FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEAL 7H STATISTICS 

U.S. DEPARTMENT OF HEALTH . Public Health Serwce Number 65 � November% 1980 AND HUMAN SERVICES Office of Health Research, Statistics, and Technology 

Cough as the Reason for Office Visits, National Ambulatory 

- Medical Care Survey: United States, 1977-781 

‘o


Cough was the principal reason for an 

estimated 29,059,242 visits to office-based 

physicians during 1977-78. Cough ranked fifth 

among all principal reasons for visits but was the 

second most frequent symptomatic reason given 

by patients (table 1). 

The estimates in this report are based on 

data coIlected in the National Ambulatory 

Medical Care Survey (NAMCS), a probability 

sample survey conducted yearly by the Division 

of Health Resources Utilization Statistics of the 

National Center for Health Statistics. 

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 subject to sampling variability. The Technical’ Notes at the end of this report provide a 

brief exphmation and guidelines for judging the 

precision of the estimates presented. A more 

detailed description of the sample design and 

definitions of certain terms used in NAMCS have 

also been published elsewhere.z 

Figure 1 is a facsimile of the 1977-78 Patient 

Record used by participating physicians to record information about office visits. The patient’s complaint, symptom, or other reason for 

the visit, expressed as nearly as possible in the 

patient’s own words, is recorded by the physi1This report was prepared by Beulah K. Cypress, 

Ph.D., and Thomas McLemore, M.S.P.H., Division of 

Health Resources Utilization Statistics. 

2National Center for Health Statistics: The National Ambulatory Medical Care Survey, 1977 Summary: United States, January-December 1977, by T. 

Ezzati and T. McLemore. Vital and Health Statktics. 

Series 13-No. 44. DHEW Pub. No. (PHS) 80-1795. 

Public Health Service. Washington. U.’S. Government 

Printing Office, Apr.- 1980. 

cian in item 6. The pn”ncipal reason is the one 

that in the physician’s judgment was most responsible for the patient making the visit. It 

is the first-listed reason in this item. These data 

were classified and coded according to a reason 

for visit classification (RVC) system presented 

in A Reason for Visit Classification for A mbulatory Care.3 Since 1977 was the first year 

that this classification system was used, caution should be exercised in comparing the 

data presented in this report with those of 

prior years. 

DATA HIGHLIGHTS 

Table 2 provides the age and sex of patients 

who visited office-based physicians for medical 

care related to cough. Most of these visits (46 

percent) \vere made by children under 15 years 

of age. Cough accounted for about 8 percent of 

all visits to pediatricians’ offices, a higher proportion than to those of other specialties (table 

3). 

The rates of visits made because of cough 

were higher in the Northeast and the West than 

in the North Central ‘and the South, and in 

metropolitan than in nonmetropolitan areas 

(table 4). 

The principal diagnosis made by the physician for the patient who presents cough as the 

3National Center for HeaIth Statistics: A reason for 

visit classification for ambulatory care, by D. Schneider, 

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

Public Health Service. Washington. U.S. Government 

Printing Office, Feb. 1979. 

I 
Figure 1. NATIONAL AMBULATORY MEDICAL CARE SURVEY PATIENT RECORD FORM: 

1977-78 

* 

ASSURANCE OF CONFIDENTIALITY–All informmion which would permit idenlificaion of m individual, 

apracti~, ora"e~btishment willkheld con fidential. will kuSd0nly by persxweng.ged in and for 

thepurp-s ofzhes.rvev and will “otmtixloSd orrdeWd moxheroermnsor .$edfora.yo~he,pu,pom. 

A 033012 

1.DATE OF VISIT PATIENT RECORD 

NATIONAL AMBULATORY MEDICAL CARE SURVEY 

mzb -

2. DATE OF BIRTH 3. SEX 4. COLOR OR 5. WAS PATIENT 6. PATIENT’S COMPLAINT(S), SYMPTOMIS), OR OTHER 

RACE REFERRED FOR REASON(S) FOR THIS VISIT 

THIS VISIT BY (in P.tient’S own words) 

, � WHITE ANoTHER 

z 13 FEMALE , � NEGRO/ PHYSICIAN? a MOST 

* ~ B LACK IMPORTANT 

, � MALE 1 � YEs 

, � OTHER b. OTHER 

� � UNKNOWN .zUNO 

7.	 TIME SINCE ONSET 8. PHYSICIAN’S DIAGNOSSS 9. HAVE YOU SEEN 10. iER10USNE3S OF 

OF COMPLAINTI PATIENT BEFORE? CONDITION IN 

SYMPTOM IN ITEM h a. PRINCIPAL DIAGNOSIS/PROBLEM ASSOClATED WITH ITEM 8a (Check one) 

m 

(Chsck one) ITEM 6a 

: � LESS THAN 1 DAY 

— . 

z � 1-6 OAYS b. OTHER SIGNIFICANT CURRENT DIAGNOSES 

~ D 1-3 WEEKS 

* � 1-3 MONTHS 

MORE THAN Sa 3 MONTHS 

* � NOT APPLICABLE 

11. OIAGNDSTIC SERVICES THIS 12. THERAPEUTIC SERVICES THIS 

I Q YES ~aNO 

I � VERY SERIOUS + 

IF YES, FOR THE 2 � SERIOUS CONDITION IN 

ITEM 88? SLIGHTLY 30 SERIOUS 

4 � NOT SERIOUS 

I � YES 10NO 

13. DISPOSITION THIS VISIT 14. DURATION OF 

VISIT fChsck all ordsred or pruv;ded) 

I � NONE z � LlhflTEO EXAM/HISTORY


1 � GENERAL EXAMIHISTORY


4 � PAP TEST


s � CLINICAL LAS TEST


6 � X-RAY


7 ti EKG 

* Q VISION TEST 

9 � EN OOSCOPY 

, 0 � BLOOD PRESSURE CHECK 

, I � OTHER /.SpScify) 

VISIT (Check all ordersd or provided) 

J � NONE 

~ � lMMUNIZATlON/ 

DESENSITIZATION 

, � DRUGS (PRESCRIPTION/ 

NONPRESCRIPTION I 

4 � CUET COUNSELING 

5 � FAMILY PLANNING 

6 � MEDICAL COUNSELING 

7 Q PHYSIOTHERAPY 

8 � OFFICE SURGERY 

� � PSYCHOTHERAPYI 

THERAPEUTIC LISTENING 

10 � oTHER (~jfy) 

(Check all that apply) 

1 Q NO FOLLOW-UP PLANNED 

2 � RETURN AT SPECIFIED TIME 

3 � RETURN IF NE ED EO, P.R.N, 

‘ � TELEPHONE FOLLOW-UP PLANNED 

5 � REFERRED .TO OTHER PHYSICIAN 

!‘ � ‘ETURNED TO REFERRING PHYSICIAN 

7 � ADMIT TO HOSPITAL 

8 � OTHER (Specifv) 

THIS VISIT 

lTime actuallv 

spent with 

physician) 

* 

MINuTES 

I
 I
 H RA-34-2 DEPARTMENT OF HEALTH, EOUCATIDN AND wELFARE O.M.S. #68-R1498 REV. 9-76 Pu6Ltc HEALTH 5EHv ICE 

HEALTH RESOURCES ADMINISTRATION 

NATlONAL CENTER FOR HEALTH STATISTICS 

e


I 
. 

0 ahEe&ta3 — 

Table 1. Number, percent, and average annual rate of office visits, by most frequent principal reasons for visit: United States, 1977-78 

Average 

Number of annual 

Principal reason for visit and RVC codel w-sitsin Percent visit rate 

thousands per 1,000 

persons 

All reasons ........................................................................................................................ 1,154550 100.0 2,727.1 

General medical examination .. .. .. .. .. .. .. .. .. ... .. . .... . ... ... . .. .. .. .. .... . . .... . ... ... . .. .. .. . . .... . .. ... . ... ... . .. ..- XIOO 58,115 5.1 139.6 

Prenatal examination, routine .. . .. .. .. .. ... .. . .... .. .. .. .. .. ... .. . .... .. . ... . ... .. .. .. ... .. .. ... .. .. ... . .. ... .. . .... . . ... X205 40,394 3.5 95.4 

Symptoms referable to throat ... ... . ... . . ... ... . .... . .. .. .. .. ... .. .. .... . . ... .. . .... .. .. .. .. .. .... .. . ... .. .. .. .. .. ... . ... S455 34,884 3.0 82.4 

Postoperative visit .. .. .. .. ... . ... .. . ... .. .. ... .. . ... .. . ..... . .. ... .. .... .. .. .... . . ... ... . .... .. . .. ... . .... .. . ... . .. ... .. . ... .. .. T205 28,674 2.6 70.1 

cough . ............................................................................................................................... S440 28,059 2.5 68.6 

lBased on A Reason for Visit Classification for Ambulatory Care (RVC). 

Table 2. Number, percent distribution, and average annual rate 

of office visits with cough as the principal reason for visit by 

age and sex of patient: United States, 1977-78 

Average 

Number of annual Percent 

Age and sex visits in distribution visit rate 

thousands per 1,000 0 II persons 

Table 3. Number and percent of office visits with cough as the 

principal reason for ‘visit, according to selected physician 

specialties: United States, 1977-7S 

Numhr in thousends I 

Percem 

specialty 

All visits Visits for 7 cough

Both sexes I I All ages ...... ....... 

l==%= 

Under 15 years ....... ..... 13,438 46.2 

15-24 years ................. 3,048 10.5 

2544 years .. ............... 4,706 16.2 

45-64 years ................. 4,899 16.9 

65 years and over . ....... 2,969 10.2 

Female 

I I All ages ................. .. I 

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

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

2544 years ....... ....... .... 

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

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

Male 

All ages ................... 

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

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

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

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

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

15,769 I 54.3 

6,103 21.0 

1,976 6.8 

2,794 9.6 

3,164 10.9 

1,732 6.0


I 

13,290 45.7 

7,335 25.2 

1,072 3.7 

1,912 6.6 T 1,735 6.0

1,237 4.3

68.6 

132.3 

38.5 

42.2 

56.7 

66.1 

72.0 

122.6 

49.1 

48.!5 

70.2 

65.6 

65.1 

141.5 

32.1 

35.5 

42.1 

66.7 

All specialties.-.. 1,154,550 

General and family 

practice .................. 433336 

Internal medicine......... 133al 

Pediatrics.................. 114S21 

General surgery.......... 68,223 

Otolaryngology............ 32,193 

28,059 2.5


,


15,185 3.5 

3#279 2.5 

8,571 7.5 

567 0.8 

�255 0.8 

chief complaint is recorded in item 8 of the 

Patient Record. Diagnostic codes are based on 

the Eighth Revision, International Classification of Diseases (lCDA).4 

Table 5 contains a Iist of the most frequent 

associated diagnoses. Bronchitis (acute, unqualified, and chronic) accounted for about 30 percent of these visits. 

4Nation~ Center for Health Statistics: ~ig~t~ 

Revision International CLrssijZcation of Diseases, Adapted 

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

Health Service. Washington U.S. Government Printing 

Office, 1967. 

* 

I 
4 advancdata 

Table 4. Number. parcent, and average annual rate of office visits with cough as the principal reason for visit, according to geographic m 

region and type of area of practice: United States, 1977-78 

Average Number in thousends . annual 

Region and type of area Visits for 

Percent visit rate 

All visits per 1,000 cough 

Regicm 

Nomheast .............................................................................................................. 

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

South ..................................................................................................................... 

Type of area 

Metropolitan .......................................................................................................... 

Nonmetropolitan ............................... ........................ ............................................ 

persons 

271,440 7,600 2.8 78.3 

281,571 7’,577 2.6 66.5 

355,754 8,291 2.3 60.0 

235,785 5,591 2.4 75.3 

865,549 21,365 2.5 73.8 

289,001 7,694 2.7 57.5 

. Table 5. Number and percent distribution of office visits with cough as the principal reason for visit 

by principal diagnosis: United States, 1977-78 

Number of 

Principal diagnosis and ICDA code] visits in Percent 

distribution thousands 

Otitis media without mention of mastoiditis ............................................................................ ............... 381 

Acute nasopharyngitis (common cold) .................................................................................................... 460 

Acute pharyngitis ................................................................................................ .................................... 462 

Acute laryngitis and tracheitis .................................................................................................................. 464 

Acute upper respiratory infection of multiple or unspecified sites ............................................................ 465 

Acute bronchitis and bronchiolitis ................................................................................................ ............ 466 

Influenza, unqualified ............................................................................................j .................................. 47o 

Pneumonia, unspecified ..................... ....................................................................................................... 486 

Bronchitis, unqualified .............................................................................................................................. 490 

Chronic bronchitis ..................................................................................................................................... WI 

Asthma .......................... ............................................................................................................................ 493 

Chronic sinusitis ......... ............................................................................................................................... 503 

Hay fever ..................................... ............................................................................................................. 507 

Other diseases of respiratory system .................................................................................................. ....... 519 

Symptoms referable to respiratory system.. .............................................................................................. 783 

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

29,059 

825 2.8 

910 3.1 

. 984 3.4 

602 2.1 

7,539 25.9 

2,177 7.5 

798 2.8 

894 3.1 

6,243 21.5 

375 1.3 

1,012 3.5 

757 2.6 

855 2.9 

837 2.9 

453 1.6 

3,798 13.1 

1 Based on the Eighth Revision International	 Classification of Diseases, Adapted for Use in the United States (lCDA). 

. 

. 
a 

. 

Table 6 shows the percent of visits with selected diagnostic and tfierapeutic services. Drug 

the;apy (either prescription or nonprescription) 

was used in 92 percent of the visits related to 

cough, a proportion that exceeded the average 

of 53 percent of all NAMCS visits. 

Like most visits for acute, self-limiting conditions, most visits for treatment of conditions 

due to cough were of short duration. Table 7 

shows that about 41 percent of such visits took 

only 6 to 10 minutes, and another 29 percent 

Iasted no longer than 15 minutes. 

Table 6. Percent of office visits with cough as the principal reason 

for visit, by selected diagnostic and therapeutic services ordered or provided: Unite~Statas, 1977-78 

Percent Diagnostic and therapeutic services of visits 

Diagnostic service 

None .......................................................................... 3.0 

Limited exam/hiqory ............................................<... 70.3 

General exam/history ................................................ 23.0 

Clinical lab. test... ............ ......................................... . 13.6 

X-ray .......................... ...... .......................................... 11.5 

EKG .......................................................................... 1.2 

Blood pressure check ............................ ................ ..... 25.2 

Therapeutic service 

Nona .......................................................................... 3.3 

lmmunization/desansitization...................................., 4.3 

Drugs (prescription/nonprescription).......................... 92.3 

Diet counseling .......................................................... 2.7 

Medical counseling ..................................................... 21.8 

achancedata 5 

Patients were most often instructed to return 

if needed (43 percent of visits) or to return at a 

specified time (about 36 percent): 

Additional data on cough and other reasons 

for office visits will be presented in more detail 

in a forthcoming publication. 

Table 7. Percent distribution of bffice visits with cough as the 

principal reason for visit by duration and disposition of visit: 

United States, 1977-78 

Percent 

Duration and disposition distribution 

of visits 

Duration 

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

O minutesl ........................................................... 

1-5 minutes .......................................................... 

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

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

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

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

Disposition 

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

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

Return if needed, P.R.N. ..................................... 

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

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

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

Return to referring physician or other 

disposition ......................................................... 

100.0 

1.2 

.	 15.3 

40.8 

29.0 

12.7 

*1.1 

15.8 

35.5 

43.0 

7.3 

*0.8 

1.2 

‘0.5 

lvisit~ in \vhiCh there was no face-tO-faCe COntaCt between 

the atient and the physician. JWill not add to 100.0 since more than one disposition was 

possible. 

I 
I 

6 acklncedata —— 

TECHNICAL NOTES ‘ e 

SOURCE OF DATA . 

‘rhe inf{]rrnation presented in this report is 

based on data collected in ~hc National Ambulatory Medical Care Survey (NAMCS) during 

1977 and 1978. The NAMCS universe is composed of office visits made within the conterminous United States by ambulatory patients 

to nonfedemlly employed physicians who m-e 

principally engaged in office practice and arc 

not in the specialties of anesthesiology, patholo:y, or radiology. The National Opinion 

Research Center, under contract to the National Center for Health Statistics, is rcsponsihle for the NALICS field opemtions. 

SAMPLE DESIGN 

NAhlCS utilizes a multistage probability 

desi<gn that involves samples of primary sampling units (PSU’S), physician practices within 

PSLT’S, and patient visits lvithin physician prdctices. For 1977-78 a sample of 6,007 nonFederal, office-based physicians was selected 

from master files maintained by the American 

Medical Association and the American Osteopathic Association. The physician response rate 

for this period was 75.1 percent. Sam@ed 

physicians were requested to complete Patient 

Records (figure 1) for a systematic random 

sample of office visits taking place during a 

randomly assigned weekly reporting period. 

During 1977-78, 98,335 Patient Records were 

completed by responding physicbdns. 

SAMPLING ERRORS 

The standard error is primarily a measure of 

the sampling variability that occurs by “chance 

because only a sample, rather than the entire 

universe, is sampled. 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 for aggregate 

statistics are shown in tables I and II. Standard 

errors for estimated percentages are shown in 

tables III and IV. 

Table 1. Approximate relative standard errors of estimatad”num, 

ber of office visits based on all physician specialties: NAMCS, 

1977-78 

I . Relative 

Estimated number of office ““’ standard 

visits in thousands error in 

percent 

500 ....................................... ................................ 54.9 

1.ooo ....... ............................................................. 17.7 

28000 .................................................................... 12.7 

5.mo ......................................................... ........... 8.3 

1o.ooo ............................... ................................... 6.2 

20.000 . ........ .................... ........................... .......... 4.8 

50.000 ......... ......................................................... 3.8 

200,000 ................................................................ 3.1 

1 .ooo.ooo ............................................................. 2.9 

ExampIe of use of table: An aggregate of 15,000,000 visits 

has a relative standard error of 5.5 percent or a standard error 

of 825,000 visits (5.5 percent of 15,000,000). 

Table II. Approximate relative standard errors of estimated number of office visits based on an individual physician specialty: 

NAMCS, 1977-78 

Relative 

Estimated number of office standard 

visits in thousands error in � 

percent 

5oo ....................................................................... 27.0 

1 .ooo .................................................................... 19.6 

2.000 ... ................ ................................................. 14.5 

5.000 .................................................................... 10.3, 

1o.ooo . ................................................................. 8.5 

20,000 .................................................................. 7.4 

50.000 .................................................................. 6.7 

loo.ooo ................................................................ 6.4 

4oo.ooo ................................................................ 6.2 

1 

Example of use of table: An aggregate of 7,500,000 visits has 

a relative standard error of 9.4 percent or a standard error of 

705,000 visits (9.4 percent of 7, S00,000). 

DEFINITIONS 

Ambulatory patient.–An ambulatory patient is an individual presenting himself for 

personal health services who is neither bedridden nor currently admitted to any health 

care institution on the.premises. 

Office. -An office is a place that the physician identifies as a location for his ambulatory 

practice. Responsibility over time for patient 

care and professionzd services rendered there e 

. 

I 
---

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

Table II i. Approximate standard errors of percent of estimated 

numbers of office visits based on all physician specialties: 

NAMCS, 1977-78 

Base of percent Estimated percent 

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

Standard error in percentage points 

500 ............................. 2.5 5.4 7.4 9.9 11.4 12.4 

1,000 .......................... 1.7 3.8 5.3 7.0 8.0 8.8 

2,000 .......................... 1.2 2.7 3.7 5.0 5.7 6.2 

5,000 .......................... 0.8 1.7 2.3 3.1 3.6 3.9 

10,000 ........................ 0.6 1.2 1.7 2.2 2.5 2.8 

20,000 ........................ 0.4 0.9 7.2 1.6 1.8 2.0 

50,000 ........................ 0.2 0.5 0.7 1.0 1.1 1.2 

200,000 ...................... 0.1 0.3 0.4 0.5 0.6 0.6 

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

Example of use of i >le: An estimate of 20 Percent based on 

on aggregate of 15,000,000 visits has a standard error of 1.9 percent or a relative standard error of 9.5 percent (1.9 percent + 20 

percent). 

generally resides with the individual physician 

rather than an institution. 

Vkzl.–A v$it is a direct personal exchange 

‘ etween an ambulatory patient and a physician 

@ }r a staff member winking 

supervision for the purpose 

rendering health services. 

Physician.–A physician 

doctor of medicine (hl.D.) 

athy (D. O.) currentIy in 

under the physician’s 

of seeking care and 

,,., is a duIy licensed 

or doctor of osteopoffice-based practice 

dKmdata7 

Table IV. Approximate standard errors of percent of estimated 

numbers of office visits based on an individual physician 

specialty: NAMCS, 1977-78 

Base of percent Estimated percent 

(number of office lOor 20 or 30 or so visits in thousands) 88 

Standard error in percentage points 

500 .......... ...... ............. 2.6 5.7 7.9 10.5 12.1 13.1 

1,000 ............... ........... 1.9 4.1 5.6 7.4 8.5 9.3 

2,000 .......................... 1.3 2.9 3.9 5.3 6.0 6.6 

5,000 .......................... 0.8 1.8 2.5 3.3 3.8 4.2 

10,000 ........................ 0.6 1.3 1.8 2.4 2.7 2.9 

20,000 ....................... . 0.4 0.9 1.2 1.7 1.9 2.1 

50,000 ........................ 0.3 0.6 0.8 1.1 1.2 1.3 

100,000 ...................... 0.2 0.4 0.6 0.7 0.9 0.9 

400,000 ..................... . 0.1 0.2 0.3 0.4 0.4 0.5 

— 

Example of use of tab[e: An estimate of 90 percent based 

on an aggregate of 3,500,000 visits has a standard error of 3.2 

percent, or a relative standard error of 3.6 percent (3.2 percent + 90 percent). 

who spends time in caring for ambulatory patients. Excluded from NAMCS are physicians 

\vho are hospital based; physicians who speciidize in anesthesiology, pathology, or mdiOlolgy; physicians \vho are federalIy empIoyed; 

physicians who treat only institutionalized patients; physicians employed fulI time by an 

institution; and physicians who spend no time 

seeing ambulatory patients. 

. 

SYMBOLS I 

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--—–--–—--———–-. * 
-----

� 

8 ahlceda 

NCHS 

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