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

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


EDUCATION, AND WELFARE office of Health Research, Statistics, and Technology Number 50 � .hly 23,1979


Office Visits by Black Patients, National Ambulatory 

Medical Care Survey: United States, 1975-761 

Presented in this report are data about the 

estimated 90.5 million office visits made by 

black ambulatory patients over the 2-year span 

from January 1975 through December 1976. 

The data, which are contrasted with corresponding data for the overall visit universe, are based 

on the findings of the National Ambulatory 

Medical Care Survey (NAMCS). The NAMCS is a 

continuing sample survey conducted annually by 

.A2ivision of Health Resources Utilization Stae istics of the National Center for Health Statistics. The survey-national in range except for 

Alaska and Hawaii-is designed to explore the 

provision and utilization of ambulatory care in 

the offices of non-Federal, office-based physicians. 

Figure 1 is a facsimiIe of the Patient Record 

used by participating physicians to record information about their office visits. The reader may 

find it useful to refer to figure 1 as selected 

survey findings are presented. 

DATA HIGHLIGHTS 

General Perspective 

During 1975 and 1976, the physician’s 

office was the setting for an estimated 

90,483,499 visits by black patients, about 7.8 

percent of the total 1,155,900,228 office visits 

made by ambulatory patients of all races. This 

represented an average annual visit rate of 1.9 

office visits per year for bIack members of the 

F- lThia report was prepared by Hugo Koch -and 

Raymond O. Gagnon, Division of Health Resources 

Utilization Statisti&. -

civilian noninstitutionalized population, a visit 

rate which is markedIy below the 2.8 visits per 

person per year estimated for all members of 

that population. Black patients showed a relatively greater tendency to visit other ambulatory care sites. According to findings of the 

Health Interview Survey, a national household 

survey conducted by the National Center for 

Health Statistics, they visited hospital outpatient clinics and emergency rooms with a 

frequency that was about 2 to 3 times that of 

white patients. 

Provider Characteristics 

About 77 percent of the office-based care 

rendered to black patients was provided in the 

offices of four specialists: the general or family 

physician, the internist, the pediatrician, and the 

obstetrician gynecologist (table 1). Visits to 

generaI and family physicians alone accounted 

for nearly one-half of all visits. T.na ratio of 

about 3 to 2, visits to solo practitioners outnumbered visits to physicians in multiplemember practice. Table 1 also shows that about 

three-fourths of all office-based care for black 

patients was provided in metropolitan areas. 

Patient Characteristics 

Nearly 2 of every 3 visits by black patients 

were made by persons under 45 years of age 

(table 2). k contrast with the median visit age 

of 37 years found for the entire visit universe, 

the median visit age of black patients was a relatively youthful 33 years. Conforming with the 

overall pattern of office-based care, the annual 

visit rate for the black population generally increased in direct parallel to advancing age (table 
... “, 

Figure 1. PATIENT RECORD 

ASSURANCE OF CON FIDENTIALITY—AII mf.mwtm. whmh would perm,t ,Kfent(flcatmn cd m mdw,dual,


a practice, or a. establishment wII be held confudenttal, wII be wed only by persons engaged m and for


the c..rpose$ of the survey a.d WN not be dsclosed or released to other persons or wed for any other purpose. D N!?


1. DATE OF VISIT PATl ENT RECORD 

NATIONAL AMBULATORY MEDICAL CARE SURVEY

.=7%+ 

2. DATE OF BIRTH 4. COLOR OR 5. PATIEN~S PRINCIPAL PROBLEM(S) 6. SERIOUSNESS OF 7. HAVE YOU EVER SEEN RACE COMPLAINT(S), OR SYMPTOM(S) ~ VISIT PROBLEM IN ITEM 5a THIS PATlENT BEFORE? 

[In patient’s own wo{ds) (Check one) 

I � WHITE I G YES ,DNO * — I � VERY SERIOUS 

3.	 SEX I � NEGROI a, MOST I 

BLACK important_. ~ � SERIOUS If YES, for the problem 

, � FEMALE , � OTHER I n SLIGHTLY SERIOUS ‘nd’cated ;“ ‘TEM 5a? 

I � MALE . � UNKNOWN b OTHER ~ o NOT SERIOUS I ~ YES ‘UNO 

B. MAJOR REASON(S) FOR THIS	 — VISIT (ciec~dimajor rem...) 9. PHYSICIAN’S PRINCIPAL OIAGNOSIS ~ VISIT

a. OIAGNOSIS ASSOCIATE WITH ITEM 5~ ENTRY 

I, � ACUTE PROBLEM u •l WELL AOULT/CHILD EXAM 

$, � ACUTE PROBLEM, FOLLOW-UP ,$ (1 FAMILY PLANNING 

,3 � CHRONIC pRIJB~~M, RolJT,NE ‘O � COUNSELINGIAOVICE 

O. � CHRo NIc pRo BLEM, FLARE. IJP II D IMMUNIZATION 

“, � PRENATAL cARE ‘? � REFERREO BY OTHER PHYS/AGENCY b. OTHER SIGNIFICANT CURRENT DIAGNOSES 

.8 � pOSTNATAL CARE ‘I Q ADMINISTRATIVE PURPOSE (In order of importance) 

$7 � POSTOPERATIVE CARE I. � OTHER (.Sp,Ci/y) 

7 

— (Ope,a[ive procedure) 

10. OIAGHOSTIC/THERAPEUTIC SERVICES OROEFIEO/PROVIOEO THIS VISIT /Ch#ck #// that aPP/y/ 11. DISPOSITION ~ VISIT 12. OURATIOWOf . 

]1 � 

)2 � 

NONE 

LIMITEO HISTORY/EXAM 

11 

12 

� 

� 

DRuG PRESCRISEO 

X. RAY 

{Check all that apply) ~ VISIT {Time 

actually XPCnf w/th 

phys;c!an) 

13 0 GENERAL HIsTORY/EXAM 13 � INJECTION I � NO FOLLOW. UP PLANNEO 

14 � tiLINlcAL LAs. TEST 14 D lMMUNf ZATION/DESENSITIZATION ~ IJ RETURN AT SPECIFIEO TIME 

15 � BLOOD PRESSURE CHECK 15 � PHYSIOTHERAPY 3 � RETURN IF NEEDED. PR N 

16 � EKG 16 � MEOICAL COUNSELING ~ n TELEPHONE FOLLOW-UP PLANNED 

17 � HEARING TEST 17 � PSYCHOTHERAPYITHE RAPEUTIC i � REFER REOTO OTHER illNUTES 

>B O VISION TEST LISTENING PHYSIC IA N/AGENCV 

()9 � EN DOSCOPY 18 � OTHER (specify) 6 ~ RETURNEO TO REFERRING 

PHYSICIAN 

10 � OFFICE SURGERY , u AOMIT TO HOSPITAL 

* E OTHER (.’iP,,,{v)___ I

HI ?A.34-5 DEPARTMENT OF HEALTH, EDUCATION. AND WELFARE 0. M.8. *60. S72; OE a( :V. s-74 PUBLIC HEALTH SERVICE EYGIR AT ION CAT!: ::,31,75 

HEALTH RESOURCES ADMINISTRATION 

NATIONAL CENTER FOR HEALTH STAT15Tl CS 

3). The rate for black patients of over 64 years yielding an average of about 1.3 return visits per 

of age, however, failed to show the pronounced year for every new problem presented. The 

increase common in the overall visit pattern. return visit rate for black patients was lower 

Visits by black females substantially exceeded than the return visit rate of 1.7 visits per year 

those by black males, both in total number and found by similar method for the entire visit 

in annual visit rate (tables 2 and 3). universe, a difference that probably resulted 

At an estimated 43 percent “of their visits, chiefly from the relatively greater frequency 

black patients presented problqms that the among black patients of acute conditions, 

physician had not previously encountered in largely self-limiting in nature, which responded 

those patients (table 2, prior visit status). These rapidly to office-based care (e.g. respiratory illnew problem encounters may be summed up as ness). For about 60 percent of the visits by 

all visits made by new patients (17 percent) plus black patients involving a symptom or C.O_rn~-, 

those made by old patients of the doctor at plaint, the problem had an onset of less than ! 

which a new problem was presented (26 per- months before the visit and was therefore—fol 7 

cent). The remaining 57 percent of visits are NAMCS purposes-classified as an “acute” probreturn visits for previously treated problems, lem, 

— 
— 

dmcdata3 

Table 1. Number and parcent distribution of office visits of Table 2. Number and percent distribution of office visits of 

black patients and percent distribution of office visits of all black patients and percent distribution of office visits of all 

patients, by physician characteristics: Unitad States, 1975-76 patients, by patient characteristics: Unitad States, 1975-76 

1Nu tier of Visits by– Nu rnber o{ Visits bycharacteristic black 

pat ients in characteristic black 

Wt ients in 

thousands 

Z!!IE!z thousands * 

Percent distribution Percent distribution 

AH visits .. .. . .... .. . 100.0 100.0 All visits .. ... .. .... . 90,484 100.0 100.0 

k 

Specialty Age

— 

Under 15 years ... ... ..... .. 15,271 16.9 18.1 

General and family 15-24 years.., . . .. .... . ..... . . 14,935 16.5 15.1 

practice .. . ...... . ...... . ... .. 42,183 46.6 39.8 25-44 years ... . .... .. .... .. . .. 28,122 31.1 25.5 

obstetrics and 45-64 years . .... .. . .. . .... .. .. 22,229 24.6 25.1 

gynecology, .. . ... .. .... ... 9,905 11.0 8.4 65 years and over . .... ... . 9,926 11.0 16.9 

Internal medicine, ... ... . 9,692 10.7 11.3 

Physician visits of Patient visits of 

pediatrics ..................... 7,760 8.6 9.3 Sex and age


General surgery .... ....... 5,657 6.3 6.7


Orthopedic surgery ...... 3,177 3.5 4.1 Female ....................... .. 57,875 64.0 60.4


Ophthalmology ........... 2,854 3.2 4.7


Darrnatology ............... 1,813 2.0 3.1 Under 15 years ....... 7,587 8.4 8.5


Wology ....................... 1,308 1.5 1.8 15-24 years ............. 10,960 12.1 9.9 

psychiatry . .... .............. 995 1.1 2.7 25-44 years ............. 19,165 21.2 16.8 

-olaryngology 

m’di~”.secular disease. 713 0.8 1.2 65 years and over .. . . 6,433 7.1 10.0 

All othar specialties .. ... 3,436 3.6 4.5 IAele .. .. .. .... .. .. ... ....m... .. .. 32,608 36.0 38.6 

Imcation of mactice Under 15 years .. .. .. . 7,664 8.5 9.6 

15-24 years . . ..... ... ... 3,974 4.4 5.2 

Metropolitan aree2 .... .. 68,137 75.3 73.3 25-44 years . .. ... .. ... . .. 8,957 9.9 8.7 

Nonmatropolitan area. 22,346 24.7 26.7 45-64 years ... .. . ..... .. 8,500 9.4 10.0 

65 years and over ... . 3,484 3.9 6.2 

........... 991 1.1 2.4 45-64 years . ............ 13,728 15.2 15.1 

Type of practice 

Prior visit status 

solo ..................... ....... 55,415 61.2 60.0 

Other ... .. ... .. .. .... .. . ..... . . 35,066 38.E 40.0 New patient .. . ..... .. .. .. ... . 

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

15,159 

75,325 

16.8 14.6 

83.3 85.4 

18aeadonl,155, 900,228 office visits over the 2-year span. 

2~cation ~thti the standard metropolitan statieti~l ‘eas 

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

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

23,507 

51,817 

26.0 23.2 

57.3 62.9 

(SMSA’S). Composition of SMSA’a does not reflect 1974 adjuat ments. l~sed on 1,15s,900,228 office viaits over the 2-YeSU sPan. 

Patient’s Reason for Visit Table 3. Number of office visits per year for black patients and 

for patients of all racas, by sex and age: United States, 1975-76 

Table 4 presents in ranked order the 20 rea- 1 

sons that most frequently motivated black Black All 

patients to visit the doctor’s office. These Sex and age I patients I

1 

patients 

reasons are those expressed by the patient, and Total ... . ... ... .. .. ... ... . .... .. . .... .. .. .. .. ... . 1.9 2.8 

they are coded according to a symptom classifi- . 

cation developed for use by the NAMCS. The — 

Sex

listing, which includes nonsymptomatic as well Female .. .... .. . .... .. . .... .. .. ... ... .. ... .. . .... . ... . 2.2 3.3 

as symptomatic reasons, accounts for 52 percent Male .. .. . ..... ... .... .. . ..... . .. .... .. .. ... .. . .... . ... 1.4 2.5 

-of _~l black visits. It is noteworthy that “preg-

“i.ncy visits” head the list. Also distinctive of 

Age I I 

jfice-based care provided black patients is the 15-24 years . .. .... . ... ... .. . .... .. .. .... . . .... .. .. 

relative prominence of respiratory symptoms 

and of complaints involving the back and extremities. ~ 
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

4 --0 

Table 4. Nutier. percent, and cumulative percent of office visits of black mtients and percent of visits of all patients, by the patients’ 

20 mosl com~n reasons for visits in ranked order: United” States, 1975-76 

Black patients 

Percent of 

Rank Patient’s principal reason for visit and NAMCS coda Number of Percent Cumulative visits of 

visits in 

thousands 

of visits percent 

all patientsl 

Pregnancy e=mination ...................................................................9O5 

Pain, swelling, injury-back region ....................................................4l 5 

tild .......... ....................... ....... ........................................ ................3l 2 

Physical examination (excluding well-baby )............................. 900,901 

Pain, swelling, injury–lower extremity ...........................................@O 

Abdominal pain ................ ..............................................................5@ 

Surgical aftercare ................................... .......... ............ ................... 986 

Pain, swelling, injury–upper extremity ................ .......................... 405 

Headache .............................. ................................................ ..........O56 

augh .............. ..................................................... ..........................3ll 

Pain, Svvalling, injury–face and neck .................... ....... ................... 410 

Sora throat ..... .............................................. .................................. 520 

High blood presure . ....................... ................................................2O5 

Allergic skin reaaion ....... ... .................. ............................... ...........l 12 

Wounds of skin ..................................................... ..........................l 16 

Pain in chast ................................................................................... 322 

Vaginal discharge .... ........ ..................................................... ...........662 

Fever ...............~............................................................ .................. 002 

Well-baby e=mination ......... ........ .. ................................................ 906 

Dizziness ..................................................... ....................................O69 

l~sed o* I,1 55,900,228” office v~lts by patients of all races over the Z-year span. 

4,203 4.7 4.7 3.9 

3,890 4.3 9.0 2.9 

3,392 3.8 12.8 1.8 

3,241 3.6 16.4 4.2 

3,222 3.6 20.0 3.7 

3,109 3.4 23.4 2.6 

2,883 3.2 26.6 4.7 

2,590 2.9 29.5 2.7 

2,585 2.9 32.4 1.7 

2,314 2.6 35.0 2.3 

1,917 2.1 37.1 1.4 

1,870 2.1 39.2 2.7 

1,852 2.1 41.3 1.3 

1,741 1.9 43.2 1.8 

1,627 1.8 45.0 1.4 

1,407 1.6 46.6 1.7 

1,281 1.4 48,0 0.8 

1,260 1.4 49.4 

1,258 1.4 50.8 1: 

1,222 1.4 52.2 A 1

Diagnostic Procedures and Diagnoses 

To diagnose the problems that black patients 

presented, physicians focused on the limited 

examination (table 5), i.e., an examination confined to the body site or system directly connected with the patient’s chief complaint. 

Reliance on this diagnostic approach, though 

general throughout ambulatory care, was significantly stronger in the treatment of black patients. It is also noteworthy from table 5 that 

blood pressure readings were taken substantially 

more often during ;isits made by black patients 

than during the overall pattern of visits (40 percent of visits by black patients compared with 

33 percent by all patients). 

The distribution of office visits made by 

black patients and by all patients is given in 

table 6 by major diagnostic groups. The five 

most common groups among black patients in 

order of frequency are diseases of the respiratory system; special conditions and examinations without illness; diseases of the circulatory 

system; accidents, poisonings, and violence; and 

Table 5. Number and oercent of office visits of black ~atients 

and percent of office visits of all patients, by diagnostic procedures ordered or provided: Un itad States, 1975-76 

Number of 

Diagnostic visits of 

procedures ordered black 

or provided patients in 

thousands 

Limited examination ..... 52,385 

Ganeral examination .... . 15,944 

Clinical laboratory test.. 22,932 

X-ray ............................. 6,522 

Blood pressure check ... .. 36,126 

Electrocardiogram ......... 2,483 

Hearing test ................... 867 

Vision teat ............ ......... 3,426 

Percent of visits by– 

Black All 

patientsl Patients* 

57.9 51.6 

17.6 16.3 

25.3 22.8 

7.2 7.6 

39.9 33.2 

2.7 3.3 

1.0 1.3 

3.8 5.0 

Endoscopy .................... 545 ~ 0.6 1.2 

lBased on 90,483,499 v%lt~. 

2Based on 1,155,900,228 vswts, 

diseases of the genitourinary system. TabJ& 

presents in ranked order the 20 specific con 

tions most frequently encountered; note thaa

they account for nearly one-half (47.3 percent) 

of alI visits made by black patients. 
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

o--/ 

admncedata 5 

Table 6. Number and percent distribution of office visits of black patients and percent distribution of office visits of all patients, by 

major diagnostic groups and inclusive ICDA codes United States, 1975-76 

Number of 

visits of Visits by– 

Major diagnostic groups and inclusive ICDA codesl black 

patients in 

thousands 

c 

Percent distribution 

All visits ........................................... ................................. .............................................. 90.484 100.0 100.0 

Infective and parasitic diwases .. .. .. .. . .... . . ..... . . ... . ... .. ... ... . .. . .... . . .... .. ... . . .. ... . . ... .. .. .. .. . .... .. . ..OOO.l 36 4,410 4.9 4.2 

N~plasms .. ..... .. ... . .. .... .. . ... ... . .. .. . ... .. . ... .. .. .. . .. .... . ... .. . .. .. .. .. ... .. . ..... . ... .. .. .... . .. ... . . .... .. . .. ... ..l4O.239 1,468 1.6 2.2 

Endocrine, nutritional, and metabolic diseases . .. .. ... . ... .. . . ... .. . .... . . .... . .. ... . . .... . .. .. .. .. ... .. . .. 240-279 4,270 4.7 4.2 

Mental disorders ... . . .... . ... .. ... . .. ... . .. .. .. .... . .... .. .. .. .. . .... . .. ... . .. .... . .. ... .. .. .. . .. ... .. . ... .. .. ... .. . ... . . ..29O.3l 5 3,068 3.4 4.2 

Diseases of nervous system and sense or@ns ... . .. .. .. .. .... .. .... . . .... .. ..... .. ... ... . .. .. .. .. .. .. ... .. .. 320-389 4,998 5.5 8.2 

Diseases of circulatory system .. .. .. .. . .... .. .... .. . .... . .. .. . ... .. ... . ... .. . .... .. .... . .... .. . ... .. .. ... . .. ... .. . .. 390458 9,366 10.4 9.6 

Diseases of respiratory sySem .. .. ... .. . ... . .. .... . . ... . ... .. .. . ... .. . . ... .. . .... . .. ... . . .... .. . ... .. . ... .. . .... .. .. 460-519 14,704 16.3 14.1 

Diseases of digestive symem . ... .. .. .. .. ..... . .. ... . . .... . .. ... .. .. ... .. . .... . . .... . . ..... .. ... . ... .. . ... ... . . ... .. ...52O.577 2,999 3.3 3.3 

Diseases of genitourinary system ... .. . .. ... . ... . .. ... .. .. .. .. .. .... . . ... ... . ... . . .... . . .... . ... .. .. .. .. . .. ... . .. .. 580-629 6,822 7.5 6.2 

Diseases of skin and subcutaneous tissue .... .. ... .. . .... .. . .... .. ... .. . .... .. . ... .. .... ... .. . .. .. .. ... . .... . . . 680-709 4,445 4.9 5.3 

Diseases of musculoskeletal system . . .... . .. ... . .. ... .. ..... .. .... .. . ... . . ..... . .. .. . .. .... . .. .. .. .. . ... . . .... . ..7l O-738 5,271 5.8 5.7 

Symptoms and illdefined renditions ... . . ... ... . .. ... . ... ... .... . .. ... .. . .... . . ... .. .. ... . .. .. .. . ..... . . ... .. ..78@796 4,063 4.5 4.7 

Accidents, poisonings, and violence . . ... . .. ... .. .. .. . ... .. .. . ... ... . .... . . .... . .. ... ... ... .. . ... ... ... .. .. ... . .. . Boo-999 8,140 9.0 7.3 

Special conditions and examinations without sicknes .. . .. .... . . .... .. .... . .. ... . ... .. . ... .. .. . .... . .. YO&Yl 3 14,295 15.8 18.1 

Other diagnows3 . .. .. ... .. . ... .. .. .. .. .. . .. .. . .... .. .. .. .. .. .. .. .. .. ... . ... . .. .... . ..... . .. .. . .. .... . ... ... . . ... .. . ... .. . ... . ... .. ... .. 1,365 1.5 1.4 

Diagnosis “none” or ''unknown'' . ... . . ... .. ... .. . . ... .. . ... .. .. ... .. .. ... . .. ... . .. ... .. .. .. . ... .. .. . .... . . .... .. .... .. . .. .. .. . 788 0.9 1.3 

lBased on E&hth Revision International G7msificatibn of Diseasws, Adapted for Use in the United 

2Based on 1,1 SS,gO0,228 office tilts by patients of all races over the 2-Ye= sPan 1975-76. States, ICDA. 

3~1~ea=s of blood and blood.for~~g organs; complications of pregmncy, childbirth and the PuerPerium; congenital anomelies; and certain causes of perinatal morbidity and mortality. 

Table 7. Number, percent, and cumulative percent of office visits of black patients and percent of visits of all patients, by the physicians’ 

20 most mmrnon diagnoses in ranked order: United States, 1976-76 

Black patients 

Percent 

Rank Principal diagnosis and ICDA codel Number of of visits 

visits in of Cumulative of all 

thousands visits percent patients2 

Medical and special examinations .. ... .. . .... .. .... .. .. .. .. .. .. .. .. ... . .. . YOO 5,177 5.7 5.7 7.4 

Essential benign hypertension . ..... .. .... . ... .. . .. ... . .. ... .. . .... .. ... . .. .. 401 5,019 5.6 11.3 4.0 

Acute upper respiratory infection . .... .. . .... . . .... . . ... .. .. ... .. ... .. . .. 465 4,403 4.9 16.2 2.9 

Prenatal care . .. .. .. .... .. . ... .. .. ... . . .. ... . . .... .. . ... .. . .... . .. .. .. .. .. .. . ... .. .. . Y06 4,211 4.7 20.9 3.7 

Medical end surgical aftercare .. .. .. ... .. .. .. . .... .... ... .... . ..... . . .... . .. . YIO 3,179 3.5 24.4 4.9 

Diabetes . .. .. . . .. .. . ... ... . ... .. .. .. .... . . .... . . .... .. .. .. ... . ... .. .. .. .. . .... . .. ... . .. . 250 2,228 2.5 26.9 1.7 

Sprains, strains: other and unspecified parts of back .. .. ..... . .. . 847 1.993 2.2 29.1 1.0 

Chronic ischemic heart disease . .. . .. ... . .. .. .. .. .. .. .. . ... . .. ... .. . ... . .. .. 412 1 ;743 1.9 31.0 2.3 

Neuroses ... . .... . ... .. .. .. ... .. .. .... . .. .... .. .... . .. ... .. .. ... . . ..... . ..... . ... .. . ... 300 1,712 1.9 32.9 2.2 

Obesity . . .. . ...... . .. ... ... .. .. . . .... . .. ... . ... .. .... .... .. .. .. .. .... ... .... . .. ... . . ... 277 1,329 1.5 34.4 1.4 

Bronchitis (unqualified) . .. ... .. .. .... .. .... ... .. . ... .. .. . . ... .. . ... ... ... .. .. .. 490 1,311 1.5 35.9 1.2 

Other eczema an”d dermatitis . ... .. . . .... .. .... .. . .. ... . ... .. . .... . . ... .. . ... 692 1,299 1.4 37.3 1.7 

Sprains, strains: sacroiliac region .. ... .. .. .. .. .. . .. .. . ... ... ... .. ... .. . .... 846 1,230 1.4 38.7 0.7 

Acute pharyngitis . .. .. .... . . .. .. .. .. .. .. .. .... ... ... .. . ... . . .. .. ... . .. .. . . ... . .. .. 462 1;177 1.3 40.0 1.5 

Asthma ... .. . ..... . .. .. .. .. ... . ... ... .. .. .. .. .. ... . .. ... . .. ... ... . ... .. .. .. . . ..... .. ... 493 1,1 6B 1.3 41.3 1.0 

Cystitis .. .. .. . ... . ... .. .. .. .... . .. . .. .. .. .. .. .. .... .. .. .. .. .. .. .. . ... ... . ... . .. .... .. ... 595 1,167 1.3 42.6 0.8 

Acute tonsillitis .. ... . ... .. . .. .... . . ... ... . ... ... . ... .. .. . ... . ... .. .. ... . ... .. . .. ... 463 1,083 1.2 43.8 1.1 

Osteoarthritis end allied conditions .. .. ... . .. . . ... .. .. . .. . .. . .. ... . . ... 713 1,051 1.2 45.0 1.1 

Disorders of menstruation . .. . ... .. .... .. . ..... .. .... .. ... . .. . ... .. .... .. .... 626 1,048 1.2 46.2 0.7 

Synovitis, bursitis, and tenosynovitis . .. .. ... . .. .. .. .. ... ..... .. .... . .... 731 1,029 1.1 47.3 1.0 

~~ased on Eighth Revision International Classificafi”on of Diseases, Adapted For use in the united States, lCDA. 

2Based on I,lss,go0,22s office visits by patients of all races over the 2-Year sPan 1975-76. 
--

--)


6 

Other Visit Characteristics 

In the physician’s judgement, most of the 

conditions presented by black office patients 

were not very severe in prognosis. Four of every 

five conditions could be categorized as ranging 

from slightly serious to not serious (table 8). 

This is about the same proportion as in visits by 

all patients. 

Drug therapy plays an extensive part in the 

overall pattern of office care. It is even more 

extensively applied in the care of black patients 

since more than half of all such visits involve 

treatment by a prescription or nonprescription 

drug (table 8, therapeutic services). 

In agreement with the overall tendency in 

office ambulatory care, a return visit was the 

form of disposition most frequently found in 

the care of black patients (table 9, disposition). 

Table 9 shows that the slightly greater-thanaverage use of the direction “return if needed” 

probably reflected the relatively higher incidence of acute, self-limiting conditions found 

among black office patients. 

Table 8. Number and percent of office visits of black patients 

and percent of office visits of all petients, by ~riousness of 

problem and selected therapeutic services orderad or wovidad: United States, 1975-78 

, 

Seriousness of Number of 

problem and visits of %CWIt of visits by– 

selected therapeutic black 

services ordered patientsin 

or provided thousands Zq= 

Seriousness of I 

problem 

Serious or vary Seriouso. 16,898 18.7 19.4 

Slightly serious .. . ....... .. . 32,009 35.4 32.0 

Not serious .. .. .. .. .... ... .. . . 41,576 46.0 46.6 

Therepaut ic 

~ 

Drug prescribed ........... 46,852 54.0 43.6 

Injection ..................... 12,604 13.9 13.1 

Immunization or 

desensitization ...... ... . 2,861 3.3 4.9 

Office surgery .. ............ 3,975 4.4 6.9 

Physiotherapy ............. 3,084 3.4 2.6 

Medical Counwling ...... 11,258 12.4 13.0 

Psychotherapy and 

therapeutic listening.. 

I 

1,720 L1.9 4.2

lBaaed on 90,483,499 visit+. z~wd on 1,155,900,22S v~ts­

—, . I 

Table 9. Number and percent distribution of office visits of 

black patients and percent distribution of office visits of all 

patients, by disposition and duration of physician-patient 

contact: United States, 1975-76 

Number o Disposition and 

duration of visits of 

black physician-patient 

contact patients in 

thousands 

All visits ........... eo,4s4 

Disposition 

NO followup planned.. 10,712 

Raturn at specified 

time ......................... . 52,496 

Raturn if nwded ......... 22,607 

Telephone followup 

planned ..................... 1,846 

Referred to other 

physician or agency.. 3,220 

Returned to referring 

physician .................. S48 

Admit to hospital ....... 1,796 

Duration of contact 

O minutes (no face-to. 

face contact with 

physician) .. .............. 758 

1-5 minutes ................ 19,147 

6-10 minutes .............. 28,968 

11-15 minutes ............ 24,006 

16-30 minutes ............ 13,86o 

31 minutes or moreC.Ct 2,744 

Visits by– 

I!!ZE!Z 

Percent distribution 

100.0 

~ 

11.8 

58.0 

25.0 

2.0 

3.6 

0.9 

2.0 

0.8 

21.2 

33.1 

26.5 

15.3 

3.0 

100.0 

12.3 

60.2 

21.9 

3.5 

2.8 

0.9 

1.8 

15.1 

31.5 

26.6 

19.5 

5.5 

J 

l~5~d on I,1 55,900,22g office visits by patients of allrmes 

over the 2-year span 1975-76. 2MWI not total to 100. o since more than one disposition ww 

possible. 

Data on duration of contact in table 9 

suggest that the overall average length of time 

spent in face-to-face contact with the physician 

was less for black than for white patients. The 

mean contact duration for black patients was 13 

minutes as compared with an estimated average 

of about 15 minutes for the total visit universe. 

It would be inaccurate to infer, however, that 

this shorter time was the direct product of color 

or race. Rather, the difference stemmed chiefly _ 

from the symptoms presented by black patients, 

of which a greater proportion than average were 

acute and self-declaring by nature, requiring 

relatively less time to diagnose and treat. 
—’ dmlceda7 — . 

TECHNICAL 

SOURCE OF DATA: The information presented


in this report is based on data collected in the


National Ambulatory Medical Care Survey


(NAMCS) during 1975 and 1976. The target


universe of the NAMCS is composed of office


visits made within the coterminous United


States to non-Federal physicians who are prin­


cipally engaged in office practice and are not in


the specialties of anesthesiology, pathology, or


radiology. The National Opinion Research


Center, under contract to the National Center


for Health Statistics, was the organization re­


sponsible for the survey’s field operation.


SAMPLE DESIGN: The NAMCS utilizes a multi-


stage probability design that involves samples of


primary sampling units (PSU’S), physician prac­


tices within PSU’S, and patient visits within


practices. Each year a sample of practicing


physicians is selected from master files main­


tained by the American Medical Association and


American Osteopathic Association. For the


“Y-year period 1975-76, a total of 6,529 physi­


cians were included in the sample. Of those


found eligible for the survey, 79.9 percent par­


ticipated. Characteristics of the physician’s


practice–for example, primary specialty and


type of practice–are obtained during an induc­


tion interview. During a 1-week reporting


period, physicians who participated in the


NAMCS completed brief encounter forms for a


sample of their office visits (see Patient Record,


figure 1). The Patient Record included an entry


for color or race (item 4). The physician was


instructed to select the racial category that,


based on his observation or prior knowledge of


the patient, was most appropriate for the


patient. The estimates presented in this report


are based on the Patient Records completed for


15,004 visits by black patients over the 2-year


period 1975-76. A detailed description of the


NAMCS design and procedures has been pre­


sented in an earlier publication. Z


SAMPLING ERRORS: Since the estimates for


this report are based on a sample rather than the


2 National Center for Health Statistics: The National 

- ‘~bulatory 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. 

NOTES 

entire universe, the y are subject to sampling 

variability. The standard error is primarily a 

measure of sampling variability. The relative 

standard error of an estimate is obtained by 

dividing the standard error of the estimate by 

the estimate itself and is expressed as a percent 

of the estimate. Relative standard errors of selected aggregate statistics are shown in table I. 

The standard errors appropriate for the estimated percentages of the office visits are shown 

in table II. 

Table 1. Approximate relative standard error of estimated 

numbers of office visits, NAMCS 1975-76 

Estimate 

in 

thousands I Relative standard 

error in 

percentage points 

600 ... . ... .. ... . .... .. .. .... .. .. .. .. .. .... .. . 30.2 

1,000 .. . . .. .. ..... .. .. ... . .... .. .. .. . .. .. . 23.5 

2,000 .. .... .. .. .. .. .. .... .. .. .... .. .. .... .. . 16.7 

4,000 .. ... ... . .... .. . .... .. .. .. .. .. ... .. .. . 12.0 

10,000 ... . .. .... . .. ... ... .. .... .. .. .... .. .. 8.0 

40,000 .. .. ... .... .. .. .. .. . .... .. . .. ... . .. .. 4.8 

200,000 .. ... .. .. . . .. .. . .. .... .. .. .. .. ... .. 3.4 . 

1,000,000 .. ... .. ... ... . .. .... .. .. .. .. . ... 3.1 

Example of use of table: An aggregate estimate of 25,000,000 

visits has a relative standard error of 6.4 percent or a standard 

error of 1,600,000 visits (6.4 percent of 25,000,000). 

Table 11. Approximate standard errors of percentages for 

estimated numbers of office visits, NAMCS 1975-76 

Base of percentage 

Estimated percentage 

(number of visits 1 or 5 or 10or 20 or 30 or in thousands) 99 95 90 80 70 

I Standard error in percentage points 

600 .............. ..... ..... 3.0 6.5 9.0 12.0 13.8 15.0 

1,000 .. .............. ..... 2.3 5.1 7.0 9.3 10.7 11.6 

2,000, ......... ..... ...... 1.6 3.6 4.9 6.6 7.5 8.2 

4,000 ................ ..... 1.2 2.5 3.5 4.7 5.3 5.8 

10,000 ................... 0.7 1.6 2.2 2.9 3.4 3.7 

40,000 ...... ...... ....... 0.4 0.8 1.1 1.5 1.7 1.8 

200,000 ................. 0.2 0.4 0.5 0.7 0.8 0.8 

1,000,000 .. ............ 0.1 0.2 0.2 0.3 0.3 0.4 

Example of use of table: An estimate of 20 percent based on 

an aggregate estimate of S0,000,000 visits has a standard error of 

1.3 percent. The relative standard error of 20 percent is 6.5 (1.3 

percent + 20 percent). 

ROUNDING OF NUMBERS: Aggregate estimates of office visits presented in the ;ables are 

rounded to the neare;t thousand. The rates and 

percents, however, were calculated on the basis 

& original, unrounded figures. Because of 

rounding of percents, the sum of percentages 

may not equal 100.0 percent. 
------------------------------------ ---

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

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

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

. . 8 admncedata 

4 

DEFINITIONS: An am In&ztm-y patient is an for ambulatory patients at an office location. 

individual presenting himself for personal health Excluded from NAMCS are physicians who 

services who is neither bedridden nor currently specialize in anesthesiology, pathology, or radiadmitted to any health care institution on the ology; physicians who are federally employed; 

premises. physicians who treat only institutionalized 

An office is a place that the physician iden- patients; physicians employed full time by an 

tifies as a location for his ambulatory practice. institution; and physicians who spend no time


Responsibility over time for patient care and seeing ambulatory patients.


professional services rendered there generally


resides with the individual physician rather than SYMBOLS an institution. 

A visit is a direct personal exchange be- Data not available 

tween an ambulatory patient and a physician or 

a staff member working under the physician’s Category not applicable . . . 

supervision for the purpose of seeking care and Quantity zero -

rendering health services. Quantity more.than O but less than 0.05---- 0.0 

A physician is a duly licensed doctor of Figure does not meet standards of * medicine (M. D.) or doctor of osteopathy (D. O.) reliability y or precision 

currently in practice who spends time in caring 

Recent Issues of Advance Data From Vital and Health Statistics 

No. 49. Office Vm.its for Family Planning, National No. 46. Hemoglobin and Selected Iron-Related F1nd- --% ,$- .,

Ambulatory Medical Care Survey: United ings of Persons 1-74 Years of Age: United 

* States, 1977 (Issued: Aprif 16, 1979) States, 1971-74 (Issued: January 26, 1979) 

No. 48.1977 Summary: National Ambulatory Medical No. 45. Use of Family Planning Services by Currently 

Care Survey (Issued: April 13, 1979) Married Women 15-44 Years of Age: United 

States, 1973 and 1976 (Issued: February 7, 

No. 47.	 Prevalence, Dkability, and Heslth Care for 1979) 

Psoriasis Among Persons 1-74 Years: United 

States (Issued: April 3, 1979) 

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

Information Branch. 

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