National Ambulatory Medical Care Survey: Terrorism

Preparedness Among Office-Based Physicians,

United States, 2003–2004

by Richard W. Niska, M.D., M.P.H., and Catharine W. Burt, Ed.D., Division of Health Care Statistics

Abstract

Objectives—This investigation describes terrorism preparedness among U.S.

office-based physicians and their staffs in identification and diagnosis of terrorismrelated conditions, training methods and sources, and assistance with diagnosis and

reporting.

Methods—The National Ambulatory Medical Care Survey (NAMCS) is an

annual national probability survey of approximately 3,000 U.S. nonfederal, officebased physicians. Terrorism preparedness items were added in 2003 and 2004.

Results—About 40 percent of physicians or their staffs received training for

anthrax or smallpox, but less than one-third received training for any of the other

exposures. About 42.2 percent of physicians, 13.5 percent of nurses, and 9.4 percent

of physician assistants and nurse practitioners received training in at least one

exposure. Approximately 56.2 percent of physicians indicated that they would

contact state or local public health officials for diagnostic assistance more frequently

than federal agencies and other sources. About 67.1 percent of physicians indicated

that they would report a suspected terrorism-related condition to the state or local

health department, 50.9 percent to the Centers for Disease Control and Prevention

(CDC), 27.5 percent to the local hospital, and 1.8 percent to a local elected official’s

office. Approximately 78.8 percent of physicians had contact information for the

local health department readily available. About 53.7 percent had reviewed the

diseases reportable to health departments since September 2001, 11.3 percent had

reviewed them before that month, and 35 percent had never reviewed them.

Keywords: bioterrorism c medical education c preparedness c ambulatory care

Introduction

In response to the terrorism

incidents of September 2001, the Office

of the Assistant Secretary for Planning

and Evaluation (OASPE), Department of

Health and Human Services, requested

that the National Center for Health

Statistics survey a nationally

representative sample of U.S.

physicians’ offices on their preparedness

for treating patients in the aftermath of

terrorist attacks. OASPE provided

funding to add several relevant

questions to the 2003 and 2004

NAMCS. Information about strengths

and limitations of terrorism preparedness

in physicians’ offices is crucial for

planning how terrorism preparedness

funding may be used to improve the

domestic defensive posture.

Methods

NAMCS is an annual survey of

U.S. nonfederal, office-based physicians,

excluding anesthesiologists, radiologists,

and pathologists. The survey reports on

trends in utilization within the

physicians’ outpatient practices. A

multistage survey design is used, with

the frame constructed from 112

geographic primary sampling units and

physician practices within those

Number 390 + July 24, 2007

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics
units. A sample of 3,000 physicians per

year was selected in both 2003 and

2004 from the masterfiles of the

American Medical Association and the

American Osteopathic Association. The

data were weighted according to the

inverse probability of selection, with an

adjustment for nonresponse. Therefore,

estimates are considered representative

of similar office-based practices across

the entire Nation. Of 2,007 in-scope

physicians sampled in 2003, 1,114

responded to the induction interview. Of

1,961 in-scope physicians sampled in

2004, 1,121 responded. The total

response rate for both years was

56.3 percent, representing about 311,000

physicians per year nationwide.

Descriptive analyses were performed

using SUDAAN 9.0.1 software, with

significant differences among

frequencies defined as nonoverlapping

95 percent confidence intervals (1).

Terrorism preparedness items were

added to the 2003 and 2004 NAMCS as

part of the physician induction interview

(see the description of the items below).

Data were collected by U.S. Census

Bureau field representatives by means of

face-to-face interviews with the

physicians. Additional information on

data collection and response to the 2003

through 2004 NAMCS has been

published (2). Excerpts from the

questionnaire related to terrorism

preparedness can be found in the

‘‘Technical Notes.’’

Physicians (allopathic or

osteopathic) were asked whether they or

their staff had received special training

since September 2001 in the

identification and diagnosis of several

terrorism-related diseases or conditions.

Staff included the physicians as well as

physician assistants, nurse practitioners,

registered and licensed practical nurses,

and other staff employed by physicians.

The diseases or conditions included

smallpox, anthrax, plague, botulism,

tularemia, viral hemorrhagic fever, viral

encephalitis, and chemical and

radiological exposures.

Physicians were also asked

questions concerning the following

areas:

+ Where they would turn for assistance

in diagnosing patients with unusual

symptoms suggesting a terroristrelated condition.

+ Whom they would contact to report a

terrorism-related disease or condition.

+ If they had contact information for

the local health department readily

available in their offices or primary

practice sites.

+ Whether they had reviewed the list of

reportable diseases in their state or

local jurisdictions since September

2001.

Results

Training

Training was received for anthrax

by 40.7 percent of either physicians or

their staffs, and by 40.2 percent for

smallpox—frequencies that were

significantly larger than those of training

for other exposures. Training was

received for chemical exposures by

32.6 percent of either physicians or their

staffs, for viral encephalitis by

28.9 percent, for botulism by

28.5 percent, for radiological exposures

by 28.5 percent, and for plague by

27.8 percent. Training was received for

viral hemorrhagic fever by 25.4 percent

of physicians or their staffs and for

tularemia by 25 percent—frequencies

that were significantly less than those of

training received for anthrax, smallpox,

and chemical exposures (Figure 1).

A breakdown of training frequencies

for each of the nine exposures by

individual clinician types is presented in

Table 1. Overall, 42.2 percent of

physicians received training in at least

one exposure (2), but only 13.5 percent

of nurses and 9.4 percent of physician

assistants and nurse practitioners

received such training. The percentages

for all three groups were significantly

different from one another (Figure 2). A

breakdown of these percentages by

practice characteristics is presented in

Table 2.

Among clinicians who received any

training, physicians were trained for a

mean of 6.0 of the nine exposures,

physician assistants and nurse

practitioners for 5.3 of the exposures,

and nurses for 4.8 of the exposures.

There were no significant differences by

practice characteristics, with the

exception of some regional variations

for physicians, physician assistants, and

nurse practitioners (Table 3).

Diagnostic assistance

Diagnostic assistance would be

sought from state or local public health

officials by 56.2 percent of physicians,

0

10

20

30

40

50

Anthrax

Chemical

Radiological

Percent

95% Confidence intervals

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey.

Smallpox

Botulism

Viral encephalitis

Plague

Hemorrhagic fever

Tularemia

Figure 1. Percentage of physicians or their staffs trained in the identification and

diagnosis of terrorism-related exposures: United States, 2003–2004

2 Advance Data No. 390 + July 24, 2007
which is significantly more frequent

than diagnostic assistance sought from

CDC or other federal agencies

(49.0 percent) and colleagues or

consultants (44.6 percent). Furthermore,

assistance in diagnosing symptoms

potentially related to terrorism would be

sought significantly more frequently

from state or local health officials,

federal agencies, or colleagues than

from the Internet (16.3 percent), medical

associations (16.0 percent), medical

journals (13.5 percent), medical

textbooks (13.2 percent), or other

sources (14.6 percent) (Table 4).

Reporting practices

The leading agencies to which

physicians indicated that they would

report a suspected terrorism-related

condition included the state or local

health department (67.1 percent), CDC

(50.9 percent), and the local hospital

(27.5 percent). These frequencies were

significantly different from one another

and from less frequently mentioned

agencies (Table 5).

Contact information for the local

health department was readily available

(e.g., posted, speed dial, or rolodex) in

78.8 percent of physicians’ offices.

Primary care physicians had this contact

information available more frequently

than medical or surgical specialists.

Physicians with 3 to 10 managed care

contracts had contact information more

frequently than those with no managed

care contracts (Table 6).

The list of diseases reportable to

health departments had been reviewed

by 53.7 percent of physicians since

September 2001 and by 11.3 percent

before September 2001, whereas

35 percent had never reviewed the list

(this includes the 5 percent who did not

respond to the question). The

information had been reviewed since

September 2001 by primary care

physicians more frequently than by

medical and surgical specialists, by rural

physicians more frequently than by

urban physicians, and by physicians

with 3 to 10 managed care contracts

more frequently than by those with

none. Physicians practicing in the South

had reviewed the list of reportable

diseases prior to September 2001 more

frequently than physicians practicing in

the West, but there were no regional

differences in physicians having

reviewed this information since

September 2001 (Table 7).

Discussion

The frequencies of training of

medical office physicians and their staffs

in the management of terrorism-related

diseases are quite low. Although this

report shows that physicians who had

received any bioterrorism training at all

had covered two-thirds of the exposures,

only about 4 of every 10 physicians

were in that category. A previous report

using NAMCS data presented a more

specific analysis with respect to the

training of physicians themselves and

the characteristics that predict the

likelihood that this training occurs.

When all physicians in the sample were

taken into account, they had received

training in only about three of the nine

exposures (3). In comparison to the

NAMCS office-based physicians,

hospital-based clinicians had received

terrorism response training more

frequently. In the 2003 through 2004

Bioterrorism Supplements to the

National Hospital Ambulatory Medical

Care Survey, about 88 percent of nurses,

75 percent of staff physicians, and

47 percent of physician assistants and

nurse practitioners working in hospital

outpatient departments and emergency

departments had received training in at

least 1 of 10 terrorism-related biological,

chemical, or radiological diseases or

conditions (4).

All of these diseases are rare in

office practice. There were three total

U.S. cases of plague in two states

reported to CDC in 2004, attributable to

contact with fleas or rabbits (5). As of

August 25, 2006, there were 13 plague

cases from four states reported in 2006,

caused by contact with rabbits, rodents,

dogs, and fleas. Prophylactic antibiotics

were administered to at least 58 people

who had contact with the patients. These

cases compare with a median of seven

plague cases per year reported to CDC

between 1990 and 2005 (6). There were

134 cases of tularemia reported to CDC

in 2004 from contact with arthropods,

mammals, and lab cultures, and 133

total cases of botulism were reported,

including those classified as infant, food

borne, wound, and toxin injection

sources. No cases of anthrax were

reported, and only one case of

0

10

20

30

40

50

Physicians Nurses Nurse

practitioners

and physician

assistants

Percent

95% Confidence intervals

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey.

Figure 2. Percentage of physician office staff trained in the identificatin and diagnosis of

at least one terrorism-related exposure: United States, 2003–2004

Advance Data No. 390 + July 24, 2007 3
laboratory exposure to anthrax spores

was reported (5).

The Health Resources and Services

Administration initiated the Bioterrorism

Training and Curriculum Development

Program in 2003, awarding $22.3

million to 19 academic institutions to

provide bioterrorism continuing

education for health professionals and

$4.2 million for health professional

school curriculum development (7).

However, funding levels have fallen

since 2005, and the budget estimate for

this program in fiscal year 2007 is about

$12.4 million (8). A large gap exists

between training for physicians and

training for the other clinicians working

in their offices. Because nurse

practitioners and physician assistants see

patients independently, with only later

review by their collaborating or

supervising physicians, the gap between

these clinicians and the physicians is of

concern. However, federal funding for

bioterrorism training is not limited to

physicians. The Bioterrorism Training

and Curriculum Development Program

reported training 26,004 nurses, 14,789

physicians, 2,737 nurse practitioners,

and 1,113 physician assistants in fiscal

year 2005 (7).

Diagnostic assistance tends to be

requested from appropriate public health

sources. Physicians are also likely to

report these diseases to appropriate

agencies, such as the health department

or CDC. Of note is the small percentage

of physicians who would report

bioterrorism-related diseases to sources

not usually capable of dealing with

these reports, particularly the local

medical association or local elected

officials.

References

1. SUDAAN (Release 9.0.1) [computer

software]. Research Triangle Park,

NC: Research Triangle Institute.

2005.

2. Hing E, Burt CW. Characteristics of

office-based physicians and their

practices. National Center for Health

Statistics. Vital Health Stat 13(164).

2007.

3. Niska RW, Burt CW. Terrorism

preparedness: Have office-based

physicians been trained? Fam Med

39(5):357–65. 2007.

4. Niska RW, Burt CW. Training for

terrorism-related conditions in

hospitals: United States, 2003–04.

Advance data from vital and health

statistics; no 380. Hyattsville, MD:

National Center for Health Statistics.

2006.

5. CDC. Summary of notifiable

diseases—United States, 2004.

MMWR 53:6–19. 2006.

6. CDC. Human plague—Four states,

2006. MMWR 55(Dispatch):1–3.

2006.

7. Department of Health and Human

Services. HHS awards $26.6 million

in new program to provide

bioterrorism training and curriculum.

Washington, DC; 2003 Sept 12.

Available from: http://www.hhs.gov/

news/press/2003pres/20030912d.html.

8. Health Resources and Services

Administration. Fiscal year 2007

justification of estimates for

appropriations committees.

Bioterrorism training and curriculum

development program. Rockville,

MD; 2006.

4 Advance Data No. 390 + July 24, 2007
Table 1. Percentage of office-based physicians, physician assistants and nurse practitioners, and nurses trained in the identification and

diagnosis of selected terrorism-related exposures: United States, 2003–2004

Exposures

Physicians PA1 and NP2 Nurses

Percent SE3 Percent SE Percent SE

Anthrax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38.3 1.6 8.0 0.8 10.6 1.0

Smallpox . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38.1 1.6 7.7 0.8 11.3 1.1

Chemical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29.8 1.4 6.4 0.8 8.7 0.9

Viral encephalitis . . . . . . . . . . . . . . . . . . . . . . . . . 26.2 1.3 4.8 0.7 6.3 0.7

Botulism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.0 1.3 4.9 0.7 6.0 0.8

Radiological . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.9 1.3 5.3 0.7 6.7 0.8

Plague . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.4 1.3 4.6 0.7 5.4 0.7

Viral hemorrhagic fever. . . . . . . . . . . . . . . . . . . . . . 22.7 1.2 4.4 0.6 4.9 0.7

Tularemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.4 1.3 3.9 0.6 5.0 0.7

1

PA is physician assistant.

2

NP is nurse practitioner.

3

SE is standard error.

NOTES: Physician estimates based on unweighted n=2,235, corresponding to 311,170 physicians per year. PA and NP estimates based on unweighted n=1,990, corresponding to 276,147 officebased physicians with physician assistants or nurse practitioners per year. Nurse estimates based on unweighted n=2,056, corresponding to 284,730 office-based physicians with nurses per year.

Table 2. Number and percentage of office-based physicians, physician assistants and nurse practitioners, and nurses trained in the

identification and diagnosis of at least one terrorism-related exposure, by selected practice characteristics: United States, 2003–2004

Exposures

Physicians PA1 and NP2 Nurses

N3 Percent4 SE5 N Percent SE N Percent SE

All physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311,200 42.2 1.7 276,100 9.4 0.9 284,700 13.5 1.1

Specialty

Primary care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153,700 49.5 2.2 133,700 13.4 1.5 138,300 17.9 1.7

Surgical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84,500 31.9 2.1 76,800 5.6 1.1 78,800 9.2 1.3

Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73,000 38.8 3.0 65,600 5.5 1.2 67,600 9.2 1.8

Metropolitan statistical area

Urban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275,000 41.4 1.7 245,500 9.0 0.9 251,500 11.9 1.2

Rural . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36,200 48.6 5.2 30,600 12.2 2.7 33,300 25.1 3.3

Region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66,600 48.6 3.0 58,600 10.3 2.0 59,900 10.2 1.7

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69,400 41.3 3.9 61,200 9.6 1.9 64,300 16.4 2.2

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105,000 39.3 3.1 92,800 8.6 1.4 95,600 15.1 2.2

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70,200 41.4 2.9 63,600 9.5 1.9 64,900 11.2 2.5

Managed care contracts

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42,700 30.5 3.6 39,000 *2.9 1.4 39,300 4.9 1.5

1–2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34,700 44.8 4.0 31,100 12.9 3.0 32,500 18.5 4.3

3–10 .................................. 121,500 44.3 2.5 105,300 9.4 1.5 109,900 14.6 1.7

More than 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112,200 43.6 2.4 100,800 10.7 1.4 103,100 13.9 2.0

Practice size

Solo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111,500 35.7 2.5 101,400 3.1 0.8 104,300 6.9 1.1

Partner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36,700 45.4 3.6 32,300 12.9 2.6 33,100 11.7 2.3

3–5 physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83,600 47.2 2.8 71,800 12.1 1.8 74,200 17.7 2.4

6–10 physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 46,100 44.6 3.7 41,600 13.9 2.7 42,700 17.1 3.0

11 or more physicians . . . . . . . . . . . . . . . . . . . . . . . 33,300 44.5 3.8 29,000 14.1 3.4 30,500 22.3 3.8

* Figure does not meet standards of reliability or precision (unweighted sample size less than 30, or relative standard error greater than 30 percent). 1

PA is physician assistant.

2

NP is nurse practitioner.

3

N is the weighted number of physician offices having each type of clinician per year.

4

Percent is the number of physician offices with training for each type of provider divided by the total number of offices that employ each type of provider. 5

SE is standard error.

Advance Data No. 390 + July 24, 2007 5
lated exposures for which selected clinicians who work in practices of office-based physicians have received training in identification and

cteristics: United States, 2003–2004

Physicians PA1 and NP2 Nurses

N3 Mean SE4 95% CI5 N Mean SE 95% CI N Mean SE 95% CI

131,300 6.0 0.1 5.8–6.3 25,900 5.3 0.3 4.7–5.9 38,300 4.8 0.2 4.4–5.3

76,000 6.0 0.2 5.6–6.3 18,000 5.3 0.4 4.5–6.0 24,800 4.7 0.3 4.2–5.3

26,900 6.1 0.2 5.6–6.6 4,300 5.6 0.6 4.5–6.7 7,300 5.2 0.5 4.3–6.2

28,400 6.2 0.3 5.7–6.7 3,600 5.2 0.7 3.9–6.6 6,200 4.8 0.6 3.6–5.9

113,700 6.1 0.1 5.8–6.4 22,100 5.5 0.3 4.8–6.1 30,000 4.8 0.3 4.3–5.3

17,600 5.7 0.4 4.9–6.5 * * * * * 8,300 5.1 0.5 4.1–6.1

32,300 5.6 0.3 5.1–6.2 6,000 5.4 0.6 4.3–6.5 6,100 4.5 0.5 3.6–5.4

28,600 5.6 0.3 5.0–6.2 5,900 6.3 0.6 5.0–7.6 10,500 5.7 0.4 4.8–6.6

41,200 6.2 0.2 5.8–6.6 7,900 4.1 0.4 3.3–4.9 14,400 4.3 0.3 3.7–5.0

29,100 6.7 0.2 6.2–7.2 6,000 6.0 0.7 4.7–7.3 7,200 4.9 0.5 3.8–5.913,000 6.1 0.5 5.2–7.0 * * * * * * * * * *15,500 6.1 0.4 5.4–6.8 * * * * * 6,000 5.0 0.6 3.9–6.2

53,800 5.9 0.2 5.6–6.3 9,900 5.6 0.5 4.6–6.6 16,100 4.6 0.4 3.9–5.4

48,900 6.1 0.2 5.7–6.5 10,800 5.0 0.4 4.2–5.7 14,300 4.9 0.4 4.2–5.6

39,800 6.2 0.2 5.8–6.7 * * * * * 7,200 4.2 0.5 3.4–5.1

16,700 5.7 0.4 5.0–6.4 4,200 4.8 0.6 3.6–6.0 3,900 4.0 0.6 2.7–5.2

39,500 5.9 0.2 5.4–6.3 8,700 5.4 0.5 4.5–6.3 13,100 5.3 0.4 4.5–6.1

20,500 6.1 0.3 5.5–6.8 5,800 5.7 0.6 4.4–7.0 7,300 5.2 0.5 4.3–6.2

14,800 6.2 0.4 5.4–7.1 * * * * * 6,800 4.7 0.7 3.3–6.1

ision (unweighted sample size less than 30, or relative standard error greater than 30 percent). 

ype of clinician per year.

ve received training in at least one exposure.

6 Advance Data No. 390 + July 24, 2007
Table 4. Percentage of physicians who would seek assistance from selected sources for diagnosing symptoms possibly related to

terrorism: United States, 2003–2004

Source Percent SE1

State or local health officials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56.2 1.7

CDC2 or other federal agency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49.0 1.4

Colleague or consultant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44.6 1.9

Internet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.3 1.2

Medical association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.0 1.2

Medical journals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.5 1.1

Medical textbook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.2 1.0

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.6 1.1

1

SE is standard error.

2

CDC is Centers for Disease Control and Prevention.

NOTES: Physician estimates based on unweighted n=2,235, corresponding to 311,170 physicians per year.

More than one source of diagnostic assistance could be reported.

Table 5. Percentage of office-based physicians who would report information about a patient with possible terrorism-related symptoms

to selected agencies: United States, 2003–2004

Source Percent SE1

State or local health department. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67.1 1.5

Centers for Disease Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50.9 1.5

Local hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.5 1.3

Other state or local government agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.4 1.0

Local medical association. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.1 0.9

Law enforcement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.8 0.8

Other federal agency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.0 0.8

Laboratory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.4 0.7

Local political office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.8 0.4

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3 0.7

1

SE is standard error.

NOTES: Physician estimates based on unweighted n=2,235, corresponding to 311,170 physicians per year. More than one agency could be reported.

Table 6. Number and percentage of office-based physicians who have health department contact information readily available in their

offices (e.g., posted, speed dial, or rolodex), by selected practice characteristics: United States, 2003–2004

Characteristic N1 Percent SE2 95% CI3

All physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311,200 78.8 1.2 76.4–81.1

Specialty

Primary care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153,700 85.6 1.7 82.0–88.6

Surgical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84,500 73.0 1.9 69.2–76.5

Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73,000 71.5 2.6 66.2–76.3

Metropolitan statistical area

Urban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275,000 77.8 1.3 75.1–80.2

Rural . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36,200 86.9 3.2 79.4–92.0

Region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66,600 76.9 2.6 71.4–81.6

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69,400 77.2 2.7 71.5–82.0

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105,000 80.7 1.9 76.6–84.2

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70,200 79.6 2.7 73.9–84.4

Managed care contracts

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42,700 68.9 3.6 61.4–75.6

1–2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34,700 82.3 3.1 75.4–87.6

3–10 .................................. 121,500 82.4 1.7 78.9–85.5

More than 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112,200 77.7 2.2 73.1–81.6

Practice size

Solo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111,500 75.2 2.1 71.0–79.0

Partner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36,700 78.3 3.3 71.0–84.1

3–5 physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83,600 83.4 2.1 78.9–87.1

6–10 physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . 46,100 79.2 2.8 73.1–84.2

11 or more physicians . . . . . . . . . . . . . . . . . . . . . . . 33,300 79.5 3.3 72.2–85.3

1

N is the weighted annual number of office-based physicians.

2

SE is standard error.

3

CI is confidence interval.

Advance Data No. 390 + July 24, 2007 7
Table 7. Percent distribution of office-based physicians who last reviewed the list of reportable diseases before September 11, 2001,

since that date, or not at all, according to selected practice characteristics: United States, 2003–2004

Characteristic

Reportable diseases reviewed

Before September 2001 Since September 2001 List not reviewed

N1 Percent2 SE3 95% CI4 Percent SE 95% CI Percent SE 95% CI

All physicians. . . . . . . . . . . . . . . . 311,200 11.3 0.9 9.6–13.2 53.7 1.5 50.8–56.6 35.0 1.5 32.2–38.0

Specialty

Primary care . . . . . . . . . . . . . . . 153,700 12.9 1.4 10.3–16.0 61.4 2.0 57.5–65.1 25.7 1.9 22.2–29.6

Surgical. . . . . . . . . . . . . . . . . . 84,500 11.6 1.3 9.3–14.4 46.1 2.4 41.5–50.8 42.3 2.3 37.8–46.9

Medical . . . . . . . . . . . . . . . . . . 73,000 7.5 1.3 5.3–10.5 46.2 2.9 40.6–51.9 46.3 2.9 40.7–52.1

Metropolitan statistical area

Urban . . . . . . . . . . . . . . . . . . . 275,000 11.8 1.0 10.1–13.9 51.9 1.6 48.8–55.0 36.3 1.6 33.2–39.4

Rural . . . . . . . . . . . . . . . . . . . 36,200 7.1 2.2 3.8–12.7 67.1 4.3 58.3–74.9 25.8 3.9 18.9–34.3

Region

Northeast. . . . . . . . . . . . . . . . . 66,600 10.2 1.9 7.1–14.6 50.5 2.8 45.0–56.0 39.3 3.1 33.4–45.4

Midwest. . . . . . . . . . . . . . . . . . 69,400 10.9 1.6 8.1–14.5 50.6 3.1 44.5–56.7 38.5 3.6 31.8–45.7

South . . . . . . . . . . . . . . . . . . . 105,000 15.3 2.0 11.9–19.5 55.6 2.9 49.9–61.1 29.1 2.7 24.2–34.6

West. . . . . . . . . . . . . . . . . . . . 70,200 6.6 1.2 4.7–9.4 56.9 2.9 51.1–62.5 36.5 2.8 31.1–42.2

Managed care contracts

None . . . . . . . . . . . . . . . . . . . 42,700 9.3 2.0 6.1–14.0 44.6 3.8 37.3–52.1 46.1 3.8 38.8–53.6

1–2 . . . . . . . . . . . . . . . . . . . . 34,700 8.9 2.0 5.8–13.6 56.0 4.2 47.6–64.0 35.1 4.0 27.7–43.3

3–10.................... 121,500 9.8 1.3 7.6–12.6 57.1 2.1 52.8–61.2 33.2 2.2 28.9–37.7

More than 10 . . . . . . . . . . . . . . 112,200 14.3 1.9 11.1–18.4 52.8 2.4 48.0–57.5 32.9 2.4 28.4–37.7

Practice size

Solo . . . . . . . . . . . . . . . . . . . . 111,500 13.3 1.7 10.3–16.9 49.6 2.4 45.0–54.2 37.2 2.4 32.6–42.0

Partner . . . . . . . . . . . . . . . . . . 36,700 12.6 2.2 8.8–17.7 50.3 4.0 42.5–58.2 37.1 3.8 30.0–44.7

3–5 physicians . . . . . . . . . . . . . 83,600 10.6 1.7 7.7–14.4 56.2 2.5 51.3–61.1 33.2 2.5 28.6–38.2

6–10 physicians. . . . . . . . . . . . . 46,100 8.9 1.8 6.0–13.1 58.6 3.6 51.5–65.4 32.4 3.5 26.1–39.5

11 or more physicians . . . . . . . . . 33,300 8.2 2.3 4.7–13.8 58.0 4.4 49.3–66.2 33.9 4.2 26.1–42.6

1

N is the weighted annual number of office-based physicians.

2

Percent is percentage of office-based physicians who last reviewed the list of notifiable diseases.

3

SE is standard error.

4

CI is confidence interval.

NOTE: Row percentages add to 100 percent.

8 Advance Data No. 390 + July 24, 2007
Technical Notes

Advance Data No. 390+ July 24, 20079
10 Advance Data No. 390 + July 24, 2007
Suggested citation

Niska RW, Burt CW. National Ambulatory

Medical Care Survey: Terrorism preparedness

among office-based physicians, United States,

2003–2004. Advance data from vital and

health statistics; no 390. Hyattsville, MD:

National Center for Health Statistics. 2007.

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.

National Center for Health Statistics

Director

Edward J. Sondik, Ph.D.

Acting Co-Deputy Directors

Jennifer H. Madans, Ph.D.

Michael H. Sadagursky

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road

Hyattsville, MD 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

To receive this publication regularly, contact

the National Center for Health Statistics by

calling 1-800-232-4636

E-mail: nchsquery@cdc.gov

Internet: www.cdc.gov/nchs

CS112222 (7/2007)

T28900

DHHS Publication No. (PHS) 2007-1250

12 Advance Data No. 390 + July 24, 2007

FIRST CLASS

POSTAGE & FEES PAID

CDC/NCHS

PERMIT NO. G-284