Vital and

Health Statistics

Advance Data

From Vital and

Health Statistics:

Numbers 81–90

Series 16:

Compilations of Advance Data From Vital

and Health Statistics

No, 9

Data in this report from health and demographic surveys present statistics by

age and other variables on contraceptive use patterns, prior source, and

pregnancy history of female family planning patients; drug utilization in office

practice, in office visits to primary care physicians, in general and family

practice by characteristics of physicians and office visits, and utilization of

psychotropic drugs in office-based ambulatory care; deliveries in short-stay

hospitals; blood pressure levels and hypertension; and summary data from the

national inventory of pharmacists and the National Ambulatory Medical Care

Survey, Estimates are based on the civilian noninstitutionalized populdion of the

United States, These reports were originally published in 1983 and 1984,

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyaftsville, Maryfand

December 1993

DHHS Publication No. (PHS) 94-1868
.. .—. ..

Copyright information

All material appearing in this report ISin the public domain and may be

reproduced or copied without permission; citation as to source, however, IS

appreciated.

Suggested citation

National Center for Health statistics. Advance data from vital and health

statistics: numbers 81-90. National Center for Health Statstics. Vital Health Stat

16(9). 1993.
National Center for Health Statistics

Manning Feinleib, M.D., Dr.P.H., Director

Jack R. Anderson, Deputy Director

Jacob J. Feldman, Ph.D., Associate Direc~orforAnaZysis

and Epidemiology

Gail F. Fisher, Ph.D., Associate Director for Planning and

Extramural Programs

Peter L, Hurley, Associate Director for Wal and Health

Statistics Systems

Robert A. Israel, Associate Director for International

Statistics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

Monroe G. Sirken, Ph.D., Associate Director for Research

and Methodology

David L. Larson, Assistant Director, Atlanta
Contents

Drug Utilization in Office Practice by Age and Sex of the Patienti National Ambulatory Medical Care Survey,

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Contraceptive Use Patterns, Prior Source, and Pregnancy History ofFemale FamiIy Planning Patients: United

States, 1980. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Deliveries in Short-Stay Hospitals: United States, 1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Blood Pressure Levels and Hypertension in Persons Ages 6-74 Years: United States, 1976-80 . . . . . . . . . . . . . .

Summary Data From the National Inventory of Pharmacists: United States, 1978-79 . . . . . . . . . . . . . . . . . . . . . .

Drug Utilization in Office Visits to Primary Care Physicians: National Ambulatory Medical Care Survey,

1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drug Utilization in General and FamiIy Practice by Characteristics of Physicians and Office Visits: NationaI

Ambulatory Medical Care Survey, 1980. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1981 Summary NationaI Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drugs Most Frequently Used in Office Practice: National Ambulatory Medical Care Survey, 1981. . . . . . . . . . .

Utilization of Psychotropic Drugs in Office-Based Ambulatory Care: National Ambulatory MedicaI Care

Survey, 1980 and 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No. 81

No. 82

No. 83

No. 84

No. 85

No. 86

No. 87

No. 88

No. 89

No. 90

...

Ill
From Vital and Health Statistics of the National Center for Health Statistics Number 81. July 26, 1982

Drug Utilizationin Office Practiceby Age and Sex of the Patient:

NationalAmbulatory Medical Care Survey, 1980

by Hugo Koch, Division of Health Care Statistics

The relationship between the age and sex of ambulatory patients and the drugs ordered or provided

for them by physicians in office-based practice is explored. Data are presented using findings from the

1980 National Ambulatory Medical Care Survey.

The National Center for Health Statistics uses the

National Ambulatory Medical Care Survey (NAMCS)

to collect descriptive data about the medicaI care provided in doctors’ offices. Each year NAMCS data collectors contact a representative sample of the

Nation’s doctors of medicine and osteopathy whose

primary jobs are office-based, patient-care practice.

The sampled physicians in turn complete records (figure 1) for a systematic random sample of their office

visits over a weekly reporting period. When the sampled findings were expanded to approximate the entire universe of office-based care, the result was an

estimated total of 575,745,000 oftice visits in calendar 1980.

The year 1980 was the fnt in the 8-year history

of NAMCS that respondents reported the number and

names of the specific drugs they used. (See figure 1,

item 11.) This resulted in an estimated 679,593,000

mentions of pharmaceutical agents ordered or provided–b y any route of administration-for the purpose of prevention, diagnosis, or treatment. Mentions

included new or continued medications and nonprescription as well as prescription drugs. The methodology used to colIect, classify, and process drug information for the 1980 NAMCS is reported elsewhere. I

1N~ti~~~ c~~t~~for He~th Statistics, H. Koch: The ~o~ection ad

processing of drug information, National Ambulatory Medical Care

Survey, United States, 1980. Vital and Health Statistics. Series 2-No.

90. DHHS Pub. No. (PHS) 82-1364. Public Health Service. Washington.

US. Government Printing Office. In press.

Actual findings of drug utilization for the year have

appeared in two prior publications.2*3

Since the estimates presented in this report are

based on a sample rather than on the entire universe

of office visits, the data are subject to sampling variability. The technical notes at the end of the report

provide a brief explanation of sampling errors, and

guidelines for judging the precision of estimates.

General patterns of drug utilization

Drug utilization may be viewed from differing

perspectives and measured in differing ways, depending on the needs of the data user (table 1). Three

evaluative terms require chuification at the outset.

. A drug visit is an office visit at which one or more

drugs are ordered or provided. In 1980 there were

an estimated 363.5 million drug visits, comprising

63 percent of the total 575.7 million office visits.

● The drug mention rate is the average number of

drugs utdized per office visit, obtained by dividing

the number of office visits into the number of

drug mentions. For the entire universe of 575.7

million office visits, the overall drug mention rate

was 1.18 drugs per average office visit.

2Natio~~ c~ter for H~th S~tistiq T. McLemcIm ad H. Koch:

1980 Summary, National Ambulatory MedicaI Care Survey. Advance

Data From Vitai and HeaZthStatistics, No. 77. DHHS Pub. No. @HS)

82-1250. Public Heaith Service. Hyattsville, Md. Feb. 22, 1982.

3National Center for Health Statistic% H. Koch: Drugs most frequently

used in offkebaserl practice, National Ambulatory Medical Care Survey, United States, 1980. Advance Data From Vital and Health Statistics, No. 78. DHHS Pub. No. (PHS) 82-12.50. Public Health Service.

Hyattsville, Md. In preparation.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service, Office of Health Research, Statistics, and Technology
2

ASSUn A?iCE OF CON: IO WTALITV-AI1 8.4., rm, o” wh,ch would .mnvt d.., #f,u, w” Ocm,, m,., of HUf,h. Eduu,,.m. ,& Wdf#m

0# ,. md,v,dua,. ● 0,,,,,.,, 0, a,, e$,ahl,,hn.rn, .41 W ti!d ,.a”ldm,!,l, will b, “fed 0“1, Ii@,. Hallh S4<”- A No. 001736 — b. rn,m.s ●nyqml m ●m I.v an Wrnows .+ me $.we. and .wll not 8. a,iclmed or re 01(,., 01 *,,” +I*WWCII,Sl,,i,,,c$. ●-d T@WlOlq”

I“ud to OIhe Dutons w “w. em..” 0,.,8 mar.- U,*. WIQ.t,, I.r Hm#,h S,.,,wc,

1. DATE OF VISIT

&

PATlENT RECORD

NATIONAL Ambulatory MEDICAL CARE SURVEY

Zm~::HOF 3. SEX 4. COLOR OR RACE 50’ ETHNICIm &pATlENrsc0MPLA4 NT[s), wMpT0MlS),0R0THER -

REASON(S) FOR ~ VISIT [In puoent’s own wordsl

1❑ wtd TE

2 ❑ BLACK 1 @ H;:ISP: . . MOST IMPORTANT

--U- :;::” ‘ U“:;:;$’” zr~NOT —

Month cm, v-, HISPANIC

d (-J.4mlcm !NDIAr.}

b OTHER

fiL.lSKAN NATIvE

7, !b4b40#,:RC:ONJOR THIS 8 DIAGNOSTIC SERVICES THIS VISIT g- PHYSICIAN’S OIAGNOSES

“ {Check .11 ordr-d or provided/

1 DNONC c ❑ EKG

., PRINCIPAL ol.GNos8s,mo0LEM ASSOCIATEO WITH ITEM at

1❑ ACUTE PROE LEM 2 C] LIMITED HISFOF4Y,EXAM 9 ❑ V,S,ON TEST

2❑ CHRONIC PROBLEM. ROUTINE

, ❑ GENERAL I+8STOBY,EXAM ,. lJENLMJSCCW

3 ❑ CHRON,CPR08LEM. FURE”P ● ❑pA, ,Es,

4 ❑ p0s7suRGERY,F0sT 1NJUR%

,, Q M::NT;LS,A7”S

—

5 ❑ CLINICAL LAB TEST

b OTHER SIGNIFICANT CURRENT 01AGN0sE5

5 ❑ NON.l LLNEsS CARE IROU71NE

‘n’’”

,, ❑ OTHER,SPCC,,,,

PRENATAL, GENERAL EXAM .

WELL BABY, ETC.) 7 ❑ fILOOD PRESSURE cHEcK

.l~m ylw&U::::E7 11- MEDICATION THERAPY THIS VISIT ❑ NONE

[Using bnw?d or genericnanus,recotiallnewandconUnued mralcations owlered. injected, adndnisrered, or otherwife

provtied a t this vist Include immunizing and dexnn”sizing a~ntrJ

,DYES 2DN0

d. FOR PRINCIPAL OIAGNOSES IN ITEM% b. FOR ALL OTHER REASONS,

I

1. 1,

IFYES, FOR THE

—

CONOITION IN 2. 2.

ITEM %? —

3. 3.

I ❑ YES 2 ❑ NO —

4. 4.

—

lzm NON-MEDICATION THERAPY

IChsek allssrvissswdewd or protided Nds visiti

13. WAS PATIENT j~. ;lf#t#;i&:l#;;lSIT 15, :yH;:onREFEE?RED

FOR THIS VISIT

1 ❑ NO FOLLOWUP PUNNED

VISIT

OY A~HER [mm .Csualiy

i Q NONE 6❑ DIET COUNSELING PHYSICIM? 2 fJRE-NATSPE13FIE0 TIME

spent with

20 WS,CM+ERAPY 7 n,:gmwcl~ 3❑ RETURM16 NEEDEO.P.R.N.

phym”ctinj

3❑ OFFICE SURGERY

‘DMEOICALCOUNSEL,NG ,Uwa

4 ❑ TELEpHON E FOLLOW.LIP PLANNEO

4DFAAE’LYPIANN,NG

*DOTHER (Smm,,,

s ❑ REFwRm7007”E*pwYs,cIAN

5❑ PSVCNOTHERAPY/

THERAPEUTIC LISTENlffi ,DNO . ❑ RmRF.sEO TO R EFEFIRING PHYSICIAN

7 ❑ AOM,T’TO HOSPITAL

S❑ OTHER /SPdW

m“”!”

PHS-61 Oa-A {9/79) OMS No. 6S-R1491

Figure 1. Patient Record from the National Ambulato~ Medical Care survey

● The drug intensity rate is the average number of

drugs utilized per drug visit, obtained by dividing

the number of drug visits into the number of drug

mentions. For the entire 363.5 million drug visits,

the rate was 1.87 drugs per average drug visit.

If simple volume of utilization is the desired

criterion, then—depending on the degree of precision

required–the data user may count the number of

drug visits or drug mentions. When this simple enumeration is applied to a study of sex differences, it

becomes readily apparent that drug visits or mentions

for female patients substantially outnumbered drug

visits and mentions for males. The ratio of about 6 to

4 in favor of female patients closely parallels the ratio

for office visits in generai. However, when drug utilization by the sexes is explored from other perspectives, especially those of. average usage, a different

picture emerges. Examine, for example, the respective

proportions of all office visits represented by the drug

visits. For female patients it was 63.3 percent, for

males 62.8 percent. The difference between the two

proportions is not statistically significant, since it

could be due to sampling error or variability. In addition, there is no significant difference between the

average female and male patient in terms of their respective drug mention rates or drug intensity rates.
Table 1. Number and percent distribution Of office visits and drug mentions, number Of drug visits and their percent of office visits, drug mention

rate, and drug intensity rate, by ags and sex of the office patient: United States, 1980

Office visirs Drug visits~ Drug mentions

Drua Drua

Age and sex of patient Number Percent Number Percent of Number Percent ment& in rensity

in distribution in office visits in distribution rate2 rete3

thousands thousands thousands

Allpetients . . . . . . . . . . . . . . . . . . 575,745 100.0 363,468 63.1 679,593 100.0 1.18 1.87

Sex

Female . . . . . . . . . . . . . . . . . . . . . 346,105 60.1 219,216 63.3 413,570 60.9 1.19 1.89

Male . . . . . . . . . . . . . . . . . . . . . . 229,639 39.1 744,274 62.8 266,023 38.1 1.16 1.64

Age

Under15years . . . . . . . . . . . . . . . 109,356 19.0 71,763 65,6 115,643 17.0 1.06 1.61

15.24years . . . . . . . . . . . . . . . ...” 81,561 14.2 46,353 56.8 75,213 11.1 0.92 1.62

2544years . . . . . . . . . . . . . . . . . . 154,695 26.9 87,343 56.5 148,126 21.8 0.85 1.70

45-64years . . . . . . . . . . . . . . . . . . 129,645 22.5 86,327 66.6 175,572 25.8 1.35 2.03

65yearsandover . . . . . . . . . . . . . . 100,488 17.5 71,704 71.4 165,038 24.3 1.64 2.30

Sexandage

Female

Under15years . . . . . . . . . . . . .

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

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

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

65yearsand over . . . . . . . . . . . .

Male

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

15.24years . . . . . . . . . . . . . . . .

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

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

65yearsandover . . . . . . . . . . . .

50,503

54,879

103,562

76,385

60,777

58,852

26,682

51,134

53.260

39,712

8.8

9.5

18.0

13.3

10.6

10.2

4.6

8.9

9.3

6.9

33,395

31,350

58,025

52,223

44,222

38,368

15,0U3

28,318

34,105

27,461

66.1

57.1

56.0

68.4

72.8

65.2

56.2

57.3

E

54,723

49,823

97,947

106,333

104,745

60,920

25,391

50,179

69,239

60,284

8.1 1.08 1.64

7.3 0.91 1.59

14.4 0.95 1.69

15.6 1.39 2.04

15.4 1.72 2.37

9.0 1.04 1.59

3.7 0.95 1.69

7.4 0.98 1.71

10.2 1.30 2.03

8.9 1.52 2.19

lAn office “i~it at which one or more drugs were ordered or Provid@d.

2_rhc avara~ number of drugs ordwed or provided Par Offims Visit.

3The ~era~ number of drugs ordwed or provided Par drug ViSit.

The sarnemeasurements maybe applied todrug

utilization by age groups. When the criterion is a

simple number of drug visitsormentions, the volume

of utilizationis greatest in the middle years, diminishingin the age interval over 64 years. However, app1ying the drug mention rate produces a different

pattern, one showing that average utilization steadily

increases after the 14th year, reaching its highest

point in the age group 65 years and over (figure 2).

For the sex-age groups (figure 3) the drug mention

rates for female and male patients follow the general

pattern shown in figure 2, pursuing closely parallel

paths untiI they diverge for the age group 65 years

and over where, at a rate of 1.72 drug mentions per

office visit, drug utilization by female patients significantly exceeds that for males (1.5 2).

Drug utilization: therapeutic categories

Table 2 measures drug utilization from another

perspective. Here the differences between the sexes

and the age groups are described in terms of the

therapeutic effects that the drugs were intended to

produce. For example, an examination of total usage

(by all patients) shows the clear preeminence of mention enjoyed by three therapeutic categories: antiinfective agents, cardiovascular drugs, and central

nervous system drugs. Together they accounted for

41 percent of the total 679.6 million drug mentions.

A comparison of the sexes reveals that:

Female patients exceeded male patients in the

proportion of their drug mentions represented by

the following therapeutic categories:

● Antineoplastic agents.

● Central nervous system drugs (here, the difference between the sexes was very slight).

● Electrolytic, caloric, and water balance substances, e.g., diuretics (again, the sex difference was slight).

● Hormones and synthetic substances.

● Vitamins.

Male patients exceeded female patients in the proportion of their drug mentions represented by the

following therapeutic categories:

● Antihistamine drugs.

● Anti-infective agents.

. Cardiovascular drugs.
4

1.70 j-.

1.60

1.50

1.40

1.30

1.20

1.10

1.00

0.90

Under 15-24 2544 45-64 65 and

15 over

Age of patient

1Av@r~ “um~r of drum ordered or provided Per Ofh visit.

— Female

1.80 r

---Male

1.70

1.60

1.50

1.40

1.30

1.20

1.10

1.00

0.90

Under 15.24 2544 45-64 65 and

15 over

Age of patient

1Awr~~ num~r of dregs ordered or provided w O~ea visit.

Figure 2. Drug mention rate by age of patient: United States, 1980 Figure 3. Drug mention rate by sex and aga of patiarm United States,

1980
akmmdda5

Table 2. Percent distribution of drug mentions by therapeutic category. according tcr sax and age of the patienti United States, 1980

Dreg mentions

Therapeutic catego~’

Sex of patient Age ofpat;ent

All

patients Female Male Under 15-24 2544 45-54 65 years

15 years years years years and over

Number in thousands

All categories . . . . . . . . . . . . . . . . . . . .. . . . . . . . .

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

Antihistamine drugs . . . . . . . . . . . . . . . . . . . . . . . .

Anti-infective agents . . . . . . . . . . . . . . . . . . . . . . .

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

Antineoplastic agents . . . . . . . . . . . . . . . . . . . . . . .

Autonomicdrugs . . . . . . . . . . . . . . . . . . . . . . . . . .

Blood formation andcoagulation . . . . . . . . . . . . . . .

Cardiovasculardmgs . . . . . . . . . . . . . . . . . . . . . . .

Cardiacdmgs . . . . . . . . . . . . . . . . . . . . . . . . . .

Hypotensiveagents . . . . . . . . . . . . . . . . . . . . . .

Vasodilatingagants . . . . . . . . . . . . . . . . . . . . . .

C8ntraln ervoussystemdrugs. . . . . . . . . . . . . . . . . .

Analgesics and antipyratics . . . . . . . . . . . . . . . . .

Psychotherapauticagents . . . . . . . . . . . . . . . . . .

Sedativesand hypnotics . . . . . . . . . . . . . . . . . . .

Electrolytic, caloric, and water balance . . . . . . . . . . .

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

Expectorantsand cough preparations . . . . . . . . . . . .

Eye,ear, nosa, andthroat preparations . . . . . . . . . . .

Gastmintestinald rugs . . . . . . . . . . . . . . . . . . . . . . .

Hormonesand synthetic substances . . . . . . . . . . . . .

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

Serums,toxoids,andvaccines . . . . . . . . . . . . . . . . .

Skinandmucous membrenepraparations . . . . . . . . . .

Spasmolytic agents . . . . . . . . . . . . . . . . . . . . . . . .

Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other therapeutic categories . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

679,593

100.00

6.47

15.44

13.26

0.79

3.71

1.22

9.49

3.87

3.33

2.16

16.29

8.51

2.41

3.68

7.65

6.30

2.78

::

8.22

2.69

3.49

8.12

1.70

3.57

2.22

1.47

412,570

100.00

5.84

14.36

11.88

0.88

3.70

1.3B

8.55

3.23

3.42

1.79

17.06

8.35

2.62

4.05

8.o5

6.70

2.53

3.56

3.47

9.98

2.67

2.84

7.86

1.40

4.67

2.04

1.49

266,023

100.00

7.28

17.11

15.22

0.47

3.73

0.97

10.94

4.87

3.19

272

1!5.08

8.74

2.10

3.12

7.02

5.69

3.17

4.24

3.67

!5.4s

2.74

4.34

8.53

215

W

1.45

115,643 75,213

Percent distribution

100.00

14.60

28.48

27.03

●0.07

2.78

“0.46

‘0.34

●0.15

●0.1 1

“0.06

5.64

4.47

“0.28

0.70

“0.56

●0.21

6.49

4.01

213

1.93

1.45

14.50

8.43

1.77

0.75

4.82

1.03

100.00

7.75

26.10

23.68

“0.18

3.09

1.42

-0.53

“0.36

●0.1 2

“0.05

11.55

6.42

1.44

2.25

1.59

“0.93

3.30

3.10

241

9.76

2.42

2.52

15.77

‘0.53

6.57

237

1.47

148,126

100JM

7.16

17.17

14.41

“0.45

4.91

1.19

2.80

1.08

1.32

●0.38

21.75

9.89

3.39

4.76

4.62

3.85

269

3.46

3.42

9.37

3.03

0.81

10.75

1.03

4.87

1.82

1.64

175,572

100.00

3.90

8.73

7.01

1.48

4.14

1.18

13.66

5.28

5.46

2.78

20.72

10.33

3.68

4.98

11.67

9.63

1.80

3.28

4.14

10.44

3.4s

0.99

5.72

1.64

296

1.52

1.84

165,038

100.00

2.28

6.30

4.46

1.14

3.12

1.75

21.44

9.08

6.59

5.52

16.16

9.10

2.22

4.08

13.81

11.69

1.07

4.98

4.56

8.52

2.56

1.28

4.61

264

3.66

1.42

1.25

lBa~ on the pharm~ologic.therapeutic classification of tho American Socioty of Ho8pital Pharmecis= Sebct.d mtWWi~Z r.pr~uced with ~~

Soci*ty’s pwrnission.
6

● Serums, toxoids, and vaccines.

● Spasmolytic agents.

There was no significant difference between the

sexes in their respective utilization of drugs in the

following therapeutic categories:

● Autonomic drugs.

● Blood formation and coagulation agents.

● Expectorants and cough preparations.

. Eye, ear, nose, and throat preparations.

. Gastrointestinal drugs.

. Skin and mucous membrane preparations.

Table 2 also shows the effect of advancing age on

the utilization of the therapeutic categories. Figure 4

graphically pictures this effect by tracing an age curve

for the three, most mentioned, therapeutic categories.

All three are age sensitive. The utilization curve for

the anti-infective agents shows a steady descent with

advancing years while the curve for cardiovascular

drugs rises gradually till the 45th year, then steeply to

a peak in the age group over 64. The utilization curve

for central nervous system drugs shows its steepest

ascent at ages 1544 years, levels off for the rest of

the middle years, and finalIy begins a gradual descent

in the older years of life.

Drug utilization: specific drugs

The data user will note that–in its attempt to

explore differences related to sex and age of the patient–this report has moved progressively in the

direction of increasing specificity. The exploration

ends with the descriptive data in table 3, which list in

rank order the 10 drugs most frequently mentioned

for each of the sex-age groups. (Inclusion of trade

names is for identification only and does not imply

endorsement by the Public Health Service or the

United States Department of Health and Human

Services.)

The drugs are listed by entry name, that is, by the

trade or generic name that the doctor recorded on the

30.0 — — Anti-infective agents

. . . . . . . cardi~va~ular drugs

--- Central nervous system drugs

25.0

.! 20.0

g /

E

/

?

u 15.0 /

~

z /’

z

~ /

.

5 10.0 /’ .“

0. .“

/’

●*

.“

.“

0’ .“

5.0 t

.’

-.”

:

....”

●. .

. .

.,..

. . . . . . . . . . . .

I I 1

Under 15-24 25-44 45-64 65 yeara

15 years yeara years years and over

Age of patient

Figure 4. Utilization of three therapeutic categories of drugs by age of

patient, based on percent of drug mentions within respective age

groups: United States, 1980

NAMCS visit record (figure 1). (Note: NAMCS respondents were instructed to use the same ently

name on the NAMCS visit record that they used cm

the patient’s medical record and/or on any prescription written.)

A superscript following a listed drug indicates a

drug famiiy; a grouping of drugs whose members have

the same core name and the same or a closely similar

therapeutic effect. For example, the drug family

Aristocortf includes the following members: Aristocort, Aristocort A, Aristocort Forte, Aristocort HP,

Aristocort Intralesional, and Aristocort R.
dmcedaa7

Table 3. Number of drug mentions and drug mention rate w 1,000 visits for the 10 drugs most frequently ordared or provided to patients in

selected sex-age group= United States, 1980

Number Drug Number Drug

Entry name antfgeneric name(s) of men don Entry name and generic name(s) of men tion

Rank of drug

mentions rate per Rank of drug men tions iate per

in 1,000 in 1.000

thousands

.——.

visits thousands visits

Female patients under 15 years Male patients under 15 years

1

:

4

:

7

8

9

10

Polio vaccine . . . . . . . . . . . . . . . . . .

Diphtheria tetanus toxoid partu.sSis . . . .

Amoxicillin . . . . . . . . . . . . . . . . . . . . . .

Tuberculintinetest . . . . . . . . . . . . . ..-

Ampicillin . . . . . . . . . . . . . . . . . . . . . . .

Penicillin . . . . . . . . . . . . . . . . . . . . . . . .

Dimetapp (brompheniramine, phenylephrine, phenylproPanolamine) . . . . . .

Allergy relief, unspecified . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . .

E.E.S . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,114

3.028

1,906

1,752

1,646

1,646

61.7

60.0

37.7

34.7

32.6

32.6

1

2

3

4

5

6

7

8

9

10

Polio vaccine . . . . . . . . . . . . . . . . . . . . .

Diphtheria tatenus toxoid pertussis . . . .

Allergy relief, unspecified . . . . . . . . . . . .

Amoxicillin . . . . . . . . . . . . . . . . . . . . . .

Dimetepp (brompheniramine, phenylephrine, phenylpropanolamine) , . . . . .

Penicillin . . . . . . . . . . . . . . . . . . . . . . . .

Tubarcuiintinetest . . . . . . . . . . . . . . . .

Ampicillin . . . . . . . . . . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxil(amoxicillird . . . . . . . . . . . . . . .

3,ffi7

2,835

2,511

2,462

52.1

48.2

42.7

41.8

2,21’2

1,720

1,686

1,635

1,324

1,230

37.6

28.2

28.8

27.8

22.6

20.9

1,471

1,325

1,086

1,041

29.1

26.2

21.7

20.6

Femaieoatients 15-24vears Male patients 15-24 years

1

2

3

4

5

6

7

8

9

10

Tetracycl inef . . . . . . . . . . . . . . . . . . . . . 1,642 29.9

Ampicillin . . . . . . . . . . . . . . . . . . -- . . . 1,291 23.5

Penicillin . . . . . . . . . . . . . . . . . . . . . . . . 1,183 21.6

Ortho-Novum (norethindrone,

mestranol) . . . . . . . . . . . . . . . . . . . . . . 1,000 18.2

Prenatai vitamins . . . . . . . . . . . . . . . . . . 972 17.7

Cleocinf (clindamycin) . . . . . . . . . . . . . . 869 17.7

Lo/Ovral (norgestrel, ethinyl,

estradiol) . . . . . . . . . . . . . . . . . . . . . . . 796 14.5

Allergy relief, unspecified . . . . . . . . . . . . 725 13.2

Materna (multivitamins prenatal) . . . . . . 692 12.6

Monistatf (miconazole) . . . . . . . . . . . . . 682 12.4

Female patients 25-44 years

1

2

3

4

5

6

7

8

9

10

Tetracyclinef . . . . . . . . . . . . . . . . . . . . .

Penicillinf . . . . . . . . . . . . . . . . . . . . . . . .

Allergy relief, unspecified . . . . . . . . . . . .

Cleocinf (clindamycin) . . . . . . . . . . .

Ampicillin . . . . . . . . . . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . .

Minocin (minocycline) . . . . . . . . . . . . . .

Tetanustoxoid . . . . . . . . . . . . . . . . . . . .

Erythromycin . . . . . . . . . . . . . . . . . . . . .

Desquam-Xf(benzoyl peroxide,

disodium edetate, etc.) . . . . . . . . . . . . .

1,394

828

801

773

664

473

“376

●326

●313

52.2

31.0

30.0

28.0

24.9

17.7

+14.1

●12.2

●11.7

●11.2

Male patients 25-44 vears

1

2

3

4

5

6

;

9

10

1

2

3

4

5

6

7

8

9

10

Tetracyclinef . . . . . . . . . . . . . . . . . . . . .

Allergy relief, unspecified . . . . . . . . . . . .

Ampicillin . . . . . . . . . . . . . . . . . . . . . . .

Penicillin . . . . . . . . . . . . . . . . . . . . . . . .

Lasix(furosamide) . . . . . . . . . . . . . . . . .

Prenatalvitamins . . . . . . . . . . . . . . . . . .

Vitamin B-12 . . . . . . . . . . . . . . . . . . . . .

Valium (diazepam) . . . . . . . . . . . . . . . . .

Monistatf (miconazole) . . . . . . . . . . . . .

Chorionic gonadotropin . . . . . . . . . . . . .

1,861

1,579

1,565

1,370

1,209

1,108

1,095

1,091

1,069

1,001

18.9

15.2

15.1

13.2

11.7

10.7

10.6

10.5

10.3

9.7

Allergy relief, unspecified . . . . . . . . . . . .

Penicillin . . . . . . . . . . . . . . . . . . . . . . . .

Tetracyclinef . . . . . . . . . . . . . . . . . . . . .

Ampicillin . . . . . . . . , . . . . . . . . . . . . . .

Valium (diazepam) . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . .

Erythromycin . . . . . . . . . . . . . . . . . . . . .

Kaflex kephalexin) . . . . . . . . . . . . . . . .

Actifed (tripolidine, pseudoeptredrine) . .

Darvocet-N (acetaminophen, nro1,062

1,022

987

971

644

607

585

571

552

20.8

20.0

19.3

19.0

12.6

11.9

11.4

11.2

10.8

,r. -

poxyphene napsylata) . . . . . . . . . . . . . 549 10.7

Female patients 4!5%4 years Male patients 45-64 years

1

2

3

4

5

6

7

8

9

10

Inderal (propranoloi) . . . . . . . . . . . . . . .

Lasix(furowmide) . . . . . . . . . . . . . . . . .

Premarin (conjugated estrogens) . . . . . . .

Dyazide (triamterene) . . . . . . . . . . . . . .

Motrin (ibuprofen) . . . . . . . . . . . . . . . . .

Valium (diazepam) . . . . . . . . . . . . . . . . .

Hydrochlorothiazide . . . . . . . . . . . . . . .

Vitamin B-lZ . . . . . . . . . . . . . . . . . . . . .

Aldomet (methyldopa) . . . . . . . . . . . . . .

Thyroid . . . . . . . . . . . . . . . . . . . . . . . . .

1,904

1,804

1,704

1,675

1,652

1,584

1,548

1,348

1,295

1,246

24.9

23.6

22.3

21.9

21,6

20.9

20.3

17.6

17.0

16.3

1

2

3

4

5

6

7

8

9

10

[nrjeral (propranolol) . . . . . . . . . . . . . . .

Dyezida (triamterene) . . . . . . . . . . . . . .

Lasix(furosemide) . . . . . . . . . . . . . . . . .

Valium (diazepam) . . . . . . . . . . . . . .

Hydrochlorothiazide . . . . . . . . . . . . .

Insulin . . . . . . . . . . . . . . . . . . . . . . . . . .

Lanoxin (digoxin) . . . . . . . . . . . . . . . . .

Tagamet (cimetidine] . . . . . . . . . . . . . . .

Lopressor (metoprolol) . . . . . . . . . . . . .

Hydrodiuril (hydrochlorothiazide) . . . . .

2,285

1,258

1,157

1,105

1,000

950

847

936

877

871

43.1

23.6

21.7

20.7

18.8

17.8

17.8

17.6

16.5

16.4

Female patients 65 years and over Malepetients65 warsandover

1

2

3

4

5

6

7

8

9

10

Lenoxin(digoxin) . . . . . . . . . . . . . . . . .

Lasix(furosemide) . . . . . . . . . . . . . . . . .

Dyezida (triamterene) . . . . . . . . . . . . . .

Inderal (propranolol) . . . . . . . . . . . . . . .

Aldomet (methyldopa) . . . . . . . . . . . . . .

Vitamin B-lZ . . . . . . . . . . . . . . . . . . . . .

Digoxin . . . . . . . . . . . . . . . . . . . . . . . . .

Motrin (ibuprofen) . . . . . . . . . . . . . . . . .

Insulin . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrochlorothiazide . . . . . . . . . . . . . . .

3,089

2,931

2,613

2,576

2,067

1,987

1,793

1,467

1,382

1,340

50.8

48.2

43.0

42.4

34.0

32.7

29.5

24.1

22.7

22.0

1

2

3

4

5

6

7

8

9

10

Lasix(furosemide) . . . . . . . . . . . . . . . . .

Lanoxin (digoxin) . . . . . . . . . . . . . . . . .

Inderal (propranolol) . . . . . . . . . . . . . . .

Digoxin . . . . . . . . . . . . . . . . . . . . . . . . .

Isordii (isosorbide} . . . . . . . . . . . . . . . . .

Dyazide (triamterene) . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . -. . . . . . . . . . . . .

Hydrochlorothiazide .- . . . . . . . . . . . . .

Hydrodiuril (hydrochlorothiazide) . . . . .

Prednisone . . . . . . . . . . . . . . . . . . . . . . .

2,247

2,078

1,608

1,512

1,143

956

765

761

742

715

66.6

52.3

40.5

38.1

26.8

24.1

19.3

19.2

18.7

18.0

Suoerscriptf denotes drug family.
8

Symbols

. . . Data not available

. . . Category 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
Technical notes

Source of data and sample design

The estimates presented in this report are based

on data collected during 1980 by the National Center

for Health Statistics by means of the National

Ambulatory Medical Care Survey. The target universe

of NAMCS comprises office visits made by ambulatory patients to non-Federal physicians who are

principally engaged in office-based, patient care practice. Visits to physicians practicing in Alaska and

Hawaii are excluded from the range of NAMCS, as are

visits to physicians who specialize in anesthesiology,

pathology, and radiology.

NAMCS uses a multistage probability sample design that involves a step-wise sampling of primary

sampling units (PSU’S), physicians’ practices within

PSU’S, and patient visits within physicians’ practices.

For 1980 a sample of 2,959 physicians was selected

from master fdes maintained by the American Medical Association and the American Osteopathic Association. The physician response rate was 77.2 percent.

%rnpled physicians were asked to complete Patient

Records (figure 1) for a systematic random sample of

office visits made during a randomly assigned weekly

reporting period. Telephone contacts were excluded.

During 1980, responding physicians completed

46,081 Patient Records, on which they recorded

51,372 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 survey’s field operations.

For a more detailed discussion of the limitations,

qualifications, and definitions of the data collected

by NAMCS, see Vital and Health Statistics, Series 13,

Number 44.

%rnpiiig errors and rounding of numbers

The standard error is a measure of the sampling

variability that occurs by chance because only a sample, rather than an entire universe, is surveyed. The

relative standard error of the estimate is obtained by

dividing the standard error by the estimate itself and

is expressed as a percent of the estimate. Tables I

and II apply these measurements to office visits;

Tables 111and IV apply them to drug mentions.

Estimates have been rounded to the nearest thousand. For this reason detailed figures within tables do

not always add to totals. Rates and percents were calculated from original, unrounded figures and will not

necessarily agree precisely with rates or percents

calculated from rounded data.

Table 1. Approximate relative standard errors of estimated number

of office visits based on all physician spaciaities: NAMCS, 1980

Relative

Estimated number of office standard

visits in thousands error in

penxmt

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.3

1,000................................... 19.5

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.1

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.4

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.9

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

100,OOO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.5

%0.000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.?

Example of use of table: An a~egate of 75,000,000 visi~ has a

relative standard error of 4.7 percent or a standard error of 3.52aOO0

visits (4.7 percent of 75,000,000).
10

Table 11. Approximate standard errors of percents Of estimated number of Office visits based On all physician specialties: NAMCS, 1980

Base of percent

(number of office visitsin thousands)

Esdma ted percent

1 or 99 5 or 95 10 or 90 20 or 80 30 or 70 50

Standard error in percent

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7 5.9 8.1 10.8 12.4

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

13.5

1.9 4.2 5.7 7.6 8.7

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

9.5

1.3 2.9 4.0 5.4 6.2

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

16.7

0.8 1.9 2.6 3.4 3.9 4.3

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.6 1.3 1.8 2.4 2.8 3.0

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.9 1.3 1.7 2.0

60,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.1

0.3 0.6 0.8 1.1 1.2 1.3

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

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.2 0.3 0.3 0.4 ID.4

Example of use of table: An estimate of 30 percent based on an aggregate of 15,000,000 visits has a standard error of 2.4 oercant. or a relative

standard arror of 8 percent (2.4 percent+ 30 percent).

Table Ill. Approximate relative standard errors of estimated number

ofdrugmentions basadon all physician specialties: NAMCS, 1980

Relative

Estimated number of drug mentions standard

in thousands error in

percent

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.3

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.7

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.2

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.1

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.2

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2

300,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.8

650,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7

Example of use of table: An aggregate estimate of 75,000,000 drug

mentions has e relative stendard error of 6.5 percent or a standard error

of4,875,000 mentjons (6.5 percantof 75,000,000).

Definitions

An ambulatory patient is an individual seeking

personal health service who is neither bedridden nor

currently admitted to any health care institution on

the premises.

A physician eligible for NAMCSis a dulylicensed

doctor ofmedicine or osteopathy currently in ofticebased practice whose primary job is caring forarnbuIatory patients. Excluded from NAMCS are: physicians who are hospital based; physicians who

specialize in anesthesiology, pathology, or radiology;

physicians who are Federally employed; physicians

who treat only institutionalized patients; physicians

employed full time by an institution; and physicians

who spendno time seeing ambulatory patients.

Ano~fice is a place that the physician identifies

as alocation forhis ambulatory practice. Responsibilityover time for patient care and professional services

rendered there generally resides with the individual

physician rather than aninstitution.

A visit is a direct personal exchange between an

ambulato~ patient and a physician or astaffrnember

working under the physician’s supervision, for the

purpose ofseeking care orrendering health services.

Adrugmentionis the physician’sentry ofapharmaceutical agent ordered. or provided–by any route

of administration–for prevention, diagnosis, ortreatment. Generic as well as brand-name drugs are inciuded, as are nonprescription as well as prescription

drugs. Along with all new drugs, the physician also

records continued medications, if the patient was

specifically instructed during the visit to continue the

medication.
amcedaa 11

Table IV. ADprOXimate standard errors of oercents of estimated numbers of drug mentions based on all nhvsiqian s~ialties: NAMG, 1~

Base of percenr

(number of drug mentions in thousands)

Estimated penent

1 or 99 5or95 10 or 90 20 or 80 39 or 70 50

Standard error in percentage points

1,000..................................... 2.7 5.8 8.0 10.7

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.9

12.2

4.1

13.3

5.7

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

7.6

1.2 2.6

8.7 9.4

3.6

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

4.8

0.6

5.5

1.3

6.0

1.8

100,000................................... 0.3

2.4

0.6

2.7 3.0

600,0cQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.8 1.1

0.1

1.2

0.2

1.3

0.3 0.4 0.5 0.5

Example of us of table: An estimate of 30 percent based on an aggrageteof 12,500,000 drug mentions has a standard error of 4.1 parcont or a

relative standard error of 13.7 percent (4.1 percent + 3sj percant).
From Vital and Health Statistics of the National Center for Health Statistics Number 82 ● June 16, 1982

Contraceptive

History of Female

Use Patterns, Prior Source, and Pregnancy

Family Planning Patients:United States, 1980

by Eugenia Eckard, Division of Health Care Statistics

Accordinz to data from the 1980 National Reporting Syst;m for Family Planning Semites, an

estimated 4,977,0G0 women visited an organized

family planning clinic in the United States at least

once during the survey year. This represents almost a

15 percent increase over the number of women who

received medical services from family planning clinics

in the previous year. 1 Using data from this survey,

the report looks at the contraceptive use patterns and

pregnancy status of women during the time they

visited an organized family planning clinic in 1980.

The National Reporting System for Family Planning Services (NRSFPS) is a sample survey conducted

by the Division of Health Care Statistics of the

National Center for Health Statistics. It was begun in

1972 for the purpose of collecting information on

visits to clinics for medical family planning services in

the United States and its territories. These services are

set up under a variety of administrative auspices,

which include Iocal health departments, public and

private hospitals, and voluntary organizations such as

Planned Parenthood Federation of America, Inc.,

community groups, and neighborhood health centers.

Medical family planning visits to private physicians’

offices are excluded from the survey.

In the survey, a family planning patient is defined

as a woman who made a visit for medical family

planning services related to contraception, infertility

treatment, or sterilization. The overwhelming majority of patients are patients seeking methods of

contraception. Persons seeking only pregnancy or

venereal disease tests are not counted as family

planning patients, nor are persons interested only in

obtaining contraceptive supplies (that is, diaphragm,

foam, jelly, cream. or condom) or counseling.

The CIinic Visit Record (CVR) is the basic form

used to collect data from the family planning patients

in the National Reporting System for Family Planning Services. The 14 items on the Clinic Visit Record

cover basic sociodemographic information about the

patient and other questions pertaining to family

planning. Other data in this report are based on

information obtained either by observation, from

medicaI records, or, in those clinics that collect data

through participation in a computerized record system, from localIy developed forms that contain the

CVR items.

Although the primary sampling unit in NRSFPS is

the family planning visit, an unduplicated count of

patients is obtained by identifying each new patient

at her f~st visit and each continuation and readmission patient at her f~st visit in the survey year.

(Continuation and readmission patients are referred

to as “return” patients in this report.) Data based on

patients rather than on visits are inherently limited

because patients’ responses to NRSFPS data items

may change from one visit to another.

Other data sources from the National Center for

Health Statistics provide related statistics on utilization of family planning services. For example, data

from the National Ambulatory Medical Care Survey,

which is also conducted by the Division of Health

Care Statistics, cover visits to office-based physicians’

practices that include family planning services.z The

National Survey of Family Growth, conducted by the

Division of Vital Statistics in 1973 and 1976,

provides more detailed statistics on women who made

family planning visits to their physicians or to

organized family planning clinics in the 3 years prior

to each survey. Unlike those for the other two

surveys, data for the National Survey of Family

Growth were colIected by means of personal interviews with a national sample of women 15-44 years

of age who were ever married or never married with

offspring living in the household. More details about

the National Survey of Family Growth and its data

pertaining to family planning visits are provided in

the latest report based on the 1976 surveys

Further discussion or NRSFPS survey methodology, the sampling variation associated with the

statistics, and definitions of certain terms used in this

report are included in the technical notes and can be

found in earlier reports.J*s

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service, Office of Health Research, Statistics, and Technology
2

Highlights

This report examines the contraceptive use patterns and pregnancy history of women who visited

organized family planning clinics in 1980, analyzing

the data according to age, race, and patient status

(new patient or return patient). The 1980 patient

population was relatively young–88.3 percent were

under 30 years of age (figure 1). More than 54

percent had never had a live birth; only 23.6 percent

had two or more children. Figure 2 shows that the

majority of women who visited a family planning

clinic were white women (71.4 percent); 26.1 percent

were black, and 2.5 percent were of other races. More

than one-third (35.7 percent) of the women who

visited clinics in 1980 were new patients; 64.2

percent of the women were returning to a family

pIanning clinic (figure 3). A more detailed presentation of the patients’ characteristics is provided in a

report soon to follow. G

100

90

80

70

60 [ 54.1

20

10

0

Under 20 20-29 30 years

years years and over

Age

NOTE: Numbersmay not add 10 totalsdua to rounding.

SOURCE: Divisionof Health CareStsmatics,National Centerfor

Health Statistics: Data from tha National ReportingSystem for

Family PlarmmgSewices.

Figure 1. Percent distribution of female family planning patients

by age: United States, 1980

100

90

80

71.4

c 70

0

.-

5’ 60

n

.-

.

.-

%

U 50

:

40 $

a.

30 26.1

.,...:.:.:.:.:.:.;

::::::.:.: .:.:-:.:,:,:,:, . . .

20 :::::: ~::::;::::::::

...... ................

::Z+:::::::f::::

.........................

10

:.:+...................

.:.:.y..:,:,:.::::: :::::

................. .,

~::::~:::y,:

......................... 2.5

.... ..................

0

... ................. ~1 .. .... . . ...

White Black Other

Race

NOTE: Numbersmay not add to totalsdue to rounding.

SOURCE: Oivisionof Health Care%atiatiea, National Canterfor

Health Statistic: Data from the National ReportingSystem for

Family PlanningServices,

Figure 2. Percent distribution of female family planning patients

by race: United States, 1980

—

100

90

80

c 70

0

64.2

.-

5 60 .~.::,:,: ............:.,.,.,.,,,,:,:.,.,.,: ;,:,:,:,:.:,*.:,

n .. . .. ..............,, . ..,., . ..,.

.. ... .. . .... .. ... .

............ . . .,.,., .- .. . #. ...................

. .. ... . .... . ..,., ,,. .............. . . . , .

...................................... G .. ... . .. . .. .,,, ,. .- 50 :.:,:,:,:,:.:..:.:.:,:,:.:.:.:.:.::::!

u

.,...,............................... %.,%%,.:.:.:.:.:.:.:. +.:.:.,.

... . ..... . .. ..,, ,, .. . .. ... .. . .. ... .. .. .

E

........- .......................

:::::::::::;::::::::::::::::~.

8 40

.. ...<....,,. ... ....

z .,.,.,,,,...,,...,.. . ......... .

L

...................................:.

.............................

30 ........................,,,,.,...,.,.

..,, ,,, ,, ... ...... . ..

.:.:.:.., +::.:,:.:.,:,:,:,:.:.:.:.:.

.... ....... .,,, .,.. ,:.:,:,:,:,;,: ;.:.>::,:,:,:,:,:,:,:,

20 .....................................

10

0

New patients Return patients

Patient status

NOTE: Numbersmay not add to totalsdue to rounding.

SOURCE: Divisionof Health CareStatistics,National Centerfor

Health Statistvx: Data from the Nat!onal ReportingSvstem for

Family PlanningServices.

Figure 3. Percent distribution of female family Planning Patients

by patient status: United States, 1980
adwmeMa3

Contraceptive use and prior sotirce

Table 1 shows that more than half of the women

who visited a family planning clinic (55.9 percent) in

1980 had used the pill prior to their visit. Women

aged 20-29 were more likely than women of any

other age group to have used the pill before their visit

(63.1 percent). The IUD had been used by 7.1

percent of all the women and was more likely to have

been used by women 30 years of age and over (18.9

percent) than by women under the age of 30. Other

methods that had been used by the women prior to

their first visit included the diaphragm (4.3 percent);

foam, jelly, or cream (3.8 percent); and other or

unknown methods (3.7 percent). About 1 out of 4 of

the women had never used a method regularly prior

to their visit to a family planning clinic. More than

twice as many teenage women as women aged 20 or

over had not used a method regularly before visiting a

clinic (41.9 percent).

More women had received their prior method of

contraception at the clinic they visited during the

survey year than at any other source (39.3 percent).

Almost 9 percent of the women had received their

prior method from another family planning clinic,

thereby making the clinic a source of prior method

for about 48 percent of the women enrolled in the

clinics in 1980. The remainder of the women received

their p-ior method either from a hospital (2.0

percent), a private physician (18.4 percent), a drugstore (2.7 percent), or other (including unknown)

sources (3.6 percent).

A Iarger proportion of women aged 20-29 (43.8

percent) and of women 30 years of age and over

(43.7 percent) had obtained their prior method from

the clinic in which they were enrolled at the time of

the survey than had teenage women (30.6 percent).

Another family planning clinic was the source of the

prior method for 5.9 percent of the women under 20

years of age, for 10.7 percent of the women aged

20-29, and for 8.8 percent of the women 30 years of

age and over. Women in their twenties were about as

Table 1. Number of female family planning patients and percent distribution by contraceptive usa, according to age: United States, 1980

Age

Contraceptive use

All ages Under 20-29 30 years

20 vears vears and over

All female patients . . . . . . . . . . . . . . . .

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

Prior contraceptive method

Pill . . . . . . . . . . . . . . . . . . . . . . . .

IUD . . . . . . . . . . . . . . . . . . . . . . . .

Diephragm . . . . . . . . . . . . . . . . . . . .

Foem, jelly, orcream . . . . . . . . . . . . . . .

Otherl . . . . . . . . . . . . . . . . . . . . . .

No method usad regularly . . . . . . . . . . . . .

Source of prior method

Same service site . . . . . . . . . . . . . . . . .

Other service site

Howital.....l:l:l:::: ::::::::

Private physician . . . . . . . . . . . . . . . . .

Drugstore . . . . . . . . . . . . . . . . . . . . .

0ther2 . . . . . . . . . . . . . . . . . . . . . .

No method used regularly . . . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . .. . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

4,977

100.0

55.9

7.1

4.3

3.8

3.7

25.1

39.3

8.8

2.1

18.4

2.7

3.6

25.1

Numixr in thousands

1,703 2,691

Percent distribution

100.0 100.0

49.0 83.1

1.8 7.9

1.2 5.7

3.1 3.7

2.9 3.1

47.9 16.5

30.6 43.8

5.9 10.7

1.1 2.2

14.2 20.7

2.4

:; 3.6

41.9 16.5

583

100.0

42.5

18.9

;::

9.1

15.7

43.7

8.S

4.1

20.2

3.1

4.5

15.7

contraceptive method adopted or continued

Pill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63.7 74.1 63.1

IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35.7

7.1 2.2 7.9 18.2

Diaphragm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2 3.8 8.7 9.8

Foam, jelly, orcream . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.6 5.0 5.1 9.5

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.9 1.3 2.6 8.8

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.6 13.5 12.6 18.1

1 Includes natural methods and sterilization.

zln~luda~ unknown=

NOTE: Numbers may not add to totals due to rounding.
4

likely as women over 20 years of age to have seen a

private physician for their prior method (each about

20 percent), while 14.2 percent of the teenage

women had visited a physician’s office for a method

prior to visiting a clinic. The smallest proportion ,of

all women, regardless of age, had obtained their prior

method from a hospital, a drugstore, or other sources.

The majority of women who visited a family

planning clinic (63.7 percent) adopted or continued

to use the pill as a method of contraception. Women

under 20 years of age were more likely than other

women to adopt or continue with the pill (74.1

percent). Sixty-three percent of the women in their

twenties adopted or continued with the pill, while

only 35.7 percent of the women 30 years of age and

over chose this method. The IUD, chosen by 7.1

percent of all of the women, was more popular

among the older women ( 18.2 percent) than for

women under 30. The diaphragm was adopted or

continued by 7.2 percent of the women enrolled in

family planning clinics. The teenage women were not

as likely as the women 20 years of age or over to

choose the diaphragm. A little fewer than 6 percent

of the women adopted foam, jelly, or cream as a

contraceptive method and another 3 percent of the

women chose other methods. As many as 13.6

percent of all women who visited the clinics did not

choose a method after the visit. The reasons for not

doing so included being pregnant, trying to become

pregnant, or relying on a partner for a contraceptive

method. More of the women over 29 than women in

their twenties or younger were in this category.

Table 2 shows the pattern of contraceptive use

for white and black women separately. It can be seen

that the proportion of white women using the various

methods differed only slightly from the overall

pattern because most patients at the clinics were

white. A larger proportion of black women used the

pill prior to visiting a clinic in 1980 than did the

white women who visited a clinic (58.9 percent

compared with 55.0 percent). The proportion of

black women who used the IUD prior to their visit

was slightly more than 8 percent, compared with 6.5

percent of white women having used this method. A

larger proportion of white women (4.9 percent) than

of black women (2.9 percent) used the diaphragm

prior to their visit. There was no significant difference

in the proportions of black or white women whose

Table 2. Number of female family planning patients and percent distribution by contraceptive use, according to race: United States, 1980

Race

Contraceptive use

All races White Black

—

Number in thousends

All female patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,977 3,552 1,301

Percent distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0

prior contraceptive method

Pill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55.9 55.0 58.9

IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diaphragm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.1 6.5 8.3

Foam, jelly, or cream . . . . . . . . . . . . . . . . . . . . . . . . . :::::::::::::

4.3 4.9 2.9

3.8 3.9 3.5

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.7

Nomethod usad regularly . . . . . . . . . . . . . . . .. . . . . . . . . . . . ...+.+..

3.9 3.2

25.1 25.7 23.2

Source of prior method

Same service site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39.3 37.0

Other service sate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

46.1

8.8 8.7

Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...++<.

9.3

2.1 1.5

Prwate physician . . . . . . . . . . . . . . . . . . . . . . . . . .4. ... . . .. $....

3.5

18.4 19.9

Drugstore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . + . . . . . . . . . . . .

14.0

2.7 3.2 1.5

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6 4.0

Nomethod usedregulariy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.5

25.1 25.7 23.2

Contraceptive method adopted or continued

Pill 63.7 63.5 65.0

IUD”::::::::::::::::: ::::::::::::::::::::: :::::::: 7.1 6.6

Diaphragm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.0

7.2 8.1

Foam, jelly, or cream . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.9

5.6 4.8 7.7

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.9 2.7 3.0

None, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.6 14.3 11.4

1 includes natural methods and sterlllZatlOn.

21ncludes unknowns.

NOTE: Numbers may not add to totals due to rounding.
ackme&a5

prior method was foam, jelly, or cream or in the

proportions who used other methods. A slightly

larger prop~rtion (although not statistically significant) of white women than of black women had

never used a method regularly prior to their clinic

visit (25.7 percent compared with 23.2 percent).

Table 2 also shows that the clinic, either the one

of current enrollment or some other clinic, was the

source of prior method for a larger proportion of

black women than for white women. About 46

percent of the black women had obtained their prior

method from the same clinic, and another 9.3 percent

of them had obtained the method from another

clinic. Thirty-seven percent of white women obtained

their prior method from the same clinic, and 8.7

percent from another clinic. While only 1.5 percent

of the white women visited hospitals for their prior

method, 3.5 percent of black women did so. It is

clear that black women who were enrolled in a family

planning clinic were more likely than white women to

have previously sought services of a family planning

clinic. On the other hand, a larger proportion of

white women (19.9 percent) than of black women

(14.0 percent) had visited a private physician for their

prior method. B1ack women also were less likely than

white women to have obtained a prior method from a

drugstore or from other sources.

Table 2 also shows the type of method adopted

or continued according to race. The pill was the

method adopted by most women, regardless of race.

More than 3 out of 5 white women and black women

adopted or continued to use the pill over any other

method. Looking at the two other effective methods

(the IUD and diaphragm), there is no significant

difference between the proportion of white and black

women who chose the IUD; a larger proportion of

white women than of black women chose the

diaphragm. On the other hand, black women were

more likely than white women to choose foam, jelly,

or cream after the visit. A larger proportion of white

women than black women (14.3 percent compared

with 11.4 percent) chose no method after their visit,

suggesting that they may already have been pregnant,

were trying to become pregnant, or were relying on

their partner for contraception. A small proportion of

both racial groups chose other methods (2.7 percent

of white women and 3.0 percent of black women).

Data in tabIe 3 reveal strong evidence that the

Table 3. Number of female family planning patients and percent distribution by contraceptive use, according to patient status: Unitad States, 1980

Patient status

Cm7traceptiveuse

All New Return

patients patients patients

All famale patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,977

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

prior contraceptive method

Pill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55.9

IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1

Diaphragm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.3

Foam, jelly, or cream . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.8

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.7

Nomethod usad regularly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.1

Source of prior method

Same service site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39.3

Other s%rvice site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.8

Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.1

Private physician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.4

Drugstore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

2.7

3.6

Nomethod u~d regularly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.1

Contraceptive method adopted or continued

Pill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63.7

IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diaphragm . . . . . . . . . . . .

7.1

Foam, jelly, or cream . . . . . . .l:l~u;:::u:::j:jl ;J~lIJIj~II;

7.2

5.6

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.9

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......... 13.6

Number in thousands

1#779

Percent distribution

100.0

31.5

2.9

2.4

4.3

4.2

54.6

. . .

. . .

. . .

32.7

5.5

7.3

54.6

60.3

4.1

7.5

6.8

2.6

18.6

3,197

100.0

69.5

9.4

5.4

3.5

3.5

8.7

61.1

13.7

3.2

10.5

1.2

1.6

8.7

65.5

8.8

7.0

4.9

3.0

10.8

1 Includes natural methods and sterilization.

Zlncludes unknowns.

NOTE: Numbar$ maY not add to totals due to rounding.
6

family planning clinics provide most of their patients

with the most effective means of contraception

currently available–the pill, the IUD, or the diaphragm. More than twice as many return patients as

new patients had used the pill (69.5 percent compared with 31.5 percent). Another 14.8 percent of

the return patients had used either the IUD or the

diaphragm prior to their visit; only 5.3 percent of the

new patients had done so. Before visiting a family

planning clinic, more than half of the. new patients

(54.6 percent) had never used a method regularly.

However, after enrolling in an organized family

planning clinic, close to 72 percent of the new

patients chose the pill, the IUD, or the diaphragm–

three of the most effective methods.

The greatest proportion of the new patients who

had used a method prior to their visit had obtained it

from a private physician (32.7 percent). An overwhelming majority of return patients, as expected,

had obtained their prior method from the same site

of current visit (61.1 percent) or from another service

site (13.7 percent). Only 3.2 percent of the return

patients had visited a hospital for their prior method.

About 1 out of 10 of the return patients received

their prior method from a private physician, despite

previous enrollment in an organized family planning

clinic. A considerably larger proportion of the new

patients than of the return patients had obtained a

prior method either from a drugstore or from other

sources (12.8 percent compared with 2.8 percent).

Unlike the new patients, the proportion of return

patients adopting or continuing to use the pill or the

IUD decreased after their visit. A higher proportion

of new patients adopted or continued with foam,

jelly, or cream as a method than had used it before

the clinic visit (6.8 percent compared with 4.3

percent). The proportion of return patients ‘who

chose this method also increased after the visit, but

still was a smaller proportion than that of new

patients who adopted foam, jelly, or cream. Further,

a larger proportion of new patients than of return

patients chose no method at the end of the visit ( 18.6

percent compared with 10.8 percent).
a&medaa7

Pregnancy history

Tables 4, 5, and 6 show the number of pregnancies, live births, and fetal deaths for women

according to age, race, and patient status. Table 4

shows that a larger proportion of women under 20

years of age than of older women had had no

pregnancies, no live births, and no fetal deaths. This

suggests the importance of the family planning

services for preventing a first pregnancy among

teenage women. However, close to one-third (31.7

percent) of the teenage patients had been pregnant at

least once before visiting a clinic. More than half of

all the women (56.5 percent) had been pregnant at

least once, but fewer than half had had a live birth.

As many as 22.7 percent of the women had had at

least one fetal death.

As expected, a larger proportion of women 30

years of age or over had had two or more pregnancies

or two or more live births than had younger women.

About threequarters of the women over 29 years of

age had had two or more pregnancies, compared with

35.6 percent of the women 20-29 years of age and

7.4 percent of the women under 20. About 70

percent of the women aged 30 years or over had had

two or more live births, compared with 26.2 percent

of the women in their twenties and 3.6 percent of

women under 20 years of age.

The majority of women in every age group had

not experienced a fetal death. The proportion of

women who had had at least one fetal death,

however, increased with age, probably because the

proportion of women who had one or more pregnancies also increased with age. Thus for the women

30 years of age or over, who had had more

pregnancies, there had also been more fetal deaths

than among women under 30 years of age.

In table 5 the number of pregnancies, live births,

and fetal deaths are distributed according to race. A

larger proportion of white women than of black

women had never had a pregnancy (46.8 percent

compared with 34.0 percent) or a live birth (58.7

percent compared with 42.1 percent). Conversely, a

larger proportion of black women than of white

women had had two or more pregnancies and two or

more live births. However, there is no significant

difference in the proportions of white and black

women who have had at least one fetal death (22.3

percent and 24.0 percent, respectively).

Table 6 shows the number of pregnancies, live

births, and fetal deaths for women according to

whether the woman was a new or a return patient.

More than half of the new patients (55.7 percent) had

not had a pregnancy, compared with 36.7 percent of

return patients. This means that a higher proportion

of the return patients (63.3 percent) than of the new

patients (44.3 percent) had had at least one pregnancy. This is also the case with number of live

births. The majority of new patients (55.7 percent)

had not had a live birth at the time of their visit, and

fewer than half of return patients had not had one

(48.5 percent). Because return patients were more

likely to have been pregnant than were new patients,

it is understandable that return patients were also

more likely to have experienced at least one fetal

death (25.4 percent compared with 17.9 percent).

Table 4. Number of female family planning patients and percent distribution by pregnancy history. according to age: United States, 1980

Age

Pregnancy history

All ages

Under 20-29 30 years

20 years years and over

Number in thousands

All female patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,977 1,703 2,691 583

Percent distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0

Number of pregnancies

o ..................................... 43.5 68.3 34.9 10.9

1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.8 24.3 29.5 13.0

2 or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30.7 7.4 35.6 76.1

Number of live births

o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54.3 79.4

1

47.0 15.0

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.1 17.0 26.8 15.1

2or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.6 3.6 26.2 69.9

Number of fetal deaths

o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77.3 85.9 74.0 67.1

1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.9 12.2 19.1 20.6

2 or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.8 19 6.9 12.2

NOTE: Numbers may not add to totals due to rounding.
8

Table 5. Number of female family planning patients and percent dis~rilnstion by pregnancy history, according to race: United States, 1980

Race

Pregnancy history

All races White Black

All female patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,977

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

Number of pregnancies

o . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 . . . . . .. . .. . . . . . . . . . .. . . . . . . . .

2ormore . ;........ . . . . . . . . . . . . . . .

Number of live births

o . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 .. . . . . . . . .. . . . . . . .. . . . .. .. . . .

2ormore . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . 43.5

. . . . . . . . . . . . . . . . . . . 25.8

. . . . . . . . . . . . . . . . . . . 30.7

. . . . . . . . . . . . . . . . . . . 54.3

. . . . . . . . . . . . . . . . . . . 22.1

. . . . . . . . . . . . . . . . . . . 23.6

Number of fetal deaths

.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77.3

1 ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.9

Number in thousends

3,552

Percent distribution

100.0

46.8

25.0

28.2

58.7

19.8

21.5

77.7

16.8

1,301

100.0

34.0

28.5

37,5

42.1

28.8

29.1

76.0

17.5

2ormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.8 5.5 6.5

NOTE: Numbers may notaddto totals due to rounding.

Table6. Num&rof female family planning patients andpercent distribution bvprmnancv historv, ~cordinq to Datient status: United States, 1980

Patient status

Pregnarrw history

All New Return

Datients Datienrs patients

Allfemalepatients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,977

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

Number of pregnancies

o . . . . . . . . . . . . . . . .

1 . . . . . . . . . . . . . . . .

2ormore . . . . . . . . . . . .

0 . . . . . . . . . . . . . . . .

1 . . . .. . . . . . .. . . . .

2ormore . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43.5

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.8

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30.7

Number of live births

. .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54.3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.1

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.6

Number of fetal deaths

o 77.3

1:::::::::::::::: :::::::::::::::::: :::::::::::: 16.9

2ormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.8

Numberinthousends

1,779

Percent distribution

100.0

55.7

22.6

21.7

64.8

18.9

16.3

82.0

13.4

4.5

3,197

100.0

36.7

27.6

35.7

48.5

23.8

27.7

74.6

18.8

6.6

NOTE: Numbers may not add to totals due to rounding.
aknceMa9

References

1National Center for Health Statistics, E. Eckard: Women who

use organized family planning services: United States, 1979

Vital and Health Statistics. Series 13-No. 62. DHHS Pub. No.

(PHS) 82-1723. Public Health Service. Washington. U.S. Government Printing Office, Jan. 1982.

2National Center for Health Statistics, B. K. Cypress: Office

visits for family planning, National Ambulatory Medical Care

Survey: United States, 1977. Advance Data From Vital and

Health Statistics, No. 49. DHEW Pub. No. (PHS) 79- I 250.

Public Health Service. Hyattsville, Md., Apr. 16, 1979.

3National Center for Health Statistics, G. E. Hendershot and

K. E. Bauman: Use of services for family planning and infertility: United States. Vital and Health Statistics. Series 23-No. 8.

DHHS Pub. No. (PHS) 82-1984. Public Health Service. Washington. U.S. Government Printing Office, Dec. 1981.

4National Center for Health Statistics, B. J. Haupt: Background and development of the National Reporting System for

Family Planning Services. Vital and Health Statistics. Series

l-No. 13. DHEW Pub. No. (PHS) 78-1313. Public Health Service. Washington. U.S. Government Printing Office, Apr. 1978.

5 National Center for Health Statistics, E. Eckard: Teenagers

who use organized family planning services: United States,

1978. Vital and Health Statistics. Series 13-No. 57. DHHS

Pub. No. (PHS) 81-1718. Public Health Service. Washington.

U.S. Government Pfiting Office, Aug. 1981.

6National Center for Health Statistics, B. Bloom: Basic data

on women who use family planning clinics: United States,

1980. Vital and Health Statistics. Series 13-No. 67. Public

Health Service, DHHS, Hyattsville, Md. To be published.

Symbols

--- Data not available

. . . CategoW 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

# Figure suppressed to comply with

confidentiality requirements
10

Technical notes

Sampling design

The 1980 National Reporting System for Family

Planning Services (NRSFPS) estimates are based on a

stratified two-stage sampling design. In the fust stage,

a probability sample of 1,381 (about 1 in 4,

nationally) family planning service sites was selected

from a stratified sampling frame developed in 1976

and updated for 1980.

In the second stage of the sampling plan, family

planning visits occurring at each sample site were

systematically selected. The sampling rate assigned by

the National Center for Health Statistics to each

sample site depended on the site’s reported visit

volume and the State in which the site was located.

Overall, there were 14 visit sampling rates used to

determine the proportion of each site’s family planning visits needed for the survey; the visit sampling

rates ranged from 1/1 to 1/30. The 1980 NRSFPS

sample for the United States encompassed 220,303

female patient records. A report delineating the

NRSFPS background, development, and evolution

has been published.Q

Estimation

The statistics provided by NRSFPS for 1980 are

derived by a complex-estimation procedure. The

estimation procedure used to produce essentially

unbiased national estimates for the NRSFPS has two

principal components–inflation by the reciprocal of

the probability of

for nonresponse.

Sampling error

sample selection and adjustment

The statistics presented in this report are based on

a sample survey and therefore differ from those that

would be obtained from a full-count (100 percent)

survey using the same data collection procedures and

definitions.

The standard error is primarily a measure of the

variability that occurs by chance because a sample

rather than the entire universe is surveyed. While the

standard error, as calculated for this report, reflects

some of the random variation inherent in the measurement process, it does not measure any systematic

error that is present in the NRSFPS data. The relative

standard error of an estimate is obtained by dividing

the standard error of the estimate by the estimate

itself and is sometimes expressed as a percent of the

estimate. The chances are about 0.68 that the interval

specified by the estimate plus or minus one standard

error of the estimate contains the figure that would

be obtained through a full-count survey of the

sampling frame. The chances are about 0.95 that the

interval specified by the estimate plus or minus two

standard errors of the estimate contains the figure

that would be obtained through a full-count survey of

the sampling frame.

To derive standard errors that would be applicable to a wide variety of statistics and could be

derived at moderate costs, several approximations

were required. For the basic categories of patients

presented in this report, estimates of totals and

relative standard errors of totals are shown in table I.

The standard error for estimated percents of patients

is shown in table II.

Nonsampling error

Nonsampling error is present in most sample

surveys and includes errors due to service site

nonresponse, item nonresponse, information incompletely or inaccurately recorded, and processing error.

Through an unpublished evaluation study conducted

in 1980, several problems associated with the co~ection of data for NRSFPS (for example, adherence to

NRSFPS definitions) were identified.

Rounding

Aggregate estimates of family planning patients in

the tables are rounded to the nearest thousand. The

—

Table 1. Number of female family planning patients and relative

standard error, by e8e, race, and Petient status: United StSWS,

1980

Numtirr Relative

Age, race, and patient status

of patients standwd

in arror in

thousands percam

Age

All ages . . . . . . . . . . . . . . . . . . . . . . . . 4977 3.8

Under 20years . . . . . . . . . . . . . . . . . . . 1,703 4.0

2029yeers . . . . . . . . . . . . . . . . . . . . . 2.691 3.9

30 years and over . . . . . . . . . . . . . . . . . 583 4.8

Race

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

3,552 4.0

Black . . . . . . . . . . . . . . . . . . . . . . . . . 1,301 4.7

Patient status

New patient . . . . . . . . . . . . . . . . . . . . . 1.779 4.4

Return natient . . . . . . . . . . . . . . . . . . . 3,197 4.0

NOTE: A list of references follows the text.
achancedaa 11

Table 11. Amroxirnate standard arror of percent of female familv planning patients, by age, race, and patient status: Unired States, 1980

Estimated percent of patients

Age, race, and patient status

1 or 99 5 or 95 10 or 90 20 or 80 30 or 70 50

Age Standard error in percentage points

Alleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.4 0.5 0.7 0.8 0.9

Under20yeers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.5 0.6 0.9 1.0 1.1

20-29years . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.4 0.5 0.7 0.8 0.9

30yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.7 1.0 1.3 1.5 1.6

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0,2 0.4 0.6 0.8 0.9 1.0

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.8 1.1 1.4 1.6 1.8

Patient status

New patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.5 0.6 0.9 1.0 1.1

Return patient . . . . . . . . . . . . ; . . . . . . . . . . . . . . . . . . . 0.2 0.5 0.6 0.8 1.0 1.1

Example of use of table: An estimate of 50percent based onaijteena@ patienm hasastandard error of 1.1 percent, orarelative standard error of 2.2

percent (l.1 percent +50 percent).

percents were computed based on unrounded esti- Department of Health and Human Services grant for

mates,andthus the figures may notsum tothe totals. the provision of family plannfig services. Military

service sites are excluded from the survey.

Definitions Family planning visit. –A family planning visit is a

visit to a family planning service site in which medical

Family planning service site. –A family planning services related to contraception, infertility treatservice site is the location where medical family ment, or sterilization are provided.

planning services are provided on a regtdar basis under Family planning patient. –A family planning

the supervision of a physician. Private physicians’ patient is an individual who has made one or more

offices and group medical practices are not consid- family planning visits.

ered sites unless they receive support through a
From Vital and Health Statistics of the National Center for Health Statistics Number 83 e October 8, 1982

Deliveries in Short-Stay Hospitals: United States, 1980

BY Barbara J. Haupt, Division of Health Care Statistics

This remrt concerns the use ofhosDitals bv women

with deliv&ies during 1980. Chara&eristi& of @e

women who delivered (age, race, and marital status)

and of the hospitals in which they delivered (region, bed

size, and ownership) are presented by type of delivery

(normal or complicated). Data on the types of obstetrical complications experienced by these women and

on the procedures they underwent are also presented.

Hospital use measurements shown include frequencies,

percents, and average len@s of stay.

The statistics presented in this report are based on

data collected through the National Hospital Discharge

Survey. This is a sample sumey that has been conducted

by the National Center for Health Statistics since

1965. In 1980, data were abstracted from the face

sheets of medical records of approximately 224,000

patients discharged from 420 short-stay non-Federal

hospitals. A brief description of the sample design, data

collection procedures, and estimation process, and

deftitions of terms presented in this report can be

found in the section entitled “technical notes.” A detailed discussion of these items, as well as the survey

form used to collect the data, have been published.1.z

Diagnostic and procedure data are coded according

to the International Classl~cation of Diseases, 9th

Revision, Clinical Modl~cation. 3 Up to seven diagnoses and four procedures are coded for each discharge;

however, the only diagnoses considered in this report

were obstetrical diagnoses (codes 640-676) and sterilization (code V25.2). Obstetrical diagnoses are those

diagnoses that refer to conditions arising from or aiTecting the management of pregnancy, childbirth, and the

puerperium (the period following delivery). Other diagnoses were not used because they were felt to be repetitious. For example, a woman with anemia wouId have

two codes for this diagnosis-one showing it as an obstetrical complication and one indicating the specific

type of anemia.

In this report, obstetrical diagnoses are categorized

into two broad types-normal deliveries and complicated deliveries: A normal delivery refers to a spontaneous delivery without mention of abnormality, complication, or the use of instruments or fetal manipulation. All other deliveries, including multiple births, are

referred to as complicated. The rationale for including

pregnancies with multiple fetuses as complicated is

based on the observation that such pregnancies are

associated with increased morbidity and mortality.g

Summary

During 1980 3.8 million women with deliveries

were discharged from short-stay non-Federal hospitals

in the United States. These women made up a sizable

portion-9.9 percent+f all the discharges (excluding

newborn infants) during that year. Women with deliveries remained hospitalized an average of 3.8 days and

used 14.2 mdlion days of inpatient hospital care. This

was oniy 5.2 percent of the total days spent in hospitals

by all patients discharged during the year.

Most of the women who had a delivery were in their

twenties, were white, and were married. The largest

percent of deliveries occurred in the South Region, followed by the North Central, Northeast, and West

Regions. The percent of women with deliveries was

lowest in the smallest hospitals and highest in the

largest hospitals. Most of the women with deliveries

were discharged from nonprofit hospitals.

About haIfof the women had a normal delivery and

about half had some sort of complication. Women more

Iikely to have a complicated delivery were older, were

races other than white, had an unknown marital status,

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

and had delivered in the South Region. These women

also stayed in the hospital longer, on the average, than

did women with a normal delivery.

The most frequently occurring complications were

forceps or vacuum extraction without mention of indication and obstetrical trauma. Episiotomy was the

most common procedure. Other frequently performed

procedures were low forceps or vacuum extraction with

or without episiotomy, cesarean section, repair of obstetric laceration, and bilateral destruction or occlusion

of fallopian tubes.

Findings

Patient and hospital characteristics

During 1980, 3,762,000 women with deliveries

were discharged from short-stay non-Federal hospitals

in the United States (table 1). Most of these women

(over 60 percent) were in their twenties; 32.5 percent

were 20–24 years of age and 31.6 percent were 25–29

years of age. Almost 16 percent were in each of the age

groups 10-19 years and 30-34 years, while only 4.5 percent were 35–54 years of age. This age distribution was

the same foreach~ ofdeiivery(nonmdorcornplicated).

The majority (70.0 percent) of women with deliveries were white, and 17.6 percent were black and other

races. These data should be viewed with some caution,

however, because of the large percent of women (12.4

percent) for whom race could not be identiled on the

face sheet of the medical record. As expected, most of

the women with deliveries during 1980 were married

(77.0 percent). However, a sizable percent-16.5

percent-had never been married. Over 3 percent of the

women were separated, divorced, or widowed, and the

marital status of 3.0 percent was unknown.

Table 2 presents data on women with deliveries by

type of delivery for the hospital characteristics region,

bed size, and ownership. The largest percent of deliveries (34.7 percent) was in the South Region, followed

by 27.3 percent in the North Central Region, 19.1 percent in the Northeast Region, and 18.9 percent in the

West Region. This distribution reflects that of civilian

noninstitutionalized women in the child-beaing ages

(10-54 years of age for this report). Unpublished data

from the Bureau of the Census show that during 1980,

33.3 percent of these women lived in the South, 25.8

percent in the North Central Region, 21.7 percent in the

Northeast Region, and 19.2 percent in the West. The

pattern of deliveries was the same for each type of

delivery (normal or complicated); that is, the largest

percent was in the South and the second largest was in

the North Central Region. (For normal deliveries the

difference between the South Region and the North

Central Region was not statistically significant.) The

percent of deliveries was approximately the same in

each of the remaining two regions.

The percent of women with deliveries generally

increased as the bed size of the hospital increased. The

smallest hospitals (6–99 beds) had 14.9 percent of the

deliveries while the largesthospitals (500 beds or more)

had 26.3 percent of the deliveries. When hospital

ownership is examined, it can be seen that the vast

majority (72.9 percent) of mothers were discharged

from nonprofit hospitals, 23.8 percent were discharged

from State and local government hospitals, and 3.2

Table 1. Number and percent distribution of women with deliveries discharged from short-stay non-Federal hospitala by age, race, and marital status,

according to type of delivery United States, 1980

AII

Type of delivery All

Type of delivery

Age, race, and marital status

deliveries

Normal Complicated

deliveries Norma! Complicated

Number in thousands Percent distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.762 1.841 1,921 100.0 100.0 100.0

Age

10-19 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 583 291 292 15.5 15.8 15.2

20-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,222 594 628 32.5 32.3 32.7

25-29 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,190 591 599 31.6 32.1 31.2

30-34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597 291 305 15.9 15.8 15.9

35-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 74 97 4.5 4.0 5.1

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,633 1.277 1,356 70.0 69.3 70.6

81ackand another . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 662 312 351 17.6 16.9 18.2

Marital status

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.898 1.434 1,464 77.0 77.9 76.2

Never married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 620 299 321 16.5 16.3 16.7

Separated, divorced, orwtdowed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 64 68 3.6 3.5 3.5

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 44 69 3.0 2.4 3.6

1,nc,u~e~ data for i,vhjch race was m! s~ated.
ackm#k&3

Table 2. Number and percent distribution of women with deliveries discharged from short-stay non-Federei hospttsls by region, bed size, and hospnal ownership,

according to type of delivery United States. 1980

Ail

Type of delivery Type of delivery

Region, bed size, and ownemfrip

AII

deliveries Normal Complicated deliveries Normal Complicated

Number in thousands Percent distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . 3.762 1,841 1,921 100.0 100.0 100.0

Region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 717 357 360 19.1 19.4 18.8

North Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,028 528 500 27.3 28.7 26.0

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,307 590 718 34.7 32.0 37.4

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 709 367 343 18.9 20.0 17.8

Bed size

6-99 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562 329 233 14.9 17.9 12.1

100-199 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 679 315 363 18.0 17.1 18.9

200-299 beds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 653 339 314 17.4 18.4 16.4

300499 beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 878 416 462 23.3 22.6 24.1

500 beds or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 990 442 548 26.3 24.0 28.5

Ownership

Nonprofit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,744 1,315 1,429 72.9 77.4 74.4

State and local government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 897 467 430 23.8 25.4 22.4

Proprieta~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 60 62 3.2 3.2 3.2

percent from proprietary hospitals. This reflects the

distribution of all discharges by ownership of hospital;

over 70 percent of all discharges during 1980 were from

nonprofit hospitals and about 20 percent were from

State and local government hospitals.

Table 3 gives the percent distribution of women

with deliveries by type of delivery for the patient characteristics age, race, and marital status and the hospital

characteristics region, bed size, and ownership. Of the

3,762,000 women who delivered, 48.9 had a normal

delivery and 51.1 percent had some complication or

other condition associated with the delivery that required

special care or management. This distribution is similar

for most of the characteristics examined (that is, about

half of the deliveries were normal and about half were

complicated). However, a significantly larger percent

of complicated births occurred to women 35–54 years

of age (57.0 percent), women for whom marital status

was unknown (61.2 percent), and women who were discharged from hospitals in the South Region (54.9 percent). Some variations also occurred by bed size of

hospital. Oniy in the smallest hospitals was there a significantly larger proportion of normal deliveries than

complicated deliveries; in hospitals of every other bed

size, except those with 200-299 beds, the proportion of

complicated deliveries was larger than the proportion of

normal deliveries. Hospitals with 200-299 beds had

about the same proportion of normal and complicated

deliveries.

The average Iengthof stay for all women with deliveries during 1980 was 3.8 days (table 4). Women with

normal deliveries stayed an average of 3.0 days while

those with complications were hospitalized, on the

average, 4.5 days.

Average Iengths of stay were longer for women with

complicated deliveries than for women with normal

deliveries foreveryage, race, markd status, region, bed

size, and ownership type examined. These differences

were statistically signi13cant for every characteristic

except marital status unknown.

Obstetrical diioses associated with deliveries

Table 5 shows the number ofwomen with deliveries

by type of delivery and number of diagnoses. Most of

the women (77.2 percent) had only one diagnosis regardless of the type of delivery. A much larger percent

of women with normal deliveries had only one diagnosis compared with the percent of women with complicated deliveries (92.5 percent compared with 62.4

percent). This is expected because women with normal

deliveries could ordy have a maximum of hvo diagnoses:

normal delivery and sterilization. Women with complicated deliveries, on the other hand, could have more

than one complication as well as sterilization and,

therefore, could have several diagnoses.

The average length of stay was longer for women

with more than one diagnosis than for women with only

one diagnosis; the difference, however, was not statistically significant for women with normal deliveries.

Women with complicated deliveries had a longer average length of stay than women with normal deliveries

regardless of the number of diagnoses.

Of the 3.8 million women who had a delivery in

1980,8.3 percent were sterilized during the same hospitalization specifically, 7.5 percent of the women with

nonnai deliveries and 9.1 percent of the women with

complicated deliveries were sterilized. As shown in
4

Table 3. Percent distribution of women with deliveries discharged from

shott-stay non-Federal hospitals by type of delivery, according to selected

characteristics: United States, 1980

All Type of delivery

Selected characteristics

deliveries

Normal Complicated

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

Age

10-19 years....,..........,..

20-24 years . . . . . . . . . . . . . . . . . .

25-29 years. . . . . . . . . . . . . .

30-34 years . . . . . . . . . . . . . . . . . .

35 years and over . . . . . . . . . . . . .

Race

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

Black and another . . . . . . . . . . . . .

Marital status

Married . . . . . . . . . . . . . . . . . . . . . .

Never married . . . . . . . . . . . . . . . . .

Separated, divorced, or

widowed . . . . . . . . . . . . . . . . . . .

Marital statua unknown. . . . . . . . .

Region

Northeast . . . . . . . . . . . . . . . . . . . .

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

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

West . . . . . . . . . . . . . . . . . . . . . . . .

Bed size

6-99 beds . . . . . . . . . . . . . . . . . . .

100-199 beds . . . . . . . . . . . . . . . .

200-299 beds . . . . . . . . . . . . . . . .

300499 beds . . . . . . . . . . . . . . . .

500 beds or more . . . . . . . . . . . . .

Ownership

Nonprofit . . . . . . . . . . . . . . . . . . . .

State and local government . . . . .

Proprietary . . . . . . . . . . . . . . . . . . .

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

48.9

49.9

48.6

49,7

48.9

43.0

48.5

47.1

49.5

48,3

48.5

38.8

49.8

51.3

45.1

51.7

58.6

46.5

51.9

47.4

44.6

47’.9

52.1

49.0

51.1

50.1

51.4

50.3

51.1

57.0

51.5

52.9

50.5

51.7

51.5

61.2

50.2

48.7

54.9

48.3

41.4

53.5

48.1

52.6

55.4

52.1

47.9

51.0

Table4. Average length ofstayforwomen w~hdeliveries discharged from

short-stay non-Federal hospitals byselected characteristica: Unned States,

1980

All

Type of delivery

Salecred charsctertsrics

deliveries

Normal Complicated

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

Age

10-19 years . . . . . . . . . . . . . . . . . .

20-24 years . . . . . . . . . . . . . . . . . .

25-29 years . . . . . . . . . . . . . . . . . .

30-34 years . . . . . . . . . . . . . . . . . .

35 years and over . . . . . . . . . . . . .

Race

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

Slack and anether .. . . . . . . . . . . .

Marital status

Married, . . . . . . . . . . . . . . . . . . . . .

Never married . . . . . . . . . . . . . . . . .

Separated, divorced, or

widowed . . . . . . . . . . . . . . . . . . .

Marital status unknown. . . . . . . . .

Region

Northeast . . . . . . . . . . . . . . . . . . . .

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

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

West . . . . . . . . . . . . . . . . . . . . . . . .

Bed size

6-99 beds . . . . . . . . . . . . . . . . . . .

100-199 beds . . . . . . . . . . . . . . . .

200-299 beds . . . . . . . . . . . . . . . .

300-499 beds . . . . . . . . . . . . . . . .

500 beds or more . . . . . . . . . . . . .

Ownership

Nonprofit . . . . . . . . . . . . . . . . . . . . .

State and local government . . . . .

Proprietary . . . . . . . . . . . . . . . . . . .

3.8

3.7

3.6

3.7

4.0

4.3

3.7

3.9

3.7

3.9

3.7

4.5

4.5

4.2

3.5

2.9

3.0

3.5

3.6

4.0

4.3

3.9

3.5

3.2

3.0

2.9

2.9

3.0

3.2

3.5

3.0

3.0

3.0

3.0

2.8

3.5

3.6

3.4

2.8

2.2

2.6

3.0

3.0

3.2

3.2

3.1

2.8

2.5

4.5

4.5

4.3

4.5

4.7

5.2

4..4

4..7

4..4

4..8

4..5

5.1

5.4

5.1

4.1

3.6

3.7

3.9

4.2

4.8

!j.1

4.6

4.3

3.9

Ilncl”desdsta forwhtch race was mxstamd. llncl@es dsts fc.r which race wss not stated.

table 6, a larger percent of the women who were sterilized had a complicated delive~, the type of delivery did

not differ significantly among the women who were not

sterilized. Although the average length of stay was

longer for women who were sterilized than for those

who were not, regardless of the type of delivery, the differences are not statistically significant. Women with a

complicated delivery had a longer length of stay, on the

average, than women with a normal delivery for both

sterilized and nonsterilized women.

The number and percent distribution of first-listed

and of all-listed obstetrical diagnoses and the average

length of stay by first-listed diagnosis for women with

complicated deliveries are shown in table 7. The two

most common diagnoses were forceps or vacuum extractor delivery without mention of indication (that is,

the reason for the use of these instruments was not

stated on the face sheet of the medical record) and

obstetrical trauma. About 18 percent of the women

with a complicated delivexy had a forceps or vacuum

extractor delivery without mention of indication. The

use of forceps or a vacuum extractor are two alternativemethods to assist delivery.s

In the field of obstetrics two distinct viewpoints

have emerged concerning the use offorceps—those holding one viewpoint advocate their use on a routine basis

to assist in guiding the child through the birth canal,

whereas the other group feels that the use of forceps is

justiiled only when the delivery cannot proceed spontaneously.e Undoubtedly the practice of many obstetricians is between these two extremes. Since the reason

for the use of forceps or a vacuum extractor was not

stated for these 350,000 deliveries, one can only speculate as to how many of the deliveries could have proceeded spontaneously+r as to how many complications were averted because of their use.
dmcdata5

Table 5, Number, percent distribution, and average length of stay for women

with deliveries discharged from short-stay non-Federal hospitals by type

of delivew, according to number of diagnoses: United States, 1980

All

Typeof delivery

Number of diagnoses

deliveries Normal Complicated

Ail women with deliveries . . . . . .

Women with one diagnosis . . . . .

Women with more than one

diagnosis . . . . . . . . . . . . . . . . . .

All women with deliveries . . . . . .

Women with one diagnosis . . . . .

Women with more than one

diagnosis . . . . . . . . . . . . . . . . . .

All women with deliveries . . . . . .

Women with one diagnosis . . . . .

Women with more than one

diagnosis . . . . . . . . . . . . . . . . . .

Table 6. Number, percent distribution, and average length of stay for women

with deliveries discharged from short-stay non-Federai hospitals, by type

of delive~, according to stariiization statua: United States, 1980

Typeof delivery

Sterilizationstatus

All

deliveries

Normal Complicated

Number in thousands Number in thousands

3,762 1,841 1,921

2,903 1,703 1,199

860 138 722

Percent distribution

100.0 100.0 100.0

77.2 92.5 62.4

22.8 7.5 37.6

Average length of stay in days

3.8 3.0 4.5

3.4 2.9 4.0

5.1 3.8 5.3

The average length of stay for these 350,000

women was 3.3 days. This length is not signiilcantly

different from the average length of stay of 3.0 days for

All women with deliveries . . . . . . 3,762 1.841 1,921

Sterilized . . . . . . . . . . . . . . . . . . . . .

~,.2

138 174

Not sterilized . . . . . . . . . . . . . . . . . 3.450 1,703 1,747

Percent distribution

All women with deliveries . . . . . . 100.0 48.9 51.1

Sterilized . . . . . . . . . . . . . . . . . . . . . 100.0 44.2 55.8

Not sterilized . . . . . . . . . . . . . . . . . 100.0 49.4 50.6

Average length of stay in day:

All women with deliveries . . . . . . 3.6 3.0 4.5

Sterilized . . . . . . . . . . ... . . . . . . . . . 4.6 3.8 5.2

Notaterilized . . . . . . . . . . . . . . . . . 3.7 2.9 4.4

normal deliveries. However, these women did stay a

signiilcantly shorter time, on the average, than did all

women with complicated deliveries.

C)bstetrical trauma accounted for 15.4 percent of

the first-listed and 14.8 percent of the all-listed obstetrical diagnoses for women with complications during

Table 7. Number, percent distribution, and average length of stayby firat-listed obstetrical diagnosis, and number and percent distribution by all-listed diagnoses

for women discharged with complicated deliveries United States, 1980

[Discharges from short-stay non-Federal hospitals. Diagnostic groupings and code numb’ara from the International Classificationof Diseases.9thRevision.ClinicalModification

Diagnosis and ICLF9-CM code

All obstetrical diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 640-648,651-676

Forceps or vacuum extractor delivery without mention of indication . . . . . . . . 669.5

Obatetncal trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 664-665

Trauma to perineum and vulva during delive~. . . . . . . . . . . . . . . . . . . . . . . . 664

fimt-degree perineai lacemtion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 664.0

Second-degree perineal laceration . . . . . . . . . . . . . . . . . . . . . . . . . . . . 664.1

~ird.degree perineaI laceration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 664.2

Founh-degme petineal laceration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 664,3

Other and unspecified trauma to perineum and vulva. . . . . . 664.4-664.9

Laceration of cervix and high vaginal laceration.. . . . . . . . . . . . . . 665.3-665.4

Other obstetrical tmuma. . . . . . . . . . . . . . . . . . . . . . 665.0-665.2. 665.5-665.9

Uterine scar from previoua surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...654.2

Esrlyonset of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...644.2

Fetopelvic disproportion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .653.4

Hypertension complicating pregnency, childbirth, and the puerperittm. . . . . . . . 642

Breech presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 652.1 -652.2,669.6

Rupture ofmembrenes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...658.1-658.3

Ceaarean delive~, without mention of indication. , . . . . . . . . . . . . . . . . . . . . . . 669.7

Postpartum hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..666

Umbilical cord complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...663

Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...648.2

Fetal distress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 656.3

Antepanum hemorrhage, abruptio placentae. and placanta previa . . . . . . . . . . . 641

Uterine inertia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 661.0-661.2

Infections of genitourinary tract in pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . 646.6

Other obstetrical complications.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Reaidual

Women with complicated delivenks

First-listeddiagnosis All-listed diagnoses

Number

percent

Average Number

in length of Percent

distriburiorr in

thousands disfnbrrtion stayin days thousands

1,921 1Coo 4.5 2,647 100,0

350

297

241

60

50

51

46

34

39

17

169

135

113

105

88

87

50

36

35

32

32

28

24

20

320

18.2

15.4

12.6

3.1

2.6

2.7

2.4

1.8

2.0

0.9

8.8

7.0

5.9

5.5

4.6

4.5

2.6

1.8

1.8

1.7

1.7

1.5

1.3

1.1

16.7

3.3

3.1

3.0

2.9

2.8

3.3

3.4

2.7

3.1

3.7

5.9

4.8

5.9

6.1

4.9

4.4

6.1

3.2

3.6

3.9

4.8

6.4

4.5

4.7

4.9

350

393

308

71

62

68

60

47

59

26

192

154

153

151

120

130

50

54

67

71

64

53

50

56

539

13.2

14.8

11.6

2.7

2.3

2.6

2.3

1.8

2.2

1.0

7.2

5.8

5.8

5.7

4.5

4.9

1.9

2.1

2.5

2.7

2.4

2.0

1.9

2.1

20.4
6 aduancedata

1980. Most of the trauma involved lacerations or other

injury to the perineum or vulva. No signiilcant diiTerences were found among the various degrees of perineal

lacerations (first, second, third, or fourth degree) that

occurred.

Significantly longer average lengths of stay were

found for the first-listed diagnoses of uterine scar from

previous surgery; fetopelvic disproportion; hypertension

complicating pregnancy, childbirth, and the puerperium;

and cesarean delivery without mention of indication.

All of these diagnoses are associated with or indications for cesarean delivery, which, of itself, necessitates a longer hospital stay.Q.6TA longer average length

of stay is also observed for the diagnosis rmtepartum

hemorrhage, abruptio placenta, and placenta previa;

however, the difference is not statistically signiilcant

due to the relatively small number of these diagnoses.

When comparing the number of first-listed diagnoses with the number of all-listed diagnoses for

specific diagnostic groups, some differences can be

seen. For example, the number of all-listed diagnoses of

infections of the genitounnary tract is almost three

times higher than the number of first-listed diagnoses of

this type. The numbers of all-listed diagnoses for the

following conditions are twice as high as the numbers of

first-listed diagnoses: anemia; uterine inertia; fetal

distress; umbilical cord complications; and antepartum

hemorrhage, abruptio placenta, and placenta previa.

This is not surprising because many of these complications are either the result of or a contributing factor to

other complications. For example, abruptio placenta

may be caused by, among other things, an abnormality

or tumor of the uterus, a short umbilical cord, and

hypertension.Q Uterine inertia causes prolonged labor

and could also result in hemorrhages Anemia may be

hereditary or, if not, has many causes such as infection,

hemorrhage, and iron deficiency.d

Procedures associated with deliveries

The number and percent distribution of all-listed

procedures performed on women with deliveries is

shown in table 8. About half of the procedures F~erformed were episiotomies, making this by far the most

common obstetrical procedure. The majority of these

episiotomies (76.7 percent) were performed without

forceps or other instruments to assist delivery. Of the

women with normal deliveries, 1,146,000, or 62.2

percent, had an episiotomy. Many physicians routinely

perform episiotomies because it is felt that this procedure eliminates the risk of perineal lacerations and it

spares the baby’s head from beating against a possible

perineal obstruction. The straight, clean incision of an

episiotomy is preferable to a ragged laceration, the

procedure shortens labor, and the possibility of a thirddegree laceration is reduced. In addition, it is felt that

the baby’s head hitting against an obstruction for any

period of time could result in brain darnage.d

Table 8. Number and percent distribution of all-listed procedures for women discharged with deliveries by type of procedure United Ststes, 198C)

[Discharges from short-stay non-Federal hospitals. Procedure groupings and code numbers from the International Classification of Diseases. 9th Revision, Clinical Modification]

.

All-listed procedures

Procedure and lCD-9-CJU code

Number in thousands Percent distribution

All procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.972 100.0

Allobstetrical proceduresl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...72-75 3,526 88.8

Low forceps operation with and without episiotomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.0-72.1 482 12.1

Extraction procedures to assist delivety. . . . . . . . . . . . . . . . . . . . . . . . . 72.2-72.5.72.7-72.9, 73.2 127 3.2

Midforceps operation with and without episiotomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.2 38 1.0

Forceps rotation of fetel head..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...72.4 31 0.8

8reechextractlon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...72.5 21 0.5

Vacuum extraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...72.7 22 0.6

Other extraction procedures to assist delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. fles]dual

Episiotomy

16 0.4

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.1, 72.21, 72.31, 72.71, 73.6 2,012 50.7

Episiotomy only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...73.6 1,543 38.8

Low forceps operation with episiotomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...72.1 428 10.8

Other instrumental delivery with episiotomy . . . . . . . . . . . . . . . . . . . . . . 72.21, 72.31, 72.71 41 1.0

Artificial rupture of membranes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73.0 120 3.0

Other procedures toassistdehvery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...72.6.73.1 117 2.9

Cesarean section . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . ...74.0-74.2.74.4--74.9 619 15.6

Diagnostic amniocentesis and fetal monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75.1, 75.34 119 3.0

Manual removal of retained placenta. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...75.4 29 0.7

Repawof current obstetric laceration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...75.5-75.6 350 8.6

Manual exploration of uterine cavity, postpartum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...75.7 17 0.4

Other obstetrical procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Residual “2 “0.1

Bilateral destruction or occlusmn of fallopian tubes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66.2-66.3 313 7.9

Dilation andcurettage ofuterm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . 69.02-69 .09 17 0.4

Other procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Residual 117 2.9

Inmdentala ppendectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...47.1 20 0.5

Insertion ofindwelling urinary catheter. . . . . . . . . . . . . . . . . . . . . . .’....... . . . . . . . . . . . ...57.94 10 0.3

1Numbe~ ~111 “Ot add tO tOtal becawe epw.lotomtes are ksted m more than On@cate90v.
adEmdab7

Others question the routine performance of episiotomies: they feel that if the delivery was allowed to

proceed normally and in an unrushed manner, many

episiotomies would be unnecessary. Moreover; since

the site of the incision can often be bothersome and

even painful during healing, they feel that episiotomies

should be done only when necessary.g

Of all the procedures performed on women with

deliveries, 12.1 percent were low forceps or vacuum

extraction with or without episiotomy. As stated previously, some physicians feel that this type ofprocedure

should be done routinely to forestall possl%le complications, while others feel it should be done only to assist

a delivery that cannot proceed spontaneously.A

The number of cesarean sections performed in

1980 was 619,000, or 15.6 percent of the total number

of procedures. This surgery was performed on 16.5

percent of all mothers and 32.2 percent of the women

with complicated deliveries.

The incidence of cesarean sections has been increasing since the late sixties, sparking much debate and

discussion about the necessity for this procedure.

During 1965 only about 5 percent, or 174,000, of the

women with deliveries had a cesarean section. In 1980,

619,000 women, about 16 percent of all women who

delivered, underwent a cesarean section. Many explanations have been given for this trend-for example,

the increased use of fetal monitoring (and the subsequent iden-tilcation of potential complications that

would otherwise be unanticipated); the policy of “once

a cesarean always a cesarean” (that is, once a woman

has this procedure, aIl subsequent deliveries should be

by cesarean section); and the feeling that a cesarean

section is preferable to a vaginal delivery for difilcult

deliveries, as a response to indications of fetal distress,

or for breech presentations .W*TJO

Repair of current obstetric laceration was one ofthe

more frequently performed obstetrical procedures; the

350,000 performed made up 8.8 percent of all procedures. Other obstetrical procedures of interest that

were performed relatively frequently were artificial

rupture of membranes ( 120,000) and diagnostic amniocentesis and fetal monitoring (11 9,000). Each of these

categories made up 3 percent of the totaI procedures

performed.

There were 446,000 nonobstetrical procedures

performed on women who delivered in 1980. These

nonobstetrical procedures made up 11.2 percent of all

the procedures performed. Most of these (3 13,000)

were bilateral destruction or occlusion of fallopian

tubes (sterilization).
8

References

lNation~ Center for Health Statistics, W. R. Simmons: Develop

ment of the design of the NCHS Hospital Discharge Survey. Vitai

and Heafth Srutistics. PHS Pub. No. 1000-Series 2-No. 39. Public

Health Service. Washington. U.S. Government. Printing Office,

Sept. 1970.

2Nationa] Center for Health Statistics, B. J. Haupti Utilization of

short-stay hospitals, annual summary for the United States, 1980.

Vital and Health Statistics. Series 13-No. 64. DHHS Pub. No.

(PHS) 82–1725. Public Health Service. Washington. U.S. Government Printing Oflice, Mar. 1982.

3U.S. public Health Service ad Health Care Financing AWlnistration: International Clasnjication of Diseases, 9th Revision,

Clinical Modification. DHHS Pub. No. (PHS) 80-1260. Public

Health Service. Washington. U.S. Government Printing Oflice,

Sept. 1980.

4J. A. pritchard and p. C. MacDonald Wi[[iams Obstetrics, 15th

ed. New York. Appleton-Century-Crofts, 1976.

51nstructions for the Silastic Obstetrical Vacuum CUP in the

Second Stage of Labor. Midland, Mich. Dow Coming Corp.,

1980.

60~ce of the Assistant Secretary for Planning and Evaluation/

Health, H. I. Marieskind: An Evaluation of Caesarean Section in

the United States. U,S. Department of Health, Education, and

Welfare. Washington. June 1979.

7P. J. Placek md s. M. Taffel: Trend in Complications Associated

With Cesarean and Non-Cesarean Deliveries, United States, 1970

and 1978. Paper presented to the Annual Meeting of the American

Public Health Association. Los Angeles, Nov. 1981.

8E. C. Hughes: obstetn.c-Gynecologic Terminology. P~ladelphia.

F. A. Davis Co., 1972.

9~ston Women’s Healti Book Collective: Our Bodies, Ourselves:

A Book by andfor Women. New York. Simon and Schuster, 1973,

pp. 185–192.

10p. J. Placek arid s. M. T~el: Trends in cesare~ section rates for

the United States, 1970-78. Pub. Health Rep. 95(6]540-548,

Nov.-Dee. 1980.

1]Natio~ Cen&r for He~th Statistics, M. G. Sirkex Utilization

of short-stay hospitals, summary of nonmedical statistics, United

States, 1965. Vital and Heakh Statistics. PHS Pub. No. 1000-

Series 13-No. 2. Public Health Service. Washington. U.S. GovernmentPrinting Oflice, Aug. 1967.

12Nation~ Center for He~~ Statistics, M. J. w:t~: u~ization

of short-stay hospitals by characteristics of discharged patients,

United States, 1965. Vital and Health Statistics. PHS Pub. No.

1000-Series 13-No. 3. Public Health Service. Washington. U.S.

Government Printing Oftice, Dec. 1967.
adww@aw9

Technical notes

Source of data

The National Hospital Discharge Survey (NHDS)

encompasses patients discharged from short-stay hospitals, exclusive of military and Veterans Administrationhospitals, located in the 50 States and the District of

Columbia. Only hospitals with six beds or more and an

average length of stay of less than 30 days for all

patients are included in the survey. Discharges of

newborn infants are excluded from this report.

The universe of the survey consisted of 6,965 shortstay hospitals contained in the 1963 Master Facility

Inventory of Hospitals and Institutions. New hospitals

were sampled for inclusion in the survey in 1972, 1975,

and 1977. In all, 544 hospitals were sampled in 1980.

Of these hospitals, 72 refused to participate, and 52

were out of scope. The 420 participating hospitals

provided approximately 224,000 abstracts of medical

records.

Sample design

All hospitals with 1,000 beds or more in the

universe of short-stay hospitals were selected with

certainty in the sample. AU hospitals with fewer than

1,000 beds were stratiled, the primary strata being 24

size-by-region classes. Within each of these 24primary

strata, the allocation of the hospitals was made through

a controlled selection technique so that hospitals in the

sample would be properly distributed with regard to

type of ownership and geographic division. Sample

hospitals were drawn with probabilities ranging flom

certainty for the largest hospitals to 1 in 40 for the

smailest hospitals.

Sample discharges were selected within the hospitals using the daily listing sheet of discharges as the

sampling frame. These discharges were selected by a

random technique, usually on the basis of the terminaI

digit or digits of the patient’s medical record number, a

number assigned when the patient was admitted to the

hospital. The within-hospital sampling ratio for selecting sample discharges varied inversely with the probability of selection of the hospital.

Data collection and estimation

The sample selection and the transcription of

information from the hospital records for abstract forms

were pefiormed by the hospital staR or by representatives of the National Center for Health Statistics or by

both. The data were abstracted ilkomthe face sheets of

the medical records. All discharge diagnoses and

procedures were listed on the abstract in the order of the

principal one, or the f~st-listed one if the principal one

was not identified, followed by the order in which all

other diagnoses or procedures were entered on the face

sheet of the medical record.

Statistics produced by the NHDS are derived by a

complex estimating procedure. The basic unit of estimation is the sample inpatient discharge abstract. The

estimating procedure used to produce essentially unbiased national estimates in the NHDS has three

principal components: inflation by reciprocals of the

probabilities of sample selection, adjustment for nonresponse, and ratio adjustment to fixed totals. These

components of estimation are described in appendix I

of two earlier publications. IIJ Z

Sampling errors and rounding of numbers

The standard error is a measure of the sampling

variability that occurs by chance because only a

sample, rather than an entire universe, is surveyed. The

relative standard error of the estimate is obtained by

dividing the standard error by the estimate itself and is

expressed as a percent of the estimate. Table I shows

relative standard errors for discharges, first-listed diagnosis, and all-listed disgnoses. Relative standard errors

for all-listed procedures are as follows:

Size of

estimate

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

2.500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

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

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

25.0(M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

50,0C0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Iomoo.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

500,C00 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Relative

standard

error

35.5

26.7

21.9

18.3

14.6

12.6

10.9

8.2

7.4

6.1

The standard errors for average lengths of stay are

shown in table II.

Estimates have been rounded to the nearest thousand. For this reason detailed figures within tables do

not always add to the totals. Percents and average

lengths of stay were calculated from original, unrounded figures and will not necessarily agree precisely

with percents or average lengths of stay calculated from

rounded data.

NOTE: A list of references follows the text.
10

Table 1. Approximate relatwe standard errors of estl mated number of

discharges, first-listed diagnosis. and all-listed d!agnoses. by selected

patient and hospnal characteristics

Ownership of hospital

Size of Roprietary Bed sjze All other

estimate or Stare less than

Nonprofit

characteristics

and local lm

government

Relatwe standard error

10,000 . . . . . . . 35.7 19.9 m.7 16.3

50,000 . . . . . . . 27.9 15.2 13.1 10.2

100,000 . . . . . . 25.5 13.7 11.0 8.5

300,000 . . . . . . 22.4 11.9 8.6 6.6

500,000 . . . . . . 21.2 11.2 7.8 5.9

I,ooo,ooo . . . . 19.9 10.4 6.8 5.1

4,000,000 . . . . 17.7 9.2 5.4 4.0

Table Il. Approximate standard errors of average Iengtha of stay

Average length of stay

Number of discharges in days

or first-listed diagnosis

2 6 10

Standard error in days

10.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.7 1.2 1.7

50.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.7 1.0

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3 0.6 0.9

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.5 0.8

l,mo,ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.5 0.8

5,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.5 0.8

Tests of significance

In this report, the determination of statistical inference is based on the two-tailed Bonferroni test for

multiple comparisons. Terms relating to differences

such as “higher” and “less” indicate that the differences are statistically significant. Terms such as “similar” or “no dtierence” mean that no statistically

significant difference exists between the estimates

being compared. A lack of comment on the difference

between any two estimates does not mean that the

difference was tested and found to be not significant.

Definition of terms

Patient. —A person who is formally admitted to the

inpatient service of a short-stay hospital for observation, care, diagnosis, or treatment. In this report the

number of patients refera to the number of discharges

during the year including any multiple discharges of the

same individual from one or more short-stay hospitals.

Obstetn”cal diagnosis. —A diagnosis relating to

conditions arising from or tiecting the management of

pregnancy, childbirth, and the puerperium (the period

following childbirth). These are code numbers 640-

676 of the International Classz@ation of Diseases,

9th Revision, Clinical Mod&ication (lCD-9-CM).3

Normal delive~. — Deiivery without abnormality

or complication of pregnancy, childbirth, or the puerperium, and with spontaneous cephalic delivery (that

is, presentation of the child headfirst and delivery of the

child without external aid). No mention of fetal manipulation or instrumentation is made. ICD-9-CM code

650 is assigned.

Complicated delivety. —Ail deliveries not considerd normal, including deliveries of multiple gestation. ICD-9-CM code numbers 640–648 and 65 1–676

are assigned.

First-listed diagnosis. —The coded diagnosis

identified as the principal diagnosis or listed first on the

face sheet of the medical record. The number of firstlisted diagnoses is equivalent to the number of discharges.

All-1isted diagnoses. —The estimated number of

discharge (or final) diagnoses, up to a maximum of

seven, that are listed on the face sheet of the medical

record for inpatients discharged from non-Federal

short-stay hospitals during the.year.

Procedure. —One or more surgical or nonsurgical

operations, procedures, or special treatments assigned

by the physician to the medical record of patients

discharged from the inpatient service of short-stay

hospitals. In the NHDS all terms listed on the face

sheet (summary sheet) of the medical record under the

captions “operation, ““operative procedures,” “operations and/or special treatment,” and the like are

transcribed in the order listed. A maximum of four

procedures are coded.

Average length of stay. —The total number of

patient days accumulated at time of discharge by

patients discharged during the year divided by the

number of patients discharged.

Race. —A term used to classify patients into one of

two groups: “white” and “all other.” The “all other”

classification includes all categories other than white.

Mexican and Puerto Rican patients are included in the

white category unless specWlcally identified as “all

other.”

Type ofownership ofhospitai. —The type of organization that controls and operates the hospital. Hospitals are grouped as follow=

. Voluntary nonpro@. —Hospitals operated by a

church or another nonprofit organization.

● Government. -Hospitals operated by State or local

governments.

● Propn”eta~. —Hospitals operated by individuals,

partnerships, or corporations for profit.

NOTE:A list of references follows the text.
Geographic region.—One of the four g-graphic

regions of the United States corresponding to those

used by the U.S. Bureau of the Census:

Region States ih;luded

Northeast . . . . . . . . . Maine, New Hampshire. Ve?mont, Massachusetts, Rhode Island, Connecticut,

New York, New Jersey, and Pennsylvania

North Central . . . . . . Michigan, Ohio, Illinois, Indiana. Wisconsin, Minnesota, Iowa. Missouri,

Region—Con. Stares included—Con.

North Dakota, South Dakota. Nebraska,

and Kansas

South . . . . . . . . . . . . . Delaware, Maryland, Dlstnct of Columbia,

V1rglnia, West Virgmla, North Carolina,

South Carolina, Georgia, Florida, Kentucky, Tennessee, Alabama, Mississippi, Arkansas, Lou!slana, Oklahoma,

and Texas

West . . . . . . . . . . . . . Montana, Idaho, Wyoming, Colorado,

New Mexico, Arizona, Utah, Nevada.

Washington, Oregon, Califom]a, Hawaii, and Alaska

Symbols

--- Data not available

. . . Categow 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
11~& ~ g_

From Vital and Health Statlstlcs of the National Center for Health Statlst[cs Number 84 ● October 8, 1982

Blood Pressure Levels and Hypertension in Persons Ages 6–74

Years: United States, 1976–80

By Michael Rowland and Jean Robertsr Division of Health Examination Statistics

Hypertension or substantially elevated blood pressure is one of the more prevalent chronic conditions

known to increase the risk of developing circulatory diseases, particularly heart disease and stroke.1-q Circulatory diseases are the leading cause of death and of hospitalization in the United States. This report presents

national estimates for blood pressure levels, the prevalence of known and previously undiagnosed hype~ension, and the extent of use of rmtihypertensive me&cation in the general U.S. population during the period

1976–80. The data are from the second National

Health and Nutrition Examination Survey, which used

a probability cross-sectional sample of the civilian noninstitutiona.lized population ages 6–74 years in the

United States, including Alaska and Hawaii.s Trends

since 1960 in the extent of treatmen~ awareness, and

control among those with hypertension are also shown.

Methods

The National Health and Nutrition Examination

Survey of 1976–80 (NHANES II) is the fti in a

series of programs of the National Center for Health

Statistics carried out over the past 20 years that were

designed to collect a broad range of morbidity data and

related health information through direct standardized

examinations, histories, tests, and procedures used in

clinical practice as previously described.G-10

In this latest survey, three blood pressure measurements were obtained on each person examined at the 64

sample locations throughout the-country. The examining physicians used standardized methods based on

recommendations ofthe American Heart Association. 11

Of the 22,732 sample persons selected for the

~S u to represent the 186.7 million persons ages

6–74 years in the U.S. popdation as of the midpoint of

the survey (March 1, 1978), 16~04persons or71.3 percent were examined.

Examination surveys lose infiorrnation not only

through the failure to examine all sample persons, but

also through the ftiure to obtain and reed all items of

information for those examined. In this survey, 1 percent of the values for systolic or diastolic or both

measurements were missing for each of the three blood

pressure determinations. When data were missing imputation was used to minimize the effect on population

estimates by considering the person’s age, sex, race, arm

girtlq weight height and any other systolic or diastolic

measurements recorded.

Additional information regarding the sample design, estimation procedure, tests of si~lcance,

sources of variation in blood pressure measures, and

sampling variability of the national estimates is included in the “Technical notes.”

For trend analyses, the nationaI estimates from

NHANES II blood pressure and medical history data

are comp~ed with those from the National Health Examination Surveys (NHES I, II, andIII) andNHANES

I, each based on findings for national probability samples of the designated civilian noninstitutionalized

target population. NHES I of 1960–62 used a sample

of adults 18–74 years of agq NHES II of 1963-65,

children 6–1 1years of agq andNHES III of 1966–70,

youths 12–17 years. In NHANES I of 1971–74 the

sample was for persons 6–24 years of agty NHANES I

of 197 1–75 and NHANES IA of 1974–75 for adults

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service
2 zJCk31MxCklb

25–74 years of age. Comparisons involving the use of

antihypertensive medication are limited findings from

NHANES II, NHANES IA, and NHES I because the

question on medication use was identical only for these

surveys. The survey data included in the trend analyses

are summarized in table 1.

Findings

Systolic pressures

Age. —Mean systolic blood pressure estimates for

the U.S. population in 1976–80 were higher in succeedkg age groups ranging from 101.3 mm Hg among

children ages 6– 11 years to 144.3 mm Hg among the

oldest adults in the study, those ages 65–74 years

(table 2).

S’ex.-At 12 through 54 years of age the mean

levels of systolic pressure among males significantly

exceeded those for females, but at 65 through 74 years,

the mean levels for women were higher.

Race.—At 18–24 years of age, systolic mean

pressures for white men exceeded those for black men,

but at 35–44 and 55–64 years, the mean systolic levels

of black men were higher. Mean systolic blood pressures of white females 12– 17 years of age exceeded

those for black females, but at 35-74 years of age,

systolic levels of black women were higher.

Diastolic pressures

Age. —Mean diastolic pressure values were generally higher in succeeding age groups and ranged from

64.3 mm Hg among children ages 6-11 years to 83.5

mm Hg at ages 55–64 years (table 3).

S’ex.-Mean levels for men si@lcantly exceeded

levels for women at ages 18 through 64 years.

Race.—At ages 35–74 years, mean diastolic pressures for black men and women exceeded those for

white men and women, respectively.

Elevated blood pressure levels

The findings for elevated blood pressure are summarized for the variables age, sex, and race in this

section. In addition, data are presented regarding the

treatment (diagnosis and medication) for elevated

blood pressure and the prevalence of hypertension. Elevated blood pressure level, for the purpose of this

report, is defined differently for people under 25 years

of age than for people 25–74 years of age. The

definitions of all terms used in this section of the report

(as well as in the section entitled “Secular trends”) are

presented in table 4 with a summary of the prevalence

estimates discussed in this section.

Age.—In 1976–80, 0.4 percent of U.S. children

ages 6– 11 years and 3.6 percent of U.S. youths ages

12– 17 years, or 0.9 million children and youths in the

general population, were found to have elevated blood

pressure levels as defined in table 4 (systolic pressure of

at least 140 mm Hg or diastolic pressure of at least 90

mm Hg or both). Among young adults ages 18–24

years, 8.9 percent or 2.5 million had elevated blood

pressure of this level.

At ages 25–74 years, 14.5 percent or 16.5 million

had elevated levels—systolic pressure of at least 160

mm Hg and/or diastolic pressure of at least 95 mm Hg.

Among adults the prevalence rates for this con&ion

were higher in each succeeding age group ranging from

5.5 percent at ages 25-34 years to 26.6 percent at ages

65-74 years (table 5).

Sex. —Among young adults ages 18–24 years,

prevalence of elevated blood pressure was significantly higher among men (15.0 percent) than women

(3.2 percent). At ages 25-64 years the prevalence (as

defined in table 4) was higher among men than women,

although the differences in rates in the 10-year age

groups within this age range were not consistently large

enough to be signiilcant at the 5-percent probability

level.

Race. —Among white adults ages 18–24 years, the

rates were higher for men than women but rates were

similar for black men and women. At ages 25-74 years,

elevated levels were signiilcantly more prevalent

among black than white adults (22.8 per 100 compared

with 13.5 ). Among white, but not black, adults the rates

were significantly higher for men than women at 2:5–74

years of age.

Treatment.—The percent of those with elevated

blood pressure who were reported as never having been

diagnosed by a doctor was higher among youths ages

12–17 years (90 percent) and young adults ages 18–24

years (78 percent) than among the adults ages 2:5–74

years (40 percent). However, an estimated 27 percent

ofthe adults ages 25–74 years who were in the high risk

group (diastolic pressure of at least 105 mm Hg) had

never been told by a doctor that they had high blood

pressure.

About one-third of the adults 25–74 years clf age

with elevated blood pressure reported they were currently taking prescribed antihypertensive medication

(table 6). This would include persons for whom such

treatment had been prescribed so recently that the

medication had not yet taken fill effect as well as those

for whom the medication did not reduce their blood

pressure below the level defined as elevated. Forty percent of the adults with diastolic pressures that placed

them in the high risk group were on antihypertensive

medication.

Hypertension

Assuming that those adults whose blood pressure

was not elevated but who reported current use of antihypertensive medication were keeping their blood pressure below the critical level (systolic of 160 mm Hg
ackmxk@3

and/or diastolic of 95 mm Hg) through medicatio~ that

is, controlling ~eir hypertension, there would have

been 25.1 million U.S. adults ages 25–74 years in

1976–80 with hypertension, a rate of 22.0 per 100.

This rate includes the 14.5 per 100 whose-pressure was

still elevated at the time of the survey and the 7.5 per

100 taking medication whose pressure was not then

elevated.

Secular trends

Mean bloodpressure.—Both mean systolic and diastolic blood pressure levels of U.S. children and

youths in 1976–80 were similar to the levels found in

1971-74, but were lower than the levels for children

and youths in 1963–65 and 1966–70, respectively.

Mean systolic blood pressure levels of adults in

1976-80 were significantly lower than mean levels at

the time of the previous national surveys in 1960-62

and 1971 –75. 1z The decrease in systolic pressure

levels from those found among adults in 197 1–75 was

significant across the age range 25–74 years and horn

1960–62 across ages 35–74 years (figure 1). The

difference in mean leveIs reflects a change primarily in

the systolic blood pressure of the older age groups. In

1960–62 the diiTerence in systolic pressure between

people ages 18–24 and those ages 65-74 was 38.4 mm

Hg. In 1976–80 the difference was only 27.2 mm Hg.

Mean diastolic levels among adults in 1976–80

were signiilcantly lower than the mean leveIs in 197 l–

160

r

:

0

t-’--”

Diastolic . . . ...= .

E 80 . . . ...9

*#~

t

- _ 1960-62

60 nmsm.. 1971-75

R 1976-80

Age in years

75 but were essentially unchangedfiom the mean levels

ih 1960-62. In other words, the 1971 –75 estimates

were higher than estimates for the earlier and later time

periods.

Mean systolic and diastolic blood pressure levels

were signiilcantly lower for both white and black adults

ages 25-74 yearn in 1976–80 than in 197 1–75. This

dit%erence was generally consistent across age groups

for both men and women. Mean systolic blood pressure

levels for each of the four race-sex groups of adults were

also generally lower in 1976–1980 than in 1960–62,

but the diastolic blood pressure levels in 1976–80 were

essentially similar to the levels in 1960– 1962 for each

of the four race-sex groups.

Elevated bloodpnmwe.-The prevalence of elevatedbkmd pressure in children 6–11 years and youths

12–17 years in 1976–80 (0.4 and 3.6 per 100, respectively) was lower than in 1971 -74(0.6 forchiklren and

6.4 for youths).I3 However, the difference was statistically signii7cant only for youths.

For adults ages 25–74, the prevalence rate of 14.5

per 100 in 1976–80 was significantly less than the ageadjusted rates of 16.7 and 17.7 per 100 in 1960–62 and

1971–75,12 respectively. Among the individual age

groups the decrease was large enough to be statistically

significant only at ages 55–74 years (figure 2). The

downward trend occurred for three of the four race-sex

groups. The differences in the age-adjusted prevalence

of elevated blood pressure between the 1976–80 survey

and the two earlier surveys were statistically significant

for white and black women and black men.

High Risk. —Blood pressure high enough to put

adults into the high risk category was slightly but not

significantly less prevalent in 1976–80 than in 1960-

62 (age-adjusted rate of 2.8 versus 3.5 per 100);

however, it was sidcantly less than in 197 1–75 (ageadjusted”rate of Z5 per 160).

_ _ 1960-62

■ m9m.. 1971-75

_ 1976-80

/.

o 30 40 50 60 70

Age in yeara

F!gure 1. Mean blood pressure In adults ages 25-74 years United States,

1960-62, 1973-75. and 1976-80

Figure 2. Prevalence rates for elevated blood pressure among adu Its ages

25-74 years. by age Umted States. 1960-62.1971-75, and 1976-80
4 aduancedata

60

40

20

0

60

40

T

60

40

1960- - “ 1974-

62 75

on medication and controlled

-r

1976-

80

20

0

62 75 80

Previously diagnosed but not on medtcatlon

20

0

60

40

20

0

T

62 75 80

on medication but not controlled

T

62 76 80

Never diagnosed

NOTE The total hypertenswe group Includes those w!th elevsted blood pressure on examj”stmn and others currently tskmg armhypertenswe medicatmn.

Figure3. Percent of total adults ages 25-74 years with hypertension by prewous diagnosis end medication status: United Stetes, 1980-62,

1974-75, and 1976-80
Treatment.—Among those adults 25–74 years

with elevated blood pressure, a higher percent reported

that they had been told by a doctor that they had high

blood pressure in 1976–80 (60 percent) than in 1971–

75 (51 percent) or in 1960-62 (45 percent). For the

high risk group, the percent previously diagnosed was

also higher in 1976-80 (73 percent) than in 1971–75

(64 percent) and in 1960-62 (59 percent). The increase in awareness of their condition among those with

elevated blood pressure was large enough to be statistically signMcant. The percent of adults 25–74 years

with elevated blood pressure who were currently taking

prescribed anti.hypertensive medication in 1976–80

(33.5 uercent) was higher than in 1974-75 (25.7 percent) and 1Y60–62 (23.0 percent).

I#yperten,sion. -The prevalence of hypertension

(as defined in table 4) among adults 25-74 years has

not changed signiilcantly since 1960–62 except for the

increase among white men (table 7). However, among

those with hypertension, the percent never diagnosed

by a physician as having hypertension or high blocxl

pressure has dropped signillcantly from51 percent in

1960-62 (age-adjusted) to 27 percent in 1976–80

(figure 3). The decrease is consistent among white and

black men and women. This decrease in unawareness

or, conversely, increase in awareness since 1960–62

has been accompanied by an increase in the proportion

of hypertensives who reported they were currently

taking antihypertensive medication and an increase in

the proportion taking such medication whose blood

pressure at the time of the survey was below the

elevated level. More than half the increase in awareness occurred prior to 1974–75; however, nearly 80

percent of the increase in the use of antihypertensive

medication has occurred since the 1974-75 period.

Discussion

The findings indicate that there has been increased

awareness, treatment, and control of hypertension

during the 1970’s. This has occurred at a time of decline in mortality from circulatory diseases and their

two major components-coronary heart disease and

stroke. Although many factors may be responsible for

this decline, the improved control of blood pressure is

considered a major contributor. 1AKannel 1S has recently estimated that effective use of antihypertensive

agents between 1968 and 1978 could be responsible for

perhaps a third of the reduction in cardiovascular mortality during the same decade. Even prior to the era of

decreased mortality from cardiovascular disease,

Moriyama, Krueger, and Starnlerlb noted that differential trends in coronary heart disease among men and

women, both black and white, in the 1940’s and 1950’s

might be associated with the differential effects of

hypertension on coronary heart disease risk and mortality.

●
6

References

10. Paul (cd.): A survey of the epidemiology of hypertension,

1964–1974. A40d Cone. Cardiov. Dis. 43(7):99-102, July 1974.

2W. B. Kannek Role of blood pressure in cardiovascular morbidity

andmortality. Progr. Cardiov. Dis. 17:5–24, 1974.

3W. B. Kannel, P. A. Wolf, J. Verter, and P. McNamara: Epidemiologic assessment of the role of blood pressure in stroke The

Framingharn study. JAMA 214:30 1–3 10, 1970.

4Buiid and Blood Pressure Study, 1959, VOL 1. Chicago. Society

of Actuaries, 1959.

5National Center for Health Statistics, A. McDowell, A. Engel,

J. T. Massey, and K. Maure~ Plan and operation of the Second

National Health and Nutrition Examination Survey, 1976–&(_I.

Viral and Health Statistics- Series I–No: 15. DHHS Pub. No.

(PHS) 81-1317. Public Health Service. Washington. U.S. Government Printing OffIce, July 1981.

6NationaI Center for Health Statistics: Plan and initial program of

the Health Examination Survey. Vital and Heal/h Statistics.

(PHS) Pub. No. 1000–Series I–No. 4. Public Health Sewice.

Washington. U.S. Government Printing Otlice, July 1965.

7National Center for Health Statistics Plan, operation rmd response results of a program of children’s examinations. Vital and

Healrh Statistics. PHS Pub. No. 1000-Series l–No. 5. Public

Health Service. Washington, U.S. Government Printing Office,

Oct. 1967.

8Nationd Center for Health Statistics: Plan, operation of a Health

Examination Survey of U.S. youths 12–17 years of age. Vital and

Health Statistics. PHS Pub. No. 1000-Series 1–No. 8. Public

Health Service. Washington. U.S. Government Printing OtliceSept. 1969.

9National Center for Health Statistics, H. W. Miller Plan and

operation of the Health and Nutrition Examination Survey, United

States, 197 1–73. Vital and Heaith Statistics. Series I–Nos. 10a

and 10b. DHEW Pub. No. (HSM) 73–13 10. Public Health

Service. Washington. U. S- Government Printing Oftlce, Feb.

1973.

Augmentation Survey of adults 25–74 years, United States, 1974-

1975. vital and Health Statistics. Series 1–No. 14. DHEW Pub.

No. (PHS) 78–13 14. Public Health Service. Washington. U.S.

Government Printing Office, June 1978.

1lcommi~ee to Revise s~~rdization of Hi~ Bl~ pressure

Readings Recommendations for human bloodpressure determinations by sph.ygmomanometem. New York. American Heart

Association, Ott 1951.

12Nation~ center for He~~ s~tistiw, J. Robefi ~ud M.

Rowland Hypertension in adults 25–74 years of age, United States

1971 – 1975. Vital and Health Statistics. Series 1I–No. 221.

DHHS Pub. No. (PHS) 81–1671. Public Health Service. Washington. U.S. Government Printing OffIce, Apr. 1981.

13Nation~ Center for Heal~ Statistics, J. Ro~fis ad K- Maurec

Blood Pressure Levels of Person 6–74Years, United States, 197 l–

1974. Vital and Health Statistics. Series 11–No. 203. DHEW

Pub. No. (HRA) 78–1648. Health Resources Administration.

Washington. U.S. Government Printing Otllce, Sept. 1977.

14R. I. hvy and J. Moskowitz Cardiovascular researck Dlecades

of progress, a decade of promise. Science 21 Z 121– 129, July 9,

1982.

15W. B. Kannel: Meaning of the downward trend in cardiovascular

mortality. L4kL4 247(6)877–880, Feb. 1982.

161. &foriy~a, D. E. ~ger, ~ J. Stier Cardiovascular

diseases in the U.S. Cambridge. Harvard University Press,, 1971.

17National Center for Health Statistics, P. J. McCarthy Repiicatiotx An approach to the analyses of data tlom complex surveys.

Vital and Heaith Statistics. PHS Pub. No. 1000-Series 2–No. 14.

Pubiic Health Service. Washington. U.S. Government Fkinting

Otllce, Apr. 1966.

18M. Spiegeimam Introduction to Demography, 2~ ed. Cambridge. Harvard University Press, 1968.

19~ G. ~~e~ Sfmu[taneous Statisfi’ca[ Inference. New YorkMcGraw-Hill Book Co., Inc., 1966.

10National Center for Health Statistics, A. Engel, R S. Murphy,

K. Maurer, and E. Collins: Plan and operation of the NHANES-I
admc4aa7

Table 1. Survey data used in study

Number of

Survey program

Current use of

7ime period Age of examinees blood pressure antihypertensive

measurements medication

j(tiANES II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1976-80 12-74 years 3 Yes

NHANES II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1976-80 B-1 1 years 3 No

NHANES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1971-75 25-74 years 3 No

NHANES IA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197&75 25-74 years 3 Yes

NHANES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1971-74 6-24 years 1 No

NHES III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1966-70 12-17 years 2 No

NHES II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1963-65 6-11 yeara 2

NHES I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No

1960-62 16-74 years 3 Yes

Table 2. Mean systolic blood pressure levels of persons 6-74 yeara by race, age, and sex, with standard errors of the means United States, 1976-80

Both sexes Male Female

Race and age Standard Standard Standard

Mean error of Mean error of Mean error of

mean mean mean

Blood pressure in mm Hg

All racasl

6-n yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

White

6–ll yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12–17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25-34 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

Black

6-n yearn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yeara . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . .

101.3

112.8

117.1

118.2

122.6

129.9

137.4

144.3

101.4

113.4

117.4

118.4

122.1

129.1

136.7

143.9

101.7

110.9

115.9

118.5

128.2

137.0

144.9

147.5

0.73 101.2

0.71 114.8

0.62 123.7

0.66 124.6

0.78 126.1

0.66 131.3

0.83 137.3

0.83 142.3

0.70 101.5

0.74 115.3

0.63 124.3

0.69 125.0

0.81 125.8

0.71 130.9

0.83 136.9

0.69 142.2

1.16 100.8

0.93 112.9

1.00 120.6

1.10 124.1

1.37 131.2

1.55 135.6

2.20 143.8

1.45 142.4

0.74

0.81

0.82

0.80

0.99

0.84

0.89

0.85

0.70

0.90

0.84

0.82

1.06

0.83

0.89

0.80

1.35

1.40

1.41

1.63

2.30

2.40

2.63

1.10

101.4

110.8

110.9

112.2

119.4

128.6

137.4

145.8

101.4

111.5

110.9

112.1

118.6

127.4

136.6

145.3

102.6

108.8

112.1

114.0

125.8

138.2

145.8

151.4

0.89

0.79

0.64

0.67

0.85

0.96

1.03

0.95

0.88

0.80

0.64

0.70

0.82

1.06

1.02

1.06

1.41

0.97

1.19

1.46

1.82

2.10

2.77

2.30

1,ncludes ~th.r ~cial groups in ●ddnien to ~ite ad black.

NOTE: All bleed prussuresam the avarqa of 3 rrwsumments.
8 achlancedata

Table 3. Mean diaatolic blood pressure levels of persons 6-74 years by race, age, and sex, with standard errora of the means United States, 1976-80

Both sexes Male female

Race and age Standard Standard Standard

Mean error of Mean error of Mean error of

mean mean me~8n

All racesl

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

White

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

55-6~ years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65->4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Slack

6-n yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

45-54 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

65-74 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

64.3

69.8

72.8

75.9

80.0

83.4

83.5

82.2

64.3

69.8

72.8

75.8

79.5

82.9

83.0

81.8

64.3

70.3

72.8

.77.2

83.9

88.5

88.5

85.5

0.46

0.44

0.36

0.51

0.59

0.58

0.51

0.49

0.45

0.46

0.40

0.54

0.58

0.59

0.55

0.54

0.99

0.56

0.63

0.74

1.24

1.20

0.79

0.79

8100d preaaure in mm Hg

64.3 0.56

70.1 0.40

75.6 0.44

79.2 0.64

82.4 0.70

85.3 0.63

85.0 0.57

82.5 0.53

64.3 0.52

70.0 0.42

75.7 0.48

79.2 0.65

82.0 0.72

85.0 0.64

84.4 0.61

82.2 0.56

64.8 1.37

70.9 0.94

74.9 0.96

80.2 1.46

86.1 1.84

88.0 1.89

90.4 1.23

85.5 0.72

64.1

69.5

70.2

72.8

77.8

81.6

82.3

81.9

64.2

69.6

70.0

72.5

77.1.

80.9

81.7

81.5

63.7

69.7

71.0

74.7

82.1

89.0

86.8

85.5

0.46

0.57

0.45

0.53

O.til

0.71

0.!33

0.!58

0.48

0.62

0.45

0.56

0.59

0.73

0.58

0.62

1.16

0.56

0.96

0.98

1.48

1.51

1.00

1 .2!2—

1,nclude~ other ~acial grOUpS in additmn to white and black.

NOTE All blood pressures are the avemge of 3 measurements.

Table 4. Definition of terms baaed on age, blood pressure measurement or questionnaire responses or both, and prevalence estimates for groups

corresponding to these terms: United States, 1976-60

Term Age &feasuns Prevalence estimate

—

Normotensmn . . . . . . . . . . . . . . . . . . . . . . . .

Elevated blood pressure . . . . . . . . . . . . . . .

High risk . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . .

Onmedlcation . . . . . . . . . . . . . . . . . . . . . .

Never diagnosed. . . . . . . . . . . . . . . . . . . . .

25-74 years Systolic below 140 mm Hg and diastolic below 80 mm Hg

6-24 years Systolic 140 mm Hg or greater and/or diastolic 90 mm Hg or greater

25-74 years Systolic 160 mm Hg or greater and/or diastolic 95 mm H9 or greater

25-74 years Diastolic at least 105 mm Hg

25-74 years Systolic 160 mm Hg orgreaterand/or diastolic 85 mm Hg orgreatar, plus

those with pressures below these Ievela at the time of examination

who reported on medical history that they were currently taking antihypertenswe medication

25-74 years Persons who reported on medical history that they were currently taking

antihypenensive medication regardless of blood pressure level on

exammatton

1 ?-74 years Persons with elevated blood pressure among those who reported on

medical htstory that they had never been told by a medical doctor that

thev had ever had hypertension (or high b100d pressure)

—

69.3

0.4 (6-1 1 years)

3.6 (1 2-17 years)

8.9 (1 6-24 yews)

I 4.5

2.8

22.0

12.3

80<0 (1 2-17 years)

77.7 (18-24 years)

40.4 (25-74 yearn)
9

Table 5. Preva Ience rates of elevated blood pressure levelal for persons 25–74 yeara by race, age, and sex, with standard errors of the rates: United States.

1976-60

&th sexes Male Female

Rate Rate Rare

Race and age per Standard per Standard per Standard

100 error of 100 error of 700 error of

popu- rate popu- rate popu- rate

fation Iation Iation

All races2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4. .

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

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

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

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

65-74 vears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

14.5

5.5

9.9

17.8

21.7

26.6

13.5

5.3

8.5

16.5

20.2

25.5

22.8

7.6

19.6

30.7

37.6

36.5

0.84

0.78

1.07

1.24

1.47

1.34

0.86

0.87

1.04

1.19

1.57

1.43

1.62

1.14

2.74

4.61

3.97

3.26

16.4

8.7

11.8

20.9

23.7

24.9

15.9

8.4

10.6

21.2

22.3

24.5

22.4

11.7

22.3

23.0

39.2

27.5

1.04

1.31

1.67

1.73

1.92

1.54

1.12

1.43

1.75

1.79

2.07

1.60

1.87

2.30

5.01

5.37

3.89

3.01

128

2.6

6.2

14.9

20.0

27.9

11.4

2.3

6.5

12.1

16.3

26.3

23.2

4.3

17.6

37.3

36.4

43.4

0.81

0.56

0.98

1.71

1.43

1.76

0.79

0.57

0.75

1.62

1.58

1.77

2.29

1.46

4.18

5.50

6.06

5.62

1sy~toiic blood pressure of at least 160 mm H9 and/or diastolic blood Presaws Of at Iesat 95 mm Hg.

21ncludesother ~Gial groups in sddition to white and black.

NOTE All blood pressuras are the average of 3 memmrments

Table 6. Number and percent of persons ages 25-74 yeara by responses to selected medical history items and specified blood pressure levels, with

standard error of the percent United States. 1976-80

systolic 160mm Hg orgreatertrnd/or

diastolic 95 mm Hg or greater At least 105 mm Hg diastolic

Medical history items

Fbpulation in Percent Standard error I%puiation in Pen2ent Standard error

thousands of percent thousands of percent

Tota125-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,541 100.0 . . . 3,253 100.0 . . .

Have you ever been told by a doctor that you had high blood

pressure or hypertension?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,863 59.6 1.50 2,363 72.6 3.19

During the past 12 months, about how many times have you seen

or talked to a doctor about your high blood pressure or hypertension?

Oneor more times . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,144 43.1 1.21 1,657 50.9 3.71

Are you now taking any medicine prescribed by a doctor for your

high blood pressure or hypertension?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,535 33.5 1.46 1.294 39.8 3.88

NOTE: All blood pressuresam the avemge of 3 measurements.
Table 7. Prevalence rates of hypertension forperaons 25-74 years of age by treatment history, race, and sex, with standard errors of the percenc Umted Ststea, 1960-62, 1974-75, and 1976–80

Race snd aex

Hypertensive 1 Never diegnosed2 On medication On medication and

contmlle d3

1960-62 1974–75 1976–80 1960-62 1974–75 1976-80 1960–62 1974–75 1976-80 1960–62 1974–75 19 76–80

Percent of p0pulat}0n4 Percent of total w!th hyperiensiorrl,4

Ailpeopla 25-74 years5, ,, ..,,., . . . . . . 20.3 22.1 220 51.1 36.4 26.6 31.3 34.2 56.2 16.0

White men . . . . . . . . . . . . . . . . . . . . . . . . . . .

19,6 34.1

16.3 21.4 21.2 57.6 42.3 40.6 22.4

White women . . . . . . . . . . . . . . . . . . . . . . . . 20.4

25.9

19.6 20.0

38.3

43.9

11.8 15,1

29.7 25.2

20.9

Black en . . . . . . . . . . . . . . . . . . . . . . . . . . .

38.2

31.8 37.1

48.5

28.3

58.6

70.5

21.9 28.1

41.0 35.7

40.3

Black women . . . . . . . . . . . . . . . . . . . . . . . . .

18.5

39.8 35.5

“24.0 40.9

39.8 35.1

5.0

28.9

“12.7

14.5

16.1

48.1 36.4 60.6 20.2 *22.3 38.3

Standard error of percent

Allpaople 25-74 years5 . . . . . . . . . . . . . . . 0,83 1.26 0.68 1.66 1.70 1.53 1.B2 2.21 1.99 1.65 1.49 2.02

White men . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.95 2.19 1.04 3.75 2.63 1.80 3.07

Wh!te women . . . . . . . . . . . . . . . . . . . . . . . . 1.07 1.14

3.22 2.47

0.66 2.77

2.59

2.08

2.56 2.01

1.97 2.24

81ack men...,,...........,., . . . . . . . . 3.37

3.61

5.94 1.86

2.40

7.07

2.24 2.93

10.38 4.27

2.99

5.53

81ack women..............,.. . . . . . . . . 3.73

10.79

3.60 1.96

4.52

3.72

2.18

7.42

6.69

2.73

3.72

3.87 6.30 3.22 3.21 7.93 4.35

1Elevated blOOd~re~~ure(that i$, ~ systolic~eas”remant Ofat least 180 mm Hg or a diastolic measur.smam of at least 95 mm Hg) or fa~n9 ant!hvpenenslve medication.

2ReP0fled “ever tofd by physician thst he or she had high blood Pressure Or hYoertanslOn.

3~ub~et of ,.0” ~adication., group; thO~e taking ~ntihypmfien~ive medi~atiOn ~hOae b100d pre~s”re wss not elevated at the time of the examination.

4,4ge ~dju,tsd by diract method to the popufatton at midpoint of tha 1976-60 National Health snd NutmiOn ExaminaliOnSuwey.

blncl”des.II Other tacea not ahwn aeparatek
amcdata 11

Technical notes

Sample design

The ~ormation presented in this report is based on

data from the direct standardized physical ewuninations, tests, measurements, and questionnaires collected in the second National Health and Nutrition

Examination Survey (NHANES II) during 1976–80.

The target population of NHANES II was the civilian

noninstitutionalized population of the United States,

including Alaska and Hawaii, ages 6 months through

74 years.

NHANES II used a multistage probability design

that involved selection of primary sampling units

(PSU’S); households; eligible persons; and, finally,

sample persons. The sample design provided for oversampling among persons 6 months-5 years of age,

persons 60–74 years of age, and persons living in

poverty areas. Under contract to the National Center

for Health Statistics and according to rigorous agreed

speciilcations, the U.S. Bureau of the Census selected

the NHANES II sample of 27,801 persons. Of this

total sample, 20,322 (73. 1 percent) were examined.

The data in this report are presented as population

or subdomain estimates. Examination findings for each

sample person have been inflated by the reciprocal of

the probability of selecting a person, adjusted for

persons who were not examined, and poststratiled so

that final population estimates closely approximate the

independent U.S. Bureau of the Census estimates for

the civilian noninstitutionalized population of the

United States by race, sex, and age as ofthemidpointof

the study, March 1, 1978.

Sampling errors

The estimates presented in this report are based on

a sample of the target population rather than on the

entire population. Thus the estimated values may differ

ffom the values that wotid be obtained from examining

the entire target population. Assuming that an estimate

is unbiased, the expected magnitude of the sampling

error is measured by a statistic called the standard

error. A variant of the pseudoreplication method was

used to produce the estimates of standard emors for this

report. 17

Standardized values

Means and rates have been adjusted for age to the

U.S. civilian noninstitutiondized population in 1976–

Note A list of references follows the text.

80, where indicated, using the direct method of standardization.lg Standardization removes the effect that

diiTerences in the age distributions may have on the

comparison of subgroup rates.

Tests of significance

The procedure used in this report for testing the

significance of the diiTerence between two means

consisted of dividing this difference by the standard

error of the difference (Z-statistic). h approximation

of the standard error of a difference d = x —y between

the two statistics x andy is given by the formula S~ =

(~ -1-S{~~ where SX and S, are estimates, respectively, of the actual standard errors. When the two

groups or measures are positively or negatively correlated, this equation yields an overestimate or underestimate, respectively, of the actual standard error of

the difference.

If more than one comparison is implied, the Bonferroni testl~ was used to test for signiilcance. In the

Bonferroni test the Z-statistic is computed for each

component in the muItiple compariso~ but each individual signiilcance level is adjusted to account for the

increased likelihood of a signiilcant result from muh.ipie

tests.

The 5-percent probability ievel has been used for

the determination of statistical significance in this

report.

Order of measurements

The examinee’s first blood pressure determination

in the NHANES II of 1976-80 was made before the

physical examination with the exarninee sitting, the

second at the end of the examination with the examinee

supine, and the third immediately aRer the second with

the examinee sitting on the edge of the examination

table. This examination protocol was also used. in the

NHANES I of 1971-75. In the NHES of 1960–

62, the order of the measurements in relation to the

examination was similar to that in the present study, but

all three were taken in a sitting position.

Initial blood pressure values for examinees on

whom more than one reading was obtained in the

National Health Examination Survey during the 1960’s

were generally higher than the subsequent ones. In contrasG blood pressure levels from ail three measurements

inthe 1971–75 NHANES I were similar as are the three

measurements in the 1976–80 NHANES IL
Summary Data From the National Inventory of Pharmacists:

United States, 1978–79

By Gloria Kapantais, Office of Vital and Health Care Statistics Program

Supply of pharmacists

Between May 1977 and June 1979, the National

Center for Health Statistics conducted an inventory of

all licensed pharmacists in the United States. The data

collection spanned 2 years in an effort to time each

State’s survey to correspond with its license renewal

period for pharmacists.

Results from this survey indicate that there were

160,664 licensed pharmacists, of which 112,335 were

known to be active in their profession, 20,912 were

inactive, and the activity status of 27,417 was unknown

(table 1). As seen in this table, the percent of active

pharmacists decreases as age increases. For those

under age 30, 95 percent were active, while only 47

percent of those 65 years and older were active. This

trend occurs among both sexes, although at every age a

smaller percent of licensed female pharmacists are

active. Table 1 indicates that 21 percent of active

pharmacists are under age 30, while 12 percent are age

60 and over. Therefore, there is a sufficient influx of

young pharmacists into the profession to replace the

older pharmacists who are most likely to be leaving the

profession.

In table 2, the activity status for those pharmacists

who did not report this information is imputed by

apportioning the 27,417 pharmacists with unknown

activity status into categories in the same ratio as

among the pharmacists whose activity status is known.

Of the resulting 135,449 active pharmacists, the largest

number is located in the South (43,932). New England

has the highest ratio of active”pharmacists per 100,000

population (69.0), while the Pacific division has the

lowest ratio (55 .9).

In 1978–79, there were 18,115 known female

pharmacists who were active in the profession, which

accounts for 16 percent of the supply of active pharmacists of known sex (table 1). Nearly three-fourths

(71 percent) of the female pharmacists were under age

40.

The distribution of the 112,335 known active

pharmacists by age, race, and Hispanic origin is shown

in table 3. Active minority pharmacists constituted

about 5 percent of all practicing pharmacists. Nearly

two-thirds of these minority pharmacists were oriental,

and approximately one-third were black. In 1978-79,

nearly 2 percent of the practicing pharmacists were of

Hispanic descent.

Work setting

In table 4 it is shown that 72 percent of the known

active pharmacists were employed in pharmacies. Of

the three types of pharmacies speciiied in the survey,

the independent community pharmacy employed the

largest number (38,408), with chain pharmacies employing 28,423 pharmacists, and clinic or medical

building pharmacies employing only 3,968 pharmacists. Hospitals employed about 20 percent of the

pharmacists, while nursing homes employed a very

small percent (1.6 percent). The remaining pharmacists were employed by pharmaceutical manufacturing companies, colleges of pharmacy, or other employers.

It is seen in table 5 that almost all (nearly 83

percent) women pharmacists are salaried (manager,

assistant manager, or staff pharmacist), while twothirds of male pharmacists are. Employment as a staff

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

pharmacist is one of the forms of practice in which

females are able to work part-time. This is the principal

form of employment for 82 percent of the part-time

female pharmacists.

Of the 112,335 pharmacists known to be active in

their profession, half (52, 129 or 50.8 percent) worked

36–45 hours a week (table 5). A Iargerpercent of males

worked 40 hours or more a week than females. As

would be expected, the longest hours were worked by

those pharmacists who were sole owners of their

principal form of employment. Over 80 percent worked

46 or more hours a week.

Inactive pharmacists

A total of 20,912 known inactive pharmacists were

surveyed, which was 16 percent of all licensed pharmacists in the survey (table 6). These pharmacists

represent a potential source of manpower because they

are trained and licensed and may at any time enter or

return to the profession. III terms of potential pharmacist resources, 12 percent of the inactive pharmacists are seeking work in the profession. An additional 8 percent are homemakers. Less than half of the

inactive pharmacists (45 percent) said they are inactive

because they are retired.

The actual unemployment rate in the profession is

less than 2 percent. That is based on the number of

inactive pharmacists seeking work relative to the total

number of licensed pharmacists. Licensed inactive

pharmacists under 40 are usually in another field and

are not seeking work in pharmacy, or are homemakers.

Additional data on the results of the 1978-79

national inventory of pharmacists will appear in a

future Vital and Health Statistics publication.1

INati~nal c~~@~ f~~ Heal~ Sbtistics, H. Davis: Cbracteristics of p~~.

macists: United States, 1978-79. Vital and Health Statistics. Series 14.

Public Health Service, DHHS. Hyattsville, Md. To be published.

Symbols

. . . Data not available

. . . Category 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

# Figure suppressed to comply with

confidentiality requirements
Table 1. Number and percent distribution of Iiceneed pharmacists by sex and activity status, according to aga: United States, 1978=79

All licensed pharmacists

Age

Male Female Sex unknown

Total Active Inactive Unknown Total Active Inactive Unknown Total Active Inactive Unknown Total Act/ve Inactive Unknown

Alleges . . . . . . . . . . . .

Under 30 years, . . . , .

30-39 years .,......

40-49 veals .,,,,.,,

W-59 years,.,..,.,

60-64 years, . . . . . . .

65 years and over . . .

Unknown, . .,,,.....

Alleges . . . . . . . . . . . .

Under 30 yaars. ., ., ,

30-39 yeara, . . . . . . .

40-49 years.....,..

50- fi9 years . . . . . . . .

60-64 years,,,.,,..

65 years and over . . .

Unknown . .,, ,. .,...

160,664

24,975

35,560

25,769

21,454

7,127

16,867

28,892

100.0

100,0

100.0

1OQ.O

100.0

100.0

100.0

100.0

112,335

23,604

32,264

23,096

19,059

5,649

7,644

819

20,912

1,371

3,316

2,673

2,395

1,478

9,023

656

84.3 15.7

94.5 5.5

90.7 9.3

89.6 ,10.4

86.8 11.2

79.3 20.7

46.5 53.5

55.5 44.6

27,417

27,417

,.,

,,,

. . .

. . .

,,.

. . .

. . .

,.,

133,474

16,644

29,337

25,569

16,976

6,525

15,832

23,591

100

100

100

100

100

100

100

100

94,158

15,931

27,085

20,544

17,155

5,251

7,501

691

Number

16,997 22,319

713

2,252

2.025

1,821

1,274

8,331

581 22,319

Percant distribution

84.7 15.3 . . .

95.7 4.3 ,..

92.3 7.7 .,,

91.0 9.0 . . .

90.4 9.6 . . .

60.6 19,5 ,..

47.4 52.6 . . .

54.3 46,7 . . .

26,147

8,318

6,223

3,185

2,465

600

989

4,367

100

100

100

100

100

100

100

100

18,115

7,664

5,160

2,640

1,896

397

342

116

82.5

92,1

82,9

79.7

76.9

66.2

34.6

64.4

3,845

654

1,063

645

569

203

647

64

17.5

7,9

17.1

20,3

23.1

33.8

65.4

35.6

4,187

0

4,187

. . .

. . .

. . .

. . .

.,.

. . .

,,.

. . .

1,043

13

20

15

13

2

46

934

100

100

100

100

100

100

100

100

62 70 911

9 4

19 1

12 3

8 5

1 1

1 45

12 11 911

47,0 53.0 . . .

69.2 30.6 . . .

95!0 5.0 ,..

80.0 20.0 . . .

6t.5 38.5 . . .

50.0 50.0 ,,,

2.2 97.8 , , ,

52.2 47.8 . . .

II

cd
4 ackmedata

Table 2. Active pharmacist, U.S. resident population, and acttve pharmacists, per 100,000 people. by geographic region and division: United States, 1978-79

Geographic region and diviavon

Act&e U.S. resident Active pharmacists

pharmacists, population

in thousands, z

uer 100,000 people,

1978-79J

1978 1978-79

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135.449 222,095 61.0

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.426 49,244 63.8

New England . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,482 12,303 69.0

Middle Atlantic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22,944 36,942 62.1

North Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35,695 58,538 61.0

East North Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.673 41,509 59.4

West North Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,022 17,028 64.7

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43,932 73,003 60.2

South Atlantic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,937 35,882 58.3

East South Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,845 14,395 61.4

West South Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,150 22.725 62.3

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24,142 41,311 58.4

Mountain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,064 10,746 65.7

Pacific . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,078 30,565 55.9

Foreign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254 . . . .

1 ~umbarofsctive pharmsci~t~ (1 I 2,335) ~dJ”~~edtO ,ncludecomesponding propomon of pharmacists with unknown activitv status [84306 Percent Of 27.417 = 23,1 14additi0nal active

~harrnacwt s). Data entrias irtcreasad pmponiorrally.

Aa of July 1. Data from US. 8ureau of the Cenaws Prellmma~ estimates of the mtarcansal population of State= 1970 co 1980,Sarias 1, Washington.

sj”c[ude~ pharmacists wo,king in U.S. territories and f0rei9n cOuntrles.

NOTE See ““Technical notes’< for States included In each geographic ramon and dwmion.

Table 3. Number and percent distribution of active pharmacist by age, according to race and Hispanic origin: United States, 1978-79

Age

Race and Hispanic origin Total

Under 30 30-39 4049 50-59 60-64 65 years

Vears years

Unknown Vears years years and over

All active pharmacists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

American Indian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oriental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hispanic origin

Allacttve pharmacists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hisoanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-Hwpan!c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allactive pharmacists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

American Indian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oriental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hispanic origin

All active pharmacists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

112,335

90,422

1,730

144

3,048

94

16,897

112.335

1,671

86,481

24,1 B3

100.0

10J.O

100.0

100.0

100.0

100.0

100.0

100.0

100.0

23,604

18,683

344

33

941

27

3,576

23,604

368

17,572

5,664

21.2

20.7

19,9

22.9

30.9

28.7

21.2

22,0

20.4

32,264

26,299

577

42

1,230

42

4,074

32,264

480

25,175

6,609

23,096

18.564

346

25

502

10

3.649

23,096

399

17,872

4,825

19,069

15,436

325

30

2B8

12

2,968

19,059

313

14,824

3,922

Percent distribution

28.9 20.7 17.1

29.1 20.6 17.1

33.4 20.0 18.8

29.2 17.4 20.8

40.4 16.5 9.5

44.7 10.6 12.8

5,649

4,637

60

7

69

1

885

5,649

49

4,490

1,110

5.1

5.1

3.5

4.9

1.9

1,1

5.1

2.9

5.2

7,844

6,638

78

7

28

2

1,091

7,844

61

6,399

1,384

7.0

7.4

4.5

4.9

0.9

2.1

7.0

3.7

7.4

819

165

.-.

. . .

. . .

. . .

664

819

1

149

669

. . .

. . .

. . .

. . .

. . .

. . .

28.9 20.7 17.1

28.7 23.9 18.7

29.2 20.7 17.2

.-

. .

. . .

. . .
dwmedda5

Table 4. Number and percent distribution of active pharmacists by primary employment setting, according to age: United States, 1978-79

Primary employment sening

Age

pharmacists Under 30 30-39 4&49 50-59 60-64 65 years

years years

Unknown

years yeara years and over

All settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Independent community pharmacy. . . . . . . . . . . . . . . . . . . . .

Chain pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Clinic or medical building pharmacy . . . . . . . . . . . . . . . . . . .

Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nuraing home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pharmaceutical manufacturer.. . . . . . . . . . . . . . . . . . . . . . . .

College of pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

All settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

‘Independent communitf pharmacy. . . . . . . . . . . . . . . . . . . . .

Chain pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Clinic ormedical building pharmacy . . . . . . . . . . . . . . . . . . .

Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nursing home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pharmaceutical manufacturer . . . . . . . . . . . . . . . . . . . . . . . . .

College of pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

112,335

38,408

28.423

3,968

19,603

1,551

2.476

1,288

2,554

14,063

100,0

39.1

28.9

4.0

19.9

1.6

2.5

1.3

2.6

23,604

4,994

7.755

835

6,305

447

206

294

349

2,419

100.0

23.6

36.6

3.9

29.8

2.1

1.0

1.4

1.6

32.264

9,235

9.086

1.242

6,980

458

682

457

718

3,407

Number

23.096 19,059

9,300 8,045

5,439 3,993

814 847

2,743 2,320

270 185

775 582

224 217

653 527

2,878 2.543

Percent distribution

100.0 100.0 100.0

32.0 46.0 48.7

31.5 26.9 24.2

4.3 4.0 3.9

24.2 13.6 14.0

1.6 1.3 1.1

2.4 3.8 3.5

1.6 1.1 1.3

2.5 3.2 3.2

5,649

2,428

1,063

179

649

61

158

56

162

895

100.0

51.1

22.3

3.8

13.7

1.3

3.3

1.2

3.4

7,844

4.279

990

245

538

128

67

36

138

1.423

100.0

66.7

15.4

3.8

8.4

2.0

1.0

0.6

2.1

819

129

97

8

67

2

6

4

6

500

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

Table 5. Number ofactive pharmacista and total houmwotied perweek. byprincipal fomofemployment andsex United Statea, 1978-79

Rincipal form of employment and sex

Totalhours

All active

pharmacists

1-35 36-45 46 and Unknown

over

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

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sole owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Partner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Manager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Staff pharmacist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

112,335

84,158

18,115

62

16.490

16.069

421

---

9.458

8,984

474

.-.

30.808

27.277

3,531

. . .

41,152

29.711

11,440

1

6,962

5,191

771.

.-.

8.465

6.926

1.478

61

13.453

8.323

5,128

2

541

4s3

58

-..

591

444

147

---

1,417

1,019

398

.-.

9,800

5.396

4,204

---

976

735

241

. . .

328

246

80

2

52,129

42,727

9,341

1

2,420

2,330

80

..-

2.654

2,534

120

---

18.716

16,227

2.489

. . .

26,297

19,038

6.259

---

2,486

2.166

320

..-

653

492

63

1

37,049 9.704

35,193 7,855

1,855 1,791

1 56

13,111 418

12,655 401

256 17

--- ---

6,045 168

5,854 152

191 16

. . . . . .

10,262 413

9,671 360

591 53

. . . -..

5,020 1,235

4,398 879

622 355

.-.

2,230 27;

2.055 235

175 3s

. . . . . .

381 7,200

360 S,828

20 1,316

1 57

1 includes asatstant manager.

21ncluden volunteara.
6 advancedata

Table6. Number of inactive pharmacists andreason fOrinactivi~, byaex and age: United States, 1978

Unemployed Working in other field

Ail

Sex and age inactwe Rerwed SeekLog Nor seeking Seeking Not seeking Other Unknown

pharmacists work in work in work m work in Homemake,

pharmacy pharmacy 1 f.harmacy pharmasy

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

Under 30 years . . . . . . . . . . . . . . .

30-39 years . . . . . . . . . . . . . . . . .

40-49 years . . . . . . . . . . . . . . . . .

50-59 years . . . . . . . . . . . . . . . . .

60-64 years . . . . . . . . . . . . . . . . .

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

Unknown . . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . ...”..

Under 30 years . . . . . . . . . . . . . . .

30-39 years . . . . . . . . . . . . . . . . .

40-49 years . . . . . . . . . . . . . . . . .

50-59 years . . . . . . . . . . . . . . . . .

60-64 years . . . . . . . . . . . . . . . . .

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

Unknown . . . . . . . . . . . . . . . . . . . .

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

Under 30 years . . . . . . . . . . . . . . .

30-39 years . . . . . . . . . . . . . . . . .

40-49 years . . . . . . . . . . . . . . . . .

50-59 yeara . . . . . . . . . . . . . . . . .

60-64 years . . . . . . . . . . . . . . . . .

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

Unknown . . . . . . . . . . . . . . . . . . . .

20,912

1,371

3,316

2.673

2,395

1,478

9,023

656

16,997

713

2,252

2,025

1,821

1,274

8,331

581

3,845

654

1,063

645

569

203

647

64

7,679

9

17

56

305

663

6,403

425

7,282

7

11

41

249

601

5,984

389

586

2

6

15

56

62

415

30

1,469

247

281

218

257

131

326

9

1,045

118

154

141

197

117

310

8

424

129

127

77

60

14

16

1

272

72

54

52

43

15

35

1

194

46

34

35

33

11

34

1

78

26

20

17

10

4

1

...

576

70

148

126

126

36

68

2

476

49

128

106

98

32

62

1

99

21

20

20

28

4

6

. . .

4.587

263

1,510

1.278

875

268

313

60

4,187

203

1,396

1,196

783

240

292

77

400

60

114

82

92

28

21

3

1,397

224

553

300

214

41

52

13

35

3

8

4

5

2

12

1

1,362

221

545

296

209

39

40

12

1,322

267

304

235

247

120

138

11

1,033

167

220

194

214

104

127

7

289

100

84

41

33

16

11

4

3,410

219

449

408

327

204

1,688

’115

2,745

‘120

301

308

242

167

1,519

97

607

95

147

97

81

36

137

14

1,“ ~ few States. this WaS phrased as “in training in pha~acy~

21nclude* 70 jnactiva pharmacistswith sex unknown.
aCbmxMa7

Technical notes

Source of data

The 1978-79 national inventory of pharmacists

was conducted through two separate but parallel mechanisms. The f~st was the Cooperative Health Statistics

System (CHSS).2 Those States with a CHSS manpower component contract collected data on pharmacists and submitted “to the National Center for Health

Statistics a specified set of data elements, using standardized processing specifications. The second data

collection mechanism was for the remaining 28 nonCHSS States (including the District of Columbia). It

utilized a singIe contractor, the American Association

of Colleges of Pharmacy (AACP), to collect the same

data items as the CHSS States. Similar data collection

methodologies were used by both the CHSS State contractors and the AACP to insure uniformity of the

data, which permitted the statistics from both mechanisms to be merged into a single national data file.

Because pharmacists were surveyed and counted

in each State in which they were Iicensed, a mectim

had to be developed to remove duplicate counts resulting from multiple licensure.The total number of

pharmacist records prior to the removal of duplicate

and multiple records was 207,169. The procedures

developed for removing duplicate records and for

producing a national data fde in which each pharmacist is counted oniy once have been described in detail

in another publications After the removal of duplicates, a total of 160,664 records remained, one for

each licensed pharmacist, regardless of the number of

States in which a pharmacist holds licenses.

The questiomaire mailout spanned 2 years, in

order to coordinate the mailings with the license

renewal period of each State. States not only stagger

their license renewal dates at varying times of the year

but some also have biemial instead of annual renewal

cycles. In all States the contractor (either the AACP or

CHSS State agency) worked with the State licensing

board to send the questiomaires to all licensed pharmacists.

Although the data ffom this survey are Ial&led as

1978-79, it should be noted that only 88 percent of the

States collected data during these years. The remaining

data were collected during 1977 or 1980. The Vital

and Health Statistics series report on this survey will

give the particular year of the data from each State. 1

2Nation~ Center for Health Statistics: The Cooperative HeaIth Statistics

System: Its mission and program. Vitaiand Health Statistics. Series 4-No.

19. DHEW Pub. No. (HRA) 77-1456. Health Resources Administration.

Washington. U.S. Government Printing Ofiice, Apr. 1977.

3Nation~ Cen&r for Health Statistics, Ronald Biggac Procedures for

unduplication of pharmacy and optometry dara. Working Paper Series. No.

9. Feb. 1982.

Response rate

The overall questionnaire response rate was 84

percent. In some CHSS States information that was a

part of the survey questionnaire was already available

in State Iicensing board records and therefore did not

have to be asked. In the case of nonrespondents this

information was provided directly horn the existing

records. This resulted in records of nonrespondents

containing data that otherwise would be missing. When

data are available on nonrespondents, they are used in

this report without distinction for response status.

Adjustment for item nonresponse

Imputations for selected item nonresponse were

performed on those records containing sufilcient other

data permitting such computations. The following selected items were imputed: year of birth, year of

graduation, sex, Hispanic origin, academic degree held

in pharmacy, and activity status.

Definitions

Practice settings are defined as follows:

● Chain pharmacy small-or large-chain community

pharmacy.

● Hospital: Government or other hospital.

Active pharmacists are placed in their work State.

When work State was missing from a record, the

following hierarchy was used for determining the State

in which to place the pharmacis~ (1) residence State

when it equaled mail State, (2) Iicensure State when it

equaled residence or mail State, (3) mail State, and

(4) licensure State.

Inactivepharmacists are placed in their residence

State. Mail State is used when data on residence State

are missing. If both States are missing, licensure State

is used.

Geographic region and division are defined as

follows: - -

Geographic region and division

Northeast

New England . . . . . . . . . . . . . .

Mid Atlantic. . . . . . . . . . . . . . .

North Central

East North Central. . . . . . . . . .

West North Central. . . . . . . . .

States included

Maine. New Hampshire, Ver.

mont.Massachusetts,Rhode lsIand, and Connecticut

New York, New Jersey. and

Pennsylvania

Ohio. Indiana. Illinois, Michigan, and Wisconsin

Minnesota. Iowa, Missouri,

North Dakota, South Dakota,

Nebraska,and Kansas
8

Geographic regwn and

division— Con.

Srates included—Con

Geographic region and

division—Con.

Stares included—Con.

South West

South Atlantlc . . . . . . . . . . . . . Delaware, Ma@and, District of Mountain . . . . . . . . . . . . . . . . . Montana, Idaho, Wyommg, ColColumb!a, Virglnla, West Vir- orado, New Mexico, Artzona,

g}nla, North Carol(na, South Utah, and Nevada

Carollna, Georgia, and Florida Pacific . . . . . . . . . . . . . . . . . . . . Washington, Oregon, Alaska,

East South Central. . . . Kentucky, Tennessee, Alabama, California, and Hawaii

and MISSISSIPPI

West South Central. . . . . . . . Arkansas, Louisiana, Oklahoma,

and Texaa
From Vital and Health Statistics of the National Center for Health Statistics Number 86 ● October 8, 1982

Drug Utilization in Office Visits to Primary Care Physicians:

National Ambulatory Medical Care Survey, 1980

By Beulah K. Cypress, Ph. D., Division of Health Care Statistics

Introduction

This report presents statistics on drug utilization

during oi%ce visits to general and family practitioners,

internists, pediatricians, and obstetrician-gynecologists,

tie physicians generally acknowledged to be most

involved in the delivery of primary heakh care. The

data were gathered in 1980 by the National Center for

Health Statistics by means of the National Ambulatory

Medical Care Survey.

For purposes of health manpower legislation (PL94-

484, 1976), Congress identified general and family

practitioners, internists, and pediatricians as primary

care providers. However, it is the policy of the American

Medical Association to include obstetrician-gynecologists in the group of primary care providers. A 1978

Institute of Medicine study defined primary health care

in terms of the scope, character, and integration of the

services provided.1 The report indicated that although

primary care may be provided by many types of health

professionals and by physicians in many different

specialties, the physicians whose practice content fit

the dimensions of primary care most closely were

generai and faily practitioners, internists, pediatricians, and obstetrician-gyneccdogists. The National Ambulatory Medical Care Survey was the principal source

of data used by the Institute of Medicine to describe the

content of primary heakh care.

The National Ambulatory Medical Care Survey is

a probability sample surve y conducted annually through

1981 by the Division of Health Care Statistics of the

National Center for Health Statistics. The technical

notes at the end of this report provide brief itiormation

about the source of the data, sampling errors, and

definitions of terms. A complete description of the survey includimg limitations and definitions was published

in Vital and Heaith Statistics, Series 13, No. 66.2 The

methodology used to collect and process the drug information is described in Vital and Health Statistics,

Series 2, No. 90.3

The Patient Record form used in the 1980 survey is

reproduced in figure 1. Up to eight specific drugs, either

new or continued during the visit, maybe recorded by the

physician in item 1I, parts a and b. In order to present

accurately what the physician ordered, prescribed, or

provided, drug mentions used in this report are based on

the physicians’ entries on the Patient Record forms.

These entries were brand or generic names of prescription

(~) or nonprescription (over-the-counter) drugs, and in

some instances the physician recorded a therapeutic

effec~ e.g., “allergy relief.”

Data highlights

Wit characteristics

Primary care physicians constituted 54percent of the

NAMCS physician universe, but had 66 percent of the

office visits and accounted for 74 percent of dl drug mentions (table 1). Among this group of physicians, general

and family practitioners (GFP’s) had a disproportionately

large share of visits and drug mentions. They had 33 percent of the visits and 41 percent of the drug mentions

although they represented only 23 percent ofthe physician

universe. Obstetrician-gynecologists (OBG’S) accounted

forordy 5 percent ofthe drug mentions compared with 10

percent of the visits, mainly because a relatively large

proportion of their visits involve prenatal and postpartum

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Setvice
9 SiA.ratwkadata —... ——-

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land:0 .nIuI mwms 01.9a Ior . . . m.w Wwom btmn.1 .4. -.1., wall. St.t-t.=

1. DATE OF VISIT

&

PATIENT RECORD

NATIONAL AMBULATORY MEDICAL CARE SURVEY

2. iWF-HOF 3. SEX 4. COLOR OR RACE 5. ETHNtCITY & PATIENT% COM?LAINTISI, SYMPTOM(S), OR OTHER

REASON(SI FOR ~ VISET [In parienr’s OWI wo?dsj

1❑ W”ITE

2❑ euc.

, ❑ HIS&j. ,, MOST lMmRTANT

_-J!J- $j::” 3 Q’:&’&’”c 2 ❑ NOT —

Momh m, Y* HISPAPLIC b OTHER

‘cl AMERICAN INOIANI

ALASKAN NATIVE

7“ %’l’?%k:Yo:eYR ‘“’s 8’ ~~e~k?~~~e~~~~o~~e~’Y “S’T

g. PHYSICIANS DIAGNOSES

* am., , ❑ EKG

. PRINCIPAL OIAGNOSISWROBLEM AsSOCIATE WITH ITEM *.

, ❑ AC”TEPROLILEM .?❑ LIM17E(I HISTOf+”/EXAM 9 ❑ VISION TEST.

2 ❑ CHRONICPROBLEM. ROUTW.JE 3 ❑ GENERAL “c5TORY/EXAM ,0 ❑ ENCIOSCOP”

3 ❑ CHRONIC PROBLEM. F LAM E(sP 4 ❑PAP TEST

. ❑ PosTs”.GERY/msT wU”*Y

,, ❑ MEJJ::LS.A7”S

50 CLINWALL4STES7

b OTHER SIGNIFICANT CURRENT OIAGN+JSES

5 ❑ NONILLN ESS CARE IROUTI Nf

‘cl

,, DOT”ER ,S,,ct,y,

X f4AV

PRENATAL. GENERAL EXAM

WELL %t13Y, ETC.I

7 ~@LOOO PRESSURE CHECK

10.~&j:B:;::E7 11. MEDICATION THERAPY THIS VISIT ❑ NONE

j UstnS bmnd or genera. names. rcco?d .If new and contifmcd medican”onsomlemd, injected, admintsfered, or otherwise

provided ar rhn wsf. :ndude immumzmg and dcxnsrtwng ascnIsl

d. FOR PPINCIPAL OIAGf.X3SES IN ITEM% kz. FOR ALL OTHER REASONS

,DYES 2DN0

{

1 1

IF YES. FOR THE

CONOITION IN 2 2.

ITEM %?

3 ‘3

I ❑ YES 2 ❑r+o

4 4

—

12. NON-MEDICATION THERAPY 13=:Vymgm

[Check al! Jervaccsordered or provided thf.r VLW/

q4. pwo:;s:cm:s;;lstr 15. OURATIOhOF THIS

FOR THIS VISIT VISIT

BY A~HER

1❑ NO FOLLOW-UP ●LAMNEO [Time actually

1❑ NONE 6❑ O,ETCOUNSELING PHYSICIAN? 2 ❑ RETURNATSPECIFIEOTIME spent Wfh

2❑ P”YsI07HERAPY

physician I

7❑ FAM,LWSOCIAL

COUNSELING .

3 QRETU*MIFNEEOEO. P.fi.N.

3❑ OFFICE suRG$s Y

c❑ MEOICALCOUNSELING , ❑ YES

4 ❑ TELEPWCSNE FOLI.(3W-”PPIANNED

4 ❑ ,AMIl.” PLANNING

9 ❑ 0THER (sxC(t,

5 ❑ nEFEHRED700THER Physician

5❑ PSVCHOT14ERAPYI

THERAPEUTIC LISTENING ,UNCI 6 ❑ RETURNED 70 REFERR,NGPHYSI.,AN

7 ❑ AIX07T0 HmP,TA’

, ❑ OTHER (Sm.+,

M“.,”

PliS-610S-0 (9179 ) OMB No. 68-SS1490

Figure 1. Patient Record from the National Ambulatory Medical Cara Survey

care, and examinations for which drugs are generally not

indicated.

The patterns of medication therapy presented in this

report difTer by specialty because drug utilization is

highly related to the patient’s age, sex, and condition.

Although GFP’s, internists, pediatricians, and OBG’S

provide primaxy care, their patients have different demographic characteristics and present more, or less, of certain diagnoses. Patterns of medical care thus vary depending on the case-mix. Table 2 shows the distribution of

ofllce visits to primary care physicians by age and sex of

the patient. By age group, GFP’s see a more heterogeneous group of patients than do the other physicians.

Internists provide care chiefly to adults over 24 years of

age, and to a larger proportion of patients over 44 yearn of

age (69 percent) than do GFP’s (44 percent). Pediatricians chiefly treat children under 15 years of age. Visits

by women in the child-bearing years, 15–44, account for

87 percent of the OBG’S caseload. Because medication

therapy, diagnosis, and the patient’s age and sex are

highly intercomelated, the range of drug utilization and

the classes of drugs prescribed vary among specialists.

OffIce visits and drug mentions

The number of office visits, the number and percent

of visits in which one or more drugs were prescribed (drug
akmecMa3

visits), and the number of drug mentions are shown in

table 3. The drug mention rate isthe number of drug mentions divided by the number of visits; e.g., GFP’s recorded an estimated 279,186,000 drug names on

Patient Record forms during 191,744,000 visits, which

resuks in a drug mention rate (DMR), or average over

all visits, of 1.46 drugs per visit. Another approach-to

measuring drug use is to divide the number of drug mentions by the number of drug visits (a visit in which one

or more drugs were ordered). Thus, when drugs were

prescribed, the average number a patient received (drug

intensity rate, DIR) when visiting a GFP was 1.93. The

percent of drug visits and the DIR are used in this report

to make comparisons among specialties.

Proportions of total visits with one or more drugs

prescribed were similar for GFP’s (75 percent), internists(76 percent), and pediatricians (71 percent). Only

44 percent of OBG’S visits included any drugs, reflectiruzthe lame volume of visits for routine urenatal care

afi gyneco~ogica.1examinations. However,-tie frequency

of drug visits varies by age of the patient. The rising

proportions of drug visits after age group 15-24 years

for GFP’s and internists is shown in figure 2, in which

there is a striking similarity in the configuration of the

two curves.

In figure 3 proportions of drug visits to GFP’s are

compared with those to pediatricians. Children under

11 years of age who visited GFP’s were more likely to

be given at least one medication than were their counterparts who visited pediatricians. This effect was the most

90

[4Internal

/“

80 medicine ~

0

\

0

g

\

0 General and

2 70 \’

family practice

2

o~

Under 15-24 25-44 45-64 65

15 and

over

Age in years

Figure 2. Percent of drug visits by age of patient and selected primary care

physician specialty United States, 1960.

pronounced for the age group 3–5 years. Although the

GFP routinely treats children in the same age range as

those of the pediatrician, visits to the pediatric specialist are more likely to be for routine examinations where

medication therapy is not aIways indicated. Two preventive health care diagnoses, health supervision of

infant or child and general medical examination, accounted for 27 percent of visits to pediatricians by

90

80

70

60

?

25 and

o I 1 I 1 I I I I I

Under 3 3-5 6-1o 11-14 15-24 25-44 45-64 65

and

over

Age in yeara

Fgure3. Persent of drug visits by age of patient and selected primary care phystcian speclal~ United States, 1980
children under 11 years of age compared with only 16

percent of those to GFP’s.

An even more marked difference is evident in figure 4 in which proportions of drug visits by the age

group of women visiting GFP’s and OBG’S are plotted.

Percents are consistently higher for GFP’s than for

OBG’S. The curves exhibit a similar pattern of change

except that women’s drug visits to GFP’s decline until

age group 15–24 years while the low point of drug visits

to OBG’S is at age group 25–44 years. The lower proportions of drug visits found in the OBG’S practice is

explained by the preponderance of visits with diagnoses

of normal pregnancy, postpartum care, and gynecological examinations (a total of 48 percent of all visits).

Only 7 percent of women’s visits to GFP’s were represented by these diagnoses.

On the average, the highest number of drugs

prescribed during drug visits was by internists, with a

rate of 2.24 drugs per drug visit, followed by GFP’s

with 1.93 (table 3). These rates are plotted by patient

age group in figures 5-7. Figure 5 illustrates drug intensity rates for GFP’s and internists. As expected, rates

increase with increasing age after age group 15-24

years, regardless of which of the two specialists was

visited. At that point, however, the curves diverge, and

beginning with age group 25-44 years, internists prescribed higher numbers of medications than GFP’s did.

90

80

w

General and

family practice

70

60

50

40

30

I

#“

\ r

\ Obstetrics and ~

\ gynecology

\

/

\

/

NJ

o~

Under 15-24 25-44 45-64 65

15 and

over

Age in years

Figure 4. Percent of drug visits by age of female patient and selected primary

care Dhys!cian spec!alty: United States, 1980

2.70

2.50

2.30

.=

.!?

> 2.10

m>

s

&

a

: 1.90

2

1.70

1.50

.

.

0

/

Internal /-

I

I

/

Under 15-24 25-44 45-64 65

15 and

over

Age in years

Figure 5. Drug intensity rate bv aae of oatient and selected primary care

physician spec~al~: United States, 1980

Differential diagnosis is likely to contribute to this difference in rates.

Although it was shown in figure 3 that a higher percent of visits by children under 11 years of age to GFP’s

included one or more drugs than did those to pediatricians, figure 6 shows that when drugs were used, the

average numbers prescribed by both &pes of physicians

were very close.

For every age group shown in figure 7, GFIP’s prescribed a higher average number of drugs than OBG’S

did, and the number prescribed tended to increase with

increasing age group after 15–24 years for GFP’s and

after 25–44 years for OBG’S. The data illustrated in

figures 4 and 7 reveal that not only did GFP’s have

more drug visits, but they also prescribed more drugs

during those visits than OBG’S did. However, these

findings are clearly related to the lower proportion of

illness-related visits made to OBG’S, as noted previously.

Number of medications

The proportions of visits that included precisely

one, two, three, or four or more drugs are listed in table

4. In the first part of this table distributions are based on

all visits and thus they include a “none” category. In the

lower section, distributions are based on the number of
dmCeCMa5

2.50 F

2.30

Genetal and family practice

2.10

1.90

1.70

over

1.50

1.30

0

Under 3-5 6-10 11-14

3

15-24 254 45-64 65

and

over

Age in years

drug visits and, therefore, arrays do not include the

“none” category. The proportions in this category are

simply the complements of the percents of drug visits

shown in table 3. For patients treated by GFP’s, internists, and pediatricians, the largest proportions of visits

were in the category of one drug mention, but the

majority of visits to OBG’S had no drugs mentioned.

When OBG’S did order drugs, 72 percent of visits

included only one. Internists were more likely than

other primary care physicians to order three or more

drugs. About 34 percent of their drug visits included

this number compared with 24 percent of GFP’s, 13

percent of pediatricians, and 7 percent of OBG’S. This

was not unexpected in view of their relatively high proportion of visits by the elderly. It has been shown that,

in general, and for certain diagnoses, the number of

Figure 6. Drug intensity rate by age of patient and selected prima~ cam physician spscial~ United Ststaa, 1980

drugs ordered increases as the patient’s age group

increases.A-6

Drug status characteristics

NAMCS drug data are characterized by entry

status (brand name,a generic entity, or therapeutic effect), prescription status (prescription or over-thecounter drug), and composition status (single ingredient,

combination drug, or multivitamin). Drug mentions are

distributed by these variables in table 5. The most common method employed by physicians to enter drugs on

aInclusion ofbrand m tradenames is foridentificationonly anddoes notimply endorsement by the Public Health Service or the U.S. Department of

Health and Human Services.
2.50

2.30

2.10

,=

.9

>

1.90

~

*

z

; 1.70

2

1.50

1.30

.

.

0

General and

family practice

/

Obstetrics and /

gynecology /

Under 15-24 25-44 45-64 65

15 and

we r

Age in years

Figure 7. Drug intensity rate by age of female patient and selected primaw

care physician special~ United States, 1980

the Patient Record form was by brand name. GFP’s,

internists, and OBG’S used brand names (manufacturer’s

product name) in over 70 percent of mentions; pediatricians in about 58 percent. Pediatricians are more likely

than other specialists to enter drugs by generic name

because of their frequent use of immunizing agents and

other injectable drugs. Prescription drugs were also

more frequently ordered than over-the-counter drugs,

ranging from 76 percent of mentions by OBG’S to 85

percent of those by internists. Drugs consisting of a

single principal ingredient were more likely to be

prescribed than combination drugs by internists, GFP’s,

pediatricians, and OBG’S, in declining order of frequency.

The NAMCS file also includes information on the

Federal control status of each drug utilized. Drugs

under the regulatory control of the Drug Enforcement

Administration of the U.S. Department of Justice are

assigned by them to one of five schedules based on

potential for abuse and psychological or physical

dependence, ranging from schedule I with the highest

potential for abuse and dependence to schedule V with

the lowest (see reference 3 for a more detailed explanation of the schedules and examples). Drug mentions are

classified in table 5 according to whether they are controlled or uncontrolled drugs. A very small proportion

of drugs listed by primary care physicians were federally controlled. amounting to 11 percent of all mentions

by GFP’s, 8 percent by internists, and 5 percent each of

those by pediatricians and OBG’S. For GFP’s, internists, and OBG’S, the majority of controlled drugs were

in schedule IV (53, 58, and 62 percent, respectively).

For pediatricians, 62 percent of controlled drugs mentioned were in schedule V.

Therapeutic categories

Each specific drug mentioned in NAMCS is a

member of a group of drugs identified by the desired

therapeutic effect. These groups are based on the classification system of the American Hospital Formulary

Service.T Drug mentions are aggregated by therapeutic

categories in table 6. The leading category of drugs used

varied among the primary care physicians, reflecting the

demographic and clinical characteristics of their patients.

For GFP’s, central nervous system drugs accounted for

the largest share of their mentions ( 19 percent). Internistsused cardiovascular drugs (21 percent) proportionately more often than other drugs. Pediatricians most

often used anti-infective agents (29 percent). Hormones

ands ynthetic substitutes constituted the major portion

of mentions by OBG’S (26 percent).

The five leading categories prescribed by both

GFP’s and internists, although in different order of

frequency, were anti-infective agents; cardiovascular

drugs; central nervous system drugs; electrolfic, caloric,

and water balance; and hormones and synthetic substitutes. These five categories accounted for 62 percent of

drug utilization by GFP’s and 70 percent of that by

internists. Three of these classes were also among the

five most frequently used by OBG’S: anti-infective

agents, central nervous system drugs, and homnones

and synthetic substitutes. Two other categories frequently ordered by OBG’S were skin and mucous membrane preparations (10 percent) and vitamins (19 percent). Pediatricians prescribed antihistamine drugs;

expectorants and cough preparations; and serums,

toxoids and vaccines proportionately more frequently

than did the other primary care physicians.

Specific drug mentions

Because GFP’s see a large number of patients in

every age group ranging from infants to the elderly, the

number and percent of the most frequently ordered

specific drugs are ranked by age group in table 7. The

other primary care specialties have a more homogeneous

patient load. Therefore, specific drugs are listed but not

shown by age group, for internists (chiefly adulks) in

table 8, for pediatricians (chiefly children) in table 9,

and for OBG’S (chiefly women 15-44 years of age) in

table 10. The reader is cautioned that estimates may

not differ from other near estimates due to sampling

variability. Therefore, ranks may be somewhat artificial.

To treat patients under 15 years of age with medica-
tion therapy, GFP’s prescribed Ampicillin, Amoxicillin,

and Penicillin in a total of 1I percent of drug mentions.

Dimetapp was the leading antihistamine ordered (4

percent). Diphtheria and tetanus toxoids and pertussis

vaccine (DPT), and poliomyelitis vaccine each accounted for 4 percent of mentions. Aspinn was mentioned in 3 percent.

Penicillin and Ampicillin led the list of drugs

mentioned when patients visiting GFP’s were 15–24

years old or 25–44 years old. However, the variety of

drugs ordered changed perceptibly beginning with age

group 25-44 years. While 16 drugs accounted for 42

percent of mentions for patients under 15 years, it tnok

twice as many or more to account for about the same

proportion of mentions for patients in the three older

groups. The diuretic, Lasix, appears for the first time

among the leading drugs ordered for patients 25–44

years of age. Over 1 million mentions of chorionic

gonadotropin, a hormone frequently associated with a

diagnosis of obesity, also appear on the list for 25-44

year old patients as well as three anorexients used in the

treatment of obesity: Ionamin, Fastin, and Phentermine

(all three are the generic entity phentermine, making a

total of 1.7 million mentions of this substance).

An increase in the number of different diuretics

utilized in treating patients 45-64 years old reflects the

increase of cardiovascular problems. Dyazide, Lasix,

Hydrodiuril, Hygroton, and Hydrochlorothiazide were

among the top 10 drugs ordered for this age group.

Inderal, a drug often used to treat hypertension and certain heart conditions, was the second leading number of

mentions. Inderal, as well as the previously mentioned

diuretics were also among the most frequently mentioned drugs when patients were in the 65 years and

over age group. Also frequently prescribed for this age

group were Lanoxin and Digoxin, cardiovascular drugs

both in the generic class digoxin; Aldomet, a hypotensive agent; and Motrin, which is commonly used to treat

arthritis. The antidiabetic agents Diabinese and Insulin

were also among the leading medications ordered by

GFP’s for older patients.

The list of drugs prescribed by internists (table 8)

closely resembles the lists of those used by GFP’s for

patients 45 years of age and over. One drug used by internists that is not arnongtlmse most commonly used by

GFP’s is Fluorouracil, an antineoplastic agent.

Poliomyelitis vaccine accounted for 7 percent and

DPT for 6 percent of all drugs mentioned by pediatricians. The tuberculin tine test was used in 5 percent.

Antibiotics were prominently represented by Amoxicillin, Penicillin, Arnoxil, Ampicillin, E.E. S., Bicillin,

Larotid, V-Cillin, Erythromycin, and Ilosone. Many of

the drugs used by pediatricians were also prominent in

the section oftable 7 (GFP’s) showing the most frequent

drugs ordered for patients under 15 years of age.

The multivitamins, Prenatal formula, Matema,

Stuartnatal 1+1, and Natalins were among the drugs

ordered most frequently by OBG’S. Table 10 also

shows that Ortho-novum, Lo/ovral, Ovral, Demulen,

and Norinyl were the most commonly prescribed oral

contraceptives. Other drugs such as Premarin (estrogen),

Monistat (used for candidiasis), Flagyl (used fortrichomoniasis), and Sultrin (for vaginal infections) reflect

the range of diagnoses made by OBG’S.

These and other data on the practice characteristics

of primary care physicians in 1980 and 1981 will

appear in a future Vital and Health Statistics Series 13

publication. Questions regarding this report may be directed to the Ambulatory Care Statistics Branch by

calling 30 1/436–7 132.

References

lNational Academy of Sciences, Institute of Medicine: A mQnpower policy for primary health care. IOM Pub. No. 78-02.

Washington. May 1978.

2National Center for Health Statistics, R. Gagnon, J. DeLozier,

and T. McLemore: The National Ambulatory Medical Care

Survey, 1979 summary. Vital and Health Statistics. Series 13-No.

66. DHHS Pub. No. (PHS) 82-1727. Public Health Service.

Washington. U.S. Government Printing Oftice. In press.

3Nationa1 Centir for He~th S@tistics, H. K@h: The collection ad

processing of drug information, National Ambulatory Medical Care

Survey, United States, 1980. VitaI and Health Statistics. Series

2-No. 90..DHHS Pub. No. (PHS) 82-1364. Public Health Service.

Washington. U.S. Government Printing Office, Mar. 1982.

4Nationa1 Center for Health Statistics, H. Koch: Dmg utilization in

oftlce-practice by age and sex of the patient, National Ambulatory

MedicalCare Survey, United States, 1980. Advance Data From

VifaI and Heafth Statistics, No.81. DHHS Pub. No. (PHS) 81-

1250. Public HeaIth Service. Hyattsville, Md. July 26, 1982.

5National Center for Health Statistics, B. K. Cypress: Medication

therapy in ofice visits for hypertension, National Ambulatory Medical Care Survey, 1980. Advance Data F’mm Vital and Health

Statistics, No. 80. DHHS Pub. No.(PHS)81-1250. Public Health

Service. Hyattsville, Md. July 22, 1982.

6National Center for Health Statistics, B. K. Cypress: Medication

therapy in office visits forselecteddiagnoses, National Ambulatory

Medical Care Suxvey, 1980. Vitaland Health Statistics. Series 13-

No. 71. DHHS Pub. No. (PHS) 82-1732- Public Health Service.

Washington. In preparation.

7American Society of Hospital Pharmacists, Inc.: The American

Hospital Fonnuiary Service. Washington. Jan. 1980.
Table 1. Number and percent distribution of physicians in NAMCS physician universe and percent distribution of visits and drug mentions, by physician

specialty: United States, 1980

Physician specialty NAMCS physician universe Visits Drug

mentions

Number

Total physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227,558

Total primary care physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122,635

General and faintly practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.147

Internal medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35,199

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.043

Obstetrica andgynecoiogy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,246

Other specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104,923

Percent

distribution

100.0

63.9

23.4

15.5

7.1

8.0

46.1

Percent distribution

100.0 100.0

66.2 74.2

33.3 41.1

12.1 17.5

11.2 10.7

9.6 4.9

33.8 25.8

Table 2. Percent distribution of visits by age and sex of patient, according to primary care physician apecial~ United States, 1980

Prima~ care physician

Age and sax of patient

General and Internal Pediatrics

Obstetrics and

family practice medicine gynecology

Percent distribution

All ages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0

Under 15 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.9 2.5 92.5 1.0

15-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.9 7.1 5.9 :32.0

25-44 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.4 21.4 1.0 55.1

45-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.4 36.4 “0.4 9.4

65veara and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.4 32.7 “0.2 2.5

Sex

Female, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60.5 59.2 46.3 96.7

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39.5 40.8 53.7 1.3

Table 3. Number of offtcevisite, number arsd percent of drug visits, number of drug mentions, drug mention rate, and drug intensity rate per visit,

by primary care physician specialty: United Statea, 1980

Primary care physician All visits Drug visitsl Percent Drug mentions

Dmg mantion Drug intensity

in thousands

rata2 rate3

in thousands drug visits in thousands

per visit per dnrg visit’

General and family practice. . . . . . . 191,744 144,478 75.3 279,186 1.46 1.93

Intamal medicine . . . . . . . . . . . . . . . 69.461 53,091 76.4 118.943 1.71 2.24

Pediatrics . . . . . . . . . . . . . . . . . . . . . . 64,223 45,575 71,0 72.825 1.13 1.60

Obstetrics and gynecology.. . . . . . . 55,123 23,984 43.5 33.026 0.50 1.38

1A visit in which one or mom dwgs Wwe Pr8SCfib8d.

2Dmg “emion5+ number ti~i~i~.

3Dmg ~entlo”s + number of drug Visiw.
akmdata9

Table4. Number andpercent distribution ofoficevisi& bynumberof medications forallvisiw and fordmgviaiG, according toprima~care ph~icianspecial~

United States, 1980

hima~ cara physician

Number of medications

Genaral and Internal Pediatrics Obste?ncs and

family pmctice medicine gynecology

Number in thousands

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191,744 69,481 64,223 55,123

Percent distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0

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

1

24.7 23.6 29.0 56.5

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

34.4 29.1 40,4 31.2

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.0 21.4

3

21.6 9.3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.5 13.0 6.4

4 or more

2.3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.6 13.1 2.5 0.8

Number in thousands

Drug viaitsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144.478 53.091 45,575 23,984

Percent dis~”bution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0

1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45.6 38.1

2

57.0 71.7

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30.5 28.0 30.5

3

21.3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.9 17.0 9.0

4 or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2

10.0 16.9 3.6 1.8

1A visit in which one or more dreg= WW8 prescribed.

Table 5. Number and percent distribution of drug mentions by selected drug status characteristics, according to primary cam physician specialty

United States, 1980

Rimary cara physician

Drug status characteristic

General and lntema/ Padiatncs Obstetrics and

fami/ypractice medicine fjyneco/ogy

Number in thousanda

All drug mentions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279.188 118,843 72,825 33,026

Percent distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 1W.o 100.0 100.0

Entry status

Generic name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.3 24.3 34.9 17.5

Brand name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71.2 72.8 57.8 77.8

Therapeutic affect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7 2.1 6.5 3.6

Undetermined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.8 0.8 0.8 1.1

Pmacription ststua

Prescription drug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83.4 84.6

Nonprescription drug

79.6 75.9

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.0 12.5 13.1 19.4

Undetermined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.6 2.9 7.3 4.8

Composition status

Single ingredient drug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66.3 78.2 58.9 47.5

Combination dmg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.3 18.1 32.5 32.6

Multivitamin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.0 0.8 1.3 15.3

Undetermined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.5 2.9 7.3 4.7

Federal control status

Controlled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.9 8.2

Uncontrolled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.6 5.2

64.5 88.9

Undetermined

88.0 90.0

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.6 2.9 7.3 4.8
10 awmedaa

Table 6. Number and percent distribution of drug mentions by therapeutic categoty, according to primary care physician specialty United States, 1980

i%imary care ph~sician

77rerapeutic categO~l

Genaral and Internal

Pediatrics

Obstetrics and

family practice medicine gynecology

Allcategorias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279,186 118,943 72.825 33,026

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

Antlhktamined rugs.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anti-infective agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antmeoplastic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Autonomic druga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Blood fomration andcoaguiation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiovascular drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Central netvous system drugs.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diagnostic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Electrolytic, caloric, and water balance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Expectorants and cough preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Eye, ear, nose and throat preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gastrointestinal druga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hormonea andsynthetic substitutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Serums, toxoids and vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skin andmucous membrane preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Spasmolytic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other, unclassified, or undetermined. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100.0

6.6

16.2

“0.1

4.4

1.4

9.9

18.6

0.3

9.1

3.3

1.4

4.6

8.1

2.7

4.9

1.7

4.1

2.9

Percent distribution

100.0 100.0

3.9 15.2

6.9 28.8

3.4 ●o. 1

3.6 3.0

1.5 “0.3

20.7 “0.2

18.2 4.8

‘0.2 4.7

14.3 “0.3

1.9 6.8

0.8 3.4

4.7 1.6

9.7 1.7

0.9 17.8

2.4 5.9

2.3 2.2

2.3 “0.5

2.4 2.9

100.0

2.3

16.9

*1.5

3.5

2.5

8.0

“o. 1

3.1

“0.9

“0.5

*1.6

26.4

‘0.9

9.9

“0.5

18.6

3.0

1Based WI tha classification system of the Amsrican Hospitsl FonnularvService (A.H.F.S.). Sae referenca 7.
11

Table 7. Number and percent distribution of drug mentions in office visits to general and family practitioners by age of patient and most frequently named drug%

United States, 1980

Number of Number of

Age of patient mentions Percent Age of patient

and name of drugl

mentions Percent

in distribution and name of drugl in distribution

thousands thousands

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

Ampicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Poliomyelitis vaccine . . . . . . . . . . . . . . . . . . . . . . .

Dimetapp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diphtheria and tetanus toxoids and

pertussls vaccine . . . . . . . . . . . . . . . . . . . . . . . .

Amoxicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Penicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allergy relief or shots . . . . . . . . . . . . . . . . . . . . . .

Reflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Erythromycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Actifed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anioxil (amoxicillin) . . . . . . . . . . . . . . . . . . . . . . . .

E.E.S.(efythromycin) . . . . . . . . . . . . . . . . . . . . . . .

Benadryl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,

Phenergan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E-mycin (erythromycin) . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Penicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ampicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tetracycline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Actifed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allergy relief or shots . . . . . . . . . . . . . . . . . . . . . .

Benadryl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenergan expectorant with codeine . . . . . . . . .

Tetanus toxoid . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pramet FA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Penicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ampicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lasix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tetracycline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chorionic gonadotropin . . . . . . . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamin B-1 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allergy relief or shots . . . . . . . . . . . . . . . . . . . . . .

Actifed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Valium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ionamin (phentermine) . . . . . . . . . . . . . . . . . . . . .

Hydrochlorothiazide . . . . . . . . . . . . . . . . . . . . . . .

Tagemet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenergan expectorant with codeine . . . . . . . . .

Erythromycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Keflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Thyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fastin(phenterrnine) . . . . . . . . . . . . . . . . . . . . . . .

Motrm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxil (amoxicillin) . . . . . . . . . . . . . . . . . . . . . . . .

Phenergan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

hrderal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Decadron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phentermine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tylenol with codeine . . . . . . . . . . . . . . . . . . . . . . .

Tylenol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Darvocet-N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E.E.S. (erythromycin) . . . . . . . . . . . . . . . . . . . . . . .

Terramycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tranxene . . . . . . . . . . . . . . . . . . . . . . . . ...+.....

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

see fOOtIIOte at end of table.

30,497

1,326

1,272

1,225

1.170

1.095

995

963

809

572

54B

539

494

490

484

456

473

17,646

29,989

1,501

1,189

646

539

482

400

“364

“340

“340

“323

23,865

68,195

1,868

1,395

1,327

1,216

1,095

1,018

845

837

785

755

730

674

654

607

588

583

579

532

504

4B8

486

476

468

463

448

443

438

434

428

411

46,620

100.0

4.3

4.2

4,0

3.8

3.6

3.3

3.2

2.7

1.9

1.8

1.8

1.6

1.6

1.6

1.6

1.4

57.7

100.0

5.0

4.0

2.2

1.8

1.6

1.3

1.2

1.1

1.1

1.1

79.6

100.0

2.7

2.0

1.9

1.8

1.6

1.5

1,2

1.2

1,2

1.1

1.1

1.0

1.0

0.9

0.9

0.9

0.8

0.8

0.7

0.7

0.7

0.7

0.7

0.7

0.7

0.7

0.6

0.6

0.6

0.6

68.4

45-64 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dyazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Inderal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lesix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamin B-1 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Motrin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrodiuril (hydrochlorothiazide) . . . . . . . . . . . .

Hygmton . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ampicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Penicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrochlorothiazide . . . . . . . . . . . . . . . . . . . . . . .

Valium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tagamet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Thyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tetracycline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prednisone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diuril . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lanoxin (digoxin) . . . . . . . . . . . . . . . . . . . . . . . . . .

Aldomet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Indocin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lopressor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Clinoril . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Premarin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tranxene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diabineae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bead@. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8utazolidin Alka . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allergy relief orshots . . . . . . . . . . . . . . . . . . . . . .

Aldoril . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenobarbital . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E.E.S. (erythromycin) . . . . . . . . . . . . . . . . . . . . . . .

Darvocet-N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ativan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8rethine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ser-ap-ea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Erythromycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Larroxin (digoxin) . . . . . . . . . . . . . . . . . . . . . . . . . .

Lesix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamin B-12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dyazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Irrderal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aldomet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dioxin.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Motrin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diabinese . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrodiuril (hydrochlorothiazide) . . . . . . . . . . . . .

Hygroton . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tagamet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aldoril . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Valium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Influenza virus vaccine, type A. B.. . . . . . . . . . . .

Nitroglycerin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Slow-K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Isordil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antivefi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tetracycline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Clinonl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

77,235

1,421

1,324

1,291

1,287

1,125

1,026

971

960

956

953

877

867

849

759

754

732

686

677

675

633

543

485

485

477

468

465

454

453

429

429

421

420

419

408

406

406

402

50,843

73.270

2,553

2,183

1,723

1,723

1.5!43

1.261

1,168

1,059

972

963

919

886

790

779

778

772

734

654

660

639

622

616

605

100.0

1.8

1.7

1.7

1.7

1.5

1.3

1.3

1.2

1.2

1.2

1.1

1.1

1.1

1.0

1.0

0.9

0.9

0.9

0.9

0.8

0.7

0.6

0.6

0.6

0.6

0.6

0.6

0.6

0.6

0.6

0.5

0.5

0.5

0.5

0.5

0.5

0.5

66.1

100.0

3.5

3.0

2.4

2,4

2.2

1.7

1.6

1.4

1.3

1.3

1.3

1.2

1.1

1.1

1.1

1.1

1.0

0.9

0.9

0.9

0.8

0.8

0.8
12

Table 7. Number and percent distribution of drug mentions in office visits to general and family practitioners by age of patient and most frequently named drug%

United States, 1980—Con.

Number of Number of

Age of patient mentions Percent Age of patient

and name of drug~

mentions Percent

in distribution and name of drug7 in distribution

thousands thousands

65 years and over—Con. 65 years and over—Con.

Hydrochlorothiazide . . . . . . . . . . . . . . . . . . . . . . . 596 0.8 Lopressor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Penicillin. . . . . . .

469

642 0.7

0.6

. . . . . . . . . . . . . . . . . . . . . . . . . . Indocin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dalmane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

455

522 0.7

0.6

Dawocet-N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Orlnase. . . 501

449 0.6

. . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 0.7 Naprosyn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 440 0.6

Nitro-bid (nitroglycerin) . . . . . . . . . . . . . . . . . . . . . 486 0.7 Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44,171 60.2

Table 8. Number and percent distribution of drug mentions in office viaits to internists by most frequently named drugs: United States, 1980

N8m8 of drugl

Number of Percent mentions distribution

in thousands

All drug mentions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Inderal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .+.....-.

Laaix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lanoxin (digoxin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dyazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrochlorothiazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aldomet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Isordil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dioxin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Valium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...................

Prednisone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nitroglycerin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allergy relief or shots ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Motrin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tagamet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fluorouracil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrodiuril (hydrochlorothiazide). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lopressor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hygroton . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tetracycline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Synthroid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Potaasium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Naprosyn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Coumadin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aldactazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Indocin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Clinoril. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamin E-l Z. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diabinese . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

118,943

4,150

3,130

2,752

2,743

2,287

2,232

2,110

2.080

1,979

1.952

1.948

1,889

1,703

1.434

1,326

1,220

1,217

1,154

1,150

1,080

1,026

1,018

1,005

992

965

959

954

945

902

848

69,793

100.0

3.5

2.6

2.3

2.3

1.9

1.9

1.8

1.7

1.7

1.6

1.6

1.6

1.4

1.2

1.1

1.0

1.0

1.0

1.0

0.9

0.9

0.9

0.8

0.8

0.8

0.8

0.8

0.8

0.8

0.7

58.8

1Based ~“ the phyatctan.s enwf on thePatient Reco~ ‘Om.
Table 9. Number and percent distribution of drug mentions in office visits to pediatricians by most frequently named drugs: United States, 1980

13

Name of drugl

Number of

Percent mentions

distribution in thousands

All drug mentions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72,825 100.0

Poliomyelitis vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diphtheria and tetanus toxoids and pertussia vaccine

4,829 6.6

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,564 6.3

Tuberculin tine test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,409 4.7

Amoxicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,146

Allergy relief or shots

4.3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Penicillin

2,991 4.1

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,252 3.1

Dimetapp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxil (amoxicillin)

1,858 2.6

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,538 2.1

Ampicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,527

E.E.S. (erythromycin)

2.1

. . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aspirin

1,440 2.0

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,236 1.7

Dimetane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6iciilin (penicillin)

1,078 1.5

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenergan

977 1.3

Larotid (amoxicillin)

892 1.2

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Actifed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

857 1.2

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 809 1.1

Vaccination (undetermined) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

V-Cillin (penicillin)

795 1.1

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 794 1.1

Novahistine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Erythromycin

789 1.1

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

M-M-R (measles, mumps, mbella virus vaccine) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

753 1.0

735 1.0

Diphtheria, tetanus toxoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tylenol

735 1.0

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 703 1.0

Phenergan expectorant with codeine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rondec . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

656 0.9

Se ptre

654 0.9

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamin B-1 2

632 0.9

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 618 0.8

Ilosone (et-ythromycin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Triaminic

693 0.8

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 691 0.8

Benadryl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual

575 0.8

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29.799 40.9

1Based on the phy$ician”s entry on the patient RECLIrdform.

Table 10. Number and percent distribution of drug mentions in office visits to obstetrician-gynecologists by most frequently named drug= United States, 1980

Number of

Name of drugl mentions Persent

in thousands distribution

All drug mentions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33,026 100.0

Prenatei formuia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....................

Ortho-nowm

1,621 4.9

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Monistat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....................

1,254 3.8

Premarin

1,236 3.7

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Metema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.215 3.7

Lolovrsl

1,116 3.4

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 936 2.6

Ampicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 760 2.4

vitamins (unspecified) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Stuartnatel 1i-l

729 2.2

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Flagyl

680 2.1

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 649 2.0

Tetracycline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ovlal

587 1.8

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Natelins

650 1.7

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Demulen

521 1.6

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sukrin

5427 1.5

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 506

Norinyl

1.5

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residual

459 1.4

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,680 59.5

1,ga=d ~ ~ ~lclan.s en~ on !ho Pwimt lbsord f~.
14

Technical notes

Source of data and sample design

The information presented in this report is based on

data collected by the National Center for Health

Statistics through its National Ambulatory Medical

Care Survey (NAMCS) during 1980. The target universe of NAMC S includes oflice visits made within the

coterminous United States by ambulatory patients to

nonfederally employed physicians who are principally

engaged in ofllce practice, but not in the specialties of

anesthesiology, pathology, or radiology. Telephone

contacts and nonoi%ce visits are excluded.

NAMCS utilizes a multistage probability sample

design that involves samples of primary sampling units

(PSU’S), physicians’ practices within PSU’S, and patient visits within physician practices. For 1980 a

sample of 2,959 non-Federal, oi%ce-based physicians

was selected from master files maintained by the

American Medical Association and the American

Osteopathic Association. The physician response rate

for 1980 was 77.2 percent. Sampled physicians were

asked to complete Patient Records (figure 1) for a systematic random sample of ofilce visits taking place

during a randomly assigned weekly reporting period.

During 1980, responding physicians completed 46,081

Patient Records, on which they recorded 51,372 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

survey’s field operations.

For a more detailed discussion of the limitations,

qualifications, and definitions of the data collected in

the NAMCS, see Vital and Heaith Statistics, Series

13. No. 66.2

Estimates presented in this report difYerfrom the

estimates reported in the National Medical Care Utilization and Expenditure Survey (NMCUES), another

program of the National Center for Health Statistics

~(NCHS). The variation in estimates is due to differences

in survey populations, data collection methodology,

and definitions. The NMCUES, cosponsored by NCHS

and the Health Care Financing Administration (HCFA),

is a national panel survey of households in which

information on visits to physicians’ offices and hospital

outpatient departments was collected. Preliminary survey data as well as a discussion of the survey methodology are forthcoming from NCHS and HCFA.

Sampling errors and rounding of numbers

The standard error is primarily a measure of the

sampling variability that occurs by chance because

NOTE: A list of references follows the text.

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.

Relative standard errors of selected aggregate visit statistics are shown in table I. Standard errors for estimated

percents of visits are shown in table II. Similar standard

errors for drug statistics and percents are shown in tables III and IV. Tables I and II should be used to obtain

the standard error of a specific drug mention (e.g., Dyazide). Tables HI and IV should be used to obtain the

standard error of a group of drug mentions (e.g., all drugs

prescribed for hypertension).

Estimates of office visits have been rounded to the

nearest thousand. For this reason detailed figures

within tables do not always add to totals. Rates and percents were calculated on the basis of original, unrounded

figures and will not necessarily agree precisely with

percents calculated from rounded data.

Definitions

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.

Aphysician eligible forNAMCS is a duly licensed

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

(D. O.) currently in office-based practice who spends

time in caring for ambulatory patients. Excluded from

NAMCS are physicians who are hospital based; physicians who specialize in anesthesiology, pathology, or

radiology; physicians who are federally employed; physicians who treat only institutionalized patients; physicians employed full time by an institution; and physicians

who spend no time seeing ambulatory patients.

An ofice is a place that the physician identities as a

Table L Approximate relative etandard errors of estimated number of office visite

based on all physician specialties NAMC8, 1980

Relative

Estimated number of office visits standard

in rhousands error in

oercenr

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l.OOO...............................................

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

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

Icj,coo ..............................................

20.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

m,m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ioo,oco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

550JXX2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

27.3

19.5

14.1

9.4

7.3

5.9

4.9

4.5

4.1

.&enrpk of useoftabk An aggregate asumata of 75COW300 waits has a relative srandard

error of 4.7 percent, or a standard errar of 3,525,000 wits (4.7 percent of 75.000000).
ackmdda 15

Table Il. Approximate standard errors of percents of estimated numbers of office visits based on all physician specialties NAMCS, 1980

Base of percent Estimatedpercent

(number of office visitsin thousands)

1or 99 5 or95 ?0 or90 20 or80 30 or 70 50

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . .

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

2.wo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

Ioo,coo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

2.7

1.9

1.3

0.8

0.6

0.4

0.3

0.2

0.1

5.9

4.2

2.9

1.9

1.3

0.9

0.6

0.4

0.2

Standard errvr in percent

8.1 10.8

5.7 7.6

4.0 5.4

2.6 3.4

1.8 2.4

1.3 1.7

0.8 1.1

0.6 0.8

0.3 0.3

12.4

8.7

6.2

3.9

2.8

2.0

1.2

0.9

0.4

13.5

9.5

6.7

4.3

3.0

2.1

1.3

1.0

0.4

Example of use of table: An estimate of 30 percent based on ●n aggregate of 15.000,OGUvi$its has astandard wrorof 2.4 pement. ora relative standard mrorof 8 parcent (2.4 percent + 30

percent).

Table Ill. Approximate relative standard errors of estimated number of dmg

mentions based on all physician specialties NAMCS, 1980

ReIative

Estimatednumber of drug manu’kms standard

in thousands error in

percent

1,000............................................... 27.3

2,m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5,000

:9.7

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.2

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.1

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.2

m,m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2

3oQ,otxl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8

650,CO0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7

.&b of use oftabh: An aggregato aatmete of 75,000.LXXtdmg mentions has ● relative

stmxfatd arm ei &5 parmnt, or ● atandmd emu of 4,875.0L13 rnenucae[8.5 percent of

75,000,00U).

location for his ambulatory practice. Responsibility

over tnne for patient care and professional services rendered there generally resides with the individual physician rather than an institution.

A visit is a direct personal exchange between an

ambulatory patient and a physician or a staff member

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

Admgmention isthe physician’s entry of apharmaceutical agent ordered or provided-by any route of

administration-for prevention, diagnosis, or treatment.

Generic as weIl as brand-name drugs are included, as

are nonprescription as well as prescription drugs. Along

with all new drugs, the physician ako records continued

medications if the patient was specifically instructed

during the visit to continue the medication.

Table IV. Approximate standard errors of percents of estimated numbers of drug mentions based on all physician specialties: NAMCS, 1980

Base of percent

(number of drug mentions in thousands)

Estimatedpercant

1or99 5 or95 10 orgf) 20 or 80 30 or 70 50

Standard error in percentage pointa

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7 5.8 8.0

2.m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.7 12.2 73.3

1.9 4.1 5.7

5.mo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...

7,6 8.7 9.4

1.2 2.6 3.6

20.0m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.8 5.5 6.0

0.6 1.3 1.8

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

2.4 2.7 3.0

0.3

600,000

0.6 0.8 1.1 1.2 1.3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.2 0.3 0.4 0.5 0.5

&ramjMeofusaofttble:An estimate of 30 percent basad on an ●ggragato of 12,500,0C0 drug mentions has ● standaml errwof 4.1 penxnt or a mlatwa standard error of 13.7 parcent (4.1

persent + 30 persant).
From Vital and Health Statistics of the National Center for Health Statistics Number 87. March 28, 1983

Drug Utilization in General and Family Practice

by Characteristics of Physicians and Office Visits:

National Ambulatory Medical Care Survey, 1980

by Beulah K. Cypress, Ph. D., Division of Health Care Statistics

Introduction

Women play an increasing role in the provision of

medical care: young physicians of both sexes enter the

relatively new specialty of family practice, and physicians who have been in practice for some time tend to

delay retirement. At the same time, new discoveries in

medication therapy are announced with great frequency.

Therefore, it is of interest to know whether a changing

population of physicians affects the number and kinds of

drugs prescribed. If differences by sex and age of the

physician do exist, are they simply the results of the

structure of the physician’s practice?

In this report drug utilization statistics are presented

based on the relationship of the sex of the office-based

physician and the year of medical school graduation to

selected visit characteristics: sex and age of the patien~

status and duration of the visiq major reason for the

visit, and the type ofphysician’s practice. An examination of these data indicated that the structure of the

practice was more likely to influence drug utilization

than was the sex of the physician or the year of medical

school graduation.

The data were gathered in 1980 by the National

Center for Health Statistics by means of the National

Ambulatory Medical Care Survey (NAMCS), a prob

ability sample survey conducted annually through 1981

by the Division of Health Care Statistics. Brief information about the source of the data, sampling errors, and

definitions of terms are provided in the technical notes

at the end of this report. A complete description of the

survey including limitations and definitions was published in Vital and Health Statistics, Series 13, No.

66.1 The methodology used to collect and process the

drug information is described in Vital and Health Statistics, Series 2, No. 90.2

Only physicians engaged in general and family practice were used in this analysis to control for the effect of

physician specialty on the nature of drug prescription.

General and family practitioners who have a doctor of

osteopathy (D. O.) degree were not included because data

on the age, sex, or year of the physician’s medical school

graduation were not available.

The Patient Record form used in the 1980 survey is

reproduced in figure 1. Up to eight specific drugs, either

new or continued during the visit+may be recorded by

the physician in item 11, parts a and b. In order to

present accurately what the physician ordered, prescribed, or provided. drug mentions used in this report

are based on the physicians’ entries on the Patient Record

forms. These entries were brand or generic names of

prescription or nonprescription drugs, though in some

instances the physician recorded a therapeutic effect

for example. ‘ballergy reliefl”’

Visit characteristics

Previous reports from NAMCS have demonstrated

that drug utilization statistics vary widely with physician

specialty and case-mix.3-5 Therefore, when analyzing

drug utilization patterns by variables such as physician

sex and year of graduation, it is important to examine

other factors that may contribute to differences. The

data presented in tables 1 and 2 are for selected patient

visit variables that could influence drug prescribing.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Servce
2 advancedaa

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1. DATE OF VISIT

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PATIENT BEFOREJ

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CONOITl ON IN

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NATIONAL AMBULATORY MEDICAL CARE SURVEY

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11. MEOICATION THERAPY THIS VISIT ~ NONE

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1

2

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I

6 l’JRfiTuFINED TO REFERRING wws,c,.w I

0M8 No. 6S-R1498

Figure 1. Patient Record

They are presented to enhance and clarify the interpretation of drug utilization presented later. The following

are noteworthy findings from tables 1 and 2 that maybe .

factors contributing to drug use differences by sex of the

physician and year of graduation from medical school.

Female patients constituted 71 percent of visits to .

female physicians, compared with 60 percent of

those to male physicians.

Patients under 25 years of age accounted for 46

percent of visits to female physicians but only 29

percent of those to male physicians. Patients 45 ●

years of age and over constituted 44 percent of visits

to male physicians, compared with 34 percent of

those to female physicians.

Female physicians treated proportionately more

new patients (27 percent) than males did (11 percent).

Proportionately more visits involving nonillness care

(general examinations, gynecological examinations,

well-baby, and so forth) took place in female physicians’ oftlces (25 percent) than in male physicians’

offices (16 percent).

Female physicians spent some time in face-to-face

encounter with virtually all their patients, while 3 per-
aduama@3

Table 1. Percent distribution of office visits to general snd family practitioners (M. D.) by selected visit characteristics, sccording to sex of physician and year of

medical school graduatlom United Ststes, 1980

Sex of physician Year of graduation

Characteristic

Both Femaia Male 8efore

sexes 1941 1941-50 1951-60 1961-70 1971-60

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

Sex of patient

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

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age of patient

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

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

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

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

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

Wsit status

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

Oldpatient, new problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oldpstient, old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major reason for visit

Acute problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chronic problem, routine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chromcp roblem,f lareup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Postsurgery orpoatinjury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonillneas care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Duration of visit

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

l-5mirrutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

16-30 mtnutea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Type of practice

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

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

100.0

60.1

39.9

14.4

15.2

26.7

23.9

19.8

11.4

34.3

54.4

46.6

24.6

9.1

3.6

16.0

2.9

12.3

38.8

27.4

16.5

2.1

61,4

38.6

100.0

71.2

28.8

26.9

19.1

20.5

18.5

15.0

27.3

25.4

47.3

40.7

22.2

8.6

3.4

25.1

●3.2

29.6

28.0

30.5

8.7

32.8

67.2

100.0

59.8

40.2

14.1

‘15.1

26.9

24.1

19,9

10.9

34.5

54.6

46.8

24.7

9.2

3.6

15.8

3.0

12.5

39.0

27.4

16.1

1.9

62.2

37.8

Percent dstnbution

100.0

57.1

42.9

6.7

9.5

22.9

29.5

31.4

11.9

26.9

61.2

43.8

36.6

7.3

3.5

8.8

91.0

5.3

30.0

35.1

23.0

5.8

92.9

7.1

100.0

59.6

40.4

12.1

15.1

24,8

27.1

20.9

8.2

34.2

57.7

43.4

28.1

8.3

3.7

16.6

2.0

13.5

38.3

26.1

18.5

1.6

85.8

14.2

100.0

59.9

40.1

14.0

14.1

26.5

24.9

20.5

9.3

35.4

55A

47.1

23.7

9.7

3.8

15.7

3.9

12.1

41.8

26.0

14.7

1.5

61.7

38.3

100.0

61.4

38.6

16.8

16.4

28.1

20.9

17.9

10.4

37.7

51.9

48.7

22.9

8.8

3.7

16.0

3.1

13.8

39.7

27.4

14.5

1.6

44.4

55.6

100.0

61.8

38.2

22.0

21.1

31,0

16.0

9.9

25.9

30.0

44.1

49.6

15.3

10.8

2.4

22.0

2.5

13.4

34.2

28.9

17.7

3.4

21.9

78.1

1 Repre~e”t~ “,slt~ in wh,ch there WaS no fsce-to-face encounter between Patmnt and Phwmn.

Zl”cludes panner$hip, group, and other tYPes of P~ctlce.

Table 2. Average number of office visits per week to general and family

practmoners (M. D.) by sex of physician and year of medical school

graduation: Untted Statea. 1980

Sex of physician

Year of graduation

Both

Female Male

sexes

Number of vtsits per

physic!an per week

Allyears of graduation . . . . . . . . . . . . . . . . . . . . 94 73 96

Before 1941 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 43 61

1941 -1950 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 30 92

1951-1960 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 87 111

1961-1970 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 45 107

1971-1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 54 85

cent of visits to male physicians ‘were “O minutex

that is, patients were treated by a staff member.

Male physicians spent less than 11 minutes in 52

percent of their patient encounters; female physicians spent that amount of time in 33 percent. About

39 percent of visits to female physicians lasted 16

minutes or longer, compared with 18 percent of

visits with the same duration to males.

● Visits to male physicians were more likely to be to

those in solo practice than in other types of practice,

while the reverse was true for females.

● In a typical work-week the average female physician

saw 73 patients in the oi%ce; the average male saw

96.
4 acklncedaa

Patients under 25 years of age were more I“ikelyto

visit physicians who graduated in recent years than

those in practice a long time, while the reverse was

true for patients 45 years of age and older (figure 2).

Physicians who graduated after 1970 treated pr~

portionately more new patients than physicians who

graduated in earlier years did.

Proportions of visits for routine chronic problems

decreased as the year of graduation became more

recent. Physicians who graduated in 197 1–80 saw

proportionately more patients for nonillness care

than older physicians did.

There were proportionately more visits lasting 16

minutes or longer, and fewer that were shorter than

11 minutes. to physicians who graduated before

1941 than to those who graduated in later years.

The more recent the year of graduation, the less

likely were visits to physicians in solo practice. A

clear trend toward practice arrangements other than

solo by more recent medical school graduates is

indicated in figure 3.

The most professionally active physicians of both

sexes were those who graduated in the period 195 l–

60, but male physicians saw more patients in a

typical work-week than females did, regardless — of

the year of graduation.

70

60

50

40

:

$

L

30

20

10

0

Age of patient

= - Under 25 years

_ 45 years and over

/d@

-H

/

-e

0-

/

0

I I I 1 J

Before 1941-50 1951-60 1961-70 1971-60

1941

Year of graduation

Figure 2. Percent of nffme vts!ts to general and fam(ly practttxoners (M.D.),

by aqe of patient and year of medical school graduation: Unned States. 1980

100

90

80

70

60

z

; 50

z

40

30

20

10

0

— solo

- _ Other

/

/’

/

/

/

/

/

Before 1941-50 1951-60 1961-70 1971-60

1941

Year of graduation

Figure 3. Percent of office visits to general and family practitioners (M.D.},

by type of practice and year of medtcal school graduation: United States, 1980

Drug utilization rates

Two measures of drug utilization are used in this

report the percent of drug visits and the drug intensity

rate. The percent of drug visits refers to the percent of

visits in which one or more drugs were ordered or provided. The drug intensity rate is the average number of

drugs ordered during drug visits. It is obtained by dividing the number of drug mentions by the number of drug

visits. These drug utilization rates by the sex of the physician and the year of medical school graduation (in 10-

year intervals) in terms of the same practice variables

used to describe the visit estimates shown in table 1 are

presented in tables 3-5. The percent distribution of drug

mentions by the precise number of medications is shown

in table 6.

Sex of physician

In general, differences in the utilization rates of

female and male physicians were not statistically significant. Differences in rates based on the sex of the patient

were also not statistically significant. Although female
atklncedata 5

Table 3. Percent of drug ws!ts and drug mtensw rate. by sex and age of pat!ent, sex of general and faintly practmoner(M.D. ]. and year of med!cal school graduation

Untted States, 1980

Sex of physjcian Year of graduation

Sex arrd age of patient

Both

Female Male

Before

sexes 1947

1947-50 1951-60 1961-70 1971-80

Sex of patient

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age of patient

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

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

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

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

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

Sex of patient

Both sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age of patient

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

15-24 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

65yeara and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75.1

75.9

74.0

71.5

64.4

72.2

80.1

83.9

1.92

1.97

1.85

1.59

1.58

1.75

2.05

2.36

78.7

76.2

85.0

73.9

67.0

76.9

84.8

97.2

2.01

2.11

1.79

1.85

1.71

1.77

2.21

2.53

75.0

75.9

73.8

71.4

64.3

72.1

8@.O

83.6

1.92

1.96

1.85

1.58

1.57

1.75

2.05

2.36

Percent drug ws!tst

82.8 74.8 78.3

85.1 75.2 79.4

79.7 74.2 76.7

73.5 68,6 77.1

68.6 65.6 66.7

818 73.5 74.5

82.9 78.1 83.4

89.6 82.2 85.8

Rate per drug waltz

1.91 1.84 2.05

1.97 1.85 2.11

1.81 1.83 1.96

1.84 1.53 1.63

1.55 1.47 1.74

1.72 1.67 1.90

1.92 1.89 2.22

2.12 2.31 2.46

70.6

72.0

68.5

69.8

62.6

66.6

76.4

78.3

1.87

1.94

1.75

1,60

1.47

1.65

2.02

2.50

66.9

65.7

68.9

64.1

5B.4

67.1

73.3

80.5

1.64

1.65

1.63

1.47

1,48

1.55

1.87

2.10

1~“,~,t ,“ ~h,~h ~ne w more drugs were ordered.

2Drug ~ent,o”s d,vtded by number of dmg vlsns.

physicians treated proportionately more female patients

than male physicians did, they used drugs to treat female patients at about the same rate as their male counterparts.

Male physicians had a higher proportion of patients

over 65 years of age than female physicians did. but proportionally fewer of those visits resulted in drug therapy

than those to female physicians (84 percent of visits to

male physicians, compared with 97 percent to females).

However, the average number of drugs (drug intensity

rate) prescribed during those visits was about the same

for all physicians. Similarly, the drug intensity rates for

patients under 25 years of age, who were more likely to

be treated by female physicians than by males, were not

statistically different by sex of the physician.

Regardless of the sex of the physician, patients seen

before were more likely to have drug visits than new

patients were. However, male physicians ordered more

drugs during drug visits by returning patients than by

new patients. The drug intensity rates for new and returningpatients did not differ significantly when the physician was a female. However, when the major reason for

the patient’s visit was a routine chronic problem, about

91 percent of visits for such care given by female physicians resulted in a drug prescription, compared with 84

percent of those by male physicians, a statistically significant difference.

Female physicians also tended to prescribe one or

more drugs proportionately more often during nonillness

visits (69 percent) than male physicians did (49 percent).

The drug intensity rates for the routine care of chronic

problems and for nonillness care were also higher for

female physicians than for males. These results may be

due in part to the relatively larger number of female

patients seen by female physicians. Also, a higher proportion of female physicians’ visits were for examinations (23 percent) than male physicians were (15 percent). Chronic genitourinary problems treated during

women’s oflice visits usually require medication therapy

while visits for gynecological examinations are likely to

include contraceptive prescription. Vitamins are commonly used for prenatal care, which is a leading diagnosis in the nonillness category.

For both female and male physicians the lowest

drug intensity rate was associated with very short visits

(less than 6 minutes). Otherwise, the average number of

drugs prescribed varied only slightly with the longer

duration of the visit. Female physicians were more

likely than males were to prescribe at least one dmg

when the visits lasted from 11 to 30 minutes. Because

female physicians had a higher proportion of visits with

a duration of 16 minutes or more, it may be that the utilization of drug therapy contributed to the greater visit

length.

In comparing drug visits by type of practice for male

physicians only, it was found that one or more drugs
6 advancedata

Table 4. Percent of drug vIsIts and drug tntenslty rate. byvisti status, major reason forwstt, durat!on of vtsn, sex of general and famdy pract!tloner(M. D.), and year of

med!cal school graduation: United States. 1980

Sex of ph ys/c:an Year of graduation

VIsIt status, major reason for vIsIt, and durat)on of ws(t

Both

Female Male

Before

1941-50

sexes 1941

1951-60 1961-70 1971-80

Vlslt status

Allpat!ents. . ,. ,., ,.

New pattent . . . . . . . . . . . . . . . . . . ...,.,,,,,.,..

Oldpatfient. new problem, . . . . . .,, ,,, ., .,.....,

Oldpatlent, old problem . . . . . . . .

Ma for reason for vtslt

Acute problem . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chrome problem, routtne. . . . . . . .

Chronic problem, flareup . . . . . . . .

Postsurgery orpostlnjury . . . . . . . . . . . . . . . . . . .

Non!llness care . . . . . . . . . . . . . . .

Ouratlon of vmlt

Ommutesz . . . . . . . . . . . . . . . . . . . . . .,.,.,.,,,., . . .

l-5mlnutea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-10 mmutes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

31minutes OrmOre . . . . . . . . . . . . ,,, ..,.,

V]slt status

Allpat!ents ...,..........,.. . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Oldpatlent, new problem ...,.... . . . . . . . . . . . . . . . . . . . .

Oldpatlent, old problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Malor reason for vts!t

Acute problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chronic problem. routine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chronic problem, flareup . . . . . . . . . . . . . .

PostsurgeV orpostlnjury . . . . . . . . . . . . . . . . . . . . .

Nonlllness care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ouration ofvlstt

0m!rtutes2, ..,......,.,...,.. . . . . . . . . . . . . . . . . . .

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

6-10 mmutes . . . . . . . . . . . . . . . . . . . . . . . . . . .

11-15 mmutes, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

31mmutes OrmOre . . . . . . . . . . . . . .

75.1

672

76.0

76.3

80.5

84.0

83.8

36,3

49.7

7’7.4

74.1

78.6

74,3

71,0

57.9

1.92

1.71

1.80

2.03

1.83

2.17

2.21

1,51

1,49

1.38

1.56

1.91

2.03

2.13

2.02

78.7

66.9

80.1

84.8

81.3

91.0

“71.7

“57.2

68.9

“81 .3

79.4

82.2

79.3

“61 .9

2.01

1.99

1.78

2.13

1,85

2.53

‘2.00

“1 .56

1.75

“1.14

1.83

1.97

2.32

“2.00

75.0

67.2

75,9

76.1

80.5

83.9

84.1

35.7

48.9

77.4

74.1

78.6

74.1

70.6

57.4

1.92

1.69

1.80

2.03

1.83

2.16

2.21

1.51

1.48

1.38

1.56

1.91

2.03

2.12

2.02

Percent drug visital

82.8 74.8

71.6 63.7

78.6 75.2

86.8 76.1

86.6 79.6

92,0 84.9

88.2 86.6

“46,9 35.0

35.3 48.2

*51 .4 92.8

88.0 76.5

83.4 79.7

84.6 7’3.4

84.8 65.3

60.5 54.4

Rate per drug vis@

1.91 1.84

1.75 1.54

1.82 1.81

1.97 1.89

1.94 1.82

1.90 2.01

2.12 2.08

“1 .61 1.30

1.41 1.29

●1 .60 1.02

1.25 1.41

1.72 1.88

2.05 1.98

2.08 1.98

1.97 1.98

78.3

69.5

80.2-

78.6

84.4

83,6

88.0

33.3

57.1

78.9

77.5

81.5

77.4

72.2

69.4

2.05

1.88

1.84

2.21

1.94

2.30

2.50

1.67

1.62

1.63

1.56

2.04

2.17

2.42

2.14

70.6

59.5

71.1

72.5

76.1

80.1

75.8

38.0

44.8

70.6

73,8

73.9

65.8

69.5

●53.9

1.87

1.83

1.77

1.94

1.69

2.39

1.91

1.28

1.21

1.18

1.82

1.83

1.94

2.05

●1 .87

66,9

70.2

69.1

63.5

72.5

79.2

76.0

840.3

44.3

“69.7

55.3

70.4

70.5

67.1

“43.3

1.64

1.50

1.64

1.74

1.55

1.94

1.81

“1.18

1.15

● 1.02

1.44

1.62

1.74

1.69

“2.00

1A “,stt ,“ ~h,ch 0“.s or more drugs were ordered

2RePrese”tsv,stts tinwh,ch there was no face. to-faca encounter between Patient and Phvs,ctan

3Drug ~e”t,o”sd,vtded by number of drug Vgssts.

were mentioned in proportionally more visits to those in

solo practice (78 percent) than to those in other types of

practice (70 percent). This difference was not statistically significant for female physicians. However, female

physicians in multiple practices had a higher proportion

of cJ-ugvisits than males in multiple practice arrangements did.

Year of graduation

It was shown previously that older physicians tended

to treat older patients, while recent graduates from medical school tended to treat younger patients. An earlier

reports indicated a high correlation between the age of

the patient and drug utilization, with rates increasing

with increasing age. The current study results reflect

these findings. Physicians who graduated before 1961

were more like 1y to include one or more drugs than those

who graduated in later years were. The most recent

graduates ( 197 1–80) prescribed, on the average, fewer

drugs per drug visit than their older counterparts did.

They also had the highest proportion of visits with only

one drug prescribed. However, their drug intensity rates

for patients 45 years of age and over increased with

increasing age as did those of other physicians, thus
ackmdab 7

Table 5. Percent of drug visits and drug mtensmy rate, by type d physlcian”s pracnce, sex of general and family practitioner (M.D.), and year of med!cai school

.graduat!otx Untted States. 1980

Sex of physician Year of graduation

Type of practice

Both

female Male

Before

1941-50 1951-60

sexes 7941

1961-70 1977-BO

Percent of drug vwttsl

Alltypes of practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75.1 78.7 75.0 82.8 74.8 78.3 70.6 66.9

solo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.0 81.6 77.9 82.9 76.2 79.8 74.6

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

69.7

70.6 77.3 70.3 81.3 66.5 76.0 67.4 66.1

Rate per drug visit3

Alltypes of practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.92 2.01 1.92 1.91 1.82 2.05 1.87 1,64

solo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ,9s 2.30 1.94 1.89 1.85 2.08 1.87 1.82

Otherz. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.87 1.86 1.87 2.22 1.74 2.01 1.87 1 .s9

1A v,s,t #n whjch one or more drugs were ordered.

2 ,ncl”des ~aflne=h,p. gOUP. and other tvPes Of Practsce.

3Dmg ~e”t80ns dtv!ded by number Of drug vlstts.

Table 6. Percent distribution of drug visits to general and family practitioners (M. D.) by number of medications, according to sex of physician and year of medical

school graduation: Umted States. 1980

Number of medtcatlons

Sex of physician and year of graduation 4

Total 1 2 3 or

more

Percent dlstnbutmn

Alldrug visitsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 46.2 30.5 13.3 9.9

Sex of physician

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 38.7 38.4 “9.0 14.0

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 46.5 30.3 13.4 9.8

Year of graduatmn

Before 1941 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 42.3 33.6 16,9 7.2

1941 -1950 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 50.3 28.3 13.1 8.3

1951 -1960 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 41.6 31.3 14.1 13.0

1961 -1970 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100,0 48.7 30.1 12.1 9.1

1971 -1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 56.5 29.4 9.4 4.7

1A “l~,t ,“ ~hlch one or more drugs were ordered.

providing evidence that the rate of drug use depends on

the age of the patient and not the age of the physician.

For all medical school graduates, except the 1971-

80 group, proportions of drug visits were higher for old

patients returning to the same physician for care of a

continuing problem than for new patients. On the other

hand, the 1971-80 graduates were more likely to prescribe one or more drugs during initial visits (which

were likely to be made by young rather than more mature

patients) than during visits by patients returning for

continuing care.

Physicians who graduated after 1960, and who had

proportionately more patients under 25 years of age

than other physicians did, had lower proportions of drug

visits for care of acute or chronic problems than physicians who graduated before 1961 did. As expected,

proportions of drug visits for nonillness care and postsurgery or postinjury were lowest among all major reasons for visit regardless of the physician’s year of graduation. Physicians in practice the longest (graduated

before 194 1) were the least likely to have drug visits for

nonillness care (35 percent). This was probably related

to the fact that nonillness care given by older physicians

was usually for a routine physical examination, while

younger physicians provided more pediatric (immunizations, and so forth) and prenatal care.

Proportions of drug visits did not vary appreciably

with changing duration intervals regardless of the year

of graduation. Only very long visits (31 minutes or

longer) had proportionately fewer drug visits than other

durations did. However, the average number of drugs

ordered during drug visits to some groups was reIated to
the duration of the visit. For physicians who graduated

before 1961 the drug intensity rate for visits lasting 11

minutes or more was higher than that for visits lasting

less than 11 minutes. This difference was not statistically significant for physicians who graduated in later

years. One possible explanation for this is that both visit

duration and drug utilization increase with increasing

patient age group, and physicians who graduated before

1961 see propofiionately more older patients than younger

physicians do.

Therapeutic categories

Sex of physician

Each drug named by the physician in NAMCS is

classified according to its desired therapeutic effect

based on the classification system of the American

Hospital Formulary Service.G The distribution of drug

mentions by therapeutic category is shown in table 7.

The use of certain kinds of drugs tended to follow the

case-mix pattern of the physician groups. The leading

category used by physicians of both sexes was central

nervous system drugs. Serums, toxoids, and vaccines

(13 percent) was the next largest category prescribed by

female physicians, and it was significantly greater than

the 3 percent of the same drugs used by male physicians.

For male physicians the second ranking therapeutic

group was anti-infective agents (17 percent), which

exceeded the use ofsuch drugs by female physicians ( 10

percent). Other differences between therapeutic categories used by female and male physicians were not

statistically significant.

There were some within-category differences depending on the sex of the physician. In the central nervous

system group. no respiratory and cerebral stimulants

were prescribed by females. In the hormones and synthetic substitutes group, males used proportionately

more adrenals and androgens than females did. while

females ordered proportionately more contraceptives.

These results reflect the distribution of patient visits by

sex of the patients likely to visit female and male physicians.

Year of graduation

As might be expected considering the age distributions oftheirpatients, physicians who graduated before

1941 made greater use of cardiovascular drugs and

diuretics than their younger counterparts did. Physicians

who graduated before 1961 were more likely to prescribe

central nervous system drugs than those who graduated

later were. The most recent graduates were more likely

to use antihistamines and skin and mucous membrane

preparations, reflecting the higher proportions of young

and female patients who visited them.

Specific drug~

The specific drugs most frequently prescribed by

general and family practitioners (including doctors of

osteopathy) were listed by age of the patient in Advance Data No. 86.4 A comparison of those data with

the drug lists generated by the physicians grouped by

sex ofthe physician and year of graduation in the current

analysis revealed few differences among the groups in

the drugs named or their relative standing.

Table 7 Percent dlstr!butlon of drugs mentioned by general and fam!ly practttloners [M. D.) by therapeutic catego~, according to sex of physlclan and year of

medical school graduation: Un!ted States, 1980

Sex of physic!an Year of graduation

Therapeutic categorfl

Both

Female Male

Before

1941

1941-50 1951-60 1961-60 197740

sexes

Percent dcstrlbutlon

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100,0

Antlhlstam8ne drugs.. . . . . . . . . . . . . 6.7 5.4 6.7 6.3 6.3 5.7 7.5 11,3

Antklnfectwe scents . . . . . . . . . . . . . 16.6 9.6 16.8 14.6 14,7 17.2 17.5 18.1

Autormmlc drugs . . . . . . . . . . . . . . . . 4.6 ‘2.6 47 3.4 4,3 4.8 4,5 5.8

Blood formatmn andcoagulatnon ,, ..,,, ,.. . . . . . 1.4 “2.8 1.4 “1.2 0.9 1.8 1.3 ‘1 o

Cardiovascular digs, . . . . . . . . . . . . . . . . . . . . . . . . . 10.3 7.8 10.4 14,8 11.7 9.6 9.4 7.7

Central nervous system drugs.... . . . . . . . 18.2 14.5 18.3 17.1 21.4 18.3 16,0 15.8

ElectrolW!c. calor!c, and water balance . . . . . . . . . . . . . 86 104 8.5 11.1 9.9 8.0 8.2 6.7

Expectorants and cough preparations . . . . 3.4 ●3.8 3.4 3.7 2.9 3.8 3.0 2.6

Eye, ear, nos.?, and throat preparations . . . . . . . . . . . . . . 1.5 “1.0 1.6 2.1 ‘0.7 1.6 1.9 “1.7

Gastrolntest!nal drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.8 6.7 4.7 4.6 5.0 4.8 5.1 4.0

Hormones and synthettc substitutes . . . . . . . . . . 7.4 7.7 7.4 5.9 6.7 8.2 8.0 6.0

Serums, toxoids. and vaccines . . . . . . . . 2.9 13.2 2.6 2.4 3.1 2.8 3.5 2.2

Skin and mucous membrane preparations . 5.1 8.4 5.0 4,9 3.9 4.4 6.5 8.6

Spasmolytlc agents . . . . 16 “o 5 1,9 “1.3 2.3 1.8 1,5 2.0

Vkamlns. . . . . . 38 “3.0 3.8 31 4,0 3.8 3.5 4.4

Another categor!es2. . . . . . . . . 2.9 2.4 2.9 35 2.2 34 26 2.1

1 ~Ssed on ,he ~,a~s,f,cat,~n SyS,e~ of the American Hospttal %mdav se~lce See reference 6

21”clUde* ~“t,neOp,asy8c age”,s, ~tagnOst,C =gen,~, ~nzyme~, gold COmDOu”OS. tje~q ~etaI ~nragon,sts, IocaI ~nestheucs. OWOcIcs. unclass,f!ed theraveul,c a9enW Pharmaceutlc sI~s,

and therapeutic calegow unde!ermsned
Discussion

This study was limited because of the small number

of female physicians in the sample. Females constitute

approximately 5 percent of the office-based general and

family practitioners in the NAMCS universe. The female

general and family practitioners (M.D.’s. doctors of medicine) accounted for 22 percent of all female physicians

who reported visits in NAMC S: The males accounted

for21 percent ofthe male physicians in the same specialty.

However, the relatively large sampling error associated

with the small size of the female sample made it difficult

to detect differences.

Most of the differences in drug utilization between

female and male physicians can be attributed to the

differences in the demographic characteristics of their

patients and the diagnoses commonly associated with

them. Although the study was restricted to only one

specialty, it is apparent that in general and family practice, case-mix is influenced by the sex of the physician.

Similarly, case-mix also depends on the age of the

physician. A medical practice is built over a period of

time and it is naturai for older patients to continue

seeking their health care from the same established

physicians. The caseload of the newly graduated physician, on the other hand, typically consists of young

patients. many of them seeing a physician for the first

time for preventive care or for self-limiting conditions.

These differences in visit characteristics were noticeable in the distribution of drugs by therapeutic category.

As expected, there was a strong correlation between

case-mix and the categories of drugs most frequently

used. It is noteworthy, however, that in the choice of

specific drugs, the age of the physician had no apparent

effect. Physicians who graduated over 40 years ago

prescribed the same brand name drugs, many of them

only recently developed. as those who graduated in

more recent decades did. Continuing medical education

courses and seminars, often required for board certification, is one factor in the updating of the physician’s

medical knowiedge. But pharmaceutical discoveries

proliferate at a rapid pace, and the manufacturers also

contribute to the modernization of the physician’s treatment armamentanum through their representatives and

literature. One conclusion that might be drawn from the

results of this study suggests that the motivation to

acquire new drug information is common to all age

physicians.

References

1National Center for Health Statistics, R Gagnon, J. DeLozier.

and T. McLemore: The National Ambulatory Medical Care Survey,

1979 summary. Vital and Heaftir Sfatkdcs. Series 13-No. 66.

DHHS Pub. No. (PHS) 82-1727. Public Health Service. Washington. U.S. Government Printing 0fi7ce, Sept. 1982.

2National Center for Health Statistics, H. Koch The collection and

processing of drug information, National Ambulatory Medical Care

‘Survey, United States, 1980. Vital and Health Statistics. Series 2-

No. 90. DHHS Pub. No. (PHS) 82-1364. Public Health Service.

Washington. U.S. Government Printing Oftice, Mar. 1982.

3National Center for Health Statistics, H. Koch Drug utilization in

otlice-based practice by age and sex of the patien~ National Ambulatory Medical Care Survey, United States, 1980. Advance Data

Front Vital and Health Statistics, No. 81. DHHS Pub. No. (PHS)

82-1250. Public Health Service. Hyattsville. Md. July 26, 1982.

4National Center for Health Statistics. B. K. Cypress Drug utilization in ofiice visits to primary care physicians. National Ambulatory

Medical Care Survey, 1980. AdvanceData From Vita[andHealth

Statistics, No. 86. DHHS Pub. No. (PHHS) 82-1250. Public

Health Service, Hyattsville. Md. OCL 8, 1982.

5National Center for Health Statistics, B. K. Cypresx Medication

therapy in otlice visits for selected diagnoses, National Ambulatory

Medical Care Survey. 1980. Vifaf andHeafth Statistics. Series 13-

No. 71. DHHS Pub. No. (PHS) 82-I 732. Public Health Service.

Washington. U.S. Government Printing Office, Jan. 1983.

6Amencan Society of Hospital Pharmacists. Inc.: The American

Hospital Formu[aq Service. Washington. Jan. 1980.
10 adwlncedata

Technical notes

Source of data and sample

design

The information presented in this report is based on

data collected by the National Center for Health Statistics (NCHS) through its National Ambulatory Medical

Care Survey (NAMCS) during 1980. The target universe of NAMCS includes.office visits made within the

coterminous United States by ambulatory patients to

nonfederaily employed physicians who are principally

engaged in office practice, but not in the specialties of

anesthesiology, pathology. or radiology. Telephone contacts and nonofflce visits are excluded.

NAMCS utilizes a multistage probability sample

design that involves samples of primary sampling units

(PSUS), physicians’ practices within PSU’S, and patient

visits within physician practices. For 1980 a sample of

2,959 non-Federal, office-based physicians was selected

from master files maintained by the American Medical

Association and the American Osteopathic Association. The physician response rate for 1980 was 77.2

percent. Sampled physicians were asked to complete

Patient Records (figure 1) for a systematic random

sample of ofllce visits taking place during a randomly

assigned weekly reporting period. During 1980, responding physicians completed 46,081 Patient Records, on

which they recorded 51,372 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 NCHS, was responsible for

the survey’s field operations.

For a more detailed discussion of the limitations,

qualifications, and definitions of the data collected in

the NAMC S, see Vital and HeaIth Statistics, Series

13. No. 66.1

Estimates presented in this report differ from the estimates reported in the National Medical Care Utilization

and Expenditure Survey (NMCUE S), another program of NCHS. The variation in estimates is due to

differences in survey populations, data collection methodology, and definitions. The NMCUES, cosponsored

by NCHS and the Health Care Financing Administration

(HCFA), is a national panel survey of households in

which information on visits to physicians’ offices and

hospital outpatient departments was collected. Preliminary survey data as well as a discussion of the survey

methodology are forthcoming from NCHS and HCFA.

Sampling errors and rounding

of numbers

The standard error is primarily a measure of the

sampling variability that occurs by chance because only

NOTE: A list of references follows the text.

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. Relative standard

errors of selected aggregate visit statistics are shown in

Table I. Standard errors for estimated percents of visits

are shown in table II. Similar standard errors for drug

statistics and percents are shown in tables HI and IV.

Tables I and H should be used to obtain the standard

error of a specific drug mention (e.g., Dyazide)- Tables

III and IV should be u;ed to obtaimthe standard error of

a group of drug mentions (e.g., all drugs prescribed for

hypertension).

Estimates of office visits have been rounded to the

nearest thousand. For this reason detailed figures within

tables do not always add to totals. Rates and percents

were calculated on the basis of original, unrcwnded

figures and will not necessarily agree precisely with

percents calculated from rounded data.

Definitions

An ambuiato~ 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.

.4 physician eIigible for NAA4CS is a duly licensed

doctor ofmedicine (M.D.) ordoctorof osteopathy (D. O.)

currently in ofilce-based practice who spends time in

caring for ambulatory patients. Excluded from NAMCS

are physicians who are hospital based; physicians who

specialize in anesthesiology, pathology, or radiology;

physicians who are federally employet physicians who

treat only institutionalized patients: physicians employed full time by an institution and physicians who

spend no time seeing ambulatory patients.

An o~ce is a place that the physician identifies as a

Table 1. Approximate relatwe standard errors of estimated number of off!ce

wstts based on all phys!cian specialties, NAMCS, 1980

Relative

Estimated number of office visits srandard

in thousands error in

percent

27.3

19.5

14.1

9.4

7.3

5.9

4.9

4.5

4.1

Example of use of fable: ArI aggregate estimate of 75,000,CQ0 vt.mts ha% a rela!w’e

standard error of 4.7 percent, or a standard error of 3,525,000 vusfits (4.7 percent of

75.000.000).
aduancedata 11

Table Il. Approximate standard errors of percents of estimated numbers of office VISIIS based on all physm!an specialties: NAMCS. 1980

Base of percent

[number of office visits in fhousands)

Est!mared percent

1 or 99 5 or 95 loor90 20 or 80 30 or 70 50

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

2.7

1.9

1.3

0.8

0.6

0.4

0.3

0.2

0.1

5.9

4.2

2.9

1.9

1.3

0.9

0.6

0.4

0.2

Standard error m percent

8.1

5.7

4.0

2.6

1.8

1.3

0.8

0.6

0.3

10.8

7.6

5.4

3.4

2.4

1.7

1.1

0.8

0.3

12.4

8.7

6.2

3.9

2.8

2.0

1.2

0.9

0.4

13.5

9.5

6.7

4.3

3.0

2.1

1.3

1.0

0.4

Example of use of table: An estimate of 30 percent based on an aggregate of 15.000.OCQ VISNS has a standard error of 2.4 percent. or a relawe standard error of 8 percent (2.4 percent -30

Table Ill. Approximate relatwe standard errrors of est!mated number of

drug mentions based on all physmtan specialties NAMCS, 1980

Relative

Estimated number of drug mentions standard

in thousands error in

percent

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

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

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

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

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

50.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

300,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

650,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

27.3

19.7

13.2

10.1

8.2

6.8

6.2

5.8

5.7

Example of use of table: An aggregate estamate of 75.000.000 drug mentmns has a relattve standard error of 6.5 percent, ora standard error of4.876,00Cr mentmns[6.5 percent

of 75,000,0COL

location for his ambulatory practice. Responsibility

over time for patient care and professional services

rendered there generally resides with the individual

physician rather than an institution.

A visit k a direct personal exchange between an

ambulatory patient and a physician or a staff member

working under the physician’s supervision, for the purpose of seeking care and rendering health services.

A drug mention is the physician’s entry 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. Along

with all new drugs, the physician also records continued

medications if the patient was specifically instructed

during the visit to continue the medication.

Table IV. Approximate standard errors of percents of est!mated numbers of drug menttons based on all phys!cmn spectalt!es: NAMCS, 1980

Base of percent

[number of drug mentions in thousands)

Esttmated percent

1 or 99 5 or 95 10or 90 20 or 80 30 or 70 50

Standard error m percent

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7 5.8 8.0

2,000

10.7 12.2 13.3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.9 4.1

5,000

5.7 76 8,7 9.4

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2 2.6 3.6 4.8

20,000

6.5 6.0

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.6 1.3 1.8 2.4

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

2.7 3.0

600,000

0.3 0.6 0.8 1.1 1.2 1.3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.2 0.3 0.4 0.5 0.5

Example of use of table: An e$tlmate of 30 percent based on an aggregate of 12.5CXI.CQO drug mentmns has a standard error of 4,1 percent, or a relatwe standard error of 13.7 percent [4 1

percent + 30 percent].
1981 Summary National Ambulatory Medical Care Survey

by Linda Lawrence and Thomas McLemore, Division of Health Care Statistics

During 1981 an estimated 585.2 million office visits

were made to nonfederally employed, ofllce-based physicians in the contenninous United States, an average of

2.6 ofice visits per person per year. These and other

estimates presented in this report are based on data collected in the 1981 National Ambulatory Medical Care

Survey, a probability sample survey conducted annually

through 1981 by the Division of Health Care Statistics

of the National Center for Health Statistics. The physician sampIe for the National Ambulatory Medical Care

Survey (NAMCS) is selected, with the cooperation of

the American Medical Association and the American

Osteopathic Association, from a list of nonfederally

employed physicians who are principally engaged in

office-based practice. Physicians practicing in Alaska

and Hawaii, and physicians in the specialties of anesthesiology, pathology, and radiology are excluded from

the survey.

This report provides an overview of the data from

the 1981 NAMCS. Utilization of office-based ambulatory medicaI care services is described in terms of the

number and percent of ofilce visits and of annual visit

rates. Utilization statistics are presented on patient,

physician, and visit characteristics as foIlow~

Table 1 Patient age and sex

Table 2 Patient race and ethnicity

Table 3 Physician specialty and type of

practice

Tables 4 and 5 Principal reason for visit as expressed by the patient

Table 6 Major reason forvisi~ prior visit

status, and referral status

Table 7 Diagnostic services ordered or

provided

Tables 8 and 9 Principal diagnosis rendered by

the physician

Tables 10 and 11 Medication therapy ordered or

provided

Table 12 Non-medication therapy

Table 13 Disposition and duration of visit

Since the estimates presented in this report are based

on a sample rather than on the entire universe of ofiice

visits, the data are subject to sampling variability. The

technicaI notes at the end of this report provide a brief

description of the sample design, an explanation of

sampling errors, and guidelines forjudging the precision

of the estimates. A more detailed description of the

NAMCS sample design and survey methodology has

ben published.]

Figure 1 is a facsimile of the 1981 NAMCS Patient

Record used by participating physicians to record information about their office visits. The Patient Record can

be a usefid reference as survey findings are reviewed.

Data highlights

Patient characteristics

Ofilce visit data according to patient demographic

characteristics are presented in tables 1 and 2. As shown

in table 1, the annual visit rate for 1981 varied from

about 2.0 visits per person per year for the age groups

under 25 years to 4.3 visits per person per year for the

65 years and over age group. Females accounted for

about 60 percent of ail visits. The annual visit rate for

females (3.1 visits per person per year) was higher than

the visit rate for males (2. 1 visits per person per year).

White persons (85.7 percent of the civilian noninstitutionalized population) accounted for 89 percent of all

office visits (table 2). As also shown in table 2.persons

of Hispanic origin accounted for approximately 4 percent of all visits. These data are essentially unchanged

since 1975.

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

Oem, tmmtd M-,,. Edvc.l ,0. .“1 w.11...

Publ!cH“.’, * S.r.!cr

011,., 01 n?.,,. flea,,. s,.,,,,,., ●ml Te”m,cq, I

CNO.499932

N.,,..., cent.. Iw Hm#,” S!,,.,,8C%

1. DATE OF Vl~

/

/ /

M.”, . 0,, Yal

T

+

0,, Y“r

::::LE

I

7. MAJOR REASON FOR THIS

VISIT [Check one/

1❑ ACUTE PROBLEM

2❑ CHRONIC PR08LEM, ROUTINE

3❑ cHRoNIc PROBLEM. FLARE”p

J @STS”RGEfWOS71WJRY

—

s ❑ NoN.l LLNEss CARE IROUTINE

PRENATAL. GENERAL EXAM

WELL BABY. ETC )

10, HAVE YOU SEEN

PATIENT BEFORE?

IF Y&. FOR THE

CONOITION IN

ITEM 9.7

PATlENT RECORD

NATIONAL AM BUIATORY MEDICAL CARE SURVEY

4. COLOR OR RACE 50 ETHNICITY

1❑ WH,TE

2 ❑ EILACK I ❑ HISPANIC

ORIGIN

3 ❑ .4SIAN,PAC!F,C

,SLANOER , DN::PAN,C

. ❑ AMERICAN INDIAN,

ALASKAN NATIVE

& DIAGNOSTIC SERVICES THIS VISIT

[Check all ordered or provided/

L ❑ NONE a ❑ EKG

2 ❑ L,M,TEO H,STOR”,EX.4M 9 ❑ “ISION TEST.

3 BGENERAL HISTORY,EXAM ,0 HENOOSCOPY

. ❑PAP TEsT ,, Q M:fENT;LSTATUS

5 UCLINIcAL LA8TEST

6 ❑ KRA,

,2 ~OTHER(SP.cIfIJ

7 /JBL000PF7ESSLIRE CHECK

6. PATI ENT’S COMPLAINT(S), SYMPTOM(S). OR OTHER

REASON(S) FOR ~vISIT /In parwtrk own words/

a MOST IMPORTANT

b OTHER

9. PHYSICIAN’S DIAGNOSES

PRINCIPAL DIAGNOSIS PROBLEM ASSOCIATED WITH ITEM Sa

CITHER SIGNIFICANT CURRENT DIAGNOSES

110 MEDICATION THERAPY THIS VISIT ❑ NONE

f U31nK brand or generrc names, record all ncw and continued rrwdica tions ordered. in!ecred. admit! mrcred. or orherwise

provtded at rhis VMI, !“clude ,nrnruntzfn# and desensi ti:ing agentsl

a. FOR PRINCIPAL OIAGNOSES IN lTEM9a b. FOR ALL OTHER REASONS

1 1

2. 2.

3. 3.

4 4.

12. NON-MEDICATION THERAPY

[Check all services urdewd or provtded rhn visit]

i ❑ NONE 6❑ DIET COUNSELING

2 lJpI.4YS10THERAPY 7❑ FAMILY60c,AL

3 DOFFICE SURGERY

COUNSELING

4❑ FAMILY PLANNING

a❑ MEDIc.4Lc0uNsELlNG

5❑ PSYCI.IOT14ERAPY,

9 QOTHER ,s,.,,,,,

THERAPEUTIC LISTENING

13. WAS PATlENT

REFERRED

FOR THIS VISIT

BY A~HER

PHYSICIAN?

,n YES

, ❑ NO FOLLOW UP PLANNEO

2 QRET.RN. T SPECIFIED TIME

3❑ RE7URN IF NEEDh3.PR N

4 ❑ TELEPHONE FOLLOW ”PPIANNED

50 REFERRE0 TO OTHER PHYSICIAN

6 ❑ RET”RNGDTOREFE*RING PHYSICIAN

7 QAOA+ITTO HOSPITAL

s ❑ OTHER,SF,<,,W

15mDURATION

OF THIS

VISIT

f Time wniallv

spent wirlf

p!l txl’ ,8,), \

Mm., e,

‘HS-61 OK (9/79)

Figure 1. 1981 National Ambulatow Medical Care Survey Patient Record

OMS No. 68-R149E3

Physician characteristics

Among office-based physicians, general and family

practitioners led all other specialties in volume ofoflice

visits, accounting for about 32 percent of all office visits

made during 1981 (table 3). The general and family

physicians’ share of visits, however, continues its steady

decline since 1975, when they accounted for 41.3 percent of visits. The distribution of visits by the physician’s

type of practice shows that 55 percent of all visits were

made to solo practitioners and 45 percent were made to

physicians engaged in multiple member practice.

Visit characteristics

Reason for visit. —Data in tables 4 and 5 represent

the principal reason for visiting the physician’s ofllce as

expressed in the patient’s own words. The principal

reason for visit is the problem, complaint, or reason

listed first in item 6 of the Patient Record. These data

have been classified and coded according to the Reason

for Visit Classzjication forAmbulato~ Care (IWC)2.

The RVC is divided into 8 modules or groups of reasons,

as shown in table 4. Reasons for visit classified as

“symptoms” (symptom module) accounted for over
dwlcdaa3

Table 1. Number, percent distribution. and annual rate of office visits by

sex and age of patient: United States. 1981

Table 3. Number and percent dtstnbut!on of office via!ts by

physician specialty and type of pracnce United States, 1981

Phystc]an spemalty and

Number of

Percent

type of practice

visits in

disrribul!on

thousands

Number of Percent

Number of

Sex and age visits in distribution

wsits per

thousands of wsirs

person

per year~

Allvisvt s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PhysicIan spec!alty

General and family pract!ce . . . . . . . . . . . . . . .

Medicai spec!alt!es . . . . . . . . . . . . . . . . . . . . . .

Internal medtcme . . . . . . . . . . . . . . . . . . . .

Pediatric s . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Surgicai specialties . . . . . . . . . . . . . . . . . . . . . .

General surgery . . . . . . . . . . . . . . . . . . . . .

Obstetrics and gynecology. . . . . . . . . . . .

Other . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .

Other spectalttes . . . . . . . . . . . . . . . . . . . . . . . .

Psychtat~ . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Type of practice

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

Partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

585.177 100.0

Both sexes

Alleges . . . . . . . . . . . . . . . . . . .

Under 15 yeara . . . . . . . . . . . . .

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

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

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

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

Female

Alleges . . . . . . . . . . . . . . . . . . .

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

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

25-44 yeara . . . . . . . . . . . . . . .

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

65 years And over . . . . . . . . . . .

Male

Alleges . . . . . . . . . . . . . . . . . . .

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

15-24 yeare . . . . . . . . . . . . . . .

25-44 yaars . . . . . . . . . . . . . . .

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

65 years And over . . . . . . . . . . .

585,177

106,773

79.234

155,689

136,055

107,426

100.0

18.3

13.5

26.6

23.3

18.4

2.6

2.1

2.0

2.4

3.1

4.3

32;5

31.3

12.s

11.0

7.5

31.4

5.6

9.2

16.6

4.8

2.7

2.1

189,966

183,136

74.691

64.539

43.906

183,635

32,697

53.912

97,026

28.440

15,954

12,486

353,612

52,130

52.397

102,833

80,646

65,606

60.4

8.9

9.0

17.6

13.8

11.2

3.1

2.1

2.6

3.1

3.5

4.5

321.688

110,330

153,159

55.0

16.9

26.2 231.565

54,643

26.837

52.856

55,408

41 .B20

39.6

9.3

4.6

9.0

9.5

7.1

2.1

2.1

1.3

1.7

2.7

4.1

1 ,nc,”de~ group practice and other

visit data from the 1977-78 NAMC S are in Vital and

Health Statistics, Series 13, Number 56.s

Table 6 shows the number and percent distribution

of ofilce visits by the physician’s determination of major

reason for visit, patient’s prior visit status, and referral

status.

Major reason for visit. —In item 7 of the Patient

Record, the physician was instructed to check the one

major reason forthe patient’s office visit. Approximately

equal proportions of visits were made for acute problems

and chronic problems (37 percent).

Prior visit status. —Approximately 86 percent of

the visits to office-based physicians were by patients

who had seen the physician before (“old” patients).

Furthermore, the majority of visits (64 percent) were

made by “old” patients with an “old” problem, i.e.,

problems which had previously been treated by the

physician. .

Referral status. —Approximately 5 percent of all

visits were the result of referrals from another physician.

However, about 27 percent of all “new” patient visits

were referrals.

Diagnostic services. —Information on various diagnostic services that may be ordered or provided during

an ofllce visit is presented in table 7. A limited history or

examination was rendered at 65 percent of alI visits.

The procedures ordered or provided most often were

blood pressure checks (35 percent) and cIinical laboratory tests (22 percent). Although a Pap test was ordered

or provided during about 4 percent of all visits, this represents about 7 percent of the visits by women.

Principal diagnosis. —Tables 8 and 9 present data

on the principal diagnosis rendered by the physician.

1 Rat=s are b.~ed O“ ~~,lmates of themwlian nomnsmmonalmed POPUlatBOn of the united

States, excluding Alaska and Hawaii. as of July 1.1981.

Table 2. Number and percent distribution of office visits by race and

ethnicity of patiant United States, 1981

Number of

Percent

visits in

distribution

thousands

Race and ethnicity

Allvk.its . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 585.177 100.0

Rata

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

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

Black. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Asian or Pacific Islander. . . . . . . . . . . . . .

American Indian or Alaskan Native . . . . .

520,974

64,203

57.674

5,517

1.012

89.0

11.0

9.9

0.9

0.2

Ethnicity

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Not Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . .

24,617

560,560

4.2

95.8

half of all visits, with symptoms of the respiratory and

musculoskeletal systems accounting for about 19 percent of aIl visits. The 20 most common specific principal

reasons for visit are listed in table 5. The reader is

cautioned that the rankings presented in table 5 may be

somewhat artificial because some estimates may not be

statistically different from other near estimates due to

sampIing variability. Detailed tabulations of reason for
Table 4. Number and percent dtstrlbutlon of office vls!ts by pat!ent”s pnnc!pal reason for wstt U,nned States, 1981

Prlnc)pal reason for vtsIt and RVC code 1

Number of

Percent

Number of

wws (n Prmctpal reason for wsrf and RVC code 1

Percent

dwtrtbuflon

Vfslfs In

thousands

distribuuon

thousands

Allvls!ts .,....... 585,177

314,524

43,083

13,886

18,106

3.173

100.0 Symptom module—Con,

Symptoms referable to the genltounna~

system. . . . ., . . .. S640-S829

Symptoms referable to the skin, nads,

and ha fir. . . . . . . . . . . . . . . . S830–S899

Symptoms referable to the musculoskeleral

system . . . . . . . . . . . . . . .. S900-S999

D!sease module . . . . . . . . . . . . . . .. DOOl-D999

Dlagnost#c, screening, and preventwe

module . . . . . . . . . . . . . . . . . . . . . X1 OO-X599

Treatment module . . . . . . . . . . . . . . TIOO-T899

Injuries and adverse effects

module . . . . . . . . . . . . . . . . . . . .. JOO1-J999

Test results module. . . . . . . . . . . . . R1OO-R7OO

Admlntstrative module. . . . . . . . . . . A1OO-A14O

Othe# . . . . . . . . . . . . . . . . . . . . . .. U99O-U999

Symptom module. . . S001 -S999

General symptoms. S001-S099

Symptoms referable to psychological and

mental dmorders . S1OO-S199

Symptoms referable to nervous system

(excludlng sense organs). S200-S259

Symptoms referable to the cardiovascular

and Iymphatlc systems . S260-S299

Symptoms referable to the eyes and

ears . . . . . . . . . . . . . . . . . . . S300-S399

Symptoms referable to the respiratory

system . . . . . . . . . .. S499. .S4OO-S499

Symptoms referable to the dlgestwe

system . . . . . . . . . . . . . . . . ,S500-S639

53.8

7.4

27,507 4.7

34.117 5.8

2.4

59,047

51,202

10.1

3.1 8.8

0.5 113,246

61,829

19.4

10.6

32,562

64,528

28,516

5,6

23,849

3,543

8,667

8,316

4.1

0.6

1.5

1.4

9.3

4.9

1 Based on A Reason for VIWt Cla$s,f,cat!o” for Ambulato~ Care,’” Vita/ and Hea/rh StatlSOcS %,les 2-No. 78. Feb. 1979.

2!nclu,je~ bla”k~, proble~~ and ~ompIa, nts not elsewhere clams!hed, entnes of “none.” and ,l@alble enmes.

Table 5. Number and percent of office visits by rhe 20 most common

principal reasons for vislr United States, 1981

Table 6. Number and percent distribution of office visits by patients’ malor

reason for visit, prior ws!t status, and referral status United States, 1981

Most common princ!pal reason for

Number of

Rank visits in Percent wsit and RVC code 1

thousands

Number of

Percent

visits m

distribution

thousands

Vis/t characrer!stic

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

General medical examination . . . . . Xl 00

Prenatal examination. . . . . . . . . . . X205

Postoperative vlslt . . . . . . . . . . . . . T205

Symptoms referable to the throat. . . S455

Progress vmit not otherwise

specified . . . . . . . . . . . . . . . . . . .. T800

Well-baby examination . . . . . . . . . X105

Cough . . . . . . . . . . . . . . . . . . . . . . .. S44O

Blood pressure test . . . . . . . . . . . . . X320

Back symptoms . . . . . . . . . . . . . . . .S905

Head cold, upper respiratory

infection . . . . . . . . . . . . . . . . . . . . S445

Fever . . . . . . . . . . . . . . . . . . . . . . . . .S010

Skin rash . . . . . . . . . . . . . . . . . . . . . .S860

Earache. or ear Infection . . . . . . . . . S355

Headache, pain !n head. . . . . . . . . . S21O

Chest patn and related

symptoms . . . . . . . . . . . . . . . . . .. S050

Abdominal pain, cramps, spasms. . . S550

Eyeexamlnatlon . . . . . . . . . . . . . . . .X230

Hypertension . . . . . . . . . . . . . . . . . . D51O

Knee symptoms . . . . . . . . . . . . . . .. S925

Vlslon dysfutrctlons . . . . . . . . . . . . . S305

All other reasons, . . . . . . . . . . . .. . . . .

30,222

23,501

18,077

15,098

14,864

12,922

12,783

10,662

10,318

9,185

9,160

8,882

8,745

8,436

8,368

8,240

7,790

7,531

7,102

6,834

346,463

5.2

4.0

3.1

2.6

2.5

2.2

2,2

1,8

1.8

1.6

1.6

1.5

1.5

1.4

1.4

1.4

1.3

1.3

1.2

1.2

59.2

Allwsms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major reason for visit

Acute problem . . . . . . . . . . . . . . . . . . . . . . . . . .

Chronic problem, rout!ne . . . . . . . . . . . . . . . . .

Chronic problem, flareup. . . . . . . . . . . . . . . . . .

Postsurgery orpostmp~ . . . . . . . . . . . . . . . . .

Nonllfness carel . . . . . . . . . . . . . . . . . . . . . . . .

Prior vistt status

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

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

Naw problem . . . . . . . . . . . . . . . . . . . . . . .

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

Referral status

Referred by another phystclan . . . . . . . . . . . . .

Not referred by another physician . . . . . . . . . .

585,177 100.0

213,794

163,715

53,691

51,624

102,352

36.5

28.0

92

8.8

17.5

81,156

504,021

128,484

375.537

13.9

86.1

22.0

64.2

26,022

559,155

4.5

95.6

1 I“cl”des, for eXamPIe. mutme prenatal care. general exammatmn. and well-babv

exam matmn,

1 Based on “A Reason for Vm!t Class, f,cst!on for Ambulatory Cam” (RVC) Vita/8ndHea/rh

.StatIsrms, Series 2-No. 78. Feb. 1979. examinations, accounted for the largest proportion of

visits (17 percent), with diseases of the respiratory system accounting for the second largest proporticm (13

percent). The 20 most common three-digitlCD-9-CM

categories are presented in table 9. The presence of severai large categories from the Supplementary Classification is evident. As in table 5, these rankings ma:yvary

somewhat due to sampling variability.

Medication therapy. —In item 11 of the Patient

Record, the physician was asked to record, using brand

or generic names. all new or continued medications

The principal diagnosis refers to the first-listed diagnosis

in item 9 on the Patient Record, the one associated with

the patient’s presenting problem. The International

Classification of Diseases-9-Clinical Modification

(ICD-9-CM)4 was used to classify these data. The

Supplementary Classification of the ICD-9-CM, which

contains categories for entries other than diseases and

injuries, e.g., general medical and normal pregnancy
Table 7. Number and percent of office visits by diagnostic service

ordered or provided: United States. 1981

Number of

Diagnostic service visits in Percent

tfrousarrds

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

Limtted hiato!y/exam . . . . . . . . . . . . . . . . . . . . . . . .

General history fexam . . . . . . . . . . . . . . . . . . . . . . .

Pap test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

x-ray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Electrocardiogram . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Endoscopy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental status exam . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

47,056

379,544

88.570

25,154

129.123

44,813

202,159

18,457

33,875

5.656

7.861

28,045

8.0

64.9

15.1

4.3

22.1

7.7

34.6

3.2

5.8

1.0

1.3

4.8

Table 8. Number and percent distribution of office visits by

principal diagnosis United States, 1981

Number of

Principal diagnosis and ICD-9-CM code~ Percent

visits in

distribution

thousands

All diagnoses. . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious and parasitic diseases . ..001-139

Neoplasms . . . . . . . . . . . . . . . . . . . ..14(J_23g

Endocrine, nutntional, and metabolic diseases

and iI?ImUni~ disorders. . . . . . . . . 240_27g

Mental disordera .

. . . . . . . . . . . . ...290-319

Diseases of the nervous system and sense

organs . . . . . . . . . . . . . . . . . . . . ...320-389

Diseases of thecwculato~system. .. 390-459

Diseases of the respirato~system. .. 460-519

Diseases of the digestive system. .. 520-579

Diseases of the genitourinary

System . . . . . . . . . . . . . . . . . . . ...580-629

Dkeases of the skin and subcutaneous

tlSSIJe . . . . . . . . . . . . . . . . . . . . ...680-709

Diseases of the musculoskeletal system

and connectwe tissue , . . . . . . ...710-739

Symptoms, signs, and ill-defined

conditions . . . . . . . . . . . . . . . . ...780-799

kIJUry and poisoning . . . . . . . . . . . . . 80&99g

Supplementary classification . . . . . . VQ1-V82

Another dlagnoses2 . . . . . . . . . . . . . . . . . . . . .

Unknown diagnoses3 . . . . . . . . . . . . . . . . . . . . .

585,177

18,086

14.687

21,205

23,281

56.980

58.654

73,128

25,659

35,568

33,207

42,367

19,506

48,536

100.348

7.670

6,294

100.0

3.1

2.5

3.6

4.0

9.7

10.0

12.5

4.4

6.1

5.7

7.2

3.3

8.3

17.2

1.3

1.1

~ Ba=~ on the International classtficat!on of Diseases. 9th ffevtsion, Clinical Modificatmn (ICD-9-CM).

21n~lUde~ dlsea~e~ of the blood and blood-fonntng organs (280-289): COMPlicatlons Of

pregnancy, ch!ldbmh, and the puerpenum (630-676}; congemtd anomahes (740-759];

and certain condmons ongmanng m the pennatal period (760-779),

31”cjudes blank dmgnoals, noncodable dtagnosls, and dlegtble dlagnOsls.

ordered, injected, administered, or otherwise provided

at this visit, including immunization and desensitizing

agents. The physician was instructed to list drugs prescribed for the principal diagnosis in item 11a and all

other drugs prescribed at that visit in item 11b. As used

in the NAMCS, the term dmg is interchangeable with

the term medication, and the termprescribing is used in

the broad sense to mean the ordering or providing of any

medication, either prescription or nonprescription.

Table 9. Number and percent of office vIsIts by the 20 most common

princtpal diagnoses: Unned States, 1981

Most common pnncrpal diagnows

Number of

Rank vswfs in Percent

and ICD-9-CM code 1

thousands

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Essential hypertension. . . . . . . . . .. 401

Normal pregnancy . . . . . . . . . . . . . ..V22

Health supervision of infant orchild . . . V20

Acute upper resplrato~ Infecnons

of multiple or unspecified sites. . 465

General medical examlnat!on . . . . . . v70

Suppuratnre and unspecified otms

media . . . . . . . . . . . . . . . . . . . . ...382

Diabetes mellitus . . . . . . . . . . . . . . ..25o

Spec!al mvestlgations and

examtnanons . . . . . . . . . . . . . . . . . V72

Followup examinations ., . . . . . . . . V67

Dlseasea of sebaceous glands . . ...706

Neurotic disordera . . . . . . . . . . . . . ..3oo

Acute pha~ngitis, . . . . . . . . . . . . . .. 462

Allergic rhimtis . . . . . . . . . . . . . . . ...477

Disorders of refraction and

accommodation . . . . . . . . . . . . ...367

Eronchins, not specified as acute

or chronic . . . . . . . . . . . . ., . . . . ..49o

Other forms of chronic lschemic

heart disease . . . . . . . . . . . . . . . .. 414

Osteoanhrosis and allied

disorders . . . . . . . . . . . . . . . . . . . .. 715

Contact dermatms and other

eczema . . . . . . . . . . . . . . . . . . . ...692

Acute tonsillltls, . . . . . . . . . . . . ... .463

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

Another diagnoses . . . . . . . . . . . . . . . . . .

28.765

25,051

18,583

14,853

14,132

13.106

10.772

10,548

10,207

9,661

9.590

8,473

8.441

8,216

6,731

6,498

5,691

5,228

5,148

5.024

360,460

4.9

4,3

3.2

2.5

2.4

2.2

1.8

1.8

1.7

1.7

1.6

1.4

1,4

1.4

1.2

1.1

1,0

0.9

0.9

0.9

61.6

1 sa~e,j on /nrernatjonal C/ass, ficarjon of Diseases. 9th Rewsmn, Clinfcd Mdlfhmfl

(ICO-9-CM}.

The NAMCS drug database permits classification

by such variables as specific product name: generic

cIass; entry form chosen by the physician, i.e., brand

name, generic name, or therapeutic effect desired: prescription status, i.e., prescription (R) or nonprescription (OTC); Federally controlled substance status (for

addicting or habituating drugs): composition status, i.e..

single or multiple ingredient; and therapeutic category.

A report describing the method and instruments used to

collect and process drug information for the NAMCS

has been published.s

Data on the provision of medication by office-based

physicians are highlighted in tables 10 and 11. Data on

drug visits, that is, visits at which at least one medication

was prescribed, are presented in table 10. Approximately 61 percent of all ofllce visits resulted in the use of

a drug, chiefly for therapy, but also as a diagnostic or

preventive agent. The percent of drug visits ranged from

35 percent for other surgical specialists to76 percent for

internists.

Data on the number and percent of drug mentions,

that is, the total number of medications listed in items

11a and 1lb (figure 1), are presented in tables 10 and

11. As shown in table 10, there were 651.2 million drug

mentions in 1981, an average of 1.1 drug mentions for
6

Table 10. Number and percent distribution of drug wslts and drug mentions by physician spec!alty Un!ted States, 1981

Physician spec]alty

Number of Number of

dmg Percent drug Percent

Percent

visits m distribution menttons in distribution

of drug

VLSLS2

thousands 1 thousands

Allspecialtles . . . . . . . . . . . . . . . . . . . . . . . . . . . ,., ., . . . . . . . . . . . .

General and famllypractme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical specialties, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Pediatrics, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., .,,,..

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Surgical apecialtles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Obatetr!cs and gynecology’ .,....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

354,285

136.623

136.735

56,708

46,925

33.102

68,590

13,318

21.385

33,888

12.337

5,813

6,525

100.0

38.6

38.6

16.0

13.2

9.3

19.4

3.8

6.0

9.6

3.5

1.6

1.8

651,153

252,880

276,489

132.427

73,690

70,372

100,759

22,179

28,179

50.402

21,025

9,351

11,674

100.0

38.8

42.5

20.3

11.3

10.8

15.5

3.4

4.3

7.7

3.2

1.4

1.8

60.5

71.9

74.7

75.9

72.7

75.4

37.4

40.7

39.7

34.9

43.4

36.4

52.3

1Those visatsat which one or mors drugs were prescribed.

2Number of dmg “8S,tSdiv,ded by number of office VLWISmuitnpl)ed by 100.

Table 11. Number and percent distribution of dmg mentions by therapeutic categories United States, 1981

therapeutic categories

Number of Number of

drug Percent

mermons in distribution

Therapeutic categories

drug Percent

mentions in distribution

thousands thousands

Allcategoties . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antihistamine drugs . . . . . . . . . . . . . . . . . . . . . .

Anti-infective agents . . . . . . . . . . . . . . . . . . . . .

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

Antineoplastic agents . . . . . . . . . . . . . . . . . . . .

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

8100d formation and coagulation . . . . . . . . . . .

Cardiovascular drugs . . . . . . . . . . . . . . . . . . . . .

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

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

Vasodilating agents . . . . . . . . . . . . . . . . . .

Central nervous system drugs . . . . . . . . . . . . . .

Analgesics and antipyretics. . . . . . . . . . . .

Psychotherapeutic agents . . . . . . . . . . . . .

Sedatives and hypnotics . . . . . . . . . . . . . . .

651.153

43,511

104,804

89,209

4,019

24,102

8.020

68,779

30,184

24,263

13,730

104,391

58,841

15,140

23,012

100.0

6.7

16.1

13.7

0.6

3.7

1.2

10.6

4.6

3.7

2.1

16.0

9.0

2.3

3.5

Electrolytic, caloric, and water balance . . . . . .

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

Expectorants and cough preparations. . . . . . . .

Eye, ear, nose, and throat preparations . . . . . .

Gastrointestinal digs . . . . . . . . . . . . . . . . . . . .

Hormones and synthetic substances . . . . . . . .

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

Serums, toxoids, and vaccines . . . . . . . . . . . . .

Skin and mucous membrane preparations . . . .

Spasmolytic agents . . . . . . . . . . . . . . . . . . . . . .

Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other therapeutic agents, pharmaceutics devices

and aids . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Therapeutic category undetermined . . . . . . . . .

55.277

45,239

17,864

23,546

24,196

53,999

20,731

22,068

49,026

10,654

20.507

11,553

4,840

8.5

6.9

2.7

3.6

3.7

8.3

3.2

3.4

7.5

1.6

3.1

1.8

0.7

1 Bawd on the pharmacologic-therapeutic ctasafificatton of the Amencm Smxety of Hospntd Ph.wnwasts, selested categories reproduced wth the perrnusmn of the Soctely.

every ofilce visitor 1.8 mentions for every visit at which

one or more medications were prescribed. Three physician specialties—general and family practice, internal

medicine, and pediatrics— accounted for 70 percent of

all drug mentions. The distribution of drug mentions by

therapeutic category is shown in table 11. Anti-infective

agents and central nervous system drugs were the leading therapeutic categories, accounting for 32 percent of

all drug mentions. Of the drug mentions for anti-infective

agents, 85 percent were for antibiotics.

Non-medication therapy. —Table 12 presents data

on various types of non-medication therapy that maybe

ordered or provided during an ofllce visit. OffIce surgery

was ordered or performed at about 7 percent of all visits.

Table 12. Number and percent of ofYice wsits by non-medication

therapy ordered or prov!ded United States. 1981

Number of

Non-medication therapy visits in Percent

thousands

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

Physiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Office surgew . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychotherapy/therapeutic listening . . . . . . .

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

Famdy/social counseling . . . . . . . . . . . . . . . . . . . .

Med!cal counseling . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

322,019

26,743

42.844

11,399

28.038

44,692

11,068

133,648

13.444

55:0

4.6

7.3

2.0

4.8

7.6

1.9

22.8

2.3
Disposition of visit. —Data on disposition show

that the majority of office visits involved some type of

scheduled followup. At about 65 percent of the visits a

return visit or telephone followup was planned (table 13).

Approximately 2 percent of the office visits ended in

hospital admission.

Duration of visit. —Duration of visit is that amount

of time spent in face-t-face contact between physician

and patient. It does not include time spent waiting to see

the physician, time spent receiving care from someone

other than the physician without the presence of the

physician, or time spent reviewing records, test results,

etc. In cases where the patient received care from a

member of the physician’s staff, but did not see the

physician during the visit, the duration of visit was

recorded as zero minutes. Some 73 percent of the visits

had a duration of 15 minutes or less (table 13).

More detailed 1981 NAMCS data are forthcoming

in the Vital and Health Statistics series. Questions

regarding this report, future reports, or the NAMCS

may be directed to the Ambulatory Care Statistics Branch

by calling (301) 436-7132.

Table 13. Number and percent dmtnbution of office vmts by

disposition and duratton of visit Untted States, 1981

Number of

Disposition and durarton

Percent

vis)ts in

distrtbut!on

thousands

Dispositjonl

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

Return atspecified time . . . . . . . . . . . . . . . . . .

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

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

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

Returned to referring physician . . . . . . . . . . . .

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

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Duration

O minutesz. . .. ---- . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

31minutes ormOre . . . . . . . . . . . . . . . . . . . . . .

65,970

357,694

131,996

20.059

14.735

4.670

13,699

1,205

16,164

74,471

173,441

165,206

121,047

34,847

113

61.1

Zz.b

3.4

2.5

0.8

2.3

0.2

2.8

12.7

29.6

28.2

20.7

6.0

1May “Ot add to t 00.o since more than one d!sposwon was Pm=.lble.

2 RepmSentS ~fice wsits m which there was no face-m-face COWdCt between the Patient

and the physician.

References

lNational Center for Health Statistics, R Gagnon, J. DeLozier, Statistics. Series 13-No. 56. DHEW Pub. No. (PHS) 82-1717.

and T. McLemore: The National Ambulatory Medical Care Survey, Public Health Service. Washington. U.S. Government Printing

1979 summary. Vital and Health Statistics. Series 13-No. 66. Oflice, Dec. 1981.

DHHS Pub. No. (PHS) 82-1727. Public Herdth Service. Washing- 4Commissionon Professional and Hospital Activities International

ton. U.S. Government Printing Office, Sept. 1982. C1asst~cation of Diseases, 9th Revision, Clinical Modt~cation

‘National Center for Health Statistics, D. Schneider, L. Appleton, AM Arbor. Edwards Brothesx, Inc., 1978.

and T. McLemore A reason for visit classification for ambulatory 5Nationa1 Center for Health Statistics, H. Koch The collection and

care. Vitaf and Health Statistics. Series 2-No. 78. DHEW Pub.

No. (PHS) 79-1352. Public Health Service. Washington. U.S,

processing of drug information National Ambulatory Medical

Government Printing Oftice, Feb. 1979.

Care Survey, United States, 1980. Vifal and Health Statistics.

Series 2, No. 90. DHHS Pub. No. (PHS) 82-1364. Public Health

3National Center for Health Statistics, B. Cypress: Patients’ rea- Service. Washington. U.S. Government Printing Office, March

sons for physician visits, NAMCS, U.S. 1977-78. Vital and Heahh 1982.
8 acwncedata

Technical notes

Source of data and sample design

The information presented in this report is based on

data collected in the National Ambulatory Medical

Care Survey (NAMCS) during 1981. The target universe of NAMCS includes office visits made within the

conterminous United States by ambulatory patients to

nonfederally employed physicians who are principally

engaged in office practice, but not in the specialties of

anesthesiology, pathology, or radiology. Telephone contacts and nonofflce visits are excluded.

NAMCS utilizes a multistage probability sample

design that involves samples of primary sampling units

(PSU’S), physicians’ practices within PSU’S, and patient visits within physician practices. For 1981 a sample of 2,846 non-Federal, office-based physicians was

selected from master files maintained by the American

Medical Association and the American Osteopathic

Association. The physician response rate for 1981 was

77.5 percent. Sampled physicians were asked to complete Patient Records (figure 1) for a systematic random

sample of ofilce visits taking place during a randomly

assigned weekly reporting period. During 1981, responding physicians completed 43,366 Patient Records. 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 survey’s field operations.

For a more detailed discussion of the limitations,

qualifications, and definitions of the data collected in

the NAMCS, see Vital and Health Statistics, Series

13, Number 66.1

Estimates presented in this report differ from the

estimates reported in the National Medical Care Utilization and Expenditure Survey (NMCUES), another

program of the National Center for Health Statistics

(NCHS). The variation in estimates is due to differences

in survey populations, data collection methodology,

and definitions. The NMCUES, cosponsored by NCHS

and the Health Care Financing Administration (HCFA),

is a national panel survey of households that collected

information on visits to physicians’ offices and hospital

outpatient departments.

Sampling errors and roundings of numbers

The standard error is primarily a measure of the

sampling variability that occurs by chance because only

a sample, rather than an entire universe, is surveyed.

The relative standard error of an estimate is obtained by

NOTE: A list of references follows the text.

dividing the standard error by the estimate itself and is

expressed as a percent of the estimate. Approximate

relative standard errors of selected aggregate statistics

are shown in tables I and II. Standard errors for percents

of visits and standard errors for estimates of drug mentions will be included in future reports.

Table 1. Provisional relative standard errors of estimated number of

office vi.mts based on all phystcian specialties NAMCS, 1981

Relative

Esrimated number of office standard

visits in thousands error in

percent

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.3

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.5

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.1

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.4

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.9

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

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

550,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1

Ex.mrp/e of use otfabk An aggregateof 35,000.000 %wtshss a reladvs standard error of

5.4 percsnt or a standard error of 1,890.000 vIsIts (5.4 percent of 35,000,000).

Table Il. Provisional relatwe standard errors of estimated number of

office visits based on an individual physician specialty: NAMCS, 1981

Relative

Estimated number of office st;mdard

visits in thousands eiror in

percent

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

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.3

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.1

5.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.8

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.0

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.9

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1

100.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.9

Example of use of table: An aggregate of 7,5CQ,000 visits has a relatwe standard error of

9.9 percent or a standard error of 742.500 ws:ts (9.9 percent of 7,500.000).

Estimates of office visits have been rounded to the

nearest thousand. For this reason detailed figures within

tables do not always add to totals. Rates and percents

were calculated on the basis of original, unrounded

figures and will not necessarily agree precisely with

percents calculated from rounded data.

Definitions

Andndatorypafient. —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.
Ph.~sician. —A physician is a duly licensed doctor

of medicine (M. D.) or doctor of osteopathy (D. O.) currently in office-based practice who spends time in caring

for ambulatory patients. Excluded from NAMCS are

physicians who are hospital based physicians who specialize in anesthesiology, pathology, or radiology; physicians who are Federally employed, physicians who

treat only institutionalized patient.y physicians employed

full time by an institutio~ and physicians who spend no

time seeing ambulatory patients.

Ofice —An office is a place that the physician

identifies as a location for his ambulatory practice.

Responsibility over time for patient care and professional semices rendered there generally resides with

the individual physician rather than an institution.

Visit.—A visit is a direct personal exchange between

an ambulatory patient and a physician or a staff member

working under the physician’s supervision, for the purpose of seeking care and rendering health services.
From Vital and Health Statistics of the National Center for Health Statistics Number 89 ● April 15, 1983

Drugs Most Frequently Used in Wlce Practice

National Ambulatory Medical Care Survey, 1981

by Hugo Koch, Division of Health Care Statistics

This report offers descriptive data about the drugs

utilized in ofilce practice in the calendar year 1981,

highlighting those pharmaceutical agents that were most

frequently ordered or provided. The data, based on the

findings of the National Ambulatory Medical Care Survey (NAMC S), were produced by a representative sample of the Nation’s physicians who are primarily engaged

in office-based, patient-care practice. Non-Federal doctors of medicine and osteopathy in all states except

Alaska and Hawaii participated by completing records

(figure 1, Patient Record) on a sample of their office

visits over a weekly reporting period.

Item 11 ofthe Patient Record (figure 1) requires that

the respondents report the names of the specific drugs

that they “utilized” (that is, ordered or provided) in the

course oftheir ofilce visits. This resulted in an estimated

651,153,000 drug mentions. All routes of administration

were allowed, and the mentions included immunizing

and desensitizing agents, and nonprescription as well as

prescription drugs. The physician recorded all new drugs

and continued medications when the patient was specifically instructed during the visit to continue the medication. Drugs ordered through telephone contact were not

included.

Because the estimates presented here are based on a

sample rather than on the entire universe of ofilce visits,

the data are subject to sampling variability. Because of

problems with statistical significance, the data user

should avoid too literal an acceptance of closely ranked

estimates. The technical notes at the end of this report

provide a brief explanation of the sampling errors and

guidelines for judging the precision of estimates. All

subsequent references to drug mentions should be interpreted as estimated drug mentions, based on the sample

of oi%ce-based physicians used in this study.

The 100 drug entries that respondents most fi-equently

recorded are listed in rank order in table 1. The listing is

arbitrarily restricted to the drugs that were specifically

named-either by brandl or by generic name. This led

to the exclusion oftwo entry choices that did not identify

a specific agen~ indicating only the therapeutic effect

desired. These two therapeutic effects were

● Alle~ relie~orshots(m~cified), with 10,833,000

mentions.

● Vitamin(s) (unspecified), with 1,520,000 mentions.

The 100 drugs comprise only 4 percent of the 2,325

agents named by respondents. However, they account

for about 341,427,000 mentions, or 52 percent of the

total 651,153,000 drug mentions.

The 11 drugs most frequently named in 1981 were

also the leading 11 in 1980. The rank order of the

specific drugs, however, varied somewhat between the

years (table 2). The two most notable gains in rank

position were registered by Inderal, a beta-adrenergic

blocking agen~ and Dyazide, a diuretic agent.

In table 3, drug utilization in 1981 is expressed

entirely in generic terms. Listed in alphabetical order

are the 100 generic substances most frequelitly ordered

or provided either in single-entity form or as ingredients

of combination products. Thus, the 29,687,000 total

mentions of the ranking generic substance, hydrochlor~

thiazide, include its 11,583,000 mentions as a singleentity drug and its 18,105,000 mentions as an active

component of a combination drug.

IInclusion oftrade names isforidentitication only and dccs nocimply endomement by the Public Health Service or the U.S. Depamnent of Health and

Human Services.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service
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Another useful overview of 1981 drug utilization

appears in table 4. Here the 651,153,000 drug mentions

are described by the chief therapeutic effect that each

was intended to produce. A comprehensive listing of 67

therapeutic categories is used. (The categories were

selected from the American Hospital Formulary Classification System. z) The data user may note the obvious

preeminence enjoyed by the nontropical anti-infective

agents, the central nervous system drugs, and the combination of cardiovascular drugs and diuretics used to

2AmerlC~n Society of ~ospi(a] Pharmacists. Inc.: The American Hospid

Formulaw Classij7ca(ion S.vsrem. Washington. Jan. 1980

combat circulatory disease. Together these three categ~

ries accounted for virtually one-half of all drug mentions.

From 1980 to 1981, the use proportion (percent of

all drug mentions) did not vary greatly for most of the

therapeutic categories (table 5). The largest single decrease (0.6 percent) was registered by skin preparations.

Their estimated number of mentions fell by abclut 6.2

million in 1981. These findings directly parallel a 0.6

percent drop found in 198 I for the number of office

visits with skin disease as the principal diagnosis. The

largest single increase in use proportion ( 1.8 percent)

was achieved by the combination of cardiovascular

drugs and diuretics. Their estimated number of mentions rose by about 6.7 million in 1981. This increase
appears directly related to the 0.7-percent increase found

in 1981 for the number of oflice visits with circulatory

disease as the principal diagnosis. Also contributing to

the increase was the sharp surge in popularity enjoyed

by certain new cardiovascular drugs, especially the

beta-adrenergic blocking agents. They are usel%l in

treating hypertension, angina, cardiac arrhythmi% and

in preventing the recurrence of myocardial infarction.

Measured in terms of drug-visit proportion (that is,

the percent of ofilce visits at which one or more drugs

were ordered or provided), the overall utilization of

drugs by office-based physicians fell from 63.1 percent

in 1980 to 60.5 percent in 1981, a decrease of 2.6

percent.

NAMCS drug findings for 1981 are reportable by

product name, generic name, entry status (generic versus brand name), prescription status (prescription versus

nonprescription), level of potential abuse (Federal control schedules), composition (single-ingredient versus

combination), and therapeutic effect. These drug dimensions may be contrasted with other NAMC S variables

to show the influence on drug utilization produced by

prescriber characteristics, patient demographics, referral status, duration and disposition of the visit. and by

such clinical features as symptoms, diagnosis, diagnostic procedures, and other (nondrug) forms of treatment.

Inquiries about the NAMCS drug database may be

directed to

Hugo Koch

National Center for Health Statistics

Center Building 2, Room 2-43

3700 East-West Highway

Hyattsville, Md. 20782

Telephone: (301 )436-7 132
4 advancedata

Table 1. The 100 drugs most frequently ordered orprowded in office prsctice by drug name (as recorded by the physician). number of mentions, snd therapeutic use

Umted States, 1981

r? Number

a

of

Name of drug

n

mentions Therapeutic use

k

in

thousands

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

All drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Inderal (propranolol) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

bs!x(furosemlde) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dyazlde (trismterene, hydrochlorothlazlde. . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . .

Ampicillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Penlclllfin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lenoxin (dtgoxin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tetracyclin e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diphtheria tetanus toxo!dspertussis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Polio vaccine............,... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Valwm(diazepam) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Motnn( ibuprofen] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxicillm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Erythromyc!n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prednisone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E. E. S.(ewthromycin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .

Aldomet (methyldopa) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tagamet (cimetidine) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrochlorothiazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dlgoxin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrodwnl( hydrochlorothiazlde). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxil(amoxicillin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hygroton (chlorthalidone) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Keflex(cephalexm) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dimetapp (brompheniramine, phenylephrine, phenylpropanolamine) . . . . . . . . . . . .

Tylenol wsth codeine (acetaminophen, codeine). . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Actifed (triprolidine. pseudoephedrine) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Isordil (isosorbide) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamin B-l Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Naprosyn (naproxen) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Septra(sulfamethoxazole, trimethoprim) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tuberculin tlnetest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sactrim (sulfamethoxazole, trimethopnm) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ctinonl (sulindac). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tylenol (acetaminophen) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lopressor (metoprolol) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenergan (promethazine) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Irrdocin (indomethacin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Benadwl (dlphenhydramine) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Decadron (dexamethasone) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nitroglycerin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Slow- K(potasslum replacement solutions} . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Zomax(zolamme) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diabmese (chlorpropamlde) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pen-Vee K(penlcillin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Premarin (estrogens} . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Depo-medrol (methylprednmolone). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Kenaiog (triamcmolone) . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Donnatal (hyosciamine, atropine, hyoscine, phenobarbital}. . . . . . . . . . . . . . . . . . . .

Influenza wrusvaccme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Coumadin (warfarin), . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ceclor(cefaclor) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neosporin (polymixin-B, neomycin).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Synthrold (levothyrox!ne) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dimetane (bromphenwamme) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E-mycm(erythromycin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aldonl (methyldopa, hydrochlorothlazlde) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bicillln (penicdlirr) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Xylocaine (lidocalne) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Butazolidin (phenylbutazone) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Naldecon (phenylephnne, phenylpropanolamine, chlorphemramme) . . . . . . . . . . . .

Darvocet-N (propoxyphene, acetamlnophen). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mylanta (magnesmm hydroxide, aluminum hydroxide). . . . . . . . . . . . . . . . . . . . . . . .

Antivert (mecllzme) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Elavll(amnrfpty llne) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

651.153

11,847

10.770

10,422

9,173

8,581

7.543

7,311

7,030

6,583

6,237

6,063

5,967

5.877

5,606

5,575

5,535

5,418

5,375

5,326

5,285

5,086

5,020

4,349

4,314

4,195

4,141

4,085

3,892

3,782

3,758

3,575

3,476

3,397

3,337

3,277

3,271

3,270

3,258

3,106

3,096

2,999

2,988

2,904

2.872

2.871

2,854

2,601

2,670

2,607

2,589

2,556

2.386

2,317

2,278

2.269

2,253

2,252

2,241

2,238

2,231

2,229

2,182

2.156

2,077

2,063

2,055

Arrhythmia, angina pectoris, hyperrenalon, migraine

Dmrettc, antihyperrensive

Dwretac. edema. hypertension

Antibiotic

Antibiotic

Analgeaic. antipyretic

Cardiotomc

Antibiotic

Immunization

Immunization

Anxiety disordera

Anti-inflammatory, analgesic

Antibiotic

Antibiotic

Anti-inflammatory

Antibiotic

Antihypenensive

Ulcer and gastrointestinal disease

Diuretic

Antidiabetic

Cardiotonic

Oiuretic

Antibiotic

Diuretic. antihypertensive

Antibiotic

Antihistaminic, decongestant

Analgeaic

Common cold, allergic rhinitis

Coronary vasodilator

Wamins

Anti-inflammatoW, analgesic, antipyretic

Urinary infections+ otitis media, pneumonitia

Tuberculosis skin test

Urinary infectiona, otitis media, pneurnonitis

Analgesic, anti-inflammatory

Analgesic

Antihyperrensive, beta-blocker

Expectorant

Anti-inflammatory

Antihistaminic

Anti- in flammatoW

Vasodilator

Potassium replacement therapy

Analgesic

Hypoglycemic agent

Antibiotic

Estrogen replacement therapy

Glucocorticoid

Anti-inflammatory

Sedative. antispasmodic

Immunization

Anticoagulant

Antibiotic

Bacterial infections, topical

Thyroid hormone

Expectorant

Antibiotic

Antihypertensive

Antibiotic

Local anesthetic

Anti-inflammatory

Hay fever, sinus, congestion

Analges\c

Antacid, anof!atulent

Antinauaeant

Antidepressant
achme&a5

Table 1. The 100 drugs most frequently ordered or provided in office practice by drug name (as recorded by the physician), number of mentions, andtherapeut!c use

United States, 1981—Con.

R

Number

a

of

Name of drug mentions

n

Therapeutic use

k

in

fftousands

67

68

69

70

71

72

73

74

75

76

77

78

79

80

81

82

83

84

85

86

87

88

89

90

91

92

93

94

95

96

97

98

99

100

Dllantln (phenytom) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Emplrmwtith codeme(aspirln, codeine). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dalmane (flurazepam) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cleocm[clindamycln) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Potassium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Theo-dur (theophyl{ine) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Comsponn (polymixm-8, bacitracin, neomycin, hydroconisone) . . . . . . . . . . . . . . . .

Phenergan with codeine {promethazine, codeine) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vibramycin (doxycycllne) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

V-cillin (penlclllin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Persantme (dipyridamole) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rondec (pseudoephedrma. carbinoxamine malaate). . . . . . . . . . . . . . . . . . . . . . . . . .

Timoptac (tlmolol) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prenatal vltamtns (multivitamins prenatal) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Minipress (prazosln) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aldactazlde (sptronolactone, hydrochlororhiazlde) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anstocort( triamcinolone) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Monlstat (miconazole) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenobarbital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ilosone (erythromycin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lerottd (amoxiclllin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Llbrax (clidimum bromide, chlordiazepoxide) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Robltussin (gualfenesin, dextromethorphan, phenylpropanolamine) . . . . . . . . . . . . .

Sudafed (pseudoephadrine) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tuss-ornade (chlorphemramine, phenylpropanolamine). . . . . . . . . . . . . . . . . . . . . . .

Atwan(lorazepam) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Libnum(chlordlazepoxide) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Flaxenl( cyclobanzaprine) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Zyloprlm (allopurinol) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drixoral (bromphenwamlne, pseudoephedrine) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Corgard (nadolol) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Celestine (betamethasone) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Parafon forte (chlorzoxazorre, acetaminophen) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ortho-novum (noreth(ndrone, estradiol). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2,054

2.042

2,041

2,033

2.028

2,026

1,979

1,978

1.957

1,946

1.932

1,928

1,914

1,873

1.789

1.788

1,766

1,743

1,694

1,692

1,640

1,635

1,633

1.604

1.580

1,579

1,569

1,568

1,567

1,561

1,550

1,544

1,528

1,519

Anticonvulsant

Analgesic, ant!pyretlc

Hypnotic

Antlblotic

Potassium replacement tharapy

Coronary vasodtlator. diuratlc

Anti-inflammatory

Expectorant

Armbtotic

Antibiotic

Coronary or myocardial insufficiency

Decongestant, antltussive

Treatment of glaucoma, ocular hypertension

Vitamins

Antlhypetienswe

Antihypertenswa

AntI-inflammatory

Antifungal

Anticonvuisant, sedative, hypnottc

Antib[otlc

Antibiotic

Gastro-intestmal disorders

Ant!tusswe, decongestant, expectorant

Decongestant

Antitusswe. decongestant

Psychotherapeutic agent

Psychotherapaut!c agent

Skeletal muscle relaxant

Antigout

Decongestant, antihistamine

Antihyperlenswe, beta-blocker

Glucocortico#d

Skeletal muscle relaxant

Oral contraceptive

Table 2. The 11 drugs most frequently named in 1980 and 1981 by frequency of ment!on and rank order United States, 1981

Number of

menoons Rank

Name of drug in thousands

1981 7980 198? 1980

Inderal. .

11.847 9.625 1 4

bsix ...:::::::::::::::::::::: : ::::::::::::::::::::::::::::: :::: :::::::::::::::::::::::: 10.770 9.879 2 1

Dyazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.422 7,435 3 7

Ampicillin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,173 9.795 4 2

Penicdlin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,581

Aspirin

9.736 5 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lanoxin

7.543 8,800 6 6

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.311 7,105 7 8

Tetracycline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,030 9.478 8 5

Oiphthenat etanust oxoidspertussm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.583 6.067 9 11

Polio vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,237 6,535 10 9

Valium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.063 6,499 11 10
6 advancedata

Table 3. Number of drug mentions, rank. and therapeutic use of the 100 generic substances most frequently utilized in office pract!cw Umted States, 1981

Number

of

R

Generic substance

a

mentions Therapeutic use

n

in

fhous8nds1

k

Acetamlnophen . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Acetam,nophen with codeine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allopurlnol, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alumlnum hydroxide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alummum suba.; t:tate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amttnptyline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxlcdlln . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ampiclllln, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Asptrtn. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Atroplne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bacltracln . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Benzoyl peroxide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Betamethasone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bismuth antld!arrhea agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bromphenlramlne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Caffeine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cefaclor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...+.

Cephalexin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chlordiazepoxide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chlorphenlram#ne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chlorpropamide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chlorthalidone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Clmetldine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Codeine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dexamethaaone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dextromethorphan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diazepam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dlgoxln . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dlphenhydramine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diphthenat etanust oxoldspertuas!s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Doxycycline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Erythromycm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Eatradiol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estrogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Furoaem,de . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Guaifenesin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydra lazlne. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrochlorothtazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrocortisone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydroxyzme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hyoscyamlne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ibuprofen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Indomethacm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Influenza virus vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ipecac . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Iron preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Isopropamide todlde . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Isosorbtde . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Levothyroxlne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

L#docaine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Magnesium antacids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mecllztine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Methyldopa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Methylprednlsolone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Metoprolol, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Multiwtamms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Naproxen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neomycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nitroglycerin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Norethlndrone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nystattn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oxycodone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pentclllin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenacet!n ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenlram{ne, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See foomc.te at end of fable.

10,830

4,092

2.193

4,670

2,137

4,674

12.356

10,270

17,268

5,871

5,265

3,343

3,509

3,393

B,l 65

6,111

2,317

4,195

4,018

12,789

2.876

5,494

6,696

7,433

5,438

3,246

6,165

12,397

4,163

6.583

2.782

17.468

5,755

2,883

10,861

8,222

3,903

29,687

6,670

3,140

5,401

5,984

3,199

2,912

5.314

3,849

5.975

3,995

4,842

2.588

2,956

5,122

3,321

7,757

3.579

3,270

11,951

4.127

8,216

5.077

3,014

2,599

2.757

17,035

5,384

2.083

14

58

97

53

98

52

11

17

3

38

47

73

70

72

20

33

96

56

60

9

87

42

41

23

43

76

32

10

57

29

90

2

39

86

13

18

62

1

26

80

44

35

79

85

46

64

36

61

51

94

83

49

74

21

67

76

12

5B

19

50

82

93

91

4

45

100

Analgesic, antlpyret!c

Analges!c, antlpyretlc

Antigout

Antactd

Aetrmgent wash

Anttdepressam

Antibmtlc

Antibiotic

Analgesic, anttpyretic

Anticholinergic

Ant#biotic

Keracolytlc, acne treatment

Glucocomcoud

Ant!diarrhea

Expectorant

Stimulant

Antibiotic

Antibiotic

Emotional disturbance. sedative

Antihistaminic

Hypoglycemic agent

Diuretic. ant]hypertensive

Ulcer and gastrointestinal disease

Analgeeic, antitussive

Anti- inflammato~

Cough suppressant

Sedative, tranquilizer

Cardiotonic

Antihiataminic

Immunization

Antibiotic

Antibiotic

Estrogen replacement therapy

Estrogen replacement therapy

Oiuretic

Cough suppressant

Anti hypertensive

Diuretic

Anti-inflammatory

Sedative, tranquilizer

Antlcholinerg#c

Anti-inflammatory

Anti-inflammatory

Immunization

Antidiabatic

Emetic

Iron deficiency

Anticholinerglc

Coronaw vaaodilator

Thyroid hormone

Local anesthetic

Antacid

Antinauseant

Antlh ypertensive

Glucocorhcotd

8eta-adreneqtc blocker

Vkamins

Anti-inflammatory, analgasic. antipyret!c

Antibiotic

Vasodilator

Oral contraceptwe

Antifungal

Narcotic analgesic

Antibiotic

Antipyretic, analgeslc

Antlhastamlmc
a&mecMa7

Table 3. Number of drug mentions, rank, and therapeutic use of the 100 generic substances most frequently utilized in office practice: United States, 1981 —Con.

Number

of

R

Generic substance mentions

a

Therapeutic use

n

in

k

l/rousandsl

Phenobarbnal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenylbutazone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenylephnne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenylproparrolamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenyltoloxamlne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Polio vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Polymix!n B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Potassium gualacolsulfonate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Potasatum replacement solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prednisolone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prednmone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Promethazme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Propoxyphene. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Propranolol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pseudoephedrine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reserpine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sallcylic acid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Scopolamine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Simethicone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,.

Spironolactone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sulfacetamide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sulfamethoxazole. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sulindac . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tetracycline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

?%eophylline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Trlamcmolone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tr#amterene. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Trimethoprim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Triprolidine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tuberculin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamin B-1 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Warfarin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Zinc topical agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Zolamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.011

2.742

14,140

16.455

3.037

6,248

6.259

3.858

7,665

3,778

5,706

5,939

3,551

12,813

12,933

4.204

2,126

3,628

2,926

2.826

3,258

7,393

3,318

10.316

6.647

6.616

10,681

7,160

4.647

3.423

5,137

2.536

3.805

2.872

34

92

6

5

81

31

30

63

22

66

40

37

68

8

7

55

99

69

84

89

77

24

75

16

27

28

15

25

64

71

48

95

65

88

Anttconvulsarrt, sedative. hypnotic

Anti-inflammatory

Sympathom!metic

Sympathomimetic

Antihistammic

Immunization

Antibacterial

Cough preparations

Potassium replacement therapy

Anti-inflammatory

Anti-inflammatory

Antihistammic, anti-emetic, sedative

Analgesic

8eta-blocker

Antihistaminic, cough suppressant

Antihypertensive

Antifungal, keratolytic

Hypnotic. sedative. anticholinergic

Antiflatulent

Diuretic

Antibacterial

Antibacterial

Analgesic, antipyretic

Antibiotic

Coronary vasodilator, diuretic

Anti-inflammatory

Diuretic

Antibacterial

Antihistaminic

Tuberculosis skin test

Vitamins

Anticoagulant

Skin disease (astringent, antiseptic)

Ant!histaminic, local anesthetic

] Combines the mentrons of a generic substance as a single-mgrsdient agent wnh ns mermons as an mgnzd!ent of ● cembkwtton drug.
8 aclwncedata

Table 4. Number and percent d!atrtbut!on of drug menoons by.selected therapeutic Cate90rleS United States. 1981

Number Number

of Percent of Percent

Selected therapeutic categories menrlons d@n- Selected therapeutic categories mentions distr/-

m button in bution

thousands thousands

All categories . . . . . . . . . . . . . . . . . . .

Antlh!stamlne drugs . . . . . . . . . . . . . . . . . . . . . . .

Antg-infective agents . . . . . . . . . . . . . . . . . . . . . . .

Ant! b(ot!cs . . . . . . . . . . . . . . . . . . . . . . . . . .

Cephalosporlns . . . . . . . . . . . . . . . . . . . .

Erythromyc!ns . . . . . . . . . . . . . . . . . . . . . .

Penlcllllns, . . . . . . . . . . . . . . . . . . . . . . . .

Tetracyclmes . . . . . . . . . . . . . . . . . . . . . . . .

Sulfonamides . . . . . . . . . . . . . . . . . . . . . .

Antineoplastlc agents . . . . . . . . . . . . . . . . . .,

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

Parasympatholyoc agents. . . . . . . . . . . . . . . . .

Skeletal muscle relaxants. . . . . . . . . . . . . . . . . .

Sympathomlmetic agents. . . . . . . . . . . . . . . . . .

Blood formation and coagulation. . . . . . . . . . . . . . . .

Anti-an em!a drugs . . . . . . . . . . . . . . . . . . . . . . . .

Anticoagulants, . . . . . . . . . . . . . . . . . . . . . . . .

Cardiovascular druga . . . . . . . . . . . . . . . . . . . . .

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

Hypotenslve events . . . . . . . . . . . . . . . . . . . . .

Vaaodllatlng agenda . . . . . . . . . . . . . . . . . . . . .

Central newoussfstem drugs . . . . . . . . . . . . . . . . . .

Analgesics and ant!pyretlcs . . . . . . . . . . . .

Anticonvulsants, . . . . . . . . . . . . . . . . . . . . . . .

Antldepressanta . . . . . . . . . . . . . . . . . . . . . . . .

Respiratory and cerebral stimulants ., . . . . .

Tranquilizers, sedatwes, and hypnotics. . . . .

Electrolytic, caloric, and water balance. . . . . . . . . . .

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

Replacement solutions . . . . . . . . . . . . . . . . . . .

Expectorants and cough preparations. . . . . . . . . . .

Eye, ear, nose, and throat preparations. . . . . . . . . . .

Anti-i nfectwe agents . . . . . . . . . . . . . . . . . . . . . .

Antabtotlcs . . . . . . . . . . . . . . . . . . . . . . . .

651,153

43,511

104,804

89,209

8,355

16,119

41,524

15,010

9,236

4.019

24.102

9.574

5.737

7,235

8,020

5,325

2,675

68,779

30,184

24,263

13,730

104,391

58.841

2,858

9,892

4,501

27.574

55.277

45,239

8,527

17,864

23,546

6,330

3,830

100.0

.6.68

16.10

13.70

1.28

2.48

6.38

2.31

1.42

0.62

3.70

1.47

0.88

1.11

1.23

0,82

0,41

10.56

4.64

3.73

2.11

16.03

9.04

0,44

1.52

0.69

4.23

8.49

6.95

1.31

2.74

3.62

0.97

0.59

Eye, ear, nose, and throat preparatlona—Con.

Anti-inflammatoV agents. . . . . . . . . . . . . . . . . .

Local anesthetics . . . . . . . . . . . . . . . . . . . . . .

Miotlcs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mydr!atlcs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vasoconstrlctors . . . . . . . . . . . . . . . . . . . . . . . . .

Gastrointestinal druga . . . . . . . . . . . . . . . . . . . . . .

Antacids andadsorbents . . . . . . . . . . . . . . . . . .

Ant!dlarrhea agents . . . . . . . . . . . . . . . . . . . . . . .

Antlflatulents . . . . . . . . . . . . . . . . . . . . . . . . . .

Cathartics andlaxatwes . . . . . . . . . . . . . . . . . . .

Emeucsa ndantt-emetics . . . . . . . . . . . . . . . . . .

Hormones and synthetic substances. . . . . . . . . . . . .

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

Contraceptives . . . . . . . . . . . . . . . . . . . . . . . . . .

Estrogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insulins and antidiabetic agents . . . . . . . . . . . .

Insulins . . . . . . . . . . . . . . . . . . . . . . . . . . .

Thyroid andantithyrold . . . . . . . . . . . . . . . . . . .

Serums, toxoids, and vaccines. . . . . . . . . . . . . . . . .

Toxoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Skm and mucous membrane preparations . . . . . . . .

Anti-tnfectwes . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fungicides . . . . . . . . . . . . . . . . . . . . . . . . . .

Anti-inflammatory agents. . . . . . . . . . . . . . . . . .

Antiprurittcs and local anesthetics . . . . . . . . . .

Emollients, protestants, demulcents. . . . . . . . .

Keratolytlc agents . . . . . . . . . . . . . . . . . . . . . . . .

Spasmolytic agents . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Multiwtamln preparations. . . . . . . . . . . . . . . . .

Vttamln B complex . . . . . . . . . . . . . . . . . . . . . . .

Other agents or therapeutic category

undetermined . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4,772

1,947

1,590

1,666

2,004

24,196

3,562

3.324

2,947

3,655

3.776

53,999

20.731

6,141

6,877

10,901

5,314

4,328

22,068

8,813

12,655

49,026

12.049

4,781

17,463

4,506

2,989

5,860

10,654

20.507

11,638

5,939

16,393

0.73

0.30

0.24

0.26

0.31

3.72

0.55

0.51

0.45

0.56

0.58

8.29

3.18

0.94

1.06

1.67

0.82

0.66

3.39

1.35

1.94

7.53

1.85

0.73

2.68

0.69

0.46

0.90

1.64

3.15

1.79

0.91

2.52

1 Based on the pharmaco[og!c.therapeutl~ ~lasslflcat,~n Of the Amerrcan Soc#ety of Hosp!tal Pharmacists. Inc.: selected Cate90rie5 reproduced with Perm!$slOn.
dmcdata9

Table 5. Use proportion of selected therapeutic categories of drugs utilized in office practice in 1980 and 1981: United States, 1981

Use proportion

selected therapeutic categoryl

Use proportion

Selected therapeutic categoryl

1981 1980 1983 ?980

Number of mentions in thousands Percent distribution

All categories . . . . . . . . . . . . . . . . . . . . . 651,153 679,593 Contraceptives . . . . . . . . . . . . . . . . . . . . 0.9 1,2

Expectorant and cough

Percent distribution preparations . . . . . . . . . . . . . . . . . . . . 2.7 2.8

All categories

Eye, ear, nose, and throat

. . . . . . . . . . . . . . . . . . . . . 100.0 100.0

Adrenals

preparations . . . . . . . . . . . . . . . . . . . .

3.2

3.6 3.8

. . . . . . . . . . . . . . . . . . . . . . . . . 2,7 Gastrointestinal drugs . . . . . . . . . . . . . .

Analgesics and antipyretics . . . . . . . . . . 9.0

3.7

8.5

3.6

Serums, toxoids, and vaccines. . . . . . . .

Antidepressants, . . . . . . . . . . . . . . . . . . 1.5

3.4

1.5

3.5

Skin and mucous membrene

Antihistamine drugs . . . . . . . . . . . . . . . . 6.7 6.5

Anti-infective agents. . . . . . . . . . . . . . . .

preparations . . . . . . . . . . . . . . . . . . . .

16.1

7.5

15.4

8.1

Spasmolytic agenta . . . . . . . . . . . . . . . . .

Antineoplastic agents. . . . . . . . . . . . . . . 0.6

1.6

0.%

1.7

Tranquilizera, sedatives. hypnotics . . . .

Autonomic drugs 3.7

4.2 4.4

. . . . . . . . . . . . . . . . . . . 3.7 Vitamins

Blood formation and coagulation. . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . .

1.2

3.2

1.2

3.6

Other agents or therapeutic catego~

Cardiovascular drugs and diuretics . . . . 17.6 15.8 undetermined . . . . . . . . . . . . . . . . . . . 9.5 11.2

1B@~ed~“ the Pha~acologjc.thempeutic classification of the American Society of Hospital Pharmacists,Inc.: selected CategOrleSreproducedvwthPerm:-wOn.
10

Technical notes

Source of data and sample design

The estimates presented in this report are based on

data collected during 1981 by the National Center for

Health Statistics by means of the National Ambulatory

Medical Care Survey (NAMCS). The target universe

of NAMCS comprises oflice visits made by ambulatory

patients to non-Federal physicians who are principally

engaged in office-based, patient-care practice. Visits to

physicians practicing in Alaska and Hawaii are excluded

from the range of NAMCS, as are visits to physicians

who specialize in anesthesiology, pathology, and radiology.

NAMCS uses a multistage probability sample design

that involves a stepwise sampling of primary sampling

units (PSUS), physicians’ practices within PSUS, and

patient visits within physicians’ practices. For 1981 a

sample of 2,846 physicians was selected from master

files maintained by the American Medical Association

and the American Osteopathic Association. The physician response rate was 77.5 percent. Sampled physicians were asked to complete Patient Records (figure 1)

for a systematic random sample of office visits made

during a randomly assigned weekly reporting period.

Telephone contacts were excluded. During 1981, responding physicians completed 43,366 Patient Records,

on which they recorded 46,424 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 of

numbers

The standard error is primarily a measure of the

sampling variability that occurs by chance because only

a sampIe, rather than the entire universe, is surveyed.

The 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. Relative standard errors of selected aggregate visit statistics are shown

in table I. Standard errors for estimated percents of

visits are shown in table II. Similar standard errors for

drug statistics and percents are shown in tables III and

IV. Tables I and II should be used to obtain the standard

error of a specific drug mention (for example, Dyazide).

Tables 111and IV should be used to obtain the standard

error of a group of drug mentions (for example, all antibiotics).

Estimates of office visits have been rounded to the

nearest thousand For this reason detailed figures within

tables do not always add to totals. Rates and percents

were calculated on the basis of original, unrounded

figures and will not necessarily agree precisely with

percents calculated from rounded data.

Table 1. Approximate relatwe standard errors of estimated number of office

vistts based on all physician specialties NAMCS, 1981

Relative

Estimared number of office visits standard

in thousands error in

percent

500. . . . . . . .. . . . .. .. . . . . .. . . . . . . . . . . . . .. . . . . . . . . . . 27.3

1,000. . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.5

2,000. . . . . . . .. . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.1

5,000. .. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . 9.4

10,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3

20,000. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. .. . . . . . . . 5.9

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

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

550,000. . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.1

Example of use of table: An sggregate estimate of 75.OCW,OQO vwts has ,3 relatwe

stsndard error of 4.7 percent, or a standard error of 3.525,000 ws!ts {4.7 pnrcent’ of

75,000.000].

Table Il. Approximate standard errors of percents of estimated numbers of offtce wstts based on all physlclan specialties NAMCS, 1981

Base of percent Estimated percent

(number of off!ce VISJCSm thousands)

1 or 99 5 or 95 10 or 90 20 or 80 30 or 70 50

2.7

1.9

1.3

0.8

0.6

0.4

0.3

0,2

01

5.9

4.2

2.9

1.9

1.3

0.9

0.6

0.4

0.2

Standard error in petcent

8.1

5.7

4.0

2.6

1.8

1.3

0.8

0.6

0.3

10:8

7.6

5.4

3.4

2.4

1.7

1.1

0.8

0.3

12.4

8.7

6.2

3.9

2.8

2.0

1.2

0.9

0.4

13.5

9.5

6.7

4.3

3,0

2.1

1.3

1.0

0.4

Example of use of fabte An esttmate of 30 percem based o“ a“ aggregate of 1 5,000 .OCQVISIW. has a skmdsrd .wrorof 2,4 percem, ora relsovestandard ermrof 8 percent (2.4 percent -30

percent),
dwmedaa 11

Table ill. Approximate relative standard errora of estimated number of drug

mentions based on all physician speclalttes NAMCS, 1981,

Relative

Estimated number of drug ment!ons standard

in thousands error m

percent

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.3

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.7

5$300.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.2

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.1

20.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.2

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.8

100.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2

300,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.8

650,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7

Example of use of table: An aggregate estlmale of 75,000,000 drug mentmns has a relattve standard error of 6.5 percent. or a standard error of4,875.000 ment90ns{6.5 percent

of 75.000, OCO).

Definitions of terms

An anzbu[ato~patient k an individual seeking personal health services who is neither bedridden nor currently admitted to any health care institution on the

premises.

A physician eIigible for NAMCS is a duly licensed

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

currently in office-based practice who spends time in

caring for ambulatory patients. Excluded from NAMCS

are physicians who are hospital base$ physicians who

specialize in anesthesiology, pathology, or radiolog~

physicians who are federally employed physicians who

treat only institutionalized patientq physicians employed

full time by an institutio~ and physicians who spend no

time seeing ambulatory patients.

An ofice is a place that physicians identify as a

location for ambulatory practice. Responsibility over

time for patient care and professional services rendered

there generally resides with the individual physician rather

than with an institution.

A visit k a direct personal exchange between an

ambulatory patient and a physician, or a staff member

working under the physician’s supervision, for the purpose of seeking care and rendering health services.

A drug mention is the physician’s entry 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.

Table IV. Approximate standard errors of percents of esttmated numbers of drug mentions based on all physician specialtte= NAMCS, 1981

Base of percent

Estimated percent

(number of drug mentions in thousands)

1 or 99 5 or 95 100r90 20 or 80 30 or 70 50

Standard error m percent

I,ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7 5.8 8.0 10.7

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

12.2 13.3

1.9 4.1 5.7 7.6

5J)OQ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.7 9.4

1.2 2.6 3.6 4.8 5.5

20.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.0

0.6 1.3 1.8 2.4

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

2.7 3.0

0.3 0.6 0.8 1.1

600,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.2 1.3

0.1 0.2 0.3 0.4 0.5 0.5

Example of use of table: An esumale of 30 percent bssed on an aggregate of 12.5CQ.CX30 drug mentmns has a standard error of 4.1 percent. or a rolanva standard error of 13.7 percent (4. 1

percent Y 30 percent).
From Vital and Health Statistics of the National Center for Health Statistics Number 90 ● June 15, 1983

Utilization of Psychotropic Drugs in Office-Based Ambulatory

Care 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

Ambulatory Medical Care Survey are combined to

describe the utilization of psychotropic drugs in oficebased ambulatory care.

The term utilization is limited to the ordering or

providing of a psychotropic drug by an office-based

physician. It does not apply to patient compliance with

the doctor’s instruction.

As used in this report, the subject groupps-ychotropic

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 or generic 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 11 Antidepressants

● Category III: Antipsychotic and antimanic agents

1The use o[trade names isfor identification only and doesnot imply endonement by the Public Health Service of the U.S. Department of Health and

Human 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

ofllce-based physicians. Of this 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.

Vkits involving one psychotropic drug or more numbered 69,269,110, about 6 percent of the overall numberof ofllce visits and about 10 percent of all drug visits.

The total number of psychotropic drug mentions was

79,582,103, divided among the subcategories as follows.

Drug mentions

Number Percent

in distrirhousavrds btrtfon

All psychotropic drugs . . . . . . . 79,582 100.0

Category I. . . . . . . . . . . . . . . . . . . . 48,048 60,4

Benzod[azep!nes . . . . . . . . . . 30,147 46.5

8arbmmc agents. . . . . . . . . . 6,087 9.4

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

Categov 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 SER’JICES P~hlir l+e~!?h se~ic~
2 achmncedata

Psyclibtroplc drugs

CategOW I

Antt-anx!ety agents, sedatwea, and hypnotics

Amobarbnal Coprobate Meprobamate

Am ytal Dalmane

Quan Ill

Meprospan

Anoquan

Qufesa

Donden Mmrafinm

Atarax

Restor!l

Equages!c Miltown Ru- Lor

Atwan Equaml Nembutal Seconal

Azene Fiormal Nevrotose

Bamo

Sedapap elixir

Fiormal w!th code!pe Nldar Serax

Buff-A-Comp Hydroxyztne Noctec

Butabarbttal

SK-lygen

Idenal Noludar

Butal

SK-phenobarbital

Indogestc Parest

Butlcaps

Sopor

In fadorm drops Pentobarbttal Tranxene

Btmgetlc Isollyl Pentothal Tuinal

Butisol Lanonnal Phencotd Tybratan

Carbrltal Librnabs Phenobarbital

Centrax

Valium

Llbnum Phremlin Valmtd

Chloral hydrate Lorazepam Plactdyl Valobar

Chlordiazepoxlde Lotusate Prazepam

Clorazepate

Verstran

Marnal Quaalude Vistarll

Categov II

Antidepressants

Adapln Elawl Nardil Sinequan

Amavil Endep Norpramin SK-pramine

Amitriptyllne Etrafon Nortriptyline

Amoxapme

Surmontd

Imipramlne Pamelor Tofranil

Asendin Llmbnrol Pamate

Aventyl

Tr!avd

Ludiomll Perphenazine Trimipramine

Deslpramine Maprotillna Pertofrane

Doxapm Marplan

Vivac~il

Phenelzine

Category Ill

Antlpsychotlc and antimanic agents

Chloramead Lidone Ormazina Thioridazine

Chlorpromazine Lithane Proketazlne Thorazine

Chiorzine Lithwm Prolixin Tindal

Compazine Lithobid Promazine

Deprol Lithonate

Trifluoperazine

Prozina 50 Trilafon

Eskalith Loxitane Serentll

HaIdol

Vesprin

Mellard Sparine

Haloperidol Moban Stelazine

Inapsine Navane Taractan

,. . ..- ----- ----

Figure 1. Psychotropic tIrUga aCIUallY flamed by ptIYSIClafl reSpOnaefltS UfllteCi StateS, 1 SW and 1 S61.

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

United States, 1980 and 1981

R Number of R

a

Number of

Name of drug 1

menttons Percent a

Name of drug7

mentions Percent

n in distribution n in distribution

k thousands k thousands

All psychotropic drugs. . . . . . . . .. . . . . . . . 79,582 100.0 12 Triawl (amltr!ptyline, perphenazlna) . . . . . 2.244 2.8

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

14 Vistartl (hydroxyz,me) . . . . . . . . . . . . . . . .

25 drugs most frequently used

1,762 2.2

15 Meprobamate . . . . . . . . . . . . . . . . . . . . . . . 1,650

1

2.1

Valium (d!azepam) . . . . . . . . . . . . . . . . . . 12,562 15.8 16

2

L]mbttrol (chlordiazepoxlde,

Elav!l(amitnptyline) . . . . . . . . . . . . . 4,419 5.6 amitrlptyline) . . . . . . . . . . . . . . . . . . . . . 1,642 2.1

3 Oalmane (flurazepam) . . . . . . . . . . . . . . . . 4.242 5.3 17 Compazine (prochlorperazine) . . . . . . . . . 1,369 1.7

4 Tranxene (clorazepata) . . . . . . . . . . . . . . . 3,621 4.6 18

5

Equagestc (meprobamate, ethoPhenobarbital . . . . . . . . . . . . . . . . . . . . . . . 3,453 4.3 heprazlne, aspirin) . . . . . . . . . . . . . . . . . 1,211 1.5

6 Atarax(hydroxyzine) . . . . . . . . . . . . . . . 3.150 4.0 19 Lithium . . . . . . . . . . . . . . . . . . . . . . . . . 1,203 1.5

7 Sinequan (doxeptn) . . . . . . . . . . . . . . . . . . 3.133 3.9 20 Stelazine (trifluoperazlne) . . . . . . . . . . . . . 1,196

8

1.5

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

9 L!bnum (chlordiazepoxlde) . . . . . . . . . . . . 2,912 3.7 22 Central {prazepam) . . . . . . . . . . . . . . . . . . 1,111 1.4

10 Fiorinal (butalbital, aapmn, phenacetin, 23 Haldol(halopendol) . . . . . . . . . . . . . . . . . . 1,036 1.3

caffeine } . . . . . . . . . . . . . . . . . . . . . . . 2,634 3.3 24 Serax(oxazepam), . . . . . . . . . . . . . . . . . . 975 1.2

11 Mallarll (thioridazme . . . . . . . . . . . . . . . . . 2.370 3,0 25 Norpramm (deslpramme). . . . . . . . . . . . . . 871 1.1

1TITSform of the drug name (brand or genonc) repmscms tho chmce o! the phystcmn m prapanng tha Pre~crlPtlOn.
aCkmmaa3

illicit channels. Because of these factors they are treated

as controlled substances and placed under the regulatory authority of the U. S. Drug Enforcement Administration. The special sensitivity 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 prescri~

tion 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 psychiatrist. It is fimdarnental then to examine the use of

psychotropic in terms of the diagnoses rendered in

office-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 of69 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 specific diagnoses were found to

be most frequently associated with psychotropic therapy

Psychotropic

Rank Diagnosis and ICD-9-CM Codef mentions

in rhousands

1 Neurotic disordera . . . . . . . . . . . . . .300 8,834

2 Essential hyprmenslon . . . . . . . ...401 5,536

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

4 Schizophrenic disorder. . . . . . . ...295 2.382

5 Affective psychosis . . . . . . . . . . ...296 1,708

1~ased ~“ the International C/ass#ficatiorrofDiseases. 9tfr Revision. cljn:esl

Modificat!orr (ICD-9-CM).

From the preceding correlations between diagnosis and

psychotropic utilizatio~ it is clearthat the use ofpsych~

tropic therapy is most frequently associated with the

chronic conditions (table 2). Wkh 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 ofpsychotropic 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 fluctuating, descent among patients in the remaining years of

life (table 3 and figure 2).

This pattern applies to each ofthe psychotropic subcategories, 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 ofllce patients

in the age group 30-50 years.

It is clear from the findings that female utilization of

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

imbalance favoring female patients lay almost 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 intervais in which

the sex differences in psychotropic utilization become

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

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 rats in the

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

almost 60 percen~

These findings correiate 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.

AIthough overall psychotropic usage did not vary

signiilcantly between black and white ofllce patients

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

blacks is an interesting fmdin~ and one not clearly

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

conditions as their white counterparts.) However, they

visited the psychiatrist with only one-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 &ncedata

Table 2. Number of office vwts, number of all psychotropm drug mentions, and number of mentmns per 1.000 visits. by major clinicsl problem

Unned States, 1980 and 1981

Psychotropic drugs

Number of’ All ps ychotrop!c drugs Category 11 Category 112 Categow 1113

Major cltmcal problem

Wslts

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

thousands ment:ons mentions ment]ons menrlons mentfons mentions mentions mentions

m per 1,000 m per 1,000 in per 1,000 in per ?,000

thousands visfts thousands visits thousands vi.wts thousands visits

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

Major diagnostic groups4

Infectious and parasitic

diseases . . . . . . . . . . . . . .

Neoplasm . . . . . . . . . . . . . .

Endocrine, nutrltlonal, and

metabolic d!seases,

snd immunity

disorders . . . . . . . . . . . . . .

Mental disorders. . . . . . . . .

Disesses of netvous

system and sense

organs . . . . . . . . . . . . . . . .

Dtseases of circulator

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

Diseases of resptrato~

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

Diseases of digestive

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

Diseases of genltourlna~

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

Diseases of skin and

subcutaneous ttssue. . . . .

Diseases of musculoskeletal

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

Symptoms, stgns, and

ill-defined conditions. . .

Injury snd poisontng. . . . . . .

Supplementary classification

(normal pregnancy, health

supervision of chdd,

and so forth . . . . . . . . . . . .

Residual . . . . . . . . . . . . . . . .

Problem categories

Acute problem . . . . . . . . . . .

Chronic problem, rcnmne. .,

Chrome problem, flareup .

Postsurgety andlor postin jury . . . . . . . . . . . . . . . . .

NonNness care. . . . . . . . . . .

1,160,922

37,714

30.707

45,371

47,624

109,573

112,344

146,014

49.080

68.504

69.421

79,206

38,526

94,723

202,585

29,530

422,223

325.791

106,393

101,792

204,722

79,582

783

1,144

3,028

25,098

3,374

13,038

5,003

3,957

2,411

3,143

5,899

4,722

3,587

2,879

1,516

22,915

38,409

12,468

2.134

3,656

69

21

37

67

527

31

116

34

81

36

45

74

123

38

14

51

54

118

117

21

18

48,048

“518

647

1,793

9,863

2,337

9,260

3,212

2,376

1,594

2,761

4,334

3,424

2,693

1,942

. . .

15,317

21,659

7,007

1,588

2,477

1Ants.snxtew agents. sedawes, and hypnottcs.

2Antidepressants.

3A”tlp*ychotlC and arwrnarm a9ents.

4 Ba3ed ~“ the I“ternatIO”aI C/asstficat/on of Diseases, 9th Revwon, Clinical MOdJficat(On.

Prescriber characteristics

Among ofilce-based specialists it was, of course,

psychiatrists who showed the highest rate of psychtropic utilization, 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 specialists tend to refer for treatment, among

them depressive conditions, schizophrenic disorders,

and affective psychoses.

What may be surprising about the findings, as shown

41

14

21

40

207

21

82

22

48

23

40

55

89

31

10

36

66

66

16

12

20,295

●149

*153

809

9,532

“505

2,717

1,148

980

●575

“240

1,205

967

*492

*627

. . .

2,223

6,190

2,095

“203

●528

17

‘4

●5

18

200

“5

24

8

20

●8

●3

15

25

“5

“3

5

19

20

“2

*3

11,239

“116

“ 344

“426

5,703

“532

1,061

643

“601

“242

“122

●360

*33 1

“202

●31O

. . .

5,375

10,560

3,366

“343

651

11

“3

“11

*9

120

●5

9

4

*12

●4

“2

*5

“9

●2

*2

13

32

32

*3

“3

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

the general practitioner and the intemisq 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 ofilce-based practice, 59 percent of

the Category II drugs, and even a substantial 45 percent

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

psychotropic utilization appear to stem less from their

clinical involvement with the mental disorders than

from their treatment of the other diagnostic groups that

invite the use of psychotropic, notably symptoms,
akmedaa5

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 Caregow 11 Categow 112 Catego~ 11P

Patiant characteristic

visits

in Number of Numbar of Number of Number of Number of Number of Number of

thousands

Number of

memions mentions mentions menrions mentions mentions mentions mentions

in per 1.OW in per ?,000 in per 7,000 in

thousands

per 1.000

visits thousands visits thousands visits thousands visits

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

‘Age

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

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

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

25-29 years . . . . . . . . .

30-34 years . . . . . . . . .

35-39 years . . . . . . . . .

40-44 years . . . . . . . . .

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

45-49 years . . . . . . . . .

50-54 years . . . . . . . . .

55-59 years . . . . . . . . .

60-64 years . . . . . . . . .

65yeara And over . . . . . . . . .

65-69 years . . . . . . . . .

70-74 years . . . . . . . . .

75-79 years . . . . . . . . .

80 years and over. . . . .

Sex

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

Male . . . . . . . . . . . . . . . . . . .

1,160,922

216,128

160,795

310.384

97,109

86,896

69,611

56,768

265,700

56,265

68,032

70,825

70,578

207,915

67,884

57,577

43,309

39,145

699,718

461,204

79,582

2,381

5,160

23,338

5,055

6,705

5,895

5,683

28,930

6,657

7,895

7,286

7,093

19,772

6,708

5,871

3,968

3,227

53,409

26,173

69

11

32

75

52

77

85

100

109

118

116

103

100

95

99

102

92

82

76

57

48,048

1,713

3,295

13.195

2.939

3,606

3,331

3,320

17,164

3,797

4,736

4,140

4,492

12,680

4,495

3,520

2.456

2.211

31,972

16,076

41

8

20

43

30

41

48

58

65

67

70

58

64

61

66

61

57

56

46

35

20.295

“307

1.021

6,178

1,159

1.740

1,553

1,725

7,966

1,894

2,093

2,117

1,864

4,823

1,633

1.542

1,061

●588

14,398

5,897

17

●1

7

20

12

20

22

30

30

34

31

30

26

23

24

27

24

●15

21

13

11,239

*361

844

3,965

958

1,359

1,011

“638

3,800

966

1,066

1,029

737

2,269

“580

809

“45 1

“428

7.039

4,200

11

●2

5

12

10

16

15

“11

14

17

16

15

10

11

●9

14

●lo

*11

10

9

1Anti..anxiety agents, sedatwas, and Wpnotw.

‘Arwdepressants.

3A”tlps~ch0tlc and anttmanic a9ants

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 “nonmental” 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 gynecologis~

The differences in psychotropic utilization between

doctors of medicine and doctors of osteopathy (table 5)

probably reflect the fact that a clear majority of oste~

pathic 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 psychotropic drug therapy than the patient whom the doctor

has 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 newpoblem-whether

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

the fmt 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 ot%ce-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

oftlce practice is 60 percen~) Although such specificity

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 oilice practice. Its magnitude is com-
6 acklncedata

j

-’

120

110

100

90

80

70

60

50

40

30

20

10

0

[117]

[921 [95]

Average [69]

----- -—-—- - ---— --—- -— -- ---- ---

[64]

[32]

[11]

I [ I I I I

I

Under 15-24 25-34 35-44 45-54 55-64 65 yeara

15 years years yeara yeara years years and over

Age of patient

Figure 2: Paychotroplc utdizatlon ratea by age of pat!ent: Unned States, 1980 and 1981

pounded by the finding that physicians, when they do

use a dn.w. 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 liesthe potential for harmful as well as helpful interactions.

In table 7 is shown the extent to which psychotropic

drugs co-occur with drugs in other therapeutic families,

and the ,co-occurrence that exists among the psych~

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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diuretms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Autonomic druga . . . . . . . . . . . . . . . . . . . . . . . .

Hypotenswe agents . . . . . . . . . . . . . . . . . . . . . .

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

Antibiotms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent of

co-occurrence

17

16

11

10

9

8

8

6

Within the psychotropic family itself, the most frequent c~occumences existed among drugs in Categories

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

and 111drugs (at 1.8 million visits). The least frequent

pattern of c~occurrence was found among the drugs in

Categories I and HI (at 1.4 million visits).
akmedaa7

Table 4. Number of office visits, number of all psychotropic drug mentions. and number of mentions per 1,000 vmts. by panent charactenst!c~

United States. 1980 and 1981

Psychotropic drugs

Number of All psychotropic drugs Category Ii Categorf 112 Category 1113

visits

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

rhousa-nds mentions mentions mentions mentions mentions mentions mentions mentfons

in per ?,000 in per 1.000 in per 1.000 in per 1,000

thousands vtsits thousands wsits thousands visits thousands visits

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

SEX AND AGE

Female

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

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

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

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

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

Male

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

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

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

45-64 yeara . . . . . . . . . . . . .

65yeara and over, . . . . . . . .

RACE4

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

Black . . . . . . . . . . . . . . . . . . .

1,160,922 79.582 69 48,048 41 20,295 17 11.239 11

1,180

3,424

15.572

19,155

14,078

11

32

75

122

111

602 8

21

43

71

69

’143

723

4,281

5.516

3,736

●1

7

21

35

30

“235

“405

2,326

2,441

1,631

●2

“4

11

16

13

102.633

107,276

206,394

157,031

126.383

2,296

8,965

11,198

8.711

113,495

53,519

103,990

108,668

81,532

1.201

1,734

7,766

9,776

5,695

11

32

75

90

70

911

998

4.230

5,967

3,969

8

19

41

55

49

“164

●298

1,897

2,451

1,087

*1

“6

18

23

13

“126

●438

1,639

1.358

*639

●1

●8

16

12

●8

1,037,590

110,546

71,783

7,403

69

67

42.740

5,066

41

46

18,976

1.247

18

11

10,067

1,090

10

10

1Anti.an~I@~agents, sedatwes, and hYIJnOtlcs.

2Antldepressants.

3Antlpsych0tlc and sntimamc a9enw

4ficiUda* abut 12,7E6.w VISIM by patmnts of mces other than Wh!te Orblack.

Table 5. Number of office vlslts and number of psychotropic drug mentions and number of mentions per 1,000 w$!ts, by prescriber characteristics:

Umted States, 1980 and 1981

Psychotropic drugs

Number of All psychotropic drugs Category IT Category 1!2 Categov 1113

Prescriber characteristic

visits

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

thousands mentions mentions mentions menttons mentions mentions menttons mentions

in per 1,000 in per ?,000 in per 1,000 m per 1,000

thousends visits thousands visns thousands vistts thousands visits

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

Most-visited specialities

General and family

practice . . . . . . . . . . . . . . . 381,710 32,199 84 21.037 55 7,852 21 3,310 9

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

Pediatric s. . . . . . . . . . . . . . 128,762 1,395 11 1,032 8 “165 *1

Obstetrics and

“197 “2

gynecology . . . . . . . . . . . . 109.035 1.720 16 ) .407 13 “204 *2 *109 “1

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

Psychiat~ . . . . . . . . . . . . . . . 31,810 14,038 441 3.878 122 5,448 171 4,712 148

All other specialties . . . . . . . 304,420 . . . . . . . . . . . . . . . . . . . . . . . .

Professional identity

Ooctor of medicine. . . . . . . . 1,089,638 74,030 68 44,717 41 18,488 17 10,625 10

Doctor of osteopathy . . . . . . 71.284 5.553 78 3,331 47 1,807 25 “41 5 ●6

1Anti.a”~tefy agents, sedawes, and hyimOt!cs-

‘Ant! daprassants.

3AnttP.ychotlc and arrtlnww dm9s.
8 aduancedata

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

United States, 1980 and 1981

Psychotropic drugs

.

Number of M psychotropic drugs Category /1 Categoty 112 Categow 11P

Selected wsit character!st!c

visms

m Number of Number of Number of Number of Number of Number of Number of Number of

thousands’ menttons merwons mermons menttons mentions mentions mentions mentions

m per 1,000 in per 1.000 in per 1,000 in per 1,000

thousands wsits thousands visits thousands Ws!ts thousands visits

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

Referral status

Referred by another

physman . . . . . . . . . . . . . .

Not referred by another

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

Patient visit status

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

Oldpat!ent . . . . . . . . . . . . . .

Old patient, new

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

Old patient, old

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

Problem status

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

Return visit for old

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

1,’

1,

60,922

51,392

09,530

79,582 69 48.048 41 20,295 Ii’ 11,239 11

947

47.101

18

42

“446

19,849

9

18

●21 7

11,022

“4

10

1,610

77,972

31

70

22

45

37

47

1,504

18,791

2,723

16,068

9

19

11

22

702

10,537

1,170

9,367

4

11

5

13

166,675

994,247

258,778

735,469

425.453

735,469

5,919

73,663

13,397

60,266

36

74

52

82

3,713

44,335

9,504

34,831

4,227

16,068

10

22

1,872

9,367

4

13

19,316

60,266

45

82

13,217

34,831

31

47

1Anti. anxlew qants, sedstlves. and hYPnOtics.

2AntUdepressants.

3A”t,p~ychOtlC and antimamc a9en~.

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

Umted States, 1980 and 1981

Selected co-occurring Category /2 Categow 1{3 Category 1114 Selected co-ocmrm”ng Categow !2 Category 113 Category 1114

therapeutic categoryT drug visits drug wsits drug vistts therapeutic category’ drug visits drug visits dmg visits

Number !n thousands Number in thousands

Adrenals . . . . . . . . . . . . . . . . . 1,709 ●438 “151 Gastrointestinal dregs . . . . . . 3,836 1,169 965

Analgesics . . . . . . . . . . . . . . . 8,843 2,557 1,209 Hypotenswe agents. . . . . . . . 3,842 1,649 “422

Antlblottcs . . . . . . . . . . . . . . . 3,076 995 ’409 Insulins and antidiabetlc

Anticonvuisants . . . . . . . . . . . 1,385 “263 “217 agents . . . . . . . . . . . . . . . . . 1,002 590 *251

Antlhistamtne drugs. . . . . . . . 2,405 625 “443 Skin preparations. . . . . . . . . . 2,883 569 *322

Anttneoplastlc agents . . . . *169 “70 ●31O Spasmolytic agents . . . . . . . . 1,475 547 ●31 2

AuIonomUc drugs . . . . . . . . . . 3,480 1,959 1,685 Thyroid and andthyroid. . . . . 1,133 552 *223

8100d formation and Vasodilatmg agents. . . . . . . . 2,776 796 ●246

coagulation . . . . . . . . . . . . . 1,217 “336 “268 Vitamms . . . . . . . . . . . . . . . . . 2.559 773 624

Cardiac drugs . . . . . . . . . . . . . 5,012 2,028 795

Diuretics . . . . . . . . . . . . . . . . . 7,709 3,227 1,030 Categow l drugs . . . . . . . . . . . . . . 3,482 1,381

Expectorants and cough Category 11 drugs . . . . . . . . . . 3,482 . . . 1,763

preparations . . . . . . . . . . . . 874 ●229 “31 Category ill drugs. . . . . . . . . . 1,381 1,763 . . .

1 Based on the pharmacologic-therapeutic Classtfmatmn of the American Society of Hospital Pharmacmts.

2AnwanxIety agents, sedatws. and hYPnc.tics.

3Ant] depressants.

4Ant,p~ychotjc and antlmamc dm9s.
achtancedata 9

Technical notes

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 oflice-based

care conducted amually from 1973 through 1981 by

the National Center for Health Statistics. The target

universe of NAMCS is composed of office visits made

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

of NAMCS, as are visits to anesthesiologists, patholgists, and radiologists.

NAMCS uses a multistage probability sample design

that involves a stepwise sampling of primary sampling

units (PSU’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 Association and the American Osteopathic Association.

Those members of the sample who proved to be inscope

and eligible participated at a rate of 77.3 percent. Responding physicians completed visit records for a systematic 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 occurs 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.j 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 specific name (for

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

relative standard error for drug mentions expressed as

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

In the tables of this report estimates have been

rounded to the nearest thousand. For this reaso~ detailed

estimates do not always add to totals.

Table L Appr&xlmate relative standard errors of estimated numbers of office

visits and of drug ment!orrs when the drug IS listed by product name (for

example, Valium), based on all physvclan spectalttes National Ambulatory

Medical Care Survey, 1980 and 1981

Relative

Estimated number of office visits standard

or specific drug mentions in thousands error in

percent

600 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

2.000.. .. . .. .. .. . . . .. . . .. .. .. . ... .. .. . . . ... .. . .. .

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

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

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

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

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

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

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

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

●44.8

*31 .7

“30.0

26.0

22.6

20.2

14.5

9.5

7.1

5.6

4.4

3.9

3.6

3.5

3.4

Example of use of table: 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,GO0 visits

(5.0 percent of 35,1YX),000 wsite).

Table IL Approximate relative standard errors of estimated numbers ot drug

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

drug family], based on all physician specialties National Ambulatory

Medical Care Suwey, 1980 and 1981

Relative

Estimated number of grouped drug mermons standard

in rhousands error in

percent

“200. . . . .. .. .. .. . . .. .. . ... .. . .. .. .. ... .. . .. .. . . .. ●54.2

“400.. . . ... . . .. .. . .. .. . ... .. . ... .. .. .. .. .. .. .. . .. ●38.5

“500.. . .. .. . ... . . .. . .. . . .. . . . ... .. .. ... . .. .. .. . .. “31 .6

‘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 of table: An aggregate estimate of 30,000.000 drug mentions

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

mentions (7.0 percent of 30.000.000 mentions+

Definitions

An ofice is a place that physicians identify as a

location for their ambulatory practice. Responsibility
10

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 physicians 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 acuteprobiem is a morbid condition with a relatively sudden or recent onset (within 3 months of the

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, jlare up is a sudden exacerbation

of a preexisting chronic condition.

Nonillness 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.

‘U.S. Govarnnml Prinllng Olflca 1993— 3J1-OIS/SKJ19
Vital and Health Statistics

series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5.

SERIES 6.

SERIES 10.

SERIES 11.

SERIES 12.

SERIES 13.

Programs and Collection Procedures –These reports

describe the data collection programs of the National Center

for Health Statistics. They include descriptions of the

methods used to collect and process the data, definitions,

and other material necessary for understanding the data.

Data Evaluation and Methods Research –These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. These studies

also include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

Analytical and Epidemiological Studies –These reports

present analytical or interpretive studies based on vital and

health statistics.These reports carry the analyses furtherthan

the expository types of reports in the other series.

Documents and Committee Reports–These are final

reports of major committees concerned with vital and health

statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

International Vital and Health Statistics Reports –These

reports are analyticalor descriptivereports that compare U.S.

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

Cognition and Survey Measurement–These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to design, evaluate, and test survey

instruments.

Data From the National Health Interview Survey-These

reports contain statistics on illness; unintentional injuries;

disabili~ use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview survey.

Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey–

Data from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or conditions in the United

States and the distributionsof the population with respect to

physical, physiological, and psychological characteristics,

and (2) analyses of trends and relationships among various

measurements and between survey periods.

Data From the Institutionalized Population Surveys–

Discontinued in 1975, Reports from these surveys are

included in Series 13.

Data From the National Health Care Survey–These

reports contain statisticson health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

SERIES 14.

SERIES 15.

SERIES 16.

SERIES 20.

SERIES 21.

SERIES 22.

SERIES 23.

SERIES 24.

Data on Health Resources: Manpower and FacHities -

Discontinued in 1990. Reports on the numbers, geographic

dktribution, and characteristics of health resources are now

included in Series 13.

Data From Special Surveys–These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics.

Compilations of Advance Data From Vital and Health

Statistics –Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reports in Series 10-13.

Data on Mortality–These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

Data on Natality, Marriage, and Divorce–These reports

contain statistics on natality, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic and trend analyses are included.

Data From the National Mortality and Natality Surveys–

Discontinued in 1975. Reports from these sample surveys,

based on vital records, are now published in Series 20 or 21.

Data From the National Survey of Family Growth –These

reports contain statistics on factors that affect birth rates,

including contraception, infertility, cohabitation, marriage,

divorce, and remarriag~ adoption; use of medical care for

family planning and infertility end related maternal and infant

health topics. These statistics are based on national surveys

of childbearing age.

Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy–

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National Vital

StatisticsSystem that were published as supplements to the

Monthly Vital SWMCS Reporf (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vital Stafisdcs of the United States. Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vital Statistics

System and may be followed by detailed reports in Series 20

or 21.

For answers to questions about this report or for a list of reports published

in these series, contact:

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National Center for Health Statistics

Centers for Disease Control and Prevention

Public Health Service

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Hyattsville, MD 20782

(301) 436-6500
.. . .

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DHHS Publication No. (PHS) 94-1868, Series 16, No. 9