the national ambulatory medical care survey: 1975 summary

Data from theNATIONAL HEALTH SURVEY

The National Ambulatory

Medical Care Survey:1975 SummaryUnited States, January - December 1975

Using data obtained from a national sample ofoffice-based physi-cians, statistics are presented which describe ambulatory medicalcare rendered in physicians’ offices. Statistics are presented on thevolume of office visits and annual visit rate by age, race, and sex ofthe patient and by selected physician characteristics. Data describ-ing the clinical substance of these visits include the patient’s prob-lem or complaint, prior-visit status, seriousness of the problem,physician’s diagnosis, diagnostic and therapeutic procedures, dis-position, and duration of the visit,

DHEW Publication No. (PHS) 78-1784

Series 13Number 33

US. DEPARTMENT OF HEALTH, EDUCATION, AND WELFAREPublic Health Service

National Center for Health StatisticsHyattsville, Md. January 1978

Library of Congress Cataloging in Publication Data

Koch, Hugo ~.National ambulatory medical care survey.

(Vital and health statistics: Series 13, Data from the National Health Survey, Data cmhealth resources utilization; no. 33) (DHEW publication; (HIM); 78-1 784)

Includes indexes.Bibliography: p. 39.1. Physician services utilization–United States–Statistics. 2. Ambulatory medical car+

United States–Statistics. 3. Health surveys-United States. 4. United States–Statistics,hledical. I. McLemore, Thomas, joint author. II. Title. III. Series: United States. NationalCenter for Health Statistics. Vital and health statistics: Series 13, Data from the NationalHealth Survey, Data on utilization; no. 33. IV. Series: United States. Dept. of Health,Education, and Welfare. DHEW publication; no. (HRA) 78-1784. [DNLM: 1. Ambulatorycare–Tables. 2. Health surveys-United States–Tables. W2 A N148vm. no. 33 ]RA407.3.A349 no. 33 [RA41O.7] 362.1’1’0973sISBNO-8406-O 115-8 [362.1’0973] 77-16199

NATIONAL CENTER FOR HEALTH STATISTICS

DOROTHY P. RICE, Director

ROBERT A. ISRAEL, Deputy Director

JACOB J. FELDMAN, Ph.D., Associate Director for Analysis

GAIL F. FISHER, Associate Director for the Cooperative Health S tatistics System

ELIJAH L. WHITE, Associate Director for Data Systems

JAMES T. BAIRD, JR., Ph.D., Associate Director for International Statistics

ROBERT C. HUBER, Associate Director for ManagementMONROE G. SIRKEN, Ph. D., Associate Director for Mathematical Statistics

PETER L. HURLEY, Associate Director for Operations

JAMES M. ROBEY, Ph.D., Associate Director for Program Development

PAUL E. LEAVERTON, Ph.D., Associate Director for Research

ALICE HAYWOOD, Information Officer

mlsloN OF HEALTHREsOWicEs UTILIZATIONsvwmcs

SIEGFRIED A. HOERMANN, Director

W. EDWARD BACON, Ph.D., Chief Hospital Care Statistics Branch

JAMES E. DeLOZIER, chief Ambulatory Care Statistics Branch

MANOOCHEHR K. NOZARY, Chief Technicaj Services Branch

JOAN F. VAN NOSTRAND, Chiej Long-Term Care Statistics Branch

Vital and Health Statistics-Series 13-No. 33

DHEW Publication No. (PHS) 78-1784Library of Congress Catalog Card Number 77-16199

CONTENTS

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .scope . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Source and Limitations of Data . . . . . . . . . . . . . . . . - . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . .

SectionI. GeneralPattcrnsof Office-BasedCare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

A.

1.

2.

3.

4.

5.

6.

7.

TEXTTABLE

Number of office visits, mean contact duration, and standard error (S.E.) of mean contactduration, by patient’s age, sex, and prior-visit status; location of visit; and seriousness of the

principal problem presented to the physician: United States, January-December 1975 . . . . . . . . .

DETAILED TABLES

Number, percent distribution, and annuaf rate of office visits by physician’s specialty,professional identity, and type and location of practice: United States, January-December 1975..

Number, percent distribution, and annurd rate of office visits by patient’s age, sex, and race:LhdtedStates,January-December1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of office visits by patient’s prior-visit status, principaf diagnosis,seriousness of problem, and duration of contact between physician and patient: United States,January-December 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent of office visits, by services ordered or provided and disposition: United States,January-December 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of office visits by patient’s age, sex, and race, accordhg tobcation of visit: United States, January-December 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of office visits by prior-visit status and seriousness of problem,according to patient’s age, sex, and race: United States, January-December 1975 . . . . . . . . . . . . .

Number and percent distribution of office visits by principal diagnosis, selected services ordered orprovided, and disposition, according to patient’s age, sex, and race: United States, January-December1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section II. Provider Patterns: Office-Based Care as Related to Characteristics of Providing Physicians . .

TEXTTABLES

B. Number and percent distribution of office visits, mean contact duration, and standard error (S. E.)of mean contact duration by physician’s speciafty: United States, January-December 1975 . . . . .

C. Percent distribution of office visits by nature of care rendered and ratio of acute to chronicmorbidity, according to physician’s specialty: United States, January-December 1975 . . . . . . . . .

D. Number of office visits, percent of visits made by new patients, and percent of visits referred to thephysician, by physician’s sDecialtv: United States. Tanuarv-December 1975 . . . . . . . . . . . . . . . . .

112

3

4

5

6

7

8

9

10

11

12

12

13

13. . . . . .“.. . . .

...Ill

DETAILED TABLES

8. Number and percent dktribution of office visits by physician’s type and location of practice,patient’s age, sex, andpfior-tisit status, andseriousness ofproblem, accor~ng tophysicim's typeofpractice andprofessional identity: United States, January-December 1975 . . . . . . . . . . . . . . . . 14

9. Number and percent of office visits, by physician’s type of practice and professional identity,according to principal diagnosis, services ordered or provided, and disposition: United States,January-December 1975, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

10. Number and percent distribution of office visits to the 5 most Visited specialties by physician’stype and location of practice, patient’s age, sex, and prior-visit status, and seriousness ofproblem: United States, January-December 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

11. Number adpercent ofoffice tisitsto fie5most tisited specialties, bypnncipd ~a~osis, sewicesordered orprovided, and disposition: United States, January-December 1975 . . . . . . . . . . . . . . . . 17

12. Number and percent distribution of office visits to 7otherselected specialties byphysician’s typeand location of practice, patient’s age, sex, and prior-visit status, and seriousness of problem:United States, January-December 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

1% Percent distribution of office visits to 7otber selected specialties by theprincipal diagnoses mostcommonly rendered by their practitioners: United States, January-December 1975 . . . . . . . . . . . 19

14. Percent of office visits to 7 other selected specialties, by selected services ordered or provided anddisposition: United States, January-December 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Section III. Clinical Patterns: Office-Based Care as Related to Patients’ Presenting Problems . . . . . . . . .

TEXT TABLES

E. Ten morbidity-related problems most frequently presented, by sex . . . . . . . . . . . . . . . . . . . . . . . . .

F. Number of new-problem encounters by 25 morbidity-related problems most frequently presentedat these encounters: United States, January-December 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

G. Number of office visits, mean contact duration, and standard error (S.E.) of mean contactduration, by the 25 morbidity-related problems most frequently presented by patients: UnitedStates, January-December 1975..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DETAILED TABLES

.15. Number, percent, and cumulative percent of office visits, by the 50 principal problems most

frequently presented by patients: United States, January-December 1975 . . . . . . . . . . . . . . . . . . .

16. Number and percent distribution of office visits for the 25 morbidity-related problems mostfrequently presented by patients as principal reason for the visit by patient’s age and sex: UnitedStates, January-December 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17. Number and percent distribution of office visits for the 25 morbidity-related problems mostfrequently presented bypatients a~principrd reason for the visit bypnor-visit status of patientmdsetiousness ofproblem: United States, Jaua~-Dec6mberl975 . . . . . . . . . . . . . . . . . . . . . . .

18. Number and percent distribution of office visits by selected patient problems and pnncipafdiagnoses most frequently associated with each problem: United States, January-December 1975.

19. Number and percent of office visits for the 25 morbidity-related problems most frequentlypresented by patients asprincipd remonfor thetisit, by&a@ostic setices ordered or provided:United States, January-December 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21

21

22

23

24

25

26

27

29

Section IV. Clinical Patterns: Office-Based Care as Related to Physician’s Diagnosis . . . . . . . . . . . . . . . . 30

TEXT TABLES

H. Number and percent of office visits andnew-problem encounters with average rate ofreturn visits,by most common morbidity-related diagnoses: United States, January-December 1975 . . . . . . . . 31

J. Numbcrof visits, percent oftisits refereed bythephysitian, meacontact duration, mdstandarderror (S.E.) of mean contact duration, by most common morbidity-related diagnoses: UnitedStates, January-December 1975..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

DETAILED TABLES

20. Number, percent, and cumulative percent of office visits, by the 50 principal diagnoses mostfrequently rendered by physicians: United States, January-December 1975 . . . . . . . . . . . . . . . . . 33

21. Number and percent distribution of office visits by patient’s ageandsex, according to selectedprincipal diagnoses: United States, January-December 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

22. Number and percent dktnbution of office visits by patient’s prior-visit status and seriousness ofproblem, accor&ng toselected principal ~a~oses: United States, Janua~-December l975 . . . . . 35

23. Number and percent ofoffice tisits, byselected principal &a~oses and&a~ostic sewices orderedorprovided: United States, January-December 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

24. Number and percent of office visits, by selected principal diagnoses and therapeutic servicesordered or provided: United States, January-December 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

25. Number and percent ofoffice visits, byselected principal &a~oses and&sposition: United States,January-December 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..O 38

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

AppendixesI. Technical Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41II. DefinitionofCertainTermsUsed inThis Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49III, Survey Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

v

SYMBOLS

Datanot available——---—------—---——-- ---

Category not applicable ------------------------ . . .

Quantity zero---—-----–-—-–--———— -

Quantity morethan Obutlessthan0.05—— 0.0

Figure does not meet standards ofreliability or precision (more than30 percent relative standard error)—— *

THE NATIONAL AMBULATORYMEDICAL CARE SURVEY: 1975 SUMMARY

Hugo Koch, M. H. A., and Thomas McLemore, M. S.P.H.,

Division of Health Resources Utilization Statistics

INTRODUCTION

In this report national estimates are pre-sented on the utilkation of ambulatory medicalcm-e services provided by office-based, patient-care physicians in the coterminous United Statesduring calendar year 1975. The data werecollected by means of the National AmbulatoryMedical Care Survey, a continuous sample sur-vey conducted by the Division of Health Re-sources Utilization Statistics of the NationalCenter for Health Statistics. A complete descrip-tion of the background and survey methodologyis available in an earlier report.1

This report presents a summary of the 1975National Ambulatory Medical Care Survey find-ings. Ambulatory medical care utilization isdescribed by the number and distribution ofoffice visits, by annual visit rates, and by suchmeasurements as mean durations and return-visitfrequencies. Findings are presented in foursections:

1. General utilization patterns.

2. Utilization by physician practice andspecialty characteristics.

3. Utilization by patient’s presenting prob-lem.

4. Utilization by physician’s diagnosis.

Prior to data presentation, a brief descrip-tion of the scope of the survey and limitationsof the data are presented to assist the reader in

interpreting the resulting estimates. A detaileddescription of the 1975 survey appears in theaccompanying appendixes.

SCOPE

The basic sampling unit for the NationalAmbulatory Medical Care Survey (NAMCS) isthe physician-patient encounter or visit. “En-counter” and “visit” are used interchangeably inthis report.a Only visits in the offices of non-federally employed physicians classified by theAmerican Medical Association (AMA) or theAmerican Osteopathic Association (AOA) as“office-based, patient care” were included in the1975 NAMCS. In addition, physicians in the

specialties of anesthesiology, pathology, andradiology were excluded from the physicianuniverse. Major types of ambulatory encountersnot included in the 1975 NAMCS were thosemade by telephone, those made outside of thephysician’s office, and those made in hospital orinstitutional settings. It is planned to extend theNAMCS to include these encounters in thefuture, though some complex methodologicaland sampling problems must be resolved first.

The definitions of office, physician, patient,and visit as they determine eligibilityy for theNAMCS are presented in appendix II.

aThe term “contact” is reserved to apply only tothat part of the visit or encounter that involved aface-to-face interchange between physician and patient.

1

SOURCE AND LIMITATIONS OFDATA

The data presented in this report werederived from information provided by a nationalprobability sample of office-based physicians. Asample of 3,507 physicians was contacted duringcalendar year 1975; of the 3,069 physicians whowere eligible for the study, 2,472 (80.5 percent)actually participated in the study, providing dataconcerning a random sample of some 60,000patient visits.

Specially trained interviewers visited thephysicians prior to their designated reportingweek, provided survey materials, and thoroughlyinstructed each physician and staff member inthe methods and definitions to be used. During arandomly assigned 7-day reporting period, thesample physician maintained a listing of alloffice visits. For a systematic random sample ofvisits, data were recorded on an encounter formprovided for that purpose (see appendix III).

Readers are urged to review the three ap-pendixes to this report. These appendixes pro-vide information necessary for proper under-standing and interpretation of the statisticspresented. Appendix I contains a general des-cription of the survey methods, the sample

design, and the data collection and processingprocedures. Imputation methods, estimationtechniques, and estimates of sampling variationare also presented. Since the statistics in thisreport are based on a sample of ambulatoryvisits rather than on all visits, they are subject tosampling errors. Therefore, particular attentionshould be paid to the section in appendix Ientitled “Reliability of Estimates. ” Charts ofrelative standard errors and instructions for theiruse are given in appendix I.

Definitions of the terms used in this reportand in the survey operations are presented inappendix II. Facsimiles of survey materials,including letters, Patient Record forms, andInduction Interview forms are reproduced inappendix III.

Another program of the National Center forHealth Statistics, the Health Interview Survey(HIS), collects data on the utilization of physi-cian services from a sample survey of the civiliannoninstitutionalized population of the UnitedStates. The estimates provided by HIS aregenerally larger for the number of visits thanNAMCS estimates because of differences incollection procedures, populations sampled, anddefinitions. Data from HIS are published inSeries 10 of Vital and Health Statistics.

2

SECTION I

GENERAL PATTERNS OF OFFICE-BASED CARE

Tables 1-7 supply summary statistics whichpermit the following general profile of office-bawd ambulatory care in 1975.

During calendar year 1975 the physician’soffice was the setting for an estimated 567.6million office visits, representing an annual rateof 2.7 visits for every member of the civiliannoninstitutionalized population. Of all visits tooffice-based physicians, about 92 percent weremade to doctors of medicine; about 8 percent todoctors of osteopathy. Among office-basedphysicians, general and family practitioners ledall others in volume of office visits, aloneaccounting for 235 million, or 2 of every 5visits. In a ratio of 3 to 2, visits to solopractitioners outnumbered visits to physicians inmultiple-member practice. While there was wideregional variation in the distribution of numberof visits, there was no significant difference inthe annual visit rate for the four regions. Thetendency to visit a physician as measured by theannual visit rate was greater for metropolitanareas (2.9 visits per person per year) than it wasfor nonmetropolitan areas (2.3 visits).

Visits by females accounted for 60 percentof all visits. Except for the age interval under 15years, females in all age intervals made morevisits than males did. The annual visit rate forfemales (3.2 visits per person) was half again ashigh as the rate for males. An examination ofannual visit rates by age and sex shows that thisdifference exists largely because the rate forfemales in the age group 15-44 years was almostdouble the corresponding rate for males.

The annual visit rates for both sexes general-ly increased with age, as did the rates for whitepersons and persons of all other races. The ratefor white persons (2.8) was higher than the ratefor other races (2,2), though this higher rate was

found chiefly in the age intervals under 25 yearsand over age 64. Evidence from outpatientclinics and emergency rooms suggests that visitsby persons of all other races may be twice asfrequent in these settings as visits by whitepersons.z Thus the visit rate by age and racemay change substantially when the full universeof ambulatory care is considered.

Office-based ambulatory care focuses onvisits by patients who have consulted the samephysician before (table 3, prior-visit status).Visits by these “old” patients accounted for 85percent of all office-based encounters. Office-based practice is further characterized by thetreatment of “old” problems, that is, problemsfor which the patient had made at least oneprior visit. About 62 percent of all visits fell intothis category. That visit status is influenced bypatient’s age, sex, and race is evident from thedata in table 6. For example, visits by patientsnew to the doctor’s office were proportionatelymore frequent among males than among femalesand among persons of other races than amongwhite persons. Vkits by “old” patients returningto the same doctor with old problems becameprogressively more common as age advanced.

The clinical content of office-based practiceis summarized in tables 3 and 7 by the groupingof individual diagnoses into major diagnosticgroups. Diagnostic information is given separateand extended treatment in section IV of thisreport.

The data on seriousness of problem pre-sented in tables 3 and 6 refer to the seriousnessof the principal (first-listed) problem presentedby the patient. The y express the physician’sjudgment of the extent of impairment thatmight result if no care were available for theproblem. The data show that office-based carechiefly involves the treatment of problemscharacterized by the doctor as “not serious” or“slightly serious” in prognosis, since about 4 ofevery 5 visits resulted in this judgment. In theproportion of visits that fell in the “serious tovery serious” category, there was little differ-

ence between races, more males had serious to

very serious problems than females had, andthere was a general increase in the proportion ofserious to very serious problems as patient ageadvanced.

The diagnostic procedure most favored in

office practice was clearly the limited history/examination (tables 4 and 7). This was trueregardless of the patient’s age, sex, or race. Thetwo other diagnostic tools most commonly

3

employed were the blood pressure check and theclinical lab test. The lab test was more fre-quently ordered for the female than for themale. The tendency to take a blood pressurereading predictably increased as patient ageadvanced, though its infrequent use with pa-tients under 15 years of age (7 percent of visits)is perhaps worthy of note. Indeed the findingthat blood pressure was taken in only one-thirdof all visits casts some doubt on the generalemployment of this procedure as a routinedetection mechanism.

Ordering or providing a prescription drugwas clearly the most frequent form of therapy inoffice-based practice (tables 4 and 7). Its use (in44 percent of all visits) did not vary substantial-ly with sex and age, though its use in the treat-ment of persons of other races (in 52 percent ofvisits) was significantly more frequent than inthe treatment of white persons (43 percent). Ofthe other therapeutic tools, it is important tounderstand that “counseling” was checked bythe physician only when it constituted a majorpart of the treatment provided during the visit.The overall use of such an intangible service is al-most impossible to quantify. Certainly, the find-ing that counseling was prominent in only 12percent of visits understates the actual extent ofthis important aspect of the physician’s officepractice.

Data about disposition (tables 4 and 7)confirm that scheduled followup was the rule inoffice-based practice. In 59 percent of all visits,the patient was directed to return at a specifiedtime. The scheduled return visit was more com-monly applied to the female than to the maleand became progressively more common witheach successive age interval. A rare 2 percent ofvisits ended in hospital admission, reflecting thenonserious clinical character of most office-based practice. The tendency to refer patients toother physicians or agencies also was not usual.Such referral occurred in about 3 percent ofvisits.

Data about duration (table 3) apply only tothe time spent in face-to-face contact betweenphysician and patient, as estimated by thephysician after the visit.b About 75 percent of

bIt is important to understand that this measure ofduration does not include waiting time, time spent in the

Table A. Number of office visits, mean contact duration, andstandard error (S.E.) of mean contact du ration, by patient’sage, sex, and prior-visit status; location of visit; and serious-ness of the principal problem presented to tha physician:United States, Jan”ua~-Dece

Patient’s age, sex, and visitstatus; location of visit;

seriousness of problem

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

Age of patient

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

15-24 years ... .. .... .. ... .. ... ... .. ... .. ....25-44 years . .. ... .. .. .... .. .. ... .... .. ... ...45-64 years . ... . .... .. ... . .... .. .... .. ... ...65 years and over . .... .. .... .. ... . .. .. ...

Sex of patient

Female ... ... . ..... ... . ... ... .... . .... .. ... .. ..Male .. .. .... .. .. ... ... .. ... .. . ... ... ... .. ... .. ..

Prior-visit status

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

Old patiant, naw problem ... .. ... .. .Old patient, old problem .. ... . ... .. ..

Location of visit

Metropolitan area........................Nonmetropolitan area .................

Seriousness of problem

Serious or vary serious . .. . ... .. .... . ..

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

Not serious .... ... ... .... .. ... .. .... .. ... .. ..

& 1975

Numberof

visits(in

thou-sands)

567,600

99,01086,571

143,525145,434

93,061

342,8%224,704

84,807132,848349,945

413,685153,915

106,981183,697276,923

Meancon-tact

dura-tion 1

(inmin-utes)

15.0

12.013.716.116.115.8

14.915.2

18.413.414.6

15.812.8

19.614.613,5

S.E.of

meancon-tactdura-tionz

(inmin-utes)

TX~

0.260.380.43

R5

0,290.36

0.450,490.32

0.280.76

0.520.400.27

ITime ~oent in face.to.face contact between nhwician andpatient. -

. .

Zstandmd error (S .E.) measurements of Preckiori are dis-cussed in appendix1.

these face-to-face contacts lasted 15 minutes orless; the mean contact duration was about 15minutes. Table A shows the extent to which

care of the patient by the physician’s staff without thedoctor’s presence, or time spent by the physician beforeor after the face-to-face contact (e.g., time spentreviewing medical histories and test results, writinginstructions, or maintaining records).

4

mean contact durationc varied with the patient’s seriousness of the problem presented to theage, sex, location, and visit status, and with the physician.

Table 1. Number. Dercent distribution. and annual rate of office visits bv Phvsician’s specialty, Professional identity, and type and.location of practice: United States, January-December 1975”

Physician characteristic

Specialty

Genaral and family practice ... ... ... .. ... .. ... ... ... .... .. .. ... .... .. .. ... .... . ... ... .... .. . ... .... . .. .... ... .. .. ... ... .. . .. ... .. ... .. .. .... .. ..Internal medicine ... ... ... .. .... .. .. .. .. ... .. .... ... .. .... .. .. .. .. .... . ... .... .. .... .. .. .... ... . ... ... ... . ... ... .. ... ... .. ... .. ... .. .... ..............

Obstetricsand gynecology . ... .... .. .. .... .. .. .... .... .. .. .... .. .. .. .. .... .. ... ... .... .. .. .. .. .. .. ... .. ... ... .. ... .. .... .. .... .. .. ... .. ... ... ... .

General w~ery .. .. .... .. .... .. .. .... ... ... .. ... ... .. .. .... .. .... .. .... .. .... . .... ... .. .. .... .. ... ... .. . ... .. .. .. .. .. .... .. ... . .. .... ..................Ophthalmology ... ... ... .... .. .. .. .. ... ... .. ... ... ... .. ..... .. ... . .. .. ... ... .. .... .. .. .... .. .... .. .. .... .. .. .. .. .. .... .. .. .. .. .. .. .... .................Orthopedic surgery .. .. .. .. .... ... .. ... .. .. .... .. .... .. .. .. .. ... ... .. .... .. .... .. .. .. .. .. ... ... .. ... ... .. .. .. .. .. ... ... ... .. ... .. ... ... .. ............OtolaWngology .. .... .. .. .. .. .... .. .. .. .. .. .. .. .. ... ... .. .. .. .... .. ... ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ... . .. .. .. . .. ... ... ... .. .. .. ....................kychiatry .. .... .. .. .... .. ..... . .... .. .. .... ... . .... ..... ... .... .. .... ... ... .. .. .... .. .... .. .. .. .. .. .. .... ... ... .. .. ... . .. .. ... ...........................

Dermatology ... .... .. .. .... ... ... .. .... ... .. .. ... .. .. .. .... ... ... .. .. .... .. .. .. .. ... ... .. ... ... .... .. ... ... . ... . .. .. ... .... .. ... . .. .... ..... ............Urology .. .. .... .. ... .. .... .. .... ... .. ... .. ... .... .. .... .. ... ... ... .. .... .. ... .. ... .... .. ... ... .. ... .. ..... .. ..o. ... ... ... .. ... ............................Cmdlovascular diseasa .... .. .. .. .... ... ... .. .... .. .. .. ... . .. .. .... .. .. .... ... ... .. .. .... ... ... .. ... .. ... .... .... .. ... .. . ... .. ... .. ... ... .. .... ... ...Neurology . .... .. ... ... .. .... ... ... ... .. ... ... .. .... .. ... .... .. .... .. .. .... . ... .. .. .... .. .. .... .. .. . ... ... ... . .. .... ... .. .. .. .. ... .. ... ...................All other specialties .. .... ... ... .. .... .. .. ... ... .... . .. .. .... .. .. .... .. ... ... ... ... .. .... .. .. ... .... .. ... .. .... . .... . .... ... .. .. .... .. ... .. ..........

Professional identity

Doctor of osteopathy . ... .. .. . ... .... ... ... .. ... .. ... .. .... .. .. .. .. .... .. ... .. ..... .. .. ... .. ... ... ... .. .... .. .. .. ... ... .... .. .... .. .. .. .... ........Doctor of mdicine ..... ... .... . ... ... ... .... ... .. .. .... .. .. .... ... .. ... ... .. .... .. .... .. ... ... .. ... . .... ... ... .. ... ... ... .. .. ... .. . ... ... ...........

Type of practice

solo .................................!............................!..........................................................................................Other .. .. .. .. .. .. . ... .. .. ... .. .... ... .. ... ... .. .... .. .. .... ... .... .. .. ... .. .... .. .. .... ... .. ... ... ... .. .. .. . ... ... ... ... ... .................................

Location of rxactica

Geographic ragion:

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

North Central .. .... .. .. .... . ... ... ... ... .. .... .. . .. ... ... ... . ... ... .... .. .. .. .. .. .. .. ... ... .. .... .... .. .. .... .... .. .. .... ... .. .. ... ...............South .... .. .. ... ... .. .. .... .. .... .. .. ... .. .. ..... . ... .. .... .. ... ... ... .. ... .. ... ... .. .. .. .. ... ... .. .. .... .. .. .. .. .. .. .. .... .. .........................

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

Metropolitan areaz .... .. .... .. . .... .... .. .. .... . .. .. .... .. . .... .. .. ... .. ... .... .. . ..... . .... ... .. .. .. .. .. .. ... . .... .... .. .. ... .. ... .. .. .............Nonmetropolitan area .. ... ... . .... .. ... . .. .. ... ... .. .... .. .. .. .. ... ... .. .. .... .. .... .. .. ... ... .. .. .... .. .. ... ... .. .. .. .. ... . .. ... .. ... .. . ... .......

lBased on population estimates for July I, 1975, furnished by the U.S. Bureau of the census.2Location within the standard metropolitan statistical areas (SMSA’S).

Numberof visits(in thou-

sands)

567,600

234,66062,117

48,07646,68441,29224,68719,31616,35514,80614,09410,832

7,5562,032

25,112

46,872520,728

339,554228,046

126,616

150,241

182,668107,875

413,685153,915

Per-cent

distri-bution

ofvisits

100.0

41.310.9

8.58.27.34.43.42.9

2.62.51.91.3

0.44.4

8.391.7

59.8

40.2

22.3

26.532.219.0

72.927.1

Num-ber ofvisitsper

pxson

peryearl

2.7

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

2.6

2.72.8

3.0

2.92.3

cVisits in which there was no face-to-face contactbetween physician and patient were not included in thecalculation of mean contact duration.

5

Table 2. Number, ~ercent distribution, and annual rate of office visits by patient’s age, sex, and race: United States, January-December1975

Patient characteristic

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

Age—

Under 15 years ................................................................................................................................ ........15-24 years ................................................................................... ............ ............................................. ..25-44 years ..............................................................................................................................................45-64 years ................................................................................................................................ ..............65 years and over.............................................................................................. .................................. .....

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

Race and age

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

Undar 15 years .............................................................................................................. ..........................15-24 years ................................................................................................................................ ..............25-44 years .............................................................. .......... ........................................................ ..............45-64 years .............................................................. .................................................................. ..............65 years and over.....................................................................................................................................

All other races .........................................................................................................................

Under 15 years ........................................................................................................................................15-24 years ..............................................................................................................................................25-44 years ..............................................................................................................................................45-64 years ..............................................................................................................................................65 years and over.....................................................................................................................................

Sex and race

Female:White ................................................................................................................................................ ..All other races......................................................................... ...........................................................

Male:Whi& ................................................................................................................... ...............................All other raws ....................................................................................................................................

lBmed on population ~stj~ate~ for July 1, 197s, f~rnjshed by the. U.S. Bureau of the Census.

Vumberof visitsin thou-sands)

567,600

99,01086,571

143,525145,43493,061

342,896

46,14057,08594,65587,67657,332

224,704

52,87029,48548,87057,75835,721

508,672

88,16677,130

125,174131,537

86,666

58,928

10,8449,441

18,35113,8976,395

305,92836,968

202,74421 ,96C

Per-centdistri-mtion

ofvisits

100.0

17.415.325.325.616.4

60.4

8.110.116.715.510.1

39.6

9.35.28.6

10.26.3

89.6

15.513.622.123.215.3

10.4

1.91.73.22,41,1

53.96.5

35.73.9

Num-ber ofvisitsper

oersonper

yearl

2.7

1.92.22.83.44.3

3.2

1.82.93.64.04.5

2.2

2.01.51.92.84.0

2,8

2.02.32.73.54.4

2.2

1.31.72.83.23.3

3,32.6

2.31,7

6

Table 3. Number and percent distribution of office visits by patient’s prior-visit status, principal diagnosis, seriousness of problem, andduration of contact between physician and patient: United States, January-December 1975

Visit characteristic and ICDA code

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

Prior-visit status

New patient .. .. .... . ... .. . ... .. ... .. .... .. ... ... .. .. .... .. ... .... .. .. .... .. .. .... ... ... .. . ... .... .. . .. . .. .. .. .. ... .. ... .. .... .. ... . ...................................Old patient, new problem ... ... ... ... ... .. ... .. .. .... ... ... .. ... .. ... .. ... .. .... .. ... .. ... .. .... . .... . .... .. ... ... .. .. ... ... . ... ... ... .. .. .. ... .. ..............Old patient, old problem .... .. ... ... ... .. .. ... ... ... ... .. ... .. .... .. ... . .. .. .. .... . ... ... ... .. ... .. ... .. .... .. ... .. ... . ... ... ... .. ... .. ... .. .. ..................

Principal diagnosis

Infective and parasitic diseases .... ... .... . ... ... .... . .... ... ... . .... ... .. ... ... .. ... .. ... .. ... ... ... ... .. .. ... ... ... .. .... .. ... .. .. .... ... .. .. .. OOO.l36Neoplasms ... ... ... .. ... .. ... ... .. ... .... . .... ... ... .. ... ... ... . ..... .. ... .. .. .. ... . .. .... ... .. .. ... ... .. ... ... .. ... .. ... . ... .. ... .........................l4O.239Endocrine, nutritional, and metabolic diseases . ... .. .... ... .. .... . ... ... ... .. ... .. ..... . .. ... ... ... ... .. ... .. ... .. ... .. .. ..... ... . ... .. .240-279Diseases of blood and blood-forming organs .. .... ... ... .. ... ... ... .. .... .. .. .. .. . ... ... .. ... .. ... .. ... ... ... . ..... .. .. .. .... .. ... .. ... ..28O.289Mental disordars ... ... .. ... ... ... .. .... .. ... ... .. .. .... .. ... .. ... .. .... ... ... ... .. .. ... ... ... ... .. ... .. ... .. .. .... .. ... .. ... .. .... . .... .................29O.3l5Dlseasesof nervous system and sense organs . .... . ..... .. ... . ..... .. .. ... .... . ... .. ... ... ... . .. .. .. ... .. ... ... ... .. ... .. ... .. ... .. .... ..32 O.389Diseases of circulatory system .. .. .... . .. . ... .... ... . .. .... ... ... ... .. ... .. ... .. .... .. .. .... .. .. ... .. ... .. ... ... .. ... .. ... .. ... ... ... .. ... . .. .. ..39W58Diseases of respiratory system .. .. .. .. .... .. ... .. .... .... .. .... .. .... . ... .. .... .. .... . ... .. .... .. .. ... ... .. .. .... . .... .. .. ... ... .. ... .... .. .. ....46O.5l9

Diseases of digestive system .. .. . .... .. .... ... .. ... .. ... ... .. ... ... ... .. ... .. .... .. .... .. .. .. ... .. ... .. .... .. ... .. ... .. .... . .... .. .. ... ... .. ... ...52 O.577

Diseases of genitourinary system .... ... .. ... ... ... .. ... .. .... .. ... ... ... .. ... .. .... ... .. .. .... . ... .. .... ... ... ... . .. ... ... ... .. .... . .... . .... ..58O.629Diseases of skin and subcutaneous tissue . ... ... . ..... .. ... . .... .. ... .. .... .. ... ... ... ... .. .... . .. .... ... .. .. .... .. .. .. .... .. ... .. .... .. ....68O.7O9Diseases of musculoskeletal system .... ... .... . ... ... ... ... .. .. .... .. ... ... ... ... .. ... ... ... . .... .. .... .. .. ... ... .. .. ... ... .. ... .. .. .... ... ...71 O.738Symptoms and ill-defined conditions .. ... .. .... .. .. ... .... . .... .. .... .. ... .. ... ... .. ..... . .. ... ... ... .. .... .. .. .. ... ... ... ... ... .. ... . ... ...78O.796Accidents, poisoning, and violence ... . ... .... . .... . .... .. .... .. ... ... ... . .. .. ... .. ..... ... .. . .... .. ... . ... ... ... .. .. ... .... .. ... ... ... .. .. ... .800-999Special conditions and examinations without sickness ... ... .. .... .. ... .. ... ... ... .. .... . .... . ... .. ... .. . ... .. .... . ... ... .... . .. .. YOO.Yl3Other diagnoses2 . .. ... .. ... ... ... .. .. . ... ... ... .. .... .. .... .. ... .. ... .. .... . .... .. ... ... ... ... ... .... . .. ... .... .. .. .... . ... .. .... ... .. . .............................Dmqnosis “none” or ''unknown' ' .. .. ... .. .... ... .. .. ... .... .. .. ... .. .... ... .. ... .. ... ... ... ... ... .. ... .. .... .. ... . .... .. .. .. . ... ... .. ... .. .... .. .. ... ......


Serious or very serious . .... .. .. ... ... ... .. .. .. .... .. .. ... .. ... ... ... ... .. ... ... ... .. .... . .... . .... .. .... .. .. ... ... .. ... .. ... .. .... .. ... .. ... . ....................Slightly serious ... .. .... .. ... .. .... .. ... .... .. ... .. .... . ..... .. ... . .... .. ... .. .... .. .... . ... ... ... ... ... .. ... .. .... .. ... .. ... .. ... ... .................................Not serious .. .. ... .. .... ... .. ... .... . .. ..... ... . .... ... ... .. ... .... .. .. ... ... .. .... .. .. ... ... ... ... .. ... .. ... ... .... . .. ... ... ... .. ......................................

Duration of contact3

O minutes (no face-to-face contact with physician) .. .... .. .... . .... . .... .. .... .. .... . ... .. ... ... .. .... .. .. ... .. ..... . .... . .... .. .. ... ... .. .... . ...1-5 minutes .... ... .. ... ... ... .. . .. .. ... ... ... ... ... .. ... .. .... .. ... ... ... .. ... ... .. ... ... .. ... .. .... .. ... . .. .. .... . .. .... .. ... .. .......................................

6.10 minutes .. . .. ... ... .. ... .. .... ....!..... ... ... ... ... .. ... .. ... ... .. .... .. .. ... ... ... ... ... .. ... .. ... .. ... .. .... . .... . .... ... .. ... ... .. ... .. .......................11.15 minutes .. ... .... .. ... .. .... .. ... .. .... . .... .. .... . .... .. ... .. .. .. .... .. . ... . .. ... ... ... ... .. .... .. .. ... ... .. ... ... .. ... .. ... ...................................16-30 minutes . .... . ... ..... . .. ... ... ... .. .... ... .. ... .. .... . .... .. .... .. .. ... ... .. ... ... ... .. ... ... ... .. ... .. ... .. ... ... .... . .... .. ..................................31 minutes or more .. ... ... ... .. ... .. .. .... ... .. .... .. .. ... .. .. . .... . .... .. ... .. ... ... .. ... ... .. .. ... ... ... . .. .. ... .. .. ... ... .. .... .. .. ............................

of visits(in thou-sands)

567,600

84,807132,848349,945

22,747

13,33224,177

4,74425,06144,94156,35880,125

20,061

37,62628,56432,73226,17740,893

100,7873,3125,963

106,981183,697276,923

6,78191,730

177,442151,964107,709

31,975

Per-cent

distri-bution

ofvisits

100.0

14.923.4

61.7

4.0

2.44.30.84.47.99.9

14.1

3.5

6.65.05.84.6

7.217.8

0.61.1

18.932.448.8

1.216.2

31.326.819.0

5.6

lBa~edon Ejg\l~}lReLsj~jonIntern~tj~n~lcl=#$jfj~~ti~~~fDi~~~~~~,Ad~pt~dforusejn the United States (ICDA)(reference 4).2Ccsmplications of pregnancy, childbirth, and the puerperium; congenital anomalies; andcettain causes ofpetinatal morbidity and

mortality.3Time spent in face.to.face contact between physician and patient.

7

Table 4. Numbrand Dercent ofoffice visits. bvwwices ordered orprovided anddsposition: United States, January-Decembar 1975

Visit characteristic

Services ordered or provided

No sewices .. ... . .... .. ... .. .... . ... .. ... .. ... . ... ... . .... .. .. ... .... .. .. .. .... .. ... . ... ... .. .... . ... .. .. .... .. . ... ... ... .. ... ... ..........................................

Diagnostic services:

Limited history/examination ... .. ... ... .. .. .... .. ... .. ... .. .... .. .. ... .. ... .. ... .. .. .. ... .. ... . .. .. .. ... .. ... ... . ... ... .. .... .. .. .. .. .. .. .. .. .... ... .. ... ..General history/examination .. .. ... .. .... . .... ... .. ... .. .. .... . ... ... .. ... .. .. .... .. . ... ... ... .. .. ... ... .. .. ... .. ... .. ... ... ... . ... .. ... .. .. ... ... . ... .. ...Clinical lab test ... .... .. .. ... .. ... .. .. .. .... . ... .. ... ... ... .. .. ... ... .. ... .... . ... ... . ... ... .. . .... ... . ... .. ... .. ... ... .. .. ... ... ... . ... .. ................. ........X-ray ... .. ... .. .. .. .... . .... .. ... ... .. .. ... .. . ... ... .. ... .... .. .. .. ... ... .. .. .. ... .. ... .... ... .. .. .. ... .. .. .. .... .. .. .. ... ... .. ...... ................................ ...Blood prassura check ... .. .. ... ... .. .. ... .. .. .... ... .. ... ... . ... .. ... ... .. ... .. .. .. .. .. .. .. ... . .. . ... .. ... ... .. .. .... .. ... . ... .. ... .. ... ... .. .. .................

EKG ... .. .. .. .... . . ... .. ... ... .. .. .. .. ... ... ... .. ..o. ... .. .... ... .. .. ... .. ... .. ... ... .. .. ... .. ... .. .. ... .. .. .. ... .. .. ... ... .............................................

Hearing test ... ... .. ... .. .. .. .. . ... ... ... .. ... .. ... .. .. .... .. .. .. .... .. .. .. .. ... ... .. .. ... ... .. .. ... . .... .. .. .. ... . .... .. .. .. .. .. ....................................Vision test ... .. .. .. .. .... .. .. . .. ... .. .. ... .. ... .. .. .... .... .. .. .. .... .. . ... ... . .... .. .. ... ... . ... .. .. .. .. .. . ... .. .. .. .. .. .. .. .. .. ....................................Endoscopy ... .. ... . ..... .. .. ... .. ... ... . ... ... ... . .. .... .. ... .. .... . ... ... .. ... .. .. .. .... .. .. .. .. .. . ... .. .. ... . .. ... .... .. ... .. ... ..................................

Therapeutic servicas:Drug prescribed . .... ... ... .. .. .. ... .. .. ... .... .. .. .. ... ... .. ... ... ... . ... ... .. .. ... ... .. ... . ... ... .. .. .. ... .. .. .. ... .... . ... .. ... .. .. ... . .. .. .....................Injection .. .... .. ... .. ... ... .. .. .. ... ... .. ... .. .. ... .. .... .. ... .. ... .. ... .. ... .. .... .. .. .. ... .. ... ... . ... .. . .. .... .. .. .... .. .. .. .. .. ................ ...................Immunization/desensitization .. ... .. ... .. .. ... .... .. .. .. .... . .. .. ... ... .. ... ... .. .. .. .... .. ... . . .. .. . .... . .... .. .. ... .. .. ... .. .. .... .. .. ... .. .. .... . ......

Off ica surgery ... .. .... .. .... . ... .. ... . ... .. .... .. . .... .. .... .. .. .. .. . ... .. .. .. .... .. .. ... ... . .. .... .. .. ... .. . ... .. ... ... .. .. ... ... .. .. ....... ......................Physiotherapy .. ... ... .. .. ... .. ... ... .. .. .. ... ... . .... .. .. ... ... .. ... .. .. .. ... ... . ... ... .. ... ... .. .. .. .. .. ... . .. ... . .... .. . ... .. ... ... .............................

Medical counseling .. .. ... . ... ... .. .. .... .. ... .. .. .... .. ... .. .. ... . .. ... ... ... .. .. ... .. ... .. .. .... . .. .. ... .. .. ... ... ... .. .. ... .. ... .. .. .... ......................Psychotherapy/therapeutic listening .. ... ... .. .. .. .... .. ... . .. .. .. .. .. ... .... . .... .. ... ... .. .... . ... .. .. .. .... .. .. ... ... . ... .. .... .. .. .. .. .. .. .. .. .... ..

Other diagnostic or therapeutic sewices .. .. .. .. .. ... . ... .. ... ... . ... .. ... . ... ... ... .. .. ... ... .. .. . .... ... . ... ... . .... .. ... ... .. .. .... .. .. ... ... ... . .. .. ... .

Disposition

No followup planned .. .. . ... . ... .. ... ... . ... .. ... .. .. .... .. ... .. . .. .. .. .. .. ... ... .. ... ... .. .. . .... .. .... .... .. ... .. ... ... ... .. .. .. .. .. .... ..........................Return at specified time ... . ... .. .. .. .. .. .. .. .. .. . . .. .. .. .... .. .. .. .. .. .. .... .. .. .. .. ... . .. .. .. .... ... .. .. ... .. ... .. ... ... . .. .. .... .. .. ... .... .....................Return if needad .. ... . ... .. .. ... . .... .. ... .. .. ... ... ... .. .. ... .. .. ... . .... .. .. ... .. .. ... ... ... .. . .... ... . .. .. ... . ... .. . .... .. . ... ... .... .. ...... .......................Telephone followup planned ... .... .. .. .. ... .. .. ... .... .. .. ... .. .. .. ... ... .. .. ... ... .. .. .. .. .. .. .. .. ... ... .. .. .. .... ... ... ... ... .. ... . ..... . .. ... .. .............

Referred to other physician/agency ... ... .. .. ... .. .. ... ... .. ... . .. .... . ... .. .... .. ... .. . ... ... .. ... ... .. ... ... .. ... ... ... .. .. .. .. .. .... .. ... .. ... .. .. .. .. ....Returned to referring physician .... .. .. ... .. ... ... .. ... .. .. ... ... .. ... .. . .... . .. .... ... .. .. ... ... . .. .... .. .. .. .. ... ... .. ... .... .. .. .. .. .. . ... .. .. .... ..........Admit to hospital ... ... .. ... .. .. .. ... ... .. .. .. .. .... .. .. .... .. .. .. .. .... .. .. ... .. .. .. ... ... ... . .. .... ... .. .. .... .. .. .. .... .. ... . .. .. ... ... .. ..... .....................Other .. .. ... ... .. .. ... ... .. .. ... ... ... . .. .. ... .. ... .. ... .. .. ... ... .. .. ... .. .... .. .. .. .. ... ... .. .... . ... .. .. ... ... .. ... ... .. ..................................................

Numberof visits

(in thou-sands)

15,200

291,29489,377

729,74041,701

166,180

19,2107,369

26,650

6,696

251,53878,08525,704

37,99a12,56569,72124,23432,738

74,542335,219126,630

20,834

16,042

5,06412,062

5,217

Par-cant

ofvisits

2.7

51.315.822.9

7.433.2

3.41.34.71.2

44.313.8

4.5

6,7

2.212.3

4.35.8

13.159.122.3

3.7

2.80.92.10.9

8

Table 5. Number and percent distribution of office visits by patiant’s age, sex, and race, according to location of visit: United States.Janua~-Decemkr” 1975

Patient characteristic

Geographic ragionMetro-

Non-All metro-

visits North politanNortheast South West areal

politanCentral area

Number of visits in thousands

567,600 II 126,616 1150,241 ] 182,868 I 107,875 I 413,685 I 153,915

Percent distribution

100.0 I!lo.c 100.0100.0 100.0

Age.

Undar 15 years ...........................................................15-24 years .................................................................25-44 years .................................................................45-64 years .................................................................65 years and ovar........................................................

17.4I

18.815.3 13.4

19.015.623.625.116.7

58.8

17.216.927.024.515.5

61.3

14.116.C26.726.416.8

62.3

17.915.126.025.715.3

60.9

16.215.623.325.519.4

59.3

7.210.215.015.511.5

40.7

25.3 23.525.6 27.316.4 17.1

60.4 59.4

Sex and aga

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

Undar 15 years ...........................................................15-24 years .................................................................25-44 years .................................................................45-64 years .................................................................65 years and over........................................................

8.110.116.715.510.1

39.6

8.78.5

16.015.910.4

40.6

8.410.315.114.810.3

41.2

8.110.718.114.99.5

38.7

7.010.617.316.910.5

37.7

8.510.017.315.59.6

39.1

Undar 15yaars ...........................................................15-24 years .................................................................25-44 years ........................ .........................................45-64 yaars ................................................. ................65 yaars and over........................................................

9.35.28.6

10.26.3

10.14.97.6

11.46.7

10.65.38.5

10.46.4

93.8

9.15.29.09.65.9

85.1

7.05.49.49.56.3

90.5

9.45.18.7

10.25.7

89.4

15.913.422.523.314.3

10.6

2.01.73.52.41.0

54.135.3

6.83.8

9.05.48.3

10.17.9

80.2

Race and age

White .......................................................... 89.6 90.7

Under 15 years ...........................................................15-24 yaars .................................................................25-44 years .................................................................4b64 years .................................................................66 years and ovar........................................................

15.513.622.1

16.911.920.525.116.3

10.3

17.514.621.623.916.2

6.2

15.013.522.520.513.6

14.9

2.23.44.54.01.9

51.933.2

9.45.5

12.114.323.724.416.0

9.5

14.714.220.722.817.8

9.8

23.215.3

All other racas............................................ 10.4

Under 15years ...........................................................15-24 years ... .. .. ... ... . .... .. ... .. .. ... ... .. .... .. ... .. . .... .... .. ... .. .. .25.44 yearn.................................................................45-64 years .................................................................65 years and over........................................................

1.91.73.22.41.1

1.91.53.02.20.8

1.51.02.01.20.5

54.838.9

4.02.3

2.01.73.02.00.8

56.733.8

5.63.9

1.51.42.62.71.6

53.537.0

5.83.7

Sex and race

Whita femala ...............................................................White mele..................................................................All other famala ... ... ... .. ... ... . .... . .. .. ... ... .. .. .. .... .. .... .. .. .... .All other mala . .... ... .. .. ... ... .. ... ... .. ... .. ... .. .... . ... .. .... .. .... .. .

53.9 53.435.7 37.3

6.5 6.03.9 II 3.3

lLocation within the standard metropolitan statistical areas (SMSA ‘s).

9

Table 6. Number and percant distribution of offica visits by prior-visit status and seriousness of problem, according to patient’s age, sex,and race: Unitad States, January-December 1975

Patiant characteristic

II Prior-visit slatus I Seriousness of problem

Old OldSari-

TotalOus

Newpatient, patient, or

SlightlyNot

patientnaw old

very sariousseri-

prob- prob-seri-

ouslam lam

Ous

of visits(in thou-

sands)


23.4 61.7 18.9

11.211.516.823.729.4

17.1

10.39.8

14.820.828.3

21.5

All patients .... .. .. .. ... .. .... .. .. .. .... .. .. .. ... .... .. ... .. .. 567,600 100.0 14.9 48.832.4

Age—

Under 15 years ... ... .. .. ... ... .. .. .. .. . ... .. .. ... ... .. .. ... .. ... .. ... .. ... .15-24 years .. .. .. .. .. .. .. . ... .. .... .. .. .. .. ... ... ... .. .. .. ... .. .. ... ... .. .. . ..25-44 yaars ... .. .... . ... . ... ... .. ... .. ... .. .. .. .. .... .. .. .. .... ... .. .. ... .. ...45-64 yaars .. .. ... .. .. ... .. ... .. ... .. ... .. ... .. . .... .. .. .. ... ... ... .. .... .. .. .

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

99,01086,571

143,525145,43493,061

342,896

100.0100.0100.0100.0100.0

100.0

15.921.117.911.98.4

13.8

35.526.422.119.416.0

22.6

48.662.560.068.775.6

63.6

30.927.331.235.535.6

31.4

30.925.329.534.936.0

33.8

57.961.352.040.835.0

51.5

Sex and age

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

Under 15 years ... .. ... .. ... .. ... . .... .. ... . .. ... .. ... . ..... .. .. .. .... .. .. ..15-24 years .... . .... .. .. .. .... . ... .. ... .. ... .. .. ... . ... ... .. ... .. ... ... .. ... . .25-44 years ... . ... ... .. .. .. ... ... .. ... ... .. .. .. .. .. .... . .. .... .. ... .. ... ... .. .45-64 years .. . ... ... .. ... .. ... .. .. .. ... ... .. ... . ... .. .. .. .... ... .. ... .. .. ... ..

65 years and ovar ... .. ... ... .. .. .. ... . ... ... .. .. .. ... .. .. ... ... .. .. ... .. ..

46,14057,08594,65587,67657,340

224,704

100.0700.0100.0100.0100.0

100.0

16.519.915.311.0

7.7

16.7

37.024.821.119.715.9

24.6

46.655.463.669.476.5

58.7

68.964.955.844.335.8

44.7Male ... . .... . ... .. .... . ... ... ... . .. .... .. ... . ... ... .. .. ... ... .. ..

Undar 15 years ... .. .. .. .. ... .. ... .. .. .. ... .. .. ... ... .. . .. .. ... ... . .... .. .. .15-24 years .. .. .. ... ... .. .. .... .... .. .. .. .... .. .. ... .. .. .. ... ... ... .. .. .. .... .25-44 years .... ... .. .. ... . ... .. .... .. .. ... .. ... .. .. .. .... . ... .. ... .. .. ... .... .45-64 years ... .. .... .. ... . ... ... .. .. .. .... .. .. .. ... .. . ... .. .... .. ... .. ... ... ..65 years and over .. ... .. .. ... .. .. ... .. .... .. .. .. .... . .. ... ... ... .. .. ... .. .

52,87029,48548,87057,75835,721

508,672

100.0100.0100.0100.0100.0

100.0

15.423.522.913.3

9.7

14.5

34.329.624.079.016.2

23.0

50.346.953.167.774.1

62.5

12.114.820.728.231.3

19.0

10.911.417.023.928.3

17.7

13.912.314.922.030.7

17,221,716.519.8

30.931.134.636.435.0

32.1

31.027.230.834.835.5

34.4

57.054.244.735,533.7

48.9

Race and age

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

Under 15 years ... .. .. .. ... ... .. .. .. ... ... .. ... . ... ... .. .. ... ... .. .. ... .... .15-24 yaars ... . ... ... ... .. ... .. ... . .. .... ... .. .. ... . ... .. ... ... .. ... .. .. .. ....25-44 yaars ... .. .... .. ... .. ... ... .. .. ... .. ... .. ... . ... ... . ... .... ... .. ... .. ...45-64 years .. .. .. .. .... .. .. .... . ... .. ... .. . .. .. . ... .. .. .. . .. ... .... .. .. ... ... .65 years and ovar .... . ... .. ... . .. .... ... .. .. ... .. .. .. ... ... ... .. ... .. ... ..

66,16677,130

125,174131,53766,666

58,928

100.0100.0100.0100.0100.0

100.0

15.420.817.3

11.88.3

18.5

35.426.521.718.515.8

27.1

36.225.825.127.618.4

22.124.226.528.2

49.252.861.069.775.9

54.4

56.161.552.141.435.1

47.9All othar races ... .. ... .. ... .. .. ... .. ... .. ... .. .... .. ... .. .. .

Under 15 years .. .. .... .... .. .... .. .. . ... ... .. ... .. ... . ... .... .. ... .. ... ... .15-24 years ... . ... .. .... . .. ... ... .. .. ... ... .. ... .. . .. . ... .. ... ... .. .. .... ... ..25-44 years .. . ... ... .. .. .. .... .. ... . .... .. .. .. .. .... . ... .. ... ... .. ... ... .. ... .

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

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

10,8449,441

18,35113,8976,395

305,928202,744

36,96821,960

100.0100.0100.0100.0100.0

100.0100.0100.0100.0

20.324.021.712.810.8

13.416.217.420.4

43.550.153.259.670.8

64.559.556.151.4

29.728.133.942.436.1

31.433,332.138.4

56.469.651.235.633.2

51.445.151.541.8

Sex and race

White famale ... ... .. ... . .... ... .. .. .. ... ... .. .. .. .... . .. ... .... .. . .... ... ...

White male ... ... .. .. .. .. .... .. .. .... . ... .. .. .. ... ... ... .. ... .. .. .... .. .. . ... .All other female . .. ... . .... .. .. .. .. .. .. .. .. .. .. ... ... .. .. ... ... .. .. .... .. ..All other male .... .. ... .. ... .. ... .. .. .... .. .. ... .. ... .. . .... ... ... . .... .. .. .

Table 7. Number and percent distribution of office visits by principal diagnosis, selected sewices ordered cm provided, and disposition, according to patient’s age,


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

Principal diagnosis

Infective and parasitic diseasas .. . . .. . . . .. . .. . . ...000-136Naoplnsms .. .. . . .. . . .. . . .. . . .. . . . .. . .. . . . .. . .. . . . .. . . .. . .. ..l4@239Endocrine, nutritional, and metabolic

diwaws ... . .. . . .. . .. . . .. . . .. . . . . .. .. . . .. . . . .. . . . .. . . .. . . ...24O.279Marital disorders .. . .. . .. .. . . . .. . .. . . .. . . .. . . . .. . . . .. . . ...29&3l5

Dieeasea of nervous system and same

OrEans ... . . . .. . . ..i . . .. . .. . . .. . . .. . . . .. . . . .. . . . .. . .. .. . .. . ..32o.389Dleeasas of circulatory system .. . ..390. .. . . .. . . . ..39O.&6Dieeaees of respiratory system .. .. . .. .. .. . . . .. . . ..46&6l9Diseasas of dlgestlva system..,., . . . . .. . . .. . . . .. . . ..52 O.577Diseases of ~nitourlnary system, . . . . .. . . .. . . ...5WJ-629Dheases of skin and subcutaneous tissue .. ..67087O8Dlseasea of musculoskeletal system ... . .. . . . ...71&738

Symptoms and 111.definad conditions .. .. . ....780-796Accidents, poisoning, and violence .. .. . ..889. ..8OO-889Special conditions and examinations

without sickness .. .. .. .. . . . . .. . . .. . . . .. . . .. . . .. . . . .. YOO-Y13Residue12 ... .. . .. . . .. .. . .. . . .. . . . . .. . . .. . . . .. . . . .. . .. . . .. . . . .. . . . .. . .. . . .

SanAcas ordered or provided(ealected sarvices)

No services..............................................................Diagnostic services:

Llmitad history laxamination .. . . .. . . .. . .. . . . .. . . . .. . . . .. .

Ganeral historylexamination., . . .. .. . . .. . . . .. . . . .. . . . .. . .Clinical lab test . . .. . . .. . . . .. . .. . . . . .. .. . . . .. . . . .. . . .. . . .. . . . .. . . .X.ray . .. . . .. . . . .. . .. . . . .. . .. . . . .. . .. . . . .. . . .. . . .. . . . .. . . . .. . .. .. . .. . . ..Blood pressure check ... . . . .. . . .. . .. . . . .. . . . .. . . . .. . . .. . .. .. ..

Haaring or vision test .. .. . . . .. . . .. . . . .. . . .. . .. . . . .. . . . .. . . .. . .

Therapeutic services:

Drug prewriN .. . . .. . .. . . .. . . . .. . . . .. . . .. . . .. . . .. . . .. . . . .. . . . .. .Injection ... . . . .. . . .. . . .. .. . .. . . . .. .. . .. .. . . . .. . . .. . . . .. . . .. . .. . . . . ..lmmunizationldawnsitization......,.,...................Office surgety . .. . .. . . . . .. . .. . . . .. . . . .. . . .. . .. . . . .. . . .. . . . .. . . . ...Physiotherapy .. . .. . .. . . . . .. . . . .. . . . . .. . . .. .. . . . .. . . .. . . . .. . . .. . . .

Medical coun~ling .. .. . .. . . . .. . . .. . .. . .. .. .. . . .. . . .. . . .. . . .. . . .Psychotherapy/therapeutic listening ... . . .. . . .. . . . .. . .

Disposition

(ealected actions)

No followup planned ... . . . .. . . . .. . .. . . . .. . . .. . . . . .. . . .. . . . .. . . .. . . .Return at spacif ied time .. . . .. . . . . .. . . .. . . .. . . . .. . . .. . . . .. . .. . . .. .Raturn if needed .. .. . . .. . . . . .. . .. . . . .. . . .. . . .. . . . . .. .. .. .. . . . . .. . . .. .Telephone followup planned ... . . . .. . . .. . . .. . .. . . .. . . . . .. . . . .. .Referrad to other physician/agency .. .. . .. .. . . .. . . .. . . . .. . . .

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

sex, and race: United Statas, January-December 1975

Age Sex Race

All Under65

patients15

15-24 25-44 45-64 years Fe-Male White

All

yearsyears years years and male other

over

Number of vmts In thousands

567,600 ii 99,010 I S6,571 1 143,525 I 145,4341 93,061 I 342,886 I 224,704 I 508,672 1 58,928


100.0

4.02.4

4.34.4

7.9

9.914.1

3.56.6

5.05.8

4.67.3

17.82.5

2.7

51.315.822.9

7.4

33.2

6.0

44.313.8

4.56.72.2

12.34.3

13.159.122.3

3.72.8

2.1

t00.0

7.10.5

0.91.5

11.7

0.526.9

1.81.8

6.31.74.37.6

24.7

2.7

3.5

48.522.416.3

5.3

7.4

7.3

42.111.214.8

6.90.6

12.3

1.2

22.045.225.9

6.22.4

1.7

100.(

5,L

1.:

2.44.1

6.:1.:

13.12..E7..!

7.72.4

4.69.4

29.c

2.6

3.5

52.716.227.8

6.331.4

6.4

41.810.0

2.87.52.0

12.13.3

18.354.022.6

3.22.5

1.6

100.0

4.12.0

4.87.9

6.04.6

12.13.49.2

4.55.1

5.48.o

20.9

2.0

2.6

50.814.324.3

7.733.6

4.5

42.712.1

1.96.82.3

12.2

7.1

12.4

59.422.2

3.03.02.3

1Oo.c

2.23.5

5.84.4

7.416.611.7

4.57.5

4.19.04.76.7

10.2

1.7

2.2

50.614.921.7

9.041.7

5.7

46.817.4

2.38.93.2

12.65.2

9.364.121.9

3.33.1

2.2

1Oo.c

2.14.2

6.32.5

9.425.9

8.44.85.5

3.69.3

3.74.5

6.9

2.9

1.8

55.011.924.9

7.5

4s.2

7.0

47.616.8

2.86.32.5

12.1

2.5

6.070.119.2

3.13.02.7

100.0

3.82.4

5.04.6

7.69.2

12.43.38.64.8

5.84.85.0

20.0

2.7

2.6

51.915.926.0

8.4

36.9

5.2

45.414.0

3.65.71.9

12.54.5

11.662.021.5

3.72.6

2.0

100.0

4.32.2

3.24.2

8.411.016.8

3.93.6

5.45.84.4

10.6

14.4

1.8

2.8

50.415.518.1

8.727.4

7.2

42.613.4

5.98.22.7

12.0

3.9

15.554.623.5

3.73.22.3

100.0

3.92.4

4.24.5

8.110.014.0

3.56.4

5.15.8

4.67.1

17.9

2.5

2.7

50.615.522.6

7.432.9

6.0

43.413.8

4.67.02.2

12.4

4.5

13.159.222.2

3.82.8

2.2

100.0

4.91.6

4.7

3.3

6.89.415.2

3.68.2

4.55.84.78.4

16.72.2

2.6

57.517.825.1

7.135.8

6.2

51.913.7

3.94.42.7

11.31.9

13.257.523.6

2.33.51.9

LBased on Eighth Revision International Ciassifica ti”onof Diseases, A dap red for Use in the Unired Sm tes (ICDA) (reference 4).21ncludes d] other diagnoses and diagnosis “none” or “unknown.’”

NOTE: Since more than one service ordispusition was possible, figures may not add to totals

11

SECTION II

PROVIDER PATTERNS: OFFICE-BASED CARE AS RELATED TO

CHARACTERISTICS OF PROVIDING PHYSICIANS

Tables 8-14 examine office-based care fromthe perspective of the physicians who providedit. In tables 8 and 9 the focus is on doctors ofosteopathy vis A vis doctors of medicine and solopractitioners vis 5 vis physicians in multiple-member practice. Tables 10 and 11 present adata profile of the five most visited specialties:general and family practice, internal medicine,obstetrics and gynecology, pediatrics, and gen-eral surgery. Tables 12-14 focus on seven otherspecialties prominent in office-based ambulatorycare: ophthalmology, orthopedic surgery, otolar-yngology, psychiatry, dermatology, urology, andcardiovascular disease. Most of the data pre-sented in these tables are self-explanatory, al-though, for exactness in interpretation of terms,the reader should consult the definitions inappendix II. A cautionary word about the data

on seriousness of problems is indicated. Thereader is reminded that the evaluations of theseriousness of the patient’s problem drr notrepresent an objective measurement of sericms-ness applied uniformly by all office-based pro-viders. Instead, they represent the physican’sjudgment of the degree of impairment thatmight result if no care were available, and thisjudgment may reflect a concept of seriousnessunique to some extent to the specialty in ques-tion.

Tables B, C, and D isolate for study certainof the more meaningful contrasts among theoffice-based providers. Table B provides data onmean contact durations, expressed as the averagetime that particular specialists spent in facc-to-face contact with their patients. Table C showsthe proportion of practice that the physician

Table B. Number and percent distribution of office visits, mean contact duration, and standard error (S.E.) of mean contact durationby Dhwician’s specialty: Unitad States, January-December 1975. . .

Physician’s specialty

All specialties ..............................................................................................................

General and family practice .........................................................................................................Internal medicine ........................................................................................................................Obstetrics and gynecology ............. ..............................................................................................Pediatrics................................................................................................................................ .....General surgery ...........................................................................................................................Ophthalmology ...........................................................................................................................Orthopedic surgery......................................................................................................................Otolaryngology ...........................................................................................................................Psychiatry ...................................................................................................................................Dermatology ...............................................................................................................................Urology .... ...................................................................................................................................Cardiovascular diseases...........................................................................................................!....All other specialties .....................................................................................................................

lTime spent in face-to-face contact between physician and patient.

2Stand~d error (S. E.) measurements of precision are discussed in appendix 1.

ofvisits

(in

thou-sands)

567,600

234,66062,11748,07646,68441,29224,66719,31616,35514,80614,09410,8327,556

27,145

Mean

Per- con-

centtact

distri- dura-

bution tion

of(in

visits min-utes) 1

100.0 15.0

41.3 12.610.9 18.28.5 13.18.2 12.17.3 12.74.4 20.33.4 14.52.9 13.62.6 46.92.5 11.91.9 15.01.3 21.34.8 -

S.E. of

con-

tactdura-tion2

[in min-

utes)

0.31~

0.500.380.480.320.451,910,671.101.850.901,202.00

12

Table C. Percent distribution of office visits by nature of carerendered and ratio of acute to chronic morbidity, accordingto physician’s specialty: United Statesr January-December1975


All specialties .. .. .... .. ..

General and family practice . .... ..Internal medicine ... ... ... .. ... .. .... ..Obstetrics and gynecology .. . .... ..Pediatrics ,, .,, ,, ., ....,.,.., ... .. .. ... .... ..General surgery ... ... .. .... .. ... .. .... ..Ophthalmology .. .. ... .. ... . .. .... ... ...Orthopedic surgery . .... .. ... ... .. .... .Otolaryngology .. . .... .. ... ... ... ... ... .Psychiatry .. .... .... . .... .. ... .. .... .. ... ..Dermatology .... ... .. .... .. ... .... . .... ..Urology .... .. ... .... .. .... .. ... .. .... .. .... .Cardiovascular disease .. ... .. .. .... ..

Nature of care

Specialcondi-tionsand

exami-nationswith-out

sick-ness

I

Mor-bidityrelateddiag-nosis

Percent

17.8

12.97.0

57.1

32.423.414.916.010.4

*0.6*2.213.0

6.0

82.2

87.193.042.9

67.676.685.184.089.6

99.497.887.094.0

Ratioof

acuteto

chron-ic

mor-bidityl

1.21

1.530.701.26

5.721.350.571.351.07

0.390.450.560.64

lDtita do not appear in detailed tables. Obtained from re-sponses to item 8 on- PatientRecord form (see appendix III).

devoted to special conditions and examinationsu~itltou t sicI~nt’ss as opposed to care that waschietly in~’olved with the treatment of morbidstutes (i.e., conditions of illness or injury).dTublc C also permits an evaluation of theprovidur’s clinical role in terms of the acute orchronic n;lture of morbid states that a particukr

‘Sprcial conditions and examinations without sick-m,ss is a supplementary classification (codes YOO-Y1 3)of theEighth Reuision International Classification ofDi.wases, Adapted for Use in the United States (ICDA).Along with all medical and special examinations, thisgroup contains such special conditions as prophylacticinoculation and vaccination, contacts with infective andpmm+itic diseases, prenatal care and postpartum observa-tion, and surgical aftercare. The data classified astreatment of acute and chronic morbidity apply to visitswhere the principal diagnosis fell in any of the 17 majorlCDA groups (codes 000-999).

Table D. Number of office visits, percent of visits made by new

patients, and percent of visits referred to the physician, byphysician’s specialty: United States, Januarv-December1975


All specialties ... ... ... .. . ..

General and family practice .. .. .. ..Internal medicine . .. .. .. ... .. ... ... ... . ..Obstetrics and gynecology .. ... . ... .

Pediatrics .. .... .. .. ... ... .. .. ... .. ... .. ... ...General surgery . .. .... .. .... .. ... . ... ... ..Ophthalmology .. ... .. .. ..... . ... .. .. ... ..Orthopedic surgery .. .. .... . .... . .. .. .. .Otolaryngology .... .. ... . ... . ... .. .. ... ...Psychiatry .. ... ... .. ... .. .. .... . ... .. .... . ...Dermatology ... ... .. ... .. .... ... .. .. ... .. ..Urology .. .. ... ... .. ... .. ... .. ... .. ... .. .... .. .

Cardiovasculardisease.................

Numberof

visits

(inthou-sands)

567,600

234,66062,11748,076

46,68441,29224,66719,31616,35514,80614,09410,832

7,556

Per-cent

ofvisits

bynewpa-

tients

14.9

12.713.114.2

9.215.830.122.631.6

6.326.317.411.7

Per-

centof

visits

ra-ferred

to thephys;-cian

2.8

1.02.61.6

*0.74.4

;::6.55.44.16.67.5

1Data do not aDDear in detailed tables. Obtabseclfrom re-sponses to item 8 o; Patient Record form (see appendix 111).

type of specialist encountered.’ Table D pre-sents data about the proportion of visits thatwere made by patients new to the doctor’s officealong with that proportion which resulted fromreferral by another physician or agency.

Because many of the providers of office-based ambulatory care will be included in re-ports concerning individual specialties, they willnot receive further textual commentary. Carefuluse of the appropriate tables will enable readersto become informed about the provider activitythat interests them most.

eAn acute problem was defined as a conditionhaving a relatively sudden or recent onset (i.e., within 3months of the visit), a chr-orzic problem as a preexistingcondition with an onset of 3 months or more before thevisit.

13

Table 8. Number and percent distribution of office visits by physician’s type and location of practice, patient’s age, sex, and prior-visit

status, and seriousness of problem, according to physician’s type of practice and professional identity: United States,January-December 1975

Physician, patient, and visit characteristic

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

Type of practice

solo ... . .. ... . .. ... .. ... .. .. .. .. .. .. .. ... .. .. .. .. .. ... . .. . .... ... . .. .. ... .. .. . .... .. .. .. .. .. .. .. .. .. ... .. .. .. .. . ..Other .. .. ... . .... .. .. . ... .. ... .. . . ... .. .. .. .. ... .. .. ... . .. ... .. .. ... .. .. .. . ... .. ... .. .. .. ... .. . .. .. .. ... . ... . .. ..

Location of practice

Geographic region:Northeast .. .... . . ... .. ... . . .... .. ... . .. ... .. . .. .. ... ... ... . .. ... .. . .. .. ... .. .. .. .. .. .. .. .. .. .. ... .. .. .. ..North Central .. ... .. ... . ... .. .. .. .. .. ... .. . .. ... .. .. .. ... . .. . .. .. .. .. ... .. . .. ... ... . .. .. .. .. .. ... . ... . .

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

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

Metropolitan areal . .. .. . .. .... . .. .. .. ... ... . .. .. .. .. .. ... .. ... .. .. . .. ... .. .. .. .. .. ... . .. .. ... .. .. .. .. . ..

Nonmetropolitan area ... .. . .. ... . .. .. .. ... . .. .. .. ... ... . .... .... . . .... .. .. .. .. ... . .... .. . ... ... .. ... ..

Age of patient

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

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

4564 years .. .. .. ... . .. .. .. ... . ... .. . .... .. .. .. . ... .. .. .. .. ... ... . .. .. .. .. ... .. .. .. .. ... . .. .. .... . .. .. ... .. .. .

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

Sex of oatient

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

Male ... .. ... . .... .. .. .. . ... . ... .. .. .. .. .. ... . .. ... . .. .. ... .. .. ... .. .. .. . ... .. ... .. .. .. . .. .. .. .. .. .. .. .. .. .. .. .. ..

Prior-visit status

New patient ... . ... .. .. .. .. .. .. .. .. . . .. . .. .. .. .. .. .. ... . .. .. ... .. .. ... .. .. . .. . .. ... . .. ... .. .. .. .. .. . .. .... .. ..Old patient, new problem ... . .. ... ... . .. .. .. .. ... . .. ... .. . .. .... . ... .. .. .. .. .. .. .. .. .... .. . .. ... .. .. ..Old patient, old problem .. .. . .... . .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. .... . . .. .. ... .. .. .. ... .. .. .. ..


Serious or very serious . ... . .. . .. .. .. . ... . ... .. .. .. .. ... . .. ... .. ... .. .. .. .. .. .. .. .. .. .. .. ... . .. ... ... .. ..Slightly serious .. . ... . ... .. .. ... .. .. . ... .. . ... .. . .. ... .. ... .. .. .. . ... .. ... . .. ... . ... .. .. .. ... .. .. .. .. .. .. .. .Not serious .. . .. . .. . ... .. . .... . ... .. . ... .. .. .. .. . ... .. .. .. ... .. ... .. . ... .. .. .. .. . ... .. .. .. ... .. ... . .. . .. .. .. . .

II Type of

I

Professionalpractice identity


567’600II339”554I 228’046I 520’728I 46’872Percent distribution

1Oo.c

59.[40.:

22.2

26.!

32.>

19.(

72.~

27.1

17.415.3

25.3

25.616.4

60.439.6

14.923.461.7

18.932.448.8

100.0

. . .

. . .

26.828.029.7

15.5

69.9

30.1

15.2

14.624.7

27.617.9

59.640.4

13.524.362.2

19.932.247.9

100.0

. . .

. . .

15.6

24.2

35.9

24,3

77.3

22.7

20.816.2

26.1

22.714.2

61.6

38.4

17.122.160.8

17.332.650.2

100.0

57.642.5

22.5

23.6

34.4

19.6

74.9

25.1

18.015.4

25.4

25.116.2

60.639.4

15.223.461.4

18.937.749.5

100.0

85.115.0

20.3

58.88.1

12.8

50.1

49.9

11.214.1

24.5

31.618.7

56.841.2

11.824.064.2

18.839.941.4

1Location within the standard metropolitan statistical areas (SMSA’S).

14

Table 9. Number and percent of office visits, by physician’s type of practica and professional identity, according to principal diagnosis,services ordered or provided, and disposition: United States, January-December 1975


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

Principal diagnosis

Infective and parasitic diseeses .... .. ... .. .... .. ... .. ... .... .. ... ... .. .. .. .... .... .. ...OOO.l36Neoplasms.......................................................................................l4O.23gEndocrine, metabolic, and nutritional diseases................................240-279Mental disorders ................. ................................o............................2gO.3l 5Diseasesof nervous system and sensaorgans...................................320-389Disaasasof circulato~ system .........................................................39O.458Diseasesof respiratory system.........................................................~O.5l9Disaasesof digestive system.............................................................52O.577Diseasesof genitourinary system.....................................................58O%29Diseasasof skin and subcutaneous tiSue .. .... . .... .. ... ... ... .. .. .. .... .... .. ...68O.7O9

Disaesesof musculoskeletal system .................................................7lO.738Symptoms and ill-defined conditions ..............................................78O.796Accidants, poisoning, and violence .................................................8OO.999Special conditions and examinations without sickness.................. YOO-Y13Other diagnoses ..........................................................................................Diagnosis “none” or “unknown” .................................................................


No servicas...................................................................................................Diagnostic services:

Limited history/examination ..................................................................Ganeral histo~/examination ...................................................................Clinical lab test .......................................................................................X-ray .. ....................................................................................................Blood pressure check ..............................................................................EKG .................................................................. ......................................Hawing ...................................................................................................Vision test...................m...........................................................................Endoscopy ..............................................................................................

Therapeutic services:Drug prascri&d .......................................................................................Injection .............m...................................................................................Immunization/desensitization .................................................................Offica su~ery .........................................................................................Physiotherapy .........................................................................................Medical counseling..................................................................................Psychotherapy/therapeutic listening .......................................................

Othar diagnostic therapeutic wwims ............................................................

Disposition

No followup planned ....................................................................................Ratu rn at specified time ...............................................................................Return if needed ..........................................................................................Talaphone followup plannad ........................................................................Referrad to other physician/agency ..............................................................Returned to referring physician ....................................................................Admit to hospital .........................................................................................

Type of Professionalpractice identity


567,600 II 339,554 } 228,046 I 520,728 I

Percent of visits

4.02.44.34.47.9

9.914.1

3.56.65.05.84.6

7.217.8

1.41.0

2.7

51.315.822.9

7.433.2

3.4

1.3

4.71.2

44.3

13.84.56.72.2

12.3

4.3

5.8

13.1

59.122.3

3.72.80.92.1

lBa~ed on Eighth Revf~i~n International c[~~~ifi~~ti~n of Diseases, Adapted for Use in the United stateS (ICDA) (U3fW3SICe 4).

2Di~eases of the blood and blood.foming organs; complications Of pregnancy, childbirth, and the puerperiUm; COngenitd

anomalies; and certain causes of perinatal morbidity and mortality.

4.02.1

5.05.87.5

10.814.9

3.66.35.16.0

4.3

6.815.4

1.51.1

2.3

49.014.519.9

5.835.6

3.0

1.0

4.90.9

47.4

17.34.86.02.6

11.5

5.7

6.2

12.8

58.024.6

4.12.70.91.8

4.12.8

3.22.48.58.7

12.93.57.24.9

5.4

5.07.8

21.31.41.0

3.3

54.717.727.2

9.628.4

4.0

1.74.41.6

39.78.64.17.81.6

13.4

2.2

5.2

13.7

60.618.9

3.13.00.92.6

4.12.5

3.94.58.2

9.913.8

3.66.65.15.2

4.8

6.918.4

1.41.0

2.8

51.816.323.7

7.633.3

3.6

1.4

5.01.2

43.512.0

4.86.81.5

12.4

4.0

5.4

13.3

59.721.1

3.82.91.02.2

46,872

3.0*0.8

8.23.34.4

10.617.6

3.06.74.0

11.6

2.5

10.310.9

1.91.5

1.7

46.110.013.6

4.431.5

1.2

*0.71.41.0

53.8

33.51.75.5

10.610.6

7.6

10.0

10.8

52.535.5

2.81.8

●0.21.1

15

Table 10. Number and percent distribution of office visits to the 5 most visited specialties by physician’s type and location of practice,

patient’s age, sex, and prior-visit status, and seriousness of problem: United States, January-December 1975

1


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

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

Type of practica

solo .... .... . . ... ... ... . .... . ... .. .. .... .. .. .. .. ... . ... .. .... .. .. ... .. ... . ... ... ... .. .. .. ..Other ... ... . .. ... . ... ... .. .. ... .. .. ... ... ... .. .. .. ... . ... ... .. ... .. .. .... . .. ... ... .... . ...


Geographic region:Northeast .. ... . ... .. .. .. ... .. ... .. .. .. ... .. .. .. .. .. ... . ... .. .... .. .. ... .. ... .. . ...North Cantral ... .. ... .. .. ... ... .. .. ... .. .. .. .. ... ... ... . ... ... .. .. ... .. ... .. .. ..South .. .. .... .. .. .. ... ... .. .. ... ... .. . ... ... . .. .. . ... ... .. .. ... ... . ... ... .. .. .... ...West .. .. .. ... ... .. .. .... . ... . ..... . ... . .... .. .. .. .. .... .. ... . ... ... ... .. .. ... ... .. .. .

Metropolitan areal . .. .. .. ... .. ... .. ... ... .. .. .. .... .. ... . .... .... .. . ... .. ... . .... .Nonmetropolitan area .. .. ... .. . .. . . ... ... .. .. .... .. ... . .. .. .. ... . .. .. .. .. .. .. .. ..

Age of patient

Under 15 years .. .. .... ... . .. .... .. .. .. ... ... . ... . .... .. ... ... .. ... .. .. ... ... .. ... . ..15-24 years .... . ... ... ... ... .. .. .. ... ... . ... .. .... . .. .. ... .... . .... . .... . .. ... ... .. . ...25-44 years .. .. .. .. .. .... .. .. .. ... .. ... ... . ... ... .. .. .. .... .. .. ... .. ... .. ... ... .. ... . ..45-64 years .... . ... .... .. ... .. .. ... .. .. .. ... .. ... .. .. ... .. ... .. ... .. .... . .. .... .. ... .. .65 years and over .. ... ... .. . .... ... .. .. .. .. .. .. . ... ... ... . .. .. ... ... .. ... ... .. .. ... .

Sex of patient

Female .. .. . .. ... ... ... .. ... .. ... .. . .. .. .. .. .... . ... .. .. ... .. ... .. ... .. .. ... ... ... .. .. . ...Male ... .. ... .. .. ... ... . ... ... ... .. .. ... .. ... .... ... . .. . . ... ... ... .. ... ... .. ... ... .. .. .. . ...

Prior-visit status

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

Old patient, new problem .. .. . ... .. ... ... .. . ... ... ... .. .... . ... .. ... .. ... .. .. ..Old patient, old problem ... .. .. .. ... ... ... . .... .. .. .. .. .... .. .. .. . ... .. .. .. .. ..


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

Slightly serious .. .. ... .... .. .. ... . ... .. ... ... ... .. .. .. ... ... . ..... . ... .. .. ... .. .. ... .Not serious .. ... .. .. .. ... .. .. . .. .... .. .. . ... ... .. .. .. ... .... .. .. ... ... ... .. .. ... . .. .. ..

I Most visited specialties

All Generalspecialties and Internal Obstetrics

Generalfamily medicine and gyne- Pediatrics

Cologysurgety

practice


567,600 ] 234,660 I 62,117 1 48,076 1 46,684 j 41,292


100.0

59.840.2

22.326.532.219.0

72.927.1

17.415.325.325.6

16.4

60.439.6

14.9

23.4

61.7

18.9

32.448.8

100.0

72.927.1

16.833.632.417.2

58.241.8

14.416.024.127.5

18.0

59.240.8

12.7

30.556.8

17.0

35.147.9

100.0

54.345.7

29.725.125.619.6

84.615.4

3.38.8

21.1

37.928.9

59.540.5

13,1

20.966.0

28.6

33.637.8

100.0

38.761.3

23.421.0

36.818.7

81.9

18.1

2.233.3

50.311.7

2.4

88.61.4

14.2

18.067.9

7.715.776.6

100.0

41.558.5

30.825.528.3

15.5

89.1

10.9

92.76.3. . .. . .

. . .

47.752.3

9.2

41.549.3

10.129.6

60.4

100.0

63.636.5

19.824.238.617.4

72.227.8

6.313.228.7

34.017.8

60.339.7

15.8

19,165.1

18.028.8

53.2

lLocation within the standard metropolitan statistical areas (SMSA’S).

16

Table 11, Number and percent of office visits to the 5 most visited specialties, by principal diagnosis, services ordered or provided, anddisposition: United States, January-December 1975


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

Principal diagnosis

Infective and parasitic diseases .... .. ... ... . .... .. .... .. .... .. .. .000-136Neoplasms .... .. .. .. .. .. .... .. .... .. .. .. .. .. .. ... .. ... ... ... .. .... ... ... .. 140-239Endocrine, nutritional, and metabolic diseases .. .... ...240-279Mental disorders .. .... .. ... .. .... ... .. ... .. ... .. .. ..... .. .. ... ... .. ... .290-315Diseases of nervous system and sense organs .. .. ... .. ....320-389

Disaases of circulatory system .,..,, . ... .. .... .. ... ... ... ... ....390-458

Diseases of respiratory system .... ... ... .. .. .. .. ... ... ... ... ....460-519Diseases of digestive system .... . .... ... ... .. .. .. .... .. .... .. .. ...520-577Diseases of genitourinary system .. .. ... ... . .. .. ... ... .. .... ...580-629Diseases of skin and subcutaneous tissue ... .. .. .... .. .. ...680-709Diseases of musculoskeletal system .. .. .. .. ... ... ... ... .. .....71 O-738Symptoms and illdefirred conditions .. ... .. ... .. ... .... ... ..78O-796Accidents, poisoning, and violence .. ... .. ... ... ... ... .. ......800-999

Special conditions and examinations withoutsickness ,,, . .. .. ... ... ... . .... ... ... .. .... .. .. .. .... .. ... .. .. . .. .. .. ... . Yoo-’fl 3

Other diagnoses2 .... .. .... .. ... .. .... . .... .. .... .. ... . .... ... .. ... .... ... . .. .. .... .Diagnosis “none” or ''unknown' ' . ... .... ... . .... .. ... ... .... .. ... .. .. ... .. .


No sewims .. ... .. ... ... .. .. ... ... .. .. .... ... .. ... ... .. ... . .. .. .. . ... .. ... ... .. .. .. .. .. .Diagnostic services:

Limited histo~/examination ... ... ... .. .... .. .. .. .. .. .... .. .... .. .. . ... .General histo~/examination ... .. ... . .... ... ... ... .. .. ... .. .. .. .... .. .. .Clinical lab test ... ... .. .. .. .... ... ... .. .... .. .. ... .. ... .... .. ... .. ... .. .... .... .X-ray .... ... . .... .. .... . ... ... ..o.. ... .. .... . .... ....o.m.... .... .. .. ... ... ... . .. ...m.

8100d pressure check ... .. .. .... ... .. ... .. ... .. ..... ... .. .. .... .. ... ... .. ... .

Hearing test .... .. .. .... ... ... . .... .. .. . .. .... ... .. ... ... .. ... ... .... .. .. .... .. .. .Vision test ... ... .. ... . .. .. .. .. .. ... ... .. .. .. .. .. ... .. .... ... .. ... ... .. .... .. .... ..

Endoscopy ... .. .. .. .... .. .. .. .. .. .... .. ... .. ... .. .. . ... .. .... ... ... .. .. . ... .. ....Therapeutic sarvicas:

Drug prescribe .... .. ... .... .. .. ... ... .. ... ... .. .. ... .... .. ... ... ... .. .. .... .. .injection .. . ... ... .. ...o.. .. ... ..i .. ... ... .. .... .. .. .. .... .... . ... .. .... .. ... .... .. .immunization/desensitization .. .... .. .. .. .... .. .. .. .. .. .... .. .... .. .. ..

Off ice surgery ,,, ,, .,,.,,..,.,,,, ................................................Physiotherapy ... .... .. .... .. .. .. .. .. .. .. .. .... .. .. .. .. .. .... .. ... ... . ... .. .. .. .

Medical counseling .... ... .. .... .. ... . .. .. ... . .. .. .. .. .. .. ... ... ... . .. .... ... .Psychotherapy/therapeutic listening ... .. .. ... ... .. .. ..... ... . . .. .. ..

Other diagnostic and therapeutic sarvices .... .... .. .. .. .... .. .. ..... . ..

Disposition

No followup plannad .. .. .... .. .. ... ... .. .. .... ... ... .. .... .. .. ... ... .. .. .... .. ...

Raturn at specifiad time .... .. ..... .. .. ... ... . ... .... ... .. .. .. .... ... .... .. .. .. .Return if needed .,., ,,,. ,,.O.,..,,.,.. ............ .................... ..............

Telephone followup planned .. .. .. ... . .. .... .. .. .. .. .... .. .. .... .. . . .... ... . .Referred to other physician/agency .. .. .. .. .. .. .. .. .. .. .. .... ... . .. .. .. .. .Returned to referring physician .. ... .. .... .. .. .. .... ... . .... .. .. . ... .. .... ..Admit to hospital .... .. .... . ... .. .... ... .. . .... ... . .... .. .... .. .. .... ... . ... ... .. ..

I Most visited specialties

All GeneralObstetrics

specialties and Internal Ganeralfamily and gyne- Pediatrics

medicineCology

surgerypractice


567,600{ 234,660 I 62,117 I 48,076 I

4.02.44.34.4

F9

14.13.56.65.05.84.67.2

7.81.41.1

2.7

51.315.822.9

7.4

33.23.41.34.71.2

44.313.8

4.5

6.72.2

12.34.3

5.8

13.1

59.122.3

3.72.80.92.1

4.61.25.83.04.7

12.4

18.53.96.44.67.1

3.98.6

12.91.51.1

1.7

55.612.621.6

6.240.2

2.30.81.40.6

55.621.5

3.75.2

3.311.7

2.9

3.6

15.551.329.2

3.73.00.41.2

Perter

2.8

3.79.13.63.3

24.9

11.75.53.82.68.6

6.64.3

7.01.41.2

1.3

61.420.138.513.161.414.0

1.52.41.6

49.511.6

2.61.5

1.117.8

2.7

1.7

9.168.416.5

5.04.40.81.7

]f visits

3.83.22.4

‘0.6●0.5

1.2

1.1●0.718.7“0.6●0.3

6.30.9

57.11.21.6

3.1

54.125.452.4

1,8

57.4‘0.3‘0.2●0. I

1.1

35.62.3

●0.63,0

●0.211.5‘0.6

5.3

7.375.713.0

2.51.6

●0.73.2

46,6841

7.0‘0.2*0.7

1.09.9

‘0.328.3

1.31.16.1

“0.74.24.7

32.41.01.0

2.9

41.033.422.4

4.17.7

●0.22.74.20.0

41.29.3

22.93.2

*0. I

15.7●0.7

2.9

23.644.523.6

9.92.9

‘0.30.9

41,292

2.67.64.91.01.8

8.8

6.19.27.86.04.04.99.7

23.4

1.41.0

7.6

46.611.011.8

7.323.1

2.1*0.5‘0.6

1.1

27.314.6+0.916.6

1.1

11.71.98.1

10.561.618.2

1.72.91.15.8

lBasedon Eighth Revition international Classification of Diseases, Adapted for Use in the United States (ICDA) (reference).2Di~eases of the blood and blood-forming organs; complications of pregnancy, childbirth, and the PUerPerium; congenital

nnomaties; andcertain causes of perinatalmorbidi~y an~mortalit~.

17

Table 12. Number and percent distribution of office visits to 7 other selected specialties by physician’s type and location of practice,patient's age, sex, andprior-visit status, andseriousness of problem: United States. Januarv-December 1975


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

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

Type of practice

solo .. .... .. .. .... .. ... .. ... .. ... .. .. ... .. ... .. .... .. ... . .... . .... .Other .. ... ... ... .. .. ... .. .... . ... ... ... .. .. ... ... .. ... ... .. .. ... ..


Geographic region:Northeast ... .. .. .... .. ... .. ... .. ... .. ... .. .... .. .. ... .. ...

North Central .... ... ... . ... ... .. ... .. .. .. .. .. .. .... .. .. .South .. .. ... .. ... ... ... .. ... .. .. .. .... .. ... .. ... .. .... .. ....West ... .. ... .. ... ... ... .. .... .. .. .. ... .. ... ... ... .. ... .. ... ..

Metropolitan areal . .. ... .. ... ... .. .. ... ... .. .. .. .... .. ... .Nonmetropolitan area., . .. .... .. .. ... ... .. ... .. ... .. .... .

Age of patient

Undar 15 years.

.... .. ... .. ... ... .. .. ... .. ... .. .... . .... .. .. ..15-24 years .... .. .. .. .... .. ... .. ... . ... ... . ... .. ... .. ... .. .. ...2544 years ... .. ... .. ... .. .... .. .. .. ... ... .. ... .... .. .. ... . ....46-64 yaars .. ... .. .. ... ... .. ... ... .. .. ... ... .. .. .... ... .. . .... .65 years and over .. ... .. ... .. .... . .... .. ... .. ... .. ... .. .... .

Sex of patient

Female .. ... ... ... .. ... ... ... .. .. ... ... .. ... .. ... .. ... ... ... . .... .Male ... .. .... . .... ... ... .. ... .. ... .. ... .. .... . ... ... ... . .... .. ... ..

Prior-visit status

New patiant .. .. . .. . .... .. .... .. ... .. ... .. ... .. ... ... ... . ... ...Old patiant, new problem ... .. ... .. .... .. ... ... .. .. ... .

Old patient, old problem .... . .... .. ... .. .... . ... .. ... ..


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

Not serious .. .. ... ... .. ... .. ... ... .. .. ... ... ... .. ... .. ... .. ... .

I Other selacted specialties

Allspecialties Ophthal- ;;:: Otolaryn- Psych i- Darma-

Cardio-

mology go logy atry to logyUrology vascular

surgery disease


567,600 I 24,667 I 19,316 \ 16,355 [ 14,806 [ 14,084 I 10,832 j 7,556


100.0

59.840.2

22.3

26.532.219.0

72.9

27.1

17.415.325.325.616.4

60.439.6

14.9

23.4

61.7

18.9

32.4

48.8

100.0

65.234.8

29.7

19.825.425.1

84.615.4

13.712.818.728.726.1

60.139.9

30.110.2

59.7

17.9

24.2

57.9

100.0

40.859.3

20.817.0

44.617.6

81.218.8

17.316.529.627.6

9.1

45.254.8

22.67.1

70.3

24.0

37.8

38.2

100.0

21.478.6

13.622.4

37.826.2

69.930.1

24.212.926.922.413.6

53.546.5

31.68.3

60.1

17.5

43.6

38.9

100.0

85.314.7

38.813.727.619.9

97.4*2.7

5.115.854.921.4

2.8

59.740.3

6.3*2.2

91.5

64.025.9

10.1

100.0

60.139.9

22.65.0

49.622.8

79.820,2

9.226.524.924.115.4

60.539.5

26.314.4

59.3

12.0

33.9

54.1

100.0

37.962.1

18.912.2

39.129.7

74.725.3

7.27.7

24.031.829.3

42.257.9

17.47.2

75.4

18.3

37.0

44.7

100,0

48.551.5

45.610.532.611.3

100.0

‘1.4●2.410.343.942.1

48.751.3

71.711.6

76,7

32.4

42.1

25,6

lLocation within the standard metropolitan statistical areas (SMSA’S).

18

Table 13. Percent distribution of office visits to 7 other selected specialties by the principal diagnoses most commonly rendered by their

practitioners: United States, January-December 1975

Specialty, principal diagnosis, and I CDA codel

Ophthalmology ... .. ... . .... .. .... .. ... .. .... .. ... ... .. .... .. . .... ... .. .. .... ... .. .. ... ... .. .. .. .. .. ... . .... .. ... .. .... .. ... .. ... .. .............................................

Diseases of nervous system and sense organs .. .. ... . ..... ... . ... ... ... .. .. .... .. ... ... .. .. .... .. ... ... .. .. ... . .... .. .... .. ... .. .. ... ... .. .... .. ... .. ... .. ... ...32O.389Special conditions and examinations without sickness ... .. .. ..... .. . .... .. ... . ... ... ... .. .... . ... .. .... .. .. ... ... .. .... .. ... .. ... ... .. ... ... .. ... ... ... YOO-Y13Accidents, poisoning, and violence .... .. .... .. ... ... ... ... .. ... .. ... .. ... ... .. ... ... ... . .... ... .. .. .... .. .. .. .... .. ... .. ... .. .... .. .. ... ... .. .... . ... .. ... .........8OO.999Other diegnoses ... ... .. ... ... ... .. .... .. ... . .... .. ... .. ..... . ... .. .... .. ... ... ... . ... ... ... .. .... .. .. ... ... .. ... .. .... .. .. .. ... .. .... .. ...................................................

Orthopedic surgery .. ... ... ... ... ... .. ... .. .... .. .... .. .. ... ... .. ... .. .... .. .. .. .... . ... .. .. ... . ... .. ... ... ... ... .. .. .. ... .... .. ... .. ... .. ....................................

Accidents, poisoning, and violence ... ... ... .. ... ... ... .. ... ... ... . .... . .... .. .... .. .. .. .. .... ... .. ... .. .. ... ... .. .. ... ... ... . .... .. ... .. ... ... ... .. ... .. .. .........8OO.999Diseases of musculoskeletal system ..... ... .. .. .... .. ... ... ... ... ... .. .. ... ... .. ... ... .. .. ... ... .. .. .... .. ... .. ... .. ... .. ... ... ... .. .. ... ... ... .. .. .... .. ...........7lO.738Special conditions and examinations without sickness .. .. ... ... ... .. ... ... ... . ... ... ... . .... .. .... .. ... .. ... .. ... .. .... .. ... .. ... .. ... .. ... .. ... ... .. .. YOO-Y13Symptoms and ill-defined conditions ... ... .. .. ... .... .. ... .. ... ... ... .. .... . .. .. .. ... .. .... . .. .. .. .... . ... ... .. ... .. ... ... .. ... .. ... ... .. ... ... .. ... ... .. .. .......78O.796

Other diagnoses ... ... .. ... ... ... .. .... .. ... .. .... .. ... .. ... ... ... .. .... ... .. ... .. ... ... .. ... ... ... .. ... ... .. ... ... . .. .. .. ... .. ... .... .. ...................................................

Otolaryngology ... .. ... .... .. .. . ... ... ... .. ... .... . .. .. .. ... ... .. . .. .. . .... .. ... .. .... .. ... ... ... .. ... ... ... .. ... ... .. .. .... .. ... .. .... .........................................

Diseases of nervous system and sense organs . .. .... ... ... ... .. .. .. .. ... .. .... . .... .. ... .. ... ... ... .. ... .. .... .. ... .. .... . ... .. .... .. .... .. .. ... ... .. ... .. .... ..32 O.389

Diseases of respiratory system .. ... .. ... .... .. .. ..... .. ... .. .... ... . ..... . ... ... ... .. .... .. .. ... ... ... ... . .... ... .. .. .... .. .. ... ... ... ... .. ... .. ... ... ................46O.5l9Special conditions and examinations without sickness .. .. .... . .... .. ... .... .. .. ... .... . .... .. .. ... ... ... ... .. .. .... ... . ... .... ... .. ... . .... .. .... .. ... . YOO-Y13Symptoms and ill-defined conditions . .... .. ... ... ... .. ... ... ... .. .... .. ... .. .... .. ... .. ... .. .... .. ... .. .... .. ... .. .... ... .. .... .. .. ... ... ... ... .. ... .. ... .. .......78O.796

Other diagnoses .... ... . ..... . .... ... ... .... .. ... .. .... .. .... .. ... . ..... .. ... .... .. ... .. .... . ... ... .... . .... . .... .. .... .. ... .. ... .. ... .....................................................

Psychiatry .. ... .. ... .. .... .. .... . .... .... . .... .. ... .. .... .. ... .. .... .. ... .. .... . .... . .... .. ... .. .... . .... .. ... ... .. ... ... .. .. .. .. ..................................................

Mental disorders . .... .. ... .. .... .. .. ... ... ... ... .. ... .. .... .. ... .. .... ... .. .. ... ... ... . .... .. .... . .... .. ... .. .... .. ... .. .. ... ... ... .. .. ......................................29O.3l5Symptoms and ill-defined conditions . ... .... .. ... ... .. .. .... .. ... ... .. .. .. . ... .. .. .... .. ... .. ... .. .... .. ... . .... .. ... .. .... . .... .. ... .. ... .. ... .. ... .. .. .. ........78O.796

Other diagnoses ... .... .. .. ... ... ... .. ... .... .. ... .. ... .. .. .. ... .. ... .. .... .. ... .. .... .. ... .. ... .. ... .. .... .. . ... .. ... .. ... ... ... .. ... .. ...................................................

Dermatology .. ... ... ... .. .... ... .. .. ..... ... . ... ... .. ... .. .... ... .. .. ... .... .. ... .. ... .. .. .... .. .. .. .. . ... .. .. ... .. .... . .... .. ... . ...............................................

Diseases of skin and subcutaneous tissue .. .... . ..... . ... ... ... .. ... .. ... .. .... .. ... .. ... ... ... .. .. .. .... .. ... .. .. ... ... .. ... ... .. ... . .. . ... ... .. ... .. ... .. .... . .680-709

Infective and Darasitic diwases .. ... ... ... . ... ... ... ... ... .. ... .. .... . .... .. .... .. ... . ... ... .. ... ... .. ... .. ... .. ... ... .. ... .. ... ... .. .. .... .. ... . .... ..................OOO.l36Neoplasms ....~. .. ... ... .. ... .. .... . .. ... .. .... .. ... ... ... .. ... .... . ... ... ... .. ... .. .... .. .... . ... .. .... . ... ... .... . .. ... ... .. ... .. .............................................f4O.239Other diagnoses . .... .. .. ... .. .... .. ... .. ... .. .... .. .... ... .. .. ... ... ... ... .. ... ... .. .. .... .. ... ... .. .. .. .... .. ... .. ... .. ... .. ... .. .... ....................................................

Urology .. ... ... .. .... . ..... . .... .. .... .. ... .. ... ... .. .... ... .. ... ... .. ... .. .... .. ... .. .... .. ... .. ... .. ... .. .... ... .. ... .. ... ........................................................

Diseases of genitourinary system .. ... ... ... .. .. ... .. .... .. .... .. .. ... ... ... .. .. .... .. ... .. .... ... .. . .. .. ... ... .. ... ... .. ... .. ... ... .. ... .. .... . ... ... ... ............58M29Special conditions and examinations without sickness ... .. ... .. ... .. ... .. .... .. ... . .... .. ... ... ... .. .. .. .. ... ... ... ... .. .. ... .. ... .. ... ... .. .. ... .. ... . YOO-’fl3

Symptoms and ill-defined conditions ... .. ... .. ... ... ... ... .. ... .. ... .. .. .. . ... .. .. .... .. ... ... .. .. ... ... .. .. ... ... .. .. ... .. ... .. ... ... ... . .. .... .. ... .. ... ........78O.7%

Neoplasms .... .. .... .. ... .. ... ... ... .. ... .. .... . .. .. ... ... .. ... .. ... .. .... .. .. .. ... ... ... . ..... . .... . ... .. .... .. ... .. .. ... ... . ... ...............................................l4O.239Other diagnoses .... .. .. ... ... ... ... ... .. .... . .... .. ... .. .... ... . ... ... .. ... ... .. .. ... .. .... .. ... .. ... .. ... .. ... .. .... .. .. ... .. ... . ..... ...................................................

Cardiovascular disease . ... ... .. . ... .. ... .. .... .. ... ... ... . .... .. ... . ..... . .... . .... . ... ... ... .. .. .. . ... .. .. .. .. .. .. .. ... ... ... . ... ... ... .. ... .. ... ................ ...........

Diseases of circulatory system .... .. .. .. .. ... ... .. ... ... .. ... ... .. .. ... .. ... ... .. .... .. ... . .... .. ... .. .... .. ... . ... .. ... .. .... .. ... . ... ... .. .... .. .. .. ................39O458

Diseases of respiratory system .. .... . .... ... ... .. .... .. ... .. ... .. ... ... ... .. ... ... .. .. ... .. ... .. .... . .... .. ... .. ... .. ... .. ... .. ... .. ... .. .. .... . ... .. .................4o.5l9Special conditions and examinations without sickness .. . .... ... ... . .... . .... .. .. ... ... .. ... .. ... ... .. .. ... ... . .... .. ... ... ... .. ... . ... .. ... .. .... .. .. .. YOO-Y13Symptoms and ill-defined conditions . ... .. . ... ... .... . ..... . ... .. .... .. .. ... ... .. ... .. ... .. ... .. ... .. .. .... .. ... ... ... . ... ... ... .. .. ... ... .. .. ... ... .. .... . .......78O.7WOther diagnoses .. . .... .. ... .. ... .. .... .. ... ... ... .. ... ... ... .. .. . .. .... ... .. .. ... .... . .. ... ... ... . .... .. ... .. ... .. .... . .... .. ... .. .... . ... ..... ................................ ...........

Per-

centdistri-mrtion

ofvisits

100.0

72.414.9

3.79.0

100.0

37.432.816.0

3.010.8

100.0

37.233.610.4

6.312.5

100.0

91.44.64.0

100.0

62.417.011.1

9.5

100.0

62.813.0

9.8

6.77.7

100.0

57.3

6.36.05.3

25.1

1Based on E@/l t~l Re~i~ion In ternation~l c[a~~ifi~~tiersofD&~s@, AdaptedforUSeintheUnitedS:@tes(ICDA) (reference 4).

19

Table 14. Percent of office visits to 7 other selected specialties, by selected services ordered or movided and disoostion: United States.

Visit characteristic

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

Services ordered or providedl

(selected services)

Diagnostic sarvices:Limited history /examination . ... .... . .... .. .. ...General history/examination .. .. ... ... ... .. ... ..Clinical lab test .. .. ... ... ... .. .. .. .... .. .... . ... ... . .. ..X.ray . .. ... ... ... .. ... ... .. ... .. ... .. .. ... ... ... .. ... ... .. ...

Therapeutic services:

Drug prescribed .. .. ... . .... . ... ... .. ... ... .. ... ... .. .. .injection ... .. ... .. ... .. ... .. .... .. .. .. .... .. ... .. ... .. .. ...Office surge~ ... .. .. ... .. ... .. .... . .... .. ... .. ... .. .... .Medical counseling .. ... ... . .... . .... .. ... .. ... .. ... ..

Disposition

(selected actions)

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

Return at specified time .... . .. ... .. .... . .... .. ... .. ... .Return if needed .. .. .. .. .... .. ... .. .... . ... . .... ... .. ... ... .Referred to other physician/agency or

admit to hospital . .. ... ... .. ... .. ... .. ... .. .... . .... .. .. ..

January~December 1975

Other selected specialties

All

specialties Ophthal-Ortho-

Otolaryn- Psychi- Derma-Cardio-

mologypedic

gology atry tologyUrology vascular

surgery disease

Number of visits in thousends

567,600I

51.315.822.9

7.4

44.313.8

6.712.3

13.159.122.3

5.0

24,667 ] 19,316 I 16,355 I 14,806 I

40.715.0

2.5

*t3.3

16.3●0.6

4.94.4

17.6

60.619.5

2.7

56.910.2*1.1

36.9

17.47.2

13.016.8

11.1

65.115.3

5.5

Percent of visits

54.312.4

4.0

5.8

51.19.8

11.89.3

14.249.727.9

5.7

4.4● 2.3‘0.6

*0.6

24.3●1.2●0.2

5.9

3.390.6

7.6

●2.1

10ther diagnostic and therapeutic services were provided as fOllOWS:

PercentService

Vision test .... .. ... .. .... .. .. .... .. .. .... ..Hearing test . ... .. ... ... .. .... . .. ... ... ... .Psychotherapy .. ... . ... ... ... .. ... ... ... .Endoscopy .. .. ... ... .. .... .. .. ... ... .. ... ..EKG ... .. .... .. .. .. .... . .... .. ... . .. . ... .... . .

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

Physiotherapy ... .. ... .. .. .... ... .. .. ... ..

Specialty

OphthalmologyOtolaryngologyPsychiatryUrologyCardiovascular diseaseUrologyCardiovascular diseaseOrthopedic surgeryDermatology

Ofvisits

74. I13.489.9

8.941.510.672.5

5.25.5

14,094I

40.93.35.4

*1.8

50.87.0

36.612.6

10.4

61.326.2

“0.8

10,832 I

57.310.967.0

8.4

38.8*2.720.4

7.6

●3.671.418.4

10.4

7,556

47.022.125.2

14.8

43.57.9

●0.55.9

*4.578.2

9.6

●4.9

20

SECTION Ill

CLINICAL PATTERNS: OFFICE-BASED CARE AS RELATED TO

I PATIENTS’ PRESENTING PROBLEMS

I Survey findings contain two maior sourcesof information a~out the clinical _content ofoffice-based practice. The first source—the pa-tient’s principal problem, complaint, or symp-tom as expressed in his or her own words–is thesubject of this section. The second source—thephysician’s principal diagnosis–is the subject ofsection IV.

The problems, complaints, or symptomspresented by patients have been identified andcoded according to a nosology specifically devel-oped for the NAMCS.3 A maximum of threeproblems were coded for each patient visit. Thedata in this report represent only the first-listedor principal problem.f

The terms “problem” or “reason for thevisit” are used comprehensively to apply to anymotivation that brought the patient to thedoctor’s office–whether the cause was morbid-ity related (i.e., related to an illness or injury) ornot (e.g., a routine examination). The descriptor“morbidity-related problem” will be used inter-changeably with the terms “complaint” or“symptom. ”

Data on presenting problems appear in tables15-19. Table 15 lists the 50 problems mostfrequently presented to office-based physicians.The rank ordering of problems in this and othersimilar tables is not absolutely reliable sincesome estimates may not be statistically differentfrom other near estimates due to samplingvariability. Prominent in the list were problemsnot directly related to illness or injury. Indeed,the three most common reasons for officevisits—surgical aftercare, nonspecific physical ex-aminations, and pregnancy examinations–fallinto this category. Prominent among the mor-

‘Recognizing that complaints or symptoms areprobably more often presented in clusters rather thansingly, future NAMCS publications will include second-

1 and third-listed symptoms in their description of pre-senting problems.

bidity-related problems were problems of theextremities and back: pain, sprain, swelling,fracture, etc. Complaints of this nature com-prised a substantial 9 percent of all visits. Thecommon complaints of sore throat, cough, andcold were also prominent, accounting for an-other 7 percent of visits.

The remaining tables in the “problem” seriescenter attention on morbidity-related problems.The data in table 16 describe complaints interms of the age and sex of the patients whopresented them. Table E compares in order offrequency the 10 morbidity-related problemsmost commonly presented by females with the10 most frequently presented by males.

In the top 10 complaints, females differedfrom males chiefly in the precedence given toabdominal pain as the second most commonreason for the visit and in the inclusion ofheadache and fatigue. Males differed from fe-males chiefly in the relative precedence given toproblems of upper extremities and back and inthe inclusion of skin wounds and chest pain.

Of other commonly occurring complaints,females were much more likely than males tocite gain in weight and symptoms of nervousnessor depression as major problems leading to thevisit (table 16).

Table E. Ten morbidity-related problems most frequently

Rank

1

2

3

45

6789

10

prasented, b)

Female

Problems, lower extrem-ity

Abdominal pain8ack problems

Sore throatProblems, upper extrem-

it yCoughHeadacheFatigueAllergic skin reaction

Cold

sex

Male

Problems, lower extrem-it y

Back problemsProblems, upper extrem-

it ySore throatCough

Abdominal painWounds of skinPain in chestCold

Allergic skin reaction

21

Data on prior-visit status are generally usefulin identifying whether a patient was “new” or“old” to the doctor’s office practice. In thedescription of presenting problems (table 17),the data on status have a special potential in thatthey permit a focus on visits where the patientpresented a problem which the doctor had notencountered before with that patient. Thesenew-problem encounters included any problempresented by a new patient along with any newproblem presented by an old patient. Visits byold patients with old problems were in realityreturn visits that the patient made in the courseof the year as the result of a new-problempresentation.

Since it is at the new-problem encounterthat complaints or symptoms receive maximumattention—at this encounter, for example, thatthe volume of diagnostic activity is probably thegreatest-future NAMCS publications will isolatethis category of encounters for special study.For present purposes, the listing that appears intable F will serve to demonstrate the effect ofreexamining morbidity-related problems by theirfrequency of appearance as new-problem en-counters.

Of the 25 most common morbidity-relatedproblems the 5 judged to be most serious inpotential–i.e., most frequently evaluated by thephysician as serious or very serious–were symp-toms of depression, shortness of breath, pain inchest, high blood pressure, and fatigue (table17).

For 13 of the most common complaints orsymptoms, table 18 shows the diagnoses mostfrequently assigned to the problem by thephysician. Of the diagnostic procedures mostprominent in office-based practice–limited ex-amination, blood pressure check, clinical labtest, general examination, and X-ray–table 19shows the frequency with which the procedurewas ordered or provided for each of the 25 mostcommon morbidity-related problems.

Table G completes the statistical description

Table F. Number of new-problem encounters by 25 morbidity-related problems most frequently presented at these en-

counters: United States, January-December 1975-

Rank

12

34

56789

1011121314

15

16

1718

19

202122232425

Morbidity-related problemand NAMCS codel

All new-problem encounters . .. ...

Sore throat . .. ... .. .... . .... .. .... .. ... ... ... .... . ....520Pain, swelling, injury–lower

extremity ..........................................400Abdominal pain .. ... .... .. .. ... .... .. .... .. ... . ...540Pain, swelling, injury–upper

extremity . .. ... ... .. ... .. .... .. ... . .... .. ... .. ....405Cough ... .... .. ... ... ... .. .. ... ... .. ... ... .. ... .. ... ....3l 1Allergic skin reaction .. .... ... ... .. ... .. .... . ...1 12

Pain, swelling, injury–back region . .. ....415Cold .. .... .. ... ... ... . .... . .... .. ... ... ... .. .. ... ... .. ...3l2Fever .. ... .... . ... .. ... ... .. ... ... .. .... .. ... ... . .... ... .002

Wounds of skin .. ... .... .. .. ... .. .. .. ... . ..... .. ... 116

Earache .. .... .. .. ... ... .. .... ... .. .. ... ... .... ... ......735Headache .. .. .. ... ... .... ... . .... .. .... . .. ... ... .. ....056Pain in chest .... .. .... . .. .... .. .. .. .... .... .. .... ....322Swelling, mass of skin .... .. ... .. .... .. ... .. ....1 15

Pain, swelling, injury-face and

neck . .. ... .. ..... .. .... ... .. ... ... .. ... ... .. ... .. ....4lo

Vision dysfunction (exceptblindness) . .... .... . .... .. .. ... .. ... ... .. .... .. ....701

Vaginal discharge ... ... .. ... .. .. .... ... .. . .. ... ...662Fatigue . ... ... .. .. .. .... .. ... .. ... .. ... ... ... .. .. ... ....m4

Nausea and vomiting . .. .... .. ... .. ... .. .... .. ...572

Vertigo .. ... .. ...... . .. ... .... .. .. ... ... .. ... .. .... ... ..069Menstrual disorders .... .. ... ... ... . ... .. ... ... ...653Skin irritation (nonallergic) .. ... ... .. ... .. ...ll3Flu ... .... .. ... .... .. .. .... .. ... .. ... ... ... . ..... .. .. ... ..3l3Eye pain and irritation ... . ... .. .. .... .. .... ....705

Othar symptoms referable to urinarytract n.e.c. Includes bladdertrouble and passad stones .. .... .. .... .. ...620

Numberof newprob-lem

encoun-ters

(inthou.

sands)

217,655

9,733

9,717

8,152

7,6887,3087,2897,0025,7625,1625,139

4,8494,6784,0713,852

3,713

3,2553,0832,8092,135

2,1332,0872,0702,0581,816

1,625

lprob]e~~ we identified and coded according to a ~YmPtOmclassification developed for use in the NAMCS (see reference 3).

of presenting problems by showing the averagetime that physicians spent in face-to-face con-tact with patients who presented a given com-plaint or symptom.

22

related Droble”ms most freauentlv presentad by patients: United States, Jenuaw-Dacember 1975

Table G. Number of office visits. mean contact duration, and standard error (S. E.) of mean contact duration, by the 25 morbidity-

Rank

12345678

1:1112131416161718

z21

22232425

Morbidity-related problem and NAMCS codal

All problems .... ... .. ... ... .. .. .. .. ... .. ... .. ... .... .. ... .. .. ... .. ... ... .... . ... .. ... .. .... .. ... ... .. .. ... .. .... .. ... .. ... .. ..

Pain, swelling, injury–lower extremiW .... .... .. ... .. ... ... .. .. .. .. .. ... ... ... .. ... ... .. .. ... ... .. ... .. ... ... .. ... ... .. ...4OOPain, swelling, injury–back region .. .. .. ... .. .. . ... .. .... .. ... ... . .. .. ... .. ... .. ... .. ... ... .. ... ... .. ... ... . .... ... .. ... .. ...4l5Sore throat ... ... .. ... .. ... .. .... .. ... . .... .. .... .. ... .. ... ... ... .. ... .... .. .. .... .. ... ... .. .... . .... .. ... .. ... ... ... . ... ... .. ... ........52OPain, swelling, injury–upper extremity .. .. .. .. ... ... .. ... ... .. ... .... .. .. ... ... .. .... . .... .. .. .... .. ... .. ... .. .. ... ... ...4O5Abdominal pain . .... . .... .. ... .. .... ... .. .. .... .. .. .. .... ... . .... ... .. ... .... .. .. ... ... .. .. ... ... ... .. ... .... . ... .. .... .. ... .. ... .. ...54OCough .... ... ... .... . ... .. ..... . ... .. . ... ... .. .. .... .. .... .. ... .. ... ... .. ... ... ... .. ... .. ... ... ... .. .. ... ... ... .. ... ... .. ... .. ... ........... 311

Fatigue .. .. ... ... ... ... .. ... ... ... ... ... .. ... .. .... .. ... .. ... ... ... .. ... .. ... ... .... .. .. .. .... .. ... .... . ... ... . .... .. ... ... .. ..............OO4Headache ,, ., .,, !.. .... .. ... ... .... . .... ... .. .... .. ... .. .... .. ... ... ... .. ... .. .... .. ... ... ... .. ... .. .... . .... .. .. ... ... .. ... .. ... ... ... . ..056Allergic skin reaction .. .. .... . .. .. .. ... .. .... .. ... ... .. ... ... ... .. .... .. ... .. .... . .... .. ... .. .... .. ... .. .... ... . ... ... .. ... ... ... ...l 12Pain in chest .... . .... ... ... ... ... .. ... .... . ... ... ... .. ... ... ... .. .... .. ... .. .... .. ... .. .. ... ... .. .... .. .. ... ... .. .. .. .. ... .. ... .. .......322Cold . .... .. ... ... ... ... .. ..... .. ... .. .... .. ... .. .... .. ... .. .... .. ... ... ... .. .... .. .. .... .. .... .. ... ... ... .. .. ... ... .. ... ... .................3l2

Earacha ,,, .. .. ... .. ... .. .. ... . .... ... ... .. ... ... ... ... ... ... . .... .. .... .. .... .. ... .. ... ... ... .... .. ... .. .. ... .... .. ... .. ... ... .... .. ...... 735

High blood pressure ... ... ... .. ... ... ... ... .. .... .. .... .. ... .. .... .. ... ... ... .. ... .. .... .. .... ... .. ... .. .... .. .. .... ... .. .. ... ... .. ..205Pain, swelling, injury–face and nack .. .. ... ... .. ... ... ... ... .. ... ... .... .. ... .. ... .. ... .. ... ... ... .. .... .. ... .. .... . ... ....41 OWounds of skin . .. ... .... .. .... ... .. .. .... .. ... .. .. .. .. ... .. .... .... . .... .. ... .. ... .. .... .. .... .. .. ... ... .. .... .. ... .. ... .. ... .. .... ...l 16Vision dysfunction (except blindness) ... ... ... .. ... ... .. ... ... .... . ... ... ... .. ... .. .... .. ... .. ... .. .... .. ... .. ... .. .... . ..7ol

Fever ... ... . .... .. ... ... ... .... .. ... . .... .. ... ... .... ... .. ... .. .... .. .... .. .. ... .... .. ... ... .. .. .... .. ... .. .... .. .. ... ... .. .................OO2Vertigo ... .. ... .. .. .. ... .... .. .. .... ... .. ... ... .. ... .... .. ... .. ... .. .... .. ... .. ... ... ... . .. ... .. ... .. ... .. ... .. .... .. .. ... ... ..............O69Swelling, mass of skin .. .... .. .... .. ... .... .. ... .. .... .. ... .. .... . ... ... .... . .... .. .... . ... ... ... .. .. .. ..... . .... .. ... ... .. .. .... ...l 15Weight gain ... .. .. .. ... ... .. ... ... ... .. .... .. .... .. .. .. .... .. ... .. .... .. ... .. .... .. .. ... ... .. .... . .... .. .... . ... ... ... .. ... . .... .. .......OlOShortness of breath .. .. ... ... ... ... ... .. .... . .... .. ... .. ... .. ... ... ... .. .... .. ... .. ... ... ... . .... .. .. ... ... ... .. .. .... .. .. ... ... ....3O6

Vaginal discharge .. .. ... .. ... .. .... .. ... .. .... .. ... .. .... .. ... .. ... .. ... .. .... ... ... . .... .. ... . .... .. ... . .... ... ... . .... .. .. ... ... ....662Symptoms of nervousness ... ... .. .... ... .. ... . ..... . .... .. .... . .... . .. .. .. ... .. .... .. ... .. ... .. .... .. .. .. ... .. ... ... .. ... ... .. ..81 OSymptoms of depression ... ... ... .. ... ... .. ... ... ... . .... .. ... .. .... . .... .. ... .. .... ... .. . .... .. ... ... ... .. .. .. ... ... ... .. ... ....8O7Skin irritation (nonallergic) . ... ... .. ... ... ... .. ... ... ... .. .... .. .... .... ... .. .. .... .. ... . .... .. ... .. ... ... .. .. .... .. .. ... ... .. ..l 13

Number

ofvisits

(inthou-sands)

567,600

21,22917,06715,27914,93314,86213,60710,46610,198

9,8279,7519,453

7,7547,7157,5557,5337,022

7,015

6,3155,9885,7775,6604,9994,5674,463

3,921

Meancon-

tactdura-tion2

(inmin-utes)

15.0

14.715.510.514.215.912.0

16.416.611.318.011.2

10.513.415.611.223.1

11.815.513.613.818.2

15.519.637.812.4

S.E.of

mean

con-tact

dura-tion3

(in

min-utes)

0.31

0.37

0.580.290.580.370.38

0.530.570.600.480.43

0.47

0.480.640.372.30

0.470.670.550.881.03

0.601.241.77

0.57

lProblems are identified and coded according to a symptom classification developed for use in the NAMCS (see reference 3).2Time spent in face-to.face contact between physician and Patient.3Standard error (s-E.) measurements of precision are discussed in appendix 1.

23

Table 15. Number, Darcent. and cumulative percent of office visits, by 50 principal problems most frecwentlY presented by patients:

Rank

123456789

1011121314151617181920212223242526272828303132333435363738394041424344454647464950

United States, January-December 1975

Principal problem and NAMCS code

Surgical aftercere ..................................................................................................................986Physical examination ....................................................................................................9oo. 901Pregnancy examination .............................................................................c...........................9O5Pain, swelling, injury-lower extremity ........... ......m...............................................................4OOPain, swelling, injury-beck region ........................................................................................4l5Sore throat ...........................................................................................................................52OPain, swelling, injury-upper extremiW .................................................................................4O5Abdominal pain ....................................................................................................................54OCough ...................................................................................................................................3llVisit for medication ..............................................................................................................9loGynecologic examination .....................................................................................................Fatigue

904................o................................................................................................................oo4

Headmhe ..............................................................................................................................O56Allergic skin reatiion ............................................................................................................ll2Pain in chest .........................................................................................................................322Cold ......................................................................................................................................3l2Well-baby examination .........................................................................................................9MEarache.................................................................................................................................735High blood pressure . .... .. .. .. .. ... ... . .... ... ... . ... .. .. ... . .... ... .. .. ... .. .. .. ... ... .. .. .. .. ... . .. .. .. .... .. .. .. .... .. .. ... ...2O5Pain, swelling, injury-face and neck.....................................................................................4loWounds of skin .....................................................................................................................l 16Eye examination ...................................................................................................................9O8Vision dysfunction, except blindness....................................................................................7OlFever .......................................... ..........................................................................................oo2Vertigo .................................................................................................................................O69Swelling, massof skin ...........................................................................................................l 15Weight gain ...........................................................................................................................010Shortness of breath ...............................................................................................................3O6Vaginal discharge..................................................................................................................662Symptoms of newousness.....................................................................................................81 OSymptoms csfdepression.......................................................................................................8O7Skin irritation (nonallergic) .......................................................... ........................................l 13Nasal mn~stion .................................. .................................................................................3OlPainful urination .......................................... .........................................................................6O4Acne .. .. .. .. .. ... ... ... . .. .. .... .. .. . ..... . ... .. ... . ... .. ..... . .. ... .. ... . .... .. .. ... .. .. . .... .. .... .. .. .. .. .. . ... .... .. ... .. ... ......... 100Menstrual disorders...............................................................................................................653Other symptoms referable to the ears...................................................................................74ONausea..................................................................................................................................572Other specific symptoms, referable to sKn ... .. ... ... .. .. .. .. .... .. .. ... ... .. .. .. .... ... ... .. .. ... ... . .... ... ... . ....l2OPain, irritation of eye .. ... . ... .. .. .. .. .. ... ... .. .. .. .. .. .... .. ... .. .. .. .. ... .. ... .. ... .. ... . .... .. .. .. . .... .. .. ... .... .. .. ... ....7O5Diabetes mellitus .... .. .. .. .. ... ... .. ... .. ... ... .. .. .. .. ... ... .. ... .. ... .. .. ... ... . ... ... ... . .. .... . .... .. ... .. .. .. .. .... .. ... . ....99lArthritis, rheumatism .... .. .. ... ... .. ... ... .. .. .. .. .... .. ... . .... .. .. .. ... .. .. ... .. .. .. .. .. .. .. .... ... . ..... . ... .. ..... .. ... ....427Sinus problem .. ... .. .. .. .. .... . ... .. .. .. .. .. .. .. .. .. . .. ... ... .. ... .. .... . .. .... . ... . ... ... .. . .. .. ... ... .. . ..... ... .. ... ... .. ... .. ...3o4Flu .. ...o.. .. .. .. ... ... .. .. ...@... ... .. .. .. .... .. .. .. .. ... ... ...o. ... .. .. .. .... . ... ... .. . ... ... .. .. .... .. .. .. ... .. .... ... ... ... .. ..........3l3Hay fever .. .. ... .. .. .. . .. ... .. ... .. ... .. ... .. ... .. ... . ... ... .. .. ... ... .. ... . ... ... .. .. .. .... .. .. .. .. .... .. .. . ... .... . ... .... .. .. .......329Situational problems ... .. .. .. .. .. .... .. .. ... ... .. .. ... ... .. ... .. ... .. . .. .. .. .. ... . ... .... . ... ... .. ... .. .. ... .. .. .. ... ... ... .. .. ..94l

Warts .... ... . .. .... .. .. ... .. ... .. .. .. .. .. ... ... . ... .. .. .. . ... .. .. ... .. .. .. ... .. .. .. . ... .. .. .... .. .. ... ... ... . .... .. ... ... .. .. ............lllSymptoms of anxiety ... .. . .... .. ... ... .. .. .... .. ..... .. ... .. .. ... .. .. .. .... .. .. .. .... .. .. ... .. ... ... .. .. .... .. .. ..... ... . ... ...8OO

Diarrhea ... .. .. ... .. ... .. .. ... ... .. . ... .. ... .. ... ... ... . ... ... .. ... .. ... ... . ... .. ... .. .. .. .... ... . .. .... .. .. .. .. .. ... ... .. ... ...........555

Nocturia .. .. ... ... .. ... .. .. .. ... . .. .... .. ... ... .. .. ... . .... .. .. ... . .... ... . .. .... .. .. ... . .... .. .. .... .. ... .. . .. ... .. ... ... .... . ........6Ol


sands)

26,08023,51822,08521,22917,06715,27914,93314,86213,60711,89311,08210,46610,198

9,8279,7519,4638,2917,7547,7157,5557,5337,0607,0227,0156,3155,9885,7775,6604,9994,5674,4633,9213,7923,7043,6403,5453,4803,4173,3013,0162,9852,9402,9312,9272,7852,7152,6912,4942,4772,435

Per-cent

ofvisits

4.64.13.9

3.73.02.72.62.62.42.12.01.81.81.71.71.71.51.41.41.31.31.21.21.21.11.11.01.00.90.80.80.70.70.70.60.60.60.60.60.50.50.50.50.50.50.50.50.40.40.4

Cumu-lativeper-cent

4.68.7

12.616.3

19.322.024.627.229.631.733.735.537.3

39.040.742.443.945.3

46.748.049.350.5

51.7

52.9!%.055.156,157.1543.058.859.6

60.3

61.067.762.362.963.5

64.1

64.765.265.766.2

66.7

67.267.768.2

68.769.169.569.9

lProbIems are identified and coded according to a symptom classification developed for use in the NAMCS (see reference 3).

24

. . . . .Table 16. Number and percent distribution of office visits for the 25 morbic

visit by patient’s age and sex: I

Morblditv-related problem and NAMCS codel

All principal problems .. . .. . . .. .. . . .. . .. . . .. . .. . . . .. . . . .. . . .. . . . .. . . . .. . . . . .. . . .. . . . .. .. . . . ..

PaIn, swelling, inhsry-lower extremity .. . . .. . .. . .. .. . . . .. . .. . .. . . . .. .. . . .. . .. . .. . . . .. . . . . . .. ..4ooPam, swelling, injury-back region .. .. . . . .. . .. . . . .. . . .. . . .. . . . . .. .. . . . . .. . .. . . . . .. .. .. . . . .. . . . ...4l5

Sore throat . . .. . . .. . .. . . .. .. . .. . . .. . . .. . .. . . .. . . . .. . . .. . . . .. .. .. . . .. . . .. . . .. . . .. . . .. . . .. . . . . .. . . .. . . .. . . . . ...52OPam, swelllng, injury-upper extremity . .. . .. . . . .. .. . . . . .. . . .. . . . .. .. . . .. .. . . .. . . .. . . . . .. . ....405

Abdominal pain . . . . ... .. . .. . . . .. . . . .. . .. . . .. . . .. . . . .. . . . .. .. .. . .. . . . .. . . .. . . . .. . . .. . .. . . . . .. . . .. . . . .. . .. ..54o

Cough .. . . .. . .. . . . .. . . .. . . .. . . .. . .. . . .. . . . .. . . .. .. . . . .. . . .. . . . . .. . . .. .. .. . .. . . .. . . . .. . . .. . . .. . . .. . . . .. . . . .. . . ...3l 1Fatigue ... ,. . .. . . .. . . .. . . .. . . . .. . . .. . .. . . .. . . . .. . .. . .. . . . .. . . . . .. . .. . . . .. . .. . . .. . . . .. . . . .. . . .. .. . . . .. . . . . .. . . ..oo4

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

Allergic skin reaction .. . . .. . . .. . . .. . .. . .. . . . .. . . .. . . . .. . .. . . .. . . . . .. . . .. . . .. . .. . . .. . . . .. . . . .. . . . .. . .. ...l 12Pam [n chest .. .. . . . .. . .. . .. . . . .. . . . .. .. .. . .. . .. . . .. . . . .. . . . .. . . . ... . . . .. . . .. . . . .. . .. . .. . . . . .. . . .. . . . .. . . ....322

Cold . .. . .. . . .. . .. . . . . .. . .. . .. . . .. . .. . . .. . . .. . . .. .. .. .. . . . .. . . . .. . . .. . . .. .. .. . . . .. . . .. . .. . . . .. . . . .. . . .. . . . . .. . . ..3l2Earache .. . . .. . .. . . .. . . .. .. . . .. . . . .. . .. . . . .. . . .. . . . .. .. . . .. . . . . .. . .. . . . .. . . .. . .. . . . .. . . .. . . .. .. .. . . . .. . . . .. . ...735High blood pressure . . . .. . . . .. .. . .. .. . . .. . . .. . . . .. .. . . . .. .. . .. .. . .. .. . . .. . . .. . . .. . .. . . . .. . . .. . .. . . . . .. . ..2O5Pain, swelling, in]ury-face and neck . . .. . . . . . . . . .. . . .. .. . . . .. . . . .. . . .. . . . .. . .. . . .. . . .. . . . . ..4loWounds of skin .. . . .. . .. . . .. . . .. . . . .. .. . . . .. . .. . . .. ... . . . .. . .. . . .. . . . .. . . .. . . .. . . .. . .. . . . .. . . .. . .. . . . .. . . ..l 16

Visicm dysfunction, except blindness .. . . .. . . .. . . .. . . .. . . .. . . .. . . . .. . . .. . .. . . . .. . . .. . . .. . . . . ...7olFever, . .. . . . .. . .. . . . .. . . .. . . . .. . . .. .. . . . .. . . . .. .. . . .. . . . .. . .. . . .. . . .. . . .. . . .. . . . .. . . .. . . .. . . .. . . .. . . .. . . . .. . . ..oo2

Vertigo .. .. . .. . . .. . .. . . .. . .. .. . .. . . .. . .. . .. . . .. . . .. . .. .. .. . . .. . . . . .. . . .. .. . . . .. . . .. . . . .. . . .. . . .. . . . .. . . .. . . . ..O69.%wdling, mass of skin .. .. . . . .. . .. . . . .. .. . . . .. . .. . . .. . . .. . . .. . . . .. . . .. . .. . . .. . . . .. . . . . .. .. . . .. . . . .. . . . ..l 15Wt?lght gain .. . . .. . .. . . .. . . .. .. . . . .. . . .. .. .. . .. . . . .. . . . .. .. . . . .. . .. . . . .. . .. . . .. . . . .. . . . .. . .. . . . .. . . .. . . . .. . . ..OlOShortness of breath . . . ... . . . .. . . .. . .. . . .. . . . .. . . .. . . .. . .. . . .. . . . .. . .. . . .. . . . .. . . . .. . .. . .. .. . . .. . . . .. . . ..3MVaginal dischar~ . . .. . . .. . .. . . .. . .. . . .. . . .. . . .. . . . .. . .. . . .. . . .. . . . . .. . . .. .. . . . . .. . . .. . . . .. .. .. . .. . . . . .. ...662

Symptoms of nervousness .. . . .. . . . .. . . .. . . .. . . .. . . .. . . . .. . . .. . .. . . . .. . . .. . . . .. . . . .. . . .. . . .. . . .. . . . ..81 O

Symptoms of depression .. . .. . .. . . . .. . . .. . .. .. . .. . . . .. . . .. . . . .. . . .. . .. . . .. . . . .. . . . . .. .. . . .. . . . .. . . ...8O7

Skin lrrltatmn (nonallemic) .. . .. . . .. . . .. . . . . .. . .. . . .. . . . .. . . .. . .. .. . .. . . .. . . . .. . . . .. .. .. . .. . . .. . . . ..l 13

t-related p

ited State:

of visits

(in thou.

sands)

567,600

21,22917,06715,27914,93314,862

13,60710,456

10,1989,827

9,7519,453

7,7547,7157,5657,533

7,022

7,015

6,3155,9685,7775,6604,999

4,667

4,483

3.921

mems most frequently presantea 13y patients as principal reason ror me

enuary-December 197511 1


100.0100.0100.0100.0100.0100.0

100.0100.0100.0100.0

100.0100.0

100.0100.0100.0100.0

100.0100.0100.0100.0100.0100.0100.0

100.0

100.0

100.0

17.4

10.5●1.936.311.811.1

40.5●2.3

8.834.3‘2.9

34.9

55.4“0.610.9

31.0

13.278.9

“3.412.5“3.7“6.4“2.5

“2.8

“0.2

16.4

15.3

14.111.523.312.417.5

10.18.1

15.120.3

8.915.5

15.5‘2.214.420.1

9.9

6.6‘4.416.312.7“2.7

27.3

“6.5

12.9

13.4

25.3

21.4

31.424.828.528.7

15.219.1

36.422.7

19.4

20.4

17.614.030.721.4

19.2

6.517.123.247.6

8.246.2

35.4

48.9

21.7

25.6

30.236.811.9

33.625.422.7

33.527.314.643.6

18.5

8.4

48.128.717.0

30.9

5.9

36.132.630.139.420.6

37.8

30.6

28.4

16.4

23.816.4

3.813.817.3

11.637.012.3

8.2

27.210.7

●3.135.115.310.5

26.8● 2.2

39.015.4“ 5.943.3●3.5

17.5

‘7.5

20.1

60.4

61.849.755.549.9

63.552.365.8

68.260.451.956.0

57.564.658.832.6

64.251.0

62.459.983.044.7

100.0

73.4

73.8

50.3

39.6

48.2

50.344.550.1

36.647.834.3

31.839.748.244.0

42.5

36.440.2

67.4

35.849.0

37.640.117.055.3

. . .26.6

26.2

49.7

lpr~bl~m, are identified and cOd~d accOrding tO a ~ymptOm classiftcat,”” developed for me i“ the NAMCS (see reference 3).

25

Table 17. Number and percent distribution of office visits for the 25 morbidity.

visit by prior-visit status of patient and seriousness ,

Morbidity-related problem a“d NAMCS code I

All principal problems .. . . . .. . .. . . . .. .. .. .. . . .. . . .. . . .. . . .. . . . . .. .. .. . . .. . . .. . . .. .. .. .. .. .. .. .. .. ..

‘Pain, swelling, injury-lower extremity .. .. . . .. .. . . .. . . .. . . . . .. .. .. . . .. . . . . .. .. . . .. .. . . . . .. . . . . .. ...4@

Pain, swelling, injury-back region ... . . . .. . .. . . .. . . . .. . . .. . . . . .. . . .. . . . .. . . .. . . . .. .. . . .. . . .. . . .. . . .. ..4I5Sore throat .. . .. .. .. .. . . .. . .. . . . .. . . .. .. .. . ... .. . . . .. . .. .. .. . . . .. . .. . . .. . . . .. . . .. . . . .. . . .. . . .. .. . . .. . . . . .. .. .. . . ...52OPain, swelling, injury-upper extremity . .. . . . . .. .. .. .. .. . . . . .. . . .. .. .. . . .. . . .. .. .. . .. . . . .. . . .. .. .. ..4O5Abdominal pain .. . .. .. . . .. . . .. . . .. . . . . .. . . . .. . .. .. . . .. .. . . .. . . .. . . .. .. .. . . . . .. . . .. . . .. . . .. . . . .. . .. . . .. . . .. . . ...54OCough .. . . . . .. . . . .. .. . . . . .. . . .. . . . . .. . .. . . .. .. . . .. . . . .. . . .. . . . .. . . . .. . . .. . . . .. . .. .. . .. .. . .. .. . . .. . . . .. . .. .. . . .. . . . . ..3 I 1Fatig”a ..............................................................................................................oo4Headsche .. . .. .. . . .. . . .. . .. . . . . . .. . . . .. . . . .. . .. . . . .. . . . . . .. . . . . .. . . . . .. .. . . .. . . . . .. . . .. . . .. . . . . .. . . .. . . . .. . . . .. . . ..OwAllergic skin reaction .. .. . .. . . .. . . .. .. . . .. . . . . .. . . .. . . .. .. .. .. . . .. . . .. . . .. .. .. .. . . .. . . . . .. .. . .. . . .. . . .. . . . ...l 12Pain in chest ......................................................................................................322Cold .. . . . .. . . . . .. . . . .. . . .. . . . . .. . . . . .. .. . . . . .. .. .. .. . . . . .. . .. . . . .. . . .. .. . . .. . . . .. . .. . . . . .. . . .. .. .. .. . . .. . . . . .. . . .. . . ..3l2Earache ... . . . . .. . . .. . . . .. . . . .. . . . .. . . . .. . . . .. . . . . .. . . . .. . . .. . . . . .. . .. . . . .. . . . .. . .. . . . . .. . . .. .. .. .. . . . .. . . .. .. . . .. ...735High blood pressure .. . . . . . .. . .. . . .. . . . .. . . . . . . .. . . .. . . .. . . . .. . . . .. . . .. . . .. . . . . . .. . . .. . . .. . . . . .. . . .. . . . . .. . . ..2O5Pain, swelling, injury-face .md "eck ... . . .. . . . . .. . . .. . . .. . . . . .. . . . .. . . . .. . .. . . . .. .. .. .. . . . .. . . . .. . . ..41 OWounds of skin . . . . .. . . . .. . . .. . . .. . . . . . .. . . .. . . . .. . . .. . . . . .. .. . .. . .. .. . . . .. . . .. . . . .. . . .. . . .. . . . . . .. . . . .. . . .. . . ..l 16Vision dysfunction, except blindneS ... . .. . . . .. . . .. . . . .. . . . .. . . .. . . . . .. . . .. . . .. . . . . .. . . . .. . . . .. .. ...7OlFever .. . . .. .. . .. . . . .. . . . .. . . . .. . . . . .. . . .. . . . .. . .. .. . . . .. . . . .. . . .. . . . .. . . . .. . . . .. . .. . . .. .. . . .. .. . . .. . . .. . . . .. . . . . .. . ...OO2

VartigO ... . . . .. . . .. .. . . .. .. . .. . .. .. .. .. .. .. .. .. .. .. . . .. .. . .. . . . .. .. .. . . .. . . . . . .. . .. . . . .. . .. .. . . .. .. . . .. . . .. . . . . .. . . ..O6g

%valling, mas of skin .. . .. . . .. .. . . . .. . . .. . . . .. . . . .. . . . .. . . . .. . . .. . . . .. . . .. . . . . .. . . .. . . . . .. . . . .. . . .. . . . .. . . ..l 15

Weight gain .. . . .. .. . . .. . . .. .. . . .. . .. . . . .. .. . . .. . . .. .. . . .. . . .. .. . . .. .. .. . . .. . . .. . . .. .. . . .. . . .. .. . . .. . . .. .. . . .. . . ...Ol O

ShOrtness of breath . .. . .. . . .. . . .. . . .. . . .. . . . . .. . .. . . .. . .. .. . . .. . . .. . . . .. . . .. . .. . . . . .. . . . . . .. . . .. . . .. . . . . .. . ...3wVaginal discharge ... .. .. . . . . .. . . . .. . . . . . . .. . .. .. .. . . .. . . .. . . .. . . .. .. . . .. .. .. . . .. .. . . .. . . .. . . .. .. . . .. .. . . . . .. ...662Symptoms of newousness ... .. .. .. . . .. .. .. .. .. . .. . .. .. . . .. . . .. .. . . .. . . .. . . . . .. .. . . . . . . .. .. .. . . .. . . .. .. . . ..81 OSymptoms of depress&on ... . . .. . . . . .. . .. . . . . . .. . . .. . . .. .. .. . . . . .. . .. . . . .. .. . . .. . . .. . . . . .. . . .. . . .. .. . . .. . . ..8O7

Skin irritation (nonallergic) . .. . .. . . . . . .. . .. . .. . .. . . . . .. . .. . . . .. . . .. . . . .. . . . . . .. . . .. . . . .. . . .. . . . . . .. . . .. . . . 113

ated protproblam:

of visits

(in thou-

%7,600

21,22917,06715,27914,93314,86213.607lo,4r%10,1989,8279,7519,4537,7547,7157,5557,5337,0227,0156,315

5,9885,7775,6604,9994,5874,463

3,921

IS most frequently presantad by patients as principal raason for the

ited S

Total

1CKlo100.0100.0100.0100.0100.0100.0100.0100.01000100.0100.0

100.0100.0100.0100.0100.0100.0100.0

100.0100.0100.0100.0100.0100.0

100.0

!s, January-Decambar 1975

Prior-visit status I Seriousness of problam

Old OldSeri-

patient, OusNew

patient, or

nawpatient

oldprob- prob-

very

lem Iemsari-Ous

I 1 I


14.9

18.817.018.818.517.813.48.6

20.423.7

14.013.921.7●3.622.127.536.315.611.2

30.313.611.421.87.4

“5.3

12.7

23.4

27.024.044.933.037.140.318.325.550.627.8

47.040.8●1.127.040.710.15s.022.6

34.06.2

13.140.114.8“6.4

40.1

61.7

54.259.036.348.545.246.373.254.125.758.3

39.137.695.350.931.853.626.4

66.236.780.375.538.177,888.3

47.2

18.9

26.221.18.317.323.213.126.615.07.5

41.08.7

13.332.018.818.221.314.926.6

74.79.3

52.018.722.067.616.4

Slightly

serious

32.4

40.7

44.841.244.142.243.135.739.434.934.531.150.946.847.131.919.944.146.4

34.537.031.532.739.128.6

33.8

Not

sari -

Ous

48.8

33.134.250.638.634.643.837.845.657.624.5

60.335.821.334.149.958.841.0

26.850.953.716.548.639.013.8

47.8

1Problems are iden titled and coded according to a symptom classification developed for we in the NAMCS (see reference 3).

26

Table 18. Number and Dercent distribution of office visits by selected patient problems and principal diagnoses most frequently-----associated with each problem: U“nitedStates, January-December 1975

Problem and NAMCS codel and diagnosis and ICDA code2

Pain, swelling, injury-lower extremity (400)...o .......................o...............................c.c....c....O.....O.C.....OC........C.

Diseasesof musculoskeletal system........ .. .......... .................. .......... .......................... ........ ................ ...... ......7lO.738Accidents, poisoning, and violence ..... ........................................ .................. ...............................................800-999Diseasasof circulatory system .......................................................................... ...........................................3904=Other diagnoses......... .......................... ...................... ........................ ............ .................... .......................................

Pain, swelling, injury–back region (415) ...................... .. ........ .. .......... ...... .................................. ....................

Accidents, poisoning, and violence .o............................................................................................................8O@999Diseasesof musculoskeletal system..............................................................................................................71 O.738Dheases of genitourinary system .................................................................................................................58 O.629Other diagnoses...................... .......................................................... .......... ..............................................................

Sore throat (520) .....................................................................................................C.................• ...............O...

Disaasasof respiratory system .....................................................................................................................46O.5l9Infective and parasitic diseases.....................................................................................................................OOO.l36Other diagnoses.................................................................... ........................................................................ ............

Pain, swelling, injury-upper extremity (405) ................................................................................................

Diseasesof musculoskeletal system... ...........................................................................................................710-738Accidents, poisoning, and violence .............................................................. ................................................8OO.999Diseasesof skin and subcutaneous tissue ................................. .......... .................................................... ......68O.7O9Other diagnoses........................................................................................................................................................

Abdominal pain (WO) ....................................................................... .............................................................

Diseasesof digestive system .........................................................................................................................52O.577Symptoms and illdefined conditions ....................................................... ....................................................78O.796Diseasesof genitourinary system ....... .............................. ...... .. .. ................ ........ .............. ............................58O*29Other diagnoses............ .................................................................................. ..........................................................

Fatigue (004) ......................... .............................. .......... .................. ........ .... .......... ........................................

Diseasesof circulatory system .....................................................................................................................39O.458Diseasesof blood and blood-forming organs.................................. .............. ........ ........................................28O.289Endocrine, nutritional, and metabolic diseases............................................................................................24O.279Other diagnoses................................................................. ............................................................... ........................

Headache (056) ................ ........ .......................................................... .. ..........................................................

Diseasesof respiratory system .....................................................................................................................46 O.5l9Mental disorders ................................................................................... ............ .. ............................. ............ 290-315Diseasesof circulatory system ............................................ .........................................................................39O.4~Other diagnoses............................. ........................................ ...................................................................................

JumbarIf visitsin thou-sands)

21,229

6,6296,4192,9165,265

17,067

6,8776,172

8253,193

15,279

12,9081,581

790

14,933

6,0975,785

7432,308

14,862

6,3932,0421,7784,649

10,466

2,5691,5011,4474,949

10,198

2,0021,7921,7134,691

Per-cent

distri-bution

ofvisits

100.0

31.230.213.724.8

100.0

40.336.2

4.818.7

100.0

84.510.4

5.2

100.0

40.838.7

5.015.5

100.0

43.013.712.031.3

100.0

24.614.313.847.3

100.0

19.617.616.846.0

See footnotes at end of table.

27

Table 18. Number and oercent distribution of office visits bv selected Datient problems and principal diagnoses most freauentlvassociated with each problem: United States, January-December 1975”—Con”.

Problem and NAMCS codel and diagnosis and ICDA codez

Pain in chest (322) .. .. .... ... . .... . .... .. .. ... ... .. ... ... . .. .. .. .. ... ... .. .... .. .. ... ... .. ... .. .. ... .... .. .. .. ... ... .. .... .. .. .. ... ... .. ... ....... .........

Disaases of circulatory system .. ... .. ... .. ... .. ... ... .. ... ... .. ... .. ... ... ... .. .. .. .... .. .... .. .. ... .. .. ... ... .. ... ... ... . ... ... ... .. .. ... .. .. .. ...39O458Diseases of respiratory system ..... .. .... .. .. .. .... .. .. .... .. .. .... .. .. .. .... .. .. ... ... .. .. .... .. ... . .... .. .. .. .. .. .. ... ... .. ... .. .. . .. ... ... .. .. ..tiO.5l9Symptoms and illdefined conditions ... .. .. ... .... .. ... .. .. ... .. ... ... .. ... .. ... . .... ... .. . .... ... ... .. .. ... ... .. .. .... . .... .. .. ... ... .. ... .. ..78O.7WOther diagnoses .. ... .. .. ... ... ... . ... ... .. ... .. ... ... . ... ... .. .... . .. .. .. .. .. .... .. .. ... .. ... ... .. ... .. .. .. . ... ... . .... . .. .. ... .. .. .... ................................

Pain, swelling, injury-face and neck (410) .. ... ... .. ... . ... ... .. .. .. .. .. .. ... ... .. ... .. .. .. ... ... .. ... .. ... .. ... ... .. ... ... .. ... ... .... .. ... ..

Accidents, poisoning, and violence .... .. .. .. .... .. .. .... .. .. .... .. . .... . .. .. .. ... ... .. .. ... ... .. ... .. ... .. .. ... ... .. .. .. .... .. .. ... ... .. .... .. ..8OO.999Diseases of musculoskeletal system ..............................................................................................................710-738Diseases of nervous system and sense organs . ..... . ... .. .. .. .. ... .. .... . .... . .. . ... .. .. .. .. .. . ... .... . ... .. ... .. ... .. .... ... . ... .... .. ... ...32O.389Other diagnoses ... .. .. .. .... .. ... . .... .. .. .. .. .... .. .. .. .. .... .. .. .... .. .. .. ... ... .. .. .. .. .. .. ... . .... .. .. ... ... .. .. .. ... ... .. .. .... .. .................................

Fever (002) .... .. .... .. .. .. ... ... . .. .... .. ... . ... .. .... .. .. .. ... ... . ... .. .. .. .. .. ... ... .. .. ... . .. .. .. .... . .. ... .. .. .... .. .. .... ... . ... ..... ....................

Diseases of respiratory system .. ... .. .... .. .. .. ... . .... .. ... ... .. ... . .. ... .. ... ... .. .. ... .. ... .. .. .. .. .. .. .. .. .... .. ... ... .. ... ... . .... ... ... . ... ..460-519Infective and parasitic diseases .. ... .. .... .. .. .. .... .. .. ... . .... .. ... . .... .. .. .. .. .... .. .. .. .... . ... .. .... .. .. .. .. .. .. .. .. .... .. .. .. .. .... ... .. ... ..OO@l 36Diseases of nervous system and sense organs .. .. .. .. ... ... .. .. .... . .... . .... .. .. ... . .... .. .. .. .. .. .. .. .. .. ... .. ... .. ... .... .. .. .... .. .. ... ..32O.389Other diagnoses ... ... .. .. .. .... .. .. .. .. .... .. .. .. .. .. . .. ... .. .... .. .. .... .. . ... .. .. .. .. .. .. .... .. .. .. .. .. .... .. .. .. .. .... .. .. .. .. .. . ... ................................

Vertigo (069) ...... ... .. .. ... ... . .. ... ... .. .. .. .. .. .. .. .. .... .. .. .. .. .. . ... .. .. .... .. .. .. ... ... .. .. .... .. .. .. .. .. .. ..... .. .. .... . ... ..........................

Diseases of circulatory system ... .. .. .. .. .. .. .. .... .. .. .. .. .... .. .. ... ... . ... .. .. .... .. ... . .. .. .. .. ... . .. .. .. .. .. .... . ... .. .... ... .. ... ... .. ... ....39O4~Diseases of nervous system and sense organs ... .... .. .. .... . .. ... .. .. .... . ... .... .. . ... .. .. .. ... ... .. ... ... ... . .. .... .... .. .. .. .. .. .. .... . ..32O.389

Symptoms and illdefined conditions ... .. .. .. ... ... .. ... .. .. .. .. . ... .. ... .. .. ... .... . ... .. .. .. ... ... .. ... .. .. .... . ... ... ... ... ... . ... ... ... .. ..78 O.796Other diagnoses ... .. ... .. .. .... .. .. ... . ... .. .. ... .. ... . .. .. ... .. .. ... .. .. .. . ... .. .. ... .. ... ... . .... .. .. .. ... .. ... ... ... .. ... .. ... .. .. .... .. .................... ........

Swelling, mass of skin (1 15) . ... ... .. .. .... .. .... . ... .. .. .. .... .. ... ... .. .. ... . .. .... .. .... ... ... ... . ... ... .. .. .. . ... .. .. ... ... .... .. .. .. .... .. .. .. ....

Diseases of skin and subcutaneous tissue .. .. .... .. ... ... .. ... . .. .. .. ... . ... ... .. .. .. ... .. ... ... .. .... . ... . .... . ... ... ... ... . .... .. ... .. .... ..68@7WNeoplasms ... . . .. .. .. . ... .. ... ... .. .. .. ... . .. .. .. .. ... . .. .... ... ... .. .. .. .... .. .. ... ... .. .. ... . .... .. ... . .. . ... . ... .. ... ... .. .. .. ............................l4&239Other diagnoses .. .. .. .. .... .. ... . ... .. ... .. ... .. ... .. .. .. ... ... .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. .. .. .... .. ... . ... ... .. .. .. .. .. .. .. .. .. .. ................................

Shortness of breath (308) . .. .... ... ... .... .. .. .... .. .. .. .. .. . ... .. .. .. .... .. .. .. . . .. .. .. .... . ... .. .. .. ... ... ... .. ... ... .. . .. .. .... .. .. ... ... .. .. .. .. ...

Diseases of respirato~ system .... .. .. .. ... .. .. .. .. ... . ... .. ... .. .. .. .... .. .. ... ... .. ... .. .. ... ... .. .. ... .. .. ... .. ... .... . .. .... .. ... ... ... .. ... ...46O+l9Diseases of circulato~ system ..... ... .. ... .. .. .. .... .. ... .. ... .. .. ... ... .. .. .. .... .. .. .... . ... .. ... ... .. .. .. ... ... .. .. .. .. .. .... .. .. .. .. ... ... .. ..39O4~Other diagnoses ... ... . ... .. .... .. .. ... .. .. ... . ... ... .. ... .. .. .. ... ... .... .. .. .. .. .. ... .. ..... .. .. .. .. .. .. .. .. .. .. .. .. .. ... .. .. ... .. .. .. ................................

of visits(in thou-

sands)

9,751

4,1031,4151,0013,232

7,555

2,6261,918

5222,489

7,015

4,747971584713

6,315

2,5891,326

9041,516

5,988

2,5961,3981,884

5,660

2,6902,201

769

Per-

centdistri-bution

ofvisits

100.0

42.114,510.333.1

100.0~

34.825.4

6.932.9

100.0

67.713.8

8.310.2

100.0

40.721.014.3

24.0

100.0

43,423.433.3

100.0

47.538.913.6

lProblems are identified and coded according to a symptom classification developed for use in the NAMCS (see reference 3).2Ba~ed on Eighth Rev&ion lntemational cla~~ificati~~ of D&~~e~,A@~t~d for UWin the united states (ICDA) (referenCe 4).

28

Table 19. Numbw and percent of office visits for the 25 morbidity-related problems most frequently presented by patients as principalreason for the visit. bv diagnostic servicesordered or rxovided: United States, Januarv-Decembar 1975..-

Morbidity -ralated problem and NAMCS codel

I

All principal problems .................................................................

Pein, swelling, injury-lower extremity .................................................4OOPain, swelling, injury-back region ........................................................4l5Sore throat ............................................................................................52OPain, swelling, injury-upper extremiW .................................................4O5Abdominal pain ........................................................................ ............54oCough ....m..b...........................................................................................3l 1Fatigue..................................................................................................OO4Headache ..............................................................................................OWAllergic skin reaction ............................................................................l 12Pain in chest..........................................................................................322Cold ......................................................................................................3l2Earache .................................................................................................735High blood pressure ................................................................ ..............2O5Pain, swelling, injury-face and neck ............................................ .........41 OWounds of skin .....................................................................................l 16Vision dysfunction, except blindness....................................................7OlFever.....................................................................................................002Vertigo ................................................................................................. 069SWalling, massof skin ...........................................................................l 15Weight gain ...........................................................................................Ol OShortness of breath ...............................................................................3O6Vaginal discharge ..................................................................................662Symptoms of newousness................................................................... ..81 OSymptoms of depression.......................................................................8O7Skin irritation (nonallergic) ...................................................................l 13

Numberof visits(in thou-sands)

!%7,600

21,22917,06715,27914,93314,86213,60710,46610,1989,8279,7519,4537,7547,7157,5557,5337,0227,0156,3155,9885,7775,6604,9994,5674,4633,921

Selected diagnostic services

-

Percent of visits

51.3

62.057.969.559.655.566.648.152.163.962.965.168.252.254.943.248.066.957.447.347.263.956.447.116.753.1

15.8

11.811.4

7.38.6

23.814.720.620.8

8.719.110.69.4

10.214.8●4.218.617.218.08.3

11.915.026.112.3●4.2●8.3

22.9

12.514.725.6

8.032.413.937.916.614.525.211.5

6.320.3

7.6*3.9*3.928.428.8

9.018.721.649.716.4*3.912.9

7.4

23.815.7*2.127.816.012.18.87.1

*2.O19.2

5.8*2.1●3.215.8*4.8*0.7●2.7●5.5*3.7*2.714.3* 0.9*3.7‘0.6●2.2

33.2

28.330.318.223.042.526.157.050.114.664.433.6

9.174.526.012.2●3.111.862.216.256.152.844.548.914.721.8

1Problems are identified and coded according to a symptom classification and developed for use in the NAMCS (see reference 3),

29

SECTION IV

CLINICAL PATTERNS: OFFICE-BASED CARE AS RELATED

TO PHYSICIAN’S DIAGNOSIS

Survey findings contain two major sourcesof information about the clinical content ofoffice-based practice. The first source—the pa-tient’s presenting problem–was the subject ofsection III. The second source—the diagnosisthat the physician assigned to the principalpresenting problem–is the subject of this sec-tion. Tables 20-25 center attention on thesediagnoses. (Diagnostic information also appearsin table 7, in reference to the age, sex, and raceof patients; in tables 9, 11, 13, in reference tophysician characteristics; and in table 18, inreference to common morbidity-related prob-lems.)

Diagnoses have been classified and codedaccording to the Eighth Revision InternationalClassification of Diseases, Adapted for Use inthe United States (ICDA).4 A maximum ofthree diagnoses were coded for each patientvisit. The data in this report apply only to thefirst-listed or “principal” diagnosis, the one thatapplied most directly to the patient’s presentingproblem.g The diagnosis could be final orprovisional. It could apply to a condition ofacute or chronic morbidity, or it could signifythe provision of care that was not primarilymorbidity-related but more concerned with cer-tain special conditions or examinations withoutsickness.h

Table 20 lists in rank order the 50 diagnosesmost frequently rendered by office-based physi-cians in 1975. As in other ranked listings, theorder may not be entirely reliable because somenear estimates may not differ statistically from

gIn future publications of NAMCS findings, second-and third-listed diagnoses will receive their proper shareof attention.

‘Special conditions and examinations without sick-ness is a supplementary classification of the ICDA whichincludes codes YOO-Y 13. Along with all medical andspeciaI examinations, this group contains such specialconditions as prophylactic inoculation and vaccination,contacts with infective and parasitic diseases, prenatzdcare and postpartum observation, and surgical aftercare.

each other due to sampling variability. Note thatthree of the leading four diagnoses belong in thegroup special conditions and examinations witho-ut sickness, underscoring the fact that a sub-stantial portion of office-based, ambulatory careis not directly concerned with conditions ofillness or injury, a finding already noted in thediscussion of the reasons why patients makeoffice visits (section III).

Using the major ICDA groups, along withselected subgroups and certain, more specific (3-digit) diagnoses, tables 21-25 relate the diagnos-tic findings to selected characteristics: age andsex of the patient (table 21, see also table 7); tothe patient’s visit and problem status, and to theseriousness of the presenting problem (table 22);to diagnostic and therapeutic services ordered mprovided during the visit (tables 23 and 24); andto the disposition decision made by the physi-cian at the end of the visit (table 25).

Text tables H and J center attention cmmorbidity-related diagnoses. Table H ranks thediagnoses according to the 13 ICDA groups inwhich they most frequently fell. The ranking isbased on all visits, that is, encounters with a ncwproblem along with the return visits that re-sulted from the diagnosis of the problem. TableH also shows the effect of ignoring return visits,by showing the frequency with which thediagnoses were assigned at new-problem en-counters. (See discussion of ncw-problwz en-counters in section III.)

Finally, table H presents a return-visit rat~’for each morbidity group, obtained by dividing

the total number of return visits for a diagnosisby the number of times that the diagnosis wusassigned at a new-problem encounter. (Usingrespiratory diseases as an example: an estimated39.8 million return visits for these conditionsdivided by the 40.3 million visits where respira-tory disease with a new-problem diagnosis indi-cates an average of about one return visit pcryear for each new diagnosis of a respiratorydisease.)

30

..-

Table H, Number and percent of office visits and new-problem encounters with average rate of return visits, by most common—u-----morbiditv-related diaanoses: United States. .lanuarv-December 1975

Morbidity-related diagnosis and ICDA codel

~All principal diagnoses .. .... ... .. .. ... ... .. ... .. ... ... . ... ... ... ... .. .. ... .. ... .. .. ... ... .. ... .. .. .. .. .... .. ..

Infective and parasitic diseases .. .. .. ... .... .. ... ... ... .. . .... ... .. .. ... ... .. ... ... .. ... . .... .. .. .. .. ... ... ..OOO.l36Neoplasms .... . ... ... ... .. .... .. .. .. .. .... ... .. ... ... .. ... .. .... .. .. ... ... .. .. .. ... ... .. ... .. .. ... ... ... .. ... .. ... .. ...l4O.239Endocrine, nutritional, and metabolic diseases . ... . .... .. .. .... .. .. .... . ... .. .. ... ... ... .. .. .. ... ..24 O.279Mental disorders ..... .. ... ... .. .... .. .. ... .. ... ... ... .. ... ... ... . .... .. ... .. . ... .... .. .. ... ... .. .. .. ... ... .. ... .. ...29 O.3l5Diseases of nervous system and sense organs .... .. .. ... ... . ... ... ... .. .. ... .. ... .. ... ... ... .. ... .. ...32 O.389Diseases of circulatory system ..... . ... .. .. ... . ... .. ... .... .. ... .. .. .... .. ... .. ... ... .. .. .. .. .... .. ... . .. .. ..39O458Diseases of respiratory system .. .. . ... .... .. ... .. ... ... ... .. .... .. .. .. ... ... .. .. .... .. .. .. ... ... .. .. ... ... ...46O.5l9

Diseases of digestive system .. .. .... .. .. .. .. .. .. ... ..... . ... ... ... .. .. .... ... .. ... .. .. ... .. ... ... .. .. ... .. ... ..52 O.577Diseases of genitourinary system .. ... ... ... . ... ... .. ... .... .. . ... ... ... .. .. .. .. .. .... .. .. .. .. ... .. .. ... ...580-629Diseases of skin and subcutaneous tissue . .. ... ... .. .. ... .. ... .. ... ... .. ... .. ... .. .. .... .. .. ... .. .. .....68 O.7O9Diseases of musculoskeletal system .. .... . ... ... .. .... . .... .. .. ... . ... .. .. .. ... .. .. ... .... . ... .. .. ... ... ..71 O.738Symptoms and ill-defined conditions .. .. . ... .. ... ... .... .. ... . ... ... ... .. ... .. ... .. .. ... ... .. ... .. ... ...78 O.796Accidents, poisoning, and violence . ..... .. ... .. ... .... . .... .. ... ... .. .. .... . ... .. ... ... .. .. .... .. .. .. .....8OO.99O


sands)

567,600

22,747

13,33224,11725,06144,94156,35880,12520,06137,62628,56432,73226,17740,893

Returnvisits

(in thou-

sands)

349,945

7,7608,899

19,44519,67124,87047,797

39,78411,22822,41514,04321,78412,56219,383

New-prob-lem en-

counters

(in thou-sands)

217,655

14,987

4,4334,6725,390

20,0718,561

40,3418,833

15,21114,52110,948

13,61521,510

Re-turnvisit

rate

1.6

0.5

2.04.23.61.25.61.01.31.51.02.0

0.90.9

lkkuwd m Eighth Revision international Classification of Diseases, Adapted for Usein the United States (ICDA)(reference 4).

Thcdataintest table J conclude this study that group, and by offering an estimate of thenf diagnostic patterns by showing for each mean duration of time that physicians spent inmorbidity group the extent to which office- face-to-face contact with patients in each mor-based physicians tended to refer diagnoses in bidity category.

31

-.. . .

Table J. Number of visits, percent of visits referred by the physician, mean contact duration, and standard error (S. E.) of mean contactduration, by most common morbidity-related diawtoses: United States, Januarv-December 1975

Morbidity-related diagnosis and ICDA codel

All principal di~noses . ... .. ... .. ... ... .. ..... ... ... .. ... .. ... .. .. .. .. ... ... .. .. .... .. ... . .... .. .... ... ... . ... .. ... .. ...

Infective and parasitic diseases ... ... . ... ... .... . .... . .... . .... .. ... ... .. ... ... .. ... .. ... .. .... .. .. ... ... .. .... .. . .....OOO.l36Naoplasms .... .. ... .. ... ... . .... ... .. ... .. .. ... .. .... .. .. . . ... .. ... . .. ... ... ... ... .. ... .. ... .. ... ... .. ... .. .... .. .. ... .... . .... ..l4O.239Endocrine, nutritional, and metabolic diseases .. .. .. ... .. ... ... .. .... .. .. ... .. ... ... .. ... ... .. ... .. .... . ... ...24O.279Mental disorders . .. ... ... ... .. ... ... .. .. .... . .. . .... .. ... .. .. .... .. ... .. .... .. ... .. ... . .... .. ... .. ... .. ... .. ... .. .. .. . .. .... ..29O.3l5Diseases of nervous system and sense organs .. .. .. .... .. ... .. ... ... .. .. ... ... .. ... .. ... .. ... .. ... .. .... .. .. ....32O.389Diseases of circulatory system ... .... . .... .. ... .. ... .. .... .. .. ... ... .. .... . .... . ... .. .. .. . .... .. .. ... .. ... .. ... .. .... ..39O458Diseases of respiratory system .. .. ... .. .... .. ... .. ... ... .. .. ... ... .. ... ... ... .. .. ... .. .... . .. ... ... .. ... ... .. ... .. .. ...46O.5l9Diseases of digestive system .... ... ... .. ... .. ... .. .... .. .. .. ... ... ... .. ... .. .... .. .. .. ... ... ... .. .. ... .. .. ... .. ... ... .. ..52O.577Diseases of genitourinary system ... . .... . ... ... ... ... ... . ... .. ... ... ... . ..... . .. ... . .... .. ... .. .. . .. ... .. .... . ... ....58O$29Diseases of skin and subcutaneous tissue .. .. .. .. .... .. ... .. .... . ... .. ... ... . .. .. ... . .... .. ... .. ... .. ... ... .. .. ...68O.7WDisaases of musculoskeletal system .. ... ... .. .... . .. ... ... ... .. ... ... .. ... .. .. .... .. .. ... ... .. .. .. .... .. .... . ... .. ..7lO.738Symptoms and ill-defined conditions .. .... .. ... .. ... .. .... . ... .. ... ... ... .. ... .. .. ... .. ... ... ... . ... ... ... .. ... ...78O.796Accidents, poisoning, and violence ... .. .... . .. .... . .. .. .. .... .. .. .. .... .. ... . .... . .... .. ... .. ... ... ... .. ... .. ... .. ..8OO.999

Numberof

visits(in

thou-sands)

567,600

22,74713,33224,17725,061

44,94156,35880,12520,08137,626

28,56432,73226,17740,893

Per-centre-

ferred

bythe

physi-cian

2.8

2.36.92.43.5

2.92.81.2

6.4

3.63.23.35.83.1

Meancon-tact

dura-tion2

(inmin-utes)

15.0

12.415.515.833.916,415.412,115.6

14.111.915.417.713.3

S.E.of

mean

con-tact

dura-tion3

0,31

0.330.490.511.36

0.670.340.470.440.280.460.470.490.32

1Based on Eighth Revision International Clasei~ication of Dieeaxs, A dapted for Use in the United States (lCDA) (reference 4).2Time spent in face.to-face contact between physician and Patient.Sstandard error (s. E.) measurements of precision are discussed in appendix 1.

32

Table 20. Numlw, percent, and cumulative percent of office visits, by the 50 principal diagnoses most frequently rendered by

Rank

123456789

101112131415161718192021222324

z27282830313233343536373839

:

x44454647484950

{

physicians: United States, January-December 1975

Principal diagnosis and ICDA codel

Medical or special examination .......................................................... ..................................YOOMedical and surgical aftercare ..............................................................................................Yl OEssmtial benign hypertension ............................................. ................................................ ..401Prenatal care ........................................................................................................................YWAcute respiratory infection, site unspecified ..................................................... ....................45Neuroses................... .................................................................................. .. ........................3ooChronic ischemic heart disease..............................................................................................4l2Otitis media ..........................................................................................................................38lDiabtes mellitus ..................................................................................................................25OOther eczema and dermatitis ................................................................................................692Acute pharyngitis ................................................. ................................................................462Refractive errors ......................................................................... ........ ............ .......... ............37OHay fever ..............................................................................................................................5O7Obesity .................................................................................................................................277Bronchitis, unqualified ............................................................ .............................................49OObservation, without need for further medical care.: ............................................................793Acute tonsillitis .......... ..........................................................................................................%3Synovitis, bursitis .................................................................................................................73lInfluenza, unqualified ............................................................ .......................... .....................47oCystitis ................................................................................................................................ .595Diseasasof sebacaousglands...... ...........................................................................................7O6Osteoarthritis .. ......................................................................................................................713Arthritis, unspecified ...........................................................................................................7l5Inoculations and vaccinations ..............................................................................................YO2Asthma ...................................................... ...........................................................................493Sprains end strains of back, unspecified ................................................................................847Other viral diseases............................................................................................ ...................O79Chronic sinusitis ................................................................................................. ..................5O3Other rheumatism ...................................................................................................... ...........7l7Diarrheal diseases..................................................................................................................O~Menopausal symptoms .......................................... .......................... ......................................627Sprains and strains, sacroiliac region .............................. .......................................................846Symptomatic heart disease................................................ ...................................................427Disorders of menstruation ,.,. ................................................................................................626Infective diseasesof uterus, vagina, vulva............................ ................ ............ ......................622Narvousnassand debility ................................................................ ......................................79oRheumatoid arthritis .................................................. ..........................................................7l2Acute bronchitis ...................................................................................................................466Otitis externa ........................................................ .......... ......................................................38OStreptococcal sora throat ................................................ ......................................................O34Other diseasesof ear and mastoid process.............................................................................387Other diseasesof urinary tract ..............................................................................................5WEmphysema ..........................................................................................................................492Postpartum obsewation .......................................................................................................YO7Acute nasopharyngitis (common cold) .............................................. ...................................46OSymptoms referable to respiratory system........................................ .... ........ ........................783Mental disorders: special symptoms NEC .............................................................................3WProstatitis .............................. .......................................................... .......................... .. .........6OlChronic cystic diseaseof breast ................................................. ...........................................61 OOther diseasesof eye ................................................................ ............................................378


sands)

40,86326,78222,82420,85114,60713.64112.5139,8999,6719,6678,5318,1697,6757,5696,8726,7946,4056,1715,8665,7215,5935,4454,8924,8464,6334,6064.3834,3204,2364,2264,1674,0743,9073,8363,2232,7292,6892,6352,5972,5572,5502,4762,4612,4032,3672,2572,2182,2162,2052,187

Per-cent

ofvisits

7.24.74.03.72.62.42.21.71.71.71.51.41.41.31.21.21.11.11.01.01.01.00.90.90.80.80.80.80.80.70.70.70.70.70.60.50.50.50.50.50.50.40.40.40.40.40.40.40.40.4

Cumu-lativeper-cent

7.211.915.919.622.224.626.828.530.231.933.434.836.237.538.739.941.042.143.144.145.146.147.047.948.749.550.351.151.952.653.364.054.755.456.056.557.057.558.058.559.059.459.860.260.661.061.461.862.262.6

I lBasedo~Eighth Revi=.On In~ernation=i cia~~ific=tiOn ~fDi~~=~~~, Adapt~df~~u~~j~th~ uniredstares (ICDA)(reference 4).

33

Table 21. Number and percent distribution of offi=visits bypatient's ageand=x, according to=lected principal diagnose% Unitad States, Januaw-Decambar


Ail principal di~noses .. . . . .. . . . . .. . . . .. . . .. . . . .. . . . .. . . . .. . . .. .. . . .. . . .. .. . . .. . . .. . . .. . . . . ..

Infective and parasitic diseases .. .. . . . .. . .. . . . . . .. . . . .. . . .. . . .. . . . . .. . . . .. . . . . .. . . .. . . . . .. .. OOO.l36Neoplasms ... . . . .. . .. . . . . .. . . . .. . . . .. . . .. . . . .. . . . . .. . . . . .. . . . .. . . . .. . . .. . . . .. . . . .. . . . . .. . . . .. .. . . . . . ..l4O.239Endocrine, nutritional, and metabolic diseases .. . .. . . . . . .. .. . . . . . . .. . . .. . . . .. . .. . ..24 O.279

Diabetes meilitus .. . .. .. . . .. . . . .. . . .. . . . .. . . . . .. . . . . .. . . . .. . . .. . . . . .. . . .. . . . . . .. . . .. . . . .. . . . .. . . . . ..25OObesity . . . .. . . .. . . .. . . . .. . . . . .. . . . .. . . . .. . . .. .. . . .. . . . . .. . . . .. . .. . . . . . .. . .. .. . . . .. . .. . .. . .. . . .. . . . . .. . . . .277

Mental disorders . . .. . . .. . .. . . . . . .. . . . .. . .. . . . . .. . . . .. . . . . . .. . . . .. . . .. . . . . .. . . . .. . . . .. . . . .. . . . . .. ...29O.3l5

Neuroses .. . . . . .. . . .. . . .. . . . .. . . . . .. . . . .. . . .. . . . . .. . . . .. . . . . .. . . .. . . . . .. . . . .. . . . .. . . . . .. . .. . . . . .. . . . . .. ..3OODieaaaas of nervous system and aensa organs .. .. . . . . .. . . . . .. . . .. . . . . .. . . . .. . . . . .. ...320.389

Diseases and conditions of the eye ... . . . .. . . . .. . . . . .. . . . .. . . . .. . . .. . . . . .. . . . .. . .. ...36G379Refractive errors .. . . .. . . . .. . . . .. . . . .. . . . .. . . . . .. . . . . .. . . .. . . . . .. . . . .. . . . .. . . .. . . . . . .. . . . .. . . .. . . . . ..37OOtitis media. . . . . .. . . .. . . . .. . . .. .. . . .. . . . . .. . .. .. . . . .. . . . . .. . . . .. . . . ..4. . . .. . . .. . . .. .. . . . .. . .. . . . . . .. ..38l

Dieaaaas of circulatory system .. .. .. . . . .. . . . . . .. . . .. .. . . .. . . . .. . . . .. . . . . .. . . .. . . . . .. . . . . .. ..39O458Eseantial benign hypertension .. . . .. . . . .. . . . .. . . . . .. . . . .. . . . . .. . . . .. . . . . .. . . . .. . . .. . . . . .. . . . ..4Ol

Chronic ischemic heart diwax .. .. . . .. . . . . . .. . . .. . . . . .. . . . . .. . . . .. . . . .. . . . .. . . . . .. . . .. . . .. ...4l2

Diseaaas of respiratory system .. . . .. . . . .. . . . .. . . . . .. . . . .. . . . . .. . . . .. . . . .. . . . . .. . . .. . . . . .. . ..46O.5l9Acute respiratory infections (except influenza) . . . .. . . . .. . . . .. . . .. . . . . .. . . ...460+6

influenza .. . . .. . . . .. . . . . .. . . . .. . . . . .. . . . .. . . . .. . . . .. . . ..i . . . . . .. . . . .. . . . .. . . . .. . . . . .. . . . .. . . . .. . ..47W74Hay fever .. . . . .. .. . . .. . . . .. . . . .. . . .. . .. . .. . .. .. . .. . .. .. . . . . .. . . . .. . . . . .. .. .. . . . . .. . . . . .. . . . .. . .. .. . .. . ..5O7

Diaaases of digestive system .. .. . . . . .. . . . .. . . . . .. . . .. . . . . .. . . . . .. . . . .. . . . .. . . . . .. . . . .. . . . . .. ..52O.577

Disaases of genitourinary ~stem .. .. . . . . .. . . . . .. . .. . .. .. .. . . . . .. . . . . .. . . .. . . . . .. . . . . .. . . ..58O$29Diaeaws of male genital organs .. . .. . . . . .. . .. .. . . . .. . . . .. . . . . . .. . . .. . . . .. . . . . .. . . . .. . ..6OO%O7Diaeaaes of female genital organs ... . .. . . . .. . . . .. . .. . .. . .. . .. . . . .. .. .. . . . . . .. . . . .. . . ..61 O%29

Oiseaees of skin and subcutaneous tissue .. . .. . . . . . .. . . . .. . . . .. . . . .. . . . . .. . . . .. . . . .. . ..68O.7WDiaaases of musculoskeletal system .. . . . .. . . . .. . .. .. . . .. .. . . . . .. . . . .. . . . . .. . . . .. . . . .. . . ..71 O.738

Arthritis and rheumatism .. . . .. . . .. . . . . . . .. . . .. . . .. . . . . . .. . .. . . .. . . .. . . . .. . . . . .. . . . .. ..71 O.7l8

Symptoms and ill-defined conditions .. .. . . . . .. . . . . .. . . . .. . . . . .. . . . .. . . . . .. . . . .. . . . .. . ..78O.7%

Accidents, poisoning, and violence .. .. . . . . .. . . . . .. . . .. . . . . .. . . . .. . . . . .. .. . .. . .. .. . . . . . ...8O&9WFracture . . . . . .. . . . .. . . . .. . . . .. . . .. . . . . .. . . . . .. . . . .. . . . . .. . . . .. . . . . .. . . . .. . . . .. . . . . . .. . . . .. . . . .. . ..8OO$29Dislocation, sprain .. .. . . . .. . . . .. . . . .. . . .. . . . . . .. . . .. . . . . .. . . . .. . . . . .. . . . .. . . . . . .. . . .. . . . . ...83O.8~

Lacerations .. . . . .. . . . .. . . .. . . . .. . . . . .. . . . .. . . . . .. . . . .. . . . . .. . . . .. . . . . .. . . . .. . . . . .. . . . .. . . . . .. . ..87O.9O7

Special conditions and examinations without sickness .. .. . . . .. . . . . .. . . . . .. . . YOO.Y13Medical and special examinations .. . .. . . . . .. . . . . .. . . . .. . . . .. . . . .. . . . . . .. . . . .. . . . . .. . . . . .. ..Y~Prenatal care .. ................................................ .......... ...... .......................YWMedical and surgical aftercare . . . . .. . . . . .. . . . .. . . . .. . . . . .. . . . .. . . . .. . . . . .. . . .. . . . . .. . . . .. . . ..YIo

1975

Number

of visits(in thou-

sands)

557,600

22,74713,33224,177

9,671

7,569

25,C61

13,641

44,94120,185

8,1689,899

56,358

22,824

12,513

80,12537,599

6,1237,675

Zo,ffil

37,6264,381

19,85228,564

32,732

17,765

26,177

40,8936,858

14,374

6,935100,787

40,66320,85126,782

Total

100.0100.0100.0100.0100.0

100.0

100.0

100.0

100.0100.0100.0100.0100.0

100.0100!0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0

Age of patientSex ofpatient

Under65

1515-24 25-44 45-64 years Fe-

yeara years yearsMale

andyears

maleover


17.4

31.03.63.7

●1.6

“4.5

6.1

● 2.4

25.714.514.570.6

0.8

‘0.5

‘0,6

33.342.814.527.0

8.94.7

●6.8‘1.7

22.0

“;;

16.118.323.5

7.2

32.424.3

43.6●1.613.5

15.3

20.57.98.7

●3.515.0

14.2

11.811.913.121.8

8.11.9

“1.3

+0.914.215.4

13.517.9

12.0

18.09.5

21.6

23.2

6.5

4.3

15.319.815.421.6

22.424.819.6

50.412.6

25.3

25.821.528.2

9.248.1

45,0

48.6

19.017.326.010.411.7

13.1

4.2

21.719.9

33.929.824.2

35.022.839.3

22,422.3

17.5

29.627.923.6

36.020.229.820.947.629.1

25.6

14.338.035.142,3

26.6

25.3

27.724.027.728.3

7.142.7

51.1

38,6

21.215.5

28.618.4

32.6

28.832.930.220.6

38.8

40.8

25,8

23.721.528.4

16.874.712.7● 0.4

30.4

16.4

8.429.024.443.4

5.8

9.4

9.819.427.5

9.5“3.842.8

34.0

55.8

9.76.49.66.9

22.3

13.526.1

7.211.7

26.4

35.8

13.210.316.0

6.69<36.43.3

14.5

60.4

57.862.670.559.4

80.4

62.4

67.556.361.664.752.6

58.1

64.0

46.1

53,054.347.053.2

E6. 178.4

. . .100.0

57.7

60.3

66.1

62.341.644.242,7

2?).9

67.959.6

99.655,2

39.6

42.237.429.540.6

19.6

37.6

32,541.838.435.347.544.0

36.0

63,9

47.045.7

53.046.843.9

21.8100.0

. . .

42.4

39.8

33.9

37.758.355,867.3

70.2

32.140.4

‘0.444.8

1 Based on E&hth Revision International Classification of Diseases, Adap ted for Use in the United States (lCDA)(reference 4).

Table 22. Number andoercent distributicm Of Officevisits bv~atlent's DriOr-visit status andseriOusness OfDrOblem. accOrdinq tOselected DrinciDal tia9n0ses: UnitedStates, January.

Principal diagnosis and I CDA code ]

All principal diagnoses .. . .. . .. . . .. . . .. . . . .. . . .. . . . . .. .. .. . . .. . . .. . . . . .. .. .. . . .. .. .. .. . . .. .. .. . . .. .

Infective and parasitic diwases ... .. . . .. . . .. . . .. .. .. . . .. . . . . .. .. .. . . .. . . .. . . .. .. . . .. . . .. .. .. .. . . ..OOO.l36

Neoplasms .. . . . .. .. .. . . .. . . .. . . .. .. . . .. ... . .. . . .. .. . . .. .. . . .. . . .. . . .. . . .. . . .. . . . . .. . . .. . . .. .. .. .. . . .. .. .. . ..l4O.239Endocrine, nutritional, and metabolic diseases ... . . .. .. .. . . .. .. .. . . .. .. . . .. . . .. . . .. . . . . ..24O.279

Diabetes mellitus .. . .. . . .. .. .. .. .. . . .. . . .. . . .. . . .. . . . .. . . .. . . . .. . . .. . . .. . . . . .. . . . . .. .. .. . .. . . . .. . . . . .. . . ..25OObesity .. . . . .. .. . . .. .. . . .. .. . . .. . . . . .. .. . . . . .. . .. . . . . .. . .. . . .. . . .. .. .. . . . . .. .. .. . . .. .. .. .. . . .. . . .. . . .. .. . . .. . . .277

Marital disorders .. . . .. . . .. .. .. .. .. .. . . .. . .. . .. .. . . .. .. .. .. .. . . .. . . .. .. .. . . . . .. . . .. . . . . .. . . .. .. .. . . .. . . ...29 O.3l5

Neuroses ... . . .. . . .. . . .. .. . . .. . . . . .. . . .. .. .. .. .. . . . .. .. .. . . .. . . . .. .. .. . . .. .. .. . . .. . . .. .. .. . . . .. . . . .. . . .. . . .. ...3oOD,seases of nervous system and sense organs .. . . . . . .. .. .. . . . .. .. . .. . . .. . . .. . . . .. . . .. . . .. ..32O.389

Diseaws and conditions of the eye .. . .. .. .. .. . . .. . . . . .. .. .. .. .. . . .. .. .. .. .. .. .. .. .. .. .. ...36O.379Refractive errofi .. . .. . . .. . . . .. .. . . .. . . . .. . . . .. . .. . . .. . . .. . . . .. .. .. .. .. .. .. . . .. . . . . .. . . .. . . .. .. .. . . .. .. . . ..37OOtitis media ... . . .. . . . .. . . .. . . .. . . .. . . .. . . . . .. . . .. . . .. .. . . .. .. . . .. .. .. . . . .. . .. .. .. . . .. . .. . .. .. .. .. .. .. . . . . ...38l

Diseases of circulatory system ... . . .. .. . .. . . . .. . . .. . . .. . . .. ... . . . .. .. .. .. .. .. .. . . .. .. .. . . .. .. .. . ..39 O.458Essential benign hy~rtension .. . .. . . .. . . .. . . .. . . .. . . . . ... . . . .. .. .. .. . . .. . . . ... .. . . .. .. . . .. . . .. .. ...4Ol

Chronic Ischamic heart dicease .. .. . .. . .. . . . .. . . . .. . .. . . .. . .. . . .. .. . . .. .. . . .. . . .. .. .. . .. . . . .. . . .. .. .412Dlsaasas of respiratory system .. . .. . . . . .. .. .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. .. .. .. . . .. .. .. . . .. .. .. ...46O.5l9

Acute respiratory infections (except influenza) . .. . . .. . .. . . .. . . .. .. . .. . . . .. . . .. . ...460-466Influenza .. .. . . . . .. .. . . .. . .. . . . . .. . .. . . . .. . .. . . . .. . . .. . . .. . .. . . . . .. .. . . .. .. . . .. .. .. . . .. . . . .. . .. .. . . ....470474

Hay fever . . .. . . .. . . .. .. .. . . .. . . .. . . .. . . .. .. .. . . . . .. . . .. . .. . . . .. . . .. .. . . . . .. .. .. .. .. .. . . .. . . . . .. .. . . .. .. . .. . . ..5o7tJIwases of digestive system .. .. .. .. .. .. . . .. .. .. . . .. . . .. .. . . . . .. .. .. .. .. . . .. . . .. .. . . .. . . .. . . .. . . ...52O.577

Dlseaaes of genitourinary ~stem .. . . .. . . . .. . . . .. . .. . .. . . . . .. . .. . . .. .. . .. . .. . . . . .. . . .. . . .. . . .. . ..58O~29Diseaaes of male genital organs .. . . .. . . .. . . .. . . .. . . .. . . .. .. .. . . .. . . .. . .. . . . . .. . .. .. .. .. .. ...6OOGO7Diseasas of female genital organs .. . .. . . . .. .. . . .. .. . .. . .. . . . .. . . .. . .. .. . . . . .. . .. . .. . . . .. . ..6l@629

Dlseasas of skin and subcutaneous tissue .. . . .. .. . . .. .. . .. . .. . . .. .. .. .. .. .. .. .. . . . .. . .. . . .. ..68O.7O9Diseasas of musculoskeletal sysmm ... .. . . .. . . .. . . .. . . . . .. .. . . .. . . . .. . . . .. . . . . .. .. .. .. . . .. .. ...71 O.738

Arthritis and rheumatism .. . .. . . . .. . . .. . . . .. . .. . . .. . .. . . .. . . .. . . . .. . .. . . . .. . . . .. . . .. . .. . . . .. . .710-718Symptoms and illdefined renditions .. . . .. .. .. . . .. . . .. . . .. . . .. . . .. .. . . .. .. .. . . .. . . .. .. .. .. ...78O.796Accidante, poisoning, and violenm ... . .. . . . .. . . .. . . .. . . .. . . .. . .. . .. .. . . .. . . .. . . . .. . . .. . . .. . . . ..8OO.999

Fracmm ... . . .. . . .. . . . . .. .. . . .. . . .. .. .. .. . . .. .. .. .. .. . . .. .. .. .. . . . ... .. .. .. .. .. .. .. .. . . .. .. .. . . .. .. .. ...8OO.629Dislomtion. ~rain .. . . .. .. . . .. . . .. . . . .. . .. . . . . .. . . .. .. . . .. . . .. . . .. .. . . .. . . .. .. .. .. .. . . .. . . .. .. .. ..83O$48Lmeretions ... .. .. . . . . .. . . .. . . .. . . .. .. . . . . .. .. . . . . . . .. .. . .. . . . . . .. .. .. .. .. .. .. .. . . .. .. .. .. .. . . .. .. . . ..87 O.9O7

Special ccmdlticms and examinations with~m sickness .. . . .. .. .. . . .. . . .. . . .. . . .. .. . Yoo.Y13

Madical and spatial examinations .. . . .. . . .. . . .. . . .. . . .. .. . . . .. . . . . .. . .. . . . .. . . .. . . . .. . .. .. .. . . ..YOO

Pranetal mre .. . . .. .. . .. . . ... .. . . .. . . .. . . . . .. .. . . .. .. . . .. . . .. . . .. .. . . .. .. .. .. . . .. . . .. .. .. .. .. . . .. .. . . .. . . ...Ym

Medicel and surgicnl aftermre ... . . .. . .. . .. . . .. . . . .. . . . .. .. . . . .. . . .. . . . .. . . .. . . .. . .. . .. .. . . .. . . .. ..Yl O

cember 19—

Number

of visits(in thou-

sands)

587,600

22,747

13,33224,177

9,6717,589

25,061

13,641

44,94120,185

8,1699,899

56,35822,82412,513

80,12537,599

6,1237,675

20,061

37,626

4,38119,85228,56432,73217,76526,177

40,893

6,85814,374

6,935100,787

40,863

20,851

26,782

5-

Total

100.0

100.0100.0

100.0

100.0100.0100.0100.0

100.0

100.0

100.0100.0100.0

100.0100.0

100.0100.0100.0100.0

100.0100.0

100.0

100.0100.0100.0

100.0100.0

100.01W.o100.0100.0

100.0100.0

100.0

100.0

Prior-visit status

I }

patient,New “ew

patient,cdd

pat ientprob. pmb-Iem Iem

I IPercent distribution

14.9

20.616.8

9.34.1

16.010.710.123.5

28.3

37.314.5

6.64.85.0

13.415.1

9.46.4

15.615.2

12.9

17.720.013.1

9.022.4

21.316.521.124.712.019.7

8.4

3.4

23.4

45.316.5

10.1

9.36.9

10.89.5

21.2

13.8

9.334.1

8.6

4.65.3

37.047.662.010.028.425.2

19.624.8

30.920.3

16.529.6

31.317.826.935.817.1

26.3

7.1

8.5

61.7

34.166.880.7

66.677.278.5

80.4

55.3

58.0

53.451.464.890.669.7

48.7

37.428.681.6

56.0

59.6

67.557.549.288.674.548.0

47.465.852.039.570.9

54.1

64.588.2


Seri-

ousor

veryseri.Ous

18.9

13.253.6

23.4

39.26.9

43.140.2

19.5

18.4

‘1.816.036.021.751.3

12.8

:;●5.324.2

14.9

16.2

12.110.521.4

23.017.2

18.1

28.114.817.3

6.2“1.3

3.5

15.7—

1

SlightlyNotsemi-

seriousOus

32.4

35.121.2

38.7

36.733.630.632.135.6

25.4

9.052.239.1

45.2

34.742.6

39.962.439.540.7

38.2

40.531.932.943.1

43.431.3

39.644.944.22Ss.2

9.8

3.6

6.023.4

46.8

51.725.3

39.924.1

59.526.327.7

44.9

%.389.2

31.924.9

33.114.0

44.652.428.955.2

35.147.0

43.3

56.056.635.6

33.661.4

42.428.141.053.564.195.1

90.6

60.9

1Baaed on Eigh th Reviskm International Classification of Diseases, A dapred for Use in the United States (ICDA) (reference 4).

35

Table 23. Numbrand percent ofoffice visits, byselected principal diagnoses anddiagnostic services ordered or provided: United States,January~Decambel

Principal diagnosis and ICDA code]

All principal diagnoses ... ... .. .... .. .. ... ... .. .... .. ... .. ... .. .... .. ... .. ... .. ... .. .

Infective and parasitic diseasas ... ... .. ... .. ... .. .... .. ... .. ... .. ... .. .... .. .. ... ...OOO.l36Neoplasms .. ... .. ... ... .... .. .. .. .... .. ... .. .... ... .. .. ... .. .... .. ... .. ... . .... .. ... ... ... .. ..l4O.239Endocrine, nutritional, and metabolic diseases .... ... .. ... .. ... .. .. .... .. ..24O-279

Diabetes mellitus . .. ... ... ... ... ... ... . .... . .... .. .... . ... .. .... . .... .. .... . ... .. ... .. .... ..250O&si~ . ... ... ... ... .. .... . .. .... .. ... .. ... .. ... ... .. .. .... . .... .. ... .. ... .. ... .. ... ... .. .. .. ....277

Mental disorders .. .. .... ... .. .. ... ... .. ... ... .. .. ... ... .. ... ... .. .. .... .. .. ... ... .. ... .. ...29O.3l5Neuroses . .. .... .. .. ... ... .. .. .... ... .. ... .. ... ... . .... ... .. .. ... ... .. ... ... ... .. ... .. ... ... .. ...3OO

Diseases of nervous system and sense organs .. .... .. ... .. .... .. ... . .... .. ...32O-389Diseases and conditions of the eye ... ... .. ... ... .. ... ... .. .. ... ... .. .... .. ..36O.379Refractive errors .. ... .. ... ... ... .. ... .. .... . ... .. .... .. ... . ... ... ... .. .... . .. ... .. .... .. .. ..37OOtitis media .. ... .. ... ... .. ... .. ... .. ... ... ... . ... ... .. .. . ... ... ... .. .. ... ... .. .... . .. ... .. ....38l

Diseases of circulatory system .. .. ... ... .. ... .. .. .... .. ... .. ... .. ... .. ... .. .... .. ...39O.458Essential benign hypertension . .. .. ... ... .. ... ... .. ... ... .. .. .... . ... .. ... .. ... .. ... ..401Chronic ischemic heart disease .. .... . ... ... .. ... ... .. ... .. .. ... .. .... ... .. .. ... . .....4l2

Diseases of respiratory system .... ... .. ... . .... .. .... . .... .. ... .. ... .. ... .. ... .. ....46O.5l9Acute respiratory infections (except influenza) .. . .... ... .. .. ... .. ...460-466influenza . .. ... .. ... ... .. .. ... .. .... .. ... .. ... .. .. .... .. ... ... .. ... .. ... .. .. ... .. ... .. ...47O474Hay fever .. .. ... ... ... . .... .. .. ... ... . .... . .... .. .... . ... .. .... .. ... .. ... .. ... .. ... .. .... .. .. ...5O7

Diseases of digestive system ... ... .. .. .. .... .. ... .. .... . ... . .. .. .. ... ... ... . .... .. ...52O.577

Diseases of genitourinary system .. .. ... .. .. ... .... .. .. ... ... .. .. ... ... .. .. .... .. ..58O.629

Disaares of male genital organs .. .... .... .. .... . .... .. .. ... ... .. .. ... ... .. ....6 OO.6O7Diseases of female genital organs ... .. ... ... .. .. ... ... .. .. ... .. .... .. .. ... ...61 O%29

Direases of skin and subcutaneous tissue ... ... .. .. ... ... .. .. ... ... .. .. .. .. .. ..68O.7O9Diseases of musculoskeletal system .... . .... .. ... .. .. ... ... ... .. ... ... .. ... .. ....71 O-738

Arthritis and rheumatism .... .. ... .. .... .. .. ... ... . .... .. ... .. ... .. ... .. .... .. ...71 O.7l8Symptoms and ill-defined conditions .. .. ... .. ... .. ... ... ... .. ... .. ... . .... ... ..78O.796

Accidents, poisoning, and violence . ... .. ... .. ... ... ... .. ... .. ... .. .. .... .. ... .. ..8 OO.W9Fracture . .. .... .. .. ... ... ... .. ... .. ... .. ... .. ... .. .. ... ... .. .... .. ... .. ... .. ... .. ... ... ...8 OO.829Dislocation, sprain .. .. .. ... .... .. .. .. .. .... . .... ... .. .. ... .. ... ... ... .. ... . ... .. ....83O.848Lacerations .... .. ... . ... ... ... .. .... .. ... . ... .. ... ... ... .. . ... ... ... .. .... .. .. .. ... .. ...87O.9O7

Special conditions and examinations without sickness ... ... .. ... .. .. YOO-Y13Medical and special examinations . .. ... .. .... .. ... .. ... .. ... .. ... .. .... .. ... .. .. ..YOOPrenatal care . .. .. .. ... ... ... .. .... .. .. .. ... ... .. ... .. ... .. .... . ... .. ... ... .. .. .... .. ... .. ....YO6Medical and surgical aftercare .. . ... .. ... .. .. .... . .. .. . .... .. ... .. ... .. .... . ... .. ....Yl O

1975

Selectad diagnostic servicesNumberof visits

(in thou-sands)

567,600

22,74713,33224,177

9,6717,569

25,06113,64144,94120,185

8,1699,899

56,35822,82412,51380,12537,599

6,1237,675

20,061

37,626

4,381

19,85228,56432,73217,76526,177

40,8936,858

14,374

6,935100,787

40,86320,85126,782

Limitedhistory/exami-

nation

51.3

60.547.850.551.748.8

25.426.354.144.643.0

64.458.654.066.559.967.944.830.857.1

56.6

61.953.150.757.958.3

45.9

56.856.1

63.440.740.126.561.948.9

mPercent of visits

15.8

14.816.316.815.416.9

9.67.7

14.115.721.614.013.812.514.510.811.2

8.55.2

19.0

16.5

10.521.3

7.010.6

9.623.7

7.75.89.3

*2.327.152.214.1

5.4

22.9

32.629.146.072.620.8

9.08.06.33.7

*2.3

6.222.822.226.514.117.611.1

5.020.9

47.7

50.134.6

9.714.117.6

33.34.6

*1.O

6.6*1.133.741.657.910.4

7.4

3.58.34.7

●3.9*4.1

3.0●2.8

2.4●0.7*0.2●1.8

5.94.56.46.63.6

●4.1‘2.314.4

5.0

●5.24.7

●1.514,911.011.5

23.156.721.6*4.7

4.86.0

‘0.9

7.4

pres-

sure

33.2

24.029.360.166.862.0

22.924.212.8

3.7*0.8

6.071.181.576.623.521.824.6

7.4

41.2

35.3

31.041.613.533.942.239.616.511.520.6

8.3

35.835.769.515.4

lBased on Eighth Revision In ternational Classification of Diseases, Adapted for Use in the United States (ICDA) (reference 4).

36

Table 24. Number and percent of office visits, by selected principal diagnoses and therapeutic services ordered or provided: Unitad

Statas, January -December 1975


All principal diagnoses . ... ... .. .... .. ... ... .. .. .... .. ... .. ... .. ... .. .... ... .. .. ... ... ... . .... .. ... .. ...

Infective and parasitic diseases ... ... .. .. ... ... .. .... .. ... .. ... .. .... . ..... .... . ... ... ... ... ... .. ... ... OOO.l36

Neoplasms .... ... ... .. ... .. .... .. ... .. .... . .... .. .. .. .... .. ... ... ... ... .. .. ... .... .. ... ... . ... ... .. .. .... ... .. .. 140-239Endocrine, nutritional, and metabolic diseases ... .. ... .. ... .. .. ... .... . ... ... ... .. .. ... .... ..24O.279

Diabetas mellitus .. ... ... .... .. ... .. ... ... .. ... ... .. ... ... ... .. ... ... .. .... . ... .. .. .... ... .. ... .. ... .. ... ... ...25OObesity .. ... ... .. .... .. ... .. .... .. ... .. .... .. ... . .... .. ... ... ... ... ... . .... .. ... .. .... .. ... . ..... . ... .. .... .. ... ....277

Mental disorders ... ... .. .... .. ... ... .. .... .. .. ... .... .. .. ... .... . .. .. . .... .. ... .. ... ... .. ... ... .. .. ... ... ....29 O.3l5Neuroses . ... ... .. .... . ... ... ... .. .... .. ... .. ... .. .... .. .... .. ... . .... .. ... ... ... .. .. .. .... .. ... ... .. .. ... ... ... .. ..3OO

Diseases of nervous system and sense organs .. .... .. ... .. ... .. .... .. ... .. ... .. .... .. .. ... ... ...32 O.389

Diseases and conditions of the eye ... .. .. ... .... .. .. ... ... .. .... .. .. ... .. ... .... .. . ... .... .. ..36 O.379Refractive errors . ... ... ... ... . ... . ... .. .. .. .. .. ... .. .. . .... .. ... .. .... . .... .. ... .. ... .. .... .. .. ... ... .. .. ... ...37OOtitis media .. .. ..... . ... .. ... .. .... .. ... .. ... .. ... ... ... .. .... ... ... .. ... .. ... .. .... . ... .. ... .. .... .. ... .. ... ....38l

Diseases of circulatory system .. .... .. .. .. ..... . .... .. ... .. .... .. ... .. ... . ... ... ... ... ... . ... ... ... ...39O458Essential benign hypertension . ... ... . .... .. .... .. ... ... ... .. ... ... .. .. ... .. ... ... ... .. ... .. ... . ..... . ..4Ol

Chronic ischemic haart disaase .. .... . .... .. ... .. ... ... ... .. ... . .... .. .... . ... .. ... ... ... .. .... . .. ... ...4l2Diseases of respiratory system .. . .... ... .. .... .. ... .. .... . ... ... .... . ... ... .. .. ... ... ... .. .. ... .. ... ..46 O.5l9

Acute respiratory infections (except influenza) .. ... .. .. .... ... .. .. .... . ... ... ... . ... ...%O466influenza . . .... . ... ... .. ... ... .. ... ... ... .. ... .. .... . ... ... ... ... ... .. ... .. .... .. .... . .. ... ... .. ... ... ... ...47O474Hay fever .. .. .. ... ... .. ... .. .... . .... .. .... . .... .. ... .. .... .. ... . .... ... ... .. .. ... ... .. ... ... ... . .... .. ... .. ... ....5O7

Diseases of digastive system .... ... ... .. ... .. ... .. .... .. ... .. ... .. .... .. ... .. ... .. .. ... ... ... ... .. ... ...52 O.577Diseases of genitourinary system .. . ... ... ... .. .. ... . .. ... ... .. .... . ... .. .. .. .. .. ... . .... .. .. .... .. ..58O629

Diseases of male genital organs ... ... .. ... .. ... ... ... . ..... .. .. .. ... ... .. .. .... .. .. .. ... ... .... ..6OO$O7Disaases of female genital organs .. .. .... . .... .. ... .. ... .. ... .. .... .. .. .. .... .. .. ... ... .. .. ... ..61 O629

Diseases of skin and subcutaneous tissue .. .. ... ... ... ... .. .. ... .. ... .. ... .. ... .. ... .. ... .. .... ..68 O.7O9

Diseases of musculoskeletal system ... ... .. ... . .. .. .. ... ... .. ... .. .. ... .. ... ... .. ... .. .. ... ... .. ....71 O.738Arthritis and rheumatism .. ... ... .. ... ... ... .. .... .. ... . .... . ... .. .... .. ... .. ... .. .. ... ... .. ... .. ..71 O.7l8

Symptoms and ill-defined conditions .. .... .. .. ... .... .. .. ... . .... ... .. .. ... .. ... .. ... .. .. .. . .... ..78O.796Accidents, poisoning, and violence . .... .. .. ... ... .. .... .. ... ... .. .. ... .. ... .. ... .. ... .. ... .. .. ... ..8OO.999

Fracture .. ... ... ... ... .. ... .. ... .. .... ... .. ... ... ... .. ... ... ... .. ... .. ... .. ... ... . ... .. ... .. ... .. .... . ... ...8OO.8~

Dislocationr sprain .... .. ... ... .. .. .... .. .. .. .... .. .... . .... .. ... .. .. ... ... .. .... .. .. .. ... .. ... ... ... ...83 O.848Lacerations .. ... .. .... .. ... ... .. .. .... ... .. ... .. ... .. ... .. .... .. ... .. ... .. ... .. .... . .... .. .. ... . ... .... .. ..87 O.9O7

Special conditions and examinations without sickness .. ... ... .. .. ... .. ... ... ... .. .. ... . YOO-Y13Medical and special examinations . .. ... .. .... .. ... .. ... .. ... .. ... ... ... .. .. .. .. .... .. ... . .... .. ... . ..YOOprenatal care ... ... .. .. ... .. .... . ... .... .. ... .. ... ... .. ... ... .. ... ... .. ... .. ... . .... . .... .. ... .. ... .. ... .. .. .. . ..YO6

Madical and surgical aftercare .. .. .... . ... ... ... ... .. .. .. .. . .... . .... .. .. .. .... .. .... . ... .. .. ... .. ... ...Yl O


sands)

567,600

22,74713,33224,177

9,6717,569

25,06113,64144,941

20,1858,169

9,89956,35822,824

12,51380,12537,599

6,1237,675

20,061

37,6264,381

19,85228,564

32,73217,76526,17740,893

6,85814,374

6,935100,787

40,86320,85126,782

Selectad therapeutic services

OrugMadi-

1njec- Office calpre-

tion surgery cons-cribed

sating

44.3

60.423.1

50.8

47.661.439.139.844.8

21.81.7

78.557.462.3

55.371.581.885.831.849,1

49.044.742.656.2

47.856.840.429.114.1

35.417.716.114.417.915.9

Percent of visits

13.8

14.811.8

17.6

12.017.9

9.19.7

10.2●1.6

17.810.7

:::28.328.147.625.2

10.813.112.317.114.6

25.529.1

8.89.6

‘2.09,8

17.64.34.2

*1.53.3

6.7

11.019.9

●0.7+0.9

0.5●0.2‘0.2

5.9

3.2“0.5

4.31.8

*0.5●0.7

0.9‘0.5

‘0.63.3

9.2“4.9

6.319.1

3.8●1.7

3.621.624.5

6.156.6

6.7‘0.7●0.521.2

12.3

11.210.920.6

20.4

26.013.312.7

9.15.62.8

11.116.114.217,6

7.8

6.3*5.6

9.020.5

12.911.115.512.112.911.113.412.614.814.1

7.810.911.010.810.8

I lBascd on Eighth Revision International Classification of Diseases, Adapted for Use in the United States (ICDA) (reference 4).

37

Table 25. Number and percent of office visits, by selected principal diagnoses and disposition: United States, January-December 1975


All principal diagnoses ... .. .... .. ... . .... .. ... . ..... . .... . ... .. .... . .... .. ... .. .. .. ... ... .. ..

Infective and parasitic diseases . ... .. ... ... ... .. .. .... .. .. ... .. ... .. .. .... .. .. .. ... ... .. ... .000-136Neoplasms .... ... . ... ... ... . ... .. ... .. ... . ..... . ... .. ... .. ... ... .. ... .. ... .. ... .. ... .. ... .. .... . ... ...l4O.239Endocrine, nutritional, and matabolic diseaws .. .. ... .. ... .. .. ... .. .. . .. ... .. ... ...24O.279

Diabetes mellitus .. .. .. ... ... ... .. .. ... .. ... ... .. .. ... .. .... . ... .. ... ... ... . ... .. ... .. .... .. .. .. ... ..25O

Obesity .. .. ... ... ... .. .. .. .. ... .. .... .. ... .. ... ... . ... .. ... ... .. .. ... .. ... .. ... ... .. .. ... .. .. .... .. .. ....277Mental disorders .. ... .. .. ... .. ... .. ... .. .... .. .. ... .. ... .. .. .... . .. .... .. ... .. ... .. .. . .. ... .. ... ...29@3l5

Neuroses . ... ... .. ... . ... ... .. .. .... .. .. ... . .... ... .. .. ... .. ... .. .... . ... ... .. .. .. ... ... .. .. .... .. .. .. ...3ooDisaasas of narvous system and sense organs ... ... .. ... . .... .. ... .. ... .. .. ... ... ....320-389

Diseases and conditions of the eye . ... .. .. ...o. ... .. ... .. ... . .... .. ... .. ... .. ... .. ..36O.379Refractive errors ... .. .. ... .. ... .. ... .. ... .. ... ... .. .. ... .. ... ... . .. .. .. ... .. ... .. ... .. .... .. .. .. ...37O

Otitis media .. .. .... . ... .. .. .. .. .... .. .. . ... .. .. ... .. ... .. .... . ... .. .. ... ... .. .... .. . ... .. .. . .. ... .. ...38lDisaases of circulatory system .. .... .. . .... .. ... . .... .. .. .. .... .. ... . .... .. .. ... ... .. .. ... ..39O458

Essential benign hypertension .. .... .. ... .. ... ... .. .. ... .. ... ... . ... .. .... . ... ... ... . ... ... ...4OlChronic ischemic heart diwaw ... ... . ... .. .... . .... .. ... .. .. ... .. ... .. .. . .. ... .. .. .. .. .. .. ...4l2

Diseases of respiratory system ... .. .. ... .. ... .. .. ... ... .. .. .... .. .. .. ... .. ... .. ... ... . .... ..46 O.5l9Acute respiratory infections (except influanza) . .. .... .. .. .. ... .. ... ... ... ...460-466influenza .. . .... . .... .. .. .. ... ... .. .. .. .... .. ... . .... .. .... . ... .. .. ... ... .. .. ... ....<.. ... .. ... ...47O474Hay fever . ... ... .. .. .. ... ... .. .. ... .. .... .. . .... ... . .. .... . ... .. .... .. .. .. .. ... .. ... .... .. . .... . .... .. ..5O7

Diseases of digestive system ..... .. .... . ... .. .. .... .. ... . ... ... .. .. ... ... .. .. .. ... ... .. .... ...52O.577Diseases of genitourinary system ... .. ... .. ... .. ... .. ... .. .. ... ... . ... .. .... .. .. ... .. ... ...58 O.62G

Diseases of male genital organs . .... .. ... .. . ... .. .... .. ... .. ... . ... ... .. .. ... ... .. ... ..6 OO%O7Diseases of female genital organs .. .. ... .. .. ... . .... .. .... . ... ... ... . ... .. ... .. ... ....61 O%2S

Diseases of skin and subcutaneous tissue ... ... .. ... .. .. ... ... .. .. ... .... . .. ... .. ... ...68O.7O$Diseases of musculoskeletal system ..... ... . .. .... .. ... .. ... .. ... . .... . ... ... ... .. .. ... ..71 O-73E

Arthritis and rheumatism .. .... .. . .... .. .. ... ... .. ... .. .. ... .. ... .. ... .. ... .. ... .. ... .. ..71 0.71 E

Symptoms and ill-defined conditions .. .... . .. .. .. ... .. .. ... ... .. . ... ... ... . ... ... .... ..78O.79tAccidents, poisoning, and violence .. ... ... .. .. .... . .... . .... .. .. ... . .. . .. ... ... ... .. ... ..8OO.99G

Fracture ... . ... .. ... .. .. ... .. ... .. ... ... .. . .... .. .... . .. ... .. ... .. ... ... .. .. ... .. ... ... ... . ..... ..8OO.82SDislocation, sprain .. .. .. ... . .... .. ... .. .. ... .. ... ... .. ... .. .. ... ... .. .. ... .. ... .. ... .. .... ..83 O.84E

Lacerations .... .. ... .. .. ... .. ... .. .. ... ... .. ... .. ... .. ... . .... . .... .. .. .. .... .. ... . ... ... .. ... ..87O.9O7

Special conditions and examinations without sicknass .. .. ... . ... .. .. ... ... .. YOO-Yl~Medical and special examinations .. .. .. ... .. .. .... .. .. ... ... .. .. ... .. ... .. ... .. ... .. .... . ..YOGPrenatal care ... ... . .... ... ... . .. ... ... .. .. .... ... .. . ... .. ... .. .... .. ... .. ... . ... .. ... ... . .... . .... ...YO6

Medical and surgical aftercare . .. . .. .. .. ... ... .. ... .. ... .. .. .. . .. ... .. .. ... .... . .... .. .. .. ...Yl C


sands)

567,600

22,74713,33224,177

9,671

7,56925,06113,64144,94120,185

8,1699,899

56,35822,82412,51380,12537,599

6,1237,675

20,06137,626

4,38119,85228,56432,732

17,76526,17740,893

6,85814,374

6,935

100,78740,863

20,851

26,782

Disposition (selected actions)

I Referred

Noturn

Returnfor fur-

Followupat thar cara

speci-if

planned neededor ad-

fied mitted totime hospital

13.1

17.24.73.1

*2.7

*3.55.74.7

15.015.9

26.112.2

3.02.9

*1.7

17.022.320.8

*6.17.15.2

*5.45.9

13.4

6.8

5.514.817.2

9.813.1

26.9

23.137.5

*2.3

15.9

Parcent of visits

59.1

40.770.381.7

82.584.972.474.757.4

59.6

49.558.780.684.688.0

38.024.814.573.7

54.365.568.462.650.5

58.0

61.250.455.470.052.755.6

63.247.1

93.566.3

22.3

33.18.8

13.7

12.9

13.119.919.723.221.6

25.425.012.412.18.0

39.046.658.719.222.822.617.323.632.5

28.9

30.522.021.815.726.4

12.912.1

13.3

*2.616.2

5.0

3.717.2

2.8

●2.9*l{o

4.33.44.6

3.9

*0,9●2.9

5.5*2.2

●3.22.71.2

●2.1*3,314.8

7.713.0

8.14.1

5,5

3.59.63.9

* 4.94.9

●3.52.2

1,8

●3.4+1.9

lBasedon Ej~hth RevjSi~n internationalClassificationof DiseaSeS,AdaptedfOr USe in the United States (ICIW(referenCe4.

NOTE: Since more than onedisposition waspossible, figures donotadd to totals.

38

REFERENCES

lNational Center for Health Statistics: NationalAmbulatory Medical Care Survey: Background andmethodology, United States, 1967-72. Vital and HealthStatistics. Series 2-No. 61. DHEW Pub. No. (HRA)74-1335. Health Resources Administration. Washington.U,!$ Gowrnment Printing Office, Apr. 1974.

“National Center for Health Statistics: Physicianvisits, volume and interval since last visit, United States,1971. Vital and Health Statistics. Series 1O-NO. 97.DHEW Pub. No. (HRA) 75-1524. Health ResourcesAdministration. Washington. U.S. Government PrintingOffice, Mar. 1975.

3National Center for Health Statistics: The Na-tional Ambulatory Medical Care Survey: Symptomclassification. Vital and Health Statistics. Series 2-No.63. DHEW Pub. No. (HRA) 74-1337. Health ResourcesAdministration. Washington. U.S. Government PrintingOffice, May 1974.

4National Center for Health Statistics: Eighth Reui-sion International Classification of Diseases, Adafited foi-Use in the United States. PHS Pub. No. 1693. PublicHealth Service. Washington. U.S. Government PrintingOffice, 1967.

5National Center for Health Statistics: Replication:An approach to the analysis of data from complexsurveys. Vital and Health Statistics. Series 2-No. 14.DHEW Pub. No. (HSM) 73-1269. Health Services andMental Health Administration. Washington. U.S. Govern-ment Printing Office, Apr. 1966.

6National Center for Health Statistics: Pseudoreplica-tion: Further evaluation and application of the balancedhalf-sample technique. Vital and Health Statistics. Series2-No. 31. DHEW Pub. No. (HSM) 73-1270. HealthServices and Mental Health Administration. Washington.U.S. Government Printing Office, Jan. 1969.

39

APPENDIXES

CONTENTS

I. Technical Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Statistical Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .DataCollectionand~rocessing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Estimation Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ReliabilityofEstimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Tests of Significance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Population Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Systematic Bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

II. Definition of Certain Terms Used in This Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Terms Relating to the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Ternts Relatingto the Patient Record Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

III. Survey Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Introductory Letter From Director, National Center for Health Statistics . . . . . . . . . . . . . . . . . .Patient RecordandPatient Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .InductionInterview Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LISTOFAPPENDIX FIGURES

I. Approximate relative standard errors for estimated numbers of office visits, 1975 NationalAmbulatoryMedical CareSumey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

II. Approximate relative standard errors forpercentages ofestimated numbers of office visits, 1975National Ambulatory MedlcalCare Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LIST OF APPENDIX TABLES

I. Distribution of physicians in the universe (AMA and AOA) and in the National AmbulatoryMedical Survey sample, by physician’s specialty: United States, January-December 1975 . . . . . .

IL Estimates of the civilian noninstitutionalized population of the United States, by age, race, sex,geographic region, and metropolitan and nonmetropolitan area as of July 1, 1975 . . . . . . . . . . .

4141424344474747

494950

53535455

45

46

42

48

40

APPENDIX 1

TECHNICAL NOTES

Statistical Design

Scope of the wmey. –The target populationof the NAMCS encompasses office visits withinthe coterminous United States made by ambula-tory patients to nonfederally employed physi-citins who are principally engaged in officepractice, but not in the specialties of anesthesi-ology, pathology, and radiology. Telephone con-tacts and nonoffice visits are excluded.

Sampling frame and sample size. –The sam-pling frame for the NAMCS is composed of allphysicians contained in the master files main-tained by the American Medical Association(AMA) and American Osteopathic Association(AOA) as of December 31, 1974, who met thefollowing criteria:

Office-based, as defined by the AMA andAOA;

Principally engaged in patient care activities;

Nonfederally employed;

Not in the specialties of anesthesiology,pathology, clinical pathology, forensic pa-thology, radiology, diagnostic radiology,pediatric radiology, or therapeutic radiology.

The 1975 physician universe included180,125 doctors of medicine and 9,696 doctorsof osteopathy.

The 1975 NAMCS sample included 3,507physicians. Sample physicians were screened atthe time of the survey to assure that they metthe above-mentioned criteria; 438 physicians didnot meet all of the criteria and were, therefore,ruled out of scope (ineligible) for the study.

The most frequent reasons for being out ofscope were that the physician was retired,deceased, or employed in teaching, research, oradministration. Of the 3,069 in-scope (eligible)physicians, 2,472 (80.5 percent) participated inthe study. The physician universe, sample size,and response rates by physician specialty areshown in table I. Of the participating physicians,391 physicians saw no patients during theirassigned reporting period because of vacations,illness, or other reasons for being temporarilynot in practice.—.

Sample design. –The 1975 NAMCS utilized amultistage probability design that involved prob-ability samples of primary sampling units(PSU’S), physician practices within PSU’S, andpatient visits within practices. The first-stagesample of 87 PSU’S was selected by the NationalOpinion Research Center (NORC), the organiza-tion responsible for field operations under con-tract to the National Center for Health Statistics(NCHS). A PSU is a county, a group of adjacentcounties, or a standard metropolitan statisticalarea (SMSA). A modified probability-proportional-to-size procedure using separatesampling frames for SMSA’S and for nonmetro-politan counties was employed. After sortingand stratifying by size, region, and demographiccharacteristics, each frame was divided intosequential zones of 1 million residents, and arandom number was drawn to determine whichPSU came into the sample from each zone.

The second stage consisted of a probabilitysample of practicing physicians selected fromthe master files maintained by the AmericanMedical Association (AMA) and American Oste-opathic Association (AOA). Within each PSU, all

41

Table 1. Distribution of physicians in the univerw (AMA and AOA) and in the National Ambulatory Medical Care Survey sample, by

physician’s spacialty: United States, January-December 1975

out.Non-

Gross of NetRe- Re-

Physicianfs specialty Universere-

totalspond-

total spond-sponse

scope ents rateents

Number of physicians

All specialties .. .. .. .... . .... .. ... ... .. .. ... ... ... . .. .. .. ... ... .. .. ... ... ... .. .. 189,821 3,507 438 3,069 597 2,472 80.5

General and family practice . ... .. ... .. .... .. . .... . .... .. ... ... .. .. ... ... 53,069 911 122 789 179 610 77.3

Madical specialties ... . .... .. ... .. .... . ... .. .... .. ... .. ... .. .. .... .. .. .... ... . 49,801 942 121 821 165 656 79.9

Internal medicine . ... ... ... .. ... .. ... ... ... . .... .. ... ... .. ... .. .. ... ... ... .. ... .. ... ... .. ... . 26,125 505 59 446 99 347 77.8

Pediatrics .. ... .. .. .... . .... .. ... .. ... .. .... . .... .. ... .. ... ... .. .. .... .. ... .. ... .. ... .. ... .. ... ... . 12,229 239 39 200 28 172 86.0

Other medical specialties .. ... . .... .. ... .. .... . ... .. ... .. ... .. ... ... .. ... .. ... ... .. ... .. .. 11,447 198 23 175 38 137 78.3

Surgical specialties . ... ... .. .. .... ... .. .. ... ... ... . .... ... .. .. ... ... .. .. ... ... 65,434 1,255 89 1,166 214 952 81.6

General surgery . .. ... ... ... .. ... ... ... . ..... . ... .. ... .... .. .. .... . .. .. . .... .. .. ... ... .. ... .. .. 19,606 37 ‘f 22 349 63 286 81.9Obstetrics and gynecology .. .. .. ... ... .. .... .. ... .. .. ... ... .. ... .. .... .. . .... .. .. .. .. .. .. 15,124 311 25 286 53 233 81.5Other surgical specialties .. ... .. ... .. ... .. ... .. ... .. ... .. .... . ... .. .... .. ... .. ... .. ... .. .. 30,704 573 42 531 98 433 81.5

Other specialties .. ... .. ... .. .. .... .. .. .. .... ... .. .. ... .. ... .. ... .. .... . ... ... . 21,517 399 106 293 39 254 86.7

Psychiatry . .... ... .. .. ... .. ... .. ... ... .. .. .... .. .. ... ... .. ... ... ... . ... ... ... .. .. ... ... .. .. ... ... 12,993 242 32 210 20 190 90.5Other specialties .. .. .. .. .... .. .... . ... .. ... .. .... . .... . ... ... ... .. ... .. ... ... .. .. ... .. ... ... .. 8,524 157 74 83 19 64 77.1

eligible physicians were arranged by nine spe-cialt y groups: general and family practice,internaJ medicine, pediatrics, other medical spe-cialties, general surgery, obstetrics and gyne-cology, other surgical specialties, psychiatry, andother specialties. Then, within each PSU, asystematic random sample of physicians wasselected in such a way that the overall probabil-ity of selecting any physician in the UnitedStates was approximately constant.

The final stage was the selection of patientvisits within the annual practices of samplephysicians. This involved two steps. First, thetotal physician sample was divided into 52random subsamples of approximately equal size,and each subsarnple was randomly assigned to 1of the 52 weeks in the survey year. Second, asystematic random sample of visits was selectedby the physician during the assigned week. Thesampling rate varied for this final step from a100-percent sample for very small practices to a20-percent sample for very large practices asdetermined in a presurvey interview. Themethod by which the sampling rate was deter-mined is described in the Induction Interviewform displayed in appendix 111.

Data Collection and Processing

Field procedures. –Both mail and telephonecontacts were used to enlist sample physiciansinto the NAMCS. Physicians received introduc-tory letters from the NCHS (see appendix III)and the AMA or AOA. When appropriate, aletter from the physician’s specialty organiza-tion, endorsing the survey and urging his pm-tici-pation, was enclosed with the NCHS letter. Afew days later, a field representative telephonedthe sample physician to briefly explain the studyand arrange an appointment for a personalinterview. An initially nonresponding physicianwas generally recontacted via a telephone call orspecial explanatory letter and requested toreconsider participation in the study.

During the personal interview the field repre-sentative determined the sample ph ysician’seligibility, ascertained his cooperation, deliveredsurvey materials with verbal and printed instruc-tions, and assigned a predetermined Mondaythrough Sunday reporting period. A short inter-view concerning basic practice characteristics,such as type of practice and expected number ofoffice visits, was administered. Office staff who

42

were to assist with data collection were invitedto attend the instruction session or were offeredseparate instruction sessions.

Before the beginning of and again during theweek assigned for data collection, the inter-viewer telephoned the sample physician to an-swer possible questions and to insure thatprocedures were going smoothly. At the end ofthe survey week, the participating physicianmailed finished survey materials to the inter-~~imver who edited the forms for completenessbefore transmitting them for central data proces-sing. Problems or missing data at this stage wereresolved by interviewer telephone followup tothe sample physician; if there were no problems,field procedures were complete with respect tothe sample physician’s participation in theNAMCS. After the end of the survey year eachsumple physician was sent a thank-you letterfrom the NCHS along with one of the survey’sstatistical reports.

Data col/t,ction. –The actual data collectionfur the NAMCS was carried out by the physicianaided by his office staff when possible. Two datacollection forms were employed by the physi-ciun: the Patient Log and the Patient Record(~ppcndis III). The Patient Log is a sequentiallisting of patients seen in the physician’s officeduring his assigned reporting weeli. This listsvrved w the sampling frame to indicate the visitfor which data were to be recorded. A perfora-tion between the patient names and patient visitcharacteristics permitted the physician to re-move patient names and protect confidentiality.

Based on the physician’s estimate of theexpected number of office visits, each physicianwas assigned a patient sampling ratio. Theseratios were designed so that about 30 PatientRecords were completed during the assignedreporting week. Physicians expecting 10 orfewer visits each day recorded data for all ofthem, while those expecting more than 10 visitsper day recorded data for every second, third, orfifth \risit, bused on the predetermined samplinginternal. These procedures minimized the datacollccti(m workload and maintained approxi-mate equal reporting levels among sample physi-citins regardless of practice size. For physiciansassigned a patient sampling ratio, a random startwm provided on the first page of the log, so thatpredesignated sample visits on each succeeding

page of the log provided a systematic randomsample of patient visits during the reportingperiod.

Data processing. –In addition to complete-ness checks made by the field staff, clerical editswere performed upon receipt of the data forcentral processing. These procedures provedquite efficient, reducing the item nonresponserates to a negligible amount-2 percent or lessfor all data items.

Information contained in item 5 (patient’sproblem) of the Patient Record was codedaccording to a special classification system devel-oped for that purposes Diagnostic information,item 9 of the Patient Record, was codedaccording to the Eighth Revision InternationalClassification of Diseases, Adapted for Use inthe United States(ICDA).4 A maximum of threeproblems and three diagnoses were coded. Atwo-way independent verification procedurewith 100-percent verification was used to con-trol the medical coding operation. Differencesbetween coders were adjudicated at the NationalCenter for Health Statistics.

Information from the Induction Interviewand Patient Record was keypunched, with 100-percent verification, and converted to computertape. At this time, extensive computer con-sistency and edit checks were performed. Dataitems still unanswered at this point were im-puted by assigning a value from a Patient Recordwith similar characteristics; imputations werebased on physician specialty, major reason forvisit, and broad diagnostic categories.

Estimation Procedures

Statistics produced from the 1975 NationalAmbulatory Medical Care Survey were derivedby a multistage estimating procedure. The proce-dure produces essentially unbiased national esti-mates and has basically three components:(1) inflation by reciprocals of the probabilitiesof selection, (2) adjustment for nonresponse,and (3) a ratio adjustment to fixed totals. Eachof these components is described briefly below.

Inflation by reciprocals of sampling prob-abilities. —Since the survey utilized a three-stagesample design, there were three probabilities:(1) the probability of selecting the PSU, (2) theprobability of selecting a physician within the

43

PSU, and (3) the probability of selecting apatient visit with the physician’s practice. Thelast probability was defined to be the exactnumber of office visits during the physician’sspecified reporting week divided by the numberof Patient Records completed. All weekly esti-mates were inflated by a factor of 52 to deriveannual estimates.

Adjustment for nonresponse. —Estimatesfrom the NAMCS data were adjusted to accountfor sample physicians who did not participate inthe study. This was done in such a manner as tominimize the impact of nonresponse on finalestimates by imputing to nonresponding physi-cians the practice characteristics of similar re-sponding physicians. For this purpose, similarphysicians were judged to be physicians havingthe same specialty designation and practicing inthe same PSU.

Ratio adjustment. –A poststratification ad-justment was made within each of nine physi-cian specialty groups. The ratio adjustment wasa multiplication factor which had as its numera-tor the number of physicians in the universe ineach physician specialty group, and as its de-nominator the estimated number of physiciansin that particular specialty group. The numera-tor was based on figures obtained from theAMA-AOA master files, and the denominatorwas based on data from the sample.

Reliability of Estimates

Since the statistics presented in this reportare based on a sample, they will differ somewhatfrom the figures that would be obtained if acomplete census had been taken using the sameforms, instructions, and procedures. However,the probability design of the NAMCS permitsthe calculation of sampling errors. The standarderror is primarily a measure of sampling variabil-ity that occurs by chance because only a samplerather than the entire population is surveyed. Ascalculated in this report, the standard error alsoreflects part of the variation which arises in themeasurement process. It does not include esti-mates of any systematic biases that may be inthe data. The chances are about 68 out of 100that an estimate from the sample would differfrom a complete census by less than the stand-ard error. The chances are about 95 out of 100

that the difference would be less than twice thestandard error and about 99 out of 100 that itwould be less than 21/2times as large.

The relative standard error of an estimate isobtained by dividing the standard by the esti-mate itself and is expressed as a percentage ofthe estimate. For this report, asterisks (*) arepresented along with the estimate for anyestimate with more than a 3 O-percent relativestandard error.

Estimates of sampling variability were calcu-lated using the method of half-sample replica-tion. This method yields overall variabilitythrough observation of variability among ran-dom subsamples of the total sample. A descrip-tion of the development and evaluation of thereplication technique for error estimation hasbeen previously published.5 ‘G

Approximate relative standard errors foraggregates and percentages are presented infigures I and II. In order to derive errorestimates that would be applicable to a widevariety of statistics and could be prepared atmoderate cost, several approximations were re-quired. As a result, the relative standard errorsshown in figures I and II should be interpretedas approximate rather than exact for any speci-fic estimate. Directions for determing approxi-mate relative standard errors from the figuresfollow.

1. Estimates of aggregates: Approximaterelative standard errors (in percent) foraggregate statistics, such as the numberof office visits with a given characteris-tic, are obtained from the curve in figureI, or calculated by the formula

RSE (x) =~001160252 + 44”6:97 ● 100

where x is the aggregate of interest inthousands.

2. Estimates of percentages: Approximaterelative standard errors (in percent) forestimates of this type can be calculatedfrom the curve in figure I as follows.Obtain the relative standard error of thenumerator and denominator. Square

NOTE: A list of references follows the text.

44

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45

Figure II. Approximate relative standard errors for percentages of estimated numbers of office visits,1975 National Ambulatory Medical Care Survey

100908070

60

50

40

30

c 20

1:

87

6

5

4

3

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.9

.8

.7

.6

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.4

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— .1

ESTIMATED PERCENTAGE

Example of use of this chart: An estimate of 20 percent (read at bottom of chart) based on anestimate of 10 million office visits has a relative standard error of 13.4 percent (read from scale at leftof chart) or a standard error of 2.7 percentage points (13.4 percent of 20 percent).

46

3,

4.

each of the relative standard errors,subtract the resulting value for thedenominator from the resulting value forthe numerator, and extract the squareroot. This calculation has been made forseveral percentages and bases and ispresented in figure II. Alternatively, theformula

RSE ~)‘m”’””

can be used to calculate RSE for anypercentage @) and base (x, in thousands).

Estimates of rates where the numeratoris not a subclass of the denominator:Approximate relative standard errors forrates where the denominator is the totalU.S. population or one or more of theage-sex-race groups of the total popula-tion are equivalent to the relative stand-ard error of the numerator that can beobtained from figure I.

Estimates of differences between twostatistics: The relative standard errorsshown in this appendix are not directlyapplicable to differences between twosample estimates. The standard error of adifference is approximately the squareroot of the sum of the squares of eachstandard error considered separately.This formula will represent the standarderror quite accurately for the differencebetween separate and uncorreIatedcharacteristics, although it is only arough approximation in most othercases.

Standard errors were calculated for thespecific estimates of mean contact duration ofvisit presented in this report; these standarderrors are presented in the tables A, B, G, and Jalong with the estimates.

In addition to sampling error, survey resultsare subject to reporting and processing errorsand biases due to nonresponse or incompleteresponse. There is no way to compute themagnitude of these errors. However, these types

of errors were kept to a minimum by methodsbuilt into the survey procedures. Extensivepretesting and careful attention was given tophrasing of the questions and the terms em-ployed and their definitions in order to elimi-nate ambiguities and encourage uniformity.Steps taken to reduce nonresponse bias werediscussed in the sections on field procedures anddata collection. Errors in coding and processingwere reduced by verification and consistencychecks.

Tests of Significance

In this report, the determination of statisticalinference is based on the t-test with a criticalvalue of 1.96 (0.05 level of significance). Termsrelating to differences, such as “higher,” “less,”etc., indicate that the differences were statis-tically significant. Terms such as “similar,” “nodifference,” etc. mean that no statistical signifi-cance exists between the statistics being com-pared. Lack of comment regarding the differ-ence between any two statistics does not meanthe difference was tested and found to be notsignificant.

Population Figures

The base population used in computingannual visit rates is presented in table H. Thesefigures are based on provisional estimates for thecivilian noninstitutionalized population as ofJuly 1, 1975, provided by the U.S. Bureau ofthe Census. Because the NAMCS includes datafor only the coterminous United States, theoriginal census estimates were modified toaccount for the extlusion of Alaska and Hawaiifrom the study. For this reason the populationestimates should not be considered as officialpopulation estimates and are presented heresolely for the purpose of providing denomina-tors for rate computations.

Systematic Bias

There have been no attempts to determinesystematic bias in the data reported here or tomeasure the impact of any biases. There areseveral factors, however, that the user of thesedata should understand, all of which indicate

47

Table 11. Estimates of the civilian non institutionalized population of the United States, 1 by age, race, sex, geographic region, andmetropolitan and nonmetropolitan area as of July 1, 1975

I Used in the calculation of rates for tables 1 and 21

Race, sex, geographic region, and area

Race

All races .. .. .... . ... .. ... ... ... .. ... .. ... .. .. ... .. .... .. ... .. ... .. .... .. ... ... .. .. .... . ..

Male .. ... .. ... .. ... .. ... .. .. ... ... .. ... .. ... .. ... .. ... .. ... .. .... . .. .... .. .. ... ... .. ... ... .. .. ... ... .. .. ...Female . . ... .. ... ... .. ... ... .. .. .. .... .. ... .. ... .. ... .. ... .. ... ... . ... .. .... .. .. .. .... .. ... . .... .. ... .. ...

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

Male .. ... .. ... .. ... ... .. .. ... .. ... . ..... .. ... . ... .. ... .. .... .. .. .. .... .. ... . .. .... . .... . ... ... ... .. ... .. .. .Female .... . .. ... ... .. ... ... .. ... .. ... .. .. ... ... .. ... .. .. ... .. ... .. .... .. .. .. ... .. .... . ... .. .... .. .. ... ...

All other races . ... .. .. ... ... .. ... .. .. ... ... ... .. ... ... . ... ... ... .. .. .... .. ... .. ... . ...

Male ... .. .... .. ... ... .. ... . .. . .... . .... .. ... .. . .. .. .. ... . .. .. .. ... .. ... .. ... ... .. .. ... .. ... ... ... .. .. ... .. .Female ... . .. .... .. ... ... .. .. .... .. .. ... ... .. .. .. .. .... . .... .. ... .. ... .. ... .. ... .. ... .. ... .. ... ... . .... ...

Geographic region

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

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

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

West . ... .... .. ... .. .... .. .. ...o. ... ... . ... ... .. ... .. ... .. ... .. .... . ... ... ... .. .. ... ... . .... .. ... .. .. ... .. ..

Area

Metropolitan .. ... .. ... .. ... ... .. .. .. .... .. .. .. ... .. ... .. .... .. ... .. ... .. ... ... .. ... .. ... ... ... . .... ...Nonmetropolitan .. .. .... .. .. .. ... ... .. .. .... .. .. .. ... ... ... .. ... .. ... . .... .. ... ... ... . .... .. .. ... ..

l~xclude~ Alaska and Hawaii.

that these data underrepresent the total numberof office visits to office-based physicians. Thesefactors are:

1. The sampling universe for the 1975NAMCS was the files of “office-based,patient-care” physicians maintained bythe AMA and AOA. There are certainly

physicians not so classified who, at thetime of the survey, would have met thecriteria for that classification. Visits tothese physicians are not represented inthese data.

2. A frequent reason for not participatingin the NAMCS was given as “too busy”

Number in thousands

207,809

101,166108,643

180,568

88,16292,406

27,242

13,00514,237

49,030

56,60766,122

36,059

141,31066,499

3.

52,307

26,68125,627

43,685

22,34221,343

8,622

4,3394,284

. . .

. . .

. . .

. . .

. . .

. . .

39,003

19,59919,404

33,324

16,82516,499

5,679

2,7742,905

. . .

. . .

. . .

. . .

. . .

. . .

52,203

25,63526,568

45,627

22,63522,991

6,578

3,0013,576

. . .

. . .

. . .

. . .

. . .

. . .

42,455

20,30822,147

38,062

18,26919,791

4,394

2,0392,356

. . .

. . .

. . .

. . .

. . .

. . .

21,840

8,94312,897

19,872

8,09211,780

1,969

8511,117

. . .

. . .

. . .

.,.

. . .

. . .

or “too busy right no~v. ” This is anindication that the busier physician wasnot as likely to participate as the lessbusy physician.

Physicians who participated in theNAMCS did a thorough and conscien-tious job in keeping the Patient Lug;however, the probability that a patientwas accidentally omitted from the sur-vey is much greater than the probability

that a patient was included who did nrst

make a visit. This factor COLdCl dso

introduce a slight bias..

48

APPENDIX II

DEFINITIONS OF CERTAIN TERMS USED IN THIS REPORT

Terms Relating to the Survey

OJficC’(s).–Premises that the physician iden-tifies as locations for his ambulatory practice.Responsibility over time for patient care andprofessil~nal services rendered there generallyresides with the individual physician rather thanwith any institution.

.1 whulatory patient. –An individual present-in~ fur personal health services, neither bedrid-den nur currently admitted to any health careinstitution on the premises.

Physician. –CarI be classified as either:

In-scope: AH duly licensed doctors of medi-cine and doctors of osteopathy currently inpractice who spend some time in caring forambuhtory patients at an office location.

Out-ojkcope: Those physicians who treatpatients only indirectly, including specizdistsin wwsthesiology, pathology, forensic pa-th{do~y, radiology, therapeutic radiology,and diagnostic radiology, and the followingphysicians:

● physicians in military service

● physicians who treat patients only in aninstitutional setting (e.g., patients innursing homes and hospitals)

● physicians employed full time by anindustry or institution and having noprivate practice (e.g., physicians whowork for the VA, the Ford MotorCompany, etc.)

● physicians who spend no time seeingambulatory patients (e.g., physicians

who only teach, are engaged in research,or are retired).

Patients. –Can be classified as either:

In-scope: All patients seen by the physicianor member of his staff in his office(s).

Out-of-scope: Patients seen by the physicianin a hospital, nursing home, or other ex-tended care institution, or the patient’shome. [Note: If the doctor has a privateoffice (which fits definition of “office”)located in a hospital, the ambulatory pa-tients seen there would be considered “in-scope.”] The following types of patients arealso considered out of scope:

●

●

●

●

patients seen by the physician in anyinstitution (including outpatient clinicsof hospitals) for which the institutionhas the primary responsibility for thecare of the patient over time

patients who telephone and receive ad-vice from the physician

patients who come to the office only toleave a specimen, pick up insuranceforms, or pay their bills

patients who come to the office only topick up medications previously pre-scribed by the physician.

Visit.–A direct, personal exchange betweenambulatory patient and the physician (or mem-bers of his staff) for the purpose of seeking careand rendering health services.

Physician specialty .–Principal specialty (in-

49

eluding general practice) as designated by thephysician at the time of the survey. Thosephysicians for whom a specialty was not ob-tained were assigned the principal specialtyrecorded in the Master Physician files main-tained by the AMA or AOA.

Region of practice location. –The four geo-graphic regions, excluding Alaska and Hawaii,which correspond to those used by the U.S.Bureau of the Census, are as follows:

Region

Northeast . . . . . . .

North Central . . .

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

West, . . . . . . . . . . .

States included

Connecticut, Maine, Massa-chusetts, New Hampshire,New Jersey, New York,Pennsylvania, Rhode Island,Vermont

Illinois, Indiana, Iowa, Kan-sas, Michigan, Minnesota,Missouri, Nebraska, NorthDakota, Ohio, SouthDakota, Wisconsin

Alabama, Arkansas, Dela-ware, District of Columbia,Florida, Georgia, Kentucky,Louisiana, Maryland, Missis-sippi, North Carolina, Okla-homa, South Carolina, Ten-nessee, Texas, Virginia,West Virginia

Arizona, California, Colo-rado, Idaho, Montana, Ne-vada, New Mexico, Oregon,Utah, Washington, Wyo-ming

Metropolitan status of practice location. –Physician’s practice is classified by its location inmetropolitan or nonmetropolitan areas. Metro-politan areas are standard metropolitan statis-tical areas (SMSA’S) as defined by the U.S.Office of Management and Budget.

The definition of an individual SMSA in-volves two considerations: first, a city or citiesof specified population which constitute thecentral city and identify the county in which itis located as the central county; second, eco-nomic and social relationships with “con-tiguous” counties which are metropolitan in

character, so that the periphery of the specificmetropolitan area may be determined. SMSA’Smay cross State lines. In New England SMSA’Sconsist of cities and towns, rather than counties.

Terms Relating to the Patient Record Form

Age. –The age calculated from date of birthwas the age at last birthday on the date of visit.

Color or race. –On the Patient Record, coloror race includes four categories: white, Negro/black, other, and unknown. The physician wasinstructed to mark the category which in hisjudgment was most appropriate for the patientbased upon observation and/or prior knowledgeof the patient. “Other” was restricted to Orien-tals, American Indians, and other races neitherNegro nor white.

Patient k principal problem(s), complaint(s),or symptom(s) (in patient k own words). —Thepatient’s principal problem, complaint, symp-tom, or reason for the visit as expressed by thepatient. Physicians were instructed to record keywords or phrases verbatim to the extent pos-sible, listing that problem first which in thephysician’s judgment was most responsible forthe patient’s visit.

Seriousness of problem in item 5a. –Thisitem includes four categories: very serious,serious, slightly serious, and not serious. Thephysician was instructed to check one of thefour categories according to his own evaluationof the seriousness of the patient’s problemcausing this visit. Seriousness refers to physi-cian’s clinical judgment as to the extent ofthe patient’s impairment that might result if nocare were given.

Major reason(s) for this visit. –The patient’smajor reason(s) for the visit were classified bythe physician into one or more of the followingcategories:

Acute problem: A condition or illness havinga relatively sudden or recent onset (i.e.,within 3 months of the visit).

Acute problem, follow up: A return visitprimarily for continued medical care of apreviously treated acute problem.

Chronic problem,to receive regular

routine: A visit primarilycare or examination for a

50

preexisting chronic condition or illness (on-set of condition was 3 months or morebefore this visit).

Chronic problem, flareup: A visit primarilydue to a sudden exacerbation of a preexist-ing chronic condition.

Prtwatal care: Routine obstetrical care pro-vided prior to delivery.

Postnatal care: Routine obstetrical care orexamination provided following delivery ortermination of pregnancy.

Postoperative care: A visit primarily for carerequired following surgical treatment. In-cludes changing dressing, removing suturesor cast, advising on restriction of activities orroutine after surgery checkup.

WC*Z1adult/ckild exam: General health main-tenance examinations and routine main-tcmance examinations and routine periodicexaminations of presumably healthy per-sons, both children and adults. Includesannu,al physical examinations, well-childcheckups, school, camp, and insurance ex-aminations.

Family planning: Services or advice thatenable patients to determine the number andspacing of their children. Includes bothcontraception and infertility services.

Counsc&lg/advice: Information of a healthnature which would enable the patient tomaintain or improve his physical or mentalwell-being. Included would be advice regard-ing diet, changing habits or behavior, andgeneral information regarding a specificproblem.

Irnrnunization: Administration of any inocu-lation of specific substances to produce adesired immunity; this includes oral vac-cines, (Allergy shots are not included in thiscategory, but are entered in “other.”)

R~~irred by another physician/agency:Medical attention prompted by advice orreferral for consultation or treatment fromanother physician, hospital, clinic, healthcenter, school nurse, minister, pharmacist,etc. Dot’s not include self-referral or referralby family or friends.

Administrative purpose: Reasons such ascompleting insurance forms, school forms,work permits, or discussion of patient’s bill.

Other: The reason for this visit is notcovered in the preceding list.

Principal diagnosis. –The physician’s diagno-sis of the patient’s principal problem or com-plaint. In the event of multiple diagnoses, thephysician was instructed to list them in order ofdecreasing importance; “principal” refers to thefirst-listed diagnosis. The diagnosis representsthe physician’s best judgment at the time of thevisit and may be tentative, provisional, ordefinitive.

Other significant current diagnosis. –The di-agnosis of any other condition known to existfor the patient at the time of the visit. Otherdiagnoses may or may not be related to thereason for that visit.

Treatments and services ordered or pro-vided. —These include the following:

Limited kistory/exam: History and/or physi-cal examination which is limited to a specificbody site or system, or which is concernedprimarily with the patient’s chief complaint,for example, pelvic exam or eye exam.

General history/exam: History and/or physi-cal examination of a comprehensive nature,including all or most body systems.

Clinical lab test: One or more laboratoryprocedures or tests including examination ofblood, urine, sputum, smears, exudates,transudates, feces, and gastric content, andincluding chemistry, serology, bacteriology,and pregnancy test.

Blood pressure check: Self-explanatory.

EKG: Electrocardiogram.

Hearing test: Auditory acuity test.

Vision test: Visual acuity test.

Endoscopy: Examination of the interior ofany body cavity, except ear, nose, andthroat, by means of an endoscope.

Office surgery: Any surgicaI procedure per-formed in the office this visit, includingsuture of wounds, reduction of fractures,

51

application/removal of casts, incision anddraining of abscesses, application of suppor-tive materials for fractures and sprains, andall irrigations, aspirations, dilatations, andexcisions.

Drug prescribed: Drugs, vitamins, hormones,ointments, suppositories, or other medica-tions ordered or provided, except injectionsand immunizations.

X-ray: Any single or multiple X-ray examina-tion for diagnostic or screening purposes.Radiation therapy is not included in thiscategory.

Injection: Administration of any substanceby syringe and needle subcutaneously, intra-venously, or intramuscularly. This categorydoes not include immunizations, enemas, ordouches.

Immunization/desensitization: Administra-tion of any immunizing, vaccinating, or de-sensitizing agent or substance by any route,for example, syringe, needle, orally, gun, orscarification.

Physiotherapy: Any form of physical ther-apy ordered or provided, including anytreatment using heat, light, sound, or physi-cal pressure or movement, for example,ultrasonic, ultraviolet, infrared, whirlpool,diathermy, cold therapy, and manipulativetherapy.

Medical counseling: Instructions and recom-mendations regarding any health problem,including advice or counsel about diet,change of habit, or behavior. Physicians areinstructed to check this category only if themedical counseling is a significant part of thetreatment.

Psychotherapy/therapeutic listening: Alltreatments designed to produce a mental oremotional response through suggestion, per-suasion, reeducation, reassurance, or SUp-

port, including psychological counseling,hypnosis, psychoanalysis, and transactionaltherapy.

Other: Treatments or services renderedwhich are not listed in the preceding cate-gories.

Disposition. –Eight categories are providedto describe the physician’s disposition of thecase as follows:

No followup planned: No return visit ortelephone contact was scheduled for thepatient’s problem on this visit.

Return at specified time: The patient wastold to schedule an appointment or wasinstructed to return at a particular time.

Return if needed, P. R. A?: No future ap-pointment was made, but the patient wasinstructed to make an appointment with thephysician if the patient considers it neces-sary.

Telephone followup planned: The patientwas instructed to telephone the physician ona particular day to report on his progress, orif the need arises.

Referred to other physician/agency: Thepatient was instructed to consult or seekcare from another physician or agency. Thepatient may or may not return to thisphysician at a later date.

Returned to referring physician: Patient wasreferred to this physician and was nowinstructed to consult again with the physi-cian or agency which referred him. .

Admit to hospital: Patient was instructedthat further care or treatment will be pro-vided in a hospital. No further office visitswere expected prior to that admission.

Other: Any other disposition of the case notincluded in the above categories.

Duration of visit. –Time the physician spentwith the patient, but does not include the timepatient spent waiting to see the physician, timepatient spent receiving care from someone otherthan the doctor without the presence of thephysician, and time spent reviewing records,tests results, and so forth. In the event a patientwas provided care by a member of physician’sstaff but did not see the physician during thevisit, “duration of visit” was recorded as zerominutes.

52

APPENDIX Ill

SURVEY INSTRUMENTS

INTRODUCTORY LETTER FROM DIRECTOR,

NATIONAL CENTER FOR HEALTH STATISTICS

@

...$~$ %,>

~:DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE:4 ,$

% “.. *“’ePUBLIC HEALTH SERVICE

HEALTH RESOURCES ADMINISTRATION

ROCKVILLE. MARYLAND _

NATIONAL CENTER FOR

HEALTH STATISTICS

Endorsing Ortsnluticuu

Arrmrloan Mndlcal AUoclaUonJamas H. Sammons, IA.O.Ex*cutlv. VIC9 Presld.nt

National M9dieal Ass..laUonAlfrtd F. Fish.rExacutlv. Dlrwctor

Amul..n A?ad.mY of otrmat0109YJohn M. Shaw, M.D.Secr*twv-TNasur*r

Am9rlcan Acad.mY of FamltyPhysNt8n1

RqJ9r Tusk..Exbcutlva Dlmr.tor

Am.rlcan Academy of N.ur.l.#Y$tanlay A. NdsonExocutlva !JkUtor

Amwlcm AaadamY of Orthonndksurg90n1

Charles V. block, M.D.Ex8cuUv9 Dkwctor

Am#rlcan Academy of ●9dlatrlc1Robwt G. Frazl*r, M.D.Executlva Dlr9ct0r

Amwlca. CON999of Omt.trl.lmwand Qyn9e010s11ts

Warr.” H.hr%., M.D.DIr.ctor

Amerhn COI19W of ?hyslclansEdward C. Roswww,Jr.,M.D.Exuutlva V[C9 Prssld9nt

Arrmrlaan CONnW 01 PrmwnNv*M*dtCln9

Ward B9ntl*YEx.cutlv. Dlr.ct.r

Am.rkm CON*S* ofSurw.nsc. Rolllnslianlon, M.D.Ex9cutlv9 Dlrcctor

Arn.rman Ottaomathlc A1soClattOnEdward P. Crowdl, 0.0.Exacutlv. Omector

Anwlcan Proctolo#lc Soc18tYAlajandro F. Castro, M.D.%cr*taw

American Psychlatrlc A1sOclaNOnMelvln Sabshln, M.D.Medical DlraCtOr

ArrI. d... sod.w of Int.rn.tM9dlclna

Wllllam R. RamSayEx.cutlva Olrwt.r

Amwiean Soclsty of Plattlc andnmonatructl.o Surwons, Inc.

Oalla$ F. WhNoYEx,c”tlv9 VIC9 Pcosldant

Arn,rlc,” urologlc AssOclatl.nHal B. Jennln%, Jr., M.0.Ex.c.tlv. OkUtOr

Association of AmwlcmI MadlcalCOII*,*S

John A, O. C0PP91, M. D., Ph.D.Prmldant

Dear Dr.

The National Center fDr Health Statistics, as part of itsccmtinuing program tD provide information on the healthstatus of the American people, is conducting a NationalAmbulatory Medical Care Survey (NMCS).

The purpose of this survey is tcicDllect informationabmt ambulatory patients, their problems, and theresources used for their care. The resulting publishedstatistics will help your profession plsn for moreeffective health services, determine health manpowerrequirements, and improve medical education.

Since practicing physicians are the only reliable sourceof this infmmtion, we need your assistance in the NAMCS.As me Df the physicians eelected in our national sample,

your participation is essential to the success of thesurvey. Of course, all information that you provide isheld in strict confidence.

Many organizations and leaders in the medical professionhave expressed their support fDr this survey, includingthose shown to the left. They jDin me in urging yourcooperation in this important research.

Within a few days, a survey representative will telephoneyou for an appointment to discuss the details of yourparticipation. We greatly appreciate your cooperation.

Sincerely yours,

Dorothy P. RiceDirector

53

—

——

—

52‘$’’’”

G-

..

...”.

.

54

INDUCTION INTERVIEW FORM

CONFIDENTIAL*NORC-4211

I NATIONAL AMBULATORY MEDICAL CARE

INDUCTION INTERVIEW

SURVEY

[ I I I(Phys. ID Number)

I BEFORE STARTING INTERVIEWI

1. ENTER PNYSICIAN I.D. NUMBER IN BOX TO RIGHT, ABOVE I2. ENTER DATES OF ASSIGNED REPORTING WEEK IN Q. 2, P.2 I

‘Doctor,before I begin, let me take a minute to give you a little backgroundabout this survey.

Although ambulatory medical care accounts for nearly 90 per cent of all medicalcare received in the United States, there is no systematic information aboutthe characteristics and problems of people who consult physicians in theiroffices. This kind of information has been badly needed by medical educatorsand others concerned with the medical manpower situation.

In response to increasing demands for.this kind of information, the NationalCenter for Health Statistics, in close consultation with representatives of themedical profession, has developed the National Ambulatory Medical Care Survey.

Your own task in the survey is simple, carefully designed, and should not takemuch of your time. Essentially, it consists of your participation during aspecified 7-day period. During this period, you simply check off a minimalamount of information concerning some of the patients you see.

Now, before we get into the actual procedures, I have a few questions to askabout your practice. The answers you give me will be used only for classificationand analysis, and of course all information you provide is held in strict confidence.*—

1. First, you are a IS that right?(ENTER SPECIALTY FROM CODE ON FACE SHEET MEL.)”

Yes . . . . . . . 1No .(ASKA). . 2

A. IF NO: What is your specialty, (including general practice)?

(Name of Specialty)

*All information which would permit identification of an individual, a

practice, or an establishment will be held confidential, will be used only bypersons.engaged in and for the purpose of the survey, and will not be disclosedor released to other persons or used for any other purpose.

55

-2-

Now, doctor, this study will be concernedwith the ambulatorypatients2“ you will.see in your office during the week of (READREPORTINGDA~s ENTERED

iELOW.)

(that’sa (that’saI Monday) through I Sunday)

month date ~ date

Are you likely to see ~ ambulatorypatientsin your officeduring

Yes . . . (GO TOQ. 3) .

No . . . .. (ASKA) .

A. IF NO: Why is that? RECORD VERBATIM,THEN READ PARAGRAPHBELCW

thatweek?

. . 1

. . 2

Since it’s very important,doctor, that we includeany ambulatorypatients that you~ happen to see in your office during thatweek, I’d like to leave these formswith yotianyway--justin caseyour plans change. 1’11 plan to check back with your office justbefore (STARTINGDATE) to make sure, and I can explain them indetail then, if necessary.

GIVE D!)CTORTHE ~PATIENT RECORD FORMS AND GOTO Q. 92 P. 6.

3. A.

B.

c.

-3-

At what office location will you be seeing ambulatory patients during that7-day period? RECORD UNDER A BELOW AND ASK B WHEN INDICATED.

IF HOSPITAL EMERGENCY ROOM OR HOSPITAL OUTPATIENT DEPARTMENT, OR OTHERINSTITUTIONAL LOCATION IN A: Thinking about the ambulatory patients you seein (PLACE IN A), do you, yourself, have principal responsibility for theircare over time, or does (INSTITUTION IN A) have primary responsibility fortheir care over time? CODE UNDER B BELOW.

Is that ~of the office locations at which you expect to see ambulatorypatients during that week?

Yes. . . . . . . 1

No . . . . . . . 2

IF NO- OBTAIN ADDITIONAL OFFICE LOCATION(S), ENTER IN “A” BELOW, AND REPEAT.—.

A.

I

B.Principal

Office LocationResponsibility?

(1)1 2

(2)1 2

(3)1 2

(4)1 2

7D.

in Scope?

Yes No

12

12

12

12

D. FOR EACH OFFICE LOCATION ENTERED IN A. CODE YES OR NO TO “IN SCOPE” AIKXJE.

IIN SCOPE (Yes)l

Private officesFree-atanding clinics

(non-hospital based)Groups, partnershipsKaiser, HIP, Mayo ClinicNeighborhood Health CentersPrivately operated clinics

(except family planning)

IN CASE OF DOUBT, ASK: Is that

IS that

IOUT OF SCOPE (No)!

Hospital emergency roomsHospital outpatient departmentsCollege or university infirmariesIndustrial outpatient facilitiesFamily planning clinicsGovernment-operated clinics

(VD, maternal &child health, etc.)

(clinic/facility/institution) hospital based?

(clinic/facility/institution) governmentoperated?

IF ALL LOCATIONS ARE OUT OF SCOPE, THANK THE DOCTOR AND LEAVE.

PATIENT RECORDS MUST BE COLLECTED FROM ALL IN-SCOPE LOCATIONSREGARDLESS OF ANSWER TO B -- PRINCIPAL RESPONSIBILITY.

57

-4-

4. A. During that week (REPEAT .DATES),how many ambulatory patients do you expect

to see in your office practice? (DO NOT COUNT PATIENTS SEBNAT [OUT-OF-SCOPE

LOCATIONS] CODED IN 3-B.)

ENTER TOTAL UNDER “A” BELOW AND CIRCLE ON APPROPRIATE LINE.

B. And during those seven days (REPEAT DATES IF NECESSARY), on how many~ do YOUexpect to see any ambulatory patients? COUNT EACH DAY IN WHICH DOCTOR EXPECTS

TO SEE ANY PATIENTS AT AN IN-SCOPE OFFICE LOCATION.

ENTER TOTAL UNDER “B” BELOW AND CIRCLE NUMBER IN APPROPRIATE COLUMN.

DETERMINE PROPER PATIENT LOG FORM FRCM CHART BELOW. READ ACROSS ON!!TOTALpATI~TSlI LINE UNDER flAlf AND c’f.RcLE ‘LETTER IN APPROPRIATE

‘lDAYSf’ COLUMN UNDER “B.”

THIS LETTER TELLS YOU WHICH OF THE FOUR PATIENT LOC FORMS (A, B, C, D)SHOULD BE USED BY THIS DOCTOR.

I

I ‘“ B.Expected total Total ~ in practice

A--Patient Record is to becompleted for ALL-.—patients listed on Log.

LOG FORM DESCRIPTION patients during during week.survey week.

ENTER TOTALENTER TOTAL FROM FROM Q. 4-B. DAYSQ. 4-A.

1 2 3 4 5 6 7

1- 12 PATIENTS AAAAAAA

B--Patient Record is to becompleted for everySECOND patient listedon Log.

C--Patient Record is to becompleted for everyTHIRD patient listedon Log.

AD--patient Record is to be

completed for everyFIFTH patient listedzg .

13- 25 “ BAAAAAA

26- 39 “ CBAAAAA

40- 52 “ CBBAAAh

53- 65 “ DCBBAAA

66- 79 “ DCBBBAA

80- 92 “ DDCBBBB

I 93=105 “~’

106-118 “ [D DCCBBB

119-131 1’ ID DCCBBB

132-145 “ DDDCCBB

146-158 “ DDDCCBB

159-171 “ DDDCCCC

1172-184 “ DDDCCCC

185-197 “ ID DDDDDD

198-210 “ DDDDDDD

211+ 11 DDDDDDD

*In the rare instance the physician will’see more than 500 patient8 during his_.—..

assigned reporting week, give him two D Patient Log Folios and instruct him to completea Patient record form for only every tenth patient. Then you are to draw an X or lineon line 5 on every other page of the two folio pads, starting with page 1 of the pad.

58

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5. FIND PATIENT LOG FOLIO WITH APPROPRIATE LETTER AND ENTZR LETTER AND NUMBEROF THIS FORM HERE.

(Folio Number)

6. HANDDOCTOR HIS FOLIO AND EXPLAIN HOW FORMS ARE TO BE FILLED OUT. SHCU DOCTORTHE INSTRUCTIONS ON POCKET OF FOLIO AND ITEM 10 DEFINITIONS ON CARD IN FOLIO,TO WHICH HE CAN REFER AFTER YOU LEAVE.

RECORD VERBATIM BELOW ANY CONCERN, PROBLEMS OR QUESTIONS THE DOCTOR RAISES.

7, IF DOCTOR EXPECTS TO SEE AMBuLATORY PATIENTS AT MORE THAN ONE IN-SCOPE LOCATIONDURING ASSIGNED WEEK, TELL HIM YOU WILL DELIVER THE FORMS TO THE OTHER LOCATION(S).ENTER THE FORM LETTER AND NUMBER(S) FOR THOSE LOCATIONS BELOW, BEFORE DELIVERINGFORM(S).

Location Patient Record Form Letter & Number

8. During the survey week (REPEAT EXACT DATES), will anyone be available to helpyou in filling out these records (at each IN-SCOPE location)?

Yea . ..(ASKA) ..1

No . . . . . . . . .2

1 B.

A. IF YES: Who would that be? *INTERVIEWER:WAS PERSON

RECORD NAME, POSITION AND LOCATION. BRIEFED

I NAMEBY YOU?

I POSITION I LOCATION Yes I No

I 12

I 12

I 12

I 12

*INTERVIEWER SHOULD BRIEF SUCH PERSON IF POSSIBLE.

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9. Do you have a solo practice, or are you associated with other physicians ina partnership, in a group practice, or in some other way?

solo. . . . . . . . . . . . 1Partnership . . . (ASK A-C). 2Group . . . . . . (ASK A-C). 3

<--- Other (SPECIFY AND ASK A-C). 4

IF PARTNERSHIP, GROUP, OR OTHER:

A. Is this a prepaid group practice? Yes . (ASK [1]) . .. 1

No. . . . . . . . . 2

[1] IF YES TOA: What per centof patients areprepaid? per cent

B. How many other physicians areassociated with you? NUMEER OF PHYSICIANS:

c. What are the specialties of the other physicians associated with you?

Specialty Number of Physicians

(1)

(2)

(3)

(4)

(5)

10. Now I have just one more question about your practice. (NOTE: IF OOCTOR PRACTICESIN LARGE GROUP, THE FOLLOWING INFORMATION CAN BE OBTAINED FR~ SOMEONE ELSE.)

A. Whs+t is the totalnumberof full-time(35hoursor moreperweek)employeesof your (partnership/group) practice? Include persons regularly employed who ars now on vacation, temporarily ill,etc. Do u include other physicians. RECORD ON TOP LINE OF COLUMN A BELOW.

(1) How many of these full-time employees are a ... (READ CATEGORIES BELOW AS NECESSARy ANORECORD NKMIER OF EACH IN COLUNN A.)

B. And what is the total number of part-time (lees than 35 hours per week) employees of your(partnership/group) practice? Again, include persc.w regularly employed who are now on vacation,ill, etc. Do not include other physicians. wCORG ON TOP LI~ OF COLUMN B BELOW.)

(1) H.w many of these part-the employees are a ... (WAD CATEGORIES BELOW AS NECESSARY ANDRECORD NUMBER OF EACH IN COLUMN B.)

A, B.Employees Full-time Part-time

(35or more.hourslweek) (Less than 35 hours/week)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

‘JXYfAL:

Registered Nurse . . . , . . . . , . . .

Licensed Practical Nurse . . . . . . . .

Nursing Aide. . . . . . . . . . . . . .

Physician Assistant* . . . . . . . . . .

Technician, , . , . . . . . . , . . . ,

Secretary or Receptionist , . . . . . .

TOTAL:

Other (SPECIFY)I

*Physician Assistant must be a graduate of an accredited training program for Physician Assistants

(Physician Extenders, Medex, etc.) or certified by the National Board of Medical Examiners through theCertification Exsm for Assistant to the Primary Care physician.

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11. During the past seven (7) days, abouthow many house calls did you make?

NUMBER OF HOUSE CALLS:

12. During the past seven (7) days, how many times did you provide to patientsadviceor consultationby telephone?

None.. , . . . . . 1

1-9 . . . . . . . .2

l@24, ,,,...3

25-49 . . . . . . .4

500rmore. .o..5

BEFOREYOU LEAVE, STRESS THAT~ AMBULATORYPATIENTSEEN BY THE DOCTOR DURINGTHE 7-DAY PERIODAT ALL IN-SCOPE OFFICE LOCATIONS (REPEAT THEM) IS TU BE IN-CLUDED IN TM SURVEY~iHAT EACH PATIENT IS TO BE RECORDED ON THE LOG, AND ONLYTNE APPROPRIATE NUMBER OF PATIENT RECORDS COMPLETED.

Thank you for your time,Dr. . If you have any (more)questions,please feel free to call me. My phone number is written in the folio. 1’11call ~ on Monday morning of your survey week just to remind you.

13. TIME INTERVIEWENDED . . . . . . . , , AMPM

14. DATE OF INTERVIEW . . . . . . . . .

“~(Month) (Day) (Year)

ICOMPLETE ITENS IANDIION THR LAST PAGE I

INMEDIATELYAPTER THE INTERVIEW.

61

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1. How much interest do you think thedoctor has in the survey?

Great interest . . . . . 1

Some interest . . . . . 2

Little interest . . . . 3

No interest . . . . . . 4

Can’ttell . . . . ...5

II. Hoi?confident are you that thedoctor will complete the forms?

Definitely will . . . . 1

Probably will . . . . . 2

Doubtful . . . . . . . 3

INTERVIEWER NUMEERI

INTERVIEWER’S SIGNAITJRE

I I I I+--

62

*U. S. GOVERNMSWT PRINTING OFFICE :1978 260-937/43

VITAL AND HEALTH STATISTICS PUBLICATIONS SERIES

Formerly Public Health Service Publication No. 1000

Series 1. Programs and Collection Procedures. –Reports which describe the general programs of the NationalCenter for Health Statistics and its offices and divisions, data collection methods used, definitions, andother material necessary for understanding the data.

Series 2, Data Evaluation and Methods Research. –Studies of new statistical methodology including experimentaltests of new survey methods, studies of vital statistics collection methods, new analytical techniques,objective evaluations of reliability of collected data, contributions to statistical theory.

Series 3, Analytical Studies. –Reports presenting analytical or interpretive studies based on vital and healthstatistics, carrying the analysis further than the expository types of reports in the other series.

Sera”cs4. Documents and Committee Reports. –Final reports of major committees concerned with vital andhealth statistics, and documents such as recommended model vital registration laws and revised birthand death certificates.

Series 10. Data ji’om the Health Intervt”ew Survey. –Statistics on illness; accidental injuries; disability; use ofhospital, medical, dental, and other services; and other health-related topics, based on data collected ina continuing national household interview survey.

Series 11. Data j%om the Health Examination Survey. –Data from direct examination, testing, and measurementof national samples of the civilian, noninstitutionalized population provide the basis for two types ofreports: (1) estimates of the medically defined prevalence of specific diseases in the United States andthe distributions of the population with respect to physical, physiological, and psychological charac-teristics; and (2) analysis of relationships among the various measurements without reference to anexplicit finite universe of persons.

Series 12. Data from the Institutionalized Population Surveys. –Discontinued effective 1975. Future reports fromthese surveys will be in Series 13.

Sert”cs 13. Data on Health Resources Utilization. –Statistics on the utilization of health manpower and facilitiesproviding long-term care, ambulatory care, hospital care, and family planning services.

Series 14. Data on Health Resources: Manpower and Facilities. –Statistics on the numbers, geographic distrib-ution, and characteristics of health resources including physicians, dentists, nurses, other health occu-pations, hospitals, nursing homes, and outpatient facilities.

Scn”es 20. Data on Mortality .-Various statistics on mortality other than as included in regular annual or monthlyreports. Special analyses by cause of death, age, and other demographic variables; geographic and timeseries analyses; and statistics on characteristics of deaths not available from the vital records, based onsample surveys of those records.

Senses 21. Data on Natality, Mawiage, and Divorce. –Various statistics on natality, marriage, and divorce otherthan as included in regular annual or monthly reports. Special analyses by demographic variables;geographic and time series analyses; studies of fertility; and statistics on characteristics of births notavailable from the vital records, based on sample surveys of those records.

Sen”eS22. Datu from the National Mortality and Natality Surveys. –Discontinued effective 1975. Future reportsfrom these sample surveys based on vital records will be included in Series 20 and 21, respectively.

Series 23. Dati @om the National Survey of Family Growth. –Statistics on fertility, family formation and disso-lution, family planning, and related maternal and infant health topics derived from a biennial survey ofa nationwide probability sample of ever-married women 1544 years of age.

For a list of titles of reports published in these series, write to: Scientific and Technical Information BranchNational Center for Health StatisticsPublic Health ServiceHyattsville, Md. 20782