FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

U.S. DEPARTMENT OF HEALTH, . Public Health Service


ED UCATION, AND WELFARE Office of Health Research, Statistics, and Technology Number 57 � January 25, 1980


Office Visits for Diabetes Mellitus, National Ambulatory 

Medical Care Survey: United States, 1977a 

Based on data collected in the 1977 National 

Ambulatory L4edical Care Survey (NAMCS), an 

estimated 11.0 million office visits were made at 

which the principal or first-listed diagnosis was 

diabetes mellitus. The estimates presented in this 

report are based on data collected in the 

NAhlCS, an annual probability sample survey of 

approximately 3,000 non federally employed 

physicians who are in office-based practice in 

the conterminous United States. Excluded from 

the NAh4CS are hospital-based physicians; those 

specializing in anesthesiology, pathology, or 

radiology; and those who are principally engaged 

in teaching, research, or administration. The 

survey sample is selected with the cooperation 

of the American h4edicaJ Association and 

American Osteopathic Association from their 

lists of nonfederally employed doctors of 

medicine and osteopathy who are principally 

engaged in office-based practice. 

Figure 1 is a facsimile of the 1977 Patient 

Record used by participating physicians to record 

information obtained during office visits for a 

7-day reporting period and it may be useful as 

a reference as selected survey findings are 

discussed. 

Caution should be exercised when comparing the 1977 survey results with NAMCS 

data from previous years. Changes which were 

made in the 1977 Patient Record that affect 

comparability between survey years have been 

discussed in a previous report. 1 -

Since the estimates presented in this report 

are based on a sample rather than on the entire 

universe of office-based physicians, the data are 

aThis report was prepared by Trena Ezzati, Division 

of Health Resources Utilization Statistics. 

subject to sampling variability. The “Technical 

Notes” at the end of this report provide a brief 

explanation and guidelines for judging the precision of the estimates presented. A more detailed description of the sampIe desicgn and definitions of certain terms used in NAklCS have 

been published.2 

DATA HIGHLIGHTS 

Utilization patterns for diabetic patients obtained from the Patient Record form (fi<gure 1) 

are presented in this report, while data available 

from the Health Inten’ie\v Sul~ey (HIS) and the 

Health and Nutrition Examination Sulvey 

(HANES) provide various national prevalence 

estimates of diabetes by demographic and socioeconomic status variables. A summal~ of current 

diabetes-related data available from the National 

Center for Health Statistics has been published.~ 

Patient Characteristics 

Of the 11.0 million office visits for diabetes 

melIitus, 58 percent \\’ere by females (table 1). 

The annual number of office visits w-ith a plincipal diagnosis of diabetes tends to increase with 

age. Approximately 69 percent of the office 

visits for diabetes were by patients 55 years of 

age and over; relatively few visits were made by 

persons under 25 years of age. The, majority of 

office visits for diabetes were made by white 

persons (86 percent); however, the annual visit 

rates were similar for white and all other persons. 

For both mzdes and females the annual visit rate 

increased with age–with a peak in the 65-74 

year age group (figure 2). The visit rate for females was slightIy greater than that for males. 
Figure 1.1977 PATlENT RECORD 

ASSURANCE OF CONF ID EN TIAL(TY AI I I. I.,.,. !(o!I w.,, h would w!mit !dent!flcamm of ,,,! mdIv Id. !1, 

, w,<,, <., o, on ,,,,b,,,hm, n, w,,, be hold .0”!,,,. ”,,,1. w,ll b. .s+,$ 0“1” by “ersons .“0,s.<, ,“ and +., Ic 

the ““r Pose, .1 ,P.e w,.., a“d w,, ! n., be d,sc, oscd ., ,,.,.,,.. t. o,tm, .,,,.., 0, .s.(, ,0, ,“, .,he, ~.,uo~ 

1.DATE OF VISIT PATl ENT RECORD 

NATIONAL AM BULATORY ME DICAL CARE SURVEY 

M. Day Y, 

2.	 DATE OF BIRTH 3. SEX 4. COLOR OR 5. WAS PATIENT 6. PATIENTS COMPLAINTIS), SYMPTOM(S), OR OTHER 

RACE REFERRED FOR REA80N{SI FOR THIS VISIT 

THIS VISIT BY //. Par,mm-s own words) 

I [.] WHITL ANOTHER 

I U! fEMALE I ~ NkGRu, PHYSICIAN? a MCIST 

J ~ MALE !’l YES VISIT , U OTHb R b, 07 HER 

4 u UN KNOWh :LINO 

F em 7. TIME SINCE ONSET 8, PHYSICIANS DIAGNOSES 9. HAVE YOU SEEIV 10, SERIOUSNESS OF 

OF COMPLAINTI PATIENT BEFORE? CONDITION IN 

SYMPTOM IN ITEM 6. . . pRINCIp AL � IA CNOSIS; PR06LEM ASSOCIATED WITH ITEM 8. (Check one) 

m (Check one) ITEM6. I L! YES 2UN0 

TIME OF 

Mo D.” Y, BLACK iMpORTANT 

I O VERY SERIOUS t 

a m. , ~ LESS THAN 1 DAY 1? YES. FOB THE % D SERIOUS C0N01710N IN — IU16 DAYS

b, OTHER SIGNIFICANT CURRENT DIAGNOSES IT EM 8,? SLIGHTLY 

pm ,0 13w EEKS SERIOUS 

. U 1.3 MONTHS � � NOT SERIOUS 

, u YES ~UNO -

am !n MORE THAN 

3 MONTHS 

pm , ~ NOT APPLICABLE 

3U 

11. DIAGNOSTIC SERVICES THIS 12. TherapeUtiC sERvlcEs 7HIS 13. DISPOSITION THIS VISIT 14. DuRATION OF 

VISIT (Check ,// ordered o, ,n,ov,ded) VISIT (Check .// ordered or prov,ded) [Check all that .POIYJ THIS VISIT 

I “J NONE , U NONE (Time actually 

> � LIMITED EXAMIHISTORV 1 L1 1MMUN1ZATION ‘ ~ NO FOLLOWUP PLANNED spenr with 

DESENSITIZATION ‘ 0 8ETu RN ATsp Ecl FIEDTl ME physician) 

t ~ GENERAL ExAMIHISTORY 

. ~ p*p TEST 3 u DRUGS (P RESCFll PTl ON/ ‘ � RETURN IF NEEDED, P. R.N. 

NONPRESCRIPTION, 

.. Ll CLINICAL LAS TEST , � DIET COUNSELING ‘ � TELEPHoNE FOLLOW.UP PLANNED 

. u XRAY , ~ PAM(LY PLANNING ‘ � REFERRED TO OTHEM PHYSICIAN 

_ MINUTES 

“ U VISION TEST 7 U pHYSIOTHEFIAPY PHYSICIAN 

v ~ EN DOSCOPY “ [j OFFICE SURGERY 7 � ADMIT To HOSPIIAL 

1“ U BLOOD PRESSURE CHECK * U PSYCHOTHERAPY 

, , U OTHER (S.DeC,f”l THERAPEuTIC LISTf NIVG “ � OTHER (SfJec!fy) 

I ‘, ~ OT H E ~ (Spec, (y) 

, U EKG * U ME UI CAL COUNSELING , � RETu RN ED To REFEFIRING 

— HRA.34.2 DE PA flTMENTc, r- HE ALr H e[lucfi TlON AND WE LI ARE (>. M.B. *68. R14gs REV. 9.76 PUE$LIC HE AL THSLRVICE 

tlt ALTH RE!,Ou RCL5 ,: DMIFNISTRATICJ,4 

,, A-, ON AL CENTE P ,(, R HL,, LTFIST.47, S7, CS 

Physician and Specialty Characteristics Visit Characteristics 

Visits to general and family practitioners (53 About 62 percent of the visits associated 

percent) and internists (28 percent) accounted with a diagnosis of diabetes had an onset of a 

for four-fifths of all office-based physician visits complaint or symptom of more than 3 months 

for diabetes mellitus (table 2). Approximately (table 3). This reflects the chronic nature of dia70 percent of all visits for diabetes were to solo betes. Data on prior visit status also reflect its 

practitioners. This exceeded the percentage (59 chronic nature: 89 percent of the office visits 

percent) of visits to solo practitioners for all for diabetes were by patients who had seen the 

diagnoses. The proportion of visits with a physician before for the same problem; only 5 

principal diagnosis of diabetes was higher in percent were by patients new to the physician’s 

metropolitan areas (77 percent) than in non- office practice. 

metropolitan areas (23 percent) in about the Information obtained in item 6 of the Patient 

same proportion as visits for all diagnoses. Record (figure 1) represents the reasons for 
achancedata 3 

Table 1. Number, percent distribution, and number of office visits per 100 persons per year for principal diagnosis of diabetes mellitus, by selected 

patient characteristics: United States, 1977 

Patient characteristic 

All patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

— 

Age

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

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

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

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

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

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

75 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Sex and age 

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

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

25-34 yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

3544 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

45-54 yeacs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

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

65-74 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

75 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Male . . . . . . . . . . . . . . . . . . . . ..- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

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

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

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

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

55-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

75 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Color and age 

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

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

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

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

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

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

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

75years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Another . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

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

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

35-44 yearn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

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

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

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

75 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Number Number of visits Percent of visits distribution per 100 persons 

in thousands per year 

11,025 100.0 5.2 

�28( *2.5 �0.3 

49E 4.5 1.6 

81E 7.4 3.6 

1,894 17.2 8.2 

3,12! 28.4 15.6 

2,95C 26.8 20.7 

1,462 13.3 18.3 

6,442 58.4 5.9 

*11$ �1.1 ‘0.3 

*3rx *2.8 *1.9 

*381 *3.5 *3.2 

932 8.5 7.8 

1,745 15.8 16.5 

1,957 17.8 24.3 

ggg 9.1 20.0 

4,581 41.6 4.5 

*16C *1.5 *0.4 

*188 *1.7 *1.2 

*435 *3.9 �3.9 

962 8.7 8.6 

1,381 12.5 14.6 

993 9.0 16.1 

462 4.2 15.4 

9,441 85.7 5.2 

�236 *2.1 “0.3 

’451 *4. 1 *1.6 

675 6.1 3.4 

1,650 15.0 8.1 

2,460 22.3 13.6 

2,589 23.5 20.2 

1,380 12.5 19.0 

1,582 14.4 5.6 

*44 *0.4 0.3 

�44 �0.4 *1.1 

*141 *1.3 �4.9 

�244 *2.2 *9.4 

666 34.4 

*361 � R *26.2 

*8 I ‘0.7 *11.3 
4 acklncedata 

Figure 2. Annual office viait rate per 100 persons for diabetes 

melliis by age and sex of patient United States, 1977 

26.0 

24.0 

[ Female I“A”\. 

22.0 L /“ 1, 

/“

i ‘\., 

i“ 

i 

/“

1“ 

i 

4.0 

2.0 

I 

Under 45 45.64 55.64 65.74 75 years 

years years years years and over 

AGE 

Table 2. Number and percent distribution of office visits for principal 

diagnosis of diabetes mellitus, by selected physician characteristics: 

Table 3, Number and percent distribution of office visits for principal 

diagnosis of diabetes mel Iitus, by selected visit characteristics: 

United Statesr 1977 

Visit characteristic 

All . . . . . . . . . . . . . . . . . . . . . . . 

Time since onset of symptom 

or complaint 

Less than l week . . . . . . . . . . . . . . . . 

l-3 weeks . . . . . . . . . . . . . . . . . . . . . 

l-3 months . . . . . . . . . . . . . . . . . . . . 

More than 3 months . . . . . . . . . . . . . 

Notapplicablel . . . . . . . . . . . . . . . . . 

Prior visit status 

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

Old patient . . . . . . . . . . . . . . . . . . . . 

Newproblem . . . . . . . . . . . . . . . . . 

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

Number Percent of visits distribution n thousands 

11,023 100.0 

461 4.2 

576 5.2 

895 

6,803 6!:; 

2,288 20.8 

537 4.9 

10,486 95.2 

646 5,9 

9,840 89.3 

United States, 1977 

Physician characteristic 

All. . . . . . . . . . . . . . . . . . . . . . . 

Physician specialty 

General and family practice. . . . . . 

Internal medicine . . . . . . . . . . . . . . . 

Other medical specialties, . . . . . . . . 

Surgical specialties. . . . . . . . . . . . . . 

Other specialties . . . . . . . . . . . . . . . . 

Type of practice 

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

Other! . . . . . . . . . . . . . . . . . . . . . . . . 

Location of practice 

MetropolitanZ . . . . . . . . . . . . . . . . . . 

Nonmetropolitan, . . . . . . . . . . . . . 

1Includes partnership and gwup practices. 

21.0ca(ed within the standard metropolitan 

Number Percent of visits distribution n thousands 

11,023 100.0 

5,891 53.4 

3,075 27.9 

1,125 10.2 

876 8.0 

“56 *0.5 

7,737 70,2 

3,286 29.8 

8,469 76.8 

2,554 23.2 

statistical areas (SMS.4) 

1Chiefly visits not involving a symptom or complaint, e.g., annual or well baby 

examination,


visiting physicians’ offices as expressed by patients in their own words. These data were classified and coded according to A Reason for Visit 

Classification for Ambulatory Care.4 Table 

presents reasons for visit associated with a principal diagnosis of diabetes. Diabetes mellitus and 

glucose level determination accounted for approximately 55 percent of the patients’ reasons 

for visits; general medical examination for 8 percent of the visits; tiredness, general weakness, 

vision dysfunctions, leg, foot, and toe symptoms 

for an additional 6 percent of the visits. 

A general examination was ordered or provided for approximately 23 percent of zdl visits 

for diabetes (table 5). The proportion (69 percent) of visits at which a clinical lab test was 

ordered or provided was nearly 3 times the proportion (21 percent) provided at visits for all 

diagnoses. Further, the proportion of diabetes 

visits involving a blood pressure check (67 percent) nearly doubled that for all diagnoses (34 

percent). 

About 62 percent of all office visits for diabetes resulted in some type of drug therapy 

(table 5) being ordered or provided at that visit. 

About 37 percent of the visits involved diet 

counseling, compared with 7 percent for alI 

4 
advancedata 5 

Table 4. Number and percent distribution of office visits, by principal 

reasons for visit most frequently associated with a principal diag 

nosis of diabetes men itus: United States, 1977 

Principal reason for visit 

and RVC code? 

All reasons . . . . . . . . . . . . . . . . 

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

Glucose level determination . . X310 

General medical 

examination . . . . . . . . . . . . X1OO 

Tiredness, general weakne~r vision 

dysfunctions, leg, foot, and toe 

symptoms. . . . sol 5, S020, S305, 

S920, S935 

Number Percent of visits distribution in thousands 

=1=


I 

4,903 44.5 

1,111 10.1 

921 8.4 L683 6.2

1 Based on A Reason for Visit Classification for .4mbuIatmy Care (RCV). 

visits. An additional 32 percent of the visits 

involved some type of medical counseling. 

Seriousness represents the extent of impairment that might result if no care were available. 

Forty-two percent of all visits involving a principal diagnosis of diabetes meIlitus were judged 

by the physician as serious or very serious (table 

Table 5. Number and percent of office visits for principal diagnosis 

of diabetes mellitus by services ordered or provided: United States, 

6); the comparable proportion for alI diagnoses 

was 18 percent. Nine of every 10 visits for a 

principal diagnosis of diabetes involved the 

physician advising the patient to return at a 

specified time (table 6). 

Duration of the visit, as obtained in NAMCS, 

represents only that amount of time spent by 

the patient in face-to-face contact with the physician. The mean duration of visits involving a 

principal diagnosis of diabetes was 15.1 minutes; 

the mean duration of all visits was 15.4 minutes. 

In addition to the principal or first-listed 

diagnosis recorded in item 8 of the Patient Record, the physician was instructed to record 

“other significant current diagnoses” (see figure 

1) known to exist for the patient at the time of 

the current visit. The second- and third-listed 

diagnoses recorded were coded in the same manner as the first-listed, that is according to the 

Eighth Revision International Classification of 

Diseases, Adapted for Use in the United States. 5 

Table 6. Number and percent distribution of office visits for principal 

diagnosis of diabetes mellitus, by selected visit characteristics: 

1977 

Services ordered or provided 

Diagnostic Services 

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

Limited examination or history. . . . . 

General examination or history. . . . . 

Clinical lab test. . . . . . . . . . . . . . . . . 

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

Electrocardiogram, . . . . . . . . . . . . . . 

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

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

Other! . . . . . . . . . . . . . . . . . . . . . . . . 

Therapeutic services 

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

Drugs (prescription or 

nonprescription) . . . . . . . . . . . . . . 

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

Medical counseling , . . . . . . . . . . . . . 

OtherZ . . . . . . . . . . . . . . . . . . . . . . . . 

Number 

of visits Percent 

n thousands 

’208 �1.9 

5,839 53.0 

2,493 22.6 

7,635 69.3 

’379 *3.4 

528 

’312 *E 

7,382 67.0 

569 5.2 

1,464 13.3 

6,869 62.3 

4,125 37.4 

3,539 32.1 

814 7.4 

United States, 1977 

Visit characteristic 

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

Seriousness of condition — 

Serious or very serious. . . . . . . . . . . . 

Slightly serious . . . . . . . . . . . . . . . . . 

Notserious . . . . . . . . . . . . . . . . . . . . 

Disposition of visitl 

No followup . . . . . . . . . . . . . . . . . . . 

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

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

Telephone followup planned. . . . . . . 

Otherz . . . . . . . . . . . . . . . . . . . . . . . . 

Duration of visit 

0minutes3 . . . . . . . . . . . . . . . . . . . 

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

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

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

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

31minutes or more . . . . . . . . . . . . . . 

Number Percent of visits distribution in thousands 

11,023 100.0 

4,645 42.1 

4,236 38.4 

2,142 19.4 

�117 *1.1 

9,926 90.1 

636 5.8 

*365 *3.3 

511 4.6 

’364 ‘3.3 

1,079 9.8 

3,436 31.2 

3,203 29.1 

2,580 23.4 

’361 *3.3 

1 Dom not add to 100.0 since more thun onc disposition u,as possible. 

1In< Iudcs I>Jp test, cndmcopy, and other diu~.nest ic scrviccs. 21ncludes referred to other physician, rctumcd to referring physiciim, and 

‘h>< ludcs imrnunicxtion or dcscnsitizuion, fi~mily planning, physiotherapy, admit to hospital. 

,Brli( c surgery, psychotherapy or thcmpcutic listening, and other therapeutic 3 RcPrcScntS .,i~it~ i“ m.hich there was no face.to.face contact between the 

wrric w, patient und the physician. 
6 acklncedata 

These ckta provide 

about the total number 

diabetes and also show 

frequently co-occur with 

In addition to the 

additional information 

of office visits involving 

which conditions most 

a diagnosis of diabetes. 

11.0 million visits in 

which diabetes was the first listed-dia~osis, 

there were an additional 7.8 million visits in 

which diabetes was a second- or third-listed diagnosis. The total office visits in which diabetes 

was a diagnosis, therefore, was 18.8 million 

(table 7). 

The data in table 7 reveal that at nearly 20 

percent of the 18.8 million visits involving diabetes mellitus there was a concomitant diagnosis 

of essential benign hypertension. Other diagnoses 

frequently associated with diabetes were chronic 

ischemic heart disease (11 percent) and nonendocrine obesity (6 percent). 

Table 7. Number and percent of office visits with diabetes mellitus as 

first-, second-, or third-listed diagnosis, by moat frequent diagnoses 

associated with a diagnosis of diabetes: United States, 1977 

I 

Diabetes mellitus as 

first-, second-, or 

Most freauent third-listed diagnosis 

diagnosis and ICDA code! Number Percent 

I of visits of 

in thousands I visits 

Total 

Essential benign hypertension. ..401 3,720 

Chronic ischemic heart disease ..412 2,081 11.0 

Obesity, not specified as of 

endocrine origin . . . . . . . . ...277 1,147 6.1 

1 I 

. . . . . . . . . . . . . . . . . . . ““w

19.7 

1 Diagms.es and codes are based on Eighth Rcz,i,sion Intwnatimal Classificatiu]! 

oj” I)iwmcs, .4 dapled fbr Use in the L!nited Statrs (l CD.4). 

REFERENCES 

1Nation~ Center for He~~ statistics: 1977 Sum. 

mary: National Ambulatory Medical Care Survey, by T. 

Ezzati and T. McLemore. Advance Data From Vital and 

Health Statistics, No. 48. DHEW Pub. No. (PHS) 79-

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

1979. 

2National Center for Health Statistics: The National 

Ambulatory Medical Care Survey, 1975 Summary, 

United States, January-December, 1975, by H. Koch and 

T. McLemore. Vital and Health Statistics. Series 13-No. 

33. DHEW Pub. No. (PHS) 78-1784. Public Health Service. Washington. U.S. Government Printing Office, Jan. 

1978. 

3American Diabetes Association: Summary of current diabetes-related data from the National Center for 

Health Statistics. Diabetes Care. Vol. 2, No. 2, Mar.-Apr. 

1979. 

4National Center for Health Statistics: A reason for 

visit classification for ambulatory care, by D. Shneider, 

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

Public Health Service. Washington. U.S. Government 

Printing Office, Feb. 1979. 

5National Center for Health Statistics: Eighth Revision International Classification of Diseases, Adapted 

for Use in the United States. PHS Pub. No. 1693. Public 

Health Service. Washington. U.S. Government Printing 

Office, 1967. 
ackincedata 7 

TECHNICAL NOTES 

SOURCE OF DATA: The information presented 

in this report is based on data collected in the 

Nat ion al Ambulatory Medical Care Survey 

(NAMCS) during 1977. The target population of 

NAMCS encompasses office visits within the 

conterminous United States made by ambulatory patients to physicians who are principally 

engaged in office practice. The National Opinion 

Research Center, under contract to the National 

Center for Health Statistics, was responsible for 

the survey’s fieId operations. 

SAMPLE DESIGN: The NAMCS utiIizes a multistage probability design that involves samples of 

primary sampling units (PSU’S), physician practices within PSU’S, and patient visits within 

practices. For 1977 a sampIe of 3,000 nonFeclera.1 office-based physicians \\’as selected 

from master files maintained by the American 

h4edical Association and American Osteopathic 

Association. The physician response rate for 

1977 was 77.5 perceni. Sampled physicians were 

requested to complete Patient Records (figure 1) 

for a systematic random sample of office visits 

taking place \vithin their practice during a randomly assigned weekly reporting period. During 

1977, 51,044 Patient Records were completed 

by sampled physicians. 

SAhlPLING ERRORS: The standard error is primarily a measure of the sampling variability that 

occurs by chance because only a sampIe, rather 

than the entire universe, is surveyed. The reIative 

stanclard error of an estimate is obtained by dividing the standard error of the estimate by the 

estimate itseIf and is expressed as a percentage 

of the estimate. ReIati\’e standard errors of selected aggregate statistics are shown in table I. The 

standard errors appropriate for estimated percentages of visits are shown in table H. 

ROUNDING OF NUMBERS: Estimates of 

office visits hme been rounded to the nearest 

thousand. For this reason detailed figures within 

tables do not always add to totals. Percents were 

calculated on the basis of originaI, unrounded 

figures and will not necessarily agree precisely 

with percents which might be calculated from 

rounded data. 

DEFINITIONS: An ambulatory patient k an indiviclmd presenting himself for personal health 

services who is neither bedridden nor currently 

admitted to any health care institution on the 

premises. 

Table I. Approximate relative standard errors of estimated 

number of office visits, NAMCS 1977 

I 

Relative Estimated number of office 

standard visits in thousands error in 

percent 

500 ......................................................................... 28.0 

600 ......................................................................... 26.5 

1.ooo...................................................................... 20.7 

2,000 ...................................................................... 14.9 

5,000 ...................................................................... 9.9 

1o.ooo ......................................................q............- 7.6 

20.000 .................................................................... 6.1 

50,000 .................................................................... 4.9 

100,000 .................................................................. 4.5 

5oo,ooo..-...,.-_ ......!.. _..._. .... ................... 4.1 

Example of use of tabZe: An aggregate estimate of 75,000,000 

visits has a relative standard error of 4.7 percent or a standard 

error of 3,525,000 visits (4.7 percent of 75,000,000). 

Table 1i. Approximate standard errors of percentages of estimated 

number of office visits, NAMCS 1977 

.-. 

Estimated percentage Base of percentage 

(number of visits 

in thousands) 

EEEEEEE 

Standard error in percentage points 

500 ............................ 2.9 6.3 8.6 11.5 13.2 14.4 

600 ............................ 2.6 5.7 7.9 10.5 12.0 13.1 

1,000 .............. ........... 2.0 4.4 6.1 8.1 9.3 10.2 

2,000 . ........................ 1.4 3.1 4.3 5.7 6.6 7.2 

5,000 .............. ......... .. 0.9 2.0 2.7 3.6 4.2 4.5 

10,000 ....................... 0.6 1.4 1.9 2.6 2.9 3.2 

20,000 ....................... 0.5 1.0 1.4 1.8 2.1 2.3 

50,000 .......... ............ . 0.3 0.6 0.9 1.1 1.3 1.4 

100,000 ..................... 0.2 0.4 0.6 0.8 0.9 1.0 

500,000 ............... ...... 10.1 0.2 0.3 10.4 0.4 0.5 

Exumple of use of tQble: An estimate of 30 percent based on an 

aggrefPte of 15,000,000 visits has a standard error of 2.5 percent. 

The relative standard error of 30 percent is S.3 percent (2.5 percent + 30 percent). 

An office is a place that the physician identifies 

as a location for his ambulatory practice. Responsibility over time for patient care and professional services rendered there generalIy resides 

with the individual physician rather than an institution. 

A zrfiit is a direct personal exchange between an 

ambulatory patient and a physician or a staff 

member working under the physician’s supervision for the purpose of seeking care and rendering heaIth services. 
----------------------------------------- ---

--------------------------------

-----------------------------------------------

------

------------------------------

8 achtancedata 

A physician is a duly licensed doctor of 

medicine (M. D.) or doctor of osteopathy (D. O.) 

currently in office-based practice who spends 

time in caring for ambulatory patients. Excluded 

from NAMCS are physicians who are hospital 

based; physicians who specialize in anesthesiology, pathology, or radiology; physicians who 

are Federally employed; physicians who treat 

only institutionalized patients; physicians employed full time by an institution; and physicians who spend no time seeing ambulatory 

patients. 

r Recent Issues of Advance Data 

No. 56.	 Wanted and Unwanted Births Reported by 

Mothers 15-44 Years of Age: United States, 

1976 (Issued: January 23, 1980) 

No. 55.	 Reproductive Impairments Among Currently 

Married CouDles: United States, 1976 

(Issued: January 24, 1980) 

No. 54.	 Fats, Cholesterol, and Sodium Intake in the 

Diet of Persons 1-74 Years: United States 

(Issued: December 17, 1979) 

SYMBOLS 

Data not available 

Category not applicable . . . 

Quantity zero -

Quantity more than O but less than 0.05 0.0 

Figure does not meet standards of * reliability or precision 

From Vital and Health Statistics 

No. 53.	 Office Visits Involving X-rays, National Ambulatory Medical Care Smvey: United States, 

1977 (Issued: September 11, 1979) 

No. 52.	 Changes in Cigarette Smoking and Current 

Smoking Practices Among Adults: United 

Statesj 1978 (Issued: September 20, 1979) 

A complete list of Advance Data From Vital and Health Statistics is available from the Scientific and Technical 

Information Branch. 

NCHS 

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