant

difference was shown in visit duration by sex of

the patient.) No contact was found between the

patient and the physician in only a small percent

of the visits. A higher proportion of visits made

by white women took 31 minutes or longer

(about 7 percent) than did those made by black

and other women (about 3 percent).

It appears, however, that the duration of the

visit was probably more dependent on the status

and condition of the patient than on her race or

age. New patients were more likely to see the

physician for 16 minutes or more than returning

patients were. Usually, new patients require

more time for history, examination, and other

aspects of a workup. The more serious the

patient’s condition, the higher the proportions

of visits were in the categories 16-30 minutes

and 31 minutes or more.

18
Table 11 shows that white women were

more likely than black women and women of

other races to visit physicians for medical or

special examinations and for treatment of

neuroses. This, together with the relatively more

frequent use of psychotherapy in visits for

neuroses, may account for the dominance of

visits by white women in the longer time

categories.

Table Q lists the mean contact duration of

visits according to principal diagnosis. The mean

contact duration is the average number of

minutes per visit that included contact with the

physician. Thus, the duration of contact with

only other staff is included in the survey (and is

shown under O minutes in table 19), but is

excluded from the calculation of the mean.

Visits involving mental disorders or nervousness

Table Q, Mean contact duration of office visits made by women

15 years and over, by ‘selected cwinci~al diaanoses: United

States, 1977

Principal diagnosis and

ICDA codel

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

Diabetes mellitus .........................................25O

Obesity ............................ ........ ...................277

Neuroses ......................................... ............3OO

Personality disorders ...................................301

Refractive errors ........................ .................37o

Cataract ............................................l .........374

Glaucoma ....................................................375

Essential benign hypertension ................... ..4oI

Chronic ischemic heart disease ....................41 2

Acute pha~ngitis ........................................462

Acute upper respiratory infection of multiple

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

Hay fever ......... ............. T.............................5O7

Infective diseases of uterus (except cervix),

vagina, and vulva ............. .........................622

Disorders of menstruation ...........................626

Menopausal symptoms ......................... .......627

Other eczema and dermatitis .......................692

Osteoarthritis and allied conditions .............7l3

Arthritis, unspecified ..................................715

Nervousness and debility .............................79O

Medical or special examination .. ................ YOO

Prenatal care ..............................................YO6

Medical and surgical aftercare ....................YIO

Mean

contact

duration2

(in minutes)

15.4

15.2

15.6

31.1

47.0

22.0

22.6

74.4

14.8

15.7

11.0

12.2

13.8

16.8

17.5

14.9

11.5

17.0

14.7

24.6

17.1

10.7

12.6

l&sed on the Eighth Revision International C[assific?atim of

Diseases, Adapted for Use in the United States (lCDA).

2Time spent in face.t@face encounter between physician and

patient.

and debility,d eye conditions (except glaucoma),

and mediczd or special examinations consumed

more time on the average than visits for other

conditions did. Vkits for acute, self-limiting

conditions and prenatal care took less than the

average time of 15.4 minutes per visit; but the

duration of visits for chronic problems, such as

hypertension, diabetes mellitus, and heart

disease, hovered - closely around the average.

These data clearly show that the length of the

visit was influenced more by the nature of the

patient’s condition than by demographic variables.

FAMILY PLANNING

Family planning data presented in this

report are based on estimates of visits made by

women aged 15-44 years. An earlier report

published in Advance Data from Vital and

Health Statistics 1 included data for patients of

both sexes aged 15 years and over. Calculations

of rates for that report were based on the

corresponding population. Therefore, the two

reports are not comparable.

Data on family planning services are also

reported from the National Survey of Family

Growth (NSFG), which is based on a sample of

currently married women aged 15-44 years who

have made a family planning visit,z 2 and by the

National Reporting System for Family Planning

Services (NRSFPS), which is based on reports

by a sample of organized family planning service

sites.23 Because of the differences in the populations sampled, and the differences in the definitions and collection procedures, statistics on

family planning visits from these data systems

differ.

The RVC delineates commonly presented

types of famiIy planning reasons for visiting

physicians that are coded on the Patient Record

as the principal reason or as an additional

reason. Because patients who visit physicians

principally for reasons such as general examination, postpartum examination, and gynecological examination often take the opportunity to

‘Visits coded “nervousness and debility” were

chiefly described as “depression” by the physician.

19
discuss or obtain family planning services, this

report is based on estimates of visits where

family planning was listed on the form as any

one of the reasons. By the same logic, visits

where family planning was checked as a therapeutic service on item 12 of the Patient Record

are also included in the aggregation of family

planning visits. However, these visits were

counted only once, that is, a visit which indicated that a family planning therapeutic service

was given was included only if family planning

was not listed as one of the reasons for the visit.

Thus, table R shows that family planning was

expressed by the patient as a reason for the visit

in about half of the 9.7 million total family

planning visits–in the other half, patients

received a family planning therapeutic service in

addition to other medical care, and reasons for

the visit other than family planning were given.

It is not known whether some patients were

reluctant to say that family planning was the

reason for their visit or whether the subject,

possibly related to the presenting problem, arose

during the course of the visit, However, for

estimating the extent of utilization of private

physicians for family planning services these

encounters should be considered “family planning” visits. About half of the time that family

planning was a part of a visit, it was a service

given during visits for other purposes, (The

principal reasons for such visits are shown in

table V.) The patient’s age or sex made no

difference in whether family planning was or

was not specifically given as a reason because

differences in these percents are not statistically

significant.

Patient Age and Race

Most family planning visits were made by

women aged 20-34 years (78 percent) representing an average of about 288 visits for each

1,000 women of that age in the United States

(table S). Patients aged 15-19 years accounted

for about 12 percent of the total with a visit rate

of about 116 per 1,000. Predictably, visits by

patients in their later reproductive years

declined considerably.

Proportions of family planning visits by race

reflected the composition of all NAMCS visits,

with a higher rate of visits by white women than

by those of black women and women of other

races. The general rate of visits by white wc]men

was 33 percent higher than that of all clther

women; the family planning visit rate was 64

percent higher. However, the smaIl sample of

visits by black women and women of other races

for family planning tends to minimize what may

appear to be very large differences in proportions and rates. Available data sources indicate

Table R. Number of family planning office visits made by women 15-44 years and percant distribution by whether family planning was

a stated reason for the visit or a therapeutic service was given, according to aga and rata of patient: Unitad Statas, 1977

Age and race of patient

All family planning visits...............................................................................

—Age

15-19 years....................................................................................................................

20-34 years....................................................................................................................

35-44 years....................................................................................................................

Race

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

Black and all other .................................................................................................... ...

Number

in

thousands

9,685

1,199

7,532

954

8,78S

597

+

Family planning visits

Total

Reason

for visit

statad

Therapeutic

service

given

100.0

100.0

100.0

100.0

100.0

100.0

Percent distribution

52.1

54.9

52,4

46.1

51.0

62.3

47.9

45.1

47.6

53.9

49.0

37.7

20
that white patients tend to visit private physicians for family planning services at a higher rate

than black patients, but black patients visit

organized family planning clinics at a higher rate

than white patients do. Of the white female

respondents in the NSFG with a family planning

visit in the last 3 years, 86 percent reported

visiting a private physician in his office; but only

63 percent of the black respondents reported

the location as the physician’s office.z z On the

other hand, organized family planning clinics

that reported to NRSFPS in 1976 showed an

enrollment rate of roughly 144 per 1,000 black

women aged 15-44 years in the population,

compared with only about 44 per 1,000 white

women of the same age.zs The reader should

note that the NAMCS visit rate includes initial

and return visits, but the NRSFPS enrollment

rate is based on an unduplicated count of

patients.

Physician Specialty

Most family planning visits (73 percent)

occurred in the offices of OBG’s with an

additional 25 percent made to GFP’s (table T).

When sampling variability is taken into account

the patient’s age or race did not appear to make

a difference in the choice of physician by

specialty.

Patient’s Reason for Visit

Table S. Number, percent distribution, and annual visit rate of

office visits made by women 15-44 years for family planning, by age and race of the patient: United States, 1977

Age and race of patient

Number

in

thousands

Percent

distribution

Visit rate

per 1,000

population

All family plannin!

. .

Vlslts .................

—Age

15-19 years ............ ...... ..

20-34 years ....................

35-44 years ....................

Race

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

Black and all other, ........

9,685 100.0 200.0

About 96 percent of the 5 million visits by

patients who specifically stated they were visiting for family planning or related reasons felI

chiefly into three major groups: those who

visited for counseling, examinations, and general

advice; those who visited for the prescription or

renewal of contraceptive medication; and those

1,199

7,532

954

8,788

897

12.4

77.8

9.9

90.7

9.3

116.1

288.1

79.7

211.8

128.9

Table T. Number and parcent distribution of family planning office visits made by women 15-44 years by most visited physician

specialty, according to age and race of patient: United States, 1977

Physician specialty

Number

in

thousands

Age and race of patient

Total

General

and family

practice

Obstetrics

and

gynecology

Al I

other

specialties

Percent distribution

All ages ............................................................. ................ ....

@

15-19 years ........... ................................................................................

20-34 years ..... .............. ................... ............................. ........................

35-44 years ...................................... .....................................................

&e

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

Black and all other ............... .............. .................................. ................

9,685 100.0 25.2 72.9 1.9

1,199

7,532

954

8,788

897

100.0

100.0

100.0

100.0

100.0

37.5

22.4

●27.2

23.6

*35.3

58.5

73.6

68.4

72.2

62.2

‘4.0

+4.0

*4.4

4.2

2.5

21
who required insertion, removal, or checkup of

contraceptive devices (table U). (Predictably, it

was observed that teenagers were proportionately more likely to visit the physician for

contraceptive medication than they were for a

contraceptive device. )

Surgical sterilization and abortion were relatively rare for worn en visiting private physicians.

Visits made by patients who received a

family planning therapeutic service without

having directly expressed family planning as one

of their reasons for the visit tended to be

associated with special examinations. Table V

shows the types of examinations given in the 63

percent of these visits. Of these visits, 17 percent

were for routine prenatal examinations and 19

percent were for postpartum examinations, indicating that family planning was considered both

during pregnancy and following delivery.

Diagnostic and Therapeutic Services

Compared with NAMCS visits for all reasons,

patients visiting for family planning received

proportionately more Pap tests, blood pressure

checks, clinical laboratory tests, and general

examinations (table W).

The rate of Pap tests performed during

family planning visits in physicians’ offices

(about 51 percent) was similar to that of the

organized family planning clinics measured by

NRSFPS.23 However, blood pressure checks

were proportionately more frequent during

Table U. Number and percent distribution of office visits made

by women 15-44 years with a family planning reason for

visit, by reason category: United States, 1977

Number Percent

Reason category and RVC codel in distrithousands bution

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

L

5,042

Family planning, not otherwise

specified ............ ....................... X5OO

Contraceptive medication ........... X505

Contraceptive device . ........ ........ X510

All other family planning

reasons ..... X51 5, X520, X525, X530

1,742

1,565

1,525

’210

100<0

34.6

31.0

30.3

+4.1

lReas~n for visit codes are based on A Reason forvi~r

Classification for Ambulatory Care @VC).

21nclu&~ IUD insertion, removal, or checkup: diaphragm

insertion, removal, or checkup.

clinic visits (about 78 percent) than they ‘were

during the physician visits that were estimated in

NAMCS (about 61 percent).

Patient age was apparently not a determining

factor in the physician’s provision of services,

because for each service shown in table W the

differences in the proportions by age (not shown

in table) were not statistically significant.

Table V. Number and percent distribution of office visits made

by women 15-44 years that included a family planning

therapeutic service but not a family planning reason for

visit, by most common principal reason for visit: tJnited

States, 1977

Principal reason for visit and Number Percent

RVC codel in di!itrithousands bution

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

n=

4,643 100.0

Gynecological examination ......... X225 908 19.6

Postpartum examination ............. X2I5 880 19.0

Prenatal examination, routine ..... X205 787 17.0

Pap smear ....................................X365 *336 7.2

All other reasons ............ ..........residual 1,732 37.2

lReason for ~5it codes are based on A Reason fol’ visit

Classification for Ambulatory Care (RVC),

Table W. Number and percent of National Ambulatory Medical

Care Survay (NAMCS) visits and numbar and percent of

family planning visits made by women 15-44 years, by most

common diagnostic and therapeutic services: IJnited

States, 1977

Most common diagnostic and

therapeutic sarvice

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

Limited history and/or

examination .............................. ....

Genaral history and/or

examination ....... ...........................

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

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

Blood pressure check .......................

Drugs (prescription or nonprescription) ......................................

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

Medical counsel ing, .......... ................

Psychotherapy or therapeutic

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

-L-Al I

All NAMCS farnil y

visits planning

visits

Number in thousands

153,504 I 9,685

Percent

57.4

21.1

13.7

26.3

39.9

48.7

7.2

18.9

7.5

49.5

38.4

51.1

35.0

60.6

43,3

7.0

21.8

*4.6

22
REFERENCES

1National Center for Health Services Research:

Women and their health: Research implications for a

new era. in V. Olesen, ed.. Research Proceedings Series.

DHEW Pub. No. (HRA) 77-3138. Health Resources

Administration, Hyattsville, Md., 1977.

2National Center for Health Statistics: Current

estimates from the Health Interview Survey: United

States-197 7, by L. J. Howie and T. F. Drury. Vital and

Health Statistics. Series 10-No. 126. DHEW Pub. No,

(PHS) 78-1554. Public Health Service. Washington. -U.S.

Government Printing Office, Sept. 1978.

3National Center for Health Statistics: National

Ambulatory Medical Care Survey: Background and

methodology, United States, 1967-72, by J. B. Tenney,

K. L. White, and J. W. Williamson. Vital and Health

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

74-1335. Health Resources Administration. Washington.

U.S. Government Printing Office, Apr. 1974.

4National Center for Health Statistics: 1977 Summary: National Ambulatory Medical Care Survey, by T.

Ezzati and T. McLemore. Advance Data from Vital and

Health Statistics, No. 48. DHEW Pub. No. (PHS) 78-

1250. Public Health Service. Hyattsville, Md., Apr. 13,

1979.

5National Center for He’alth Statistics: The National

Ambulatory Medical Care Survey: 1977 Summary, by T.

Ezzati and T. McLemore. Vital and Health Statistics.

Series 13-No. 44. DHEW Pub. No. (PHS) 80-1795.

Public Health Service. Hyattsville, Md. In preparation.

6National Center for Health Statistics: A reason for

visit classification for ambulatory care, by D. Schneider,

L. Appleton, and T. McLemore. Vital and Health Statistics. Series 2-No. 78. DHEW Pub. No. (PHS) 79-1352.

Public Health Service. Washington. U.S. Government

Printing Office, Feb. 1979.

‘National Center for Health Statistics: The National

Ambulatory Medical Care Survey: Symptom Classification, by S. Meads and T. McLemore. Vital and Health

Statistics. Series 2-No. 63. DHEW Pub. No. (HRA)

74-1337. Health Resources Administration. Washington,

U.S. Government Printing Office, May 1974.

8National Center for Health Statistics: Unpublished

data from the 1977 Hospital Discharge Survey.

9National Center for Health Statistics: Unpublished

data from the 1976 diabetes mellitus supplement to the

Health Interview Survey.

1‘National Center for Health Statistics: Blood pressure

levels of persons 6-74 years, United States, 1971-1974,

by J. Roberts and K. Maurer. Vital and Health Statistics.

Series 1l-No. 203. DHEW Pub. No. (HRA) 78-1648.

Health Resources Administration. Washington. U.S.

Government Printing Office, Sept. 1977.

11National Center for Health Statistics: Physician

visits: Volume and interval since last visit, United States,

1971, by K. M. Danchik. Vital and Health Statistics.

Series 1O-NO. 97. DHEW Pub. No. (HRA) 75-1514.

Health Resources Administration. Washington. U.S.

Government Printing Office, Sept. 1977.

1‘National Center for Health Statistics: Utilization of

shortstay hospitals, annual summary of the United

States, 1977, by B. J. Haupt. Vital and Health Statistics.

Series 13-No. 41. DHEW Pub. No. (PHS) 79-1557.

Public Health Service. Washington, U.S. Government

Printing Office, Mar. 1979.

13National Center for Health Statistics: Prevalence of

chronic skin and musculoskeletal conditions: United

States-1976, by G. S. Bonham. Vital and Health Statistics. Series 1O-NO. 124. DHEW Pub. No. (PHS) 79-1552.

Public Health Service. Washington. U.S. Government

Printing Office, Nov. 1978.

14Nationd Center for Health Statistics: Overweight

adults in the United States, by S. Abraham and C. L.

Johnson. Advance Data from Vital and Health Statistics,

No. 51. DHEW Pub. No. (PHS) 78-1250. Public Health

Service. Hyattsville, Md., Aug. 30, 1979.

15Nation~ Center for Health Statistics: Office visits

for diseases of the circulatory system: The National

Ambulatory Medical Care Survey, United States, 1975-

76, by B, K. Cypress. Vital and Health Statistics. Series

13-No. 40. DHEW Pub. No. (PHS) 79-1791. Public

Health Service. Washington. U.S. Government Printing

Office, Jan. 1979.

16Chesler, P.: Women and Madness. New York.

Doubleday, 1972.

17Unpublished data from the Psychological Mental

Health =Index of the General Well-Being Schedule, Health

and Nutrition Examination Survey I (1971-75). H. J.

Du uy, Psychological Adviser. Personal communication.

1‘Dupuy, H. J.: Self-Representations of General

Psychological Well-Being of American Adults. Paper

presented at the annual meeting of the American Public

Health Association, Los Angeles, Calif., Oct. 17, 1978.

1‘National Center for Health Statistics: A concurrent

validational study of the NCHS General Well-Being

Schedule, by A. F. Fazio. Vital and Health Statistics.

Series 2-No. 73. DHEW Pub. No. (HRA} 78-1347.

Health Resources Administration. Washington. U.S.

Government Printing Office, Sept. 1977.

20 National Center for Health Statistics: Eighth

Revkion International Classification of Diseases,

23
Adapted for Use in the United States. PHS Pub. No.

1693. Public Health Service. Washington. U.S. Government Printing Office, 1967.

21 National Center for Health Statistics: Office visits

for family planning, National Ambulatory Medical Care

Survey, 1977, by B. K. Cypress. Advance Data from

Vital and Health Statistics, No. 49. DHEW Pub. No.

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

‘ii” National 16? ‘979” Center for Health Statistics: Use of family

planning services United States, 1976, by K. Bauman

and G. Hendershot. Vital and Health Statistics. Public

Health Service. Hyattsville, Md. To be published.

23 National Center for Health Statistics: Provisional

Data from the National Reporting System for Family

Planning Services, January 1976-December 1976.

Mimeograph.

24 National Center for Health Statistics: Replication:

An approach to the analysis of data from complex

surveys, by P. J. McCarthy. Vital and Health Statistics.

Series 2-No. 14. DHEW Pub. No. (HSM) 73-1269. Health

Services and Mental Health Administration. Washington.

U.S. Government Printing Office, Apr. 1966.

25National Center for Health Statistics: Pseudoreplication: Further evaluation and application of the balanced

half-sample technique, by P. J. McCarthy. Vital and

Health Statistics. Series 2-No. 31. DHEW Pub. No.

(HSM) 73-1270. Health Services and Mental Health

Administration. Washington. U.S. Government Printing

Office, Jan. 1969.

24
LIST OF DETAILED TABLES

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15,

16.

17.

18.

19.

Number and percent distribution of office visits made by women 15 years and over and number of visits per person per

year, by age and race of patient: United States, 1977 ..............................................................................................................

Number, percent distribution, and cumulative percent of office visits made by women 15 years and over, by principal

reasonsfor visit in rank order: United States, 1977 ..................................................................................................................

Number and percent distribution of office visits made by women 15 years and over, by age of patient and the 20 most

frequent principal reasonsfor visit: United States, 1977 ...........................................................................................................

Number and percent distribution of office visits made by women 15 years and over by principal reason for visit, according

to rata of patiant: Unitad States, 1977 .....................................................................................................................................

Number and percent of new problem office visits mada by women 15 years and ovar, by time since onset of complaint or

symptom and principal symptom: United States, 1977 ............................................................................................................

Number and percent of new problem office visits mada by women 15 years and over, by time since onset of complaint or

symptom and specific principal reason for visit: Unitad States, 1977 .......................................................................................

Number and parcent distribution of new problam offica visits mada by women 15 years and over by time sinca onset of

complaint or symptom, according to aga of patient: United States, 1977 .................................................................................

Number and percent distribution of office visits made by women 15 years and over by most visited physician specialty,

according to rata of patient: United States, 1977 .....................................................................................................................

Number, percent distribution, and cumulative percent of office visits made by women 15 years and over, by principal

diagnosas in rank order: United States, 1977 ............................................................................................................................

Numbar and percent distribution of office visits made by woman 15 years and over by age of patient and the 20 most

frequent principal diagnoses: United Statas, 1977 ....................................................................................................................

Number and percant of office visits mada by women 15 years and ovar, by race of patient and selected principal diagnoses:

United States, 1977 ...................................................................................................................................................................

Return visit rate for women 15 years and over, by selected principal diagnoses: United States, 1977 .......................................

Numbar and percent distribution of office visits made by patients 15 yaars and over by seriousnessof the problem, according

to age and sex of patient: United States, 1977 ..........................................................................................................................

Number and parcent of office visits made by patients 15 years and over, by age of patient and diagnostic and therapeutic

sarvicesordered or provided: United States, 1977 ....................................................................................................................

Number and percent of office visits made by patients 15 years and ovar, by race of female, sex of patient, and diagnostic

and therapeutic sarvicesordered or provided: United Stetes, 1977 ..........................................................................................

Number and parcent of office visits made by women 15 years and ovar, by selacted diagnostic servicesand selected principal

reasonsfor visit: Unitad States, 1977 ........................................................................................................................................

Numbar and percent of office visits made by women 15 yaars and ovar, by salected therapeutic services ordered or provided

and selacted principal diagnoses: United States, 1977 ...............................................................................................................

Number and parcent distribution of naw famale patients 15 yeers and ovar referred from another physician, by principel

diagnosis: United Statas, 1977 ..................................................................................................................................................

Numbar and parcent distribution of office visits made by women 15 years and over by duration of visit, according to selected

patient characteristics and seriousnessof condition: United States, 1977 .................................................................................

26

27

28

30

31

31

32

32

33

34

36

37

38

39

40

41

41

42

43

25
Table 1. Number and percent distribution of office visits made by women 15 Years and over and number of visits Per Person Pelf Year,

by age and race of patient: United States, 1977

Age and race of patient

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

Age —

Race

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

Black and all other.. .............................. .......... ........................................................................

Number in

thousands

294,958

56,055

60,547

36,902

42,194

42,047

35,081

22,131

266,811

28,146

Percent

distribution

100.0

19.0

20,5

12.5

14.3

14.3

11.9

7.5

90.5

9.5

Number

of visits

per person

per yearl

3.5

2.8

3.7

3.1

3.5

4.0

4.4

4.4

3.6

2.7

lRate~ are ba5ed on ~5timate~ of the ~i~lian noninstitutionalized population of the United States for JulY 1, 1977) furnished by the

U.S. Bureau of the Census (see appendix I).

26
Table 2. Number, percent distribution, and cumulative percent of office visits made by women 15 years and over, by principal reasons

Rank

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

28

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

for visit in rank order:l United States, 1977

Principal reason for visit and RVC codez

All principal reasons for visit ............................... ..................................

Prenatal examination, routine ................................... ........................... ..... ... X205

Gynecological examination ... ...... .. ........................................ ....................... X225

Blood pressure test ........ .. .......................... ...... ........ ................ .............. ....... X32O

Postoperative visit ........................... .... .. ................................ .......... ............. T205

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

Symptoms referable to throat ......... ........................................ ......................M55

Headache, pain in head ................................ ........ .........................................S2lO

Back symptoms .............................................................................................s9o5

Abdominal pain, cramps, spasms ................................................................. ..S55O

Hypertension .......... ......................................................... ............................. D510

Cough ...........................................................................................................wo

Haad cold, uppar respiratory infection ....................... ...... .............................w45

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

Anxiety and nervousnes ................................................................. ..............Sl~

Vision dysfunctions ......................................................................... .............~O5

Vertigo-dizziness ....... .............. ...... ...... ...................................... .... ..............S225

Pap smear ......... ........................ ............................ .............................. .... ...... X365

Weight gain ........... ........................................................................................SO4O

Skin rash ...... ........ .................... ........ .............................. .................. .............S8m

Eye examination ......... ............................ .............. ............... ........................ x230

Acne or pimplas .... ........................... .............................................................SwO

Diabetes mellitus ......... .................................... ............... ............ ...... ............ D205

Tiredness, exhaustion ....................................................................................sol5

Leg symptoms ............. .................................... ..............................................S92O

Depression ........................ ............................................................................Sl 10

Neck symptoms .......................................................................... ..................sm

Earache, or ear infection ...............................................................................s55

Knee symptoms .......................................................................... ..................S925

Shoulder symptoms .........................................................b............................s94o

Allergy mediation ........ ........ ...................... ................................................. TIOO

Postpartum examination ............................................ ..................... ............ . X215

Uterine and vaginal bleeding ....................... .................... ..................... .........s755

Low beck symptoms .................................. .. .................... .............................S9lO

Other vaginal symptoms ................................................................................S765

Nasal congestion ......................................................................................... ..Mm

Vaginal discharge ...... ........ ............................................................................S76O

Injections .... ...... .............. .......................................................................... ... TI 10

Lump or mass of braast .... ................ .................... .........................................S8O5

Painful urination ...........................................................................................s9

Pain, site not referable to a specific body system ,................ ............ .. ...........S056

Diet and nutritional counseling ............. .............................................. ......... T600

Anhritis ...... ..................................... ..... .......... .................... ......................... D900

Skin lesion .................. ....... ..... ... ................... .. ..............................................S865

Foot and toe symptoms ............................................................. ...................S935

General weakness ....................... .......................................................... ...... ...SO2O

Stomach pain, cramps and spasms .................... ...... .................................... ...S545

Abnormal sensations of the eye ....................................................................s2o

Nausaa..........................................................................................................S525

Symptoms of unspecified joints ....................................................................s97o

Heart examination ....................... ................................................................X235

Family planning, not otherwise specified .. .......................................... ........ . X500

Contraceptive device .... .. ...... .................................... .. .......................... ........ x510

Frequency and urgency of urination .... ...................... .......................... .........S645

Allergy, not otherwise specified .................................................... ................S@O

Hand and finger symptoms ... .. ............ .. ...................... .... ................ ..............S96O

Menopausal symptoms ..................................................................................S75O

Psychotherapy ................................................................................ ............ . T410

All other reasons ..... ................ ...... ...... .. ...... .............. ........ ............ .. ...... ....residual

Number in

thousands

284,958

19,823

9,486

8,886

8,690

8,477

6,357

5,868

5,534

5,493

5,128

4,680

4,358

4,304

3,924

3,887

3,834

3,732

3,621

3,508

3,050

3,017

3,012

3,011

2,951

2,845

2,764

2,403

2,345

2,334

2,321

2,310

2,281

2,280

2,284

2,243

2,128

2,126

2,023

1,955

1,889

1,832

1,812

1,753

1,742

1,734

1,601

1,534

1#493

1,399

1,377

1,369

1,345

1.344

1,342

1,342

1,307

1,272

. . .

Percent

distribution

100.0

6.7

3.2

3.0

2.9

2.9

2.2

2.0

1.9

1.9

1.7

1.6

1.5

1.5

1.3

1.3

1.3

1.3

1.2

1.2

1.0

1.0

1.0

1.0

1.0

1.0

0.9

0.8

0.8

0.8

0.8

0.8

0.8

0.8

0.8

0.8

0.7

0.7

0.7

0.7

0.6

0.6

0.6

0.6

0.6

0.6

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.4

0.4

33.1

Cumulative

percent

100.0

6.7

9.9

12.9

15.8

18.7

20.9

22.9

24.8

26.7

28.4

30.0

31.5

33.0

34.3

35.6

36.9

38.2

39.4

40.6

41.6

42.6

43.6

44.6

45.6

46.6

47.5

48.3

49.1

49.9

50.7

51.5

52.3

53.7

53.9

54.7

55.4

56.1

56.8

57.5

58.1

58.7

59.3

59.9

60.5

61.1

61.6

62.1

62.6

63.1

63.6

64.1

64.6

65.1

65.6

66.1

66.5

66.9

100.0

lThe ordering of reasons for visit is mainly a convenience for listing because many estimates are not statistically different from other

near estimates because of sampling variability y.

2Reason for visit codes are based on A Reason for Visit Classification for Ambulatory Care (RVC).

27
Table 3. Number and percent distribution of office visits made by women 15 years and ovar, by age of patient and the 20 most frequent

principal reasonsfor visit: Unitad States, 1977

Age of patient, principal reason for visit, and RVC codel

All ages................................................................................................................................. .........

15-24 years

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

Prenatal examination, routine ...........................<..............<...................................................o.............cx205

Symptoms referable to throat ................................................................................................c.to..........M55

Acne or pimples ...................................................................................................................................smo

Gynacoiogical examination ...........................................................m......................c....t. mm.m........c........c..X225

Head cold, upper respiretory infection .................................................................................................M45

Abdominal pain, cramps, spasms.......................................................................o.............to....t......o.......S55O

Postoperative visit ..................................................................................................o....4c.oc....t.....@..qc.... T205

Skin rash ................................................................................................................................ ..............

Cough

S860

................................................................................................................................................... S440

Ganeral medical examination .............................................................................................................. Xloo

Headacha, pain in head................................................................................................................m...,,. S210

Other vaginal symptoms .......................................................................................................................S765

Postpartum examination ..................................................................................................................... X215

Contraceptive medication .................................................................................................................... X505

Weight gain................................................................................................................................ ........... S040

Earache, or ear infection ..................,,.,.,,..,,.., .....................................4..,,.,..,, ......................................S355

Pap smear................................................................................................................................ ............ X365

Family planning, not otherwise specified ............................................................................................ X500

Back symptoms ...................4................................................................................................................s9o5

Eye examination ................................................................................................................................ .

Other

X230

................................................................................................................................................ residual

25-44 years

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

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

Gynecological examination .................................................................................................................X225

Postoparativa visit ............................................................................................................................... T205

Ganeral medical examination .............................................................................................................. Xloo

Symptoms referable to throat ..............................................................................................................s55

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

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

Pap smear............................................................................................................................................ X365

Anxiety and nervousness ................. ...... .............................................................. .................................Sloo

Weight gain................................................................................................................................ ........... S040

Back symptoms ..............$.....................................................................................................................so5

Depression............................................................................................................................................ Silo

Postpartum examination ....O...........................................................................o.....................o.............. X2l5

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

Cough

S445

................................................................................................................................................... S440

Vaginal discharge................................................#.,,.,, .........................m.,,,,,........ ................,.................

Skin rash

S760

................................................................................................................................ .........4,.,. S660

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

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

Other vaginal symptoms .......................................................................................................................S765

Other ....................................................................................................t.c..........tt.....e........t...o..m......jr9~idual

lReason for visit codes are based on A Reason for Visit Classification for Ambulato~ Care (RVC).

Number in

294,956

56,055

9,305

2,260

1,857

1,689

1,200

1,157

1,144

‘ 1,078

1,076

1,015

894

810

788

668

653

647

639

634

616

603

27,322

97,450

10,372

4,884

3,187

2,545

2,364

2,026

1,995

1,856

1,824

1,756

1,639

1,547

1,499

1,495

1,267

1,240

1,121

1,074

1,064

1,041

51,654

Percent

distribution

.—

100.0

100.0

.—

16.6

4.0

3.3

3.0

2.1

2.1

2.0

1.9

1.9

1.8

1.6

1.4

1.4

1.2

1.2

1.2

1.1

1.1

1.1

1.1

48.9

100.0

10.6

5.0

3.3

2.6

2.4

2.1

2.0

1.9

1.9

1.8

1.7

1.6

1.5

1.5

1.3

1.3

1.2

1.1

1.1

5:::

28
Table 3. Number end percent distribution of office visits made by women 15 years and over, by age of patient and the 20 most frequent

principal reasons for visit: United States, 1977–Con.

Age of patient, principal reason for visit, and RVC codel

45-64 years

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

Blood pressure test .. ......................................... ......... .................... .... ..................................................X32O

Postoperative visit .......... ...... .................... ........ ...... .. ...................... .. .... .................... ............ .. ............. T205

General medical examination .................................... ........................... ...... .........................................xloo

Gynecological examination .... ................................. ......... ................................... .................. .............. X225

Hypertension ................................................................... ................ .................................................... D510

Beck symptoms .......... ..... .....................................................................................................................s9o5

Headache, pain in head ................................................................................ .............. ................ ...........s2lo

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

Abdominal pain, cramps, spasms ....... ................... ...................... ..... ...... ...............................................s55o

Vertigo-dizziness ...... .............................. .................... .. .... ........ ...................... .......................... ...........S225

Vision dysfunctions ................. ................ ........ ..... ....... .............. ........ .... .......... ...... ............ ........ ...........s3o5

Chest pain and related symptoms (not referable to body system) ........................................................so5o

Diabetes mellitus .................. ........................................ .. ............ ...... ................................................... D205

Anxiety and nervousness ...... ...... ................ ................................. ................................ ............... ..........SI 00

Symptoms refarable to throat ..... .............. .............. ...... .. ...... ............ ........ ...... .................... ...... ...........%55

Leg symptoms ...................... .......... ........................................................... ............................ ...............S92O

Tiredness, exhaustion .... .. ...... .......... ............ ...... .............. ...... .................................... .................. .........sol5

Weight gain ....................... ...... ........ ............................ ...... ............ ........................................................ S040

Injections .. ........ ........ ...... ................ ............ ................ ........................................................................ TI 10

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

Other .......... .. ...... ............ ........ .. ............ .. .......................... ........ ...... .. .... ....................................... ..... residual

65 years and over

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

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

General medical examination ...................................................................... ........................................ XIOO

Hypertension ............................... ........................................................................................................ D510

Gynecological examination ......... .................................................................................... .....................S225

Chest pain and related symptoms (not referable to body system) .... .... ................ ...... .................... ......so5o

Diabetes melIitus .................................................................................. ............................... ................ D205

Postoperative visit ....................................... ..................... ........ .. ......................... ............... ................. T205

Vision dysfunctions . ......................................................... ..................................... ...............................so5

Arthritis .................................................. ............................................................................................ D900

Headache, pain in head ..... .. .......................................... ........ ............ .......................................... ..........s2lo

Back symptoms ................ .. .................................................. .................................. .............................. S805

Heart examination ............ ..................................... .......................................................... .................... X235

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

General weakness ................. ...................... ...... ............................ ...... .. ................................ ................so2o

Knee symptoms ....................................................................................................................................S925

cough Leg symptoms ................................................................................................................. .....................woS920

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

Eye examination ............................ ......................... ............................................................................ X230

Tiredness, exhaustion ...... .................... .. .................... .............. ....................... ......................................sol5

Shortness of breath ................................................................... ...........................................................M75

Other ................. .............................................. ........... ......................................................................residua[

lReason for visit codes are based on A Reason for Visit C[assi#fcationfor Ambulatory Can? (RVC).

Number in

thousends

84,241

4,119

2,993

2,722

2,457

2,446

2,235

2,028

1,543

1,381

1,380

1,321

1,271

1,259

1,201

1,150

1,150

1,143

1,106

1,075

1,058

49,203

57,212

4,095

2,194

2,124

1,639

1,%3

1,454

1,367

1,363

1,066

1,051

1,043

998

929

868

885

813

804

781

692

667

30,795

Percent

distribution

100.0

4.9

3.6

3.2

2.9

2.9

2.7

2.4

1.8

1.6

1.6

1.6

1.5

1.5

1.4

1.4

1.4

1.4

1.3

1.3

1.3

58.3

100.0

7.2

3.8

3.7

2.9

2.7

2.5

2.4

2.4

1.9

1.8

1.8

1.7

1.6

1.6

1.5

1.4

1.4

1.4

1.2

1.2

53.9
Table 4. Number and percent distribution of office visits made by women 15 years and over by principal reason for visit, according to

race of patient: United States, 1977

Race of patient

Principal reason for visit and RVC co&l

All principal reasons for visit ....................................................................................................................

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

General symptoms ..................................................................................................................................sool.so99

Symptoms referable to psychological and mental disorders .. ........................................ ..........................slm.sl99

Symptoms referable to the nervous system (excluding sense organs) .............. ................................. ....... S2OO.S259

Symptoms referable to the cardiovascular and lymphatic systems ............. .............................................S26O.S299

Symptoms referable to the eyes and ears ......................................... ...................... .......... .......... ...... .......s3oo.s399

Symptoms referable to the respiratory system ........... ...... ................ ........ ........ .......................... .............S4OO.W99

Symptoms referable to the digestive system ........................ ........ ......................... ..... .................. ............s5oo.s39

Symptoms referable to the genitourinary system .............. .................................................................. ....S64@S829

Symptoms referable to the skin, nails, and hair .... ................ .............................................................. .. ... S83O.S899

Symptoms referable to the musculoskeletal system ................................................................................s9oo.s99

Infective and parasitic dseases ..... ................................ ................................ ............................... .......... DoOI-D099

Neoplasms ............................ ................................. ....... ......................................................................... DIOO-D199

Endocrine, nutritional, and metabolic diseases ..................................................... ................................. D200-D249

Diseases of the blood and bloodforming organs .................................................................................... D250-D299

Mental disorders ...................... ............................................... ................................ .............. .. ............... D300-D349

Diseases of the nervous system .................... ................................................ ................................ .......... D350-D399

Diseases of the eye ........... ...... .. ........ ........ ............................................................................................. D400-D449

Diseases of the ear ... .......... ...... ........ ................................ ........................ ................ ...... ........................ D450-D499

Diseases of the ci rcu Iatory system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D500-D599

Diseases of the respiratory system ............ .................................................................. ........................... D6@3-D649

Diseases of the digestive system ................. ........ ........................ ..................... ........... ...................... ..... D650-D699

Diseases of the genitourinary syswm .... ...................................................... .......... ...................... ........... D700-D799

Diseases of the skin and sutm-rtaneous tissue ........................ ................ ............................................ ..... D800-D899

Diseases of the musculoskeletel system and connective tissue .............. ................ ....... .......................... D900-D949

General examinations ..................... ...... ...................................... .. ........ ...... ........ .. ...... ...... .... ...... ........... XIOO-X199

Special examinations ............. ................... ...... ...................... ................................................................. X200-X299

Diagnostic tests ............................................... ................................................ ............ .......................... x300-x399

Other screening and preventive procedures .. .. ................ ........................ ........ ...................................... . X400-X499

Family planning ............................................. ....................................................................................... x500-x599

Mediations ............................................................................................................................................TlOO.Tl99

Preoperative and postoperative care ............................... .. ..................................... ......................... .. ...... T2O@T299

Specific types of therapy ................................................................................................ ....................... T4OOT499

Specific therapeutic procedures ................................................................ ............... .............................. T5OO.T599

Medical counseling ..... ...... ................................................ ...................... ................................... .............T6OO.T699

Social problems counseling ......... ............... ............................................... ....................................... ...... T7OO.T799

Progress visit, not elsewhere classified ........ ...... .. ...... .......................... .............. ...... .. .. ................ ............ T8OO.T899

Injury by type and/or location ................................................... ...... ......... .............................................. JOOl.J799

Injury, not otherwise specified .................................................................... ............................................ J800-J899

Test results module ..................................................................................... ...................... .................... RIOO-R700

Administrative module ...................................................................................... ................... ................. AIOO-A140

All other reasons2 ........................................ ................................................................................................residual

lReason forvisit codes are based on ARea.ron for Visit Classification for Ambulatory Care (RVC).

-1 Black

White and all

other

Number

266,811 I 28,146

Percent

distribution

100.0

7.3

3.2

4.1

0.6

4.6

7.9

4.9

7.9

4.7

9.2

0.3

0.8

1.2

‘0.2

*ool

0.2

0.5

‘0.0

2.3

0.9

0.4

0.8

0.8

0.7

3.0

13.0

5.0

0.3

1.3

1.9

3.1

0.7

1.0

0.8

0.5

0.6

2.2

0.3

0.6

1.0

1.3

100.0

7.2

2.2

4.5

‘0.5

2.6

8.4

5.6

9.9

4.5

10.4

*0.1

*0.6

2.1

*0.4

*0.O

*0.4

*0.4

*0.O

*3.8

“0.8

*0.2

*0.5

*0.6

*1.5

2.3

10.8

5.4

*0.O

1.7

*1.O

3.3

“0.3

“0.7

‘0.9

*0.2

*0.8

2.1

‘0.4

* 0.3

*1.4

*1.3

‘Includes congenital anomalies (D9s0.D989), poisoning and adverse effects (j900-J999), “and blank and uncodable entries

(U990-U999).

30
.,

Table 5. Number and percent of new problem office visits made by women 15 years and over, by time since onset of complaint or

symptom and principal sympton: United States, 1977

principal symptom and RVC code 1

General symptoms ................................................. ........ ...... ....... ....Sml.SO99

Symptoms referable to psychological and mental disorders ... ......... S100-S1 99

Symptoms referable to the nervous system (excluding

sense organs) ............. ............... ............... ....... .................... .. ........ WW.S259

Symptoms referable to the cardiovascular and lymphatic

systems ................................................... ...................... ............... S26O.S299

Symptoms referable to the eyes and ears ............................... ......... S3OO-S388

Symptoms referable to the respiratory system .. .............................. SWCf-S488

Symptoms referable to the digestive system ...... .............................s500-s639

Symptoms referable to the genitourinary system .................... ...... ...S84O-S82g

Symptoms referable to the skin, nails, and hair .............................. S630-S899

Symptoms referable to the musculoskeletal system ........................ S900-S998

Number of

new problem visita

in thousands

8,048

1,795

4,744

615

7,143

12,833

8,050

12J43

7,516

11,300

fime since onset of complaint or symptom

Less

than

1-3

1 week

weeks

41.9

23.1

42.6

*49.8

46.3

72.6

47.4

34.8

24.1

40.9

1-3

months

Percent distribution

19.4

*21.7

17.7

*1 2.2

12.9

18.8

24.5

26.7

17.8

24.1

13.9

*21 .5

16.7

*2 I .4

13.6

5.5

12.7

19.7

20.7

17.5

More

than

3 months

21.7

30.6

20.2

*13.O

21.5

4.7

14.3

16.2

32.7

16.3

lReason for visit codes are based on A Reason for Visit Classification for Ambulatory Care (RVC).

Zpercents till not add to 100.0 because time since onset of complaint was not applicable to a small percent of visits, e.g., visits for

screening and preventive care.

Table 6. Number and percent of new problem office visits made by women 15 yeara and over, by time since onset of complaint or

symptom and specific principal reason for visit: United States, 1977

Specific principal reason for visit and RVC codel

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

Anxiety and newmsness ................................................................. ...........................SlOO

Headache, pain in head ..............................................................................................s2lo

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

Cough ........................................................................................................................wo

Head cold, upper respiratory infection ....................... .............. ..................... .............%45

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

Abdominal pain, cramps, spasms ................. ......... ..................... .................................S5~

Uterine and vaginal bleeding .......... ........................................................ ....................S755

Vaginal discharge ............ .............. ........ .......................................... .............. .. ...........S760

Other vaginal sympmms .................................................... ... ......................................S765

Lump or mass of breast ..................................... ................................................... ......S8O5

Back sympmms ...................................... ................................... .................................sO5

Prenatal examination, routine3 ............. .................................... ................................ )(205

Number of

new problem visits

in thousands

1,636

8,822

2,544

1,621

2,618

2,873

4,228

3,151

1,374

1,273

1,417

1,131

2,056

3,296

i_ime since onset of complaint

or symptom

Less

than

1 week

52.6

● 25.3

35.2

●10.3

70.9

75.8

79.8

46.8

*16.2

*31.7

48.0

●31 .2

41.5

*1.3

1-3

weeks

Percent2

21.5

●27.5

19.3

*6.O

22.5

19.3

14.8

27.9

36.0

46.2

* 28.0

●28.6

28.8

*2.8

1 month

or more

24.4

*44.9

41.5

68.9

*6.7

*3.9

*5.O

23.6

46.9

*19.5

●23.5

●34.3

28.7

68.8

lReason for visit codes are based on A Rqasors for Visit Classification for Ambulatory Care (RVC).

2percent5 ~i]l not add to ICIO.O because time since onset of complaint was SSOt applicable tO a SKdl percent of visits! e.g.) ~sits ‘or

scre ning and preventive care.

3The “time since onset” for 34 percent of these visits was more than 3 months.

31
Table 7. Number and percent distribution of new problem office visits made by women 15 years and over by time since onset of

complaint or symptom, according to age of patient: United States, 1977

Age of patient

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

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

35-44 yearn ............. .......................... ............................

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

55-84 yean ....................................... ................ ............

65-74 years ...................................................................

75 years and over ................ .............. ........ ...................

Number

of new

problem

visits in

thousands

26,766

24,654

14,220

14,707

12,498

8,790

5,181

Total

Time since onset of complaint or symptom

Less 1-6 1-3 1-3 More Not

than days wee ks months than 3 appli1 day months cablel

100.0 6.4

L

100.0 5.1

100.0 5.2

100.0 4.3

100.0 4.8

100.0 4.5

100.0 5.5

PI

31.9

28.1

33.6

30.9

34.6

28.6

35.3

cent distribution

16.2

16.1

16.3

19.6

18.2

24.6

17.6

13.4

16.1

12.1

15.7

15.0

12.7

11.7

14.2

17.2

17.1

19.0

16.7

21.1

22.2

17.9

17.4

15.8

10.6

10.8

8.6

8.3

lRefers ~hiefl~ to visits not involving a symptom or complaint, e.g., annual examination.

Table 8. Number and percent distribution of office visits made by women 15 years and over by most visited ohvsician sDecialtv.

..

according to race of patient: United States, 1977

Physician specialty

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

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

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

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

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

Ophthalmology.. .. ........... ................................................ .......................................................

Dermatology ........................................... .............................................................................. .

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

Orthopedic surgery ......................................................................... .......................................

Otolaryngology ............... ........ ...............................................................................................

Urological surgery ........ ........ .. ...... ........ .......... ...... .. ...................... ........................ ................ ..

Cardiovascular diseases .......................... .................................................................................

Neurology ............................................ .......................................................... .. .... ..................

All other specialties ....... ........ .......................... ............................ .. ........................ .................

Number

in

thousands

294,958

116,967

48,629

37,487

19,575

14,341

9,222

9,159

8,157

7,030

4,271

3,039

1,394

15,687

Race of patient

~—

Percent distribution

100.0

39.7

16.5

12.7

6.6

4.9

3.1

3.1

2.8

2.4

1.5

1.0

0.5

5.3

100.0

39.3

16.4

12.7

6.6

5.0

3.2

3.3

2.8

2.4

1.5

1.1

0.5

5.2

43.0

17.4

12.5

6.8

3.6

2.6

1.4

2.7

2.1

1.4

0.6

0.3

5.6

——

32
Table 9. Number, percent distribution, and cumulative percent of office visits made by women 15 years and over, by principal diagnoses

Renk

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

z

24

25

26

27

28

28

30

31

32

z

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

in rank order: United States, 1977

Principal diagnosis and ICDA codel

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

Prenatal care .................................................................................................. Y06

Medical or special examination ...................................................................... You

Essential benign hypertension .........................................................................4OI

Madical and surgical aftercere ........................................................................Ylo

Neuroses .........................................................................................................3W

Diabetes mellitis .............................................................................................2~

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

Chronic ischemic heart disease........................................................................4l2

Obesity ...........................................................................................................277

Hay faver ........................................................................................................507

Other eczema and dermatitis ...........................................................................692

Refractive errors .............................................................................................37o

Diseasesof sebaceousglanda ...........................................................................706

Osteoarthritis and allied condtions .................................................................7l3

Disorders of menstruation ...............................................................................626

Menopausal symptoms ....................................................................................627

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

Infective diseasesof uterus (axcept cervix), vagina, and vuIva

Arthritis, unspecified

.........................622

......................................................................................715

@stitis ............................................................................................................~5

Synovitis, bursitis, and tenosynovitis ..............................................................731

Sprains and strains of other unspecified parts of back.....................................

Chronic sinusitis..............................................................................................%

8ronchitis, unqualified ....................................................................................490

Other nonarticu Iar rheumatism .......................................................................717

Nervousnessand debility .................................................................................790

Observation without need for further care ......................................................793

Postpartum observation ................................................................................. Y07

Dthar diseasesof urinary tract ........................................................................599

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

~titis meda ....................................................................................................38 I

Symptomatic heart disease..............................................................................427

Dthar viral dseaws ..........................................................................................O7g

Diarrheal disease.............................................................................................008

Chronic cystic diseaseof breast.......................................................................6lO

3ther diseasesof eye.......................................................................................378

Rheumatoid arthritis and allied conditions .....................................................7l2

Vertebro~nic pain syndrome .........................................................................728

Fitting of prosthetic device ............................................................................ Y12

blyxedema ......................................................................................................2U

Woniliasis........................................................................................................ll2

>taract ..........................................................................................................374

Wtain symptoms raferable to nervous system and special sensas...................78O

Laboratory examination ................................................................................

.

Y03

. .. . . . . ........................................................................................................375

)ther diseasesof ear and mastoid process.......................................................387

‘personalitydisorders .......................................................................................301

Stricture of urethra .........................................................................................598

nfluenza, unqualified .....................................................................................470

‘unctional disorders of intestinal ...................................................................664

lther and unspecified anemias........................................................................285

iastritis and duodanitis ..................................................................................535

@rainsand strains of sacroiliac region ............................................................646

!cute tonsillitis ...............................................................................................463

nfective diseasesof cervix uteri ......................................................................620

)ther and unspecified forms of neuralgia and neuritis ....................................355

!chizophrania .................................................................................................295

;ymptoms raferable to abdoman and lower gastrointestinal tract ...................785

W other diagnoses....................................................................................residual

Number in

thousands

284,958

20,714

17,125

15,419

9,906

8,157

6,378

6,036

5,711

5,399

5,131

4,339

4,246

4,087

3,957

3,889

3,678

3,293

3,192

3,126

3,001

2,605

2,501

2,485

2,393

2,339

2,326

2,284

2,197

2,142

1,848

1,633

1,631

1,758

1,609

1,602

1,576

1,571

1,501

1,468

1,459

1,458

1,453

1,451

1,392

1,348

1,329

1,289

1,253

1,245

1,176

1,176

1,150

1,148

1,128

1,114

1,101

1,101

1,032

. . .

Percent

distribution

100.0

7.0

5.8

5.2

3.4

2.8

2.2

2.0

1.9

1.8

1.7

1.5

1.4

1.4

1,3

1.3

1.2

1.1

1.1

1.1

1.0

0.8

0.8

0.8

0.8

0.8

0.8

0.8

0.7

0.7

0.7

0.6

0.6

0.6

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.4

0.4

0.4

0.4

0.4

0.4

0.4

0.4

0.4

0.4

K

34.1

Cumulative

percent

100.0

7.0

12.8

18.0

21.4

24.2

26.4

28.4

30.3

32.1

33.8

35.3

36.7

38.1

39.4

40.7

41.9

42.0

43.1

44.2

45.2

46.0

46.8

47.6

48.4

49.2

50.0

50.8

51.5

52.2

52.9

53.5

54.1

64.7

55.2

55.7

56.2

56.7

57.2

57.7

58.2

58.7

59.2

59.7

60.2

60.7

61.2

61,6

62.0

62.4

62.8

63.2

63.6

E

64.8

65.2

65.6

65.9

100.0

lBased on the Eighth Revision International Classification of Diseaw, Adapted for Use in the United States (ICDA).

33
Table 10. Number and percent distribution of office visits made by women 15 years and over, by age of patient and the 20 most

frequent principal diagnoses: United States, 1977

Age of patient, principal diagnosis, and ICDA codel

All ages............................................................................................. ................ ............................

15-24 veara

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

Prenatal care ............................................................ ................ ................. ...................... .......................YO6

Medical or special examination ................... ........................................................................................... YOO

Diseases of sebaceous glands ... .. ........................................................................ ........ ...... .................. ......7O6

Acute upper respiratory infection of multiple or unspecified sites ......................... ........ .. ................ ......W5

Medical and surgical aftemare ........................... .................. ...... ................. ....................... ..................... YIO

Disorders of menstruation ....... .................. ....................................................................... ......... .............626

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

Hay fever .................. ........................ ........ ........ ............... .......................................................................5O7

Obesity ............. ........ ............... ........................................ .. ........................ .............................................277

Refractive errors ............................................................... ......................................................................37O

Infective diseases of uterus (except cervix), vagina, and vulva ..................... .............................. .......... ...622

Other eczema and dermatitis ... ......................... ............... .......... ........ ............ ........ .................................692

Neuroses .......................................... ........ ........................ ............................................ ...........................3OO

Other person without complaint or illness2 .......... ...................................................... ...... ..................... Y09

Postpartum observation .... .......................................................................................................... ...........YO7

Acute tonsil litis ............................... ................. ...... ................................................................................463

Other viral diseases ........................................ .................. .......................................................................o79

Otitis media ... .................... ...... ......... ......... ................................ ........ .... .................................................38l

Qstitis ... .......... ...... .......... ...... .................... ................ .......................... .......... ...... ..................................595

Diseases of parametrium and pelvis peritoneum ......... .................................................. .. ............ .... ...... ..6l6

Other ................................................ .......................................... ........ .. ............................................residual

2544 years

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

Prenatal care ..... ........ ........................ .......... ........ ........ ...... ................................................ .....................Y~

Medical or special examination ............ .................................................... ........ ........................... ...........YOO

Neuroses ..................................................................... ..................................... .......................................3OO

Medical and surgical aftercare .............................. ................ ....................................................... ...... .....Yl O

Obesity ...................................... .......... ...... .............................................................................................277

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

Hay fever .................................................................... .......... ..................................................................5O7

Disorders of menstruation ........................ .. ........................!..... ........................ .......... ............................626

Other eczema and derm~itis ..................... .......... ...... .......... ........ ............................ ........ ................ .... ...692

Diseases of sebaceous glands ............................................. .... ...................... ...... ................ ................ ......7O6

Postpartum observation .... ................................ .......................................................................... ...........YO7

Essential benign hypertension ......................................................................... ................................. ......4Ol

Infective diseases of uterus (except cervix), vagina, and vulva .......................................... ........ ..............622

Refractive errors .....................................................................................................................................37O

Sprains, strains of other and unspecified parts of back ...........................................................................w7

Acute pharyngitis ....................................................... ............................................................................@2

Cystitis ........... .................................. .......... ...................... .................... ..................................................595

Other person without complaint or iliness3 ...................... .............................. ....................................... Y09

Bronchitis, unqualified .............. .............. .......... ...... .............................. .......... ............ .... ................ .......49O

Personality disorders .................................. ............................................................................................3Ol

Other ...... .......... .................................. ..... ... ............ .................. .. ............ ..........................................residual

See footnotes at end of table.

Number in

thousands

284,958

56,055

9,951

5,106

2,140

1,635

1,380

1,324

1,289

1,206

1,180

1,053

1,019

994

923

864

764

637

610

563

552

535

22,330

97,450

10,626

7,629

4,412

3,223

2,707

2,233

2,156

1,634

1,585

1,422

1,411

1,340

1,324

1,154

1,128

1,090

1,079

1,038

926

881

48,252

Percent

distribution

100.0

100.0

17.8

9.1

3.8

2.9

2.5

2.4

2.3

2.2

2.1

1.9

1.8

1.8

1.6

1.5

1.4

1.1

1.1

1.0

1.0

1.0

39.8

100.0

10.9

7.8

4.5

3.3

2.8

2.3

2.2

1.9

1.6

1.5

1.4

1.4

1.4

1.2

1.2

1.1

1.1

1.1

1.0

0.9

49.5

34
Table IO. Number and percent distribution of office visits made by women 15 years andover, by age of patient and the 20 most

frequent principal diagnoses: United Stetes,1977-Con.

Age of patient, principal diagnosis, and ICDA code~

45-64 years

Totil ..................................................................................................................................................

Essential benign hypertension ................................................................................................................4ol

Medical or special examination ........ ......................... ....................... ..... ...... .......................... ................. YOO

Medical and surgical aftercare ................................... ....................................................... ...... ...... ........ .. YIO

Menopausal symptoms ................................ ............................... .......................... ...... ..... ....... ...... ..........627

Diabetes mellitus ................ .............. ........ .... ................ ...... ........ ...... ...... ................................................25O

Neuroses ...... .................................................................................................... ...... ................ ................. 300

Refractive errors .......................... ......... .................. ......................................... ............ ...........................37O

Acute upper respiratory infection of multiple or unspecified sites .......... ........ .......................... .. ...........%5

Osteoarthritis and allied conditions .... .......................................... ............ ........ .................................... ..7l3

Chron;c ischemic heart disease ..................... .................... .................... .. ................................................4l 2

Other eczema and dermatitis ................................................................. .................................................692

Hay fever .... ................................................................ ..............a. ............. ...............................................m7

Arthritis, unspecified ............ .... ... ............................... ................. .................. ............................ ...... .......7l 5

Synovitis, bursitis, and tenosynovitis ... .................................................................. ...... ...........................73l

Other nonarticular rheumatism ................................................................................................... ........ ...7l7

Nervousness and debility4 .......................... ...... .. .................... ...... .............. ............ .............. ...... ............79O

Chronic sinusitis ....................................................... .................... .............. ...... ......................................~3

Qstitis ............................. ............ ........ .............. ........ ............................................................................595

kthma .............................. ......................................... ..................... .......................................................493

Other .................................................................................. .............. ................................................residual

65 years and over

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

Essential benign hypertension ...... .......................................... ...... ........ ...... ...... ........ ........ ......................4ol

Chronic ischemic heart disease ..... ................ ........ .................. ........ ...... ........ ........ .... ..............................4l 2

Diabetes melliws .................. .. .............. ........ ........ ...... ............................ ...... ........ ............ ...... ................25O

Osteoarthritis and allied con&tions ....................... ........................................................................... ......7l3

Medical and surgical aftercare ... ..................................... ................... ....... .. ...... ..... ............... .................. Y1O

Arthritis, unspecified ................ .. ............................ ........ ...... ...... ............................ .............. ...... ............7l 5

Symptomatic heart disease ................... ................................ ..................... ............................................427

Medical or spatial examination .... ............................... ............. ........................................ ...................... Yoo

Glaucoma ............................................. ................................. ............................ ...... ...............................375

Other diseases of eye .................... ................................................................................................... .......378

Acute upper respiratory infection of multiple or unspecified sites .. ...... ........ .......................... ...............%5

Neuroses ............................ .......... .................... .......................... .................................. ...........................3OO

Hay fever ........ .................................................. ..... ........................... ..................... ...... ............ ............... 507

@stitis ........... ...... ...................................... .................... ...... .................................... ..............................595

Diverticula of intestine ..................................... ......................................................................................W2

Other and unspecified anemias ............. ........ .......................... ..................... ...........................................285

Rheumatoid arthritis and allied condtions .............................................................................................7l 2

Synovitis, bursitis, and tenosynovitis ........ ...... ........ ...... ........................................ ............ .. ....................73l

Other eczema and dermatitis ....................................... ................ .............. .............................................692

Other ..................... .................... .. .................... ...... .......... ...... .............. .... ................ .........................residual

Vumber in

84,241

7,421

3,518

3,504

2,764

2,677

2,208

1,601

1,513

1,470

1,338

1,263

1,289

1,221

1,030

1,014

954

953

870

823

790

45,990

57,212

6,517

4,306

2,957

2,338

1,799

1,703

1,244

1,062

873

639

814

655

614

549

547

534

501

491

475

471

27,923

Percent

distribution

100.0

8.8

4.2

4.2

3.3

3.2

2.6

1.9

1.8

1.7

1.6

1.5

1.5

1.4

1.2

1.2

1.1

1.1

1.0

1.0

0.9

54.6

100.0

11.4

7.5

5.2

4.1

3.1

3.0

2.2

1.9

1.5

1.5

1.4

1.1

1.1

1.0

1.0

0.9

0.9

0.9

0.8

0.8

48.8

lBased on the Eighth Revision International Classification of Diseases, A dapted for Use in the United States (ICDA).

21n fj7 percent of the5e visits, the reason for visit was farniW planning.

31n 70 percent of these visits, the reason for visit was family Planning.

4About s $ percent of these diagnoses were depression (790.2).

35
Table 11. Number and percent of office visits made by women 15 Years and over. by race of Patient and selected cwin~;mnl

diagno&: United Stat&, 1977

Principal diagnosis end ICDA codel

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

Diabetes mellitus .............................................................................................................................2W

Obesity ...........................................................................................................................................277

Neuroses.........................................................................................................................................3OO

Refractive errors .............................................................................................................................370

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

Chronic ischemic heart disease........................................................................................................4l2

Acute phaWngitis ............................................................................................................................462

Acute upper respiratory infection of multiple or unspecified sites..................................................466

Hay fever ........................................................................................................................................5O7

Cystitis ......................................,,,...,,,,,.,..,,,.. ...................................................................................595

Infective diseasesof uterus (except cervix), vagina, and vulva .........................................................622

Disorders of menstruation ...............................................................................................................6%

Menopausal symptoms ....................................................................................................................627

Other eczema and dermatitis ...........................................................................................................692

Diseasesof sebaceousglands, ..........................................................................................................706

Osteoarthritis and allied condtions .................................................................................................7l3

Arthritis, unspecified ......................................................................................................................7l5

Nervousnessand deMlity .................................................................................................................79O

Medical or special examination ......................................................................................................YW

Prenatal care ...................................o............................................................o.......o.......................m.YW

Medical and surgical aftercare ........................................................................................................ YI o

.-.r”.

Race of patient

All

races

Number

294,958 II 266,811

Percent*

2.2

1.8

2.8

1.4

5.2

1.9

::

1.7

1.0

1.1

1.3

1.3

1.5

1.4

1.3

:::

5.8

7.0

3.4

2.0

1.8

2,9

1.5

5.0

1.9

1.2

2,0

1.8

1.0

1.0

1.3

1.3

1.5

1.4

1.3

:::

6.0

7.1

3.3

:28,146

3.5

2.2

1.8

1.0

7.0

2.5

*0.8

2.1

*1.O

*1,0

1.8

1.7

*loo

*1.4

*1.1

1.5

1.8

*0.5

4.2

6.3

4.1

lBased on the Eighth Revision International Classification of Diseases, Adapted for Use fn the United States (lCDA).

*percent~ till not add to 100. o because all diagnoses are not listed in the table.

36
Table 12. Return visit rate of women 15 years and over, by selected principal diagnoses: United States, 1977

Principal diagnosis and ICDA codel

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

Diabetes mellitus ........................................................ ...... ................ ...................................................................................2W

Obesity ....................................... .................................. .................... ...................................................................................277

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

Chronic ischemic heart tisease ........ ...................................................................................... ...... .........................................4l2

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

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

Hay fever .................................................................................. .................. ................ .........................................................5O7

Cystitis ......................................................................... ........................................ ...............................................................595

Infective diseases of uterus (except cervix), vagina, and vuiva ..............................................................................................622

Disordars of menstruation ..... .......................... .......... .... ........ .............. ................................................................. ............... 626

Menopausal symptoms ......................................................................................................... .. .... ..........................................627

Other eczema and dermatitis .................. ......................... ....................................................................................................692

Osteoarthritis and allied conditions ............................ ...... ...................................................................................................7l3

Arthritis, unspecified ......... ......... ..... ...................... ................................ ..............................................................................7l 5

Prenatal care ................................................... .. ............ ...................................................................................................... Y06

Return

visit

rate2

1.76

7.69

3.05

3.60

9.38

12.40

0.48

0.60

5.31

0.85

0.76

0.74

3.67

1.55

3,88

3.57

3.95

lBased on the Eighth Revision International Classification of Diseases, Adapted for Use in the United States (ICDA).

2The return visit rate is the ratio of return visits to new problem visits. Where the rate is less than 1.0, new problem visits exceeded

return visits.

37
Table 13. Number and parcent distribution of office visits made by patients 15 years and over by seriousness of the problem, according

to age and sex of patient: United States, 1977

Age and sex of patient

15-24 years:

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

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

24-44 years:

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

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

45-64 years:

FemaIe ................................... .......................... ...... ................................ .............. ..........

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

65 years and over:

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

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

Number of

visits in

thousands

466,296

294,958

171,339

56,055

29,706

97,450

48,880

84,241

57,922

57,212

34,831

-ILLSerious Slightly

Total or very

serious

serious or not

serious

Percent distribution

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

18.3

18.1

24.4

8.4

14.5

14.0

17.9

20.7

27.9

30.8

36.2

81.7

81.9

85.6

91.7

85.0

86.0

82.1

79.3

72.1

69.2

63.8

——

38
Table 14. Number and percent of office visits made by women 15 yeara and over, by age of patient and diagnostic and therapeutic

servicesordered or provided: United States, 1977

Diagnostic and therapeutic services

All visis ..............................................

Diagnostic service

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

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

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

Clinical Iaboratorv test........................................

X.ray ..................~................................. ...............

Elwtrocardogram ...............................................

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

Endowopy ........................................... ...............

Blood pressure check ..........................................

Other diagnostic services.....................................

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

Therapeutic service

Immunization or desensitization .........................

Drugs (prescription or nonprescription) ..............

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

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

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

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

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

Psychotherapy or therapeutic listening ...............

Other therapeutic services...................................

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

Age of patient

All 15-24 25-34 35-44 45-54 55-64 65-74 75 years

ages years yeara yaars years years years and over

Number in thousands

294,958 II 56,055 I 60,Ex17 I 36,902 I 42,194 I 42,047 I 35,081 I

Percent

57.5

20.9

10.3

24.4

7.1

2.8

3.7

1.5

43.9

4.5

11.3

3.5

55.2

7.6

2.6

20.9

3.2

7.1

6.4

2.8

20.0

59.1

21.2

12.0

27.9

4.4

* 0.4

3.7

1.0

37.3

4.5

11.5

3.8

49.3

7.1

5.5

18.0

2.6

7.0

5.3

2.7

24.2

58.4

20.3

30.7

27.9

5.4

1.1

2.1

1.4

42.9

4.1

12.7

4.0

46.0

7.5

5.7

20.3

3.1

6.9

8.1

2.2

24.2

53.4

22.4

16.4

21.4

7.0

2.1

2.4

1.3

38.9

4.7

14.9

3.8

52.2

7.0

1.6

18.3

3.9

7.9

9.8

2.7

20.1

%

14.1

20.3

8.5

3.6

4.0

1.7

43.3

4.2

12.3

3.7

58.6

7.8

“0.5

21.5

3.6

6.7

8.0

3.7

17.2

57.0

20.9

9.7

22.9

9.0

4.4

4.6

2.0

47.7

5.1

10.0

3.4

61.2

9.1

*0.O

22.1

3.3

7.9

5.3

2.7

17.3

59.4

19.1

4.9

23.8

9.8

5.6

5.2

1.8

51.3

4.8

8.o

3.0

64.2

8.4

*0.O

23.4

3.5

6.5

3.2

2.9

16.1

22,131

62.4

18.8

2.1

22.0

8.1

E

*1.7

53.7

4.2

6.2

2.1

68.4

6.2

*0.O

27.1

2.2

6.1

3.4

2.9

15.2

1Percents will not add to 100.0 because more than 1 diagnostic or therapeutic service may have been ordered or provided.
Table 15. Number and percent of office visits made by patients 15 years and over, by race of female, sex of patient, and diagnostic and

therapeutic sewices ordered or provided: United States, 1977

Diagnostic and therapeutic service

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

Diagnostic service

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

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

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

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

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

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

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

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

Blood pressure check ............ .......... .............. ...... ........ .. ........ .......... ...... ........ .................... .....

Other diagnostic services ...................................... ................................ .................................

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

Therapeutic service

Immunization or desensitization ............... ....................................................... .....................

Drugs (prescription or nonprescription) .................................................................... .... ........

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

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

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

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

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

Psychotherapy or therapeutic listening ....... .......... .................................................................

Other thera~eutic services .......... .................................................................... ........ ...............

None ......... J.........e.............................. ...................................................................................

=

Number in thousands

266,811 I 28,146 I 284,958 I 171,339

Percent

57.0

20.9

10.5

24.3

7.2

2.8

3.8

1.5

43.0

4.6

11.7

3.7

54.2

7.7

2.6

21.2

3.2

7.3

6.6

2.9

20.4

62.8

21.2

8.5

24.7

6.5

2.0

2.9

*1.2

52.3

3.6

7.2

2.3

64.6

7.3

2.4

18.1

3.2

6.0

4.5

1.9

16.4

57.5

20.2

10.3

24.4

7.1

2.8

3.7

1.5

43.9

4.5

11.3

3.5

55.2

7.6

2.6

20.9

3.2

7.1

6.4

2.8

20.0

57.7

18.9

...

19.2

11.2

5.2

4.8

1.4

33.4

4.9

13.1

4.5

53.2

6.4

‘0.2

20.9

4.8

10.4

5.9

3.1

18.9

lpercents ~il] “ot add to 100.o b~caur,emore than I diagnostic or therapeutic service may have been ordered or provided.

40
Table 16. Number and percent of office visits made by women 15 years and over, by selected diagnostic services end selected principal

reasons for visit: United States, 1977

Principal reason for visit and RVC coda]

Tiredness, exhaustion .........................................................Wl5

Che8.tpain and related symptoms (not

related to body systam) ...................................................S050

Anxiety and nervousness....................................................Sl 00

Depression..........................................................................S110

Headache, pain in head .......................................................S2lO

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

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

Head cold, upper respiratory

infection ..........................................................................3445

Symptoms referable to throat .............................................W55

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

Painful urination .................................................................S&30

Menopausal symptoms ..................0.....................................S750

Uterine and vaginal blaeding ...............................................s75Li

Vaginel dscharge ................................................................S76O

Other vaginal symptoms .....................................................S765

Back symptoms ..................................................................S805

Low beck symptoms ...........................................................WlO

Number

in

thousends

3,011

4,304

3,924

2,845

5,968

3,687

4,690

4,358

6,357

5,493

1,955

1,307

2,291

2,128

2,264

5,534

2,290

Diagnostic sarvice

I 1 I

Percent*

58.6

63.0

41.5

16.5

59.6

49.2

68.9

69.2

78.1

55.9

65.3

50.5

55.1

64.6

67.9

60.4

61.2

21.3

25.4

18.7

*7.7

25.2

27.2

22.3

17.0

14.5

31.6

*16.9

*21.2

37.8

27.9

*19.2

20.7

● 17.6

36.9

23.7

*11.2

*3.2

15.7

1.0

13.1

10.5

18.9

33.6

81.1

●16.4

29.0

50.2

48.6

17.1

* 18.9

56.6

62.8

44.0

15.8

56.0

*4.9

44.7

45.2

30.8

46.6

39.6

62.3

62.8

44.2

36.9

38.0

39.6

lRaason for visit codes are based on A Reason for Visit Classification for Ambulatory Care (RVC).

‘Percents will not add to 100.0 because more than 1 sewice may have been ordered or provided.

Table 17. Number and percent of office visits made by women 16 years and over, by selected therapeutic servicesordered or provided

and selected principal diegnosas: United S’tit&, 1977

Principel diagnosis and ICDA codal

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

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

Chronic ischemic heart disease.........................412

Obesity ............................................................277

Neumws ..........................................................3OO

Hay fevar .........................................................507

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

Other eczema and dermatitis ...........................692

Number

in

thousands

15,419

6,378

5,711

5?399

8,157

5,131

1,948

4,339

Therapeutic service

Drugs

(prescription D\at Madical

or nonpra. counseling counseling

scription )

lmmuni- Psychozetion or therapy or

desansi- therapeutic

tization listening

81.1

65.4

77.8

67.6

52.5

34.2

60.9

70.6

16.5

36.5

11.7

68.2

*4.6

*2.8

●1.1

*1.4

Percent2

24,4

32.8

36.8

19.8

13.6

11.0

27.2

10.6

,..

,..

...

63.0

39.7

23.7

3.1

*2.2

*2.9

13.2

61.4

“0.9

*2.7

‘0.5

lBased on the Eighth Revision In ternational Classification of Diseases, Adap ted for Use in the United States, 1965.

2percent8 ~11 not add to 100.0 because more than I service may have been ordered or urovided, and alI services are not listed in the

table.

41
Table 18. Number and percent distribution of new female patients 15 years and over rafarrad from another physician, by principal

diagnosis: United States, 1977

Principal diagnosis and ICDA coda]

All principal dagnoses ..................... ....................................................................................................

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

Endocrine, nutritional, and metabolic tiseases .... ...................................................................................24O.279

Mental disorders ... ...... ........................................ ........ ................ ............................................................29O.3l 5

Disaases of the nervous system and sense organs .................... ........................ ................................. .......32O389

Disaases of tha circulatory system .. .. ...................... ...................................... .. ............ .......... ................ ..39W58

Diseases of the respiratory system ............................................................................... ...........................46O.5l9

Diseases of the digestive system ........................................... ........ ................ ............ ...............................52O.577

Diseases of the genitourinary system .......... ...... ...... .......................................... ......................................58Q%29

Diseases of the skin and subcutaneous tissue .... .............................. ................................ ........................68G7O9

Diseases of the musculoskeletal system ................. ..................................................................... ............7l@738

Symptoms and ill-defined conditions ................... .................................................... ..............................78O.796

Accidents, poisoning, and violence ... ................ .......................................................... ............................8OO.99O

Special conditions and examinations without sickness .... ................ ..................................................... YOO-Y13

Other diagnoses2 ... ................. ..................................................................................................... ............ rasidual

Numbar

of new

patients in

thousends

11,138

963

444

488

1,262

690

521

519

1,263

878

860

994

945

839

472

Percent

distribution

100.0

8.7

4.0

4.4

11.3

6.2

4.7

4.7

11.3

7.9

7.7

8.9

8.5

7.5

4.2

——

1Based on the Eighth Revision International CWssiflcation of Diseases, Adapted for Use in the United States (ICDA).

21ncl~des infective and parasitic diseases (000-1 36); diagnosis of “none;” blank, noncodable, and illegible diagnoses; and other

diagnoses.

42
Table 19. Number and percent distribution of office visits made by women 15 years and over by duration of visit, according to selected

patient characteristics and seriousness of condition: United States, 1977

Patient characteristic and seriousness Of ~Onditicm

Race

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

Black and all other ..................... ............................

Age

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

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

35-44 years .............................................................

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

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

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

status

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

Old patient, new problem ......................... ..............

Old patient, old problem ....... ...... .. ............ .............

Seriousness of condition

Not serious .............................................................

Slightly serious .......................................................

Serious ........................ ...........................................

Very serious ..................... .............................. ........

Number in

thousands

266,811

28,146

56,055

60,547

36,902

42,194

42,047

57,212

41,068

65,748

188,141

152,618

88,934

44,035

9,370

Duration of visit

Total o 1-1o 11-15 15-30 31 minutes

minutesl minutes minutes minutes or more

Percent distribution

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

2.4

* 0.8

1.2

1.7

3.1

3.2

2.6

2.4

“0.5

*0.6

3.2

2.2

2.3

1.8

*3.3

41.2

45.5

51.3

44.7

37.9

37.2

38.4

37.0

25.8

43.0

44.6

47.0

41.5

27.9

19.7

27.2

28.7

23.7

25.8

28.0

27.8

28.8

30.5

27.9

30.4

26.1

27.1

27.4

28.8

22.8

22.6

21.7

19.0

20.3

21.7

24.8

24.5

25.7

33.4

22.9

20.0

19.8

23.3

28.2

33.7

6.6

3.3

4.8

7.5

9.4

7.0

5.6

4.4

12.5

3.2

6.0

3.9

5.5

13.2

20.5

lIndicates no ~ect encounter between patient and physician.

43
APPENDIXES

CONTENTS

I.

IL

Technical Notes ..............................................................................................................................

Statistical Design .......................................................................................................................

Data Collection and Processing .................................................................................................

Estimation Procedures ..............................................................................................................

Reliability of Estimates .............................................................................................................

Tests of Significance .................................................................................................................

Population Figures ....................................................................................................................

Systematic Bias..........................................................................................................................

Definition of Terms ........................................................................................................................

Terms Relating to the Survey ....................................................................................................

Terms Relating to the Patient Record Form .............................................................................

111, Survey Instruments ........................................................................................................................

Introductory Letter From Director, National Center for Health Statistics ................................

Patient Record and Patient Log ................................................................................................

Induction Interview Form .........................................................................................................

LIST OF APPENDIX FIGURES

I. Approximate relative standard errors for estimated numbers of office visits, 1977 Nationrd Ambulatory Medical Care Survey ... ,,,.,,.,...4 .,.,...0..,,,,0..,,.0,.,...,,.., ............,,,.,...O,..,....0....,.,,,,,., ...........0

II. Approximate relative starrdrmd errors for percentages of estimated numbers of office visits, 1977

National Ambulatory Medtcal Care Survey ...................,, . . . . . . . . . . . . . . ...0.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LIST OF APPENDIX TABLES

I. Distribution of physicians in the universe and in the 1977 National Ambulatory Medical Care

Survey sample and response rates, by physician’s specialty

.,

,.,., ,,,0...,..,..,.,,.,.,. ..,,,,0..............00,,..,....

II. Estimates of the civilian noninstitutionalized population of the United States, by age, race, and

sex: United States, July 1, 1977 ....................0.,.,........0.,,,,,0,..............0........................., . . . . . . . . . . . . . . .

45

45

46

47

48

50

51

51

53

53

54

57

57

58

59

49

50

46

51
APPENDIX I

TECHNICAL NOTESe

This report is based on data collected in the

1977 National Ambulatory Medical Care Survey

(NAMCS), an annual sample survey of officebased physicians conducted by the Division of

Health Resources Utilization Statistics of the

National Center for Health Statistics.

Statistical Design

Scope of Lhe survey. –The target population

of NAMCS encompasses office visits within the

conterminous United States made by ambulatory patients to nonfederally employed physicians who are principal y engaged in office

practice, but not in the specialities of anesthesiology, pathology, or radiology. Telephone contacts and nonoffice visits are excluded.

Sample design. –The NAMCS utilizes a multistage probability design that involves probability sampIes of primary sampling units (PSU’s),

physician practices withk PSU’S, and patient

visits withiri practices. The first-stage sample of

87 PSU’S was seIected by the National Opinion

Research Center (NORC) of the University of

Chicago, the organization responsible for

NAMCS field and data processing operations

under contract to the National Center for Health

Statistics. A PSU is a county, a group of adjacent counties, or a standard metropolitan

statistical area (SMSA). A modified probabilityproportionai-to-size procedure using separate

sampling frames for SMSA’S and for nonmetropolitan counties was employed. After sorting

and stratifying by size, region, and demographic

characteristics, each frame was divided into

sequential zones of 1 million residents, and a

ePrepared by Thomas McLemore, M. S.P. H.,Division

of Health Resources Utilization Statistics.

random number was drawn to determine which

PSU came into the sample from each zone.

The second stage consisted of a probability

sample of practicing physicians selected from

the master files 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 of_ anesthesiology,

pathology, clinical pathology, forensic pathology, radiology, diagnostic radioIogy,

pediatric radiology, or therapeutic radiology.

The 1977 NAMCS physician universe included

188,690 doctors of medicine and 10,010 doctors of osteopathy (see table I).

Within each PSU, all eligible physicians were

arranged by nine specialty groups: genera! and

family medicine, internal medicine, pediatrics,

other medical specialties, generaI surgery, obstetrics and gynecology, other surgical specialties,

psychiatry, and all other specialties. Then,

within each PSU, a systematic random sample of

physicians was selected in such a way that the

overall probability of selecting any physician in

the United States was approximately constant.

The 1977 NAMCS physician sample included 3,000 physicians. Sample physicians were

screened at the time of the survey to ensure that

they met the aforementioned criteria; 507 physicians did not meet all the criteria and were

therefore ruled out of scope (ineligible) for the

study. The most common reasons for being. out

4.5
Table 1. Distribution of physicians in the universel and in the 1977 National Ambulatory Medical Care Survey sample and response

rates, by physician specialty

Physician specialty

All specialties .. ...................... ..................................

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

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

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

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

Other medical specialties .... ...........................................

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

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

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

Other surgical specialties ... ...... ......................................

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

Psych iatry .............................................. .......................

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

Universe

198,700

52,432

54,011

28,109

13,260

12,642

68,901

20,067

15,937

32,897

23,356

13,747

9,609

Gross

total

3,000

740

826

430

203

193

1.062

302

249

511

372

221

151

lIn~l~des d~ctors of medicine (M. D.’s) and doctors of osteopathy (D. O.’S).

of scope were that the physician was retired,

deceased, or employed in teaching, research or

administration. Of the 2,493 in-scope (eligible)

physicians, 1,932 (77.5 percent) participated in

the study. Of the participating physicians, 265

physicians saw no patients during their assigned

reporting period because of vacations, illnesses,

or other reasons for being temporarily not in

practice. The physicians sample size and response data by physician specialty are shown in

table 1.

The final stage was the selection of patient

visits within the annual practices of the sample

physicians. This involved two steps. First, the

total physician sample was divided into 52

random subsamples of approximately equal size,

and each subsample was randomly assigned to 1

of the 52 weeks in the survey year. Second, a

systematic random sample of visits was selected

by the physician during the assigned week. The

sampling rate varied for this final step from a

100-percent sample for very small practices to a

20-percent sample for very large practices. The

method by which the sampling rate was determined is described later in this appendix and in

the Induction Interview Form in appendix III.

During 1977, 51,044 useable Patient Record

forms were completed by physicians participating in NAMCS.

out

of

scopa

507

140

132

65

34

33

112

41

21

50

123

47

76

Net

total

2,493

600

694

365

169

160

950

261

228

461

249

174

75

Nonents

561

162

169

99

34

36

187

44

54

89

43

32

11

1

Respondents

1,932

438

525

266

135

124

763

217

174

372

206

142

64

————

Response

rate

77.5

73.0

75.6

72.9

79.9

77.5

80.3

83.1

76.3

80.7

82.7

81.6

85.3

Data Collection and Processing

Field procedures. –Both mail and teIephone

contacts were used to enlist sample physicians

for NAMCS. Physicians received introductory

letters from NCHS (see appendix III) and AMA

or AOA. When appropriate, a letter from the

physician’s specialty organization, endorsing the

survey and urging his participation, was enclosed

with the NCHS letter. A few days later, a field

representative telephoned the physician to explain briefly the study and arrange an appointment for a personal interview. A physician who

did not respond initially was generally recontacted via a telephone call or special explanatory

letter requesting him to reconsider participation

in the study.

During the personal interview the field representative determined the physician’s eligibility,

ascertained his cooperation, delivered survey

materials with verbal and printed instructions,

and assigned a predetermined Monday-Sunday

reporting period. A short interview concerning

basic practice characteristics, such as type of

practice and expected number of office visits,

was conducted. Office staff who were to assist

with data collection were invited to attend the

instruction session or were offered separate

instruction sessions.

46
Before the beginning of and again during the

week assigned for data collection, the interviewer telephoned the sample physician to

answer questions that might have arisen and to

ensure that procedures were going smoothly. At

the end of the survey week, the participating

physician mailed the finished survey materials to

the interviewer, who edited the forms for

completeness before transmitting them for central data processing. Problems of missing or

incomplete data were resolve d at this stage by

interviewer telephone followup to the sample

physician; if there were no problems, field

procedures were complete with respect to the

sample physician’s participation in NAMCS.

After the end of the survey year, each sample

physician was sent a thank-you letter from

NCHS along with one of the survey’s statistical

reports.

Data collection. –The actual data collection

for NAMCS was carried out by the physician,

aided by his office staff when possible. Two data

collection forms were employed by the physician: the Patient Log and the Patient Record

(appendix III). The Patient Log is a sequential

listing of patients seen in the physician’s office

during his assigned reporting week. This list

served as the sampling frame to indicate the

visits for which data were to be recorded. A

perforation between the patient names and

patient visit characteristics permitted the physi-

~cian to remove and retain the patient names,

thus protecting the confidentiality of the

patients.

Based on the physician’s estimate of the

expected number of of~lce visits, each physician

was assigned a patient sampling ratio. These

ratios were designed so that about 30 Patient

Record forms were completed during the assigned reporting week. Physicians expecting 10

or fewer visits each day recorded data for all

visits, those expecting more than 10 visits per

day recorded data for every second, third, or

fifth visit, based on the predetermined sampling

interval. These procedures minimized the data

collection workload and maintained approxi- ,

mately equal reporting levels among sample

physicians regardless of practice size. For physicians assigned a patient sampling ratio, a random

start was provided on the first page of the log, so

that predesignated sample visits recorded on

each succeeding page of the log provided a

systematic random sample of patient visits during the reporting period.

Data processing. -In addition to completeness checks made by the field staff, clerical edits

were performed upon receipt of the data for

central processing. These procedures proved

quite efficient, reducing the item nonresponse

rates to a negligible amount-2 percent or less

for all items.

Information contained in item 6 (patient’s

problem or reason for visit) of the Patient Record was coded according to A Reason jfor Visit

Classification for Ambulatory C’are.6 Diagnostic

information (item 8 of the Patient Record) was

coded according to the Eighth Revision International Classification of Diseases, Adapted for

Use in the United States.20 A maximum of

three entries were coded from each of these

items. Quality control in the medical coding

operation involved a two-way independent verification procedure with 100-percent verification.

Coding differences were adjudicated at the

National Center for Health Statistics.

Information from the Induction Interview

and Patient Record forms was keypunched, with

100-percent verification, and converted to computer tape. At this point, extensive computer

consistency and edit checks were performed. Incomplete items were imputed by assigning a

value from a Patient Record with similar characteristics; physician specialty and broad diagnostic categories were used as the basis for these

imputations.

Estimation Procedures

Statistics from the 1977 National Ambulatory Medical Care Survey were derived by a

multistage estimation procedure, which produces essentially unbiased national estimates and

has three basic components: (1) inflation by

reciprocals of the probabilities of selection, (2)

adjustment for nonresponse, and (3) a ratio

adjustment to fixed totals. Each component is

described briefly.

Inflation by reciprocals of sampling probabilities.–Since the survey utilized a three-stage

sample design, there were three probabilities of

NOTE: A list of references follows the text.

47
selection: (1) the probability of selecting the

PSU, (2) the probability y of selecting a physician

within the PSU, and (3) the probability y of

selecting a patient visit within the physician’s

practice. The last probability was defined to be

the exact number of office visits during the

physician’s specified reporting week divided by

the number of Patient Records completed. All

weekly estimates were inflated by a factor of 52

to derive annual estimates.

A djustmerzt for nonresponse. —Estimates

from the NAMCS data were adjusted to account

for sample physicians who did not participate in

the study. This was done in such a manner as to

minimize the impact of nonresponse on final

estimates by imputing to nonresponding physicians the practice characteristics of similar responding physicians. For this purpose, physicians were judged similar if they had the same

specialty designation and practiced in the same

Psu.

Ratio adjustment. –A poststratification adjustment was made within each of nine physician specialty groups. The ratio adjustment was

a multiplication factor of which the numerator

was the number of physicians in the universe in

each physician specialty group and the denominator the estimated number of physicians in that

particular specialty group. The numerator was

based on figures obtained from the AMA-AOA

master files, and the denominator was based on

data from the sample.

Reliability of Estimates

Since 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, instructions, and procedures. However,

the probability design of NAMCS permits the

calculation of sampling errors. The standard

error is primarily a measure of sampling variability that occurs by chance because only a sample

rather than the entire population is surveyed.

The standard error, as calculated in this report,

also reflects part of the variation that arises in

the measurement process. It does not include

estimates of any systematic biases that may be

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

that an estimate from the sample would differ

from a complete census by less than the standard error. The chances are about 95 out of 100

that the difference would be less than twice the

standard error, and about 99 out of 100 that it

would be less than 2?42times as large.

The relative standard error of an estimate is

obtained by dividing the standard error by the

estimate itself and is expressed as a percent of

the estimate. For this report, an asterislk (*)

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.zA~Zs

Approximate relative standard errors fc,r aggregates and percentages are presented in figures

I and II. In order 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 from the figures follow.

Estimates of ag~egates. –Approximate relative standard errors (in percent) for aggregate

statistics, such as the number of office visits

with a given characteristic, are obtained from

the curve in figure I or calculated by the

formula:

41.31046

“ 100

x

where x is the aggregate of interest in thousands.

Estimates- of percentages. —Approximate

relative standard errors (in percent) for estimates

of this type can be calculated from the curve in

figure I as follows. Obtain the relative standard

error of the numerator and denominator. Sc[uare

each of the relative standard errors, subtract the

NOTE: A list of references follows the text.

48
Figure 1. Approximate relative standard errors for estimated numbars of office visits, 1977 National Ambulatory Madical Care Survey

1Og 100

60

90

80

70 70

60 60

so 50

40 40

“30 30

20 20

10 10

9

8

9

8

7 7

6 6

5

4

100 1,000 10,000 100,000 1,000,000

SIZE OF ESTIMATE (IN THOUSANDS)

Exawzple of use of this chart: An estimate of 10 million office visits (read from scale at bottom of

chart) has a relative standard error of 7.6 percent (read from scale at left side of chart) or a standard

error of 760,000 office visits (7.6 percent of 10 mfliion visits).

resulting value for the denominator from the resulting value for the numerator, and extract the

square root. This calculation has been made for

severaI percents and bases and is presented in

figure II. Alternatively, the formula

RSE @)= -*1OO .

can be used to calculate the ROSEfor any percent

(p) and base (x, in thousands).

Estimates of rates where the numerator is

not a subclass of the denominator. —Approximate relative standard errors for rates in which

the denominator is the total U.S. population or

one or more of the age-sex-race groups of the

total population are equivalent to the relative

standard error of the numerator that can be obtained from figure I.

Estimates of differences between two statistics. –The relative standard errors shown in

this appendix are not directly applicable to differences between two sample estimates. The

standard error of a difference is approximately

the square root of the sum of the squares of

each standard error considered separately. This

formula represents the standard error quite

accurately for the difference between separate

49
Figure II. Approximate relative standard errors for percentages of estimated numbers of office visits, 1977 National Ambulatory

Medical Care Survey

(Base of percentage shown on curves in millions)

a

n

a

2

100

90

100

80

90

70

80

70

60 60

50 50

40 40

30 30

20 20

10

9

:0

8

7

B

6

7

6

5 5

a 4

3 3

2 2

1

,9

1

,8

.9

,7

6

:;

.6

,5 .5

,4 .4

,3 .3

,2 .2

.1 .1

A 2 ‘“’’789A 2 3456789A

1 10 100

ESTIMATED PERCENTAGE

Exam~le of use of this chart: An estimate of 20 Dercent (read at bottom of chart) based on an

estimate ~f 10“ millio; office visits has a relative stand&d error ‘of 12.9 percent (read from scale at left

of chart) or a standard error of 2.6 percentage points (12.9 percent of 20 percent).

and uncorrelated characteristics, although it is

ordy a rough approximation in most other cases.

In addition to sampling error, survey results

are subject to reporting and processing errors

and biases due to nonresponse or incomplete

response. There is no way to compute the magnitude of these errors. However, they were kept

to a minimum by procedures built into the survey operation. Careful attention and extensive

pretesting were given to the phrasing of the

questions and the terms (and their definitions)

employed in order to eliminate ambiguities and

encourage uniformity of reporting. The steps

taken to reduce nonresponse bias are discussed

in the sections on field procedures and datal collection. Quality control procedures and consistency and edit checks, discussed in the data processing section, reduced errors in data coding and

processing.

Tests of Significance

In this report, the determination of statistical inference is based on the t-test with a critical

50
value of 1.96 (O.05 level of significance). Terms

relating to differences, such as “higher,” “less,”

etc., 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

The base population used in computing

annual visit rates is presented in table II. The figures are based on provisional estimates for the

civilian noninstitutionalized population of the

United States as of July 1, 1977, provided by

the U.S. Bureau of the Census. Because NAMCS

included data for only the conterminous United

States, the original census estimates were modified to account for the exclusion of Alaska and

Hawaii from the study. For this reason the population estimates should not be considered

official and are presented here solely to provide

denominators for rate computations.

Systematic Bias

There have been no attempts to determine

systematic bias on the data reported here. There

are several factors, however, which the user of

these data should understand, that indicate that

these data underrepresent the total number of

office visits to office-based physicians. Some of

the factors are:

1. The sampling frame for the 1977

NAMCS included all nonfederally employed, “office-based, patient care” phycians on the AMA-AOA master files.

There are certainly physicians not so

classified who, at the time of survey,

would have met the criteria for that

Table il. Estimates of the civilian noninstitutional ized population of the United States, 1 by age, race, and sex: United States, July 1,

1977

[Used in the calculation of rates for this report]

Age

Race and sex

All

ages Under 16-24 25-34 35-44 45-54 55-64 6574 75 years

15 years years years years years years years and over

Race Number in thousands

All races ......................... ... 210,843 51,186 39,425 31,947 22,946 23,075 20,065 14,217 7,983

Male ........ .......................................... 101,745 26,110 19,350 15,499 11,021 11,126 9,471 6,178 2,991

Female .............................................. 109,098 25,076 20,075 16,448 11,925 11,950 10,594 8,039 4,892

White ................................... .. 182,781 42,495 33,648 27,878 20,059 20,469 18,129 12,836 7,267

Male ............. ..................................... 88,607 21,734 16,639 13,703 9.754 9,926 8,582 5,567 2,701

Female ............................................. . 94,174 20,761 17,010 14,175 10,305 10,643 9,546 7,269 4,565

Black ....................... ............... 24,970 7,761 5,262 3,458 2,+7 2,311 1,767 1,280 664

Male .............. .................................... 11,610 3,911 2,465 1,512 1,060 L038 807 556 259

Female ......................................... ..... 13,360 3,850 2,797 1,945 1,407 1,273 959 724 405

All other races .............. ...... .... 3,093 930 514 611 420 295 170 100 52

Male .................................................. 1,529 464 246 284 207 161 82 55 31

Female .............................................. 1,564 466 268 328 213 135 88 46 21

1Excludes Alaska and Hawaii.

51
classification. Visits to these physicians probability that a patient visit was acciare not represented here. dentally omitted from the survey is

much greater than the probability that a

2. Physicians who participated in NAMCS patient was included who did not mlake a

did a thorough and conscientious job visit. This factor also introduces an unin keeping the Patient Log; however, the known bias into the data.

000

52
APPENDIX II

DEFINITION OF TERMS

Terms Relating to the Sutvey

Office(s). –Premises identified by the physician as locations for his ambulatory practice.

The responsibility over time for patient care and

professional services rendered there generally

resides with the individual physician rather than

with any institution.

Ambulatory patient. –An individual seeking

personal health services, who is neither bedridden nor currently admitted to any health care

institution on the premises.

Physician. –Classified as either:

In scope: All duly licensed doctors of medicine and doctors of osteopathy currently in

practice who spend some time in caring for

ambulatory patients at an office location.

Out of scope: Those physicians who treat

patients only indirectly, including specialists in anesthesiology, pathology, forensic

pathology, radiology, therapeutic radiology,

and diagnostic radiology, and the following

physicians:

Physicians in military service.

Physicians who treat patients only in an

institutional setting (e g., patients in

nursing homes and hospitals).

Physicians employed full time by an industry or institution and having no private practice (e g., physicians who work

for the Veterans Administration, the

Ford Motor Company, etc.).

Physicians who spend no time seeing

ambulatory patients (e g., physicians

who only teach, are engaged in research,

or are retired).

Patients. –Classified as either:

In scope: All patients seen by the physician or a member of his staff in his office(s).

Out of scope: Patients seen by the physician

in a hospital, nursing home, or other extended care institution, or the patient’s

home. [Note: If the physician has a prz”vate

office (fitting the definition “office”) located in a hospital, the ambulatory patients

seen there are considered in scope.] The following types of patients are considered out

of scope:

Patients seen by the physician in an institution (including outpatient clinics of

hospitals) for whom the institution has

the primary responsibility y over time.

Patients who telephone and receive advice from the physician.

Patients who come to the office only to

leave a specimen, pick up insurance

forms, or pay their bills.

Patients who come to the office only to

pick up medications previously prescribed by the physician.

Visit. –A direct, personal exchange between

an ambulatory patient and a physician (or members of his staff) for the purpose of seeking care

and rendering health services.

Physician specialty .–Principal specialty (including general practice) as designated by the

physician at the time of the survey. Those physicians for whom a specialty was not obtained

were assigned the principal specialty recorded in

the master physician files maintained by the

53
American Medical Association

Osteopathic Association.

Terms Relating to the Patient

Record Form

or the American

Age.–The age calculated from date of birth

was the age at last birthday on the date of visit.

Color or race. –On the Patient Record, color

or race includes four categories: white, Negro/

black, other, and unknown. The physician was

instructed to mark the category which in his

judgment was most appropriate for the patient

based on observation and/or prior knowledge

of the patient. “Other” was restricted to Oriental people, American Indians, and persons of

other nonwhite, non-Negro races.

Was patient referred for this visit by another

physician ?–Referrals are any visits that are

made because of 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 o ther

reason(s) for this visit (in patient’s own words). —

The patient’s principal problem, complaint,

symptom, or other reason for this visit as expressed by the patient. Physicians were instructed to record key words or phrases verbatim

to the extent possible, listing that problem first

which, in the physician’s judgment, was most

responsible for the patient’s visit.

Time since onset of complaint/symptom in

item 6a. —Physicians were instructed to check

the category corresponding to the length of time

since the known beginning of the patient’s most

important problem. “Not applicable” was used

when the reason for visit was not a complaint

or symptom (e g., annual and well-baby examinations). For postoperative visits, “onset” refers

to the length of time since the surgery. For

routine prenatal visits, onset refers to the length

of time since conception. For a flareup of a

chronic condition (e g., arthritis), onset refers

to the length of time since the flareup, not the

onset of the original condition.

Pn-ncipal diagnoses. –The physician’s diagnosis of the patient’s principal problem, complaint, or symptom. In the event of multiple

diagnoses, the physician was instructed to list

them in order of decreasing importance; “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 diagnosis. —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 reason for that visit.

Sen”ousness of problem in item 8a. –This

item includes four categories: very serious, serious, slightly serious, and not serious. The physician was instructed to check one of the four

categories according to his own evaluation of the

seriousness of the patient’s problem causing this

visit. Seriousness refers to the physician’s clinical judgment as to the extent of the impairment

that might result if no care were given.

Diapostic services this visit. —Physicians

were instructed to check any of the following

services that were ordered or provided during

the current visit:

Limited exam/history: History and/or jphysical examination which is limited to a specific

body site or system, or which is concerned

primarily with the patient’s chief complaint, for example, pelvic examination or

eye examination.

General exam/history: History and/or physical examination of a comprehensive nature,

including all or most body systems.

Pap test: Papanicolaou test, self-explanatory.

Clinical lab test: One or more laboratory

procedures or tests , including examination

of blood, urine, sputum, smears, exudates,

transudates, feces, and gastric content, and

including chemistry, serology, bacteriology,

and pregnancy test (excludes Pap test).

X-ray: Any single or multiple X-ray examination for diagnostic or screening purposes.

Radiation therapy is not included in this

category.

EKG: Electrocardiogram, self-explanatory.

Vision test: Visual acuity test.

Endoscopy: Examination of the interior of

any body cavity, except ear, nose, and

throat, by means of an endoscope.

Blood pressure check: Self-explanatory.

54
Other: All other diagnostic services ordered

or provided that are not included in the preceding categories.

Therapeutic services this visit. –Physicians

were instructed to check any of the following

services that were ordered or provided during

the current visit:

Immunization/desensitiza tion: Administration of any immunizing, vaccinating, or desensitizing agent or substance by any route,

for example, syringe, needle, oral, gun, or

scarification.

Drugs (prescription/no nprescription): Drugs,

vitamins, hormones, ointments, suppositories, or other medications ordered or provided, except injections and immunizations.

Includes both prescription and nonprescription (over-the-counter) medication.

Diet counseling: Instructions, recommendations, or advice regarding diet or dietary

habits.

Family planning: Services, counseling, or advice that might enable patients to determine

the number and spacing of their children.

Includes both contraception and infertility

services.

Medical counseling: Instructions and recommendations regarding any health problem,

including advice or counsel about change of

habit or behavior. Physicians were instructed

to check this category only if the medical

counseling was a significant part of the

treatment. (Excludes diet and family planning counseling.)

Physiotherapy: Any form of physical therapy ordered or provided, including any treatment using heat, light, sound, or physical

pressure or movement, for example, ultrasonic, ultraviolet, infrared, whirlpool, diathermy, cold therapy, and manipulative

therapy.

Office surgery: Any surgical procedure performed in the office this visit, including

suture of wounds, reduction of fractures,

application and/or removal of casts, incision

and draining of abscesses, application of

supportive materials for fractures and

sprains, and all irrigations, aspirations, dilatations, and excisions.

Psych otherapy/therapeu tic listening: All

treatments designed to produce a mentaI or

emotional response through suggestion, persuasion, reeducation, reassurance, or support, including psychological counseling,

hypnosis, psychoanalysis, and transactiomd

therapy.

Other: Treatments ordered or provided

which are not included in the preceding categories.

Disposition this visit. –Eight categories are

provided to describe the physician’s disposition

of the case as follows:

No followup planned: 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, RR.N.: No future appointment was made, but the patient was instructed to make an appointment with the

physician if the patient considered it necessary.

Telephone followup planned: Patient was

instructed to telephone the physician on a

particular day to report on his progress, or

if the need arose.

Referred to other physician: Patient was

instructed to consult or seek care from

another physician. The patient may or may

not return to this physician at a later date.

Returned to referring physician: Patient was

referred to this physician and was now instructed to consult again with the physician

who referred him.

Admit to hospital: Patient was instructed

that further care or treatment would be provided in a hospital. No further office visits

were expected prior to that admission.

Other: Any other disposition of the case not

included in the above categories.

55
Dwation of this visit. –Time the physician ence of the physician, and time spent reviewing

spent with the patient, not including the time records, tests results, etc. In the event a patient

the patient spent waiting to see the physician, was cared for by a member of the physician’s

time the patient spent receiving care from some- staff but did not see the physician during the

one other than the physician without the pres- visit, the duration of visit was recorded as zero.

000

56
APPENDIX Ill

SURVEY INSTRUMENTS

Introductory Letter From Director, National Center for Health Statistics

o

.1. ,.,.,, .,.

(f$’j ‘j

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ,..”

,,. PUBLIC HEALTH SERVICE

NATl ONAL CENTER FOR ME ALT14 5TAT15T8CS

HYATTSVILLE, MA RVLAND 20782

!hdorsing Organimt ions

American Academy

of Dermatology

Amertcan Academy of

Family Phwc,ans

American Academv

of Neurology

Amer,can Academv of

Orthopaedlc Surgeons

Amer(can Academv

of Ped,atncs

.Amencan Assoc,atmn of

Neurological Surgeons

Amer, can College of

Obstetr,cmns and

Gvn@co109, sw

American College

of Phys(c,ans

Amertcan College of

Preventwe Med,c, ne

Amer, can Osteopathic

Assocrat #on

Amertcan Proclolog,c

Soctety

American Psychiatric

Assocmtmn

Amer!can Soc,etv of

Internal Medtcine

Am?ncan Soctety of

Plaslm and Fteconstructlve

Surgeons, Inc.

Amer! can Urolog,c

Awociat ton

Assoc,al#on of Amwcan

Medical Colleges

Nauonal Medical

Association

NATIONAL AM B” LATORV

MEDICAL CARE SURVEY

Dear Dr.

The National Center for Health Statistics, as part of its

continuing program to provide information on the health

status of the American people, is conducting a National

Ambulatory Medical Care Survey (NAMCS).

The purpose of this survey is to collect information

about ambulatory patients, their problems, and the

resources used for their care. The resulting published

statistics will help your profession plan for more

effective health services, determine health manpower

requirements, and improve medical education.

Since practicing physicians are the only reliable source

of this information, we need your assistance in the NAlfCS.

As one of the physicians selected in our national sample,

your participation is essential to the success of the

survey. Of course, all information that you provide is

held in strict confidence.

Many organizations and leaders in the medical profession

have expressed their support for this survey, including

those shown to the left. They join me in urging your

cooperation in this important research.

Within a few days, a survey representative will telephone

you for an appointment to discuss the details of your

participation. We greatly appreciate your cooperation.

Sincerely yours,

Dorothy P. Rice

Director

57
PATl ENT LOG

As each ~ax,,., A,,,v,s ,eco,d “am, and l,rne

01“,,,, .“ ,he log below. F., ,h, p.,,,”, en

lewd m !hne *5. .1s0 com!dete the mmcnt

,ec., d ,0 the ,,gh,

PATl ENT’S NAME TIME OF

VISIT

1---em,

1

p.m

1---- *.m.

2

pm,

I

pm,

tam

4

pm

Y

Record items 1-14 for th]s patient

CONTINUE LISTING PATIENTS

ON NEXT PAGE

ASSURANCE OF CONF ID ENTIALITY-AII inf.mm.tie” which would pemni%Idenzi+ic.ticm of m i“dlvidu.i.

2

. practice, or an emabli$hm.”t will Lx held confidential, will be used O“IY by pemo.$ e.gaged in md for

the P. WOS.S of the survey and will mr be disclmed m released to Other wmm$ or used for ..” .Ihw purpose.

*

-.

@

zJ

1. DATE OF VISIT PATlENT RECORD

#;~;-- NATIONAL AMBULATORY MEDICAL CARE SURVEY g

R

2. DATE OF BIRTH 3. SEX 4. COLOR OR 5. WAS PAT lENT 6. PATlENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER

RACE REFERREo FOR

z

REASON(S) FOR THIS VISIT

THIS VISIT BY (In uadent’sawn words) 9s

.

Zk;fr

, ❑ WHITE ANOTHER ‘

I ❑ FEMALE 1 ❑ NEGRoI PHYSICIAN? ,. MOST

BLACK IMPORTANT

2 0 MALE 1 ❑ YES

, ❑ OTHER b. OTHER _

I

7. TIME SINCE ONSET

OF COMPLAINT/

SYMPTOM IN ITEM 6a

(Check one)

1 •l LEss THAN I DAY

, ❑ 1-6 DAYS

S ❑ 1-3 WEEKS

4 ❑ 1-3 MONTHS

Sn MORE THAN

3 MONTHS

● ❑ UNKNOWN 2fl N0 I

if. PHYSICIAN’S OIAGNOSES

a. PRINCIPAL DIAGNOSIWPROBLEM ASSOCIATED WITH

ITEM 6.

b. OTHER SIGNIFICANT CURRENT DIAGNOSES

4 ❑ NOT APPLICABLE

11. DIAGNOSTIC SERVICES THIS

VISIT (Check all ordered or provided)

I ❑ NONE

1 ❑ LIMITED EXAM/HISTORY

3 ❑ GENERAL EXAM/HISTORY

. (1 PAP TEST

s ❑ CLINICAL LAB TEST

. ❑ X-RAY

7 ❑ EKG

6 ❑ VISION TEST

, ❑ EN DoSCOPY

,0 ❑ BLOOD pRESSURE CHECK

! i ❑ OTHER (Specify)

{ RA-34-2

IEV. 9-76

12. THERAPEUTIC SERVICES THIS

VISIT lCh~k all ordersd or provided)

I ❑ NONE

, a IMMUNIZATIONI

DESENSITIZATION

s ❑ DRUGS (PRESCFfl PTION/

NONPRESCRIPTIONI

4 0 DIET COUNSELING

$ ❑ FAMILY PLANNING

* ❑ MEDICAL COUNSELING

7 El Physiotherapy

a ❑ OFFICE SURGERY

* ❑ PSYCHOTHERAPY/

THERAPEUTIC LISTENING

I * O OTHER (Specify]

DEPARTMENT oF HEALTH, ED UCATI’

PUBLIC HEALTH SERV

HEALTH flESOu RCES AD MINI:

NATIONAL cENTER FOR HEALTI

~. HAVE YOU SEEN

PATlENT BEFORE?

1 ❑ YES I~NO

t

IF YES. FOR THE

CDNDITION IN

ITEM S.7

1 ❑ YEs ZDNO

&

i& SERIOUSNESS OF

CONOITION IN ~

ITEM Sa (Check one)

I ❑ vERY SERIOUS

1 ❑ SERIOUS

, ❑ SLIGHTLY

SERIOUS

z ❑ NOT SERIOUS

13. DISPOSITION THIS VISIT

(Check all that apply)

‘ ❑ NO FOLLDW-UP PLANNED

2 ❑ RETURN AT SPECIFIED TIME

3 ❑ RETuRN IF NE ED EO. P.R.N.

‘ ❑ TELEPHONE FOLLOW-UP PLANNEO

‘ ❑ REFERREO TO OTHER PHYSICIAN

6 ❑ ‘ETURNEDTO REFERRING PHySICIAN

7 ❑ ADMIT TO fjOSPITAL

8 Q OTHER (~CifY)

AND WELFARE

;ATION

iTATISTICS

—

14. DURATION OF

THIS VISIT

(Time 6shIa//y

spent w“th

physician)

MINUTES

o.M.B. ,+ P58-R1498
Induction Interview Form

CONFIDENTIAL*

NORC-4233

FOR OFFICE USE

ONLY:

m

5-61

CHtl .

7-10/

NATIONAL AMBULATORY

BEGIN DECK 3

Form Approved

OM8 No. 68R1498 I

MEDICAL CARE SURVEY

INDUCTION INTERVIEW

BEFORE STARTING INTERVIEW

m

1. ENTER PHYSICIAN I.D. NUMBER IN BOX TO l-4/

~ 1=.-:1

2. ENTER DATES OF ASSIGNED REPORTING WEEK IN

Doctor, before I begin, let me take a minute to give you a little background about

this survey.

The National Ambulatory Medical Care Survey is authorized by

Congress in public Law 93-353, section 308. It is a voluntary

study and there are no penalties for refusing to answer any

question. All information collected is confidential and will

be used only to prepare statistical summaries. No information

which will identify an individual or a physician’s practice

will be released.

Although ambulatory medical care accounts for nearly 90 per cent,of all medical care

received in the United States, there is no systematic information about the characteristics and problems of people who consult physician in their offices. This kind

of informationhas been badly needed by medical educators and others concerned with

the medical manpower situation.

In response to increasing demands for this kind of information, the National Center

for Health Statistics, in close consultation with representativesof the medical

profession, has developed the National Ambulatory Medical Care Survey.

Your own task in the survey is simple

of your time.

, carefully designed, and should not take much

Essentially, it consists of your participation during a specified

7-day period. During this period, you simply check off a minimal amount of information concerning patients that you see.

Now, before we get into the actual procedures, I have a few questions to ask about

your practice. The answers you give me will be used only for classificationand *

analysis, and of course all information you provide is held in strict confidence.

1. First, you are a Is that right?

(ENTER SPECIALTY FROM CODE ON FACE SHEET LABEL.)O

Yes . . . . . .. . . . . .X

No... .(ASKA) . . ..Y

A. IF NO: What is your specialty (includinggeneral practice)?

ml

(Name of Specialty) 11-131

59
-2-

2. Now, doctor, this study will be concerned with the ambulatory patients you will

see in your office during the week of (READ REPORTING DATES ENTERED BELOW).

(that’s a (that’s a

/ Monday) through I Sunday)

Are

A.

month date

you likely to see ~

IF NO: why is that?

month date

ambulatory patients in your office during that week?

Yes. . . . . .(GO TO Q. 3). . x

No . . . . . . (ASKA) . . ..y

RECORD VERBATIM, THEN READ PARAGRAPH BELOW

Since it’s very important, doctor, that we include any ambulatory patients

that you do happen to see in your office during that week, I’d like to

leave the= forms with you anyway --just in case your plans change. I’ll

plan to check back with your office just before (STARTING DATE) to make

sure, and I can explain them in detail then, if necessary.

GIVE DOCTOR THE ~ PATIENT RECORD FORMS AND GO TO Q. 9, P. 6.

60
-3-

3. A. At what office location will you be

7-day period? RECORD UNDER A BELOW

seeing ambulatory

AND THEN CODE B.

patients during that

B. FOR EACH OFFICE LOCATION ENTERED IN A, CODE YES OR NO TO “IN SCOPE.,”

IN SCOPE (Yes)

Private offices

Free-standing clinics

(non-hospital based)

Groups, partnerships

Kaiser, HIP, Mayo Clinic

Neighborhood Health Centers

Privately operated clinics

(except family planning)

IN CASE OF DOUBT, ASK: Is that

Is that

[OUT OF SCOPE (No)[

Hospital emergency rooms

Hospital outpatient departments

College or university infirmaries

Industrial outpatient facilities

Family planning clinics

Government-operated clinics

(VD, maternal & child health, etc.)

(clinic/facility/institution)hospital based?

(clinic/facility/institution)government

operated?

c. Is that all of the office locations at which you expect to see ambulatory

patient=uring that week?

Yes. . . . . . . . . . . X

No . . . . . . . . . . . Y

IF NO: OBTAIN ADDITIONAL OFFICE LOCATION(S), ENI’ERIN “A” BELOW, AND REPEAT.

A. B.

Office Location In Scope?

Yes I

No

(1) x Y

(2) x Y

(3) x Y

(4) x Y

IF ALL LOCATIONS ARE OUT OF SCOPE, THANK THE DOCTOR AND LEAVE.

61
4. A.

B.

-4- DECK 3

During that week (REPEAT DATES), how many ambulatory patients do you expect

to see in your office practice? (DO NOT COUNT PATIENTS SEEN AT [OUT-OF-SCOPE

LOCATIONS] CODED IN 3-B.)

ENTER TOTAL UNDER “A” BELOW AND CIRCLE ON APPROPRIATE LINE.

And during those seven days (REPEAT DATES IF NECESSARY), on how many ~ do

you expect to see any ambulatory patients? COUNT’EACH DAY IN WHICH DOCTOR

EXPECTS TO SEE ANY PATIENTS AT AN IN-SCOPE OFFICE LOCATION.

ENTER TOTAL UNDER “B” BELOW AND CIRCLE NUMBER IN APPROPRIATE COLUMN.

DETERMINE PROPER PATIENT LOG FORM FROM CHART BELOW. READ ACROSS

ON “TOTAL pATIENTS” LINE ~ER “A” AND CIRCLE LETTER IN APPROPRIATE

“DAYS” COLUMN UNDER !!B.IJ

THIS LETTER TELLS YOU WHICH OF THE FOUR PATIENT LOG FORMS (A, B, C, D)

SHOULD BE USED BY THIS DOCTOR.

LOG FORM DESCRIPTION

A--Patient Record is to be

completed for ALL

patients liste=n Log.

B--Patient Record is to be

completed for every

SECOND patient listed

on Log.

C--Patient Record is to be

completed for every

THIRD patient listed

on Log.

*D--Patient Record is to be

completed for every

FIFTH patient listed

on Log.

14-16/

A.

Expected total

patients during

survey week.

ENTER TOTAL FROM

Q. 4-A.

1

1- 12 PATIENTS

13- 25 “

B.

Total @ in practice

during week.

ENTER TOTAL

FROM Q. 4-B. DAYS

1 2 3 4 5 67

II

AAAAAAA

BAAAAAA -

26- 39 “ CBAAAAA40- 52 “ CBBAAAA -

53- 65 “ DCBBAAA

66- 79 “ DCBBBAA -

80- 92 “ DDCBBBB -

93-105 “ DDCBBBB -

106-118 “ DDCCBBB -

: 119-131 “ ID DC CBBB

I 132-145 “ ID DDCCBB

I 146-158 “ ID DDCCBB

I 159-171 “ ID DDC CCC

I 172-184 “ ID DD C C C C

I 185-197 “ ID DDDDDD

] 198-210 “ ID DDDDDD

I

211+ II DDDDDDD

*

In the rare instance the physician will see more than 500 patients during his

assigned reporting week, give him two D Patient Log Folios and instruct him to complete a patient record form for only every tenth patient. Then you are to draw an X

through the Patient Record on every other page of the two folio pads, starting with

page 1 of the pad. The physician then completes the

completes the Patient Record on every second page.

62

Patient Log on every page, but
DECK 3

5. FIND LOG FOLIO WITH APPROPRIATE

OF THE FORM AND NUMBER OF LINES

FORMS (if no lines are stamped,

-5-

LETTER AND CIRCLE

STAMPED “BEGIN ON

enter “O”) BELOW.

LETTER, ENTER FIRST FOUR

NEXT LINE” FOR THE B-C-D

I

FOLIO No. Lines FOR OFFICE USE ONLY

Stamped “BEGIN Number patient record

Letter .Number ON NEXT LINE” forms Com leted.

A

B

c

D

NUMSERS

LOG

17-21/

22-24/

6. HAND DOCTOR HIS FOLIO AND EXPLAIN HOW FORMS ARE TO BE FILLED OUT. SHOW DOCTOR

INSTRUCTIONSON THE POCKET OF FOLIO, ITEMS 11 AND 12 DEFINITIONS ON CARD IN POCKET

OF FOLIO AND ITEM DEFINT.TIONSON THE BACK OF FOLIO, TO WHICH HE CAN REFER AFTER

YOU LEAVE.

EMPHASIZE THAT EVERY PATIENT VISIT EXCEPT ADMINISTRATIVE PURPOSE ONLY IS TO BE

RECORDED ON THE LOG FOR ENTIRE REPORTING PERIOD. FOR EXAMPIZ, IF A MEDICAL

ASSISTANT GAVE THE PATIENT AN INOCULATION, OR A TECHNICIAN ADifINISTEREDAN

ELECTROCARDIOGRAMAND THE PATIENT DID NOT-SEE THE DOCTOR, THIS VISIT IS TO BE

LISTED ON THE LOG.

RECORD VERJ3ATIMBELUN ANY CONCERN, PROBLEMS OR QUESTIONS THE DOCTOR RAISES.

7. IF DOCTOR EXPECTS TO SEE AMBULATORY PATIENTS AT MORE THAN ONE IN-SCOPE LOCATION

DURING ASSIGNED WEEK. TELL HIM YOU WILL DELIVER THE FORMS TO THE OTHER LOCATION(S). ,.

ENTER THE FORM 113TTEkAND NUMBER(S) AND NUMBER OF LINES STAMPED “BEGIN ON NEXT ‘

LINE” FOR THE B-C-D LOG FOR THOSE LOCATIONS BELOW, BEFORE DELIVERING FORM(S).

FOLIO No. Lines FOR OFFICE USE ONLY:

Location Stmped IIBEGIN Number patient recor(

Letter .Num~er ON NEXT LINE” forms completed

25-29/

30-32/

33-37/

38-40/

41-45/

46-48/

63
-6- DECK 3

8. During the survey week (REPEATEXACT DATES), will anyone be available to help

you in filling out these records (at each IN-SCOPE location)?

Yes . . . . (ASKA). ..X

No . . . . . . . . . . .Y

A. IF YES: Wo would that be?

RECORD NAME, POSITION AND LOCATION.

NAME I POSITION I LOCATION

PERSONALLY BRIEF EACH PERSON LISTED ABOVE.

EMPHASIZE THAT EVERY PATIENT VISIT DURING THE ENTIRE WEEK IS TO BE RECORDED ON THE

LOG EXCEPT “ADMINISTl+iTIVEPURPOSE ONLY.”

9. Do you have a solo practice, or are you associatedwith other phyaiciana in a

partnership, in a group practice, or in some other way?

solo. . . . . (GO TO,Q. 10) . . 1

Partnership . . (ASK A-C) . . . 2

49/

Group

<--- Other

IF PARTNERSHIP,GROUP, OR OTHER:

A.

B.

c.

Is this a prepaid group practice?

[1] IF YES TO A: What per cent

of patients are

prepaid?

How many other physicians are

associatedwith-you?

~S;EiI&”Af&l;-;!Cj 1 :;

Yes . . (AsK [l]) . . . 1 50/

No . . . . .

NUMBER OF PHYSICIANS:

. . . . . 2

per cent 51-53/

54-56/

What are the specialties of the other physician associated with you?

(How many of these are there?)

(1)

(2)

(3)

(4)

(5)

Specialty Number of Physicians

64
10. Now I have just

IN LARGE GROUP,

-7- BEGIN DECK 4

one more question about your practice. (NOTE: IF DOCTOR PRACTICES

THE FOLLOWING INFORMATIONCAN BE OBTAINED FROM SOMEONE ELSE.)

A. What is the total number of full-time (35 hours or more per week) employees of your (partnership/

group) practice? Include persons regularly employed who are now on vacation, temporarily ill,

etc. Do not include other physicians. RECORD ON BOTTOM LINE OF COLIJFNA BELUJ.

(1) Ho~any of these full-time employees are a . . . (READ CATEGORIES BELCW AS NECESSARY

AWD RECORD HER OF EACH IN COLUMN A.)

B. And what is the total number of part-time (less than 35 hours per week) employees of your

(partnership/group) practice? Again, include persons regularly employed who are now on vacation,

ill, etc. Do not include other physicians. RSCORO ON BOTTOM LINE OF COLUMN B BELOW.

(1) How many Of these part-the employees are a . . . (READ CATEGORIES BELCW AS NSCESSARY

AND RSCORD NUMBER OF EACH IN COLlJi4NB.)

1 “A.

Employees FW1-time

J (35 cm more hours/week)

(1)

<2)

(3)

(4)

(5)

(6)

(7)

Registered Nurse . . . . . . . . . . .

Licensed Practical Nurse . . . . . . .

Nursing Aide. . . . . . . . . . . . .

Physician Assistant* . . . . . . . . .

Technician. . . . . . . . . . . . . .

Secretary or Receptionist . . . . . .

Other (sPECIFY)

TWML :

11-13/

14-16/

17-19/

20-22/

23-25/

26-28/

29-31/

32-34/

B.

Part-time

(Less than 35 hours/week) I

35-37/

38-40/

41-43/

44-46/

47-49/

50-52/

53-55/

I’OTAL : 56-58/

*

E%ysician Assistant amst be a graduate of an accredited training urogrsm for P&sician

Aeaiatants _@byslcian Extenders, Medex,-etc.) or certified by the Nation~l Boa;d of Medic~l

Examiners through the Certification Exam for Assistant to the Primary Care Physician.

BEFORE YOU LEAVE, AGAIN STRESS THAT EACH AND EVERY AMBULATORY PATIENT SEEN BY THE

DOCTOR OR HIS STAFF DURING THE 7-DAY=IOD AT ALL IN-SCOPE OFFICE LOCATIONS (~EAT

THEM) IS TO BE INCLUDED IN THE SURVEY, THAT EAC=ATIENT IS TO BE RECORDED ON THE LOG,

AND ONLY THE APPROPRIATE NUM8ER OF PATIENT RECORDS COMPLETED.

Thank you for your time, Dr. . If you have any (more) questions,

please feel free to call me. My phone number is written in the folio. 1’11

call ~ on Monday morning of your survey week just to remind YOU.

11. TIME INTERVIEWENDED . . . . . . . . AM

PM

12. DATEOFINTERVIEW . . . . . . . . . . . . . . .

1111 I

(Month) (Day) (Year)
-8-

NUMBER

1

INTERVIEWER’S SIGNATURE

FOR OFFICE USE ONLY:

No. of Patients Seen:

on “-’1’

MJSGOVERNMENTPRINTINGOFFICE:1980 311-240/4 1-3
.1

Series 1.

Series 2.

Series 3.

Series 4.

Series 10.

Stries 12.

Series 13.

Series 14.

Series 20.

Series 21$

Series 22.

Series 23.

VITAL AND HEALTH STATISTICS Series

Programs and Collection Procedures. –Reports which describe the general programs of the National

Center for Health Statistics and its offices and divisions and data collection methods used and include

definitions and other material necessary for understanding the data.

Data Ermluation and Methods Research. --Studies of new statistical methodology including experimental tests of new survey methods, studies of vital statistics collection methods, new analytical

techniques, objective evaluations of reliability of collected data, and contributions to statistical theory.

Analytical Studies. –Reports presenting analytical or interpretive studies based on vital and health

statistics, carrying the analysis further than the expository types of reports in the other series.

Documents and Committee Reports. –Final reports of major committees concerned with vital and

health statistics and documents such as recommended model vital registration laws and revised birth

and death certificates.

Data From the Health Interview Survey. –Statistics on illness, accidental injuries, disability, use of

hospital, medical, dental, and other services, and other health-related topics, all based on data collected

in a continuing national household interview survey.

l)ata b’rom the Health Examination Survey and the Health and Nutrition Examination Survey. -–Data

from direct examination, testing, and measurement of national samples of the civilian noninstitutionalized population provide the basis for two types of reports: (1) estimates of the medically defined

prevalence of specific diseases in the United States and the distributions of the population with respect

to physical, physiological, and psychological characteristics and (2) analysis of relationships among the

various measr.crements without reference to an explicit finite universe of persons.

Data From the Institutionalized Population Surveys. –Discontinued effective 1975, Future reports from

these surveys will be in Series 13.

Data on Health Resources Utilization. –Statistics on the utilization of health manpower and facilities

providing long-term care, ambulatory care, hospital care, and family planning services.

Data on Health Resources: .%fan~ower and Facilities. –Statistics on the numbers. geogra~hic distribution, and characteristics of health resources including physicians, dentists, nur~es,” o~her health

occupations, hospitals, nursing homes, and outpatient facilities.

Data on Mortality. –Various statistics on mortality other than as included in regular annual or monthly

reports. Special analyses by cause of death, age, and other demographic },ariables; geographic and time

series analyses; and statistics on characteristics of deaths not available from the vital records based on

sample surveys of those records.

Data on Natality, Marriage, and Divorce. –Various statistics on natality, marriage, and divorce other

than as included in regular annual or monthly reports. Special analyses by demographic variables;

geographic and time series analyses; studies of fertility; and statistics on characteristics of births not

available from the vital records based on sample surveys of those records.

Data From the National Mortality and Natulity Survey s.–Discontinued effective 197.5. Future reports

from these sample surveys based on vital records wiil be inciuded in Series 20 and 21, respectively.

Data From the National Survey of Family Grototh. –Statistics on fertiiit\. famiiv formation and dis-

. .

solution, family planning, and related maternal and infant heaith topics derived from a hienniai survey

of a nationwide probability sampie of ever-married women 15-44 years of age.

/-’

For a iist of tides of reports pubiished in these series, write to: Scientific and Technical Information Branch

r

Nationai Center for Heaith Statistics

Ptrbiic IIealth Service

Hyattsviiie, Kid. 20782
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