-.

——

Patterns of

Ambulatwy Care in

Internal Me9dicine

The Rktional

Ambuktwy Medical

Care Survey

United States, January 1980-

December 19S1

Data on the ambulatory medical care

provided during visits to office-based

internists are presented. Individual practice

profiles are drawn for female and male

physicians and for different age groups of

physicians. Patterns of care are described

for physicians in solo or other practices

and for those in the four major geographic

regions and in metropolitan and

nonmetropolitan aress. Descriptors

of practice include patient demographic

characteristics, prior visit status, and

patient condition. Data are also presented

on the patient management techniques

utilized, including diagnostic services,

medication therapy, and nonmedication

therapy. Comparisons are made between

practice patterns of internists and

other specialists.

Dsts Fromthe NationalHealthSurvey

Series13, No. SO

DHHS Publication No. (PHS) 84–1 741

U.S. Department of Health and Human

Services

Public Health SewIce

National Center for Health Statistics

Hyattsville, Md.

September 1984
Copyright Information

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

reproduced or copied without permission: citation as to source,

however, is appreciated.

Suggested Citation

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

ambulatory care in internal medicine, The National Ambulatory Medical

Care Survey, United States, January 1980–December 1981. Vital and

Health Statistics. Series 13, No. 80. DH HS Pub. No. (PHS) 84-1741.

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

Sept. 1984.

Librsry of Congress Cataloging in Publication Data

Cypress, Beulah K.

Patterns of ambulatory care in internal medicine.

~ (Data from the national health survey. Series 13:

no. 80) (DHHS publication ; no. (PHS) 84-1 741)

Supt. of Doca. no.: HE 20.6209:1 3/80

1. Physician services utilization—Unitad States—

Statistics. 2. Internists—United States—Statistics.

3. Ambulatory medical care—United States—Utilization—

Statistics. 4. Health surveys-United States—

?’ Statistics. 1. Title. Il. Series: Vital and health

statistics. Series 13, Data from the national health

survey ; no. 80. Ill. Series: DHHS publication ; no.

(PHS) B4-1 741. [DNLM: 1. Ambulatory Care/United

Statea—statistics. 2. Internal Medicine/United Statea—

statiatica. 3. Office Visits/United States—

statistics]

I RA410.7.C96 1984 362.1 ‘2’0973 84–600265

ISBN 0-8406 -0301-0 (pbk.)

For SSISby the Suparintmdmt of DWUIIULtS,U.S. Oovsnuosmt Prhtlw Oars, Washington,D.C. =
National Center for Health Statistics

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

Robert A. Israel, Deputy Director

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

and Epidemiology

Garrie J. Losee, Associate Director for Data Processing

and Services

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

Statistics

E. Earl Bryant, Associate Director for Interview and

Examination Statistics

Robert L. Quave, Acting Associate Director for Management

Gail F. Fisher, Ph. D., Associate Director for Program

Planning, Evaluation, and Coordination

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

and Methodology

Peter L. Hurley, Associate Director for Vital and Health

Care Statistics

Alice Haywood, Information Oficer

Vital and Health Care Statistics Program

Peter L. Hurley, Associate Director

Gloria Kapantais, Assistant to the Director for Data Policy,

Planning, and Analysis

Division of Health Care Statistics

W. Edward Bacon, Ph. D., Director

Joan F. Van Nostrand, Deputy Director

James E. Delozier, Chief Ambulato~ Care Statistics Branch
Contents

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

Purpose and background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .’. . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . .

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

Sources and limitations ofthedata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Visits byspecialty . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Overviewofvisit characteristics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Physician andpractice characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Type and location ofpractice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age and sex ofphysician . . ,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patient characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Patient condition and management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sexofthe patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Pnorvisit status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reason forvisit and diagnostic semices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . .

Principal diagnosis andtherapeutic services . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . , . . . . . . .

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

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

Comparisonwith otherspecialties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Comparison withprioryears data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

References . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Appendixes

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

H. Definitions ofcertain terms usedin thkreport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HI.Surveyi nstruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. American Hospital Formulary Service classification system andtherapeutic catego~ codes . . . . . . . . . . .

List of text figures

1. Percent distributionofofflcevisitsby physician specialty: United States, January 1980-December 1981

2. Percent distribution of office visits to internists by type of practice, according to age of physician:

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

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

Jnited States,

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

3. Average audrate ofotice visits totitemisKbyage mdsexofpatienti United States, Jau~1980-December l98l...

4. Average mudrateofoficevisifi totitetis& byagemdrace ofpatienti Utited States, Jauq1980-Decembr l98l . . .

5. Average amualrate ofofice visiWto titetists byagemd Hispmic otiginof patienL United States, Jmuql98ODecember 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

1

1

1

1

2

4

4

4

7

7

7

8

9

9

9

11

11

11

11

12

12

13

16

17

48

56

59

69

2

6

7

8

8

...

Ill
6.

7.

8.

9.

10.

Percent of oftlce visits to internists by number of medications and age of patienti United States, January 1980–December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent distribution of office visits by selected physician specialty and the United States population by age of patient

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

Drug intensity rate by age of patient and selected physician specialty: United States, January 1980–December 1981 . . .

Percent distribution of oftlce visits by major reason for visit, according to selected physician specialties: United States,

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

Average annual rate ofoffice visitstointemists by age ofpatienC United States, 1975 and 1980-81 . . . . . . . . . . . . . . . . .

List of text tables

A.

B.

c.

D.

E.

F.

G.

H.

J.

K.

L.

Number and percent distribution of office visits to internists by type of practice, according to location of physician’s

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

Number of office visits to internists, number and percent of drug visits, number of drug mentions, drug mention rate,

and drug intensity rate, bytype and location ofphysician’s practice: United States, January 1980-December 1981 . . . .

Average number of office visits per week to internists and mean duration of visit, by age and sex of physician United

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

Number ofoffice visits tointemists, >umber and percent of drug visits, number ofdrug mentions, drug mention rate,

and drug intensity rate, by age and sex ofphysician: United States, January 1980–December 1981 . . . . . . . . . . . . . . . . . .

Medianvisit ageof patients inoffice visits to internists andto all specialists bysex, race, andHispanic origin ofpatienti

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

Number of office visita to internists, number and percent of drug visits, number of drug mentions, drug mention rate,

and drug intensity rate, by selected characteristics of patienti United States, January 1980–December 1981 . . . . . . . . . .

Average number of visits per week and mean duration of visit, by selected physician specialty and sex of physician

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

Percent of oflice visits to solo practitioners by selected physician specialty and age of physiciarx United States, January

1980–December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Median visit age by selected physician specialty: United States, January 1980–December 1981 . . . . . . . . . . . . . . . . . . . . .

Visit rate per 100population andretum visit rate, by age of patient andselected physician specialty United States,

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

Percent of office visits to all physician specialties by selected principal diagnoses rendered in office visits to internists:

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

.-.

.,.

0.0

z

Symbols

Data not available

Category not applicable

Quantity zero

Quantity more than zero but less than

0.05

Quantity more than zero but less than

500 where numbers are rounded to

thousands

10

13

14

14

15

4

5

5

6

7

10

12

12

12

13

15

*

Figure does not meet standards of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements
Patterns of Ambulatory

Care in Internal Medicine

The National Ambulatory

Medical Care Survey

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

Introduction

Purpose and background

This report is a presentation of national estimates of the

use of ambulatory medical care services provided by nonfederally employed ofllce-based internists in the conterrninous

United States during the calendar years 1980-81. It is the fti

in a series of reports based on the visit characteristics of various medical and surgical specialties. Previous publications

highlighted the visit characteristics of general and family practice, pediatrics, obstetrics and gynecology, and general surgery.‘q The data were gathered by the National Center for

HeaIth Statistics by means of the National Ambulatory Medical

Care Survey, a sample survey of physicians’ oflice visits conducted annually through 1981 by the Division of Health Care

Statistics. Data collection and processing for the 1980 and 1981

National Ambulatory Medical Care Surveys were the responsibility of the National Opinion Research Center at the University of Chicago. Sample selection was accomplished with the

assistance of the American Medical Association and the

American Osteopathic Association.

A report based on 1975 estimates of visits to internists was

published in Vital and Health Statistics, Series 13, No. 36.5

However, because the reason for visit coding system was revised in 1977 and the Ninth Revision of the International

Ciass~JTcationof Diseases was introduced for coding diagnoses

in 1979, data from that report may not be strictly comparable

to the data in this report.

Detailed information on the background and methodology

of the survey was published in Vital and Health Statistics,

Series 2, No. 61.6A description of the 1980 and 1981 surveys,

including statistical design, data collection and processing, and

estimation procedures, may be found in appendix I of this report. Technical details regarding reliability of estimates are

also given in appendix I. Definitions of terms used in the survey are provided in appendix II. Facsimiles of survey instruments appear in appendix III. Prior to data presentation the

scope of the survey and limitations of the data are described

briefly to assist the reader in interpreting the estimates.

Scope of the survey

The basic sampling unit for the National Ambulatory

Medical Care Survey (NAMCS) is the physician-patient encounter or visit. The current scope of NAMCS includes all

office visits within the conterminous United States made by

ambulatory patients to nonfederally employed, office-based

physicians as classified by the American Medical Association

or the American Osteopathic Association. The NAMCS physician universe excludes anesthesiologists, pathologists, radiologists, and physicians principally engaged in teaching, research,

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

Source and limitations of the data

Thedata in this report are based on information obtained

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

for the 1980”and 1981 NAMCS included 5,805 physicians,

1,124 of whom were ineligible because they were out of scope

at the time of the survey. Of 4,681 eligible physicians, 3,676

(78.5 percent) participated (see appendix I). There were 871

internists in the sample of whom 158 were out of scope. Of713

eligible internists, 531 participated (74.5 percent).

Sample physicians listed all otlice visits during a randomly

assigned 7-day reporting period. During the 2-year period, information was recorded on Patient Records for a systematic

random sample of 89,447 visits including 12,354 visits to internists.

The 1980 and 1981 NAMCS were conducted in identical

fashion using the same instruments, definitions, and procedures.

The 2 years of data were combined to provide more reliable

estimates; therefore, the estimates of number of visits and drug

mentions contained in this report are for a 2-year period, but

ratios and rates represent average annual estimates.

The information in this report is derived from a complex

sample survey, and the appendixes should be reviewed to insure

a proper understanding and interpretation of the statistical estimates presented. Because the statistics are based on a sample

of oflice visits rather than on all visits, they are subject to sampling errors. Therefore, particular attention should be paid to

the section “Reliability of estimates.” Charts on relative standard errors and instructions for their use are also given.

Visits by specialty

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

1
All other

Psychiatry specialties

2.7% 2.7%

\#

Other surgical

\

A

specialties .

16.0%

General surgery J.::.:.... . ...........

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

..,.,..:,:.:.,.,

----

!J.3Y0

Obstetrics and

gynecology 0

9.4%

Other medical ‘

--L

aDecialties J

7“.5% T

Pediatrics

11.1%

General

practice

32.9%

al medici

and

me

family

Figure 1. Percent distribution of office visits by physician specialty United States, January 1980-Dacamber 1981

There were an estimated 144,172,000 office visits to internists

during the 2-year period. They constituted about 12 percent of

the visits to all physicians, making internal medicine the second

most frequently visited specialty in NAMC S.

Overview of visit characteristics

In this report separate patterns of ambulatory care are presented for solo and other types of practice, four geographic

regions, age and sex of physician, and patient sex and age

groups. Patterns are also described for visits that fall into different visit status categories. A general description of visits to

internists has not been published since the report based on 1975

data. Therefore, an overview of the characteristics of visits to

internists regardless of controlling variables, is offered first.

These statistics are shown in the first column of table 1. The

percents referred to in the text as “NAMCS average” are proportions based on visits to all specialties in 1980–81 and are

derived from data alluded to in previous publications. 1-’$However, a separate summary of 1980–81 data has not been published.

About 71 percent of the visits to internists were made by

patients 45 years of age and over, compared with the NAMCS

average of 41 percent for such patients, underscoring the major

dflerence between visits to internists and those to general and

family physicians, where visits included a broader age range.

The median age of patients visiting internists was 57.9 years,

compared with 36.4 years for all NAMCS visits. The proportion of visita by females (59 percent) was close to the NAMCS

average of 60 percent.

As may be expected when patients are predominantly

middle-aged or older, internists treated chron;c problems in the

majority of their visits (57 percent). Nonilhzess care accounted

for only 10 percent, and acute problems for 32 percent. Blood

pressure was measured in 61 percent of internists’ visits and

electrocardiograms were made in 12 percent, compared with

the NAMCS averages of 34 percent and 3 percent, respectively,

for these diagnostic services. The relatively frequent use of

these tests reflects the higher than average proportion of visits

for diseases of the circulatory system (26 percent, compared

with 10 percent). The principal (first-listed) diagnoses rendered

by physicians during visits are coded according to the International Classl$cati”on of Diseases, 9th Revision, Clinical

Modification (ICD-9-CM).7

Counseling was used proportionately more often by internists than any other nomnedlcation therapy shown in NAMCS.

About 34 percent of their visits included medical counseling

13 percent included diet counseling. One or more drugs were

prescribed in 76 percent of internists’ visits, and patients were

likely to be treated with more than a single drug in 41!percent

of visits. Because the average rate of drug utilization measured

in NAMCS increases with each older patient age group, it is

2
not surprising that 26 percent of internists’ visits included three About 40 percent of internists’ visits lasted 16 minutes or longer,

or more drugs, compared with the average of 13 percent for the compared with the average proportion of 27 percent for this

same number of drugs in all physician visits. duration. Patients were instructed to return at a specified time

The average duration of internists’ visits was 20.3 minutes, in 69 percent of the visits, and the same proportion of visits

which is longer than the NAMCS average of 15.9 minutes. were made by patients returning for care of continuing problems.

.

3
Physician and practice

characteristics

Type and location of practice

About 48 percent of visits to internists were to those in

solo practice, representing a decrease from the 54 percent of

such visits estimated in 1975. This finding reflects the trend

toward multiple practice projected by the Center for Health

Services Research and Development of the American Medical

Association.s The characteristics of visits according to type

and location of practice are shown in table 1. Drug mentions

are detailed in table 2. There were few remarkable differences

among the patterns of practice, and most small differences may

be attributed to sampling variability. Physicians in solo practice and those located in the Northeast Region tended to counsel patients regarding diet proportionately more frequently than

other physicians did. As table A shows, solo practice visits

were more likely to occur in the Northeast Region than in other

regions. Thus, there is a correlation in the patterns of visits to

physicians in solo practice and those located in the Northeast

Region.

Visits to physicians in metropolitan areas.were about evenly

divided between solo and other types of practice, but visits to

physicians in nonmetropolitan areas were more likely to be to

those in multiple practice where the proportion of such visits

was twice as high as that of visits to solo practices. A similar

tendency was observed in visits to general and family practitioners. 1

Clinical laboratory tests, X-rays, and electrocardiograms

Table A. Number and percent distribution of office visits to

internists by type of practice, according to location of physician’s

practice: United States, January 1980–December 1981

Number of Type of practice

visits in

Geographic region and area thousands Total solo Otheri

Percent distribution

All office visits .,, . . . . . . . . . 144,172 100.0 47.5 52.5

Geographic region

Northeast . . . . . . . . . . . . . . . . 46,388 100.0 58.0 42.1

North Central . . . . . . . . . . . . . 32,926 100,0 42.2 57.8

South . . . . . . . . . . . . . . . . . . . 36,975 100.0 40.4 59.7

Vest . . . . . . . . . . . . . . . . . . . . 27,883 100.0 45.8 54.2

Area

Metropolitan . . . . . . . . . . . . . 119,871 100,0 50.8 49.2

Nonmetropolitan . . . . . . . . 24,301 100.0 31.4 68.6

llncludes partnership, group, and other type of practice.

were more likely to be ordered or provided by physicians in

metropolitan areas than in others. However, the data do not

indicate any statistically significant differences in disease categories that might account for this. The greater likelihood of

such tests in visits to internists in metropolitan areas may be

due to proportionately more internists with subspecialties in

cardiovascular diseases, gastroenterology, and puhnonary diseases in these areas. Metropolitan areas may also have a higher

concentration of other specialists such as radiologists, and the

availability of advanced medical technology in such areas may

also be a factor.

Medical counseling was also provided proportionately more

often by internists in metropolitan areas. The greater use of

these services in metropolitan areas probably accounts for the

higher proportion of relatively long visits in that area, because

41 percent of such visits lasted 16minutes or longer, compared

with 34 percent with that duration in nonmetropolitan areas.

Because proportions of disease categories differed minimally among the practice profiles based on type of practice and

location, it is not surprising that drug utilization pattefis based

on these variables were also similar. Estimates of drug utilization in NAMCS are based on the physicians’ entries on the Patient Record form. These entries may be brand or generic names

of prescription or over-the-counter drugs, or a therapeutic effect.

Drug mentions include all new or continued drugs listed in

item 11. Physicians may make up to eight such entries. The

methodology used to collect and process this drug information

is described in Vital and Health Statistics, Series 2, No. 90.9

Drug mentions are listed in table 2 by therapeutic categories

that are based on the American Hospital Formulary Service

classification system (see appendix IV). 10The distribution of

dmg mentions according to type of practice and location are

remarkably similar. The percents of drug visits (visits in which

one or more drugs were prescribed) that are shown in table B

hover around the average of 76 percent for all visits to internists. Drug utilization rates shown in the same table are also

similar regardless of the qualifying variable.

Age and sex of physician

There were 1,362,000 visits to internists who identified

themselves as doctors of osteopathy. These visits are not included in tables that relate to the age and sex of the physician

because this information was not available for these physicians.

Internists aged 45–64 years had a higher average number

of visits per week than their younger and older counterparts

4
Table D. Number of office visits to internists, number and parcent of drug visits, number of drug mentions, drug mention rate, and drug

intensity rate, by age and sex of physiciam United States, January 1980-December 1981

Office visits Drug Drug

Drug mention intensity

Age and sex of physician All visits Drug visits2 mentions rate3 rate4

Age

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

Number

in

thousands

142,810

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

35-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Sex

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

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

15,051

36,800

50,340

32,323

8,295

5,269

137,541

in

thousands

108,830

11,404

29,323

37,048

24,614

6,442

4,117

104,713

Percent

76.2

75.8

79.7

73.6

76.2

77.7

78.1

76.1

Number

in

thousands

Rate

per

visit

Rate

per drug

visit

248,864

25,423

66,323

84,953

57,800

14,365

8,598

240.266

1.74

1.69

1.80

1.69

1.79

1.73

1.63

1.75

2.29

2.23

2.26

2.29

2.35

2.23

2.09

2.29

1Does not include doctors of osteopathy.

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

3Drug mentions divided by number OfViSitS.

4Drug mentions divided by number of drug visits.

70

60

50

20

10

o~

Under 35-44 45-54 55-64 65

35 and

over

Aga of physician in years

NOTE: Ooes not include doctors of osteopathy.

therapeutic listening (17 percent, compared with 5 percent)

and proportionately more medical counseling (53 percen~ compared with 33 percent). Because male internists treated proportionately more cardiovascular conditions than females did,

they were more likely to prescribe cardiac drugs (10 percent,

compared with 5 percent). Female internists, who saw proportionately more patients with musculoskeletal problems, prescribed proportionately more analgesics (16 percent, compared

with 10 percent for males).

It has been shown that physicians entering the practice of

medicine are likely to join a multiple practice while established

physicians tend to remain in solo practice. Female physicians,

on the whole, are newer to the profession than males and thus

are found in greater proportions in multiple practices. NAMCS

data show that 64 percent of the visits to female internists were

to those engaged in a group or multiple practice, compared

with 52 percent of visits to male internists in the same type of

practice. Some research has shown that female physicians tend

to join group practices because the flexibility of work schedules

in such a setting permits them to combine professional and

family responsibilities. It has also been suggested that female

physicians are more likely to practice in metropolitan areas,

where domestic and child care services are likely to be available, than in other areas. According to NAMCS data, 92 percent of the female intemist.s’ visita were in metropolitan areas,

compared with 83 percent of those to males.

Figure 2. Percent distribution of office visita to internista by typa

of practice, according to age of physician: United States, January

1980-Decamber 1981

6
Table B. Number of office visits to internists, number and percent of drug visits, number of drug mentions, drug mention rate, and drug

intensity rate, by type and location of physician’s practice: United States, January 1980–December 1981

Office visits Drug Drug

Drug mention intensity

Type and location of practice All visits Drug visits 1 mentions rate2 rate3

Number Number Number Rste Rate

in in in per per drug

Type of practice thousands thousands Percent thousands visit visit

Alltypes of practice, . . . . . . . . . . . . . . . . . . . . . . 144,172 109,799 76.2 251,370 1.74 2.29

solo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68,479 53,468 78.1 124,653 1,82 2.33

Othefi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75,693 56,332 74.4 126,717 1.67 2.25

Geographic region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46,388 35,651 76.9 75,997 1.64 2.13

North Central......,......,.. . . . . . . . . . . . . . 32,926 26,249 79.7 64,091 1.95 2.44

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36,975 26,929 72.8 63,682 1.72 2.36

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27,883 20,971 75.2 47,600 1.71 2.27

Area

Metropolitan, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119,871 91,435 76.3 205,182 1.71 2.24

Nonmetropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24,301 18,364 75.6 46,188 1,90 2.52

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

2Drug mentions divided by number of visits.

3Drug mentions divided by number of drug visits.

41ncludas partnership, group, and other types of practice.

(table C). Like other female physicians, females in internal

medicine averaged fewer visits than male internists did. However, unlike those to other female physicians, visits to female

internists did not last longer than visits to males in the same

specialty did.

Patterns of practice based on the visit characteristics described in NAMCS are outlined by age and sex of the physician in table 3. Drug mentions are detailed in table D and

table 4. Internists 45 years of age and over had a higher proportion of visits by patients 45 years of age and over than

younger physicians did. The tendency of older patients to visit

older physicians is typical of most specialties, and probably

reflects a pattern of continuing patient care.

There was a steady decrease in the proportions of new paTable C. Average number of office visits per week to internista and

mean duration of visit, by age and sex of physician: United States,

January 1980-December 1981

Average

number of Mean

office visits duration

per physician of visit

Age and sex of physician 1 per week in minutes

Age

Alleges, . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

Sex

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

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

51.4

42.8

48.7

58.3

58.0

33.0

41.6

51.8

20.3

20.0

19.6

20,5

20.2

22.5

21.3

20.2

1Doas not include doctors of osteopathy.

tients across increasingly older physician age groups that probably reflects the development of an established caseload.

The clinical attributes of practice were very similar for

physicians under 45 years of age and for those older despite the

somewhat older caseload of the latter group. There was less

variation in the profiles of the internists’ age groups than there

was in those of other primary care physicians. But similar to

those of other specialists, proportions of visits to internists in

solo practice increased after age 44 years (figure 2), reflecting

the preference of younger physicians for multiple practice.

Differences between the practice patterns of female and

male internists were more pronounced than those by physician’s

age were. Female internists treated female patients in 70, percent of their visits in contrast to 58 percent seen by male internists. Patients visiting female internists were younger than

those visiting male internists. About 41 percent were aged 15–

44 years, compared with 27 percent the same age who visited

males. Female internists were also more likely than their male

counterparts were to see new patients (23 percent for the former,

compared with 12 percent for the latter). The “young, female,

new patient” dominated pattern is typical of most female physicians. Clinical patterns were affected by the patient dem~

graphic pattern associated with the sex of the physician. Diseases of the circulatory system and diseases of the musculoskeletal system and connective tissue were preeminent in visits

to all internists, but male internists saw proportionately more

patients with the former problems than female physicians did.

Female physicians, who had a proportionately higher number

of visits by females, saw proportionately more patients with the ‘

latter than males did. As a result of the case-mix, male internists made proportionately more blood pressure checks (61 percent) than female internists did (49 percent—still higher than

average), and used more electrocardiograms for diagnosis (12 percent, compared with 6 percent). Female internists offered more

5
Patient characteristics

Age, sex, race, and ethnicity

There were no statistically significant differences between

the age distributions of visits by female and male patients shown

in table 5. The median visit age for females was 58.2 years and

for males it was 57.4 years, not a statistically significant difference (table E). The median age of patients who visited internists exceeded the NAMCS average of 36.4 years by about 20

years for each sex. This was also true of visits by black patients

although their median visit age was slightly younger than that

of white patients visiting internists or other specialists. This

appears to be due to the smaller proportion of black patients 65

years of age and over (25 percent) than that of white patients

the same age (35 percent).

Only about 4 percent of internists’ visits were made by

Hispanic patients, and 52 percent of such visits were made by

patients under 45 years of age in contrast to only 29 percent by

that age group of non-Hispanics. Despite the relatively younger

makeup of the Hispanic patient load in internists’ offices, the

median visit age of Hispanic patients visiting internists was

about 13 years older than the NAMC S average for that ethnic

group.

Visit rates

Average annual visit rates by age, sex, race, and ethnicity

are shown in table 5. Female patients in all age groups over 14

years of age visited at higher rates than male patients did, but

the increase in rates by age was similar for both sexes, as illustrated in figure 3.

Table E. Median viait age of patients in office visits to internists

and to all specialists, by sex, race, and Hispanic origin of patienti

January 1980-December 1981

Sex, race, and Hispanic Internal All

origin of patient medicine specialists

Sex Madian visit age in years

Female . . . . . . . . . . . . . . . . . . . . . . . . . 58.2 36.4

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 57.4 36.4

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . 58.4 36.8

Black . . . . . . . . . . . . . . . . . . . . . . . . . . 54.2 34.1

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . 43.9 30.1

Non-Hispanic . . . . . . . . . . . . . . . . . . . 58.3 36.8

From age 25 years to age 64 years, rates did not differ significantly by race, but the rate for white patients (65 years and

over was higher than that of black patients the same age

(figure 4).

110

100

90

80

70

60

50

40

o~

Under 15-24 25-44 45-64 65

15 and

over

Age of patient in years

Figure 3. Average annual rate of office visits to internists by age

and sex of patient: United States, January 1980-Decamber 1981

7
110

100

90

80

70

c

0

.-

;

3

Q

0

60

0.

0

0

; 5(3 0.

w

G

a

40

30

20

10

.

I

/

I

/

Under 15-24 25-44 45-64 65

15 and

over

Age of patient in years

Figure 4. Average annual rate of office visits to internists by age

and race of patient: United States, January 1980-December 1981

The visit rate curves plotted in figure 5 for Hispanic and

non-Hispanic patients are more divergent than those by sex or

race. From age 45 years, visit rates of Hispanic patients are

considerably lower than those of non-Hispanic patients.

Prior visit status

In table 6 visits are distributed by prior visit status according to the variables of sex, age, race, and ethnicity. Proportions

of visits by new patients 15 years of age and over decreased

110

r

80

70

60

50

40

30

20

10

0

t

/

I

Under 15-24 25-44 45-64 65

15 and

+ over

Age of patient in years

Figure 5. Average annual rate of office visits to internists by age

and Hispanic origin of patienti Unitad States, January 1980--

December 1981

with each older age group. Concomitantly, visits by patients

the physician had seen before visiting for the same problem

(old patients, old problems) increased. The return visit rate

(the ratio of all old patient visits to new patient visits) is a

simple index derived from these statistics. Patients 65 years of

age and over made about 15 return visits to the same physician

for each initial visit by patients the same age. By contrast, this

ratio was only about 4 to 1 for patients 25–44 years of age.

Return visit rates by sex, race, or ethnicity were not as

disparate as those by age.

8

. .. . .,“.”- -,. -”-. --. M.-., ,-”... a.. a - . . . . ..e_
Patient condition and

management

Sex of the patient

Many of the differences between patterns of care for female and male patients that were observed in other specialty

studies dissolve as the physician’s caseload ages. With more

than half of their visits made by patients over 57 years of age,

the average internist’s practice is largely in geriatrics, even

though that may not be a designated area of specialization.

When prenatal care is no longer the leading diagnosis for female patients, when members of both sexes become equally at

risk of hypertension and heart disease, and visits for chronic

gerontological illnesses exceed those for acute self-limiting ones,

profdes of care for female and male patients tend to converge.

Table 7 shows that proportions of the major reasons for visit

were almost identical based on the patient’s sex. For both sexes

the majority of major reasons concerned chronic problems, with

less nonillness care (about 9 percent) than average (18 percent).

Proportions of visits by principal reason for visit modules were

also within sampling variability for visits by female and male

patients. In NAMCS patients’ reasons for visit are recorded as

closely as possible in the patient’s own words in item 6 of the

Patient Record. The reason given by the patient, which in the

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

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

coded and grouped in eight modules according to a classification system that is detailed in A reason for visit ciassz~cation

for ambulato~~ care. 11 These modules are listed in table 7.

Specific reasons for visit are listed in table 8 and shown separately for each sex in table 9. General examination was the

principal reason for visit in 10 percent of all visits and was the

leading reason for both sexes. Blood pressure test, hypertension (usually a followup visit atler the patient has been given

a diagnosis), and chest pain were the next most frequent reasons given by female and male patients. Proportions of visits

for other reasons, although listed in descending order of their

NAMCS estimates, do not differ sufficiently to consider them

as listed in rank order.

Proportions of visits by principal diagnosis category are

shown in table 10. Here too, patterns by sex of the patient were

very much alike, with diseases of the circulatory system accounting for the largest share of visits regardless of sex. However, while male patients (29 percent of visits) were more likely

than females were (23 percent) to be diagnosed with circulatory condition% visits by female patients (13 percent) were more

likely than those by males (8 percent) to be for diseases of the

musculoskeletal system.

The list of specific diagnoses in table 11 shows that essential hypertension accounted for the largest proportion of all

visits (13 percent), with the same proportion for females’ visits

and 12 percent for males’ (table 12). Other forms of chronic

ischemic heart disease accounted for 6 percent of males’ visits,

compared with 3 percent of those by females. Osteoarthrosis

and rheumatoid arthritis together accounted for 6 percent of

females’ visits, compared with 3 percent of the visits by males

for the same two diagnoses.

Proportions of diagnostic services ordered or provided

during visits were similar for both sexes, except that male patients were more likely than females to be given electrocardb

grams, as may be expected with their higher proportions of

heart conditions (table 13).

The sex of the patient made little difference in the pattern

of therapeutic services, including medication therapy. The proportions of drug visits made by female and male patients and

their drug utilization rates were similar (table F). The only statistically significant differences found in drug use were for the

therapeutic categories generally prescribed for the diagnoses

likely to be associated with one sex or the other (table 14).

Higher proportions of antineoplastic agents and central nervous

system drugs were prescribed for female patients, and proportionately more cardiac drugs and vasodilating agents were prescribed for male patients. The specflc drugs named by internists are shown in table 15. This list is based on the physicians’

entries on the Patient Record form. Thus, the table includes

both brand names and generic entities depending on the physician’s method of prescribing. As expected, cardiac drugs

(inderal, knoxin, digoxin, and isordil) are prominent on the

Iisq as are diuretics (Iasix, dyazide, and hydrochlorothiazide).

The most frequent hypotensive agent mentioned was aldomet.

Aspirin and prednisone were the most commonly named antiinflammatory agents. Physicians may select from a wide range

of pharmaceuticals, many of them used for the same therapeutic

effect. Thus, 100 different medications constituted two-thirds

of the drugs mentioned by internists, with almost no differences

among their proportions.

Information on the duration and disposition of visits is provided in table 16. Like many other variables measured in

NAMCS, these do not clearly distinguish visits by female patients from those by males because proportions are very close.

Age of the patient

There is a sharper distinction among patterns when the patient’s age group is the qualifying variable than when the sex of

1

9
Table F. Number of”office visits to internists, number and percent of drug viaits, number of drug mentions, drug mention rate, and drug

intensity rate, by selected characteristics of patient United Statas, January 1980-December 1981

Office visits Drug Drug

Drug mention

Characteristic

intwtsit y

All visits Drug visits~ mentions rete2 rate3

Sex

Both sexes4 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Age

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

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

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

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

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

Race

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

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

Hispanic origin

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

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

Prior visit status

New patient...,......,......,.. . . . . . . . . . . .

Oldpatient, new problem . . . . . . . . . . . . . . . . . . .

Oldpatient, old problem . . . . . . . . . . . . . . . . . . . . . .

Number

in

thousands

144,172

84,798

59,374

3,027

9,346

29,866

53,543

48,389

129,061

13,498

5,100

139.072

17,451

28,133

98,588

Number

in

thousands

109,799

65,449

44,350

2,222

5,825

20,381

41,292

40,080

97,863

10,647

3,660

106,139

10,195

20,489

79,115

Percent

76.2

77.2

74.7

73.4

62.3

68.2

77.1

82.8

75.8

78.9

71.8

76.3

58.4

72.8

80.2

Number

in

thousands

251,370

151,001

100,369

3,463

9,354

37,232

95,148

106,174

223,157

25,451

7,149

244.221

17,556

40,633

193,181

Rate

per

visit

1.74

1.78

1.69

1.14

1.00

1.25

1.78

2.19

1.73

1.89

1.40

1.76

1.01

1.46

1.96

per drug

visit

2.29

2.31

2.26

1.56

1.61

1.83

2.30

2.65

2.28

2.39

1.95

2.30

1.72

1.98

2.44

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

‘Drug mentions divided by number of visits.

3Drug mentions divided by number of drug visits,

41ncludes races not identified as white or black not shown aa separate categories.

the patient is involved. As table 7 shows, the proportion of

visits for routine chronic problems ranges from a low of 20 percent of the visits by patients 15–24 years of age to a high of 56

percent of those by patients 65 years and over. At the same

time proportions of visits for acute problems and nonillness

care decline as the patient’s age group advances.

The most frequent specific principal reasons for visit given

by patients are shown by age group in table 17, and physicians’

diagnoses are categorized in table 10. It should come as no surprise that proportions of visits for diseases of the circulatory

system and musculoskeletal system increased with advancing

age. It can be seen in table 18 that essential hypertension was

the most frequent diagnosis for all age groups over 24 years of

age and that diabetes mellitus and other forms of chronic

ischemic heart disease were the next two leading problems for

these patients. Four forms of heart disease together accounted

for 7 percent of visits by patients 45–64 years old and 14 percent of those by patients 65 years and over. Rheumatoid arthritis

and osteoarthrosis are also prominent for all age groups 25

years of age and over.

Blood pressure measurement was increasingly likely with

each older age group, and patients 45 years and over had proportionately more electrocardiograms than those younger did.

As with most physicians, medication was the foremost therapy

used by internists. The proportion of visits in which one or

more drugs were mentioned by internists increased from 62 pert

10

cent of visits by patients 15-24 years of age to 83 percent of

those by patients 65 years and over (table F). Furthermore,

the older the patients, the more likely they were to have three

or more drugs prescribed (figure 6). This is clearly related to

●

40

1-

None /4

0

30 /

(n

.e

.!?

>

/

z

20

E

/

0

f? 3 or more

:

/’

10

/

0

---

o~

Llndar 16-24 25-44 45-64 65

15 and

over

I

Age of patient in years

Figure 6. Percant of office visits to internists by number of

medications and age of patient: United States, January 1980-

December 1981
the commonly accepted correlation between age and multiple

chronic illnesses for the elderly. The larger proportions of cardiovascular drugs and diuretics used by patients 45 years and over

than by those younger reflect the diagnoses associated with

middle-aged and elderly patients. The decreasing proportions

of antihistamines as patients age reflect the decreasing amount

of acute conditions.

Emphasis on followup care as patients become older is

evidenced by the larger proportions of middle-aged and elderly

patients scheduled for return visits.

Prior visit status

Patterns of care according to the status of the patient’s

visit are differentiated by the same characteristics that distinguished those by age. It was shown in the introductory overview of this report that68 percent of all visits to internists were

made by patients the physician had seen before (old patients)

returning for care of old problems (table 1). Such return visits

were more likely to be made by middle-aged and elderly patients than by younger patients because 79 percent of those

visits were made by patients 45 years of age and over. The

majority (58 percent) of the average internist’s new patients

were under 45 years of age. Because visit status is correlated

with age, the pattern for return visits is like that for middle-aged

and elderly patients, and the pattern for new patients resembles

that of the younger group. For example, new patients were

more likely to visit for acute problems (51 percent) and nonillness care (23 percent) than old patients with old problems

were (15 percent and 8 percent, respectively). As seen in the

statistics for patients over 44 years, returning patients presented

chronic problems proportionately more frequently than new

patients did. The acute problems of new patients were likely to

be diagnosed as diseases of the respiratory system (14 percent),

while old patients visited for chronic problems of the circulatory system (33 percent). In most aspects the prior visit status

variables correlated closely with the age groups. Complete statistics on each visit status group are presented in tables 7, 10,

13, 14, and 16.

Reason for visit and diagnostic services

The relationship between the diagnostic services ordered

or provided during internists’ visits and the reason for the visit

is explored in table 19. Except for the limited history and/or

examination, blood pressure check, and mental status examination, sewices were proportionately most frequent when nonillness care was the major reason for the visit. These data reflect the general examination reasons typically found during

nonillness visits. Blood pressure was measured by internists in

more than half of all visits whether the major reason was an

acute or chronic problem, or nonillness care.

Principal diagnosis and therapeutic

services

For the typical case-mix in the oflice-based practice of

internal medicine, nomnedication therapy is limited. Medical

counseling was offered proportionately more frequently than

any other therapy, and it occurred in from 29 to 42 percent of

visits depending on the diagnosis (table 20). Diet counseling

was proportionately more frequent when patients had endocrine,

nutritional, and metabolic diseases (39 percent) or diseases of

the digestive system (28 percent) than when other conditions

were treated. This was not unexpected because diet is an integral part of the treatment for such illnesses. Patients with diseases of the circulatory system were also counseled regarding

diet in 17 percent of their visits.

Medication was the principal therapy used by internists.

Only when diagnoses were in the supplementary classification

(chiefly examinations) was medication less likely to be used

(67 percent of such visits included no mention of medication).

For each of the disease categories shown in table 20, at least

two of three visits included one or more drugs. The percent of

drug visits is the complement of the “none” category. The diagnostic groups with the proportionately highest number of drug

visits were diseases of the respiratory system with 89 percent

and diseases of the circulatory system with 87 percent. The intensity of drug utilization maybe evaluated by the distribution

categorized by the number of drugs mentioned during a visit,

although it is possible that some of the drugs maybe prescribed

for conditions that are concomitant with the principal diagnoses.

As patients age, a multiplicity of illnesses are increasingly likely.

Except when patients visited for neoplasms or diseases of the

circulatory system, a single drug was the most likely number to

be ordered or prescribed. In visits with a principal diagnosis of

neoplasms, three or more drugs were prescribed in 29 percent

of visits. In those for dis,eases of the circulatory system, 39 percent included three or more drugs. The specific drugs mentioned

during visits for certain diagnoses were published in Vital and

Health Statistics, Series 13, No. 71.12

Principal diagnosis and duration,

disposition

Statistics are distributed by visit duration intervals and the

disposition of the visit according to diagnosis category in table 21.

For most disease categories the largest proportion of visits fell

in the duration interval of 11–15 minutes; however, the mean

duration of visits was atTected by the patient’s prior visit status

(table 22). The mean duration of all visits was 20.3 minutes,

but visits were longer when new patients (29.7 minutes) than

when old patients visited (about 19 minutes). This was true for

every group of diseases and was probably related to the more

intensive workup required when physicians examined patients

they had not seen before. It is noteworthy that only when general medical examination was the principal diagnosis did the

visit average 40.9 minutes for old patients with old problems,

compared with 21.5 minutes for new patients with the same

diagnosis. These data suggest that general examinations given

old patients were probably more intensive because of known

conditions that required careful evaluation in the course of a

comprehensive examination.

Table 22 also includes the mean duration for the most

commonly rendered specific principal diagnoses. Internists

spent, on the average, more time with new patients who had

heart disease, allergic rhinitis, chronic airway obstruction, rheumatoid arthritis, and osteoarthrosis than they did with patients

with other diagnoses.

11

. . . . ..-?
Conclusion

Comparison with other specialties

Internists averaged less visits per week (51 .4) than did

general and family practitioners (86.8), obstetrician-gynecologists (68.5), or pediatricians (106.9); however, the average

duration of internists’ visits was longer than ~hat of other specialists. For all four of the specialties shown in table G, female

internists had fewer visits in an average week than their male

counterparts did, but except for internists, these female physicians spent more time with their patients than male physicians

did. The mean durations of visits to female and male internists

were close. Each of the specialties shown in table H had proportionately more visits to those in solo practice when physicians were 55 years of age and older, a trend toward multiple

practice by young physicians that was projected by the American Medical Association and confiied by NAMCS visit data.

Data on the visit characteristics of internists, general and

family practitioners, obstetrician-gy necologists, and pediatriTable G. Average number of visits per week and mean duration of

visit, by selected physician specialty and sex of physician: United

States, January 1980-December 1981

Average

number of Mean

office visits duration

per physician of visit

Specialty and sex of physician per week in minutes

Internal medicine

Both sexes . . . . . . . . . . . . . . . . . . . . 51.4 20.3

Female . . . . . . . . . . . . . . . . . . . . . . . 41.6 21.3

Male . . . . . . . . . . . . . . . . . . . . . . . . . 51.8 20,2

General and family practice

Both sexes . . . . . . . . . . . . . . . . . . . . 86.8 13.5

Female . . . . . . . . . . . . . . . . . . . . ,,. . 52.0 16.7

Male . . . . . . . . . . . . . . . . . . . . . . . . . . 88.3 13.4

Obstetrics and gynecology

Both sexes . . . . . . . . . . . . . . . . . . . 68.5 13.9

Female . . . . . . . . . . . . . . . . . . . . . . . . 49.0 17.1

Male . . . . . . . . . . . . . . . . . . . . . . . . . . 69.5 13.8

Pediatrics

Both sexes . . . . . . . . . . . . . . . . . . . 106.9 12.8

Female . . . . . . . . . . . . . . . . . . . . . . . . 95.8 14.6

Male . . . . . . . . . . . . . . . . . . . . . . . . . 108.9 12.5

1Doesnot include doctors of osteopathy.

Table H. Percent of office visits to solo practitioners by selected

physician specialty and age of physician: United States, January

1980-December 1981

Physician specialty

General

and Obstetrics

Internal family and

Age ofphysiciani medicine practice gynecology Pediatrics

Percent of visits to solo” practitioner

Under35 years. . . 43.1 25.5 38.3 32.8

35-44 years. . . . . 39.7 31.4 44.6 30.3

45-54 years. . . . . 41.0 65.5 34.7 35.4

55-64 years. . . . . 62.9 72.7 57.9 49.8

65 years and

over . . . . . . . . . . . 67.3 88.5 81.3 77.9

1Does not include doctors of osteopathy.

cians are shown in table 23. Compared with the other three

specialists, the average internist’s case-mix was more likely to

consist of patients over 44 years of age, with chronic problems

of the circulatory or musculoskeletal systems. Internists were

less likely than pediatricians and general and family practitioners were to treat acute problems or to have patients visiting for nonillness care. It is apparent that the age or sex distributions of the visits to various specialists determined the shape

of the individual profiles of care. The pattern of internal medicine and that of general and family practice were more alike

than that of internal medicine was with the other two specialties. Most differences between internal medicine and general

and family practice may be attributed to the age range of their

patient loads. Table J shows that the median visit age was

higher for internists than for any of the other specialists. The

population of the United States and the percents of visits to

internists and to general and family practitioners are plotted by

Table J. Median visit age by selected physician specialty: United

States, January 1980-December 1981

Median

visit

age

in

Physician specialty years

Internal medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57.9

General and family practice . . . . . . . . . . . . . . . . . . . . . . . . 39.9

Obstetrics and gynecology . . . . . . . . . . . . . . . . . . . . . . . . 28.4

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6

12
age in figure 7. The shape of the curve for general and family

practice approximates the shape of the population curve, but

the curve for internal medicine shows a disproportionately high

percent of visits at the upper age range and a disproportionately

low percent at the younger end. However, the visit rates of all

age groups were higher for general and family physicians than

for internists (table K). Although patients 45 years of age and

over dominated the caseloads of internists, there were 61 visits

per 100 persons 45-64 years old in the population to internists,

compared with 109 for the same age group to general and

family physicians. Patients 65 years of age and over also had a

higher visit rate to general and family practitioners (151) than

they did to internists (99). The tendency of some patients to

make more return visits than others may contribute to differences in visit rates. The return visit rates (the ratio of visits by

old patients to those by new patients) for patients 45–64 years

old were similar for internists and general and family practitioners, but the return visit rate for patients 65 years of age

and over was higher for the latter practice than for internal

medicine.

Drug mentions for the same four specialties are listed in

table 24. As expected, drug utilization followed the path of the

diagnoses most evident in each specialty. It is noteworthy that

central nervous system dregs constituted the same proportion

of mentions for both internists and general and family practitioners (18 percent). The average number of drugs mentioned

during drug visits (drug intensity rate) was higher for internists

than for general and family physicians beginning with the age

group 45-64 years, and higher than that of obstetrician-gyne40

30

20

10

0

99 . - Visits to

internists

= _ Visits to general

and family

practitioners

— Population of

r United States

/-*\

,/’ ‘*

-~ d/’

/’

.0”

I I I I

Under 15-24 25-44 45-64 65

15 and

over

Age of patient in years

Figure 7. Percent distribution of office visits by selected physicien

specialty and the United States population by age of petient:

United States, January 1980-December 1981

Table K. Visit rate per 100 population and return visit rate, by age

of patient and selected physician specialty United States, January

1980-December 1981

Physician specialty

General

and Obstetrics

Internal family and

Age of patient medicine practice gynecology

Visit rate per 100 population

Al[ ages . . . . . . . . . . . . . . . . . . . . 32.4 85.7 146.8

Under 15 years . . . . . . . . . . . . . . 2.9 52.0 1.5

15-24 years . . . . . . . . . . . . . . . . 11.5 69.1 81.1

25-44 years . . . . . . . . . . . . . . . . 23.8 82.4 94.7

45-64 years . . . . . . . . . . . . . . . . 60.9 108.6 21.9

65 years And over . . . . . . . . . . . 98.7 150.7 9.1

Return visit ratez

Alleges . . . . . . . . . . . . . . . . . . . . 7.3 7.9 7.5

Under 15 years . . . . . . . . . . . . . . 2.4 5.7 6.5

15-24 years . . . . . . . . . . . . . . . . 2.1 4.9 5.4

25-44 years . . . . . . . . . . . . . . . . 3.8 5.9 8.9

45-64 years . . . . . . . . . . . . . . . . 11.2 12.2 9.7

65 years And over . . . . . . . . . . . 15.4 20.6 6.3

I Based on the female population.

‘Old patient visits divided by new patient visits.

cologists for all age groups (figure 8). The greater use of drug

therapy by internists was probably because of the dominance

of their practice by older patients with multiple chronic illnesses.

As figure 9 shows the majority of internists’ visits concerned

chronic problems, while general and family practitioners and

pediatricians were more likely to encounter acute problems

than other kinds. For obstetrician-gynecologists, nonillness care

was foremost.

Although internists accounted for only 12 percent of all

visits to ofilce-based physicians in 1980-81, they had a disproportionate share of the total visits for certain conditions.

For the selected diagnoses shown in table L, at least 30 percent of the visits to all physicians for these problems were to

internists. Internists had the majority of all visits for rheumatoid

arthritis and other inflammatory polyarthropathies (57 percent),

and from 34 percent to 42 percent of those for the heart conditions listed in table L. They exceeded all other specialties in

the number of visits for malignant neoplasm of female breast

(40 percent), acute myocardial infarction (39 percent), angina

pectoris (40 percent), and other forms of chronic ischemic heart

disease (42 percent).

Comparison with prior years data

The difference between the internists’ proportion of all

physician visits in 19755 and that of 1980–81 represents a

small, but statistically significant increase; the reader is cautioned, however, that a difference between two points in time

does not necessarily indicate a trend. A brief analysis of trends

from 1975 through 1980 was published in Vital and Health

Statistics, Series 13, No. 66, and indicated little significant

variation in the proportions of visits to internists over the 6-year

period.’3

13
2.8

2.6

2.4

2.2

2.0

1.8

1.6

1.4

1.2

/

/

o

_ Internal

medicine

- D General and

family practice

_ = = Obstetrics and

gynecology

,/

Under /

\

25 years 45 years

k.e”d’

and over

I I I I 1

Under 15–24 25-44 45-64 65

15 and

over

Age of patient in years

Figure 8. Drug intensity rate by age of patient and selected

physician specialty: United Statas, January 1980-December 1981

Some of the salient characteristics of visits to internists are

shown in table 25 with their proportions for 1975 and 1980–81.

In the more recent data collection period, there were proportionately more visits by patients 65 years of age and over than

there were in 1975 (figure 10). The proportion of visits to internists in solo practice declined from 54 percent in 1975 to

48 percent in 1980–81. There was also a small, but statistically

significant, difference in visits to internists in metropolitan areas,

which accounted for about 85 percent of their visits in 1975,

compared with 83 percent in 1980–8 1.

Except for a small increase in visits for diseases of the

musculoskeletal system (11 percent, compared with 9 percent

in 1975), there was little difference in the pattern of diseases

treated by internists in the two time periods. What appears to

be a large increase in the proportion of medical counseling given

should be interpreted with caution as it was probably the result

of definitional differences between the two surveys.

100

90

80

70

60

50

40

30

20

10

0

1.5

a Poataurgetyorposti.jury

E! Nonillness

❑ Chronic

❑ Acute

I

7,1 I

Internal General Obstetrics Pediatrics

medicine and family and

practice gynecology

Figure 9. Percent distribution of office visita by major reason for

visit, according to selected physician specialties: United Statea,

January 1980-December 1981

The average number of visits per week to female internists

increased from 37.6 in 1977 to 41.6 in 1980–8 1.14At the same

time, the average number of weekly visits to male internists

dropped from 58.5 to 51.8. In 1977 female internists spent

more time, on the average, with patients than male internists

did (23.5 minutes, compared with 18.7 minutes), but in 1980-

81 the means converged to close to 20 minutes for each sex.

14
Table L. Percent of office visits to all physician specialties by

selected principal diagnoses rendered in office visits to internists

United States, Janua~ 1980-Decamber 1981

Percent of

office visits

to all

physician

Principal diagnosis and ICD–9-CM codel specialties

Malignant neoplasm of female breast . . . . . . . . . ...174 40.4

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . ...250 35.0

Essential hypertension . . . . . . . . . . . . . . . . . . . . . ...401 33.5

Hypertensive heart disease . . . . . . . . . . . . . . . . . . ...402 34.0

Acute myocardial infarction . . . . . . . . . . . . . . . . . ...410 38.9

Anginspectoris . . . . . . . . . . . . . . . . . . . . . . . . . . . ...413 40.0

Other forms of chronic ischemic heart disease. . ...414 42.2

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . ...427 37.7

Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428 36.6

Chronic airway obstruction, not elsewhere

classified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...496 30.1

Rheumatoid arthritis and other inflammatory

polyarthropathies . . . . . . . . . . . . . . . . . . . . . . . . . ...714 57.1

Osteoarthrosis and allied disorders. . . . . . . . . . . ...715 32.3

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

Modification (ICD–9-CM.]7

100

90

80

70

60

50

40

30

20

10

0

1980–81

1 1 I I J

Under 15-24 25-44 45-64 65

15 and

over

Age of patient in years

Figure 10. Average annual rate of office visits to internists by age

of patient United States, 1975 and 1980-81

15

—.. - —-.———.—- — ———— . — _
References

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(PHS) 83-1734. Public Health Service. Washington. U.S. Government Printing Office, Sept. 1983.

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(PHS) 84-1740. Public Health Service. Washington. U.S. Government Printing Oftlce, Sept. 1984.

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and Health Statistics. Series 13, No. 36. DHEW Pub. No. (PHS)

79-1787. Public Health Service. Washington. U.S. Government Printing Oftice. Dec. 1978.

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J. Williamson National Ambulatory Medical Care Survey, background

and methodology, United States, 1967-72, Vital’and Health Statistics. Series 2, No, 61, DHEW Pub. No. (HRA) 74-1335, Health

Resources Administration. Washington. U.S. Government Printing

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U.S., 1975. Chicago, Ill. American Medical Association, 1976.

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processing of drug information, National Ambulatory Medical Care

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

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

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

loAmeric~ Society of Hospital Pharmacists, Inc.: The &Ze~”c?an

Hospital Formulary Service. Washington. Jan. 1980.

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and T. McLemore A reason for visit classification for ambulatory

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

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

lzNational Center for Health Statistics, B. K. Cypress: Medication

therapy in office visits for selected diagnoses, National Ambulatory

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

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and T. McLemore: The National Ambulatory Medical Care Survey,

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U.S. Government Printing Office, Sept. 1982.

IdNational Center for Health Statistics, B. K. Cypress: Characteristics

of visits to female and male physicians, National Ambulatory Medical

Care Survey, 1977. Vital and Health Statistics. Series 13. No. 49.

DHHS Pub. No. (PHS) 80-1710. Public Health Service. Washington.

U.S. Government Printing Oflice, June 1980.

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16
List of detailed tables

1. Number of ofiice visits to internists by type and location of

physician’s practice and percent distribution by selected visit

characteristics, according to type and location of physician’s

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

2. Number of drug mentions in ofiice visits to internists by type

and location of physician’s practice and percent distribution

by therapeutic category, according to type and location of

physician’spractice: United States, January 1980-December

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

3. Number of ofilce visits to internists by age and sex of physicirmand percent distribution by selected visit characteristics,

according to age and sex of physicirnx United States, January

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

4. Number of drug mentions in ofiice visits to internists by age

and sex of physician and percent distribution by therapeutic

category, according to age and sex of physician: United

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

5. Number of office visits to internists by sex, race, and Hispanic origin of patient, percent distribution by age of patien~

according to sex, race, and Hispanic origin of patient, and

average annual rate of office visits by sex, race, Hispanic

origin, and age of patienti United States, January 1980-

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

6. Number of office visits to internists and return visit rate by

selected patient characteristics and percent distribution by

prior visit status, according to selected patient characteristics: United States, January 1980-December 1981 . . . . .

7. Number of olllce visits to internists by sex and age of patient

and prior visit status and percent distribution by major reason

for visit and principal reason for visit module, according to

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

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

8. Number and percent distribution of oftlce visits to internists

by most frequent principal reasons for visifi United States,

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

9. Number and percent distribution of oftlce visits to internists

by sex of patient and most frequent principal reasons for

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

10, Number of otlice visits to internists by sex and age of

patient and prior visit status, old problem rate by principal

diagnosis categories, and percent distribution by principal

diagnosis categories, according to sex and age of patient and

prior visit status: United States, January 1980-December

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

11. Number and percent distribution of ofice visits to internists

by most frequent principal diagnoses: United States,

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

12. Number and percent distribution of office visits to internists

by sex of patient and most frequent principal diagnoses:

United States, January 1980-December 1981,...,, . . . . . 33

19 13. Number of office visits to internists by sex and age of patient

and prior visit status, percent of visits by diagnostic services,

nonmedication therapy, sex and age of patient, and prior

visit status, and percent distribution by number of medications, according to sex and age of patient and prior visit

22 status: United States, JanuaIY 1980–December 1981 . . . . . 34

14. Number of drug mentions in office visits to internists by sex

arrd age of patient and prior visit status and percent distribution by therapeutic category, according to sex and age of

23 patient and prior visit status: United States, January 1980-

December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 “

15. Number and percent distribution of drug mentions in office

26 visits to internists by the 100 most frequently named drugs:

United States, January 1980-December 1981 . . . . . . . . . . . 36

16. Number of o!lice visits to internists by sex and age of patient

and prior visit status, percent distribution by duration of

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

status, and percent of visits by disposition of visit, sex and

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

1980–December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

17. Number and percent distribution of office visits to internists

by age of patient and most frequent principal reasons for

27 visi~ United States, January 1980-December 1981 . . . . . . 38

28

29

18. Number and percent distribution of office visits to internists

by age of patient and most frequent principal diagnoses?

United States, January 1980-December 1981 . . . . . . . . . . . 39

19. Number of office visits to internists by major reason for

visit and principal reason for visit modules and percent of

visits by diagnostic services and major reason for visit and

principal reason for visit modules: United States, January

1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

20. Number of office visits to internists by principal diagnosis

30 categories, percent of visits by selected nonmedication

therapy and principal diagnosis categories, and percent distribution by number of medications, according to principal

diagnosis categories United States, January 1980-

December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

21. Number of ofilce visits to internists by principal diagnosis

31 categories, percent distribution by duration of visit, according to principal diagnosis categories, and percent of visits by

disposition of visit and principal diagnosis categories: United

32 States, January 1980-December 1981 . . . . . . . . . . . . . . . . . 42

17
22.

23.

Mean

status

duration of office visits to internists by prior visit 24.

and principal diagnosis categories: United States,

January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . 43

Number of office visits by selected physician specialties

and percent by selected visit characteristics and selected 25.

physician specialties: United States, January 1980-

December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Number of drug mentions by selected physician specialties

and percent dktribution by therapeutic categories, according to selected physician specialties: United States, January

1980 -December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Percent of all physician visits to internists and percent

distribution of office visits to internists by selected visit

characteristics: United States, 1975 and 1980–1 981 . . . . . 46

18
Table 1. Number of oilfice visits to internists by type and location of physician’s practice and percant distribution by salected visit characteristics,

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

Type of practice Geographic region Area

All types

of North NonCharacteristic practice solo Otherl Nottheast Central South West Metropolitan metropolitan

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

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

Sex of patient

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

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

Age of patient

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

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

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

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

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

Prior visit status

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

Old patient, new problem. . . . . . . . . .

Old patient, old problem. . . . . . . . . . .

Referral status

Referred by another physician . . . . . .

Not referred by another physician . . .

Major reason for visit

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

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

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

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

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

Principal reason for visit

and RVC codez

Symptom module. . . . . . S001-S999

Disease module . . . . . . . DOO1 -D999

Diagnostic, screening, and preventive

module . . . . . . . . . . . . .X100-X599

Treatment module. . . . . . T100–T899

Injuries and advarse effects

module . . . . . .. C. . . . .. J999-J999

Test results module . . . . RI 00-R700

Administrative

module, . . . . . . . . . . ..Al 00-A140

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

Diagnostic service4

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

Limited history and/or

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

General history and/or

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

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

Clinical laborato~ test . . . . . . . . . . . .

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

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

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

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

Endoacopy . . . . . . . . . . . . . . . . . . . . . .

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

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

144,172

100.0

58.8

41.2

2.1

6.5

20.7

37.1

33.6

12.1

19.5

68.4

3.6

96.4

31.6

45.0

12.2

1.5

9.8

54.9

13.1

17.9

7.5

1,4

0.8

1.8

2.6

4.2

62.7

18.1

3.2

34.3

13.5

61.0

12.1

1.6

1.5

1.1

3.5

68,479

100.0

60.4

39.7

2.1

6.5

18,9

37.2

35.3

10.9

20.0

69.1

3.0

97.0

33.4

43.7

11.9

2.0

9.1

57.3

12.8

15.8

6.9

1.6

“0.6

2.1

2.9

4.3

60.9

19.7

3.0

33.3

11.5

62.7

12.1

2.1

1.7

1.0

3.5

75,693

100.0

57.4

42.6

2.1

6.5

22.4

37.0

32.0

13.2

19.1

67.7

4.2

95.8

29.9

46.2

12.4

1.2

10.3

52.6

13.3

19.7

8.1

1.3

1.1

1.5

2.4

4.0

64.4

16.7

3.4

35.2

15.2

59.5

12.0

1.1

1.3

1.1

3.6

Number in thousands

46,388 32,926 36,975

Percent distribution

100.0

58.3

41.7

2.1

7.8

23.2

36.4

30.6

12.4

19.9

67.7

3.0

97.1

32.1

45.9

11.6

1.3

9.1

55.6

14.8

15.6

6.4

1.4

“0.6

2.2

3.4

5.2

64.2

19.2

2.0

32.3

11.8

61.6

10.9

1.8

1.3

“0.9

4.4

100.0

57.5

42.5

3.5

6.9

19.3

36.9

33.4

11.1

20.4

68.4

3.2

96.8

30.9

46.0

12.2

*1.3

9.6

57.0

11.1

17.1

7.0

1.8

“0.8

2.0

3.2

4.0

64.0

15.8

4.0

34.7

10.2

59.1

8.9

*1.1

1.5

“0.6

3.3

100.0

60.0

40.0

1.1

5.4

31.1

38.3

34.1

13.0

19.2

67.9

4.8

95.2

31.7

42.4

13.4

2.0

10.6

51.5

11.9

21.5

9.4

*1.2

“0.8

1.5

2.4

3.0

58.9

21.1

3.3

37.4

17.6

58.6

16.0

2.0

1.9

1.3

2.1

27,883

100.0

59.6

40.4

1.7

5.3

17.8

37.2

38.0

11.6

18.2

70.2

3.8

96.2

31.4

45.7

11.4

1.6

10.0

55.5

14.0

17.6

7.6

*1.4

*1.4

*1.3

*1.2

4.1

63.8

15.1

4.1

33.2

14.7

65.6

12.5

*1.1

“1.1

*1.6

4.2

119,871

100.0

59.0

41.1

1.6

6.7

21.4

37.2

33.2

12.6

19.1

68.3

3.8

96.2

32.1

44.4

12.1

1.6

9.8

55.7

13.3

17.4

7.1

1.4

0.7

1.6

2.8

4.3

61.8

19.0

3.1

36.2

14.2

60.6

12.7

1.6

1.5

1.2

3.7

24,301

100.0

58.2

41.8

4.5

5.6

17.5

37.0

35.4

9.7

21.3

68.9

3.0

97.0

28.9

47.9

12.5

*1.3

9.4

50,6

12.0

20.0

9.8

“1.5

*1.3

2.8

“2,0

3.3

67.1

13.5

3.9

25.0

9.8

63.4

9.0

*1.3

*1.2

“0.5

2.7

See footnotes at end of table.

19
Table 1. Number of or%cevisits to internists by type and location of physician’s practice and percent distribution by salected visit characteristics,

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

Type of practice Geographic region Area

All types

of North NonCharacteristic practice solo OtherJ Northeast Central South West Metropolitan metropolitan

Nonmedication therapy4

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

Physiotherapy, . . . . . . . . . . . . . . . . . .

Office surgeV . . . . . . . . . . . . . . . . . . .

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

Psychotherapy or therapeutic

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

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

Family or social counseling . . . . . .

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

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

Number of medications

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

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

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

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

4 or more . . . . . . . . . . . . . . . . . . . . . . .

Principal diagnosis and

ICD-9-CM code5

Infectious and parasitic

diseases . . . . . . . . . . . . ...001-l 39

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

Endocrine, nutritional and metabolic

diseases, and immunity

disorders . . . . . . . . . . . . ..24O-279

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

Diseases of the nervous system and

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

Diseases of the circulatory

system . . . . . . . . . . . . . . ..39 O-459

Diseases of the respiratory

system . . . . . . . . . . . . . . ..46O-5l 9

Diseases of the digestive

system . . . . . . . . . . . . . . ..52 O-579

Diaeaaes of the genitourinary

system . . . . . . . . . . . . . . ..58 O-629

Diseasea of the skin and

subcutaneous tissue . . . 680-709

Diseases of the musculoskeletal

system and connective

tissue . . . . . . . . . . . . . . . ..71 O-739

Symptoms, signs, and ill-defined

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

Injury and poisoning . . . . . . 800–999

Supplementary

classification . . . . . . VO1-V82

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

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

Duration of visit

0minutes6 . . . . . . . . . . . . . . . . . . . .

l–5 minutes . . . . . . . . . . . . . . . . . . . .

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

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

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

31minutes or longer . . . . . . . . . . . . .

See footnotes at end of table.

Percent distribution

47.8

3.5

2.9

“0.2

4.8

16.7

2.7

36.0

1.4

23.2

31.7

21.6

56.7

6.0

2.2

“0.5

5.1

10.1

1.5

28.3

“0.8

20.3

28.1

21.1

58.5

4.2

“1.1

“0.4

6.0

12.4

1.4

29.2

1.0

27.2

27.7

18.8

10.7

15.7

52.1

4.2

1.9

“0.3

5.2

12.9

2.0

33.6

1.0

23.8

29.2

20,6

12.1

14.3

48.8

4.8

1,7

“0.2

5.3

16.2

1.7

36.1

1,0

21.9

28.1

21.8

13.3

14.9

55.1

3.6

2.0

‘0.4

5.1

9.9

2.3

31.3

1.0

25.6

30.1

19.5

11.0

13.8

45.6

3.0

“0.8

*0.1

4.7

10.6

2,3

41.7

“0.8

50.5

4.3

1.8

“0.3

5.5

13.4

2.1

35.2

1.0

60.2

3.6

2.0

“0.4

3.7

10.5

“1.6

25.7

“0.9

24.8

28.3

20.6

12.6

13.7

23.7

29.6

21.1

12.0

13.5

2!4.4

26.9

18.2

12.2

18.3

11.9 13.5

11.7 17.1

1.8 1.6 2,0 2.1

4,1 2.8 5.2 3.7

2.1 1.5 *1.5

3.9 5.8 2.6

1.9

4.1

“1.6

3.9

8.7 9.6 7.9 10.0

3.3 3.5 3.1 3.3

8.9 7.3 8.2

3.3 3.1 3.4

8.8

3.2

2.8

8.2

3.6

2.8 3.1 2.6 3.0 2.7

25.5 26.8 24.3 25.1

11.7 11.5 11,7 14.4

3.3 2.5 2.4

24.9 23.5 29.4

9.5 9.9 11.9

5.9 6.7 6.8

26.1 22.3

11.9

6.2

3.3

10.5

6.2 6.5 6.0 5,8 6.4

3.3 3.3 3.3 2.8 4.0 3.1 3.7 3.2

2.3 2.5 2.2 2.4 2,6 2.1 , 2.0 2.2

11.2 11.6 10.8 10.4 12.9 10.2 11.8 11.8 8.1

5.2 4,5 5.8 4.4

3.7 4.2 3.2 4.1

4.4 6.5 5.7

4.3 3.0 3.2

5.0

3.8

5.9

3.4

7,8 6.4 9.1 6.3

1.4 1.2 1.5 1.1

1.1 0.9 1.3 1.0

7.8 11.7 5.2

1.4 1.5 “1.5

“1.0 1.7 ‘0.7

6.6

1.3

0.9

13.9

“1.5

1.9

2,3 3.0 1.6 1.8

5.6 5.6 5.7 7.7

17.3 16.1 18.3 15.6

35.4 34.0 36,8 35.8

28.6 30.8 26.5 30.5

10.9 10.6 11.1 8.6

1.7 4.1 “1.4

6.2 4.0 3.7

23.0 13.1 18.8

39.6 30.2 36.8

21.8 31.6 29.4

7.7 17.1 9.9

2.3

5.1

15.9

36.1

30.1

10.6

2.1

8.0

24.2

32.2

21.2

12.4

20
Table 1. Numbar of office visits to internists by type and location of physician’s practice and percent distribution by selected visit characteristics,

according to type and location of physician’s practice: United Stetes, January 1980-December 1981—Con.

Type of practice Geographic region Area

All types

of North

Characteristic

Nonpractice solo Otharl Northeast Central South West A4etropolitan metropolitan

Disposition of visit7 ,

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

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

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

Telephone followup planned . . . . . . .

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

Returned to referring physician . . . . .

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

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

Percent distribution

7.8 7.8 7.8 8.2 9.2 7.9

68.7 69.2 68.2 70.3 67.1 66.8

16.7 16.3 17.1 14.0 17.9 17.0

6.5 7.0 6.0 6.7 6.1 7.1

4.2 3.5 4.9 4.8 3.5 3.6

0.9 1.0 0.8 1.0 “0.7 80.9

1.7 1,5 1.9 1.3 1.4 2.8

0.3 “0.3 *0.4 “0.5 “0.2 “0.5

5.4

70.4

19.5

5.7

5.1

“1.0

*1.4

“0.2

7.5

69.0

16.6

7.2

4.4

1.0

1.4

“0.3

9.2

66.9

17.3

3.0

3.3

“0.5

3.3

“0.7

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

‘Baaed cmA reason for visit classification for ambulatory care (RVC). 7I

aln~l~dea blank~; problems, comp]ainta not elsawhere classified; entrias Of “nOne”; and illegible entries.

4Percents will not total 100.0 because more than 1 service or therapy may have been rendered during a visit.

5Baaed on the Jnternatjonal Classification of Dise8ses, 9th Revision, Clinical Modification (1Ck9-CM).7

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

7Percents will not total 100.0 because more than 1 disposition was possibla.

21
Table 2. Number of drug mentions in office visits to internists by type and location of physician’s practice and percent distribution by therapeutic

catagory, according to type and location of physician’s practice: United Statas, January 1980-December 1981

Type of practice Geographic region Araa

All types

of North NonTherapeutic categoryl practice solo Otherz Northeast Central South West Metropolitan metropolitan

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

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

Antihistamine druga. ., , . . . . . . . .

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

Antibiotics . . . . . . . . . . . . . . . . .

Sulfonamides . . . . . . . . . . . . . . .

Antineoplastic agents . . . . . . . .

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

Blood formation and coagulation. . .

Antianemia drugs . . . . . . . . . . .

Coagulant and anticoagulants . . . . . . . . . . . . . . . .

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

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

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

Vasodilating agents . . . . . . . .

Central nervous system drugs . . . .

Analgesics and antipyretics. . . .

Anticonvulsants . . . . . . . . . . . .

Psychotherapeutic agents . . . .

Respiratory and cerebral

stimulants . . . . . . . . . . . . . . . . .

Sedatives and hypnotics . . . . . .

Electrolytic, caloric, and water

balance . . . . . . . . . . . . . . . . . . . .

Expectorants and cough

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

Eye, ear, nose and throat

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

Gastrointestinal drugs . . . . . . . .

Antacids and absorbents. . . . . .

Antiflatulents . . . . . . . . . . . . . . .

Cathartics and laxatives. . . . . . .

Hormones and synthetic

substitutes . . . . . . . . . . . . . . . . .

Adrenals . . . . . . . . . . . . . . . . . . .

Estrogens . . . . . . . . . . . . . . . . . .

Insulins and anti-diabetic

agents . . . . . . . . . . . . . . . . . . . .

Thyroid and antithyroid . . . . . .

Serums, toxoids and vaccines . . .

Skin and mucous membrane

preparation . . . . . . . . . . . . . . . .

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

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

Other, unclassified, or

undetermined . . . . . . . . . . . . . . . .

251,370

100.0

3.2

6.4

5.2

0.6

2.3

3.8

1.4

0.6

0.8

21.8

9.8

6.7

5.1

17.9

10.4

0.5

2.3

0.3

4.3

15.7

1.7

0.7

4.8

1,0

0.6

0.7

9.7

3.1

0.9

3.5

1.8

1.1

2.6

2.1

2.2

2.6

124,653

100.0

3.2

6.4

5.4

0.6

1,0

3.7

1.4

0.6

0.8

22,3

10.0

6.7

5.5

17.6

9.7

0.5

2.3

0.4

4.7

15.9

1.7

0.7

5.1

1.0

0.5

0.8

9.7

3.1

0.9

3.6

1.7

1.4

2.7

2.0

2.6

2.6

126,717

100.0

3.3

6.3

5.1

0.7

3.5

4,0

1.5

0.6

0.8

21.2

9.7

6.7

4.7

18.1

11.2

0.5

2.2

“0.2

4.0

15.5

1.7

0.7

4.6

1.1

0.8

0.6

9.6

3.1

0.8

3.4

1.8

0.9

2.5

2.2

1.7

2.7

Number in thousands

75,997 64,091 63,682

Percent distribution

100.0

4.0

6.8

5.8 .

“0.5

2.5

3.8

1.4

0.7

0.7

21.9

9.4

7.3

5.0

16.9

10.2

“0.4

1.7

“0.3

4.2

15.6

1.9

0.9

4.2

O.B

0.6

0.6

9.2

2.9

“0.3

4.0

1.8

1.2

2.7

2.4

2.4

2.2

100.0

3.0

6.1

4.8

“0.6

1.8

4.4

1.5

0.7

0.8

20.5

9.5

6.1

4.8

19.3

11.8

“0.6

2.3

“0.4

4.2

15.9

1.8

0.7

5.4

1.2

0.9

‘0.5

9.2

2.4

0.9

3.4

1.9

1.1

2,9

1,9

2.1

2.4

100.0

2.9

6.1

4.9

“0.6

3.1

3.7

1.5

“0.6

0.9

23.0

10,6

6.3

5.9

18.1

9.6

“0.4

3.2

“0.2

4.7

13,8

1.6

“0.5

5.4

1.2

“0.5

1.2

10.1

3.7

1.1

3.3

1.4

0.9

2.6

1.9

1.8

3.3

47,600

100.0

2.7

6.6

5.3

“0.9

1.4

3.1

1.3

“0.4

1.0

21.6

9.9

7.1

4.5

17.3

10.2

“0.6

1.9

*0.5

4.1

18.1

1.4

*0.6

4.2

1.0

“0.5

‘0.5

10.5

3.6

1.4

3.1

2.2

1.5

2.1

2.4

2.4

2.8

205,182

100.0

3.3

6.4

5.2

0.6

2.3

3.9

1.4

0.6

0.8

21.1

9.4

6.8

4.7

17.8

10.5

0.5

2.3

0.2

4.2

16.1

1.8

0.7

4.6

1.0

0.6

0.7

9.8

3.2

0.8

3.5

1.8

1.1

2.6

2.2

2.2

2.7

46,188

100.0

2.9

6.3

5.2

“0.6

2.2

3.4

1.4

‘0.7

“0.8

24.7

11.6

6.2

6.7

18.4

10.1

“0.5

2.4

‘0.7

4.7

13.7

1.4

“0.5

6.1

1.2

“0.7

“0.9

9.2

2.6

1.1

3.6

1.6

1.0

2.6

1.8

2.0

2.4

lBasedon theclsssification system of the American Hospital FormulaiyService (see appendixlV)

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

22
Table 3, Number of office visits to internists by aga and sex of physician and percent distribution by selected visit characteristic, according

toageand sexof physician: Unitad States, January 1980-December 1981

Age of physician 1 Sex of ph ysician

All Under 35-44 45–54 55-64 65 years

Characteristic ages 35 years years years years and over Female Male

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

“’Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex of patient

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

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

Age of patient

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

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

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

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

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

Prior visit status

New patient.....,.........,.. . . . . . . . . . . . . . . . . . . . .

Oldpatient, new problem . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oldpatient, old problem . . . . . . . . . . . . . . . . . . . . . . . . . . .

Referral status

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

Not referred by another physicisn . . . . . . . . . . . . . . . . . . . .

Major reason for visit

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

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

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

Postaurgery or postinjury . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonillnass care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Principal reason for viait module and RVC codez

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

Disease module . . . . . . . . . . . . . . . . . . . . . . . . DOOI -D999

Diagnostic, screening, and preventive

module . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. XI OO-X599

Treatment modula . . . . . . . . . . . . . . . . . . . . . .. T899-T899

Injuries and adverse effects module . . . . . . . . JOO1-J999

Teat results module.......,,.. . . . . . . . . .. R1OO-R7OO

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

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

Diagnostic setvice4

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

Limited history and/or examination. . . . . . . . . . . . . . . . . . .

General history and/or examination . . . . . . . . . . . . . . . . . .

Paptest . .. c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

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

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

1,42,810

100.0

58.9

41.1

2.1

6.5

20.7

37.2

33.5

12.1

19.6

68.3

3.7

96.4

31.5

45.1

12.0

1.6

9.8

54.8

13.0

17.9

7.6

1.4

0.8

1.8

2.7

4.2

62.8

18.0

3.2

34.3

13.5

60.8

12.1

1.6

1.5

1.1

3.6

15,051

100.0

59.7

40.3

2.8

9.0

23.6

36.0

28.5

20.3

17.8

61.9

6.3

93.7

31.3

44.3

13.3

*1.7

9.4

58.6

12.8

14.3

6.1

*1.4

“0.7

*2.4

3.7

2.5

63.0

21.0

*2.7

35.8

9.8

51.0

7.2

“0.9

“0.7

*0. I

*2.8

36,800

100.0

60.4

39.6

2.1

7.1

27.0

36.9

26.9

14.3

19.0

66.7

4.2

95.8

31.5

45.5

13.4

1.3

8.3

57.7

13.9

15.3

7.7

1.5

*1.2

*1.2

1.5

2.2

65.2

18.9

2.9

34.5

14.2

62.9

10.8

*1.1

“0.9

1.8

3.9

Number in thousands

50,340 32,323

Percent distribution

100.0

59.1

40.9

1.5

5.6

17.8

38.2

36.9

11.8

17.7

70.5

3.4

96.6

30.8

46.3

11.9

1.4

9.6

51.6

13.6

20,3

8.0

1.2

“0.9

2.0

2.4

3.0

65.9

17.1

3.1

35,3

15.9

65.7

13.9

1.7

1.7

‘0.6

4.1

100.0

56.2

43.8

2.8

6.1

17.7

38.4

35.0

7.8

21.8

70.4

2.8

97.2

30.8

44.4

11.5

1.9

11.3

54.4

11.2

18.7

7.7

1.4

“0.6

2.0

4.0

8.5

55.3

16.8

3.6

31.5

11.6

58.7

12.5

2.4

2.3

1.6

3.1

8,295

100.0

59.8

40.2

*2.1

5.6

17.4

29.9

45.1

6.2

28.1

65.6

“1.6

98.4

38.8

40.3

6.5

*1.7

12.7

55.2

12.8

18.8

6.2

*2.5

*O. 1

*1.5

*2.9

6.8

61.9

19.6

*4.4

35.0

10.4

47.5

14.0

*1.O

*1.1

*0.2

*1.5

5,269

100.0

70.2

29.8

“3.0

11.4

29.5

36.0

20.3

22.9

21,1

56.0

*5.3

94.7

35.1

40.3

11.5

*1.3

11.8

54.8

17.3

15.2

*5.1

“2.0

80.8

*3.3

*1.5

*5.1

64.3

17.3

*7.7

37.7

17.4

49.3

*5.8

*1.8

“0.6

*1,0

‘0.7

137,541

100.0

58.4

41.6

2.1

6.3

20.4

37.3

34.0

11.7

19.5

68.8

3.6

96.4

31.4

45.3

12.1

1.6

9.7

54.8

12.8

18.0

7.7

1.4

0.8

1.8

2.7

4.2

62.7

18.1

3.0

34.1

13,4

61.2

12.3

1.6

1.5

1.1

*3.7

See footnotes at and of table.

23

/
,

Table 3. Number of office visits to internists by age and sex of physician and percent distribution by selected visit characteristics, according

to age and sex of physician: United States, January 1980-December 1981 —Con.

Age ofphysiciarrl Sex of physician

All Under 35-44 45-54

Characteristic

55-64 65 years

ages 35 years years years years and over Female Male

Nonmedication therapy4

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

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

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

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

Psychotherapy or therapeutic listening. . . . . . . . . . . .

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

Family orsocisl counsel ing . . . . . . . . . . . . . . . . . . . . . . . . .

Madical counseling.,.......,.. . . . . . . . . . . . . . . . . . . . .

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

Number of medications

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

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

2: : : : : : . . . . . . . . . . . . . . . . ...%..... . . . . . . . . . . . .

3, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

40rm0re . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Principal diagnosis and ICD-9-CM codes

Infectious and parasitic diseaaes. . . . . . . . . .. 001-139

Neoplssms . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Endocrine, nutritional and metabolic diseases, and

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

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

Diseases of the nervous system and sense

organs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...320-389

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

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

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

Diseasea of the genitourinary system . . . . . . ...580-629

Diseases of the skin and subcutaneous tissue, .680-709

Diseases of the musculoskeletal systam and connective

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-739

Symptoms, signs, and ill-defined conditions . ..780-799

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

Supplements classification . . . . . . . . . . . . . . . . VOI-V82

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

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

Duration of viait

O minutesa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

31minutes or longer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disposition of visit7

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

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

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

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

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

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

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

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

Type of practices

solo . . . . . . . . . . . . . . . . . ! . . . . . . . . . . . . . . . . . . . . . . . . . .

Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See footnotes at end of table.

52.5

3.8

1.8

“0.3

5.2

12.8

2.0

33.4

1.0

23.8

29.3

20.6

12.1

14.3

1.8

4.1

8.6

3.3

2.8

25.5

11.7

6.2

3.3

2.3

11.1

5.2

3.6

7.9

1.3

1.1

2.3

5.7

17.3

35.5

28.4

10.9

7.8

68.5

16.8

6.5

4.2

0.9

1.7

0.4

47.4

52.6

55.7

4.0

“2.0

‘0,2

4.7

7.6

“1.6

31.6

“1.4

24.2

30.0

20.4

12,5

13.0

2.5

7,2

9.9

3.2

3.9

19.7

9.4

5.2

3.9

3.1

13.7

5.9

4.4

5.2

1.5

*1.2

2.3

6.8

17.0

33.7

29.5

10.8

9.3

64.3

18.9

5.4

4.7

“1.4

“1.9

“0.3

43.1

56.9

47.2

4.3

1.8

“0.7

7.2

15.5

2.5

36.1

“1.0

20.3

30.6

22.5

11.9

14.7

2.1

3.7

9.5

3.9

2.4

25.8

11.8

6.3

3.1

2.2

12.6

6.2

3.1

5.2

1.3

“1.0

2.0

3.1

20.6

36.5

27.8

10.1

4.8

69.1

19.3

8.3

4.9

*1.O

1.7

“0.2

39.7

60.4

Percent distribution

54.4

3.4

1.2

*0.1

4.2

12.0

1.7

34.7

1.1

26.4

28.8

19.2

11.4

14.3

1.4

4.9

8.5

2.3

2.6

26.2

9.7

6.8

3.0

2.0

11.4

5.1

3.8

9.7

1.5

1.1

2.9

6.4

17.8

35.5

26.2

11.3

7.6

70.3

16.3

6.3

3.6

‘0.9

2.1

“0.5

41.0

59.0

53.0

3.9

2.3

“o. 1

4.6

13.4

2.3

31.0

“0.7

23.9

28.0

20.3

12.9

14.9

1,7

2.5

7.7

4.2

3.1

26.1

14.9

5.9

3,9

2.5

8.6

3.7

3.5

9.3

1.1

1.5

1.8

7.5

14.6

36.6

28.6

10.9

9,6

69.8

14.3

4.1

4.2

“0.7

1.4

“0.2

62.9

37,1

56.6

*2.8

“3.4

“0.3

5.5

13.1

*1.4

25.2

“0.8

22.3

30.4

22.0

12,9

12.4

2.6

1.5

7.4

3.8

3.2

28.9

14.9

6.4

2.4

3.0

7.1

5.4

3.9

7.7

“1.5

“0.3

“1.5

*3.8

11.1

29.8

41.7

12.0

12.8

58.5

14.3

10.8

*4.6

“0.3

“0.7

“0.5

67.3

32.7

27.6

*2.4

“3.0

‘1.9

17,4

17.9

*2,3

52.9

‘1.4

21.9

30.7

26.1

11,1

10.3

“2.7

“1.3

8.7

*4.4

“1.6

20.4

9.2

*6.3

*5.4

“2.7

18.9

“4.2

*4.4

8.6

“0.6

“0.7

“0.9

*2.3

*5.2

37.7

46.6

*7.3

8.3

65.2

17,6

*5.4

“7.5

“0.9

‘0.6

“0.2

36.4

63.7

53.5

3.8

1.8

“0.2

4.7

12.6

2,0

32.6

1.0

23.9

29.2

20.4

12.1

14.5

1.8

4.2

8.6

3.3

2.9

25.7

11.8

6.2

3.2

2.3

10.8

5.2

3.6

7.8

1.4

1.1

2.3

5.8

17.8

35.4

27.7

11.0

7,8

66.7

16.8

6.5

4.1

0.9

1.8

0.4

47.8

52.2

24
Table 3. Number of office visits to internists by age and sex of physician and percent distribution by salacted visit characteristics, according

to age and sex of physicien: United States, January 1980-December 1981 —Con.

Age ofphysicianl Sex of physician

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

Characteristic eges 35 years years yeara years and over Female Male

Geographic region Percent distribution

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32.0 27.8 28.1 32.4 34.5 44.9 35.6

North Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31.9

22.6 37.8 19.5 16.5 30.9 12.8 13.3 22.9

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.9 15.1 30.9 31.7 18.9 15.4 30.2

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

25.7

19.5 19.3 21.5 19.4 15.7 26.9 20.9 19,5

Area

Metropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83.0 73.7 83.7 84.7 81.9 90.7 92.4 82.6

Nonmetropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.0 26.3 16.3 15.3 18.1 9.3 7.6 17.4

1Does not include doctors of osteopathy.

‘Baaed on A reason for visit classification for ambulatory care (RVC).l 1

31ncludea blanka; problems, complaints not elsewhere classified; entires of “none”: and illegible entries.

4Percants will not total 100.0 becauae more than 1 sewice or therapy may have been rendered during a visit.

5Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9–CM).7

6Repreaents visits in which there was no face-to-face encounter betw’een patient and physician.

7Percents will not total 100.0 bacause more thsn 1 disposition was possible.

81nctudea partnership, group, and other types of practice.

25
Table 4. Number of drug mentions in office visits to internists by age and aex of physician and percent distribution by therapeutic categc)ry,

according to age and sex of physician: United States, January 1980–December 1981

Age of physician Sex of ph ysician

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

Therapeutic category~ ages 35 years years years years and over Female Male

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

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

248,864

100.0

3.2

6.3

5.2

0.6

2.3

3.8

1.4

0.6

0.8

21.8

9.9

6,7

5.1

18,0

10.5

0.5

2.3

0.3

4.3

15.6

1.7

0.7

4.8

1.1

0.6

0.7

9.6

3,0

0.9

3.5

1.8

1.1

2.6

2.1

2.2

2.8

25,423

100.0

2.8

6.5

5.5

“0.4

5,1

3.8

1.8

“0.8

“1.0

17.9

8.0

5.6

4.2

22,2

13.8

“0.6

2.8

‘0.1

4.9

12.5

*1,1

“0.6

5.1

“1.5

“0.9

“0.4

10.3

3.3

“1,3

3.3

2,0

“0.4

2.6

1.6

2.5

3.2

66,323

100,0

3.1

6.2

5.1

“0.6

2.3

4.3

1.1

“0,4

“0.7

22.4

9.7

7.2

5.4

18.0

11.2

“0.4

2.2

“0.3

3.9

15.3

1.6

“0.4

4.5

0.8

“0.6

0.8

9.8

3.9

“0.4

3.1

1.9

0.9

2.8

2.6

1.9

2.8

Number in thousands

84,953 57,800

Percent distribution

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

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

Antibiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sulfonamides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antineoplastic agents . . . . . . . . . . . . . . . . . . . . . . .

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

Blood formation and coagulation . . . . . . . . . . . . . . . .

Antianemia drugs . . . . . . . . . . . . . . . . . . . . . . . . .

Coagulant and anticoagulants. . . . . . . . . . . . . . . .

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

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

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

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

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

Analgesics andantipyretics . . . . . . . . . . . . . . . . .

Anticonvulsants .,,......,,.. . . . . . . . . . . . . . . .

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

Respiratory and cerebral stimulants . . . . . . . . . . . . . . .

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

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

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

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

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

Antacids andadsorbents . . . . . . . . . . . . . . . . . . . . .

Antiflatulents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cathartics and laxatives . . . . . . . . . . . . . . . . . . . . . .

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

Adrenals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estrogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insulins and anti-diabetic agents . . . . . . . . . . . .

Thyroid and antithyroid ...,..... . . . . . . . . . . . . . . . . .

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

Skin and mucous membrane preparations, . . . . . . . . . . .

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

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

Other, unclassified, or undetermined . . . . . . . . . . . . .

lBased on the classification system of the American Hospital FormulaV Servica (see appendix IV).

2Does not include doctors of osteopathy.

100.0

2.8

6.2

5.1

0.6

3.1

3.8

1.5

0.6

0.9

21.8

10.1

6.7

4.8

17.2

10.6

“0.4

1.9

“0.3

4.0

15.9

2.0

0.8

5.0

1.2

0.7

0.7

9.8

3.1

0.9

3.9

1.5

1.3

2.5

2.0

2.0

2.3

100.0

4.2

5.8

4.5

“0.7

“0.4

3.6

1.5

“0.7

0.8

23.2

10.8

6.6

5.7

17.6

8.7

“0.8

2.7

‘0.5

4.9

16.9

1.6

0.9

4.8

0.9

“0.6

“0.7

9.2

2.1

1.2

3.4

2.1

1.2

2.5

2.0

2.2

2.4

14,365

100.0

4.0

9.1

7.8

“0.9

*o. 1

“2.5

‘2.0

“1.0

*1.1

21.2

8.6

7.0

5.4

16.2

8.2

“0.4

“2.3

“0.4

4.7

15.3

*2.5

“0.8

5.0

“1.0

“0.2

“0.8

8.2

*1.9

“0.6

3.7

“1.6

*2.4

*3.O

*1.7

4.3

*1.7

8,598

100.0

*2.4

9.3

7.0

“1.1

“0.9

“3.7

*0.9

“0.4

“0.5

13.8

5.1

6.7

“2.1

21.3

15.8

“0.9

*2.1

*0.4

2.1

12.7

*1.4

‘0.5

“4.1

“1.5

“0.4

*O. 1

14.7

5.8

*0.8

“4.6

“2.3

“1,1

*5.O

*1.5

2.0

4.7

240,266

100.0

3.3

6.2

5.1

0.6

2.3

3.8

1.5

0.6

0.8

22.1

10.0

6.7

5.2

17.8

10.3

0.5

2.3

0.3

4.4

15,7

1.7

0.7

4.9

1.0

0.6

0.7

9.4

2,9

0.9

3.5

1.8

1.1

2.5

2.1

2.2

2.7

26
Table 5. Number of office visits to internists by sex, race, and Hispanic origin of patient, percent distribution by age of patient, according to

sex, race, and Hispanic origin of patient, and average annual rate of office visits by sex, race, Hispanic origin, and age of patient: United States,

January 1980-December 1981

Sex Race Hispanic origin

Both All NonAge of patient sexes Female Male White Black other Hispanic Hispanic

Aliases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144,172

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

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.1

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5

25-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.7

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.1

65 years And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33.6

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32.4

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.9

15–24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.5

25-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.8

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60.9

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98.7

84,798

100.0

1.7

6.7

20.3

36.6

34.7

36.8

2.9

13.7

26.8

67.1

101.8

Number of visits in thousands

59,374 129,061 13,498 1,613

Percent distribution

100.0 100.0 100.0 100.0

2.7 2.0 3.1 *3.8

6.2 6.5 5.6 *12.1

21.3 20.1 25.7 32.6

37.9 36.8 41.2 28.6

31.9 34.7 24.5 “23.0

Visit rate par 100 population

27.6 33.8 25.9 14,6

3.1 3.1 2.7 “2.0

9.2 12.3 7.0 *9.2

20.7 24.0 25.2 14.5

54.0 60.9 67.1 27.9

94.3 100.9 81.0 “60.1

5,100

100.0

*3.2

13.2

35.6

32.4

15.7

17.6

1.8

10.6

22.4

42.2

56.7

139,072

100.0

2.1

6.2

20.2

37.3

34.2

33.3

3.1

11.4

24.1

61.4

100.6

Table 6. Number of office visits to internists and return visit rate by selected patient characteristics and percent distribution by prior visit status,

according to selected patient characteristics: United States, January 1980-December 1981

Prior visit status

Number of Return

visits in New Old patient, Old patient, visit

Characteristic thousands Total patient new problem old problem rate 1

Sex Percent distribution

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144,172 100.0 12.1 19,5 68.4 7.3

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84,798 100.0 11.4 19.7 68.9 7.8

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59,374 100.0 13.1 19.2 67.7 6.7

Age

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,027 100.0 29.5 29.6 41.0 2.4

15-24 yeers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,346 100.0 32.4 30.0 37.7 2.1

25-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29,866 100.0 20.7 25.2 54.1 3.8

45-64 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.543 100.0 8.2 17.9 73.9 11.2

65 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48,389 100,0 6.1 15.2 78.8 15.4

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129,061 100.0 11.5

black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13,498 100.0 16!6

Another . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,613 100.0 *22.5

19.9

16.0

“20.5

68.6

67.4

57.1

7.7

5.0

*3.4

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,100 100.0 23.2 23.2 53.6 3.3

Non-Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139,072 100.0 11.7 19.4 68.9 7.5

10ld patient visits divided by new patient visits.

27
Table 7. Number of office visits to internists by sex and age of patient and prior visit status end percent distribution by major reaaon for visit

and principal reason for visit module, according to sex and age of patiant and prior visit statua: United States, January 1980-December 1981

Sex Age Prior visit status

Old patient

Major reason for visit and Both Under 15-24 25-44 45-64 65 years New New Old

principal reason for visit module sexes Famale Male 15 years years years years andover patient problem problem

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

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

Major reason for visit

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

Chronic problem, routine. . . . . .

Chronic problem, flareup . . . . . .

Postsurgew or postinjury. . . . . . .

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

Principal reason for visit

and RVC codel

Symptom module. . . S001 -S999

Disease module. . . . DOOI-D999

Diagnostic, screening, and preventive module. . .X IOO-X599

Treatment module. . TIOO-T899

Injuries and adverse effects

module . . . . . . . . . ..IOOI-J999

Test rasults

module . . . . . . . . . . R1OO-R7OO

Administrative

module . . . . . . . . .. A100-Al 40

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

144,172

100.0

31.6

45.0

12.2

1.5

9.8

54.9

13.1

17.9

7.5

1,4

0.8

1.8

2.6

84,798

100.0

32.1

45.1

12,5

1.3

9.0

57.2

12.6

17.2

7.3

1.3

0.8

1.2

2.4

59,374

100.0

30.8

44.8

11.7

2.0

10.9

51.5

13.7

18.7

7.9

1.7

0.9

2.7

2.9

3,027

100.0

46.6

27.2

5.9

*1.5

18.8

62.9

5.4

17.3

*6.6

*1.9

“0.1

*5.1

“0.7

Number in thoussnds

9,346 29,866 53,543

Percent distribution

100.0

51.7

20.0

7.7

*2.6

18.1

65.4

5.2

9.8

“4.5

*3.5

“0.5

9.8

*1.3

100.0

43.2

32.0

11.7

1.6

11.6

59.8

11.6

13.9

6.9

2.0

‘1.0

3.2

*.1 6

100.0

28.2

48.1

13.1

1.5

9.1

52.0

14.3

19.7

8.2

1.1

“0.8

1.0

2.9

48,389

100.0

23.2

55,5

12.7

1.4

7.2

52.4

14.6

19.9

7.8

1.1

*0.8

‘0.1

3.3

17,451

100.0

51.2

15.9

9.2

“0.9

22.8

61.2

9.3

14.2

2.9

2.7

“0.4

8.4

“0,9

28,133

160.0

75.9

7.9

5.6

1.7

9.0

79.1

4,1

7,4

2.4

3.8

“0.1

2,2

“0.9

98,588

100.0

15.4

60.7

14.6

1.6

7.7

46.8

16.3

21.5

9.8

0.5

1,1

0.5

3.5

‘Based on A reason forvisit classification forambu/8tory care (RVC),11

‘Includes blanks; problems, complaints notelsewhsre classified: entries of “nons”; and illegible entries.

28
Table 8, Number andpercent distribution ofotice visits tointernists bymostfrequent principal reasons forvisk: United States, January

1980-December 1981

Number of

visits in Percent

Principal reason for visit and RVC code 1 thousands distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Genersl medical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X1OO

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

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

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D51O

Abdominal pain, cramps, andapasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S550

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

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

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

Back symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S905

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

Vertigo —dizziness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S225

Tiredness, exhaustion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..so15

Leg symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S920

Shormess of breath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S415

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

Symptoms of unspecified joints... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S970

Shoulder symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S940

Head cold, upper respiratory infection (coryza) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S445

General weakness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S020

Ischemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D515

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

Neck symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S900

Low back symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S910

Abnormal pulsations and palpitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S260

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

Skin rash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S860

Physical examination required for employ meri t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. AIOO

Hand and finger symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S960

Chemotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T425

Other blood test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X315

Depression, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S110

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

Pain and related symptoms, generalized, site unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S060

Nasal congestion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S400

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

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

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

Nausea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,. .. S525

Pain, site notreferable to aspecific body system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S055

Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5595

Medication, other and unspecified kinds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T115

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

Symptoms referable to anus-rectum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S605

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

Forother andunspecified test results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. R7OO

General ill feeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S025

Symptoma of fluid abnormalities.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. S035

Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. T11O

Labored ordifficult breathing (dyspnea) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S420

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

Diseases of the thyroid gland.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D200

Arm symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., S945

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

Hip symptoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ..s915

Glucose level determination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. x310

Disturbances of sensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S220

Painful urination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S650

Prophylactic innoculationa .,..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X400

Skin irritations, not elsewhere classified. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..0 . . . . . . . . . . . ..ss70

Physical examination required forachool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. AI 10

Ankle symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s930

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

144,172

14,951

5,939

5,292

5,149

3,450

3,342

3,163

2,970

2,957

2,709

2,554

2,353

2,219

2,065

1,854

1,731

1,648

1,647

1,646

1,571

1,413

1,389

1,340

1,317

1,287

1,254

1,211

1,088

1,049

976

975

920

908

905

903

903

889

888

880

868

864

814

773

771

758

734

724

692

685

685

674

661

606

566

540

537

524

494

484

461

452

40,100

100.0

10.4

4.1

3.7

3.6

2.4

2.3

2.2

2.1

2.1

1.9

1.8

1.6

1.5

1.4

1.3

1.2

1.1

1.1

1.1

1.1

1.0

1.0

0.9

0.9

0.9

0.9

0.8

0.8

0.7

0.7

0.7

0.6

0.6

0.6

0.6

0,6

0.6

0.6

0.6

0.6

Og

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

0.4

0.4

0.4

0.3

0.3

0.3

0.3

27.8

1Based on A reason for visit classification for ambulatory care (RVC).11

29
Table 9. Number and percent distribution of office visits to internists by sex of patient and most frequent principal reasons for visit: United

States, January 1980-December 1981

Number of Number of

Sex and principal reason for visir and visits in Percent Sex and principal reason for visit and visits in Percent

RVC codel thousands distribution RVC codeq thousands distribution

Female

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

General medical examination . . . . . . . X1OO

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

Hypertension: . . . . . . . . . . . . . . . . . .. D51O

Chest pain and related symptoms (not

referable to body system) . . . . . . . S050

Headache, pain in head . . . . . . . . . S21O

Abdominal pain, cramps, and

spasms . . . . . . . . . . . . . . . . . . . . . . .. S550

Back symptoms . . . . . . . . . . . . . . . . .. S905

Cough . . . . . . . . . . . . . . . . . . . . . . . . .. S44O

Symptoms referable to throat. . . . . . S455

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

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

Tiredness, exhaustion . . . . . . . . . . . . S015

Leg symptoms . . . . . . . . . . . . . . . . ... S920

Knee aymptoms . . . . . . . . . . . . . . . . .. S925

Symptoms of unspecified joints. . . . . S970

Shoulder symptoms. . . . . . . . . . . . . S940

General weakness . . . . . . . . . . . . . ,.. S020

Shortness of breath . . . . . . . . . . . . ,,. S415

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

Neck symptoms . . . . . . . . . . . . . . . . .. S900

Head cold, upper respirato~ infection

(coryza). ., . . . .. S445 . . . . . . . . . . .. S445

Chemotherapy . . . . . . . . . . . . . . . . . .. T425

Abnormal pulsations and

palpitations . . . . . . . . . . . . . . . . . . .. S260

Hand and finger symptoms. . . . . . . . S960

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

Depression . . . . . . . . . . . . . . . . . . . . .. S110

Low back aymptoms . . . . . . . . . . . ... S910

Anxiety and nervousness . . . . . . . . . . S1OO

Skin rash . . . . . . . . . . . . . . . . . . . . . . . S860

Pain and related symptoms, generalized,

site unspecified . . . . . . . . . . . . ... .. S060

Nausea . . . . . . . . . . . . . . . . . . . . . . . .. S525

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

Diarrhea . . . . . . . . . . . . . . . . . . . . . . .. S595

Diseases of the thyroid gland. . . . . . D200

Stomach pain, cramps, and

spasms . . . . . . . . . . . . . . . . . . . . . . .. S545

Other blood test . . . . . . . . . . . . . . . .X 315

Ischemic heart disease. . . . . . . . . . . . D515

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

Nasal congestion . . . . . . . . . . . . . . . .. S400

Injections . . . . . . . . . . . . . . . . . . . . . .. T11O

84,798

8,219

3,367

3,059

2,563

2,289

2,267

1,862

1,854

1,794

1,720

-1,544

1,511

1,432

1,287

1,243

1,087

1,042

1,032

992

945

922

823

820

784

765

745

745

737

689

639

638

588

581

579

566

566

546

512

509

493

100.0

9.7

4.0

3.6

3.0

2.7

2.7

2.2

2.2

2.1

2.0

1.8

1.8

1.7

1.5

1,5

1.3

1.2

1.2

1.2

1.1

1.1

1.0

1.0

0.9

0.9

0.9

0.9

0.9

0.8

0.8

0.8

0.7

0.7

0.7

0.7

0.7

0.6

0.6

0.6

0.6

Female—Con.

Medication, other and unspecified

kinds . . . . . . . . . . . . . . . . . . . . . . . . .. T115

Physical examination required for

employ merit . . . . . . . . . . . , . . . . . .. A1OO

Symptoms of fluid abnormalities . . . S035

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

Male

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

General medical examination . . . . . . . XIOO

Cheat pain and related symptoms (not

referable to body system) . . . . . . . . S050

8tood pressure test . . . . . . . . . . . . . .. X320

Hypertension . . . . . . . . . . . . . . . . . . ., D51O

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

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

Abdominal pain, cramps, and

spasms . . . . . . . . . . . . . . . . . . . . . . .. S550

8ack symptoma, . . . . . . . . . . . . . . . .. S905

Shortness of breath . . . . . . . . . . . . . .. S415

Ischemic heart disease. . . . . . . . . . . . D515

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

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

Headache, pain in hesd . . . . . . . . . . .S210

Tiredness, exhaustion. . . . . . . . . . . . . SOI 5

Leg symptoms . . . . . . . . . . . . . . . . . .. S920

Physical examination required for

employ merit . . . . . . . . . . . . . . . . . .. AIOO

Head cold, upper respiratory infection

(coryza) . . . . . . . . . . . . . . . . . . . . . . .. S445

General weakness..........,.. . .. S020

Low back symptoms . . . . . . . . . . . . .. S910

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

Skin rash . . . . . . . . . . . . . . . . . . . . . .. S860

Shoulder symptoms. . . . . . . . . . . . . . . S940

Anxiety and nervousness . . . . . . . . . . S1OO

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

Abnormal pulsations and

palpitations . . . . . . . . . . . . . . . . . . .. S260

Symptoms of unspecified joints. . . . . S970

Pain, site not referable to a specific body

system . . . . . . . . . . . . . . . . . . . . . . .. S065

Neck aymptoms . . . . . . . . . . . . . . . . .. S900

Arthritis . . . . . . . . . . . . . . . . . . . . . . ..0900

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

492

462

456

29,032

59,374

6,732

2,730

2,572

,2,090

1,488

1,250

1,183

1,095

1,033

1,026

1,010

915

874

841

788

749

725

604

595

567

566

560

550

541

497

487

480

*444

*421

25,961

0.6

0.5

0.5

34.2

100.0

11.3

4.6

4.3

3.5

2.5

2.1

2.0

1.8

1.7

1.7

1.7

1.5

1.5

1.4

1.3

1.3

1.2

1.0

‘1.0

1.0

1.0

0.9

0.9

0.9

0.8

0.8

0.8

0.7

0.7

43.7

1Based on A reason for visit dassificatiori for ambu/amry care (RVC).11

30
Table 10. Number of offica visits to internists by sex and age of patient and prior visit status, old problem rate by principal diagnosia categories, and percent distribution by principal

diagnosis categories, according to sex and age of patient and prior visit status: Unitad States, January 1980-December 1981

Sex Age Prior visit status Old

problem

Old patient ratez

6 Both Under 15-24 25-44 45–64

per new

65 years New New

Principal diagnoses and ICD-9-CM codel sexes Female Male

Old problem

15 years years years years and over patient problem problem visit

Number in thousands

All visits . . . ...<. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144,172 84,798 59,374 3,027 9,346 29,866 53,543 48,389 17,451 28,133 98,588

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

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

Infectious and parasitic diseases . . . . . . . . . . . ...001-139

Neoplasm . . . . . . . . . . . . . . . . . . . . .,. ,.. o,, . ..140_239

Endocrine, nutritional and matabolic diseases, and

immunity disorders . . . . . . . . . . . . . . . . . . . . . . . ..2427g7g

Mantaldisordars . . . . . . . . . . . . . . .{, . . . ..m2g&31g&31g

Diseaaes of the nervous system and sense

Organs . . . . . . . . . . . . . . . . . . . . ..o. c. . ..m320_3890_389

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

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

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

Diseasas of the genitourinary system . . . . . . . . . . . 580-62g

Disaases of the skin and subcutaneous tissue, . . . 680-709

Diseases Of the musculoskeleta[ system and Connective

tissue . . . . . . . . . . . . . . . . . . . . . ... . . . ..710 _739710_739

Symptoms, signs, and ill-defined conditions . . . .. 780-799

Injury andpoiaoning . . . . . . . . . . . . ... ,t. .,. .,,800_ggg

Supplementary classification. . . . . . . . . . . . . . , , . . Vol -V82

Another disgnoaes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown diagnoses . . . . . . . . . . . .....,..C,C..........

100.0

1.8

4.1

8.7

3.3

2.8

25.5

11.7

6.2

3.3

2.3

11.2

5.2

3.7

7.8

1.4

1.1

100.0

1.8

4.1

9.0

3.6

3.0

23.3

10.6

6.2

4.0

2.3

13.2

5.2

3.6

7.6

1.4

1.2

100.0

1.8

4.0

8.3

2.9

2.5

28.7

13.2

6.2

2.3

2.3

8.4

5.2

3.9

8.2

1.2

1.0

Percent distribution

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

*4.O 6.8 2.8 1.3 “0.8

*2.5

3.2

*1.O

4.2

2.3 4.5

0.9

5.3 2.1 *1.1 5.2

*5.4 “5.0 8.4 10,2 8.2 7,0

*1.9 *3.4

3.4

6.3

10.5

2.8 2.0 4.7 3.2 3.1

“7,7 *3.5 4.0 2.0 2.4 2.9

*5.5

4.6

*4.7 12.1

2.3

27.9

31.5

36.4 12,2

18.0

8.0

15.9

32.8

10,4 7.9 13.5

*3.8 6.8

20,4

7.8

8.8

6.5 4.9 6.3

*2.4 7.0

8.5

4.0

5.6

3.1 2.5

‘2.0

3.9 4.8

*4.3 2.9

2.8

1,8 2.1 *2.4 5.9 1.3

*5.7 5.2 9.7 12.5 12.2

*1.7

10.6

6,2

9.6

6.9

11.8

4.8 4.6 6.9

*5.6 7.3

8.3

4.5

4.0

3.4 2.7 5.4

*14.2

7.9

17,2 9.8

2.2

7.0 5.2

*2,2

15.5

*1.3

7.9

81.3

6.4

1.0 1.7

‘4.0

*2.2 ‘0.7

*2.4

1.4

*1.2 ‘0.8 1.0 *1.2 1.7 0.9

2.2

. . .

0.5

7.7

4.8

1,8

1.3

7.4

1.1

1.6

1.4

0.6

2.5

1,1

0.7

1.3

.,.

. . .

] Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9-CM).7

‘Old problem visits divided by new problem and new patient visits.

GJ
Table 11. Number and percent distribution of office visits to internists by most frequent principal diagnoses: United States, January

1980-December 1981

Number of Number of

vi<its in Percent visits in Percent

Principal diagnosis and ICD–9-CM codel thousands distribution Principal diagnosis and ICD-9-CM code~ thousands distribution

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

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

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

General medical examination . . . . . . V70

Other forms of chronic ischemic heart

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

Osteoarthrosis and allied disorders . ..715

Acute upper respirator infections of

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

Rheumatoid arthritis and other

inflammato~ polyarthropathies . . . . 714

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

Allergic rhinitis (including hay fever). .. 477

Obesity and other hyperalimentation. .. 278

Hypertensive heart disease. . . . . . . .. 402

Bronchitis, not specified as acute or

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

Symptoms involving respiratory system

and other chest symptoms . . . . 786

Cardiac dyarhythmias. . . . . . . . . . . . ...427

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

Genera l symptoms . . . . . . . . . . . . . . . ..7B0

Angina pectoris . . . . . . . . . . . . . . . . ...413

Other disorders of soft tissues . . . . ...729

Functional digestive disorders, not

elsewhere classified . . . . . . . . . . . . . . 564

Chronic airway obstruction, not

elsewhere classified ., . . . . . . . ...496

Malignant neoplasm of female breast. .. 174

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

Peripheral enthesopathies and allied

syndromes, . . . . . . . . . . . . . . . . . . ...726

Heart failure . . . . . . . . . . . . . . . . . . . ...428

Other and unspecified arthropathies. .. 716

Other and unspecified disorders of

back . . . . . . . . . . . . . . . . . . . . . . . . ,. .724

Other disorders of urethra and urinary

tract . . . . . . . . . . . . . . . . . . . . . . . . ...599

Other noninfectious gaatroenteritis and

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

Spondylosis and allied disorders . . ...721

Other ill-defined and unknown csuses

of morbidity and mortality. . . . . . . ...799

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

Observation and evaluation for suspected

condition s . . . . . . . . . . . . . . . . . . . . ..V71

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

Influenza . . . . . . . . . . . . . . . . . . . . . . . ..4B7

Certain adverse effects, not elsewhere

claasified3 . . . . . . . . . . . . . . . . . . . . ...995

144,172

18,030

7,105

6,064

5,672

3,384

3,092

3,060

2,162

2,0B5

1,710

1,643

1,621

1,607

1,598

1,523

1,397

1,395

1,370

,298

,283

,276

,274

,250

,242

,215

,189

,181

950

935

934

923

893

892

B43

830

100,0

12.5

4.9

4.2

3.9

2.3

2.1

2.1

1.5

1,4

1,2

1.1

1.1

1.1

1.1

1,1

1.0

1.0

1.0

0.9

0.9

0.9

0.9

0.9

0.9

0.8

0.8

0.8

0.7

0.6

0.6

0.6

0.6

0.6

0.6

0.6

Other symptoms involving abdomen and

pelvis . . . . . . . . . . . . . . . . . . . . . . . ...789

Oppressive disorder, not elsewhere

class ified ..,........,.. . . . . . . ...311

Acquired hypothyroidism . . . . . . . . ...244

Special investigations and

examination . . . . . . . . . . . . . . . . . . ..V72

Gastritis and duodenitis . . . . . . . . ...535

Acute bronchitis and bronchiolitis . ...466

Ill-defined descriptions and complications

of heart disease . . . . . . . . . . . . . . . ...429

Sprains and strains of sacroiliac

region . . . . . . . . . . . . . . . . . . . . . . . ...846

Acute myocardial infarction . . . . . . ...410

Pneumonia, organism unspecified . ...486

Strains and sprains of other and

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

viral infection in conditions classified

eLsewhere and of unspecified site . ..079

Peptic ulcer, site unspecified . . . . . ...633

Phlebitis and thrombophlebitis. . . . ...451

Other and unspecified disorders of

joint . . . . . . . . . . . . . . . . . . . . . . . . . ..719

Diffuse diseases of connective tissue. .. 710

Symptoms involving skin and other

integumentary tissue . . . . . . . . . . . . . 782

Other disorders of synovium, tendon, snd

bursar . . . . . . . . . . . . . . . . . . . . . . . ...727

Contact dermatitis and other

eczema . . . . . . . . . . . . . . . . . . . . . . . . . 692

Symptoms involving head and neck. .. 784

Thyrotoxicosis with or without goiter. .. 242

Malignant neoplasm of trachea, bronchus,

and lung . . . . . . . . . . . . . . . . . . . . . ...162

Oiverticuls of intestine . . . . . . . ., . ..562

Oisorders of external ear. . . . . . . . . . ..380

Cystitis . . . . . . . . . . . . . . . . . . . . . . . ...595

Special symptoms or syndromes, not

elsewhere classified. . . . . . . . . . . . , 307

Duodenal ulcer. . . . . . . . . . . . . . . . . ...532

Other and unspecified anemias . . . ...285

Suppurative and unspecified otitis

media . . . . . . . . . . . . . . . . . . . . ...,..382

Menopausal and postmenopausal

diaordera . . . . . . . . . . . ...4... . . . . . . 627

Gout . . . . . . . . . . . . . . . . . . . . . . . . . . ..274

Other hernia of abdominal cavity without

mention of obstruction or gangrene. .. 553

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

797

749

746

725

701

698

678

672

663

631

631

628

627

619

614

611

607

585

583

561

528

526

519

511

497

492

490

479

467

463

454

453

42.241

0.6

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

0.4

0.4

0.4

0.4

0.4

0.3

0,3

0,3

0,3

0<3

0.3

0.3

+ 0,3

29,3

I Based on the /nternationa/ C/assificWion of Diseases, 9th Revision, C/irrica/ Modification (1CD-9-C M),7

—

2Chiefly V67.0, followup examination following surgery,

3Chiefly 995.3, allergy unspecified.

4Chiefly 307.81, tension headache.

32
Table 12. Number and percent distribution of office visits to internists by sex of patient and most frequent principal diagnoses: United States,

January 1980-December 1981

Number of Number of

Sex, principel diagnosis, end visits in Percent Sex, principal diagnosis, and visits in Percant

lCD-9-CI%f code~ thousands distribution ICD-9-C&f code! thousands distribution

Femala

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

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

Diabetas mellitus . . . . . . . . . . . . . . ... ,250

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

Ostaoanhrosis and allied disorders . ..715

Rheumatoid arthritis and othar

inflammatory arthropathies . , , . . . . . . 714

Other forms of chronic ischemic heart

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

Acute upper respiratory infections of

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

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

Malignant neoplasm of female breast. ., 174

Obesity and other hyperalimentation. .. 278

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

Other disorders of urethra and urinary

tract . . . . . . . . . . . . . . . . . . . . . ,. .,..599

Hypertensive heart disease. . . . . . . ...402

Other disorders of soft tissues . . . . ...729

Functional digestive disorders, not

elsewhere classified . . . . . . . . . . . . . . 564

Cardiac dysrhythmias. . . . . . . . . . . . ...427

Allergic rhinitis (including hay fever). .. 477

Symptoms involving respiratory system

and othar cheat symptoms . . . . . . ...786

Bronchitis, not specified as acute or

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

Acute phafyngitis . . . . . . . . . . . . . . . ...462

Peripheral anthesopathies and allied

syndromes . . . . . . . . . . . . . . . . ,. . ...726

General symptoms . . . . . . . . . . . . . . . ..780

Other and unspecified arthropathies. .. 716

Other ill-defined and unknown causes

of morbidity and mortality. . . . . . . . ..799

Heart failure . . . . . . . . . . . . . . . . . . . ...428

Other and unspecified disorders of

back . . . . . . . . . . . . . . . . . . . . . . . . . ..724

Acquired hypothyroidism . . . . . . . . ...244

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

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

Influenza . . . . . . . . . . . . . . . . . . . . . . ...487

Spondylosis and allied disorders . . ...721

Observation and evaluation for

suspected conditions . . . . . . . . . . . . . V71

Angina pectoris . . . . . . . . . . . . . . . . . ..413

Other symptoms involving abdomen and

pelvis . . . . . . . . . . . . . . . . . . . . . . . . .. 789

Diffuse diseases of connective tissue. .. 710

Other noninfectious gastroenteritia and

colitis . . . . . . . . . . . . . . . . . . . . . . . . ..55B

84,798

10,755

3,893

3,070

2,653

2,262

2,257

1,808

1,4]6

1,276

1,222

1,025

1,014

1,007

985

930

925

918

878

749

742

735

708

696

696

685

674

646

619

617

576

575

553

552

551

537

534

100.0

12.7

4.6

3.6

3.1

2.7

2.7

2.1

1.7

1.5

1.4

1.2

1.2

1.2

1.2

1.1

1.1

1.1

1.0

0.9

0.9

0.9

0.8

0.8

0,8

0.8

0.8

0.8

0.7

0.7

0.7

0.7

0.7

0.7

0.7

0.6

0.6

Femala—Con.

Chronic airway obstruction, not elsewhere

classified, . . . . . . . . . . . . . . . . . . . ...496

Spatial investigations and

examinations . . . . . . . . . . . . . . . . . . ..V72

Depressive disordar, not alsewhere

classified . . . . . . . . . . . . . . . ., . . . ...311

Certain adversa effects, not elsewhere

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

Menopausal and postmenopausal

disorders . . . . . . . . . . . . . . . . . . . . . . . . 627

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

Male

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

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

Other forms of chronic ischemic heart

disaase . . . . . . . . . . . . . . . . . . . . . ...! 414

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

Ganeral medical examination . . . . . . . . V70

Acute upper respiratory infections of

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

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

Bronchitis, not specified as acute or

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

Anginepectoris . . . . . . . . . . . . . . . . ...413

Rheumatoid arthritis and other

inflammatory polyarthropathies . . . . . 714

Chronic airway obstruction, not elsewhere

classified . . . . . . . . . . . . . . . . . . . . ...496

Ostaoarthrosis and allied disordars . ..715

Symptoms involving respiratory systam

and other chest symptoms . . . . . . ...786

General symptoms . . . . . . . . . . . . . . .. ,780

Naurotic disorders . . . . . . . . . . . . . . ...300

Cardiac dysrhythmias. . . . . . . . . . . . ...427

Hypertensive heart disease. . . . . . . ...402

Heart failure . . . . . . . . . . . . . . . . . . ,. ..428

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

Other and unspecified arthropathies. ., 716

Other and unspecified disorders of

back . . . . . . . . . . . . . . . . . . . . . . . . . . .724

Peripheral enthesopathies and allied

syndromes . . . . . . . . . . . . . . . . . . . ...726

Acute myocardial infarction . . . . . . ...410

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

Obesity and other hyperalimentation, .. 278

Other noninfectious gastroenteritis and

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

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

533

521

512

509

463

32,461

59,374

7,276

3,415

3,212

2,994

1,284

1,167

872

843

798

750

731

729

689

686

673

636

558

532

519

516

515

500

498

488

*41 6

28,077

0.6

0.6

0.6

0.6

0.5

38.3

100.0

12.3

5.8

5.4

5.0

2.2

2.0

1,5

1.4

1.3

1.3

1.2

1,2

1.2

1.2

1.1

1.1

0.9

0.9

0.9

0.9

0.9

0.8

0.8

0.8

0.7

47.3

1Based on the international Classification of Diseases, 9th Revision, Clinical Modification (1CD-9-C M). 7

2Chiefly V67.0, followup examination following surgery.

3Chiefly 995.3, allergy unspecified.

33
Table 13. Number of office visits to internists by aex and age of patient and prior viait statua, percent of visits by diagnostic services,

nonmedication therapy, aex and age of patient, and prior visit status, and percent distribution by number of medications, according to sex and

age of patient and prior visit status: United Statas, January 1980-December 1981

Sex Age Prior visit status

—

Old patient

Both Under 75-24 25-44 45–64 65 years New New Old

Service or therapy sexes Female Male 15 years years years years and over patient problem problem

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

Diagnostic service!

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

Limited history and/or

examination, . . . . . . . . . . . .,, .

General history and/or

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

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

Clinical laborato~ teat. . . . . . .

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

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

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

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

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

Mental status examination. . . .

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

Nonmedication therapyl

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

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

Office surge~ . . . . . . . . . . . . . . . .

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

Psychotherapy or therapeutic

listening ...,.....,......,..

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

Family or social counseling . . . .

Medical counseling . . . . . . . .

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

Number of medication

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

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

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

2

3 ::::::::::::::::::::::::::

4 or more . . . . . . . . . . . . . . . . . . .

144,172

4.2

62.7

18.1

3.2

34.3

13.5

61.0

12.1

1.6

1.5

1.1

3.5

52.1

4.2

1.9

“0.3

5.2

12.9

2.0

33.6

1.0

100.0

23.8

29.2

20.6

12.1

14.3

84,798

4.2

63,7

17.5

5.4

35.0

12.8

60.5

10.2

1.1

1,1

1,1

3.3

51.9

4.2

1.7

“0.5

5.9

13.3

2.2

32.9

0.9

100.0

22,8

29.0

21.2

12.3

14.7

59,374

4.1

61.3

19.0

33.3

14.3

61.8

14.8

2.2

1.9

1.0

3.9

52.5

4.1

2.1

4.1

12.3

1.8

34.6

1.1

100.0

25.3

29.4

19.8

11.7

13.8

3,027

*3.8

66.2

24.3

“0.5

30.7

*7.5

25.5

*3.3

“2.0

“0.3

*3.8

57.5

*3.3

*5.8

“0.5

“7.5

*2.5

28.8

*1.3

100.0

26.6

43.7

21.9

“5.3

*2.6

Number in thousands

9,346 29,866 53,543

Percent of visits

5.9

59.0

23.2

“3.1

39.2

12.5

42.8

5.3

“4.7

“0.8

“1.3

“4.4

54.3

“4.0

*2.7

*2.4

“4.7

9.3

*2.6

29.8

“1.3

5.9

59.6

21.3

3.3

35.5

15.9

51.9

10.4

2.3

*1.2

1.6

3.3

50.1

4.2

3.2

“0.6

6.4

12,0

2.3

32.0

“1.5

3.6

62.5

17.7

3.6

34.8

13.8

65.2

13.6

1.4

1.9

0.9

4.0

51.5

3.9

1.1

“0.0

5.8

15.3

2.2

34.3

“0.8

Per?ent distribution

100.0 100.0 100.0

37.7 31.7 22.9

35.6 34,2 28.2

19.0 19.9 22.0

5.6 8.9 12.6

“2.1 5.2 14.2

48,389

3.4

65.4

15.2

2.9

32.4

12.1

67.8

13.3

“0.6

1.4

1.0

2.9

53.4

4.5

1.4

“0.0

4.1

11.8

1.6

34.9

*0.8

100.0

17.2

24.9

19.7

15.1

23.2

17,451

*1.5

40.0

50.0

4,9

51.9

28,6

56.2

21.2

5.1

“1.1

“2.2

3.6

51.3

5.2

3.3

“0.4

3.6

11.6

“1.7

34.7

*0.8

100.0

41.6

30.6

17.7

7.3

*2.7

28,133

1.9

69.9

16.6

3.5

31.5

18.1

53.8

10.4

1.9

2.4

“0.6

3.1

52.8

5.1

2.7

“0.5

3.7

9.3

“1.2

32.9

1.7

100.0

27.2

33.6

20.7

10.2

8.3

98,588

5.3

64.7

12.9

2.8

32.0

9.5

64.0

10.9

0.8

1.3

1.0

3.7

52.1

3.7

1.4

“0.2

5.9

14.2

2.3

33.6

0.8

100.0

19.8

27.7

21.1

13.4

18.1

1Percents will not total 100,0 because more than 1 service or therapy may have been rendered during a visit.

34
Table 14. Number of drug mentions in office visits to internists by sex and age of patient and prior visit status and percent distribution by

therapeutic category, according to sex and age of patient and prior visit status: United States, January 1980-December 1981

Sex Age Prior visit status

Old patient

Both Under 75-24 25-44 45–64 65years New New Old

Therapeutic categoiy~ sexes Female Male 15 years years years years andover patient problem problem

Number in thousands

9,354 37,232 95,148

Percent distribution

All categories . . . . . . . . . . . . . . 251,370

100.0

3.2

6.4

5.2

0.6

2.3

3.8

1.4

0.6

0.8

21.8

9.8

6,7

5.1

17.9

10.4

0.5

2,3

0.3

4.3

15.7

1.7

0.7

4.8

1.0

0,6

0.7

9.7

3.1

0.9

3.5

1.8

1.1

2.6

2.1

2.2

2.6

151,001 100,369 3,463

100.0

20.0

23.6

21.2

*2.5

*2.7

*4.2

“0.1

“0.1

*2.1

*1.O

“0.8

“0.3

“11.5

“10.1

“0.4

“0.3

“0.7

‘3.0

‘4.0

“0.8

“3.1

*1.1

“0.3

“0.9

“6.9

*3.2

*1.2

“0.8

*8.1

*3.8

*3.1

“0.8

*2,2

106,174

100.0

1.7

3.3

2.4

0.5

1.7

2.8

1.7

0.7

1.0

27.8

13.1

7.5

7.1

16.9

10.4

0.5

2.0

‘0.2

3.8

18.7

1.0

0.6

4.4

0.9

0.5

0.9

9.3

2.6

“0.0

4.0

1.7

1,3

1.8

2.5

2.6

1.9

17,556

100.0

6.2

14.0

12.2

“1.0

*1.O

5.8

“0.9

“0.5

“0.4

12.3

5.0

3.9

3.5

19.9

13.6

“0.4

*1.5

‘0,4

4.1

8.8

3.5

*1.4

5.6

*1.7

“0.4

‘0.9

7.1

“2.2

“0.4

*2.4

*1.2

*1.5

5.2

*2.3

*1.4

3.1

40,633

100.0

4.9

15.8

13.7

1.3

“0.2

5.0

“0.9

*0.4

*0.5

13.0

6.4

3.8

2.7

18.9

12.3

“0.2

1.8

“0.2

4.3

8.3

5.0

1.4

+5.7

1.1

“0.6

“0.8

7.9

3.0

“1.1

1.9

1.3

1,3

5.7

1.7

1.3

3.0

193,181

100.0

2.6

3.7

2.8

0.5

2.8

3.4

1.6

0.7

0.9

24.5

11.0

7.6

5,7

17.5

9.8

0.6

2.5

0.4

4.3

17,9

0.8

0.5

4,6

1,0

0.7

0.7

10.3

3.2

0.8

3.9

1.9

1.1

1.7

2.2

2.4

2.4

100.0

8.4

24.9

21.7

*1.9

“0.8

7,6

“0.7

*0.5 -

“0.2

“3.8

*2.1

*1.3

“0.3

14.6

8.6

*0.5

“1.5

‘0.7

*3.4

*2.1

“4.0

“2.0

8.4

“1.6

“0.9

*1.4

7.6

*2.9

“2.0

*1,6

“1.1

*1.7

8.0

*1.9

*1.7

*2.8

100.0

6.7

11.4

9.7

“0.9

1.7

6.4

1.7

*1.O

“0.6

9.4

4.2

3.7

1.4

22.1

11.9

“0.9

3.4

“0.6

5.4

8.2

3.8

1.6

5.7

1.3

“0.9

“0.5

9.4

4.0

“0.5

2.3

1.8

“0.7

3.9

1.4

2.1

3.8

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

Antihistamine drugs . . . . . . . .

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

Antibiotics . . . . . . . . . . . . . .

Sulfonamides . . . . . . . . . . . .

Antineoplastic agents . . . . . . .

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

8100d formation and

coagulation . . . . . . . . . . . . . .

Antianemia drugs. . . . . . . . .

Coagulant and anticoagulants . . . . . . . . . . . . .

Cardiovascular drugs . . . . . . . .

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

Hypotensive agents. . . . . . .

Vasodilating agents. . . . . . .

Central nervous system

drugs . . . . . . . . . . . . . . . . . . . .

Analgesics and antipyretics, . . . . . . . . . . . . . . .

Anticonvulsants. . . . . . . . . .

Psychotherapeutic

agents . . . . . . . . . . . . . . . . .

Respirator and cerebral

stimulants . . . . . . . . . . . . . .

Sedatives and hypnotics. . .

Electrolytic, caloric, and water

balance . . . . . . . . . . . . . . . . . .

Expectorants and cough

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

Eye, ear, nose and throat

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

Gastrointestinal drugs . . . . . . .

Antacids and absorbents. . .

Antiflatulents . . . . . . . . . . . .

Cathartics and laxatives. . . .

Hormones and synthetic

substitutes . . . . . . . . . . . . . . .

Adrenals . . . . . . . . . . . . . . . .

Estrogens . . . . . . . . . . . . . . .

Insulins and anti-diabetic

agents . . . . . . . . . . . . . . . . .

Thyroid and antithyroid. . . .

Serums, toxoids and

vaccines . . . . . . . . . . . . . . . . .

Skin and mucous membrana

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

Spasmolytic agents . . . . . . . . .

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

Other, unclassified, or

undetermined. . . . . . . . . . . . .

100.0

3.2

6.1

4.9

0.6

2.8”

4.1

100.0

3.3

6.8

5.7

0.6

1.4

3.4

2.5

5.4

4.4

0.6

3.2

3.5

1.3

0.7

1.6

“0.4

1.1

“0.3

0.6

19.4

8.6

6.7

4.0

1.2

25.4

11.7

6.8

6.7

0.8

22.4

9.5

7.7

5.0

17.8

10.1

‘0.4

2.3

“0.4

4.7

17.1

1.4

“0.4

4.8

1.1

0.7

0.6

10.5

3.2

“0.0

3.8

1.9

0.8

2.4

2.0

1.9

2.8

19.2 15.9

11.2

0.4

9.4

0.7

2.6 1.8

0.4

4.6

“0.2

3.8

15,7 15.8

1.6 2.0

0.7

4.8

1.0

0.5

0.9

0.7

4.9

1.0

0.8

0.5

10.7

3.3

1.2

8.1

2.8

‘0.3

3.2

2.5

3.9

0.7

1.1 1.1

2.6

1.8

2.4

2.6

2.7

1,9

2.5 2,4

1Based on the classification system of the American Hospital Formulary Service [see appendix IV).

35
Table 15. Number and percent distribution of drug mentions in office visits to internists by the 100 most frequently named drugs: United States,

January 1980–December 1981

Number of Number of

mentions in Percent mentions in Percent

Name of drugl thousands distribution Name of drug~ thousands distribution

All mentions . . . . . . . . . . . . . . . . . . . . . . . .

Inderal ., . . . . . . . . . . . . . . . . . . . . . . . . . .

Lasix . ., . . . . . . . . . . . . . . . . . . . . . ,, .,..

Dyazide, , . . . . . . . . . . . . . . . . . . . . ,, . . . .

Lanolin, , . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Dioxin. ..,.....,,......,,,,. . . . .

Isordil . . . . . . . . . . . . . . . . . . . . . . . . . ...

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prednisone . . . . . . . . . . . . . . . . . . . . . . . .

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

Nitroglycerin ., . . . . . . . . . . . . . . . . .

Tagamet . . . . . . . . . . . . . . . . . . . .

Hygroton . . . . . . . . . . . . . . . . . . . . . . . . . .

Motrin . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lopressor . . . . . . . . . . . . . . . . . . . . . . . . .

Synthroid . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrodiuril . . . . . . . . . . . . . . . . . . . . . . .

Naprosyn . . . . . . . . . . . . . . . . . . . . . . . . . .

Potassium .,.....,.......,.. . . . . . . . .

Indocin ...,..,..,,......,.. . . . . . .

Clinoril . . . . . . . . . . . . . . . . . . . . . . . .

Tetracycline. . . . . . . . . . . . . . . . . . . . . . .

Coumadin . . . . . . . . . . . . . . . . . . . . . . . .

Allergy relief or shots . . . . . . . . . . . . . . . . .

Aldactazide . . . . . . . . . . . . . . . . . . . . . . . . .

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

Slow- K, . . . . . . . . . . . . . . . . . . . . . . . .

Tylenol. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fluorouracil . . . . . . . . . . . . . . . . . . . . . . . . .

Tylenol with codeine . . . . . . . . . . . . . . . .

Ampicillin . . . . . . . . . . . . . . . . . . . . . . . .

Persantine . . . . . . . . . . . . . . . . . . . . . . . . . .

Apresoline . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Erythromycin . . . . . . . . . . . . . . . . . . .,, ,..

Penicillin . . . . . . . . . . . . . . . . . . . . . . . . .

Zyloprim . . . . . . . . . . . . . . . . . . . . . . . . . .

Mylanta . . . . . . . . . . . . . . . . . . . . . . . . . .

Diuril . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aldoril . . . . . . . . . . . . . . . . . . . . . . . . .

Premarin . . . . . . . . . . . . . . . . . . . . . . . . . .

Minipress . . . . . . . . . . . . . . . . . . . . . . .

Corgard, . . . . . . . . . . . . . . . . . . . . . . . . . . .

Influenza virus vaccine type A, B. . . . . .

Catapres . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Maalox, . . . . . . . . . . . . . . . . . . . . . . . . . . . .

251,370 100.0

9,678 3.9

7,560 3.0

7,414 2,9

5,525 2.2

58045 2.0

4,856 1.9

4,710 1.9

4,550 1.8

4,194 1.7

3,907 1.6

3,791 1.5

3,640 1.4

3,335 1.3

2,B31 1.1

2,815 1.1

2,39B . 1,0

2,378 0.9

2,243 0.9

2,196 0.9

2,182 0.9

2,144 0.9

2,072 0.8

2,001 0.8

1,976 0.8

1,976 0.8

1,846 0.7

1,833 0.7

1,805 0.7

1,652 0.7

1,604 0.6

,535 0.6

,515 0.6

,515 0.6

,481 0.6

,390 0.6

,336 0.5

,334 0.5

1,329

1,281

1,231

1,214

1,211

1,194

1,193

1,169

1,153

1,138

1,128

1,116

1,109

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

Methotrexate. . . . . . . . . . . . . . . . . . . . . . . .

Dilantin . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Theo-dur . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cytoxan . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dalmane . . . . . . . . . . . . . . . . . . . ,. ...,,,

Donnatal . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antivert . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Esidrix . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reflex, . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nitro-bid . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Enduron . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Darvocet-N . . . . . . .. . . . . . . . . . . . . . . . . . .

Quinidine . . . . . . . . . . . . . . . . . . . . . . . . . . .

Zomax . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sorbitrate . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenergan . . . . . . . . . . . . . . . . . . . . . . . . . .

Aldactone . . . . . . . . . . . . . . . . . . . . . . . . . .

Brethina . . . . . . . . . . . . . . . . . . . . . . . . . . .

Robitussin . . . . . . . . . . . . . . . . . . . . . . . . . .

Benadryl . . . . . . . . . . . . . . . . . . . . . . . . . . .

Librium . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Butazolidin . . . . . . . . . . . . . . . . . . . . . . . . .

Norpace . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Metamucil . . . . . . . . . . . . . . . . . . . . . . . . . .

Xylocaine . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenobarbital . . . . . . . . . . . . . . . . . . . . . . .

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

E-mycin . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Libra.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ascriptio n, . . . . . . . . . . . . . . . . . . . . . . . . .

Nalfon . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Depo-Medrol . . . . . . . . . . . . . . . . . . . . . . . .

Pen-Vee K . . . . . . . . . . . . . . . . . . . . . . . . . .

Actifed . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

K- Lyta . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Flexeril . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Decadron . . . . . . . . . . . . . . . . . . . . . . . . .

Bactrim . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Triavil . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fiorinal . . . . . . . . . . . . . . . . . . . . . . . . . . .. .

Tolectin . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drixoral . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sudafed . . . . . . . . . . . . . . . . . . . . . . . . ..:.

Vi bramycin . . . . . . . . . . . . . . . . . . . . . . . . .

Dimetapp . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pronestyl . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bufferin . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydralazine . . . . . . . . . . . . . . . . . . . . . . . . .

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

1,085

1,079

1,071

1,061

1,036

1,033

1,015

1,012

985

923

897

891

870

869

854

841

832

812

810

797

797

772

771

748

746

737

731

729

727

716

711

705

670

645

643

643

630

603

602

600

588

586

582

571

566

559

557

553

543

535

83,302

0.4

0.4

,0.4

0.4

().4

0.4

0.4

0.4

0.4

0.4

0.4

0.4

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

().3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

().2

0.2

0.2

0.2

0.2

0.2

0.2

0.2

0.2

0.2

0.2

0.2

0.2

33.1

lBased on the physician’s entry on the Patient Record form.

36
Table 16. Number of office visits to internists by sex and age of patient and prior visit status, percent distribution by duration of visit, eccording

to sex and age of patient and prior visit status, and percent of visits by disposition of visit, sex and aga of patient, and prior visit status: United

States, January 1980-December 1981

Sex Age Prior visit status

Old patient

Both Under 15-24 25-44 45-64 65 years New New Old

Duration and disposition sexes Female Male 75 years years years years andover patient problem problem

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

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

Duration of visit

Ominutesl . . . . . . . . . . . . . . . . . .

1-5 minutes. . . . . . . . . . . . . . . . .

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

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

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

31 minutes or longer . . . . . . . . . .

Disposition of visitz

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

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

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

Telephone followup planned. . . .

Referred to other physician . . . . .

Returned to referring physician. . .

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

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

144,172 84,798

100.0 100.0

2.3 2.5

5.6 6.0

17.3 16.5

35.4 35.5

28.6 28.9

10.9 10.6

7.6 7.0

68.7 69.2

16.7 17.1

6.5 6.6

4.2 4.2

0.9 0.9

1.7 1.8

0.3 “0.4

59,374

100.0

2.0

5.1

18.3

35.4

28.1

11.2

8.9

67.8

16.2

6.3

4.3

0.9

1.7

“0.2

3,027

100.0

*o. 1

*1 2.9

28:9

34.7

17.5

“6.0

15.7

44.4

33.4

6.2

*4.7

*2.7

*1.8

Number in thousands

9,346 29,866 53,543

Percent distribution

100.0 100.0 100.0

*1.3 2.2 2.7

9.9 7.5 5.0

20.2 17.5 17.6

31.2 32.2 36.2

28.4 27.9 27.4

9.0 12.8 11.1

Percent of visits

21.6 11.7 5.9

39.7 54.1 74.1

27.5 23.0 14.2

10.3 8.5 5.5

5.8 5.8 4.0

“0.3 *1.1 1.0

“0.6 1.6 1.7

“0.7 “0.4 “0.2

48,389

100.0

2.2

3.9

15.4

37.5

31.0

10.1

4.4

78.8

12.5

5.5

3.1

“0.6

2.0

“0.4

17,451

100.0

“0.4

3.1

10.2

21.8

34.4

30.1

19.4

47.1

20.1

9.1

5.0

3.9

*2.3

“0.4

28,133

100.0

“0.9

5.4

19.8

38.5

28.3

7.1

13.1

43.8

29.4

10.6

7.0

“0.3

2.4

‘0.2

98,588

100.0

3.0

6.1

17.8

37.0

27.6

8.5

4.2

79.6

12.5

4.8

3.3

0.5

1.4

“0.4

lRepresents visitsin which therewaa no face-to-face enrmunter between patient and physician.

2Percents will n0ttrxal 100. Obecauaemcwe than 1 disposition was possible.

37
Table 17. Number andpercent distribution ofofice visits tointernists bya~eof patient andmost frequent principal reasons for visit United

States, January 1980-Dacember 1981

Number of Number of

visits in Percent visits in

Principal reeson for visit end RVC code 7

Percent

thousends distribution Principal reeson for visit and RVC code~ thousands distribution

Under 25 years

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

General medical examination . . . . . XIOO

Symptoms referable to throat, . . . . . S455

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

Physical examination required for

school . . . . . . . . . . . . . . . . . . . . . . .. AIIO

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

Physical examination required for

employ merit . . . . . . . . . . . . . ... . .. AIOO

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

25-44 years

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

General medical examination . . . . Xl 00

Chest pain and related symptoms (not

referable to body system) . . . . . . . s050

Symptoms referable to throat. . . . . S455

Abdominal pain, cramps, spasms. ., . S550

Headache, pain in head ., . . . . . . . . S21O

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

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

Hypertension . . . . . . . . . . . . . . . . . . . .D51O

Back symptoms . . . . . . . . . . . . . . . . .. S905

Tiredness, exhalation . . . . . . . ., . . S015

Physical examination required for

employ merit . . . . . . . . . . . . . . . . . .. A1OO

Head cold, upper respirato~ infection

(coryza) . . . . . . . . . . . . . . . . . . . . . . .. S445

Weight gain . . . . . . . . . . . . . . . . . . . ..s040

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

45-64 years

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

General medical examination . . . . . . . X1OO

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

Hypertension . . . . . . . . . . . . . . . . . . .. D51O

Chest pain and related symptoms (not

referable to body system) . . . . . . . . . S050

Diabetea mellitus. . . . . . . . . . . . . . . . . D205

Abdominal pain, cramps, spasms. . . . S550

Back symptoms . . . . . . . . . . . . . . . . .. S905

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

Cough . . . . . . . . . . . . . . . . . . . . . . . . .. S44O

Tiredness, exhaustion. ., ., . . . . . . . SO15

Leg symptoms . . . . . . . . . . . . . . . . . .. S920

12,373

944

786

587

*439

’402

“373

8,842

29,866

2,531

1,116

1,062

1,040

959

761

733

614

612

601

570

453

*435

18,379

53,543

5,601

3,161

2,377

2,287

1,336

1,272

1,090

1,048

1,025

971

794

100.0

7.6

6.4

4.7

*3.5

*3.3

“3.0

71.5

100.0

8,5

3.7

3.6

3.5

3.2

2.5

2.5

2.1

2.0

2.0

1.9

1.5

“1.5

61.5

100.0

10.5

5.9

4.4

4,3

2.5

2.4

2.0

2.0

1.9

1.8

1.5

45–64 years—Con.

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

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

Symptoms of unspecified joints. . . . . S970

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

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

Shoulder symptoms. . . . . . . . . . . . . . . S940

Abnormal pulsations and

palpitations . . . . . . . . . . . . . . . . . . .. S260

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

Head cold, upper respiratory infection

(cotyza) . . . . . . . . . . . . . . . . . . . . . . .. S445

Chemotherapy . . . . . . . . . . . . . . . . . .. T425

Shortness of breath . . . . . . . . . . . . . .. S415

Low back symptoms . . . . . . . . . . . . .. S910

Neck symptoms . . . . . . . . . . . . . . . . .. S900

Iachemic heart diseaae. . . . . . . . . . . . D515

General weakness . . . . . . . . . . . . . . .. S020

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

65 years and over

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

Generel medical examination. . . . . . Xl 00

Hypertension . . . . . . . . . . . . . . . . . . .. D51O

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

Chest pain acd related symptoms (not

referable to a specific body

system) . . . . . . . . . . . . . . . . . . . . . . .. S050

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

Shortness of breath . . . . . . . . . . . . . .. S415

Diabetea mellitus. . . . . . . . . . . . . . . . . D205

General weakneas . . . . . . . . . . . . . . .. S020

Leg symptoms . . . . . . . . . . . . . . . . . .. S920

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

Iachemic heart disease. . . . . . . . . . . . D515

Eack symptoms . . . . . . . . . . . . . . . . .. S905

Abdominal pain, cramps, spasms. . . . S550

Headache, pain in head . . . . . . . . . . . S21O

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

Tiredness, exhaustion . . . . . . . . . . . . . S015

Symptoms of unspecified joints. . . . . S970

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

Shoulder symptoms. . . . . . . . . . . . . . . S940

Abnormal pulsations and

palpitations . . . . . . . . . . . . . . . . . . .. S260

Other blood test . . . . . . . . . . . . . . . .. X315

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

735

716

684

676

673

661

638

631

609

593

585

560

533

521

456

23.310

48,389

5,875

2,053

1,950

1,699

1,411

1,286

1,154

983

979

969

962

955

803

753

687

626

576

544

543

503

500

22,578

1.4

1.3

1.3

1,3

1,3

1.3

1.2

1.2

1.1

1.1

1.1

1.0

1.0

1.0

0.9

43.5

100.0

12.1

4.2

4.0

3.5

2.9

2.7

2.4

2.0

2.0

2.0

2.0

2.0

1.7

1.6

1.4

+.3

1.2

1.1

1.1

1.0

1.0

46.7

1Based on A reason for visit classification for ambulatory care (RVC).”

38
Table 1S. Numbar and parcent distribution of office visits to internists by age of patient and most fraquent principal diagnoses: United States,

January 1980-December 1981

Number of Number of

Principal diagnosis, and visits in Percent Principal diagnosis, and visits in Parcent

ICD-9–CM code~ thousands distribution ICD-9-CM code~ thousands distribution

Under 25 years

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

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

Acute upper raspirato~ infections of

multiple or unspecified cites. . . . . ...465

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

Allergic rhinitis (including hay

fever) . . . . . . . . . . . . . . . . . . . . . . . . . . .477

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

25-44 years

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

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

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

Acuta upper respiratory infections of

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

Allergic rhinitis (including hay

fever) . . . . . . . . . . . . . . . . . . . . . . . . . . .477

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

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

Obasity and othar

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

Rheumatoid arthritis and other

inflammato~ polyarthropathies . . . . . 714

Ganeral symptoms . . . . . . . . . . . . . . . ..780

Functional digestive disorders, not

elsewhere classified . . . . . . . . . . . ...564

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

45-64 years

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

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

Diabetes mallitus . . . . . . . . . . . . . . . ...250

Other forms of chronic ischemic haart

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

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

Rheumatoid arthritis and other

inflammatory polyarthropathies . . . .. 714

Osteoarthrosis and allied disorders . ..715

Acute upper respiratory infections of

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

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

Malignant neoplasm of female

breast . . . . . . . . . . . . . . . . . . . . . . . .. ,174

Angina pactoris . . . . . . . . . . . . . . . . . ..413

Bronchitis, not specified as acute or

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

45-64 years—Con.

Hypertensive heart diseasa. . . . . . . ...402

Symptoms involving respiratory systam

and other chest symptoms . . . . . . ...786

Othar disorders of aoft tissue . . . . . ...729

Allergic rhinitis (including hay

fever) . . . . . . . . . . . . . . . . . . . . . . . . . .. 477

Obesity and other

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

Cardiac dyarhythmias. . . . . . . . . . . . ...427

Chronic airway obstruction, not

elsawhera classified . . . . . . . . . . . ...496

Other and unspecified

arthropathies . . . . . . . . . . . . . . . . . ...716

Peripheral enthesopathies and allied

symptoms . . . . . . . . . . . . . . . . . . . . ...726

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

Spondylosis and allied disorders . . ...721

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

65 years and over

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

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

Other forms of chronic ischemic heart

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

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

Osteoarthrosis and allied disorders . ..715

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

Cardiac dyrhythmias , . . . . . . . . . . . ...427

Hypertensive heart disease. . . . . . . . . .402

Rheumatoid arthritis and other

inflammatory polyarthropathies . . ...714

Heart failure . . . . . . . . . . . . . . . . . . . ...428

Chronic airway obstruction, not elsewhere

classified . . . . . . . . . . . . . . . . . . . . ...496

Angina pectoris . . . . . . . . . . . . . . . . ...413

Symptoms involving respirato~ system

and other chest symptoms . . . . . . . . . 786

Other and unspecified

arthropathies . . . . . . . . . . . . . . . . . ...716

Peripheral enthesopathias and allied

syndromes . . . . . . . . . . . . . . . . . . . ...726

Bronchitis, not specified as acute or

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

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

12,373 100.0

1,234 10.0

619 1.2

593

576

1.1

611 4.9 1.1

“443 3.6

570 1.1

“330 2.7

78.8 568

527

1.1

1.0

9,755

29,866

2,156

519 1.0

100.0

7.2

5.5

3.9

3.4

2.9

2.8

2.3

2.0

1.8

1.5

66.7

514 1.0

,643

,164

,020

8B0

840

683

585

541

510

497

468

25,795

1.0

0.9

0.9

48.2

4B,3B9

7.407

100.0

15.3

3,420

2,914

2,049

1,368

974

957

7.1

6.0

4.2

2.8

2.0

2.0

’447

19,907

53,543

8,199

3,157

100.0

15.3

5.9

3.9

3.4

2.B

2.3

1.6

1.6

1.3

1.3

1.2

853

844

1.B

1.7

746

650

1.5

2,077 1.3

1,819

550 1.1

1.517

1,255 510 1.1

B74 502 1.0

868

474

24,171

1.0

704 50.0

678

639

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM].7

39
Table 19. Number of office visits to internists by major reason for visit and principal reason for visit modules and percent of visita by diagnostic services and major reason for visit and

principal reason for visit modules: United States, January 1980-December 1981

Diagnostic service~

Number

of Limited General

visits history history Clinical Blood

Major reason for visit and principal

Mental

in and/or and/or Pap laboratory pressure Vision status

reason for visit module thousands None examination examination test test X-ray check Electrocardiogram m test Endoscopy examination Other

Major raason for visit

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

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

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

Postsurgerv or postinjuv . . . . . . . . . . .

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

Principal reason for visit module

and RVC codez

Symptom module. . . . . . . S001–S999

Disease module . . . . . . . . DOO1 -D999

Diagnostic, screenin9, and Preventive

module . . . . . . . . . . . . ..x100-x59g

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

Injuries and adverse effects

module . . . . . . . . . . . . . .. JOOl–J999

Test results module . . . . . RI 00-R700

Administrative module. . . A1OO-A140

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

45,500

64,845

17,543

2,222

14,063

79.072

18,815

25,735

10,846

2,064

1,190

2,592

3,384

Percent of visits

2.5 68.8 17.5

5.7 64.2 11.8

*2.5 69.1 16.5

‘3.9 75.6 *8.4

4.8 25.9 52.6

2.9 68.5

3.2 65.9

4.5 48.5

14.2 59.9

*3.4 72.9

‘10.8 44.7

*1.3 33.5

*3.1 51.4

17.0

13.0

25.5

9.5

*8.7

*1 5.6

57.5

18.6

2.0 32.7

2.0 31.2

*1.7 33.9

‘0.9 *19.8

14.6 56.8

2.3 32.2

*1.6 35.1

8.5 40.6

“0.5 32.9

“ 14.8

*2.4 51.0

‘1.2 48.9

*4.9 29.6

17.7

6.7

15.5

*11.1

28.6

15.5

7.7

15.5

5.2

17.5

*13.2

“14.0

‘7.1

53.7 10.5 “0.9 1.8 1.2 3.2

65.7 8.2 ‘0.6 “0.7 0.8 3.2

61.3 13.5 “0.5 *1.1 *1.2 4.7

44.6 *4.7 *3.1 “0.3 “0.3 4.0

65.6 34.5 8.9 4.6 ‘1.8 4.9

58.4

67.8

70.7

47.8

42.3

51.0

63.6

65.0

11.2

9.1

20.5

5.3

*3.5

*6.3

‘10.6

14.4

0.8 1.3

‘0.6 ‘0.9

2.2 2.9

“0.3 “0.2

“0.6

31.5 “1.4

*1.4 *3.O

1.2 3.1

*1.2 5.2

“0.9 3.9

“0.4 ‘2.6

“0.3 *1.7

“2.1

“0.4 ‘10.5

‘0.5 *1.5

lPercents will not total 100.0 becauae more than 1 sewice may have been randered during avieit.

‘Baaed on A raason for visit classification for ambulatow care (RVC).l 1

31ncludes blanks; problems, complainta notelsewhara classified; antries of “none’”; and illegible entries.
Table 20. Number ofotice visits tointernists byprincipal diagnosis categories, percant ofvisits byselected nonmedication therapy andprincipal diagnosis categories, and percent

distribution bynumber ofmadications, according toprincipal diagnosis categories: United Statas, Janua~1980-Decemker l98l

Nonmedication therap yz Number of medications

Number of Psychotherapy

visits in

Principal diagnoses and ICD-9–CM code~

Office

3

or therapeutic Diet Medical

thousands None Physiotherapy surgery listening

or

counseling counseling Total None 1 2 more

tnfactious and parasitic diseases . . . . . . . . 001_13g

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . ..14 CI_239

Endocrine, nutritional and metabolic diseasas, and

immunity disorders . . . . . . . . . . . . . . . . . . 240_27g

Mental disorders . . . . . . . . . . . . . . . . . . . ..2g31glg

Diseases of tha nervous system and sense

organs . . . . . . . . . . . . . . . . . . . . . . . . ,, ... 320-389

Diseases of tha circulatory system . . . . . . . 390=359

Diseasas of the respiratory system. , . . . . . 46r)_519

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

Diseases of the ganitourinary system. . ...580-629

Diseases of the skin and subcutaneous

tissua . . . . . . . . . . . .. c... . . . . . . . . . . . . 680-709

Disaases of tha musculoskeletai system and

connective tissue . . . . . . . . . . . . . . . . . . ..71 &73g

Symptoms, signs, and ill-defined

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

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

%pptamenta~ classification ., . . . . . . . . . VO1-.V82

Percent of visits

59.1

Percent distribution

“1.0 *3.8

50.1

*2.2

“0.6

*6.4

*1.7

33.9

11.4

100.0 :

*3.3 41.8 100.0

2,638

5,843

12,550

4,743

4,036

36,744

16,790

8,959

4,792

3,317

16,148

7,456

5,325

11,263

23.2

32.3

24.1

26.8

19,4

13.1

11.5

24.5

25.5

24.0

13.7

38.9

30.0

67.1

43.4

24.3

32.5

34.2

33.1

23.5

31.8

30.4

42.7

35.8

34.7

28.4

32.0

19.3

21.4

14.7

16.4

23.2

22.6

24.0

31,2

18.9

14,2

21.4

21.5

15.8

19,7

7.8

12,0

28.7

27.1

15.9

24.9

39.4

25.4

26.2

17.6

18.9

30.1

16.8

18.3

5.8

39.7

30.6

*1.1

‘1.7

‘0.2

80.4

3.5

34.3

38,5

*5.6

34.6

33.0

100.0

100.0

56.0

51.0

65.1

43.5

52.5

*4.2

1.6

81.7

“1.5

*3.5

*6.9

“0.2

*1.3

“1.0

*1.9

*6.7

X9

*2.3

*4.6

*2.7

*5.2

17.0

5.4

28.0

*7.2

29.0

36.9

29.6

36.9

37.2

100.0

100.0

100.0

100.0

100.0

50.3 *5.9 *8.4 “5.0 *8.2 36.1 100.0

45.9 18.4 2.8 4.8 6,7 36.1 100.0

55.6

42.3

74.0

“2.1

17.3

“0.3

‘0.8

“7.3

4.3

6.2

*3.4

“2,2

7.4

*3.8

5.3

33.7

36,4

15.4

100.0

100.0

100.0

~Based on the International Classification of Diseases, 9th Revision, Cl;mcal Modification (ICD-9 -C MI. 7

‘Percents will not total 100.0 because more than 1 therapy may have been rendered drmng a wwt.

●
...

Table 21. Number of offica visits to internists by principal diagnosis categories, percent distribution by duration of visit, according to principal diagnosis categoriaa, and percent of visits by

disposition of visit and principal diagnosis categories: United States, January 1980-December 1981

Duration of visit Disposition of visit3

Number

31 Return Referred Returned

minutes No

Principal diagnosis and of visits in

at

o 1-5

Return Telephone to to Admit

6–10 1 1–15 16-30 followup

ICD–9–CM codef

or specified if folfowup

thousands Total minutesz

other referring to

minutes minutes minutes minutes longer planned time needed planned physician physician hospital Other

Percent distribution Percent of visits

Infectious and parasitic

disaases. . . . 001–139

Neoplasm.. . 140–239

Endocrine, nutritional

and metabolic

diseases, and immunity

disorders . . . 240–279

Mental

disorders . . 290–319

Diseases of the nervous

system and sense

organs . 320-389

Disaases of the

circulatory

system . . . . . 390–459

Diseases of the

respiratory

system. .460–519

Diseasas of the digestive

system . . . . . 520–579

Diseases of the

genitourinary

system . . . . 580-629

Diseases of the skin and

subcuteneoua

tissue . . . . . . 680–709

Diseases of the

musculoskeletal system

and connective

tissue . . . ...710-739

Symptoms, signs, and

ill-defined

conditions. . . 780-799

Injury and

poisoning. .. 800-999

Supplementary classification. , . . .VO1-V82

2,638

5,843

12,550

4,743

4,036

36,744

16,790

8,959

4,792

3,317

16,148

7,456

5,325

11,263

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

*1.9

“4.7

4.2

“0.8

‘1.4

2.1

*1.2

“0.3

“1.4

*0.5

*2.3

*1.6

*3.3

*2.9

*6.8

●4.8

4.6

*2.8

“7.1

3.2

12.1

*2.9

*7.4

*5.6

3.5

*3.8

*6.9

10.2

19.6

15,1

17,0

12.7

23.1

17.3

23.4

15.5

16.7

21.1

17.1

12.5

22.4

10.5

42.8

30.7

39.3

32.7

30.7

39.5

34.4

36.8

35.0

40.4

36.0

33.2

36.5

24.1

23.1

34.0

23.5

28.5

26.6

29.3

22.0

34.2

28.4

29.1

30.3

34.7

27.2

29.7

“14.2

“3!0

*3.4

*5.1

“10.1

2.1

10.3

5.6

●7.3

*9.2

4.8

8.2

13.5

31.5

*5.9

10.8

11.5

22.5

11.1

8.6

7.0

10.4

11.1

3.3

10.9

14.2

*3.6

22.7

41.3

85.8

85.3

63.1

51.5

88.4

53.7

59.9

59.7

53.2

70.4

58.9

49.4

43.9

32.8

‘4.0

7.3

26.4

28.8

8.6

28.0

21.1

21.6

24.8

18.3

19.7

24.1

15.9

“11.0 *4,5

“3.2 *3.7

5.0 “3.0

“6.7 *8.1

*7.3 *8.O

4.1 2.4

9.8 *1.7

10.3 6.1

*7.8 *8.1

*8.2 “7.0

6.7 4.8

9.1 6.1

6.7 8.9

6.1 4,7

“1.1

*1,3

‘0.4

*1.3

*1.6

“0.7

“0.9

“1.3

‘0.7

“1.5

‘0.8

*1.2

*1.1

‘0.7

*1.1

*4.8

*1.5

‘0.5

*1.9

*1.2

●1.1

“3.7

“2.0

*1.4

“0.4

“4.5

*1.4

“0.5

“0.1

‘0.1

*o. 1

‘0.3

“0.4

*0,5

“0.2

*0.3

“0.3

“0.7

‘0.3

“1.0

lBased onthehrternationalC lassificationo fDiseases, 9th Revision. Clinical Modification (lCD-9-CM).7

‘Repraaents visits inwhich there wasno face-to-face ancmintar between patient and physician.

3Percanta will not total 100. Obecauae more than 1 disposition was possible.
Table 22. Mean duration of office visits to internists by prior visit status and principal diagnosis categories: United States, January 1980-

December 1981

Prior visit status

All New Old patient, Old patient,

Principal diagnosis and ICD-9-CM code! patients patient new problem old problem

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

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

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

Malignant neoplasm of female breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...174

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

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

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

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

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

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

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

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

Hypertensive heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...402

Angina pectoris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...413

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

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...427

Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428

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

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

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

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

Bronchitis, notspecified as acute or chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490

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

Chronic airway obstruction, not elsewhere classified. . . . . . . . . . . . . . . . . . . . . . . . . . . ...496

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

Other noninfectious gastroenteritis and colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...558

Functional digestive disorders, not elsewhere classified. . . . . . . . . . . . . . . . . . . . . . . . ...564

Diseases of thegenitourina~ system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...580-629

Other disorders ofurethra and urinary tract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...599

Diseases of theskin and subcutaneous tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...680-709

Diseases of the musculoskeletsl system and connective tissue. . . . . . . . . . . . . . . . ...710-739

Rheumatoid arthritis and other inflammato~ polyarthropathies . . . . . . . . . . . . . . . . . . . . .714

Osteoarthrosis and allied disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...715

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

Spondylosis and allied disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...721

Other andunspecified disorders of back. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...724

Peripheral enthesopathies and aliied syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...726

Other disorders ofsoft tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...729

Symptoms, signs, and ill-definad conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...780-799

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

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

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

20.3

17.7

20.7

20.5

20.1

18.5

21.2

26.5

2B.3

20.3

19.5

19.0

18.4

22.1

20.1

21.1

20.3

16.8

14.0

14.3

12.4

18.1

18.0

18.3

20.8

19.4

22.1

19.7

18.3

16.8

20.8

20.8

22.0

18.6

21.9

18.0

19.7

19.5

22.7

16.4

25.9

32.0

Mean duration in minutes

29.7

22.1

40.3

37.4

38.6

39.0

28.4

33.6

38.2

31.1

34.5

32.0

53.2

42.8

41.5

54.3

31.4

24.2

16.2

16.1

41.7

23.9

37.3

42.9

30.6

20.0

36.3

31.3

28.1

20.5

39.5

50.4

43.2

22.8

38.2

31.3

36.6

26.7

33.2

20.6

20.9

21.5

18.5

16.6

24.0

17.3

23.7

23.8

32.5

22.5

19.2

16.0

23.3

26.3

32.7

18.0

31.9

22.9

30.1

15.7

12.8

14.1

14.0

18.0

13.6

23.0

21.1

19.0

22.8

18.2

17.9

16.5

17.9

21.7

20.2

17.6

15.7

15.7

17.9

15.7

21.6

15,4

18.3

20.7

19.1

16.4

19.1

19.4

17.5

16.6

19.1

25.8

28.3

20.4

18.3

17.9

17.0

20.0

18.9

19.7

18.3

15.5

15.2

13.8

8.9

16.2

16.5

16,9

18.7

19.7

19.0

17.5

15.1

15,9

18.4

17.8

18.5

18.4

20.2

16.3

17.1

20.0

20.2

15.6

30.9

40.9

1Baaed on the International Classification of Diseases, 9th Revision. Clinical Modification (ICD-9-CM). 7

43
Table 23. Number of office visits by selected physicisn specialties and percent by selected visit characteristics and selected physician specialties:

United States, January 1980-December 1981

Physician specialty

General

and Obstetrics

Internal family and

Characteristic medicine practice gynecology Pediatrics

Number in thousands

381,710 109,035

Percent

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144,172 128,762

Age of patient

13.9

14.7

27.1

25.0

19.4

88.7

11.3

4.6

95.4

11.3

32.4

56.3

47.8

25.9

8.5

3.7

14.2

3.3

1.2

6.2

2.6

5.1

13.1

17.3

5.6

5.3

4.0

7.6

3.8

9.8

13.0

3.2

21.6

6.7

44.7

5.5

10.3

22.5

0.9

30.8

56.2

9.6

2.5

87.2

12.8

5.6

94.4

11.8

17.5

70.7

18,3

8.3

4.5

7,1

61.9

3,2

1.7

1.3

*0.4

“0.1

1.3

0,7

0.7

19.1

0.5

0.6

1.8

1.0

62.5

29.4

42.8

1.6

68.4

4.8

7.6

25.6

2.1

6.5

20.7

37,1

33.6

91.9

6.1

1.2

0.6

“0,2

Race

89.5

10.5

85.9

14.1

Hispanic origin

3.5

96.5

5,8

94.2

Prior visit status

12.1

19.5

68.4

6.7

37.6

53.7

Major reason for visit

31.6

45.0

12.2

1.5

9.8

53.7

9.0

4.5

1,7

31.2

Principal diagnosis category

Infectious parasitic diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Endocrine, nutritional and matabolic diseases, and immunity disorders . . . . . . . . . . . . . . . . .

Mental disordera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diaeases of thenervous system and sense organs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diaeases of the circulatory system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the respiratory system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the digestive system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diaeases of thegenitourina~ system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of theskin and subcutaneous tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the muscuioskeletal system and connective tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Symptoms, signs, andill-defined conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Injury and poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Supplementary classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.8

4.1

8.7

3.3

2.8

25.5

11.7

6.2

3.3

2.3

11.2

5.2

3.7

7.8

6.1

“0,2

0.6

0.5

14.8

“0.3

28,0

2.9

1.3

3.8

0.8

3.1

4.6

31.0

Diagnostic service

“0.1

25.6

2.3

8.5

3.2

34.3

13,5

61.0

Nonmedication therapy

7.1

11.5

24.6

1.9

12.9

33.6

Number of medications

23.8

29.2

20.6

26.4

26.4

34.7

22.5

16.4

58,4

30.3

8.8

2.5

28.2

40.6

23.0

8.3

44
Table 24. Number of drug mentions by selected physician specialties and percent distribution by therapeutic categories, according to selected

physician specialties: United States, January 1980 -December 1981

Physician specialty

General

and Obstetrics

Internal family and

Therapeutic catego# medicine practice gynecology Pediatrics

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

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

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

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

Antibiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sulfonamides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antineoplastic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Blood formation and coagulation.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antianamia drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Coagulants and anticoagulants.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiovascular drugs . . . . . . . . . . . . . . . . . . . . . . ...!.. . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Central nervous system drugs, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Analgesics andantipyretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anticonvulsants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychotherapeutic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Respiratory and cerebral stimulants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Electrolytes, caloric, and water balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

Antacids andadsorbents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

‘Anti-diarrhea agents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antiflatulents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cathartics and laxatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Adrenals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estrogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insulins andanti-diabetic egents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Thyroid andsntithyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Skiiland mucous membrane preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Other, unclassified, or undetermined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

251,370

100.0

3.2

6.4

5.2

0.6

2.3

3.8

1.4

0.6

0.8

21.8

9.8

6.7

5.1

17.9

10.4

0.5

2.3

0.3

4.3

15.7

1.7

0.7

4.8

1.0

0.4

0.6

0.7

9.7

3.1

0.9

3.5

1.8

1.1

2.6

2.1

2.2

2.6

Number in thousands

532,065 61,204

Percent distribution

100.0 100.0

6.8 2.2

17.3 15.9

15.2 9.2

1.3 0.9

0.1 *0. I

4.4 1.5

1.3 4.7

0.9 4.5

0.4 “0.2

10.0 1.9

3.7 “0.4

4.4 1.3

1.8 “0.2

17.9 7.7

9.6 4.4

0.3 “0.0

2.1 “0.5

1.9 “0.5

4.0 2.3

9.2 3.0

3.4 0.9

1.5 “0.6

4.6 1.9

0.6 80.3

0.7 “0.3

0.6 *0.4

0.6 “0.6

8.2 26.0

2.8 *0.3

1.0 6.3

1.9 “0.4

0.9 “0.6

2.7 “0.6

4.8 10.7

1.6 “0.3

3.7 19.3

2.5 2.7

146.515

100.0

15.2

30.1

26.8

3.1

*0. I

2.6

0.4

0.4

“0.0

“0.2

“o. 1

“0.1

4.9

3.7

‘0.2

‘0.3

‘0. 1

0.7

0.6

6.7

3.1

1.7

“0.1

1.0

*0,1

“0.1

1.6

1.3

“0.0

*ool

*0.1

17.4

5.9

2.2

0.9

6.4

1Based on ths classification of the American Hospital FormulaV Service (see appendix IV).

45
Table 25. Percent of all physician visits to internists and percent distribution of office visits to internists by selected visit characteristics:

United States, 1975 and 1980–81

Characteristic 1975 1980-81 Characteristic 1975 1980-81

Percent of ail physician visits . . . . . . . . . . . .

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

Sex of patient

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

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

Age of patient

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

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

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

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

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

Type of practice

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

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

Area

Metropolitan ..,......,.....,,.. . . . . . . . . . .

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

Principal diagnosis categoryz

Infectious and parasitic diseeses . . . . . . . . . .

Neoplasm. , . . . . . . . . . . . . . . . . . . . . . . . . . .

Endocrine, nutritional and metabolic diseases,

and immunity disorders . . . . . . . . . . . . . . . . .

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the nervous system and aenae

organs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the circulatory system . . . . . . . . . . .

Diseases of the respiratory system . . . . . . . .

Diseases of the digestive system . . . . . . . . . . . . .

Diseases of the genitourinary system. . . . . . .

Diseases of the skin and subcutaneous tissue. . .

10,9 12.4

Percent distribution

100.0

59.5

40.5

3.3

8.8

21.1

37.9

28.9

54.3

45.7

84.6

15.4

2.8

3.7

9.1

3.6

3.3

24,9

11.7

5.5

3.8

2.6

I 00.0

58.8

41.2

2,1

6.5

20.7

37,1

33.6

47.5

52.5

83,1

16.9

1.8

4.1

8.7

3,3

2.8

25.5

11.7

6.2

3.3

2.3

Principal diagnosis catego~2—Con.

Diseases of the musculoskeletal system and

connective tissue . . . . . . . . . . . . . . . . . . . . . . . . . .

Symptoms, signs, and ill-defined conditions . . . . .

Injury and poisoning.....,,.. . . . . . . . . . . . . .

Diagnostic service3

Limited history and/or examination . . . . . . . . . .

General history and/or examination . . . . . . . . . . .

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

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

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

Electrocardiogram . . ...,..... . . . . . . . . . . . . . . .

Vision test, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Endoscopy, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonmedication therapy3

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

Physiotherapy .,,........,,.. . . . . . . . . . . . . . . .

Medical counseling.......,,. . . . . . . . . . . . . .

Psychotherapy or therapeutic listening . . . . . . .

Duration of visit

0minutes4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l-10 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

16–30 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Disposition of visit5

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

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

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

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

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

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

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

Percent distribution

8.6

6.6

4,3

61.4

20.1

38.5

13.1

61.4

14.0

2.4

1.6

1,5

1.1

17,8

2.7

0.7

30.4

35.6

24.6

8.7

9.1

68.4

16,5

5.0

4.4

0.8

1.7

11,2

5.2

3.7

62.7

18.1

34.3

13.5

61.0

12.1

1,6

1,5

1.9

4.2

33.6

5.2

2.3

22.9

35.4

28.6

10.9

7.8

68.7

10.7

6.5

4.2

0.9

1.7

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

2percent~ will not ~Otal 100,0 because all categories are not listed,

3Percent will not total 100.0 because more than 1 service or therapy may have bean rendered during a visit,

4Represents visits in which there was no face-to-face encounter between patient and physician,

5Percents will not total 100.0 because more than 1 disposition was possible,

46
Appendixes

Contents

I. Technical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Statistical design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Scope ofthe survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Sample design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Data collection andprocessing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Fieldprocedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Data processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Estimation procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Inflation by reciprocals ofprobabilities ofselection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Adjustment fornonresponse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Ratio adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . 50

Reliability ofestimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Estimates ofaggregates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Estimates of percents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . 53

Estimates ofrates wherethenumerator is not asubclass ofthedenominator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Estimates ofdifferences between two statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . ., . . . . . . 53

Tests ofsignificance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Population figures and rate computation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Roundingofnumbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Systematic bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . . 54

H. Definitions ofcertain terms usedin this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Terms relatingto the survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Terms relatingto the Patient Record Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

HI. Survey instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

$

Introductory letter from Director,NCHS. . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Patient Record Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Induction Interview Form..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

IV. American Hospital Formulary Service classification system andtherapeutic category codes . . . . . . . . . . . . . . . . . . . . . . . . 69

Listofappendix figures

1. Approximate relative standard errors for estimated numbers of oflice visits based on all physician specialties (J), and

individual specialties(n), 1980–81 National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

II. Approximate relative standarderrors forestimatednumbersofdrugrnentions basedon all physicianspecialties (~), and

individual specialties(n), 1980–81 National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Lkt ofappendix tables

I. Distribut.ion ofphysicians inthe 1980–81 National Ambulato~ Medical Care Survey sample and response rates, by

physician specialty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

II. Estimates of the civilian noninstitutionalized population of the United States used in computing annual visit rates in

this report by age, race, sex, and Hispanic origin: 1980-81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

47
Appendix 1

Technical notes

Cs

This report is based on data collected during 1980 and

1981 in the National Ambulatory Medical Care Survey

(NAMCS). an annual sample survey of oflice-based physicians conducted by the Division of Health Care Statistics of

the National Center for Health Statistics (NCHS). The two

surveys were conducted with identical instruments, defitlitions,

and procedures. Two years of data were combined to increase

the reliability of the estimates. The annual su-rvey design and

procedures are presented in the following sections.

Statistical design

Scope of the survey

The target population of NAMCS includes office visits

made within the conterminous United States by ambulatory

patients to nonfederally employed physicians who are principally engaged in office-based patient care practice, but not in

the specialties of anesthesiology, pathology, or radiology. Telephone contacts and nonofflce visits are excluded from

NAMCS.

Sample design

The NAMCS utilizes a three-stage survey design that involves probability samples of primary sampling units (PSU’S),

physician practices within PSU’S, and patient visits within physician practices. The first-stage sample of 87 PSU’S was selected by the National Opinion Research Center (NORC) of

the University of Chicago, the organization responsible for

NAMCS field and data processing operations under contract

to NCHS. A PSU is a county, a group of adjacent counties,

or a standard metropolitan statistical area ( SMSA). A modified probability -proportional-to-size procedure using separate

sampling frames for SMSA’S and for nonmetropolitan counties

was used to select the sample PSU’S. Each frame was stratified

by region. size of population, and demographic characteristics

of the PSU’S, and was divided into sequential zones of 1 million residents; then, a random number was drawn to determine

which PSU came into the sample from each zone.

The second stage consisted of a probability sample of practicing physicians, selected from the mastetilles maintained by

the American Medical Association (AMA) and the American

Osteopathic Association (AOA), who met the following criteria:

Q Office-based, as defined by AMA and AOA.

● Principally engaged in patient care activities.

NOTE: Prepared by Thomas McLemore, Division of Health Care Statistics.

4P

● Nonfederally employed.

. Not in the specialties of anesthesiology, pathology, clinical pathology. forensic pathology, radiology, diagnostic

radiology, pediatric radiology, or therapeutic radiology

Within each PSU, all eligible physicians were sorted by

nine specialty groups: general and family medicine, intelmal

medicine, pediatrics, other medical specialties, general surgery,

obstetrics and gynecology, other surgical specialties, psychiatry, and all other specialties. Then, within each PSU, a systematic random sample of physicians was selected so that the

overall probability of selecting any physician in the United

States was approximately constant.

During 1980-81 the NAMCS physician sample included

5,805 physicians. Sample physicians were screened at the time

of the survey to ensure that they met the aforementioned criteria; 1.124 physicians did not meet the criteria and were,

therefore, ruled out of scope (ineligible) for the study. The most

common reasons for being out of scope were that the physician

was retired, deceased, or employed in teaching, research, or

administration. Of the 4,681 inscope (eligible) physicians, 3,676

(78.5 percent) participated in the study. Of the participating

physicians, 509 saw no patients during their assigned reporting

period because of vacations, illnesses, or other reasons for being temporarily out of ofice-based practice. The physician sample size and response data by physician specialty are shown

in table I.

The third stage was the selection of patient visits within

the annual practices of the sample physicians. This stage involved two steps. First, the total physician sample was divided

into 52 random subsamples of approximately equal size; then

each subsample was randomly assigned to 1 of the 52 weeks

in the survey year. Second, a systematic random sample of

visits was selected by the physician during the assigned reporting week. The visit sampling rate varied for this final step from

a 100 percent sample for very small practices to a 20 percent

sample for very large practices. The method for determining

the visit sampling rate is described later in this appendix and

in the Induction Interview form in appendix III. During 1980–

81, sample physicians completed 89,447 usable Patient Record forms.

Data collection and processing

Field procedures

Both mail and telephone contacts were used to enlist sample physicians for NAMCS. Initially, physicians were sent introductory letters from the Director of NCHS (see appendix

111). When appropriate, a letter from the physician’s specialty
Table 1. Distribution of physicians in the 1980–81 National Ambulatory Medical Care Survey samples and response rates, by physician specialty

Physician specialty Gross total Out of scope Net total Nonrespondents Respondents

Response

rate

All specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

Other medical specialties....,.. . . . . . . . . . . . . . . . . .

Surgtcal specialties . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Other surgical specialties . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Other spectaltles, . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5,805

1,340

1,695

871

414

410

1,978

521

484

973

792

414

378

1,124

289

296

158

83

55

246

75

71

100

293

96

197

4,681

1,051

1,399

713

331

355

1,732

446

413

873

499

318

181

1.005

272

298

182

42

74

351

115

63

173

84

43

41

3,676

779

1,101

531

289

281

1,381

331

350

700

415

275

140

78.5

74,1

78.7

74.5

87.3

79.2

79.7

74.2

84,7

80.2

83.2

86.5

77.3

organization endorsing the survey and urging his participation

was enclosed with the NCHS letter. Approximately 2 weeks

prior to the physician’s assigned reporting period, a field representative telephoned the physician to explain briefly the study

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

via telephone or special explanatory letter and requested to

reconsider participation in the study.

During the personal interview the field representative determined the physician’s eligibility for the study, obtained his cooperation, delivered survey materials with verbal and printed

instructions, and assigned a predetermined Monday-Sunday

reporting period. A short induction interview concerning basic

practice characteristics, such as type of practice and expected

number of office visits, was conducted. Oflice staff who were

to assist with data collection were invited to attend the instructional session or were offered separate instructional sessions.

The field representative telephoned the sample physician

prior to and during the assigned reporting week to answer questions that might have arisen and to ensure that survey procedures were going smoothly. At the end of the reporting week,

the participating physician mailed the completed survey materials to the field representative who edited the forms for completeness before transmitting them for central data processing.

At this point problems of missing or incomplete data were resolved by telephone followup by the field representative to the

sample physician: if no problems were found, field procedures

were considered complete regarding the sample physician’s participation in NAMCS.

Data collection

The actual data collection for NAMCS was carried out by

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

data collection forms were employed by the physician: the Patient Log and the Patient Record form (see appendix III). The

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

sampling frame to indicate the ofllce visits for which data were

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

patient visit information permitted the physician to detach and

retain the listing of patients, thus, assuring the anonymity of

the physician’s patients.

Ba~ed on the physician’s estimate of the expected number

of ofllce visits and expected number of days in practice during

the assigned reporting week, each physician was assigned a

visit sampling rate. The visit sampling rates were designed so

that about 30 Patient Record forms would be completed by

each physician during the assigned reporting week. Physicians

expecting 10 or fewer visits per day recorded data for all visits.

Those physicians expecting more than 10 visits per day recorded data for every second, third, or fifth visit based on the

predetermined sampling interval. These visit sampling procedures minimized the physician’s data collection workload and

maintained approximately equal repxting levels among sample

physicians regardless of practice size. For physicians recording

data for every second, third, or fifth patient visit. a random

start was provided on the first page of the Patient Log so that

the predesignated sample visits recorded on each succeeding

page of the Patient Log provided a systematic random sample

of patient visits during the reporting period.

Data processing

In addition to followups for missing and inconsistent data

made by the field staff, numerous clerical edits were performed

on data received for central data processing. These manual

edit procedures proved quite efiicient, reducing item nonresponse rates to 2 percent or less for most data items.

Information contained in item 6 (Patient’s problem or reason for visit) of the Patient Record form was coded according

to A Reason for Visit CIasstjication for A mbulatoq Care

(RVC).1 lDiagnostic information (item 9 of the Patient Record

form) was coded according to the ln~ernational Ciasszjkation

of Diseases, 9th Rerision, C[inica[ Modzxca[ion (ICD- 9–

CM).T A maximum of three entries were coded from each of

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

into batches with approximately 650 forms per batch. Quality

control for the medical coding operation involved a two-way

5-percent independent verification procedure. Error rates were

defined as the number of incorrectly coded entries divided by

the total number of coded entries. The estimated error rates

for the 1980-81 medical coding operation were 1.7 percent for

NOTE: A list of references follows the text,

49

J
item 6 and 2.3 percent for item 9. Additionally, a dependent

verification procedure was used to review and adjudicate all

records in batches with excessive error rates. This procedure

further reduced theestimated error rates to 1.6percent for item

6and 2.1 percent foritem9.

The NAMCS medication data (item 11 of the Patient Record form) was classified and coded according to a scheme developed at NCHS based on the American Society of Hospital

Pharmacists’ Drug Product Information File. A description of

the new drug coding scheme and of the NAMCS drug data

processing procedures is contained in Vital and Health Statistics, Series 2, No. 90.9 A two-way 100 percent independent verification procedure was used to control the medication

coding operation. As an additional quality control, all Patient

Record forms with differences between drug coders or with

illegible drug entries were reviewed and adjudicated at NCHS.

Information from the Induction Interview and Patiept Record forms was keypunched with 100 percent verification and

converted to computer tape. At this point, extensive computer

consistency and edit checks were performed to ensure complete and accurate data. Incomplete data items were imputed

by assigning a value from a randomly selected Patient Record

“form with similar characteristics; patient sex and age, physician specialty, and broad diagnostic categories were used as

the basis for these imputations.

Estimation procedures

Statistics from NAMCS were derived by a multistage estimation procedure that produces essentially unbiased national

estimates and has three basic components: ( 1) inflation by reciprocals of the probabilities of selection, (2) adjustment for nonresponse, and (3) a ratio adjustment to fixed totals. Each component is briefly described below.

inflation by reciprocals of probabilities of selection.

Because the survey utilized a three-stage sample design,

three probabilities of selection existed: ( 1) the probability of

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

within the PSU, and (3) the probability of selecting an office

visit within the physician’s practice. The third probability was

defined as the number of office visits during the physician’s

assigned reporting week divided by the number of Patient Record forms completed. All weekly estimates were inflated by a

factor of52 to derive annual estimates.

Adjustment for nonresponse

NAMC S data were adjusted to account for sample physicians who were inscope, but did not participate in the study.

This adjustment was calculated in order to minimize the impact of response on final estimates by imputing to nonresponding physicians the practice characteristics of similar responding

physicians. For this purpose, physicians were judged similar if

they had the same specialty designation and practiced in the

same PSU.

NOTE: A list of references follows the text.

50

Ratio adjustment

A poststratification adjustment was made within each of

nine physician specialty groups. The ratio adjustment was a

multiplication factor that had as its numerator the number of

physicians in the universe in each physician specialty group

and as its denominator the estimated number of physicians i;

that particular specialty group. The numerator was based on

figures obtained from the AMA and AOA masterfiles, and

the denominator was based on data from the sample.

Reliability of estimates

As in any survey, results are subject to both sampling and

nonsampling errors. Nonsampling errors include reporting and

processing errors, as well as biases due to nonresponse and

incomplete response. The magnitude of the nonsampling errors

camot be computed. However, these errors were kept to a minimum by procedures built into the survey’s operation. To eliminate ambiguities and encourage uniform reporting, careful

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

definitions. Also, extensive pretesting of most data items and

survey procedures was performed. The steps taketi to reduce

bias in the data are discussed in the sections on field procedures and data collection. Quality control procedures and consistency and edit checks discussed in the data processing section reduced errors in data coding and processing. However,

because survey results are subject to sampling and nonsampling

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

Iing variability alone.

Because the statistics presented in this report are based on

a sample, they differ somewhat from the figures that would be

obtained if a complete census had been taken using the same

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

probability design of NAMCS permits the calculation of samp

ling errors. The standard error is primarily a measure of

sampling variability that occurs by chance because only a

sample rather than the entire population is surveyed. The standard error, as calculated in this report, also reflects part of the

variation that arises in the measurement process, but does not

include estimates of any systematic biases that may be in the

data. The chances are about 68 out of 100 that an estimate

from the sample would differ from a complete census by less

than the standard error. The chances are about 95 out of 100

that the difference would be less than twice the standard error,

and about 99 out of 100 that it would be less than 21%times

as large.

The relative standard error of an estimate is obtained by

dividing the standard error by the estimate itself and is expressed as a percent of the estimate. For this report, an asterisk (*) precedes any estimate with more than a 30 percent relative standard error.

Estimates of sampling variability were calculated using the

method of half-sample replication. This method yields overall

variability through observation of variability among random

subsamples of the total sample. A description of the development and evaluation of the replication technique for error estimation has been published.15’16 Approximate relative standard

errors for aggregate estimates are presented in figures I and II.
30

20

100

%

70

60

50

40

30

20

50

40

6

5

4

3

2

0.:

08

0.7

0.6

05

0.4

03

02

0.1

10

9

8

7

6

5

4

3

2

$.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

A 2 3 456789A 2 3 456789A 2 3 456789A 2 3 456789A 2 3 456789A

100 1,000 10,000 100,000 1,000,000 10,000,000

S!ze of estimate (In thousands)

EXAMPLE An est!mate of 20 mllhon ofhce ws[ts to general surgeons (read from scale at bottom of chart) has a relatwe standard error of 7.7 percent [read from curve 8 on scale at left of chart) or a standard error

of 1,540.000 office wslts (7 7 percent of 20 milllon wslts).

Figure I. Approximate relative standard errors for estimated numbers of office visits based on all physician specialties (A], and individual specialtiaa (B], 1980-81 National Ambulatory Medical

m Care Survey
m

W

100

90

80

70

60

50

40

30

20

10

9

8

7

6

5

4

3

2

1

::

0.7

0.6

0.5

0.4

0.3

0.2

0.1

A 2 3 456789A 2 3 456789A 2 3 456789A 2 3 456789A 2 3 456789A

100

90

80

70

60

50

40

30

20

10

9

8

7

6

5

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3

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ri9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

100 1,000 10.000 100,000 1.000,000 10,000,000

SIZe Of estimate (in thousands)

EXAMPLE An estimate of 60 million drug mentions (read from scale at bottom of chart) has a relative standard error of 5.1 percent (read from cuwe A on scale at left of chart} or a standard arror of 3,060.000 drug

mentions (5.1 percent of 60 m!llmn drug mentions).

Figure Il. Approximate relativestandard errorsfor estimated numbers of drug mentions based on allphysician specialties (.4),and individual specialties (B), 1980–81 National Ambulatory Medical

Care Survey
To derive error estimates that would be applicable to a wide

variety of statistics and could be prepared at moderate cost,

several approximations were required. As a result, the relative

standard errors shown in figures I and II should be interpreted

as approximate rather than exact for any specific estimate. Directions for determining approximate relative standard errors

follow.

Estimates of aggregates

Approximate relative standard errors (in percent) for aggregate statistics are presented in figures I and II. The approximate relative standard errors for aggregate estimates of ot%ce

visits are shown in figure I, and the approximate relative standard errors for aggregate estimates of drug mentions are shown

in figure 11. In each figure, curve A represents the relative

standard errors appropriate for estimates based on all physician specialties, and curve B represents relative standard errors appropriate for estimates based on an individual physician

specialty. For the specific case where the aggregate estimate

of interest is the number of mentions of a specific drug, for

example, the number of mentions of Dyazide, figure I, curve

B should be used to obtain approximate relative standard

errors.

Instead of using figures I and II, relative standard errors

for aggregate estimates may be calculated directly using the

following formulae where x is the aggregate estimate of interest in thousands. For visit estimates based on all physician

specialties,

For visit estimates based on an individual physician specialty,

For drug mention estimates based on all physician specialties,

For drug mention estimates based on an individual physician

specialty,

‘sE(x)=~”’”O

Estimates of percents

Approximate relative standard errors (in percent) for estimates of percents may be calculated from figures I and II as

follows. From the appropriate curve obtain the relative

standard error of the numerator and denominator of the

percents. Square each of the relative standard errors, subtract

the resulting value for the denominator from the resulting value

for the numerator, and extract the square root. This approximation is valid if the relative standard error of the denominator

is less than 0.05 or if the relative standard errors of the

numerator and denominator are both less than 0.10.

Alternatively, relative standard errors for percentages

may be calculated directly using the following formulae where

p is the percent of interest and x is the base of the percent in

thousands. For visit percentages based on all physician

cialties,

For visit

cialty,

-@=m’”””

percentages based on an individual physician

R’E(p) =

d

42.88175 “(l –p)< ~ooo

p“x

For dmg mention percentages based on all physician

cialties,

spespespe-

“’@)= -’”O°

For drug mention percents based on an individual physician

specialty,

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 United States population or one

or more of the age-sex-race groups of the total population are

equivalent to the relative standard error of the numerator that

can be obtained from figures I or H.

Estimates of differences between

two statistics

The relative standard errors shown in this appendix are

not directly applicable to differences between two sample estimates. The standard error of a difference is approximately the

square root of the sum of squares of each standard error considered separately. This formula represents the standard error

quite accurately for the difference between separate and uncorrelated characteristics, although it is only a rough approximation in most other cases.

Tests of significance

In this report, the determination of statistical inference is

based on the t-test with a critical value of 1.96 (0.05 level of

significance). Terms relating to differences, such as ‘“higher,”

and “less” indicate that the differences are statistically significant. Terms such as “similar” or “no difference’” mean that

no statistical significance exists between the estimates being

compared. A lack of comment regarding the difference between

any two estimates does not mean that the difference was tested

and found to be not significant.

53
Table 11. Estimates of the civilian noninstitutionalized population of the United States used in computing annual visit rates in this report by age,

race, sex, and Hispanic origin: 1980-81

All Less than 15-24 25-44 45-64 6!F years

Race, sex, and Hispanic origin ages 15 years years years years and over

Race and sex Numbers in thousands

All races . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222,674 50,832 40,710 62,658 43,963 24,512

Male. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107,429 25,976 20,076 30,487 20,849 10,042

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115,244 24,856 20,634 32,171 23,114 148470

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191,052 41,693 34,229 53,973 38,993 22,165

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92,640 21,366 17,012 26,558 18,637 9,067

Female, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98,412 20,327 17,217 27,415 20,357 13,098

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26,107 7,627 5,430 6,870 4,143 2,039

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,103 3,840 2,544 3,057 1,838 826

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,005 3,787 2,886 3,814 2,305 1,213

Another . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,515 1,512 1,052 1,816 828 308

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,687 770 520 873 375 150

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,829 744 532 943 452 158

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114,528 4,645 3,174 4,047 1,955 706

Non-Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ‘208,507 46,525 38,028 58,081 42,233 23,640

lBased on the April 1, 1980, census, Figures will not add to total.

NOTE: Excludes Alaska and Hawaii.

Figures may not add to total due to rounding.

Population figures and rate

computation

The population figures used in computing annual visit

rates are presented in table II. The figures are based on an

average of the July 1, 1980, and July 1, 1981, estimates of

the civilian noninstitutionalized population of the United

States provided by the U.S. Bureau of the Census. Because

NAMCS includes data for only the conterminous United

States, the original population estimates were modified to account for the exclusion of Alaska and Hawaii from the study.

For this reason, the population estimates should not be considered ol%cial and are presented here solely to provide denominators for rate computations.

Estimates of numbers of visita and drug mentions in this

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

average annual estimates. For example, the average annual

visit rates are calculated as follows. The numerator is obtained

by dividing the estimated number of office visits for 1980-81

by 2 to obtain an average annual number of office visits. This

number is then divided by the appropriate population figure to

obtain an average annual visit rate. As previously discussed,

estimates of reliability for average annual visit rates may be

calculated from figures I and H.

Rounding of numbers

Estimates presented in this report are rounded to the nearest thousand. For this reason detailed figures within tables do

not always add to totals. Rates and percents are calculated on

the basis of the original, unrounded figures and may not necessarily agree precisely with percents calculated from rounded

data.

Systematic bias

No formal attempt was undertaken to determine or measure

systematic bias in the NAMCS data. But it should be noted

“that there are several factors affecting the data which indicate’

that these data underrepresent the total number of oftice visits.

Some of these factors are briefly discussed below.

. Physicians who participated in NAMCS did a thorough

and conscientious job in keeping the Patient Log, however,

post survey interviews with participating physicians indicate that a small number of patient visits may have been

accidentally omitted from the Patient Lo% although this

number is quite small, such omissions would result in an

undercoverage of oftice visits.

The same post survey interviews indicate that the inclusion of patient visits that dld not actually occur was

infrequent and would have a negligible effect on survey

estimates.

. As previously stated, the physician universe for the

1980–8 1 NAMCS included all nonfederal, office:based,

patient-care physicians on the AMA and AOA master-tiles.

The NAMCS was designed to provide statistically unbiased estimates of office visits to this designated population. Not included in the universe were physicians who

were classified as federally employed; or hospital-based;

or who were principally engaged in research, teaching, administration, or other nonpatient care activity. Consequently, ambulatory patient visits to these physicians in

an oftlce setting would not be included in NAMCS estimates. In an attempt to measure the number of ofllce visits

to physicians not in the NAMCS universe, a NAMCS

Complement Survey was conducted in 1980. This study

54
involved a sample of approximately 2,000 physicians suits indicate that about 17 percent of the Complement

selected from among the 230,000 physicians in the AMA Survey physicians saw some ambulatory patients in an

and AOA masterfles who were not eligible (in scope) for ofice setting and that an estimated 69 million office visits

the 1980 NAMCS. Details of the Complement Survey were made to these physicians in 1980.

methodology and results are forthcoming. Prelimina~ re55
Appendix 11

Definitions of certain terms

used in the report

Terms relating to the survey

0Jj7ce-Premises identified by physicians as locations for

their ambulatory practices. The responsibility over time for

patient care and professional services rendered there generally

resides with the individual physician rather than with any institution.

Ambulatory patient—An individual seeking personal

health services who is neither bedridden nor currently admitted

to any health care institution on the premises.

Ph-vsician—Classified as either

● In scope—Ail duiy licensed doctors of medicine or doctors of osteopathy currently in practice who spend some

time caring for ambulatory patients at an office location.

● Out of scope—Those physicians who treat patients only

indirectly, including physicians in the specialties of anesthesiology, pathology, forensic pathology, radiology, therapeutic radiology, and diagnostic radiology, and the following physicians:

●

●

●

●

Physicians who are federally employed, including

those physicians in military service.

Physicians who treat patients only in an institutional

setting, for example, patients in nursing homes and

hospitals.

Physicians employed full time in industry or by an

institution and having no private practice, for example,

physicians who work for the Veterans’ Administration or the Ford Motor Company.

Physicians who spend no time seeing ambulatory patients, for example, 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 staff

member in the office of the physician.

● Out ofscope—Patients seen by the physician in a hospital,

nursing home, or other extended care institution, or in the

patient’s home. (Note: If the physician has a private office, meeting the definition of “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 primary responsibility over time.

● Patients who contact and receive advice from the

physician via telephone.

● Patients who come to the office only to leave a specimen, to pick up insurance forms, or to pay a bill.

. Patients who come to the ofilce only to pick up medications previously prescribed by the physician. .

Visit—A direct, personal exchange between an ambulatory patient and a physician or a staff member for the purpose

of seeking care and 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 physician

master files maintained by the American Medical Association

or the American Osteopathic Association.

Region of practice location—The four geographic regions,

excluding Alaska and Hawaii, that correspond to those used

by the U.S. Bureau of the Census:

Region States included

Northeast. . . . Connecticut, Maine, Massachusetts, New

Hampshire, New Jersey, New York,

Pennsylvania, Rhode Island, and

Vermont

North Central . . . Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska,

North Dakota, Ohio, South Dakota, anp

Wisconsin

South . . . . . . . . . Alabama, Arkansas, Delaware, District

of Columbis, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi,

North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and

West Virgina

West . . . . . . . . . . Arizona, California, Colorado, Idaho, ‘

Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming

Metropolitan status of practice location—A physician’s

practice is classified by its location in a metropolitan or nonmetropolitan area. Metropolitan areas are standard metropolitan

statistical areas (SMSA’S) as defined by the U.S. Office of

Management and Budget. The definition of an individual

SMSA involves two considerations: first, a city or cities of

specified population that constitute the central city and identifi

the county in which it is located as the central county; second,

economic and social relationships with “contiguous” counties

that are metropolitan in character so that the periphery of the

specific metropolitan area may be determined. SMSA’S may

56
cross State lines. In New England, SMSA’S consist of cities

and towns rather than counties.

Terms relating to the

Patient Record Form

Age—The age calculated from date of birth was the age

at last birthday on the date of visit.

Race—White, Black, Asian or Pacific Islander, or American Indian or Alaskan Native. Physicians were instructed to

mark the category they judged to be the most appropriate for

each patient based on observation or prior knowledge. The

following definitions were provided to the physician:

●

●

●

●

W7zite-A person having origins in any of the original

peoples of Europe, North Africa, or the Middle East.

13[ack-A person having origins in any of the black racial

groups of Africa.

Asian or Paclj7c Islander—A person having origins in

any of the original peoples of the Far East, Southeast

Asia, the Indian subcontinent, or the Pacific Islands, including, for example, China, India, Japan, Korea, the

Philippine Islands, and Samoa.

American Indian or Alaskan Native—A person having

origins in any of the original peoples of North America

and who maintains cultural identification through tribal

affiliation or community recognition.

Ethnicity—Category judged by the physician to be the

most appropriate. The following definitions were provided:

● Hispanic origin—A person of Mexican, Puerto Rican,

Cuban, Central or South American, or other Spanish culture or origin, regardless of race.

● Not Hispanic—Any person not of Hispanic origin.

Patient’s complaint(s), symptom(s), or other reason(s)

for this visit (in patient’s own words)–The patient’s principal

problem, complaint, symptom, or other reason for this visit as

expressed by the patient. Physicians were instructed to record

key words or phrases verbatim to the extent possible, listing

that problem first which, in the physician’s judgment, was

most responsible for the patient’s visit.

Major reason for this visit—The one major reason (selected from the following list) for the patient’s visit as judged

by the physician:

●

●

●

●

Acute problem—A visit primarily for a condition or illness having a relatively sudden or recent onset (within 3

months of the visit).

Chronic problem, routine—A visit primarily to receive

regular care or examination for a preexisting chronic

condition or illness (onset of condition was 3 months or

more before the visit).

Chronic problem, jlareup-A visit primarily to receive

care for a sudden exacerbation of a preexisting chronic

condition or illness.

Postsurgeq orpostinjury-A visit primarily for followup

care of injuries or for care required following surgery, for

example, removal of sutures or cast.

● Nonilhzess care (routine prenatal, general exam, wellbaby)—General health maintenance examinations and

routine periodic examinations of presumably healthy persons, both children and adults, including prenatal and

postnatal care, annual physicals, well-child examinations,

and insurance examinations.

Diagnostic services this visit—Physicians were instructed

to check any of the following services that were ordered or

provided during the current visifi

●

b

●

●

●

●

●

●

Limited histo~ and/or examinatiorz-History or physical examination limited to a specific body site or system

or concerned primarily with the patient’s chief complaint,

for example, pelvic examination or eye examination.

General history and/or e.lamination—History or physical examination of a comprehensive nature, including all

or most body systems.

Pap test—Papanicolaou test.

Clinical lab test—One or more laboratory procedures or

tests, including examination of blood, urine, sputum,

smears, exudates, transudates, feces, and gastric content,

and including chemistry, serology, bacteriology, and pregnancy tes~ excludes Pap test.

X-ray—Any single or multiple X-ray examination for

diagnostic or screening purposes; excludes radiation

therapy.

Moodpressure check.

EKG—Electrocardiogram.

Vision fest—Visual acuity test.

Endoscopy—Examination of the interior of any body

cavity except ear, nose, and throat by means of an endoscope.

Mental status exam—Any formal, clinical evaluation designed to assess the mental or emotional status of the patient.

Other—All other diagnostic services ordered or provided

that are not included in the preceding categories.

Principal diagnosis—The physician’s diagnosis of the

patient’s principal problem, complaint, or symptom. In the

event of multiple diagnoses, the physician was instructed to

list them in order of decreasing importance. The term “principal” refers to the first-listed diagnosis. The diagnosis represents the physician’s best judgment at the time of the visit and

may be tentative, provisional, or definitive.

Other signl~cant current diagnoses—The diagnosis ~f

any other condition known to exist for the patient at the time

of the visit. Other diagnoses may or may not be related to the

patient’s reason for visit.

Have you seen patient before?—” Seen before’” means

provided care for at any time in the past. Item 10b refers to

the patient’s current episode of illness.

Medication therapy this visit—The physician was instructed to list, using brand or generic names, all medications,

including drugs, vitamins, hormones, ointments, and suppositories ordered, injected, administered, or provided this visit

including prescription and nonprescription drugs, vaccinations,

immunization, and desensitization agents. Also included are

57
drugs and medications ordered or provided prior to the visit

that the physician instructed or expected the patient to continue taking. Medications for the principal diagnosis are listed

in item 11a; all other drugs are listed in item 11b.

Nonmedication therapy—Physicians were instructed to

check any of the following services that were ordered or provided during the current visit ‘

●

●

●

●

●

●

●

●

Physiotherapy—Any form of physical therapy ordered or

provided, including any treatment using heat, light, sound,

or physical pressure or movemen~ for example, ultrasonic,

ultraviolet, infrared, whirlpool, diathermy, cold, and

manipulative therapy.

Office surge~—Any surgical procedure performed in the

off]ce this visit, including suture of wounds, reduction of

fractures, application or removal of casts, incision and

draining of abscesses, application of supportive materials

for fractures and sprains, irrigations, aspirations, dilations,

and excisions.

Family planning—Services, counseling, or advice that

might enable patients to determine the number and spacing of their children, including both contraception and infertility services.

Psychotherapy or therapeutic listening—All treatments

designed to produce a mental or emotional response

through suggestion, persuasion, reeducation, reassurance,

or support, including psychological counseling, hypnosis,

psychoanalysis, and transactional therapy.

Diet ccmnseling—Instructions, recommendations, or advice regarding diet or dietary habits.

Family or social counseling—Advice regarding problems

of family relationships, inchrding marital or parent-child

problems, or social problems, including economic, educational, occupational, legal, or social adjustment difficulties.

Medical counselin&–Instructions and recommendations

regarding any health problem, including advice or counsel

about a change of habit or behavior. Physicians were instructed to check this category only if medical counseling

was a significant part of the treatment. Family planning,

diet counseling, and family or social counseling are excluded.

Other—Treatments or nonmedication therapies ordered

or provided that are not listed or included in the preceding categories.

Was patient referred for this visit by another physician?—

Referrals are any visits that are made at the advice or direction of a physician other than the one being visited. The interest is in referrals for the current visit and not in referrals for

any prior visit.

Disposition this visit—Eight categories are provided to

describe the physician’s disposition of the case. The physician was instructed to check as many of the categories as

apply:

No followup planned—No return visit or telephone contact was scheduled for the patient’s problem.

Return at specij7ed time—Patient was told to schedule an

appointment or was instructed to return at a particular

time.

Return # needed, P.R. N.—No future appointment was

made, but the patient was instructed to make an appointment with the physician if the patient considered it necessary.

Telephone followup planned—Patient was instmcted to

telephone the physician on a particular day to report either

on progress, or if the need arose.

Referred to other physician—Patient was instructed to

consult or seek care from another physician. The patient

may or may not return to this physician at a later date.

Returned to referring physician—Patient was instructed

to consult again with the referring physician.

Admit to hospital—Patient was instructed that further

care or treatment would be provided in a hospital. No

further oflice visits were expected prior to hospital admission.

Other—Any other disposition of the case not included in

the preceding categories.

Duration of this visit—Time the physician spent with the

patient, not including time the patient spent waiting to see the

physician, time the patient spent receiving care from someone

other than the physician without the presence of the physician,

and time the physician spent in reviewing such things as records

and test results. If the patient was provided care by a member

of the physician’s staff but did not see the physician during

the visit, the duration of visit was recorded as O minutes.

58
Appendix III

Survey instruments

Endorsing Organizations

American Academy

of Dermatology

American Academy of

Fam]ly Physicians

American Academy

of Neurology

American Academy of

Orthopaedlc Surgeons

American Academy

of Pedtatrlcs

American Association of

Neurological Surgeons

American College of

Emergency Physicians

American College of

Obstetricians and

Gynecologmrs

American College

of Physicians

American College of

Preventwf? Medicine

American Osteopathic

Associarlon

American Society of

Colon and Rectal

Surgeons

Amertcan Psychiatric

Assoclatlon

American Socletv of

Internal Medicine

American Society of

Plast!c and Reconstructwe

Surgeons, Inc.

American Urological

Association

Association of American

Medical Colleges

National Medical

Association

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

OFFICE OF HEALTH RESEARCH, STATISTICS AND TECHNOLOGY

HYATTSVILLE, MARYLANO 20782

NATIONAL AMBULATORY

MEDICAL CARE SURVEY

The National Center for Health Statistics, as part

of its continuing program to provide information on

the health status of the American people, is conducting

a National Ambulatory Medical Care Survey (NAMCS).

The purpose of this survey is to collect information

about ambulatory patients, their problems, and the

resources used for their care. The resulting published

statistics will help your profession plan for more

effective health services, determine health manpower

requirements, and improve medical education.

Since practicing physicians are the only reliable source

Of this information, we need your assistance in the

NAMCS . As one of the physicians selected in our national

sample, your participation is essential to the success

of the survey. Of course, all information that you

provide is held in strict confidence.

Many organizations and leaders in the medical profession

have expressed their support for this survey, including

those shown to the left. In particular, your own specialty society has reviewed the NAMCS program and supports

this effort (see enclosure). 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

Enclosure

59
OT

o

,

CNO.499932

PATIENTLOG

As anch patient arrives, record name an~

time of visit OR ths log below. For the

p3tient antered on line #3, also cOmplate the patient record to the right.

I

PATl ENT’S NAME TIME OF

VISIT

3

a.m

Record ,Ienw 1.15

lo, thtswteent. I

mm

CONTINUE LISTING PATIENTS

ori NEXT PAGE

ASSURANCE OF CONFIDE NTALITY–A,! ,nlornmt c.” v,hKhwo.ld De’Wmt ,de”tdm.a, m” Decd81me”! Ot Heallh E<l”c. t(on. .n,, w,.o(. r,.

.{ ,“ ,nd,v!du,l. , 0,,.,,.,, 0, . . t-$,, b,,, hm,n, w,,, lx held conl,d, n,,.,, v+,, be used !).,” PWI,C H,..l!h S.,.,..

b oe, m.s -mea m and (o< the Dur00se5 of the wr.ev and +.,1, not w 68SC1OWI5 or re 0,!,,,01 ti. a!,h R.,,,,<. S,,,,, !..%...,, T...!>,,,,,,,,, cNO.d$l$)gsz

lea,eti ,0 o,he, 0,, s.”, m “sell 10, ,“” o,h.r L,urPc,,e Na, aonal C.nt?r Io( H.d, h S!.,,,,,, S

lm DATE OF VISIT

&

PATIENT RECORD

NATIONAL AMBULATORY MEDICAL CARE SURVEY

//

Month Da, V,.,

3mSEX

I ❑ FEMALE

2UMALE

7. MAJOR R EASON FOR THIS

VISIT [Check onel

, ❑AC”TEPROBLEM

2 ❑ CHRON,CPR08LEM, ROUTINE

3 ❑ CHRCINIC PROBLEM. FLARE”P

a❑F’oSTS”R GERY(POST INJURY

5 ❑ NON-ILLNESS CARE 1170uTl NE

PRENATAL. GENERAL EXAM

WELL BABY, ETc.)

10. HAVE YOU SEEN

PATIENT BEFORE?

,UYES ,DNO

\

IF YES, FOR THE

CONOITION IN

ITEM 9aJ

,0,,s , ❑ NO

~, COLOR OR RACE

I HkVHiTE

2 ❑51LAcK

3 ❑ AS,AN,PAcIF\c

ISLANDER

. ❑ AMERICAN INDIAN,

ALASKAN NATIVE

5. ETHNICITY

, ❑HISPANIC

ORIGIN

2 fJNOT

HISPANIC

B, DIAGNOSTIC SERVICES THIS VISIT

/Check all ordered or pro.ided/

I ❑tdONE 8 ❑ EKG

2 ❑LIM,TED H,STORY,EXAM. 9 ❑ “ISION TEST

3 @GENERAL HISTORYIEXAM 10 ❑ ENDOSCOFW

. ❑PAF’TEST ,1 ❑ MI::; LSTATUS

5 ❑ CLINICAL LAB TEST

6 ❑ X.RAY

,, ❑ OTHER (SF..,,,,

7 ❑ BLOOO PRESSURE CHECK

& PATIENtiS COMPLAINT(S), SYMPTOM(S), OR OTHER

REASON(S) FOR ~ VISIT //11 ,MIf[c,rf‘s <)v.wword.r/

. MoST IMPORTAN1

b OTHER

9mPHYSICIANS OIAGNOSES

a PRINCIPAL DIAGNos[S PRoE3LEMPSSOCIATED WITH lT&M &

b OTHER SIGNIFICANT CURREW7 DIAGhJ05ES

7 la MEDICATION THERAPY THIS VISIT ❑ NONE

I Using brand or generic names, record all new und con tinued medicnrions cmfwcd, i)!iecfed. mlminisrerrd. m ,,rhrr!t’m>

provided a t this viss Include immunizing and desensitizing age?? ts/

d. FOR PRINCIPAL OIAGNOSES IN ITEM 9, tz. FOR ALL OTHER REASONS

1. 1

2. 2

3. 3

4. 4.

12. NON-MEDICATION THERAPY

/Check all services ordered or provided this v.iritj

I ❑ N.NE 6 Q DIET COUNSELING

2❑ pHY5,0THEflAPY 7❑F:}J:;OCA.L

3❑ OFFIcE SURGERY

“cl

8❑ MEOlcAL Counseling

FAMILY PLANNING

5❑ PSYCHOTHEFIAPy/

9 ❑ OTHER ,SPKVr,

THERAPEUTIC LISTENING

[3=~;sFwl&ru

FOR THIS VISIT

BY A~HER

PHYSICIAN?

,“DYES

J4. ::::<:S;;l:: :~:,WT

* ❑ NO FOLLOW .PPLANNED

2 ❑13ETURNATSPECIFIED TIME

3 QRETuRNIF NEEoEo.p13 N

. ❑TELEf+iO NE FOLLOWUP PLANNED

5 PREFERRED TO OTHER pHysIcIAN

6 ❑ RET.RNE 0 TO REFERRING PHYSICIAN

7 ❑,4cIMITT0 HoSPITAL

* ❑ OTHER’S,},,,,,,

P HS-61 06-C (9/791 OMB No. 6WR149S
CONFIDE~IAL;’

NoRc-4284

BEGIN DECK 3

FOR OFFICE USE

ONLY:

m

7-10/

NATIONAL AMBULATORY MEDICAL CARE

INDUCTION INTERVIEW

SURVEY

I BEFCWSTARTINGImERvIEwl I m’ (

1. ENTER PHYSICIAN I.D. NUMH?R IN BOX TO ~ 1-4/

RIGHT.

2. ENTER DATES OF ASSIGNED REPORTING WEEK M

Q. 2, P. 2.

w

Doctor, before I begin, let me take a minute to give you a little background about

this survey.

Although ambulatory medical care accounts for nearly 90 percent of all medical care

received in the United States, there is no systematic infonnatiou about the characteristics and problems of people who consult physicians in their offices. fiis kind

of information has been badly needed by medical educators and others concerned with

the medical manpower situation.

In response to increasing demands for this kind of information, the National Center

for Health Statistics, in close consultation with representatives of the medical

profession, has developed the National Ambulatory Mdical Care Survey.

Your own task in the survey is simple, car%fully designed, + should not take much

of your time. Essentially, it consists of your participation during a specified

7-day period. During this period, you simply check off a minimal mount of info~-

tion concerni~ patients that you see.

Now, before we get into the actual procedures, I have a few questions to ask about

your practice. The answers you give me will be used only for classification and *

analysis, and of course information YOU provide is held in strict confidence.

1. First, you are a

(ENTER SPECIALTY FROM CODE ON FACE SNEET IM3EL.)”

Is that right? Yes . . . . . . , . . . .X

No...’. (ASKA) . . ..Y

A. IF NO: What is your specialty (including general practice)?

1111

(Name of Specialty) 11-13/

*

The National Ambulatory Medical Care Survey is authorized by

Congress in Public Law 93-353, section 308. It is a voluntary

study and there are no penalties for refusing to answer any

question. All information collected is confidential and will

be used only to prepare statistical sunmarfes. No information

which will identify an individual or a physician’s practice

will be released.

61
-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 BELiJW).

Are

A.

(that’s a (that’s a

/ Monday) through I Sunday)

month date month date

you likely to see ~ ambulatory patients in your office during

Yes. . . . . .(GOTQQ. 3),

that week?

.x

t40 .’. . . . . (ASK A). . . . Y

IF NO: Why is that? RECORD VERBATI~ THEN READ PARAGRAPH BELCW

Since it’s very important, doctor, that we include any ambulatory patients

that you ~ happen to see in your office during that week, I’d like to

leave these forms with you anyway--just in case your plans change. 1’11

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 j PATIENT RECORD FORMS AND GO TO Q. 9, P. 6.

62
-3-

3, A, A$ what office location will you be Beet

ME

ipad;t;ry

7-dayperiod? RECORD UNDER A BELW AND ●

B. FOR EACH OFFICE LOCATION ENTERED IN A, CODE YES OR NO TO “IN SCOPE.”

IN SCOPE (Yes) ~OUT OF SCOPE (No){

Private offices Hospital emergency rooms

Free-standing clinics Hospital outpatient departments

(non-hospital based) College or university infirmaries

Groups, partnerships Industrial outpatient facilities

Kaiser, HIP, Mayo Clinic Family planning clinics

Neighborhood Health Centers Government-operated clinics

Privately operated clinics (VD, maternal &child health, etc.)

(except family planning)

IN CASE OF DOUBT, ASK: IS that (clinic/facility/institution)hospital based?

Is that (clinic/facility/institution)government

operated?

c. Is that all of the office locations at which you expect to see ambulatory

patient~uring that week?

Yes. . . . . . . . . . . X

No . . . . . ,. . . . . Y

IF NO: OEi’AINADDITIONALOFFICE LOCATION(S),ENl!ERIN “A” BELW, AND REPEAT.

A: B.

Office Location In Scope?

Yea I

No

(1) 1 0

(2) 1 0

1 0

(3) 1 0

(4)

TOTAL IN-SCOPE LOCATIONS:

o

14/

IF ALL LOCATIONSARE OUT OF SCOPE, THANK THE DOCTOR AND LEAVE.

63
--+- DECK 3

4. A. During that week (REPEAT DA’TES),,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 NUMBER CATEGORY ON APE’~E JQ&

B. And during those seven days (REPEAT DATES IF NECESSARY), on how many @ dc)

you expect to see any ambulatory patients? COUNT EACH DAY IN WHICH DOCTOR

EXPECTS TO SEE ANY PATIENTS AT AN IN-SCOPE OFFICE LOCATION.

CIRCLE NUMBER OF DAYS IN APPROPRIATE CCLUMN UNDER “B;’ BELOW.

DETERMINE PROPER PATIENT LOG FORM FROM CHART BELOW. READ ACROSS

ON “TOTAL pATIENTS” LINE UNDER “A” AND CIRCLE LETTER IN APPROPRIATE

“DAYS” COLUMN UNDER “B.”

THIS LETTER TELLS YOU WHICH OF THE FOUR PATIENT LOG FORMS (A, B, C, D)

SHOm BE USED BY THIS DOCTOR.

A. B.

LOG FORM DESCRIPTION Expected total Total @%_ in practice

patients during duripg week.

survey week.

I 1

I ENTER TOTAL FROM 1

A--Patient Record is to be

completed for ALL

patients liste=n Log.

Q. 4-A.

15-17/ m“ -+lsr’l+l;

1- 12 PATIENTS AAAAAAA

13- 25 “ B AAAAAA—

B--Patient Record is to be

completed for every

SECOND patient listed

on Log.

I 26-39 ‘1 IcBAAA AA

40- 52 “ CBBAA AA

53- 65 “ DC BBA AA

66- 79 “ DC BB BAA

C--Patient Record is to be

coqleted for every

THIRD patient listed

on Log.

I

80- 92 ““ IDDCBBB13

93-105 “ DDCBBB13

106-118 “ D ‘D C C B B B—

119-131 “ DDCCBBB

*D--Patient Record is to be

completed for every

FIFTH patient listed

on Log.

132-145 “ DDDCCBB

146-158 “ DDDCCBB—

159-171 “ DDD CCCL=

172-184 “ DDDCCCC

I 185-197 “ ID DDDDDD

198-210 “ DDDDDDD

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 L~olios and instruct him

to complete a patient record form for only every tenth patient. Then you are

to draw aa ?. :l~roughtihe?atient Record on every other page of the two folio pads,

starting with Page 1 of the pad. The physician then completes the Patient Log

on every page, but completes the Patient Record on every second page.

64
-5-

5. FIND LOG FOLIO WITH APPROPRIATELETTERAND CIRCLE

OF THE FORM AND NUMBER”OF LINES STAMPED“BEGIN ON

FORMS (if no lines are stamped,enter “O”) BELOW.

LETTER,ENTER FIRST FOUR

NEXT LINE” FOR THE B-C-D

FOLIO No. Lines FOR OFFICE USE ONLY

Stamped“BEGIN Number patient record

Letter .Number ON NEXT LINE” forms Colmleted.

*A

B

c

D

—---- .

D!XK 3

NUMBERS

LOG

19-23/

24-26/

6. HAND DOCTOR HIS FOLIO AND EXPLAINH(X4FORMS ARE TO BE FILLJiDOUT. SHOW DOCTOR

INSTRUCTIONSON THE POCKE’i’OF FOLIO, ITEMS ~ AND 11 ON CARIX?IN POCKET

OF FOLIO AND ITEM DEFINITIONSON THE BACK OF FOLIO, TO WHICH HE CAN REFER AFTER

YOU LEAVE.

EMPHASIZETHAT EVERY PATIENTVISIT EXCEPT ADMINISTRATIVEPURPOSE CEILYIS TO BE

RECORDEDON THE LOG FOR ENTIRE REPORTINGPERIOD. FOR EXAMPLE, IF A MEDICAL

ASSISTANTGAVE THE PATIENTAN INOCULATION,OR A TECHNICIANADMINISTEREDAN

ELECTROCARDIOGRAMAND THE PATIENTDID Nm SEE THE D~ORq T~S VISIT MUST STILL BE

LISTED ON THE LOG.

RECORDVERBATIMBELCXJANY CONCERN,PROBLEMSOR QUESTIONSTHE DOCTOR RAISES.

7. IF DOCTOR EXPECTSTO SEE AMBULATORYPATIENTSAT lY3RETNAN ONE IN-SCOPELOCATION

DURING ASSIGNEDWEEK. TELL HIM YOU WILL DELIVER THE FORMS TO THE OTHER LOCATION(S).

ENl!ERTHE FORM LETTEkAND NUMBER(S)AND NUMBER OF LINES STAMPED “BEGINON NEXT -

LINE” FOR THE B-C-D LOG FOR THOSE LOCATIONSBELOW, BEFORE DELIVERINGFORM(S).

No. Lines w FOR OFFICE USE ONLY:

Location FOLIO Stamped “BEGIN Number patient recor~

Letter .Number ON NEXT LINE” forms completed ___

r

27-31/

32-34/

35-391

40-42/

43-47/

48-50/

65
-6- DECK 3

8. During the survey week (REPEAT EXACT DATES), will anYone be available to help

you in filling out these records (at each IN-SCOPElocation)?

Yea . . . . (AsKA) ...1

No . . . . . . . . . . .2

51/

A. IF YES: Who would that be?

RECORD NAME, POSITION AND LOCATION. :;

1

NAME I POSITION I LOCATION J

PERSONALLY BRIEF EACH PERSON LISTED ABOVE.

EMPHASIZE THAT EVERY PATIE~ VISIT DURING TNE ENTIRE WEEK IS TO BE RECORDED ONTNE

LOG EXCEPT “ADMINISTRATIVEPURPOSE ONLY.”

9. Do you have a OO1O practice,or are you amociated with other physiciem in 8

partnership, in a group practice, or in some other wayf

solo. , ● ● , (G070, Q. 10) . . 1

Partnership. . (ASK A-C) . . . 2

Group . . . ..(ASKA-C) . ..3

<--- Other (s~CI~ ~ &jKA.C) . . 4

IF PARTNERSHIP. GROUP. OR OTHER:

A. Ia this a prepaid group practice? Yea . . (ASK [l]) . . . 1

[1] IF YES TO A: What per cent

No . . . . . . . . . .2

of patients are

prepaid? per cent 54-56/

B. How many other physicians are

amociated with you? NUMBER OF PHYSICIANS: 57-59/

c. What are the specialties of the other physician associated with you?

(How manyof these are there?)

52/

53/

Specialty Number of Physician8

(1)

(2)

(3)

(4)

(5)

D. CIRCLE ONE:

All physicians in this partnership/group practice

have the same specialty . . . . . . . . . . . . . . . . . . 1

More than one specialty in this partnership/group practice . . 2

60/

66
10. Now I have just

IN LARGE GROUP,

one

THE

-7- BEGIN DECK 4

more question about your practice. (NOTE: IF DOCTOR PMCTICES

FOLLOWINGINFORMATIONCAN BE OBTAINEDFROM SOMEONEELSE.)

A. What is the total number of full-time (35 hours or more per week) employees Of your (part*rahip/

group) prsctice? Include persons regularly employed who m? nw on vacation, temporarib ill,

etc. Do not include other physicians. RECORD ON BOTTOM LINB OF COLUM A BEUW.

(1) Hw—msnyof these full-time employees are s . . . (READ CATEGORIESBELCW AS NECESSARY

AND RRCORD NUMBEROF 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, eec. Do not include other physicians. RECORD ON BOTTOM LINS OF COLW B BELOW.

(1) How many of these part-time etiployees are a . . . (READ CATEGORIESBELCW AS HECESSARY

AHD IW20RD NUKBER OF EACH INCOLW B.)

t

-A. B.

Employees 1%11-tw Part-time

(35 or more hours/week) (Less than 35 hours/week) I

(1)

(2)

(3)

(4)

(5)

(6)

(7)

RegisteredNurse.... . . . . . . . 11-13/

LicensedRactical Hurse . . . . . . . 14-16/

Hursing Aide . . . . . . . . . . . . . 17-19/

Physician Aasiatant* . . . . . . . . . 20-22/

Technician . . . . . . . . . . . . . . 23-25/’

secretaryor Receptionist . . . . . . 26-28/

Other (SPECIFY) 29-31/

mfi: n 32-341

35-37/

38-40/

41-43/

44-461

47-49/

50-52/

53-55/

~~: n 56-58/

*

Physician Aasiatant wst be a graduate of an accredltsd training program for physician

Assistants (PhysicianExtenders,Msdex, ●tc.) or certifiedby the NationalBoard of lkdical

-iners through the Cartificstion Exm for Assistant to the Rfury Care physician.

BEFORE YOU LEAVE, AGAIN STRESS THAT EACH AND EVERY AMBUIA30RI!PATIENT SEEN BY THE

DocroR OR HIS STAFF DURING ~ 7-DAY~~IOD ATIiZ IN-SCOPE OFFICE LOCATIONS (l@EAT

THEM) IS TO BE INCLUDEDIN THE SURSfEY,THAT EAC~ATIENT IS TO BE RECORDEDON THE LOG,

AND ONLY THE APPROPRIATENUMBER OF PATIENTRECORDS COMPLETED.

Thank you for your time, Dr. If you have any (more) questions,

plea8e feel free to call me. w phone n=er is written in the folio. I’ll

call ~ on Monday morning of your surveyweek just to remind you.

11. TIME INTERVIEWENDED . . . . . . . . AM

PM

12. DATE OF INTERVIEW . . . . . . . . . . . . . . . 11111 I

. (Month) (Day) (Year)

67
INTERVIEWER NUMEER

111111

INTERVIEWER’S SIGNATURE

FOR OFFICE USE ONLY:

No. of Patients Seen: I I I I 59-61/

u

62/

Tots’iDay-jin Practice during Week:

68

r
Appendix IV

“

American Hospital Formulary

Service classification system

and therapeutic category codes

AMESUCAN

HOSPITAL

FORMULARY

SERVtCE

CLASSIFICATION

SYSTEM

AMERICAN HOSPITAL FORMULARY SERVICE CLASSIFICATION SYSTEM

AND THERAPEUTIC CATEGORY CODES (AHFS#)

(Clasdicationz io parcnthczcs are providond but rruy be wed in DPIF) —

04:00 ANHHS8TAMU4E DRUGS

0S:00 ANTI-lNFECTSVE AGENTS

08:04 .k’nebacidm

08:08 .kllthebllilUiCS

08:12 Antibiotics

08:12.02 Aminoglycosides

08:12.04 .htifUn@ Antibiotic,

08:12.06 Cephafosporins

OS: 12.0S Chloramphenicol

OS: 1212 Erythromycins

08:12.16 Penicillins

08:12.24 Tetracycline!

OS 1224 Other .kltibi0tiC5 .

08:16 Antitubmcufosis Agcnrr

08:18 .&niyirak

08:20 Plarmodicides

08:24 SuUonamidm

0S:26 Sulfones

08:28 Treponemicides

08:32 Trichomomddes

08:36 Urinary Germicides

0S:40 Other Ant&Infective

10:00 ANT1NEOPLA8TSC AGENTS

12:00 AUTONOMIC DRUGS

12:04 Parssympathominrctic A@nU

12:08 Pamtympatholytic .4gmrts

12:12 Sympathomimetic Agent4

12:16 Sympmltolytic Agrmtr

1220 Skeletal Musck Relaxants

16:00 BLOOD DERSVATIVSS

20: C@” BLOOD FORMATION AND COAGULATION

20:04 Andanenria Drugr

2004.04 kon Pmpamtiom

20M.08 Liver and Stomach

Prepamtions

20:12 Coagufsntr and Antico@snu

20: 12.M AIUiC0@lIIt5

20:1208 Amihepuin Agents

20:12.12 COagukntr

20:12.16 Hemostatic

2040 ‘1’hrombolytic Agents

24:00 CARDIOVAEULAR DRUGS

24:04 Cardiac Drug,

24:06 Antilipernic Agcmr

24:08 Hypetemive Agents

24:12 Varodikting Agcntr

24:16 Sclerositrg Agents

28:0+3 CENTRAL NERVOUS SYSTEM DRUGS

28:04 General Arm$thcrics

28:08 Analgesics and Arrtipyretics

28:10 Narcotic Antagcmistr

28:12 Anticonvufrsntr

2816 Psychotherapeutic Agentr

28:16.04 Antidepressmtr

28:16.08 Tranquilizers

2S: 16.12 Other Psychotherapeutic

Agents

2S:20 Rcspimtory and Cerebral

Stimulants

2S: 24 Sedatives and Hypnotics

36:00

36:o4

36:08

36:12

36:16

36:18

36:W

36225

3626

36:28

36:30

36:32

36:34

36:36

36:38

36:40

36:4

36:48

36:52

36S6

36:60

36:61

3662

36:64

3666

36:68

36:72

36:76

36:78

36:8o

36:84

36:88

40:00

40:04

40:08

40:10

40:12

40:16

40:18

4JX20

4Q24

4028

4Q36

40:40

Diagnostic AGENTS

Adrenocortiul Insufficiency

Anryloidosfl

Blood VoIume

Bmcetlosir

CaIdkc Function

Circuhtion Time

(cystic Fitiotk)

LXzbctm Mellitus

Diphth*

Drug Hypasmrritivity

Fungi

Gallbladder Function

Gastric Function

Intertind ALwOrption

Xidney Functkon

river Function

Lymphouutuloma Venereum

Mumps -

My=thmia Gravir

Myxc&ma

Pancreatic Function

Phenylketonuria

PheochrOmOcytOm

Pituitary Function

Rocntgcnography

Scarlet Ftvcr

Swuting

(Thyroid Function)

Trichinoiir

Tubcrctdotk

Urine Contents

ELECTROLYTIC, CALOR3C,

WATER BALANCE

Ack!ifyin; ~ntr

. . .

AfMmmmg &Mr

Armrwrtis Detoxicatttr

Rephcemcnt .%lutktu

Sodium-Remo$irW Rcsfnr

Potassiutn-RenrovirrI Reriq

Caloric.Amrts -

Sdt and S_W Suhtitutet

Diuretic,

krigating SOIutiom

UricOmric Agmrtr

AND

U:OO ENZYMES

48:00 SXP~ORANTS AND COUGH

PREPARATIONS

.52:00 EYE, ~, NOSE AND THROAT

PREPARATIONS

52:04 A,lti-hfCCtiVCZ

52: 04.M Antibiotics

52:0s

52:10

52:12

S2: 16

5220

S224

S2:2S

S2:32

52:36

56:oo

56:o4

56:08

56:10

56:12

56:16

56:20

56:24

56:40

52:M.06 AI,tivimk

52:04.08 Sulfonmrtidm

52:04.12 MirG Anti-Infoctivm

Antk-IntllrnllutOly Agmlu

&bXdC Anhydrase klhibitor$

Contict Lcnr Solutions

LOCII Amstheticr

MkOtka

MYdriatics

Mouth Warhm and Gargles

Vmocorutrfctors

UnchrsKed Agents

GASTROINTESTINAL DRUGS

Anucidr and Adrabcmu

Anti-Diarrhes Agmrtr

Antiftatuknu

Cathartics and Laxatives

Di@ants

Entaticr and Antk-Errteticr

Lipotropic Agcntr

Mire. GI Drug,

60:00 GOLD COMPOUNDS

64:00 HEAVY METAL ANTAGONISTS

68:00 HORMOXES AND SYNTNETIC

SUBSTSTUTE8

68:M Adrenals

68:08 Androgens

68:12 Contraceptives

6S: 16 =tlO&ItS

68: 1S Gomdotmpinr

6S20 krsulinr and Anti.Diabetic

Agents

6S:20 .08 Inmlins

68:24

68:28

6ti32

68:34

68:36

72:oil

76:00

78:00

80:00

SO@4

S0:08

80:12

S4:CJ2

84:04

Pamtbyroid

tituitw

Ro@stogenr

Other Corpus Luteum Hormones

Thyroid and Anlithyroid

LOCAL ANE8THETSCS

0XYTOC1C8

RADIOACTIVE AGENTS

SERUMS, TOXOIDS AND VACCINES

Serums

Toxoi&

Vaccines

SKIN AND MUCOUS MEMBRANE

PREPARATIONS

Anti-Irlfcctives

S4:04.M Antibiotics

B4:M.08 Fungkcidm

S4:04.12 Sabicides and ?dculicides

S4:04.16 Mitc. k-al Anti-htfectivcs

S4:06 Antk.InOammatory Agents

S4:08 Antipmzitws and Local

Aswstheticr

24:12 A$tlingcrlts

S4 :16 cell stirtruIItrtJ and Pmhferants

84:20 Detergents

S4:24 Emollients, Demulccnu -“d

Rotcctmtr

S4:24.04 Bane Louons and Lmimenu

84:24.08 Bark OilI and Other Sdwnts

S4:24. 12 BarIc Orrnments and

?mtectmts

S4:24. 16 Bark Powderr and Demulcerm

S4:2S Kemto]ytic Agmru

S4: 32 Keratopk$tic Agents

54:36 Mt#eUaWoltr Agents

84:50 pigmenting & S3ipuwntentmg Agenu

84:50.04 Lkpigrrrcnung Agents

84:50.06 Pigmenting Agents

84:80 Sumcrcen *ents

86:~ SPASMOLYTIC AGEtTi7i

88:00 VITAMINS

88:04 Vttamin A

88:08 Vitamin B Complex

86:12 Vltimin C

88:16 Vit8min D

88:20 Vkanrin E

88:24 Vkamitr K Activity

88:28 MuUwitamin hcparations

92:tXI UNCLASSIFIED THERAPEUTIC AGENTS

94:00 (DEVICES)

%:C4 (PHARMACEUTIC AIDS)

Copyright 01980. Drug Products Information File; American Society of Hospital Pharmacists, Bethesda, Maryland.

AII rights reserved. Reprinted with permission.

69

.
Vital and Health Statistics

series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5.

SERIES 10.

SERIES 11.

SERIES 12.

Programs and Collection Procedures-Reports describing

the general programs of the National Center for Health

Statistics and its offices and divisions and the data COI.

Iection methods used. They also include definitions and

other material necessary for understanding the data.

Data Evaluation and Mathods Rssmsrch-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. Studies also include comparison of

U.S. methodology with those of other countries.

Analytical and Epidamiological Strsdies-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 Committae Reports-Final reports of

major committees concerned with vital and health statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

Comparative International Vital and Health Statistics

Reports-Analytical and descriptive reports comparing

U.S. vital and health statistics with those of other countries.

Data From the National Health Intewiew Survey-Statistics on illness, accidental injuries, dkability, use of hospital, medical, dental, and other services, and other

health-related topics, all based on data collected in the

continuing national household interview survey.

Data From the National Health Examination Survey and

the National Health and Nutrition Examination SurveyData from direct examination, testing, and measurement

Of nattonal samples of the civilian noninstitutional ized

population prowde the basis for (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 measurements without reference to

an explictt finite umverse of persons.

Data From the Institutionalized Population Surveys-Discontinued in 1975. Reports from these surveys are included in Series 13.

SERIES 13. Data on Health Resources Utilization-Statistim on the

utilization of health manpower and facilities prowding

long-term care. ambulatory care, hospital care, and familv

planning services.

SERIES 14. Data on Health Resources: Manpower and FacilitiosStatistics on the numbers, geographic distribution, and

characteristics of health resources including physicians,

dentists, nurses, other heaIth occupations, hospitals,

nursing homes, and outpatient facilities.

SERIES 15. Data From Special Survays-Statistics on health and

health-related topics collected in special suweys that

are not a Part of the continuing data systems of the

National Center for Health Statistics.

SERIES 20. Data on Mortality-Various statmtics on mortality other

than as included in regular annual or monthly reports.

Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses;

and statistics on characteristics of deaths not available

from the wtal records based on sample surveys of those

records.

SERIES 21. Data on Natality, Marriag% and Divorce-Various statistics on natality, marriage, and divorce other than as

included in regular annual or monthly reports. Special

analyses by demographic variables; g?ographlc and time

series analyses; studies of fertility; and statistics on

characteristics of births not available from the vital

records based on sample surveys of those records.

SERIES 22. Data From the National Mortality and Natality SurvaysDiscontinued m 1975. Reports from these sample surveys

based on vital records are included in Series 20 and 21,

respectwely,

SERIES 23. Data From the National Survey of Family GrowthStatistics on fertlllty, family formation and dissolution,

family planning, and related maternal and infant health

topics derived from a periodic survey of a nationwide

probability sample of ever-married women 1544 years

of age.

For a list of titles of reports published in these series, write to:

. Scientific and Technical Information Branch

Nattonal Center for Health Stat/sties

Publlc Health Serwce

Hyattswlle, h~d. 20782

or call 301.436NCHS
. .

U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Publlc Health Sew Ice

Nat(onal Center for Health Statlstlcs

37oO East-West Highway

Hyattsvllle, Ma~land 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

-__.l THIRD CLASS MAIL

BULK RATE

POSTAGE& FEES PAID

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PER MI TNO. G-281