“. 

‘ 

Uti~zation of Psychotropic Drugs in Office-Based Ambulatory


Car= National Ambulatory Medical Care Survey,


1980 and 1981


by Hugo Koch, Division of Health Care Statistics, and William H. Campbell, Ph. D., 

University of Washington 

*


‘ In this report the annual findings of the National 

Center for Health Statistics 1980 and 1981 National 

bulatory Medical Care Survey are combined to 

scribe the utilization of psychotropic drugs in offlceased ambulatory care. 

The term utilization k limited to the ordering or 

providing of a psychotropic drug by an ofilce-based 

physician. It does not apply to patient compliance with 

the doctor’s instruction. 

As used in this report, the subject grouppsychotropic 

drugsis composed of the 136 psychotropic agents actually named by physician respondents in 1980 and 1981. 

A list of these agents appears in figure 1. Along with all 

new psychotropic ordered or provided, the physician 

also recorded continued psychotropic, if the patient 

was specifically instructed during the visit to continue 

the medication. (However; the data base does not distinguish between the new and the continueddrug.)The 

listed agents appear as brandl orgenenc names, depending on the choice made by the physician in preparing the 

prescription. The group psychotropic drugs is divided 

among three subcategories. 

�	 Category I: Anti-anxiety agents, sedatives, and 

hypnotics 

� Category II: Antidepressants 

� Category III: Antipsychotic and antimanic agents 

‘heuse oftrade names isfor identification only and does not imply endorsement by the Public Health Service of the U.S. Department of FIe~th ~d 

Humm- Services. 

General findings 

Over the 2-year span 1980 and 1981, combined 

National Ambulatory Medical Care Survey findings 

resulted in an estimated 1,160,921,856 visits made to 

oi%ce-based physicians. Ofthis total, 717,774,562(62 

percent) were drug visits, that is, visits at which one 

drug or more of any type was utilized. The total number 

of drug mentions for the 2-year span amounted to an 

estimated 1,330,746,129 mentions. 

Visits involving one psychotropic drug or more numbered 69,269,110, about 6 percent of the overall number of office visits and about 10 percent of all drug visits. 

The total number of psychotropic drug mentions was 

79,582,103, divided arnongthe subcategories as follows. 

Drug mentions 

-. 

\ Number Percen; ‘. in distri­ -. -,. thousands bution 

All psychotropiC<~9s . . . . . . . 79,582 100.0 

Categov l. . . . . . . . . . . . . . . . . . . . 48,048 60.4 

Benzodiazepines. . . . . . ..-. 30,147 46.5 

Barbituric agents. . . . . . . ... . 6,087 9.4 

Category 11. . . . . . . . . . . . . . . . . . . 20,295 25.9 

Categow ill . . . . . . . . . . . . . . . . . . 11,239 14.1 

Table 1 lists the 25 psychotropic agents most frequently mentioned. They accounted for virtually fourfifths of all psychotropic mentions. 

An extremely important issue in health and social 

policy is the use of medications having significant potential for addiction or habituation, especially because the 

use of such agents also creates the risk of diversion into 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service 
2 acklncedata


Psychotropic drugs 

Category I 

Anti-anxiety agents, sedatives, and hypnotics 

4 

Amobsrbital Coprobate Meprobamate Quan Ill 

Amytal Dalmane Meprospan Quiess 

Atarax Equagesic M i Itown Ru- Lor f Ativan Equanil Nembutal Seconal / 

Azene Fiorinel Nevrotose Sedapap elixir : 

Bamo Fiorinal with codeine Nidar Serax 

Buff-A-Comp Hydroxyzine Noctec SK-lygen ‘ 

Butabarbital Idenal Noludar SK-phenobarbital 

Butal 

Buticaps .. 

Indogesic 

Infadorm drops 

Parest 

Pentobarbital 

Sopor ,.’ Tranxene 

Butigetic Isollyl Pentothal Tuinal 

Butisol Lanorinal Phencoid Tybratan ~ 

Ca rbrita I Libritabs Phenobarbital Valium 

Centrax Librium Phrenilin Valmid , 

Chloral hydrate Lorazepam Placidyl Valobar 

Chlordiazepoxide Lotusate Prazepam Verstran ‘“ 

Clorazepate Marnal Quaalude Vistaril 

Category II 

Antidepressants 

Adapin Elavil Nardil Sinequan 

Amavil Endep Norpramin SK-pramine ‘ 

Amitriptyline Etrafon Nortriptyline Surmontil 

Amoxapine Imipramine Pamelor Tofranil / 

Asendin Limbitrol Parnate Triavil . 

Aveniyl Ludiomil Perphenazine Trimipranjine 

Desipramine Maprotiline Pertofrane Vivactil 

Doxepin Marplan Phenelzine I 

Category Ill 

Antipsychotic and antimanic agents 

Chloramead Lidone Ormazine Thioridazine 

Chlorpromazine Lithane Proketazine Thorazine 

Chlorzine Lithium Prolixin Tindal 

Compazine Lithobid Promazine Trifluoperazine 

Deprol Lithonate Prozine 50 Trilafon 

Eskalith Loxitane Serentil Vesprin 

HaIdol Mellaril Sparine 

Haloperidol Moban Stelazine 

Inapsine Navane Taractan 1 

Anoquan Doriden Micrainin Restoril 

Figure 1. Psychotropic drugS actually named by physician respondents United States, 1980 and 1981. 

— 

Table 1. The 25 psychotropic drugs most frequently mentionad in office-based practice, by name of drug and number and percent distribution of mentions: 

United States, 198(J and I 981 

R Number of ./ R Number of 

a Name of drug 1 mentions Per~erjt a Name of drugl mentions Percent 

n in dif?fibuti~n n in distribution 

k tfrousan$a~ k thousands 

9 ~brium (chlordiazepoxide) . . . . . . . . . . . . 2,912 3.7 22 Central (prazepam) . . . . . . . . . . . . . . . . . . 1,111 1.4 

All’psychotropic drugs. . . . . . .. . . . . . . . ‘79,582 100.0 12 Triavil (amitriptyline, perphenazine) . . . . . 2,244 2.8 

13 Tofranil (imipramine),, . . . . . . . . . . . . . . . 1,778 2.2 

14 Vistaril (hydroxyzjne) . . . . . . . . . ., . . . . . 1,762 2.2 25 drugs most frequently dsed 15 Meprobamate . . . . . . . . . . . . . . . . . . . 1,650 2.1 

1 Valium (diazepam} . . . . . . . . . . . . . . . . 12,562 15.8 16 Limbitrol (chlordiazepoxide, 

,2 Elavil(amitriptyline) . . . . . . . . . . . . . . 4,419 5.6 amitriptyline) . . . . . . . . . . . . . . . . . . . . . 1,642 2.1 

3 Dalmane (flurazepam) . . . . . . . . . . . . . . 4,242 5.3 17 Compazine (prochlorperazine] . . . . . . . . . 1,369 1.7 

4 Tranxene (clorazepate) . . . . . . . . . . . . 3,621 4.6 18 Equagesic (meprobamate, etho5 Phenobarbital . . . . . . . . . . . . . . . . . . . . . . . 3,453 4.3 heprazine, aspirin) . . . . . . . . . . . . . . . . . 1,211 1.5 

6 Atarax(hydroxyzine) . . . . . . . . . . . . 3,150 4.0 19 Lithium . ., . . . . . . . . . . . . . . . . . . . . . . . . . 1,203 1.5 

7 Sinequan (doxepin) . . . . . . . . . . . . . . . . . . 3,133 3.9 20 Stelazine (trifluoperazine) . . . . . . . . . . . . . 1,196 1.5 

8 Ativan(lorazepam) . . . . . . . . . . . . . . . . . . . 3,082 3.9 21 Thorazine (chlorpromazine). . . . . . . . . . . . 1,137 1.4 

10 Fiorinal (butalbital, aspirin, phenacetin, 

11 Mellaril 

caffeine) 

(thioridazine). 

. . . . . . . . .

.

.

.

.

.

.

.

.

.

.

.

. .

. .

. .

.

.

.

.

.

.

.

.

.

.

.

. 

. . 

2,634 

2,370 3.0 

3.3 

25 

23 

24 

Norpramin 

Serax(oxazepam) 

Haldol(haloperidol) 

(desipramine)

.

. 

.

. 

. 

.

. 

.

. 

.

. 

.

. 

. 

.

. 

. 

.

. 

. 

.

. 

. 

.

. 

. 

.

. 

. 

.

. 

. 

.

. 

. 

.

. 

. 

.

. 

. 

. 

. 

. 

. 

. 

. 

. 

. 1,036 

871 

975 

1.1 

1.2 

1.3 � lTh fom of the drug name (brand or generic) representa ttm choice of the physician in preparing the Prescription. 
a&mHkia3 

K 

e 

e 

illicit channels. Because of these factors they are treated 

s controlled substances and placed under the regulary authority of the U.S. Drug Enforcement Adminisation. The special sensitivi~ of the psychotropic series 

is evident in the NAMCS findings. More than one-half 

(56 percent) of all psychotropic mentions entailed the 

use of a controlled drug. 

Because most of the psychotropic agents are under 

regulatory control, it comes as no surprise that there 

were no over-the-counter drugs among their members. 

The use of all psychotropic required a formal prescription by the physician. About 9 of every 10 psychotropic 

were prescribed by trade name. Only a relatively minor 

proportion (13 percent) were combination drugs, the 

most frequently mentioned combinations involving the 

addition of an analgesic ingredient to an anti-anxiety 

base. 

Diagnosis 

Proper evaluation of the patterns of psychotropic 

utilization requires that the data user look first to the 

conditions that the drugs were intended to prevent or 

treat. The most direct and frequent linkage occurs here. 

A psychotropic agent is seldom if ever utilized for the 

sole reason that the patient is over 65 years or a femal~ 

or that the physician is a general practitioner or a psyhiatrist. It is fimdarnental then to examine the use of 

sychotropics in terms of the diagnoses rendered in 

ofilce-based care. The rate of psychotropic utilization 

as it varied among the major diagnostic groups and with 

the general nature of the patient’s problem is shown in 

table 2. Apart from the class of mental disorders, which 

sui generis command the highest rate of all psychotropic 

utilization, four other diagnostic classes exceeded the 

average utilization rate of 69 mentions per 1,000 visits. 

They are 

� Symptoms, signs, and ill defined conditions 

� Diseases of the circulatory system 

� Diseases of the digestive system 

� Diseases of the musculoskeletal system 

For these “nonmental” disorders it is the use of the 

Category I drugs that most clearly causes the aboveaverage rates. 

When the diagnostic findings are subjected to a finer 

scrutiny, the following speciiic diagnoses were found to 

be most frequently associated with psychotropic therapy 

Psychotropic 

Rank Diagnosis and IC>9-CM Code 1 mentions 

in thousands 

o 1 Neurotic disorders. . . . . . . . . . . ...300 8,834 

2 Essential hypertension . . . . . . . ...401 5,536 

3 Depressive disorder. . . . . . . . . . ...311 2,675 

4 Schizophrenic disorder. . . . . . . ...295 2,382 

5 Affective psychosis . . . . . . . . . . ...296 1.708 

1ea~e,j on the /nter”ationa/ C!lassir7cationof Diseases, 9th Revision, c!iniCa! 

Modification (ICD-9-CM). 

From the preceding correlations between diagnosis and 

psychotropic utilization it is clear that the use ofpsych~ 

tropic therapy is most frequently associated with the 

chronic conditions (table 2). With the acute conditions 

it is much less common. With nonillness care and with 

the post-traumatic conditions of surgery or injury, the 

use of psychotropic drugs is extremely modest. 

Patient characteristics 

From its lowest level, for patients under 25 years, 

the office-based utilization of psychotropic drugs accelerates sharply in successive age groups until it reaches 

its highest point among middle-aged patients in the age 

group 45–54 years. It then begins a gradual, if fluctuatin~ descent among patients in the remaining years of 

life (table 3 and figure 2). 

This pattern applies to each of the psychotropic sub -

categories, in large part reflecting the corresponding 

patterns of morbidity revealed by NAMCS diagnostic 

findings. For example, mental disorders, the conditions 

which command the highest rate of psychotropic usage, 

are proportionately most evident among oflce patients 

in the age group 30–50 years. 

It is clear from the findings that female utilization of 

office-based, psychotropic therapy substantially exceeded its utilization by male patients (table 3). The 

imbalance favoring female patients lay ahnost entirely 

in the use of drugs in Categories I and II. For the antipsychotic and antimanic agents there was little or no 

difference between the sexes. 

The sex-age findings show the age intervals in which 

the sex differences in psychotropic utilization become 

most manifest (table 4). Up to the 45th year, the general 

rate of utilization is equivalent for females and males. 

From the 45th year on, however, the rates diverge dramatically. In the age group 45–64 years, the female rate 

is roughly one-third again as high as the male rate in the 

age group 65 and over, it exceeds the male rate by 

almost 60 percent. 

These findings correlate positively with NAMCS 

diagnostic evidence. For example, mental disorders and 

essential hypertensio~ the conditions that command 

the highest rate of psychotropic utilization, were pr~ 

portionately more frequent among the older female patients than among males. 

Although overall psychotropic usage did not vary 

signillcant.ly between black and white office patients 

(table 4), the below-average use of antidepressants by 

blacks is an interesting finding, and one not clearly 

explicable by diagnostic correlates. (Black office patients show about the same proneness to depressive 

conditions as their white counterparts.) However, they 

visited the psychiatrist with only on~third the frequency 

of white patients, a fact that may partly explain the 

seeming anomaly. As evidenced by the findings, psychiatrists’ use of antidepressants substantially exceed 

their use by other physicians (table 5). 
4 acklmedata 

Table 2. Number of office visits, number of all psychotropic drug mentions, and number of mentions per 1,000 visits, by major clinical problem: 

United States, 1980 and 1981 

Psychotropic drugs j 

Number of All psychotropic drugs Category 11 Category 112 Categoq 1113 

visits Major clinical problem in Number of Number of Number of Number of Number of Number of Number of Number of 

thousands mentions mentions mentions mentions mentions mentions mentions mentions 

in per 1,000 in per 1,000 in per 7,000 in per 1,000 

thousands visits thousands visits thousands visits thousands visits 

All visits . . . . . . . . . . . . . . . . 1,160,922 79,582 69 48,048 41 20,295 17 11,239 11 

Major diagnostic groups4 

Infectious and parasitic 

diseases . . . . . . . . . . . . . . 37$714 783 21 *518 14 “149 *4 *116 *3 

Neoplasm . . . . . . . . . . . . . . 30,707 1,144 37 647 21 “153 *5 “344 *II 

Endocrine, nutritional, and 

metabolic diseases, 

and immunity 

disorders . . . . . . . . . . . . . . 45,371 3,028 67 1,793 40 809 18 “426 *9 

Mental disorders. . . . . . 47,624 25,098 527 9,863 207 9,532 200 5,703 120 

Diseases of nervous 

system and sense 

organs, . . . . . . . . . . . . . . . 109,573 3,374 31 2,337 21 “505 *5 *532 *5 

Diseases of circulatory 

system . . . . . . . . . . . . . . . . 112,344 13,038 116 9,260 82 2,717 24 1,061 9 

Diseases of respiratory 

system .,...,.,.,...,., 146,014 5,003 34 3,212 22 1,148 8 643 4 

Diseases of digestive 

system . . . . . . . . . . . . . . . . 49,080 3,957 81 2,376 48 980 20 “601 *I2 

Diseases of genitourinary 

system . . . . . . . . . . . . . . . . 68,504 2,411 35 1,594 23 *575 *8 *242 *4 

Diseases of skin and 

subcutaneous tissue. 69,421 3,143 45 2,781 40 “240 *3 ’122 *2 

Diseases of musculoskeletal 

system . . . . . . . . . . . . . . . . 

Symptoms, signs, and 

79,206 5,899 74 4,334 55 1,205 15 ’360 “5 � ill-defined conditions. 38>526 4,722 123 3,424 89 967 25 ’331 *9 

Injury and poisoning. . . . 94,723 3,587 38 2,893 31 *492 *5 “202 “2 

Supplementary classification 

(normal pregnancy, health 

supervision of child, 

and so forth . . . . . . . . . . . . 202,585 2,879 14 1,942 10 *627 *3 “310 *2 

Residual . . . . . . . . . . . . . . . . 29,530 1,516 51 . . . . . . . . . 

Problem categories 

Acute problem . . . . . . . . . . . 422,223 22,915 54 15,317 36 2,223 5 5,375 13 

Chronic problem, routine. 325,791 38,409 118 21,659 66 6,190 19 10,560 32 

Chronic problem, flareup . . . 106,393 12,468 117 7,007 66 2,095 20 3,366 32 

Postsurgew and/or postin jury . . . . . . . . . . . . . . . . . 101,792 2,134 21 1,588 16 “203 *2 *343 *3 

Nonillnesa care. . . . . . . . . . . 204,722 3,656 18 2,477 12 *528 “3 651 *3 

1 Anti. an~iafy agenta, sedativas, and hypnotics.


2Antidspresssnta.


3A”tipsychotic and sntimsnic sgents.


4 ~a~ed on the /“rernationa/ Ckjssification of Diseases, 9tfr Revision, Ciinical Modification. 

Prescriber characteristics 

Among office-based specialists it was, of course, 

psychiatrists who showed the highest rate of psychotropicutilization, especially of the Category II and III 

agents (table 5). After all, a substantial part of their 

professional effort is associated with those disorders 

that other specialist tend to refer for treatment, among 

them depressive conditions, schizophrenic disorders, 

and affective psychoses. 

What may be surprising about the findings, as shown 

in table 5, is the extent that two primary care providers, 

the general practitioner and the internist, were involved 

in the utilization of psychotropic drugs. In sheer numbers 

of mentions they accounted for 66 percent of all Category I drugs used in office-based practice, 59 percent of 

the Category 11drugs, and even a substantial 45 percent 

of the Category 111drugs. Their above-average rates o 

psychotropic utilization appear to stem less from thei 

clinical involvement with the mental disorders thana 

from their treatment of the other diagnostic groups that 

invite the use of psychotropics, notably symptoms, 
admmedm5 

Table 3. Number of office visits, number of all psychotropic drug mentions, and number of mentions per 1,000 visits, by patient characteristics 

~ United States, 1980 and 1981 

Psychotropic drugs 

Number of All psychotropic drugs Category /1 CategO~ 112 Categow 1113 

Patient characteristic visits 

in Number of Number of Number of Number of Number of Number of Number of Number of 

thousands mentions mentions mentions mentions mentions mentions mentions mentions 

in per 1,000 in per 1,000 in per 1,000 in per 1,000 

thousands visits thousands visits thousands visits thousands visits 

All visita . . . . . . . . . . . . . . . . 1,160,922 79,582 69 48,048 41 20,295 17 11,239 11 

Age 

Under 15yaars . . . . . . . . . . . 216,128 2,381 11 1,713 8 “307 *1 *361 *2 

15-24 years . . . . . . . . . . . . . 160,795 5,160 32 3,295 20 1,021 7 844 5 

25-44 years . . . . . . . . . . . . . 310,384 23,338 75 13,195 43 6,178 20 3,965 12 

25-29 yeara . . . . . . . . . 97,109 5,055 52 2,939 30 1,159 12 958 10 

30-34 years . . . . . . . . . 86,896 6,705 77 3,606 41 1,740 20 1,359 16 

35-39 years . . . . . . . . . 69,611 5,895 85 3,331 48 1,553 22 1,011 15 

40-44 years . . . . . . . . . 56,768 5,683 100 3,320 58 1.725 30 *638 *11 

45-64 years . . . . . . . . . . . . . 265,700 28,930 109 17,164 65 7,966 30 3,800 14 

45-49 years . . . . . . . . . 56,265 6,657 118 3,797 67 1,894 34 966 17 

50-54 years . . . . . . . . . 68,032 7,895 116 4,736 70 2,093 31 1,066 16 

55-59 yeara . . . . . . . . . 70,825 7,286 103 4,140 58 “ 2,117 30 1,029 15 

60-64 years . . . . . . . . . 70,578 7,093 100 4,492 64 1,864 26 737 10 

65 years and over. . . . . . . . . 207,915 19,772 95 12,680 61 4,823 23 2,269 11 

65-69 years . . . . . . . . . 67,884 6,708 99 4,495 66 1,633 24 “580 “9 

70-74 years . . . . . . . . . 57,577 5,871 102 3,520 61 1,542 27 809 14 

i’5-79 years . . . . . . . . . 43,309 3,968 92 2,456 57 1,061 24 *45 1 *lo 

80 years and over. . . . . 39.145 3.227 82 2,211 56 *588 *15 *428 *11 

Sex 

Female . . . . . . . . . . . . . . . . . .	 699,718 53,409 76 31,972 46 14,398 21 7,039 10 

461,204 26,173 57 16,076 35 5.897 13 4,200 9

e Anti-anxiety agents, sedatwes, and hypnotics, 

3Ant,p~ychot,c and antlmanlc a9ents. 

signs, and ill-defined conditions; and the circulatory, 

digestive, and musculoskeletal disease groups. About 

30 percent of all visits to the general practitioner and45 

percent of all the internists’ visits were associated with 

one of these “nonmetal’,’ disease groups. 

Among the most-visited specialties, the lowest rates 

in psychotropic utilization occurred among the specialists with the largest proportion of nonillness care, the 

pediatrician and the obstetrician and/or gynecologist. 

The differences in psychotropic utilization between 

doctors of medicine and doctors of osteopathy (table 5) 

probably reflect the fact that a clear majority of osteopathic physicians are in general practice. The general 

practitioners, as already noted, well exceed the average 

in their use of psychotropic agents. 

Other visit characteristics 

An examination of the utilization rates reveals that 

the new patient is much less likely to receive psychoepic drug therapy than the patient whom the doctor 

Of as seen before (table 6). This is especially true if the 

new patient has been referred by another physician. In 

fact, the findings suggest that a newproblem—whether 

it is one presented by a new patient or one appearing for 

the f~st time in an old patient-will probably result in a 

use of psychotropic agents that is considerably below 

average. Thus newness of patient or problem (or both) 

seems to invite a more conservative approach toward 

psychotropic therapy by the prescribing physician. 

Not only does this conservatism prevail at the point 

of entry into office-based ambulatory care, it is also 

evident at the end point of the visit. Of those visits that 

involved the prescription of one psychotropic drug or 

more, by far the most frequent disposition instruction— 

given the patient at 72 percent of visits—was to return at 

a specified time. (The average use of this instruction in 

office practice is 60 percent.) Although such specitlcity 

of return instruction was probably strongly influenced 

by the nature and potential seriousness of the patient’s 

problem, it seems also to reflect a commendable desire 

by the physician to maintain a closer than usual surveillance on a family of drugs that has its own unique 

hazards of use. 

Co-occurrence 

Utilized at 62 percent of oflice visits, drug therapy 

(of all types) is by far the most frequent form of treatment provided in ofllce practice. Its magnitude is com-
----- ----- ----- ----- ----- ----

6 achancedata 

120 r [117] 

110 

100 

[92] [95] 

90 

80 

70 Average [69] 

-

[64] 

60 

50 

40 

[32] 

30 

20 

[11] 

10 

o I I I I I 1 

Under 15-24 25-34 35–44 45-54 55-64 

15 years years years years years yeara 

Age of patient 

Figure 2: Psychotropic utilization rates by age of patient: United Statea, 1980 and 1981 

J 

65 years 

and over 

Percent of 

co-occurrence 

17 

16 

11 

10 

9 

8 

8 

6 

pounded by the finding that physicians, when they do 

use a drug, tend to use more than one. The overall 

average is about two drugs per drug visit, but larger 

multiples are not uncommon, especially when the patient suffers from more than one disorder. With cooccurrence the rule rather than the exception, it is interesting—indeed mandatory-to explore the patterns of 

concomitant utilization of drugs, for herein lies the potential for harmful as well as helpful interactions. 

In table 7 is shown the extent to which psychotropic 

drugs c~occur with drugs in other therapeutic families, 

and the ,co-occurrence that exists among the psycho 

tropic subcategories themselves. 

At the 69.3 million visits at which a psychotropic 

agent was utilized, its use (expressed as a percent of 

these visits) co-occurred most frequently with the use 

of one member or more of the following eight therapeutic families: 

Co-occurring therapeutic family 

Analgesics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Diuretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

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

Other psychotropic agents. . . . . . . . . . . . . . . . . 

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

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

Gastrointestinal drugs . . . . . . . . . . . . . . . . . . . . 

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

Within the psychotropic family itself, the most frequent co-occurrences existed among drugs in Categorie 

I and II (at 3.5 million visits); next among Category 

and HI drugs (at 1.8 million visits). The least frequen* 

pattern of c~occurrence was found among the drugs in 

Categories I and 111(at 1.4 million visits). 
ackmeMa7 

Table 4. Number of office visits, number of all psychotropic drug mentions, and number of mentions per 1,000 visits, by patient characteristics 

United States, 1980 and 1981 

Psychotropic drugs 

@ 

Number of All psychotropic drugs Category 11 Categow 112 Category 1113 

visits 

Patient characteristics in Number of Number of Number of Number of Number of Number of Number of Number of 

thousands mentions mentions mentions mentions mentions mentions mentions mentions 

in per 7,000 in per 1,000 in per 1,000 in per 1.000 

thousands visits thousands visits thousands visits thousands visits 

All visits . . . . . . . . . . . . . . . . 1,160,922 79,582 69 48,048 41 20.295 17 11,239 11 

SEX AND AGE 

Female 

Under 15 years . . . . . . . . . . . 102,633 1,180 11 802 8 *143 *1 *235 *2 

15-24 years . . . . . . . . . . . . . 107,276 3,424 32 2,296 21 723 7 “405 *4 

25-44 years . . . . . . . . . . . . . 206,394 15.572 75 8,965 43 4,281 21 2,326 11 

45-64 years . . . . . . . . . . . . 157,031 19,155 122 11,198 71 5,516 35 2,441 16 

65 years and over. . . . . . . . . 126,383 14,078 111 8,711 69 3,736 30 1,631 13 

Male 

Under 15 yeara . . . . . . . . . . . 113,495 1,201 11 911 8 *164 *1 *126 *1 

15-24 years . . . . . . . . . . . . . 53,519 1,734 32 998 19 *298 *6 *438 *8 

25-44 years . . . . . . . . . . . . . 103,990 7,766 75 4,230 41 1,897 18 1,639 16 

45-64 years . . . . . . . . . . . . . 108,668 9,776 90 5,967 55 2,451 23 1,358 12 

65 years and over. . . . . . . . . 81,532 5.695 70 3,969 49 1,0B7 13 *639 *8 

RAC# 

White . . . . . . . . . . . . . . . . . . . 1,037,590 71,783 69 42,740 41 18,976 18 10.067 10 

Black . . . . . . . . . . . . . . . . . . . 110,546 7.403 67 5,066 46 1,247 11 1,090 10 

t Anti-anxiety agents, sedatives, and hypnotics. 

2Antidepressants. 

3AntlP~y~h~tlc and antimcmic agents. 

Excludes about 12,786,000 VISI:S by pat!ents of races other than whtte or black. 

e 

Table 5. Number of office visits and number of psychotropic drug mentions and number of mentions per 1,000 visita, by prescriber characteristics 

United States, 1980 and 1981 

Psychotropic drugs 

Number of All psychotropic drugs Catego~ 11 Category 112 Category 1113 

visits 

Prescriber characteristic in Number of Number of Number of Number of Number of Number of Number of Number of 

thousands mentions mentions mentions mentions mentions mentions mentions mentions 

in per 1,000 in per 1,000 in per 7,000 in per 1,000 

thousands visits thousands visits thousands visits thousands visits 

All prescribers. . . . . . . . . . . . 1,160,922 79,582 69 48,048 41 20,295 17 1 1)239 11 

Most-visited specialities 

General and family 

practice . . . . . . . . . . . . . . . 381,710 32,199 84 21,037 55 7,852 21 3,310 9 

Internal medicine . . . . . . . . . 144,172 16,559 115 10,827 75 4,047 28 1,685 12 

Pediatrics . . . . . . . . . . . . . . . 128,762 1,395 11 1,032 8 *165 *1 *197 *2 

Obstetrics and 

gynecology . . . . . . . . . . . . 109,035 1,720 16 1,407 13 “204 *2 *109 *1 

General surgery . . . . . . . . . . 61,013 2,392 39 1,851 30 “408 *7 “133 *2 

Psychiatry . . . . . . . . . . . . . . . 31,810 14,038 441 3,878 122 5,448 771 4.712 148 

All other specialties. . . . . . . 304.420 . . . . . . . . . . . . . . . . . . . . . . . . 

Professional identity

e“octor of medicine. . . . . . . . 1,089,638 74,030 68 44,717 41 18,488 17 10,825 10 

octor of osteopathy. . . . . . 71,284 5,553 78 3,331 47 1,807 25 *41 5 *6 

1A“~i.anxiery agents, sedatives, and hypnot!cs. 

2Antidepressants.


3Antipsychotic and antimanic drugs.

8 achnncedata 

Table 6. Number of office vkhs, number of psychotropic drug mentions, and number of mentions per 1,000 visits, by selected visit characteristics 

United States, 1980 and 1981 

Psychotropic drugs 

Number of All psychotropic drugs Category /1 Category 112 Category 1113 

Selected visit characteristic 

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

Referral status 

Referred by another 

physician . . . . . . . . . . . . . . 

Not referred by another 

physician . . . . . . . . . . . . . . 

Patient viait status 

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

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

Old patient, new 

problem . . . . . . . . . . . 

Old patient, old 

problem . . . . . . . . . . . 

Problem status 

New problem . . . . . . . . . . . . 

Return visit for old 

problem . . . . . . . . . . . . . . . 

visits 

in Number of Number of Number of Number of Number of Number of Number of Number of 

thousands mentions mentions mantions mantions mentions mentions mantions mentions 

in per 1,000 in per 1,000 in per 1,000 in per 1,000 

thousands visits thousands visits thousands visits thousands visits 

1,160,922 79,582 69 48,048 41 20,295 17 11,239 11 

51,392 1,610 31 947 18 *446 9 *217 *4 

1,109,530 77,972 70 47,101 42 19,849 8 11,022 10 

166,675 5,919 36 3,713 22 1,504 9 702 4 

994,247 73,663 74 44,335 45 8,791 9 10,537 11 

258,778 13,397 52 9,504 37 2,723 11 1,170 5 

735,469 60,266 82 34,831 47 6,068 22 9,367 13 

425,453 19,316 45 13,217 31 4,227 10 1,872 4 

735,469 60,266 82 34,831 47 16,068 22 9,367 13 

1Anti.an~iety agents, sedatives. and hYpnOti= 

2Antidepressants.


3A”tipsychotic and antimanic agents.


Table 7. Number of drug visita at which the uae of a psychotropic drug co-occurred with the use of drugs in other therapeutic categories: 

United States, 1980 and 1981 

Selected co-occurring 

therapeutic catego~ 1 

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


Analgesics . . . . . . . . . . . . . . .


Anti biotics . . . . . . . . . . . . . . .


Anticonvulsants ., .,


Antihistamine drugs,


Antineoplastic agents . . . . .


Autonomic drugs .,


Blood formation and


coagulation . . . . . . . . . . . . . 

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

Diuretics . . . . . . . . . . . . . . . . . 

Expectorants and cough 

preparations, . . . . . . . . . . . 

Category 12 Catego~ 113 Category 1114 

drug visits drug visits drug visits 

Number in thousands 

1,709 *438 *151 

8,843 2,557 1,209 

3,076 995 “409 

1,385 *263 *217 

2,405 625 *443 

*169 *7O *31O 

3,480 1,959 1,685 

1,217 *336 *268 

5,012 2,028 795 

7,709 3,227 1,030 

874 *229 *31 

Selected co-occurring 

therapeutic categoiyl 

Gastrointestinal drugs . . . . . . 

Hypotensive agents. . . . . . . . 

Insulins and antidiabetic 

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

Skin preparations. . . . . . . . . . 

Spasmolytic agents . . . 

Thyroid and antithyroid . . . . . 

Vaaodilating agents. . . . . . . 

Vitamins . . . . . 

Catego~l drugs . . . . . . . . . . . 

Categow 11drugs . . . . . . . . . . 

Catego~ Ill drugs. . . . . . . . . 

Category 12 Category 113 Category 1114 

drug visits drug visits drug visits 

Numbar in thousands 

3,836 1,169 965 

3,842 1,649 *422 

1,002 590 *251 

2,883 569 *322 

1,475 547 ’312 

1,133 552 *223 

2,776 796 *246 

2,559 773 624 

3,482 1,381 

3,482” . . . 1,763 

1,381 1,763 . . . 

1 ~a~ed on the pharmacologic. therapeutic classification of the American SOcietYof Hospital pharmacists 

2A”ti.anxietY ~ge”ts, sedatives, and WwOtics. 

3Aktidepressants.


4A”tjp~ychotic and antimanic drugs.

-----

ackincedata 9 

Technical notes 

@ 

a 

Source of data and sample design 

The estimates presented in this report are based on 

the findings of the National Ambulatory Medical Care 

Survey (NAMCS), a sample survey of office-based 

care conducted annually from 1973 through 1981 by 

the National Center for Health Statistics. The target 

universe of NAMC S is composed of office visits made 

by ambulatory patients to non-Federal and noninstitutional physicians who are principally engaged in officebased, patient-care practice. Visits to physicians practicing in Alaska and Hawaii are excluded from the range 

of NAMCS, as are visits to anesthesiologists, pathol~ 

gists, and radiologists. 

NAMCS uses a multistage probability sample design 

that involves a stepwise sampling of primary sampling 

units (P SU’S), physicians’ practices within PSU’S, and 

patient visits within physicians’ practices. The physician 

sample (5,805 for 1980 and 198 1) was selected from 

master files maintained by the American Medical ASSG 

ciation and the American Osteopathic Association. 

Those members of the sample who proved to be inscope 

d eligible participated at a rate of 77.3 percent. Reonding physicians completed visit records for a sysematic random sample of their office visits made during 

a randomly assigned weekly reporting period. Telephone 

contacts were excluded. During 1980 and 1981 responding physicians completed 89,447 visit records on which 

they recorded 97,796 drug mentions. Characteristics of 

the physician’s practice, such as primary specialty and 

type of practice, were obtained during an induction 

interview. The National Opinion Research Center, under contract to the National Center for Health Statistics, 

was responsible for the field operations of the survey. 

Sampling errors and rounding 

The standard error is a measure of the sampling 

variability that occtis by chance because only a sample, 

rather than the entire universe, is surveyed. The relative 

standard error of an estimate is obtained by dividing the 

standard error by the estimate itself and is expressed as 

a percent of the estimate. In this report, any estimate 

that exceeds a relative standard error of 30 percent is 

marked with an asterisk. Table I should be used to 

obtain the relative standard error for aggregates of office 

visits or for mentions of drugs by specflc name (for 

example, Valium). Table 11should be used to obtain the 

lative standard error for drug mentions expressed as 

g groups (for example, the psychotropic drug family). 

In the tables of this report estimates have been 

rounded to the nearest thousand. Forthis reason, detailed 

estimates do not always add to totals. 

Table 1. Appr~ximate relative standard errors of estimated numbers of office 

visits and of drug mentions when the drug is listed by product name (for 

example, Valium), based on all physician specialties: National Ambulatory 

Medical Care Survey, 1980 and 1981 

Relative 

Estimated number of office visits standard 

or specific drug mentions in tlrousands error in 

percent 

‘200. . . . .. . . . .. .. . .. .. . .. . .. . . .. .. . . . .. . .. .. .. . .. *44.8 

“400. . .. .. .. . .. .. . .. .. . . . .. . . . .. .. . . .. . . .. . . .. . .. *3I.7 

“450 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “30.0 

600.. . . .. . .. . .. .. . .. .. . . . .. .. . .. .. . .. .. . . . .. .. . .. 26.0 

800.. . . .. . .. .. . .. .. . .. . . . .. .. .. . .. . . . .. . . .. . .. .. . 22.6 

1,000. . .. .. . .. .. . . . .. . . . .. .. . .. .. . . .. . . .. .. .. . . . . 20.2 

2,000. . .. .. . .. .. . .. .. .. . . . .. . .. .. .. . .. .. . .. .. . .. . 14.5 

5,000. . . . .. . .. .. . .. .. .. . . . .. . . .. . .. . .. .. . .. . . . .. . 9.5 

10,000. .. .. . .. .. . .. .. .. . . . .. . .. .. .. . .. . . . .. .. .. . . 7.1 

20,000. .. .. . .. . .. .. .. . . . .. .. . .. .. . . . .. .. . .. .. . .. . 5.6 

50,000. .. .. . .. .. . .. .. .. . .. .. . .. .. . . . .. .. . .. .. . . . . 4.4 

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9 

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6 

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5 

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4 

Example of use oftab/e: An aggregate estimate of 35,000,000 office visits has 

a relative standard error of 5.0 percent or a standard error of 1,750,000 visita 

(5.0 percent of 35,000,000 visits). 

Table IL Approximate relative standard errors of estimated numbers of drug 

mentions when the drugs appear in groups (for example, the psychotropic 

drug family), based on all physician specialties: National Ambulatory 

Medical Care Survey, 1980 and 1981 

Relative 

Estimated number of grouped drug mentions standard 

in thousands error in 

percent 

“200.. . . .. .. . .. .. . .. .. . .. .. .. . .. .. . .. .. .. . .. .. .. . *54.2 

“400. . .. ,. .. ..- ..----- . .. .. .. . .. .. . .. .. .. . .. .. .. . *38.5 

“600. .. . .. .. . .. .. .. . .. . .. .. . . . .. .. . . . .. . . .. . .. .. . *31 .5 

“650. . . . . ..-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “30.0 

800. . . . . . ..- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.3 

1,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.5 

2,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.6 

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.6 

10,000 . . . . . . . ..-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.7 

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8 

50,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.3 

100,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.7 

200,000 . . . . . . . . ..- . . . . ..- . . . . . . . . . . . . . . . . . . . . . . . . 4.4 

500,000. .. .. . .. .. . .. .. . .. .. . . . .. .. . . . .. . . .. .. . .. . 4.2 

1,000,000. .. . .. .. .. .. . . . .. . .. .. .. . . . .. .. . . . .. . .. . 4.1 

Example of use oftabla: An aggregate estimate of30,000,000 drug mentions 

has a relative standard error of 7.0 percent or a standard error of 2,100,00 

mentions (7.0 percent of 30,000,000 mentions). 

Definitions 

An ojfce is a place that physicians identify as a 

location for their arnbulato~ practice. Responsibility 
10 ackincedata 

for patient care and professional services rendered there 

resides with the individual physician rather than an 

institution. 

A visit is a direct personal exchange between an 

ambulatory patient seeking health care and a physician, 

or staff member working under the physician’s supervision, who provides the health services. 

A drug mention is the physician’s entry on the visit 

record of a pharmaceutical agent ordered or provided 

by any route of administration for prevention, diagnosis, or treatment. Generic as well as brand-name 

drugs are included, as are nonprescription as well as 

prescription drugs. The physician records all new 

drugs, and continued medications when the patient is 

specifically instructed during the visit to continue 

the medication. 

An acuteproblem is a morbid condition with a rel 

tively sudden or recent onset (within 3 months of th9 

visit). 

A chronic problem, routine is a morbid condition 

that existed for 3 months or more before the visit. The 

care indicated is of a regular, maintenance nature. 

A chronicproblem, $are up is a sudden exacerbation 

of a preexisting chronic condition. 

Nonilbzess care denotes health examinations and 

care provided for presumably healthy persons. Examples are: prenatal and postnatal care, annual physicals, 

well-child examinations, and insurance examinations. 
11


Symbols 

..- Data not available 

. . . Categoy not applicable 

Quantity zero 

0.0 Quantity more than zero but less than 

0.05


z	 Quantity more than zero but less than 500 

where numbers are rounded to thousands 

* Figure does not meet standards of 

reliability or precision (more than 

30-percent relative standard error) 

#	 Figure suppressed to comply with 

confidentiality requirements 
12 acklncedata 

Recent Issues of Advance Data From Vital and Health Statistics 

No. 89. Drujzs Most Frequently Used in Ofilce Practice: National 

Ambulatory Medical Care Survey, 1981 (Issued April 15, 1983) 

No. 88. 1981 Summary National Ambulatory Medical Care Survey (Issued March 16, 1983) 

No. 87. Drug Utilization in General and Family Practice by Pharacteristics of Physicians and Office Visits: National Ambulato~ 

Medical Care Survey, 1980 (Issued: March 28, 1983) 

SUGGESTED CITATION 

National Center for Health Statistic, H. Koch: 

Utilization of psychotropic druga in office-based 

ambulatory care, National Ambulatory Medical Care 

Suwey, 1980 and 1981. Advance Data From Vital 

and Health Statistics, No. 90. DHHS Pub. No. 

(PHS) 83-1250. Public Health Service, Hyattsville, 

Md., June 1983. 

U.S. DEPARTMENT OF HEALTH


AND HUMAN SERVICES


Public Health Service


National Center for Health Statistics


3700 East-West Highway


Hyattsville, Maryland 20782


OFFICIAL 8USINESS


PENALTY FOR PRIVATE USE, $300


To receive this publication regularly, contact the


National Center for Health Statistics by calling


301–436–NCHS


DHHS Publication No. (PHS) 83-1250


No. 86. Drug Utilization in Ofllce Visits to Primary Care Physicians: National Ambulatory Medical Care Survey, 1980 (Issued 

October 8, 1982) 

No. 85. Summary Data From the National Inventov of Pharmacists: United States, 1978-79 (Issued October 8, 1982) 

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