This reportdescriptionEditor ServiZorica Tomi

Number 387 + June 29 2007

National Ambulatory Medical Care Survey2005 Summary

by Donald K Cherry MS David A Woodwell BAand Elizabeth A Rechtsteiner MS Division of Health Care Statistics

AbstractObjectivesmdashThis report describes ambulatory care visits made to physician

offices in the United States Statistics are presented on selected characteristics of thephysicianrsquos practice the patient and the visit

MethodsmdashThe data presented in this report were collected in the 2005 NationalAmbulatory Medical Care Survey (NAMCS) a national probability sample surveyof visits to nonfederal office-based physicians in the United States Sample data areweighted to produce annual national estimates of doctor visits

ResultsmdashDuring 2005 an estimated 9636 million visits were made to physicianoffices in the United States an overall rate of 3310 visits per 100 persons Inone-quarter of office visits electronic medical records were utilized by physicianswhile at 839 percent of visits claims were submitted electronically As the babyboomer generation aged there was a shift in utilization as the majority of visits in1995 were by patients 25ndash44 years of age compared with 2005 when most visitswere by patients 45ndash64 years of age In 2005 527 percent of office visits weremade by patients with at least one chronic condition Hypertension was the mostfrequent condition (228 percent) followed by arthritis (143 percent)hyperlipidemia (135 percent) and diabetes (98 percent) Medication therapy wasreported at 6792 million office visits accounting for 705 percent of all officevisits In 2005 there were about 20 billion drugs prescribed resulting in an overallrate of 2107 drugs per 100 visits Drugs with amoxicillin were more likely to benew prescriptions (854 percent) while ibuprofen and acetaminophen were just aslikely to be a new or continued drug The overall mean time spent with a physicianexcluding psychiatrists has not changed since 1995 however visits with a durationof 6ndash10 minutes decreased by 28 from 1995 while visits lasting 16ndash30 minutesincreased by 20

Keywords ambulatory care c physician office care c diagnoses c injury cmedications c ICDndash9ndashCM c primary care c chronic disease

Acknowledgments

was prepared in the Division of Health Care Statistics Sarah Gousen in the Technicalof the sampling procedure The report was edited by Gail V Johnson CDCCCHISNCces Branch typeset by Annette F Holman CDCCCHISNCHMDivision of Creative Sc-Whalen CDCCCHISNCHMDivision of Creative Services NOVA contractor

US DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics

IntroductionThe National Ambulatory Medical

Care Survey (NAMCS) which began in1973 was inaugurated to gatheranalyze and disseminate informationabout the health care provided byoffice-based physicians Ambulatorymedical care is the predominant methodof providing health care services in theUnited States and occurs in a widerange of settings

Ambulatory medical care inphysician offices is the largest and mostwidely used segment of the Americanhealth care system consumingapproximately 27 percent of health carespending in 2003 (12) Physicianoffices comprise about four-fifths of allambulatory medical care deliveredPhysician consultation services includeeverything from primary care to highlyspecialized surgical and medical careThis report describes care delivered inthe offices of nonfederally employedphysicians It includes visits not only toprivate practices but other settings suchas freestanding clinicsmdashincludingurgicenters public health clinics family

Services Branch contributed to theHMDivision of Creative Services Writer-

ervices and the graphics were produced by

All others surgerery practiceger

Orthopedic surgery

Ophthalmology

Obstetrics and gynecology Pediatrics

Internal medicine

General and family medicine

292224

174

13467

61

48

SOURCE CDCNCHS National Ambulatory Medical Care Survey

2 Advance Data No 387 + June 29 2007

planning clinics mental health centersand faculty practice plans It does notinclude visits to hospital emergency oroutpatient departments freestandingambulatory surgery centers Departmentof Veterans Affairs medical offices orindustrial occupational or institutionalclinics Many of the estimates in thisreport are provided separately byphysician specialty as recent researchhas demonstrated that certain physicianpractice characteristics such as volumeownership revenue and practicepatterns can be significantly influencedby physician specialty (34)

NAMCS is part of the ambulatorycomponent of the National Health CareSurvey a family of surveys thatmeasures health care utilization acrossvarious types of providers Moreinformation about the National HealthCare Survey can be found at theNational Center for Health Statistics(NCHS) website wwwcdcgovnchsnamcshtm

The emphasis for the 2005 surveyyear was chronic conditions Additionsto the routine encounter data that relatedto chronic conditions included

+ A chronic disease checklist includingconditions affecting the respiratorycardiovascular renal and endocrinesystems arthritis cancer depressionobesity and osteoporosis

+ Ascertainment of patient enrollmentin a disease management program forspecified chronic conditions

+ Measurements for height and weight+ Additional diagnostic and screening

service items

Other additions included

+ Gestation week of pregnancy+ Health education and nonmedication

treatment items such as injuryprevention complementary andalternative medicine (CAM) durablemedical equipment (DME) homehealth care and hospice care

+ New or continued status for eachmedication

+ Ability to check more than one typeof expected source of payment

Other Advance Data From Vital andHealth Statistics reports havehighlighted visits to hospital outpatientdepartments (OPDs) (5) and emergencydepartments (EDs) (6) Detailed reportson physician-level estimates in theUnited States (3) medication use atambulatory care visits (7) training forterrorism-related conditions in hospitals(8) and staffing capacity andambulance diversion in emergencydepartments have also been published(9) NAMCS data have also been usedin articles examining important topics ofinterest in public health and healthservices research (10ndash19)

Additional information aboutphysician office utilization is availablefrom the NCHS Ambulatory HealthCare website httpwwwcdcgovnchsnamcshtm Individual-year reports andpublic-use data files are available fordownload from the website Data fromthe 2005 NAMCS will also be availableon CD-ROM These and other productscan be obtained from the NCHS Officeof Information Services InformationDissemination Staff at 1-800-232-4363or the Ambulatory Care StatisticsBranch at 301-458-4600 or by e-mail atNCHSquerycdcgov

Figure 1 Percent distribution of office visits b

Highlights

Physician office utilization

+ In 2005 an estimated 9636 millionvisits were made to office-basedphysicians an average of about 3310visits for every 100 persons (Table 1)

+ About one-quarter of all visits wereto general and family practicephysicians with an additional375 percent of visits to physiciansspecializing in internal medicinepediatrics or obstetrics andgynecology (Figure 1)

+ Visits are also presented by specialtytype a grouping of specialties andsubspecialties split into three majorgroups primary care surgicalspecialties and medical specialties(see lsquolsquoPhysician specialty groupsrsquorsquo inlsquolsquoMethodsrsquorsquo) In 2005 595 percent ofoffice visits were made to primarycare specialists 208 percent tosurgical specialists and the remaining197 percent to medical specialists(Table 1)

+ About 81 percent of office-basedphysicians were located inmetropolitan statistical areas (20) andthey provided 871 percent of annualphysician office encounters (Table 1)

y physician specialty United States 2005

All others surgerery practiceger

Orthopedic surgery

Ophthalmology

Obstetrics and gynecology Pediatrics

Internal medicine

General and family medicine

292224

174

13467

61

48

SOURCE CDCNCHS National Ambulatory Medical Care Survey

2 Advance Data No 387 + June 29 2007

planning clinics mental health centersand faculty practice plans It does notinclude visits to hospital emergency oroutpatient departments freestandingambulatory surgery centers Departmentof Veterans Affairs medical offices orindustrial occupational or institutionalclinics Many of the estimates in thisreport are provided separately byphysician specialty as recent researchhas demonstrated that certain physicianpractice characteristics such as volumeownership revenue and practicepatterns can be significantly influencedby physician specialty (34)

NAMCS is part of the ambulatorycomponent of the National Health CareSurvey a family of surveys thatmeasures health care utilization acrossvarious types of providers Moreinformation about the National HealthCare Survey can be found at theNational Center for Health Statistics(NCHS) website wwwcdcgovnchsnamcshtm

The emphasis for the 2005 surveyyear was chronic conditions Additionsto the routine encounter data that relatedto chronic conditions included

+ A chronic disease checklist includingconditions affecting the respiratorycardiovascular renal and endocrinesystems arthritis cancer depressionobesity and osteoporosis

+ Ascertainment of patient enrollmentin a disease management program forspecified chronic conditions

+ Measurements for height and weight+ Additional diagnostic and screening

service items

Other additions included

+ Gestation week of pregnancy+ Health education and nonmedication

treatment items such as injuryprevention complementary andalternative medicine (CAM) durablemedical equipment (DME) homehealth care and hospice care

+ New or continued status for eachmedication

+ Ability to check more than one typeof expected source of payment

Other Advance Data From Vital andHealth Statistics reports havehighlighted visits to hospital outpatientdepartments (OPDs) (5) and emergencydepartments (EDs) (6) Detailed reportson physician-level estimates in theUnited States (3) medication use atambulatory care visits (7) training forterrorism-related conditions in hospitals(8) and staffing capacity andambulance diversion in emergencydepartments have also been published(9) NAMCS data have also been usedin articles examining important topics ofinterest in public health and healthservices research (10ndash19)

Additional information aboutphysician office utilization is availablefrom the NCHS Ambulatory HealthCare website httpwwwcdcgovnchsnamcshtm Individual-year reports andpublic-use data files are available fordownload from the website Data fromthe 2005 NAMCS will also be availableon CD-ROM These and other productscan be obtained from the NCHS Officeof Information Services InformationDissemination Staff at 1-800-232-4363or the Ambulatory Care StatisticsBranch at 301-458-4600 or by e-mail atNCHSquerycdcgov

Figure 1 Percent distribution of office visits b

Highlights

Physician office utilization

+ In 2005 an estimated 9636 millionvisits were made to office-basedphysicians an average of about 3310visits for every 100 persons (Table 1)

+ About one-quarter of all visits wereto general and family practicephysicians with an additional375 percent of visits to physiciansspecializing in internal medicinepediatrics or obstetrics andgynecology (Figure 1)

+ Visits are also presented by specialtytype a grouping of specialties andsubspecialties split into three majorgroups primary care surgicalspecialties and medical specialties(see lsquolsquoPhysician specialty groupsrsquorsquo inlsquolsquoMethodsrsquorsquo) In 2005 595 percent ofoffice visits were made to primarycare specialists 208 percent tosurgical specialists and the remaining197 percent to medical specialists(Table 1)

+ About 81 percent of office-basedphysicians were located inmetropolitan statistical areas (20) andthey provided 871 percent of annualphysician office encounters (Table 1)

y physician specialty United States 2005

Advance Data No 387 + June 29 2007 3

Physician practicecharacteristics

+ Overall 874 percent of the visitswere to practices that were eitherowned by a physician or a group ofphysicians In contrast a smallerproportion of visits 757 percentwere made to sampled physicianswho owned the practice Aboutone-half of the office visits(488 percent) were made tophysicians who were part of a grouppractice having three or morephysicians (Table 2)

+ One-fifth or 224 percent of visitsoccurred in multispecialty practicesand 384 percent were to single-specialty practices Solo practitionersaccounted for the remaining393 percent of the office visits(Table 2)

+ In one-quarter of office visits patientinformation was documented usingelectronic medical records while for839 percent of the visits claims weresubmitted electronically

Patient characteristics

+ The visit rate to physician offices washighest for infants under 1 year ofage and the elderly 75 years and over(7816 and 7677 visits per 100persons respectively) The visit ratedeclined from infancy to young

75 years and over1

65ndash74

45ndash641

25ndash441

15ndash24

Under 15

202530

261

189

229

1Significant difference in percentages between 1995 and 2005

SOURCE CDCNCHS National Ambulatory Medical Care Surv

Pat

ient

age

in y

ears

Figure 2 Percent distribution of office visits b

adulthood (15ndash24 years of age) thenrose again as age increased (Table 3)

+ In 1995 the majority of visits weremade by patients 25ndash44 years of agecompared with 2005 when visits bypatients 45ndash64 years of age weremost prominent This patternrepresents a utilization shift as thebaby boom generation reached the45ndash64 age group in 2005 (Figure 2)

+ Private insurance was the mostfrequently recorded expected sourceof payment accounting for631 percent of visits IndividuallyMedicare and MedicaidStateChildrenrsquos Health Insurance Program(SCHIP) accounted for 240 percentand 113 percent of visitsrespectively however visits made bypatients with Medicare and Medicaidrepresented 20 percent of all visits(Table 4) Visits by patientscategorized as self-pay no charge orcharity an approximation ofuninsured constituted 45 percent ofall office visits

Continuity of care

+ In 504 percent of physician officevisits the providers indicated thatthey were the patientrsquos primary carephysician or provider (PCP)455 percent were to a provider otherthan the patientrsquos PCP and at

2001995

0 50051015

7381

130

111

(p lt 05)

Percent of visits

ey

y patient age according to year United States

42 percent of visits it was unknownif the provider was the PCP (Table 5)

+ Of the visits to a provider other thanthe patientrsquos PCP about one-third(310 percent) were referrals(calculated from Table 5) Visits bynew patients were more likely to bereferrals than visits made byestablished patients (434 percentversus 98 percent)

+ Among visits to non-PCPs thespecialties with visits most frequentlyreferred by other physicians weregeneral surgery (538 percent)neurology (493 percent) andotolaryngology (388 percent)Approximately one-half of visits toobstetricians and gynecologistsophthalmologists dermatologistspsychiatrists and urologists wereself-referrals (Table 6)

+ Established patients accounted for873 percent of office visits Four-fifths of office visits (816 percent)were made by established patientswho had at least one previous visit inthe last 12 months (calculated fromtable) and 236 percent had six ormore visits in the previous 12 months(Table 7) New patients accounted for127 percent of visits representing a9 decrease since 1995 (140percent)

+ Primary care specialists (907 percent)were more likely to see established

5

10 15 20 25 30

294

209

134

124

167

1995 and 2005

+

+

+

+

+

C

+

4 Advance Data No 387 + June 29 2007

patients compared with medical(851 percent) and surgical(799 percent) specialties (Table 7)

Conditions seen

+ In 2005 symptom complaintsaccounted for approximately one-halfof all office visits Some of the moreprominent symptoms includedrespiratory (99 percent)musculoskeletal (99 percent) andeyes and ears (50 percent) (Table 8)

+ General medical examination(74 percent) was the most frequentlymentioned specific reason for visitand was more likely to be made bymales (88 versus 64 percent) Cough(34 percent) was the most frequentlymentioned reason regarding an illnessor injury (Table 9)

+ Chronic conditions including routinefollow-up and flare-up problemsaccounted for 395 percent of visits(Table 10) New problems includinginfectious diseases and newlydiagnosed chronic conditionsaccounted for 331 percent of visitsThe percentage of visits for newproblems declined with patient agewhereas the percentage of visits forboth types of chronic conditions (forexample routine and flare-up)increased with patient age

+ Approximately 181 percent of allvisits were for preventive care(Table 10) The female visit rate forpreventive care (744 visits per 100persons) was significantly higher thanthe rate for males (448 visits per 100persons) (Table 11) The preventivecare visit rate among infants under 1year of age (4214 visits per 100persons) exceeded that of all otherage groups Persons with visitscategorized as self-pay no charge orcharity an approximation ofuninsured had a significantly lowerpreventive care visit rate (146 visitsper 100 persons) compared withpersons with private or public healthinsurance possibly placing them at adisadvantage for disease preventionand early diagnosis

+ The physicianrsquos primary diagnosis for186 percent of visits involved thesupplementary classification used for

preventive and follow up care (forexample general medicalexamination routine prenatalexamination and health supervisionof an infant or child) (Table 12)The most frequent illness diagnosesfor office visits included essentialhypertension acute upper respiratoryinfections (excluding pharyngitis)arthropathies and related disordersmalignant neoplasms diabetesmellitus and spinal disorders(Table 13) Since 1995 hypertensionhas been ranked either first or secondas the primary illness diagnosis byphysicians at office visitsThe leading diagnoses by age wereroutine infant or child health checkfor infants (under 1 year) children(1ndash12 years of age) and adolescentsthrough young adults (13ndash21 years ofage) and essential hypertension formiddle-aged persons (50ndash64 years)and seniors (65 years of age andover) (Table 14)Although normal pregnancy leads theprimary diagnosis list among adults22ndash49 years of age the leadingdiagnosis for males in this age groupwas essential hypertension (Table 14)There were an estimated 894 millioninjury- or poisoning-related officevisits including adverse effects ofmedical treatment in 2005representing 93 percent of all visitsand yielding a rate of 307 visits per100 persons (Table 15) The injury- orpoisoning-related visit ratesignificantly increased with patientage The rate for patients 75 yearsand over (507 per 100 persons) wasmore than double that for age groupsunder 25 years of ageAdverse effects of medical careincluding surgical complications andadverse drug reactions wereresponsible for 83 million visits(92 percent of injury visits)(Table 16)

hronic conditions

In 2005 527 percent of office visitswere made by patients with one ormore chronic conditions (Table 17)Hypertension was the most frequentcondition (228 percent) followed by

arthritis (143 percent) hyperlipidemia(135 percent) and diabetes(98 percent)

+ Since 1995 the percentage of visitsmade by adults 18 years and overwith hypertension indicated on themedical record increased by 41(Figure 3) During the same timeperiod visits by adults with chronicrenal failure depression or diabetesincreased by 114 42 and 53respectively Since 1995 thepercentage of visits by patients witharthritis or obesity has not changedsignificantly An 18 decrease invisits was observed for patientssuffering from chronic obstructivepulmonary disease

Services ordered or provided

+ Diagnostic or screening services wereordered or provided at 871 percent ofvisits The most frequently occurringexamination was related to skinconditions (126 percent) (Table 18)Visits by females were more likely tohave a depression screening orderedor provided Imaging was ordered orprovided at 135 percent of visitsFemales were more likely to haveimaging ordered or providedcompared with visits by males adifference due mostly tomammography and ultrasound

+ The patientrsquos blood pressure (BP) wasmeasured at 593 percent of visitsAmong visits with a BP takenmeasures were in the moderately highrange (140ndash159 mmHg systolic or90ndash99 mm Hg diastolic) and theseverely high range (160 mmHg orgreater systolic or 100 mmHg orgreater diastolic) in 203 and74 percent of visits Moderate tosevere BP elevations were seen morefrequently in visits by patients aged45 years or older compared withyounger patients (Table 19) Bloodpressure classification was based onthe Seventh Report of the JointNational Committee on preventiondetection evaluation and treatmentof high blood pressure (21)

+ Health education was ordered orprovided at 384 percent of visits(Table 20) As in 1995 the most

+

+

+

+

0

5

10

15

20

25

30 20051995

ObesityHypertension1Diabetes1Depression1COPD12Chronic renal failure1

Arthritis

Per

cent

of v

isits

1Significant differences in percentages between 1995 and 2005 (p lt 005)

2COPD is chronic obstructive pulmonary disease

Chronic condition

182 175

07 15

60 4973

10478

119

199

281

87 83

SOURCE CDCNCHS National Ambulatory Medical Care Survey

Figure 3 Percentage of office visits by adults 18 years and over with selected chronic conditions United States 1995 and 2005

Advance Data No 387 + June 29 2007 5

frequent counseling or educationprovided at office visits related to dietor nutrition (148 percent) andexercise (109 percent) Injuryprevention counseling was morelikely to be given at visits made bymales (53 percent) compared withfemales (36 percent) while all othergender comparisons for healtheducation visits were equivalent

+ Nonmedication treatment was orderedor provided at 177 percent of visits(Table 21) Physical therapy andexcision of tissue were bothmentioned at 24 percent of visitsfollowed by psychotherapy(23 percent) and wound care(21 percent)

+ Durable medical equipment homehealth care and speech oroccupational therapy were ordered orprovided at 73 25 and 19 millionvisits respectively (Table 21)

+ An estimated 659 million surgicalprocedures were ordered or providedduring office visits (Table 22) Atleast one surgical procedure wasordered or performed at 62 percentof office visits The two mostcommon procedures were related tointegumentary (355 percent ofprocedures) and digestive systems(217 percent of procedures)

Medications

+ Medications were providedprescribed or continued (referred to

the physician and patient

as drug mentions) at 6792 millionoffice visits accounting for705 percent of all office visits(Table 23) At 402 percent of allvisits 2ndash7 drugs were recorded whileat 56 percent of visits eight or moredrug mentions were recordedDuring 2005 there were about 20billion drugs mentioned resulting inan overall drug mention rate of 2107mentions per 100 visits (Table 24)The percent of visits with at least onedrug mention ranged from901 percent for psychiatrists to408 percent for general surgeonsDrug mentions are displayed bytherapeutic class in Table 25Antidepressants were the leading drugsubclass indicated in 53 percent ofall drug mentions followed closelyby antihypertensive agents(52 percent) hyperlipidemia drugs(50 percent) antiarthritics(42 percent) and antiasthmatics orbronchodilators (41 percent)Aspirin was the most frequentlymentioned generic equivalent used indrugs ordered or supplied at officevisits occurring in 26 percent ofdrug mentions (Table 26) This wasfollowed by atorvastatin calciumlevothyroxine metoprolol andalbuterolFor a majority of the 20 mostfrequently occurring genericequivalents the patient was instructedto continue taking the drug howeveramoxicillin was more likely to be

new (854 percent) while ibuprofenand acetaminophen were just as likelyto be associated with a new orcontinued drug (Table 26)

+ Overall drugs were more likely to becontinued rather than new (698versus 256 percent) (Table 26)Figure 4 shows that as patient ageincreased drugs were more likely tobe continued

Providers seen dispositionand duration

+ Overall 962 percent of visits wereattended by a physician (Table 27)Nurses (registered and licensedpractical nurses) were seen at280 percent of office visits Mid-level providers such as physicianassistants nurse practitioners andmidwives were seen at 61 percent ofoffice visits

+ At about two-thirds of visits(647 percent) patients were told toreturn to the office by appointment(Table 28) lsquolsquoReturn if neededrsquorsquo andlsquolsquono follow up plannedrsquorsquo wereindicated at 275 and 64 percent ofvisits respectively Patients werereferred to other physicians at67 percent of visits

+ In 2005 896 percent of office visitswith face-to-face contact between thephysician and patient had a durationof 6ndash30 minutes (Table 29) At 367million visits or 38 percent therewas no face-to-face contact between

NewContinued

Per

cent

of d

rug

men

tions

NOTES Linear trends by age are significant (p lt 005) for percentage new and continued New or continued status was unknown for about 45 percent of all drug mentions

Patient age in years

0

20

40

60

80

100

75 and over65ndash7445ndash6425ndash4415ndash24Under 15All ages

698

256328

600

451495

575

372

753

207

820

146

839

117

SOURCE CDCNCHS National Ambulatory Medical Care Survey

Figure 4 Percentage of drugs mentioned at office visits that were new or continued by patient age United States 2005

6 Advance Data No 387 + June 29 2007

+ Overall the mean time spent with aphysician was 197 minutes(Table 30) The visit duration forpsychiatrists had the largestvariability a difference of 299minutes between the third and firstquartiles

+ Although the overall mean time spentwith a physician excludingpsychiatrists has not changedsignificantly since 1995 there havebeen variations in certain blocks oftime Specifically visits lasting 6ndash10minutes decreased by 28 while

0

10

20

30

40

6ndash1011ndash5

20051995

Per

cent

of v

isits

1Difference between 1995 and 2005 percentage is significant NOTES Percent distributions do not include visits to psychia187 minutes respectively)

40 27

242

17

SOURCE CDCNCHS National Ambulatory Medical Care Su

Figure 5 Percent distribution of office visits w2005

visits lasting 16ndash30 minutes increasedby 20 (Figure 5)

Methods

Data source

The data presented in this report arefrom the 2005 NAMCS a nationalprobability sample survey of nonfederaloffice-based physicians conducted bythe Centers for Disease Control andPreventionrsquos National Center for HealthStatistics Division of Health CareStatistics The survey was conducted

16ndash30111ndash15

(p lt 005)trists Mean time spent with physician in 2005 was not significantly d

Duration in minutes

4

339361

307

368

rvey

here a physician was seen by duration of visit

from December 27 2004 throughDecember 25 2005 The NAMCS datacollection is authorized under Section306 of the Public Health Service Act(Title 42 US Code) 242k Participationis voluntary In April 2003 the PrivacyRule of the Health Insurance Portabilityand Accountability Act (HIPAA) wasimplemented to establish minimumFederal standards for safeguarding theprivacy of individually identifiablehealth information

Data collected in the NAMCS areconsistent with the Privacy Rule of the

61 and over131ndash60

ifferent from mean time in 1995 (193 versus

63 65

09 04

according to year United States 1995 and

Advance Data No 387 + June 29 2007 7

Health Insurance Portability andAccountability Act (HIPAA) Nopersonally identifying information suchas patientrsquos name address or SocialSecurity number is collected in theNAMCS All information collected isheld in the strictest confidenceaccording to law [Section 308(d) of thePublic Health Service Act (42 USCode 242m (d))] and the ConfidentialInformation Protection and StatisticalEfficiency Act (Title 5 of PL 107ndash347)Approval for the NAMCS protocol wasrenewed by the NCHS Research EthicsReview Board in February 2005Waivers of the requirements to obtaininformed consent of patients and patientauthorization for release of patientmedical record data by health careproviders were granted

The target universe of NAMCSincludes visits made in the United Statesto the offices of nonfederally employedphysicians excluding those in thespecialties of anesthesiology radiologyand pathology who were classified bythe American Medical Association(AMA) and the American OsteopathicAssociation (AOA) as lsquolsquooffice-basedpatient carersquorsquo Visits to privatenonhospital-based clinics and healthmaintenance organizations (HMOs) werewithin the scope of the survey but thosethat occurred in federally operatedfacilities and hospital-based outpatientdepartments were not Telephonecontacts and visits made outside thephysicianrsquos office were also excluded

The NAMCS utilizes a multistageprobability sample design involvingsamples of 112 geographic primarysampling units (PSUs) physicianpractices within PSUs and patient visitswithin physician practices The PSUsare counties groups of counties countyequivalents (such as parishes orindependent cities) or towns andtownships for some PSUs in NewEngland A sample of physicians wasselected from the master files of AMAand AOA 1936 were in scope (eligibleto participate in the survey) Of these1281 physicians participated inNAMCS for an unweighted responserate of 66 percent Sample physicianswere asked to complete Patient Recordforms (see lsquolsquoTechnical Notesrsquorsquo) for asystematic random sample of

approximately 30 office visits occurringduring a randomly assigned 1-weekreporting period The number of PatientRecord forms completed was 25665Some physicians did not provide theexpected number of visit recordsthereby reducing the unweighted totalvisit response rate to 615 percent

The US Census Bureau acting asthe data collection agent for the surveyprovided training to field representatives(FRs) throughout the Nation FRsoversaw data collection at thephysicianrsquos office They contactedphysicians for induction into the surveyafter an advance letter was mailed byNCHS notifying the physicians of theirselection in the survey In many casesphysicians or their staff completed theinformation requested on the PatientRecord forms However in 519 percentof the weighted visits FRs abstractedthe data from medical records orcomputer printouts either alone or withthe doctor or office staff

Data processing and medical codingwere performed by Constella GroupInc Durham North Carolina As part ofthe quality assurance procedure a10-percent quality control sample ofsurvey records was independently keyedand coded Coding error rates rangedbetween 03 and 45 percent for varioussurvey items

Medical data collected in the surveywere coded as follows

+ Patientrsquos reason for visitmdashThepatientrsquos main complaint symptomor reason for visiting the physicianrsquosoffice was coded according to AReason for Visit Classification forAmbulatory Care (RVC) (22) Up tothree reasons could be coded pervisit

+ Physicianrsquos diagnosismdashPhysicians ortheir staff were asked to record theprimary diagnosis or problemassociated with the patientrsquos mostimportant reason for the current visitand any other significant currentdiagnoses Up to three diagnoseswere coded according to theInternational Classification ofDiseases 9th Revision ClinicalModification (ICDndash9ndashCM) (23)

+ Injury poisoning adverse effect ofmedical treatmentmdashAlthough there is

a separate item on the Patient Recordform to indicate whether the visit wasfor an injury poisoning or adverseeffect of medical treatmentsometimes an injury reason for visitor an injury diagnosis is recordedwithout the injury item beingchecked Therefore the visit iscounted as an injury visit if the injuryitem is marked or if any of the threereasons for visit were in the injurymodule or any of the three diagnoseswere in the injury or poisoningchapter of the ICDndash9ndashCM (24)

+ MedicationsmdashPhysicians or their staffwere instructed to record all new orcontinued medications orderedsupplied or administered at the visitThis included prescription andnonprescription preparationsimmunizations desensitizing agentsand anesthetics In this surveyrecorded medications are referred toas drug mentions and are codedaccording to a classification systemdeveloped at NCHS (25) As used inthe NAMCS the term lsquolsquodrugrsquorsquo isinterchangeable with the termlsquolsquomedicationrsquorsquo The termlsquolsquoprescribingrsquorsquo is used broadly tomean ordering or providing anymedication whether prescription orover-the-counter Visits with one ormore drug mentions are termed lsquolsquodrugvisitsrsquorsquo in NAMCS Therapeuticclassification of drugs is based on the4-digit therapeutic categories used inthe National Drug Code Directory1995 edition (26) Drugs may havemore than one therapeutic applicationand in NAMCS up to threetherapeutic drug classes are includedfor each drug For the first time since1993ndash94 providers in 2005 wereasked to indicate whether medicationswere new or continued

Physician specialty groups

This report classifies specificphysician specialties into two generalcategorical schemes physician specialtyand type of specialty The NAMCSsurvey design groups physicians into 15strata or specialty groups for samplingpurposes One stratum doctors ofosteopathy was based on informationfrom the AOA The lsquolsquophysician

8 Advance Data No 387 + June 29 2007

specialtyrsquorsquo classification includes thesame strata as used for samplingpurposes with the exception of thedoctors of osteopathy stratum which iscombined with doctors of medicine inthe following 14 categories general andfamily practice internal medicinepediatrics general surgery obstetricsand gynecology orthopedic surgerycardiovascular diseases dermatologyurology psychiatry neurologyophthalmology otolaryngology and aresidual category of other specialtiesThe lsquolsquophysician specialtyrsquorsquo classificationis created using updated informationfrom the AMA as well as informationprovided by sampled physiciansSpecific physician specialties in each of

Text box A

Physicianspecialty

General practice Family medicine family practice

Internal medicine Internal medicine

Pediatrics Adolescent medicine critical care(pediatrics) neurodevelopmentalcardiology pediatric endocrinologpediatric gastroenterology pedia

General surgery General surgery

Obstetrics andgynecology

Gynecological oncology gynecolgynecology) reproductive endoc

Orthopedic surgery Adult reconstructive orthopedicsmedicine (orthopedic surgery) o

Cardiovasculardiseases

Cardiovascular diseases

Dermatology Dermatology

Urology Urology pediatric urology

Psychiatry Addiction psychiatry child psych

Neurology Child neurology clinical neuroph

Ophthalmology Ophthalmology pediatric ophthal

Otolaryngology Otology-neurotology otolaryngolo

Other Allergy addiction medicine allerg(internal medicine) abdominal susurgery clinical genetics clinicalimmunology diabetes dermatolotoxicology (emergency medicine)surgery hematologyoncology hamedicinediagnostic lab immunomanagement medical geneticsmedicine oral amp maxillofacial surmedicine pediatric cardiothoracicphlebology public healthgeneralrehabilitation pain medicine spoplastic surgery within the head ampmedicine spinal cord injury sleeundersea medicine vascular me

the 14 categories are defined in text boxA

In this classification a pediatriccardiothoracic physician for example isgrouped with other pediatricians On theother hand the lsquolsquospecialty typersquorsquoclassification divides AMA specialtiesinto three major categories primarycare surgical specialties and medicalspecialties and puts more emphasis onspecialization type For examplepediatric cardiothoracic physician areclassified as a surgical specialty in thisclassification The specific physicianspecialties included in each of the threespecialty types are provided in text boxB

It should be noted that lsquolsquoprimarycare specialistrsquorsquo as defined in the textbox

Specific physician specialty

(geriatric medicine) sports medicine (family practice) gen

pediatrics developmental-behavioral pediatrics internaldisabilities (psychiatry amp neurology) neonatal-perinatal my pediatric infectious diseases pediatric pulmonology m

tric hematologyoncology pediatric nephrology pediatric r

ogy maternal amp fetal medicine obstetrics amp gynecology orinology

foot and ankle orthopedics musculoskeletal oncology perthopedic surgery of the spine orthopedic trauma

iatry neuropsychiatry psychiatry forensic psychiatry psyc

ysiology endovascular surgical neuroradiology neurology

mology

gy pediatric otolaryngology

y and immunology allergy amp immunologydiagnostic labrgery clinical biochemical genetics clinical cytogeneticsmolecular genetics colon and rectal surgery cosmetic sugic surgery emergency medicine endocrinology epidemi facial plastic surgery gastroenterology general preventind surgery interventional cardiology cardiac electrophysi

logy geriatric medicine (internal medicine) sports medicinnephrology neurological surgery nuclear cardiology pedigery osteopathic manipulative medicine medical oncologsurgery pediatric surgery pediatric emergency medicine

preventive medicine pediatricdiagnostic lab immunologrts medicine (physical medicine and rehabilitation) pediatneck medical toxicology (preventive medicine) pulmona

p medicine surgical oncology traumatic surgery thoracicdicine vascular surgery other specialty unspecified

differs from lsquolsquoprimary care physician orprovider (PCP)rsquorsquo which is reported bythe survey respondent based on thequestion lsquolsquoAre you the patientrsquos primarycare physicianrsquorsquo (see lsquolsquoTechnicalNotesrsquorsquo) A PCP coordinates thecomprehensive health care of the patientand serves as the entry point for all ofthe patientrsquos health care needs PCPs areadvocates for the patient in coordinatingthe use of the entire health care systemto benefit the patient (27) TypicallyPCP visits include physicians in generaland family practice internal medicinepediatrics or obstetrics and gynecologyIn the NAMCS a checkbox defines aPCP visit therefore these visits mayalso include specialist physicians ornonphysicians such as physicianassistants and nurse practitioners

eral practice

medicinepediatrics neurodevelopmental disabilitiesedicine pediatrics pediatric allergy pediatricedical toxicology pediatric emergency medicineheumatology sports medicine (pediatrics)

bstetrics critical care medicine (obstetrics and

diatric orthopedics orthopedic surgery sports

hoanalysis geriatric psychiatry

(diagnostic radiology) vascular neurology

immunology aerospace medicine adolescent medicinecritical care medicine critical care surgery craniofacialrgery dermatological immunologydiagnostic labology sports medicine (emergency medicine) medicalve medicine hematology hepatology head and neckology infectious diseases immunology internale (internal medicine) legal medicine medical

atric surgery (neurology) nutrition occupationaly clinical pharmacology pulmonary critical care(emergency medicine) pharmaceutical medicine

y palliative medicine physical medicine andric rehabilitation medicine proctology plastic surgeryry diseases rheumatology pediatric rehabilitationsurgery transplant surgery urgent care medicine

Text box B

Physicianspecialty type Specific physician specialty

Primary carespecialties

Family practice geriatric medicine (family practice) sports medicine (family practice) general practice internal medicine internal medicine(pediatrics) adolescent medicine (internal medicine) geriatric medicine (internal medicine) adolescent medicine pediatrics pediatric sportsmedicine gynecology maternal and fetal medicine obstetrics and gynecology obstetrics

Surgicalspecialties

General surgery gynecological oncology critical care medicine (obstetrics and gynecology) hand surgery (orthopedic surgery) adultreconstructive orthopedics foot and ankle orthopedics musculoskeletal oncology pediatric orthopedics orthopedic surgery sports medicine(orthopedic surgery) orthopedic surgery of the spine orthopedic trauma urology pediatric urology ophthalmology pediatric ophthalmologyotology and neurotology otology otolaryngology pediatric otolaryngology abdominal surgery cardiovascular surgery colon and rectal surgerycardiothoracic surgery craniofacial surgery critical care surgery dermatologic surgery facial plastic surgery head and neck surgery handsurgery (plastic surgery) hand surgery (surgery) critical care (neurological surgery) neurological surgery pediatric surgery (neurology) pediatriccardiothoracic surgery pediatric surgery plastic surgery surgical oncology thoracic surgery transplant surgery traumatic surgery vascularsurgery

Medicalspecialties

Critical care pediatrics developmental-behavioral pediatrics neurodevelopmental disabilities (pediatrics) neurodevelopmental disabilities(psychiatry amp neurology) neonatal-perinatal medicine pediatric allergy pediatric cardiology pediatric endocrinology pediatric infectious diseasespediatric pulmonology medical toxicology (pediatrics) pediatric emergency medicine pediatric gastroenterology pediatric hematology andoncology pediatric nephrology pediatric rehabilitation medicine pediatric rheumatology reproductive endocrinology cardiovascular diseasesdermatology psychiatry addiction psychiatry child psychiatry forensic psychiatry psychoanalysis geriatric psychiatry neurology child neurologyclinical neurophysiology neurology (diagnostic radiology) addiction medicine aerospace medicine allergy allergy and immunology anddiagnostic laboratory immunology cardiac electrophysiology clinical genetics clinical biochemical genetics clinical molecular genetics criticalcare medicine dermatological immunology diagnostic laboratory immunology diabetes emergency medicine epidemiology endocrinologygastroenterology general preventive medicine hematology hematology and oncology infectious diseases internal medicine and diagnosticlaboratory immunology interventional cardiology legal medicine medical management medical genetics medical toxicology (emergencymedicine) medical oncology nephrology neurodevelopmental disabilities (pediatrics) nuclear cardiology nutrition occupational medicineosteopathic manipulative medicine pain medicine palliative medicine pediatric emergency medicine (emergency medicine) pediatric anddiagnostic laboratory immunology pharmaceutical medicine phlebology public health public health and general preventive medicine clinicalpharmacology physical medicine and rehabilitation pulmonary critical care medicine pulmonary diseases sports medicine (emergencymedicine) sports medicine (physical medicine and rehabilitation) rheumatology spinal cord injury sleep medicine undersea medicine vascularmedicine vascular neurology

Advance Data No 387 + June 29 2007 9

Estimation

Because of the complex multistagedesign of NAMCS a sample weight iscomputed for each sample visit thattakes all stages of design into accountThe survey data are inflated or weightedto produce unbiased national annualestimates The visit weight includes fourbasic components inflation byreciprocals of selection probabilitiesadjustment for nonresponse populationratio adjustments and weightsmoothing For the first time in 2004changes were made to the nonresponseadjustment factor to account for theseasonality of the reporting period

Starting with 2003 data thenonresponse adjustment additionallyaccounts for nonresponse fromphysicians by weekly visit volume andfor the variability in number of weeksparticipating physicians saw patientsduring the year (28) In previous yearsthe nonresponse adjustment accountedonly for nonresponse by physicianspecialty geographic region andmetropolitan statistical area status

The standard error is primarily ameasure of the sampling variability thatoccurs by chance because only a samplerather than an entire universe issurveyed Estimates of the sampling

variability for this report were calculatedusing Taylor approximations inSUDAAN which take into account thecomplex sample design of NAMCS Adescription of the software and itsapproach has been published (29) Thestandard errors of statistics presented inthis report are included in each of thetables

Tests of significance

In this report the determination ofstatistical inference is based on thetwo-tailed t-test The Bonferroniinequality was used to establish thecritical value for statistically significantdifferences (005 level of significance)based on the number of possiblecomparisons within a particular variable(or combination of variables) of interestA weighted least-squares regressionanalysis was used to determine thesignificance of trends at the 005 level

Nonsampling errors

As in any survey results are subjectto both sampling and nonsamplingerrors Nonsampling errors includereporting and processing errors as wellas biases due to nonresponse andincomplete response The magnitude ofthe nonsampling errors cannot be

computed However these errors werekept to a minimum by procedures builtinto the operation of the survey Toeliminate ambiguities and to encourageuniform reporting attention was givento the phrasing of items terms anddefinitions Also pretesting of most dataitems and survey procedures wasperformed Quality control proceduresand consistency and edit checks reducederrors in data coding and processing

The weighted response rate for the2005 NAMCS was 625 percentTable 31 presents weightedcharacteristics of NAMCS respondentsand nonrespondents along withweighted response rates Respondingversus nonresponding distributions weresimilar with the exception of highercooperation among female physiciansand pediatricians while cooperation wasless likely from male physicians andneurologists The effect of thisdifferential response is minimized in thevisit estimates in most cases as NAMCSuses a nonresponse adjustment factorthat takes annual visit volume specialtygeographic region and MSA intoaccount

Item nonresponse rates in theNAMCS are generally low (5 percent orless) However levels of nonresponsecan vary considerably in the survey

10 Advance Data No 387 + June 29 2007

Most nonresponse occurs when theneeded information is not available inthe medical record or is unknown to theperson filling out the survey instrumentNonresponse can also result when theinformation is available but surveyprocedures are not followed and theitem is left blank In this report thetables include a combined entry ofunknown or blank to display missingdata For items where combined itemnonresponse is between 30 and50 percent percent distributions are notdiscussed in the text However theinformation is shown in the tablesThese data should be interpreted withcaution If nonresponse is random theobserved distribution for the reporteditem (ie excluding cases for which theinformation is unknown) would be closeto the true distribution However ifnonresponse is not random the observeddistribution could vary significantlyfrom the actual distribution Researchersneed to decide how best to treat itemswith high levels of missing responsesFor items with nonresponse greater than50 percent data are not presented

Weighted item nonresponse rates(ie if the item was left blank or thelsquolsquounknownrsquorsquo box was marked) were50 percent or less for data items withthe following exceptions was visit forinjurypoisoningadverse effect ofmedical treatment (77 percent) andstatus of patient enrollment in a diseasemanagement program (240 percent)

For some items missing valueswere imputed by randomly assigning avalue from a Patient Record form withsimilar characteristics and were basedon physician specialty geographicregion and 3-digit ICDndash9ndashCM codes forprimary diagnosis Imputations wereperformed for the following variablesbirth year (19 percent) sex(10 percent) ethnicity (249 percent)race (208 percent) patient seen beforein practice (31 percent) how many pastvisits in last 12 months (55 percent)and time spent with physician(136 percent) Blank or otherwisemissing responses are noted in the dataEthnicity was imputed by randomlyassigning a value from a Patient Recordform with similar characteristics basedon physician specialty state and 3-digitICDndash9ndashCM codes for primary diagnosis

Use of tables

First-listed reason for visit anddiagnosis are presented in the tables Itshould be noted that estimates differingin ranked order may not be significantlydifferent from each other For itemsrelated to diagnostic and screeningservices procedures providers seen anddisposition physician office staff wasasked to check all of the applicablecategories for each item Thereforemultiple responses could be coded foreach visit

In this report estimates are notpresented if they are based on fewerthan 30 cases in the sample data onlyan asterisk () appears in the tables Therelative standard error (RSE) of anestimate is obtained by dividing thestandard error by the estimate itself Theresult is then expressed as a percentageof the estimate Estimates based on 30or more cases include an asterisk () ifthe RSE of the estimate exceeds30 percent

In the tables estimates of officevisits have been rounded to the nearestthousand Consequently estimates willnot always add to totals Rates andpercentages were calculated fromoriginal unrounded figures and do notnecessarily agree with figures calculatedfrom rounded data

Estimates presented in the tables forspecific race categories reflect visitswhere only a single race was reportedDenominators used in computingestimates of visit rates by expectedsource of payment were obtained fromthe 2005 National Health InterviewSurvey (NHIS) Individuals reportingmultiple insurance categories in theNHIS were counted in each categorythey reported with the exception ofMedicaid and SCHIP which werecombined into a single category

References1 Burt CW McCaig LF Rechtsteiner

EA Ambulatory medical careutilization estimates for 2005Advance data from vital and healthstatistics no 388 Hyattsville MDNational Center for Health Statistics2007 Available from httpwwwcdcgovnchsdataadad388pdf

2 Centers for Medicare and MedicaidServices and Office of the AssistantSecretary for Planning andEvaluation An Overview of the USHealth Care System Chart BookAvailable from httpwwwcmshhsgovTheChartSeriesdownloadsus_health_chap1_ppdf

3 Hing E Burt CW Characteristics ofoffice-based physicians and theirpractices United States 2003ndash2004National Center for Health StatisticsVital Health Stat 13(164) 2006

4 Hing E Cherry DK Woodwell DANational Ambulatory Medical CareSurvey 2004 summary Advancedata from vital and health statisticsno 374 Hyattsville MD NationalCenter for Health Statistics 2006

5 Middleton KR Hing E Xu JNational Hospital AmbulatoryMedical Care Survey 2005outpatient department summaryAdvance data from vital and healthstatistics no 389 Hyattsville MDNational Center for Health Statistics2007 Available from httpwwwcdcgovnchsdataadad389pdf

6 Nawar E Niska R NationalHospital Ambulatory Medical CareSurvey 2005 emergency departmentsummary Advance data from vitaland health statistics no 386Hyattsville MD National Center forHealth Statistics 2007 Availablefrom httpwwwcdcgovnchsdataadad386pdf

7 Raofi S Schappert S MedicationTherapy in Ambulatory MedicalCare United States 2003ndash2004National Center for Health StatisticsVital Health Stat 13(163) 2006

8 Niska R Burt CW Training forterrorism-related conditions inhospitals United States 2003ndash2004Advance data from vital and healthstatistics no 380 Hyattsville MDNational Center for Health Statistics2006

9 Burt CW McCaig LF Staffingcapacity and ambulance diversion inemergency departments UnitedStates 2003ndash2004 Advance datafrom vital and health statistics no376 Hyattsville MD NationalCenter for Health Statistics 2006

10 Altman KW Stephens RM LyttleCS Changing impact ofgastroesophageal reflux in medicaland otolaryngology practiceLaryngoscope 115(7)1145ndash53 2005

11 Fiscella K Franks P Does thecontent of primary care visits differ

+

+

+

+

+

C

+

4 Advance Data No 387 + June 29 2007

patients compared with medical(851 percent) and surgical(799 percent) specialties (Table 7)

Conditions seen

+ In 2005 symptom complaintsaccounted for approximately one-halfof all office visits Some of the moreprominent symptoms includedrespiratory (99 percent)musculoskeletal (99 percent) andeyes and ears (50 percent) (Table 8)

+ General medical examination(74 percent) was the most frequentlymentioned specific reason for visitand was more likely to be made bymales (88 versus 64 percent) Cough(34 percent) was the most frequentlymentioned reason regarding an illnessor injury (Table 9)

+ Chronic conditions including routinefollow-up and flare-up problemsaccounted for 395 percent of visits(Table 10) New problems includinginfectious diseases and newlydiagnosed chronic conditionsaccounted for 331 percent of visitsThe percentage of visits for newproblems declined with patient agewhereas the percentage of visits forboth types of chronic conditions (forexample routine and flare-up)increased with patient age

+ Approximately 181 percent of allvisits were for preventive care(Table 10) The female visit rate forpreventive care (744 visits per 100persons) was significantly higher thanthe rate for males (448 visits per 100persons) (Table 11) The preventivecare visit rate among infants under 1year of age (4214 visits per 100persons) exceeded that of all otherage groups Persons with visitscategorized as self-pay no charge orcharity an approximation ofuninsured had a significantly lowerpreventive care visit rate (146 visitsper 100 persons) compared withpersons with private or public healthinsurance possibly placing them at adisadvantage for disease preventionand early diagnosis

+ The physicianrsquos primary diagnosis for186 percent of visits involved thesupplementary classification used for

preventive and follow up care (forexample general medicalexamination routine prenatalexamination and health supervisionof an infant or child) (Table 12)The most frequent illness diagnosesfor office visits included essentialhypertension acute upper respiratoryinfections (excluding pharyngitis)arthropathies and related disordersmalignant neoplasms diabetesmellitus and spinal disorders(Table 13) Since 1995 hypertensionhas been ranked either first or secondas the primary illness diagnosis byphysicians at office visitsThe leading diagnoses by age wereroutine infant or child health checkfor infants (under 1 year) children(1ndash12 years of age) and adolescentsthrough young adults (13ndash21 years ofage) and essential hypertension formiddle-aged persons (50ndash64 years)and seniors (65 years of age andover) (Table 14)Although normal pregnancy leads theprimary diagnosis list among adults22ndash49 years of age the leadingdiagnosis for males in this age groupwas essential hypertension (Table 14)There were an estimated 894 millioninjury- or poisoning-related officevisits including adverse effects ofmedical treatment in 2005representing 93 percent of all visitsand yielding a rate of 307 visits per100 persons (Table 15) The injury- orpoisoning-related visit ratesignificantly increased with patientage The rate for patients 75 yearsand over (507 per 100 persons) wasmore than double that for age groupsunder 25 years of ageAdverse effects of medical careincluding surgical complications andadverse drug reactions wereresponsible for 83 million visits(92 percent of injury visits)(Table 16)

hronic conditions

In 2005 527 percent of office visitswere made by patients with one ormore chronic conditions (Table 17)Hypertension was the most frequentcondition (228 percent) followed by

arthritis (143 percent) hyperlipidemia(135 percent) and diabetes(98 percent)

+ Since 1995 the percentage of visitsmade by adults 18 years and overwith hypertension indicated on themedical record increased by 41(Figure 3) During the same timeperiod visits by adults with chronicrenal failure depression or diabetesincreased by 114 42 and 53respectively Since 1995 thepercentage of visits by patients witharthritis or obesity has not changedsignificantly An 18 decrease invisits was observed for patientssuffering from chronic obstructivepulmonary disease

Services ordered or provided

+ Diagnostic or screening services wereordered or provided at 871 percent ofvisits The most frequently occurringexamination was related to skinconditions (126 percent) (Table 18)Visits by females were more likely tohave a depression screening orderedor provided Imaging was ordered orprovided at 135 percent of visitsFemales were more likely to haveimaging ordered or providedcompared with visits by males adifference due mostly tomammography and ultrasound

+ The patientrsquos blood pressure (BP) wasmeasured at 593 percent of visitsAmong visits with a BP takenmeasures were in the moderately highrange (140ndash159 mmHg systolic or90ndash99 mm Hg diastolic) and theseverely high range (160 mmHg orgreater systolic or 100 mmHg orgreater diastolic) in 203 and74 percent of visits Moderate tosevere BP elevations were seen morefrequently in visits by patients aged45 years or older compared withyounger patients (Table 19) Bloodpressure classification was based onthe Seventh Report of the JointNational Committee on preventiondetection evaluation and treatmentof high blood pressure (21)

+ Health education was ordered orprovided at 384 percent of visits(Table 20) As in 1995 the most

+

+

+

+

0

5

10

15

20

25

30 20051995

ObesityHypertension1Diabetes1Depression1COPD12Chronic renal failure1

Arthritis

Per

cent

of v

isits

1Significant differences in percentages between 1995 and 2005 (p lt 005)

2COPD is chronic obstructive pulmonary disease

Chronic condition

182 175

07 15

60 4973

10478

119

199

281

87 83

SOURCE CDCNCHS National Ambulatory Medical Care Survey

Figure 3 Percentage of office visits by adults 18 years and over with selected chronic conditions United States 1995 and 2005

Advance Data No 387 + June 29 2007 5

frequent counseling or educationprovided at office visits related to dietor nutrition (148 percent) andexercise (109 percent) Injuryprevention counseling was morelikely to be given at visits made bymales (53 percent) compared withfemales (36 percent) while all othergender comparisons for healtheducation visits were equivalent

+ Nonmedication treatment was orderedor provided at 177 percent of visits(Table 21) Physical therapy andexcision of tissue were bothmentioned at 24 percent of visitsfollowed by psychotherapy(23 percent) and wound care(21 percent)

+ Durable medical equipment homehealth care and speech oroccupational therapy were ordered orprovided at 73 25 and 19 millionvisits respectively (Table 21)

+ An estimated 659 million surgicalprocedures were ordered or providedduring office visits (Table 22) Atleast one surgical procedure wasordered or performed at 62 percentof office visits The two mostcommon procedures were related tointegumentary (355 percent ofprocedures) and digestive systems(217 percent of procedures)

Medications

+ Medications were providedprescribed or continued (referred to

the physician and patient

as drug mentions) at 6792 millionoffice visits accounting for705 percent of all office visits(Table 23) At 402 percent of allvisits 2ndash7 drugs were recorded whileat 56 percent of visits eight or moredrug mentions were recordedDuring 2005 there were about 20billion drugs mentioned resulting inan overall drug mention rate of 2107mentions per 100 visits (Table 24)The percent of visits with at least onedrug mention ranged from901 percent for psychiatrists to408 percent for general surgeonsDrug mentions are displayed bytherapeutic class in Table 25Antidepressants were the leading drugsubclass indicated in 53 percent ofall drug mentions followed closelyby antihypertensive agents(52 percent) hyperlipidemia drugs(50 percent) antiarthritics(42 percent) and antiasthmatics orbronchodilators (41 percent)Aspirin was the most frequentlymentioned generic equivalent used indrugs ordered or supplied at officevisits occurring in 26 percent ofdrug mentions (Table 26) This wasfollowed by atorvastatin calciumlevothyroxine metoprolol andalbuterolFor a majority of the 20 mostfrequently occurring genericequivalents the patient was instructedto continue taking the drug howeveramoxicillin was more likely to be

new (854 percent) while ibuprofenand acetaminophen were just as likelyto be associated with a new orcontinued drug (Table 26)

+ Overall drugs were more likely to becontinued rather than new (698versus 256 percent) (Table 26)Figure 4 shows that as patient ageincreased drugs were more likely tobe continued

Providers seen dispositionand duration

+ Overall 962 percent of visits wereattended by a physician (Table 27)Nurses (registered and licensedpractical nurses) were seen at280 percent of office visits Mid-level providers such as physicianassistants nurse practitioners andmidwives were seen at 61 percent ofoffice visits

+ At about two-thirds of visits(647 percent) patients were told toreturn to the office by appointment(Table 28) lsquolsquoReturn if neededrsquorsquo andlsquolsquono follow up plannedrsquorsquo wereindicated at 275 and 64 percent ofvisits respectively Patients werereferred to other physicians at67 percent of visits

+ In 2005 896 percent of office visitswith face-to-face contact between thephysician and patient had a durationof 6ndash30 minutes (Table 29) At 367million visits or 38 percent therewas no face-to-face contact between

NewContinued

Per

cent

of d

rug

men

tions

NOTES Linear trends by age are significant (p lt 005) for percentage new and continued New or continued status was unknown for about 45 percent of all drug mentions

Patient age in years

0

20

40

60

80

100

75 and over65ndash7445ndash6425ndash4415ndash24Under 15All ages

698

256328

600

451495

575

372

753

207

820

146

839

117

SOURCE CDCNCHS National Ambulatory Medical Care Survey

Figure 4 Percentage of drugs mentioned at office visits that were new or continued by patient age United States 2005

6 Advance Data No 387 + June 29 2007

+ Overall the mean time spent with aphysician was 197 minutes(Table 30) The visit duration forpsychiatrists had the largestvariability a difference of 299minutes between the third and firstquartiles

+ Although the overall mean time spentwith a physician excludingpsychiatrists has not changedsignificantly since 1995 there havebeen variations in certain blocks oftime Specifically visits lasting 6ndash10minutes decreased by 28 while

0

10

20

30

40

6ndash1011ndash5

20051995

Per

cent

of v

isits

1Difference between 1995 and 2005 percentage is significant NOTES Percent distributions do not include visits to psychia187 minutes respectively)

40 27

242

17

SOURCE CDCNCHS National Ambulatory Medical Care Su

Figure 5 Percent distribution of office visits w2005

visits lasting 16ndash30 minutes increasedby 20 (Figure 5)

Methods

Data source

The data presented in this report arefrom the 2005 NAMCS a nationalprobability sample survey of nonfederaloffice-based physicians conducted bythe Centers for Disease Control andPreventionrsquos National Center for HealthStatistics Division of Health CareStatistics The survey was conducted

16ndash30111ndash15

(p lt 005)trists Mean time spent with physician in 2005 was not significantly d

Duration in minutes

4

339361

307

368

rvey

here a physician was seen by duration of visit

from December 27 2004 throughDecember 25 2005 The NAMCS datacollection is authorized under Section306 of the Public Health Service Act(Title 42 US Code) 242k Participationis voluntary In April 2003 the PrivacyRule of the Health Insurance Portabilityand Accountability Act (HIPAA) wasimplemented to establish minimumFederal standards for safeguarding theprivacy of individually identifiablehealth information

Data collected in the NAMCS areconsistent with the Privacy Rule of the

61 and over131ndash60

ifferent from mean time in 1995 (193 versus

63 65

09 04

according to year United States 1995 and

Advance Data No 387 + June 29 2007 7

Health Insurance Portability andAccountability Act (HIPAA) Nopersonally identifying information suchas patientrsquos name address or SocialSecurity number is collected in theNAMCS All information collected isheld in the strictest confidenceaccording to law [Section 308(d) of thePublic Health Service Act (42 USCode 242m (d))] and the ConfidentialInformation Protection and StatisticalEfficiency Act (Title 5 of PL 107ndash347)Approval for the NAMCS protocol wasrenewed by the NCHS Research EthicsReview Board in February 2005Waivers of the requirements to obtaininformed consent of patients and patientauthorization for release of patientmedical record data by health careproviders were granted

The target universe of NAMCSincludes visits made in the United Statesto the offices of nonfederally employedphysicians excluding those in thespecialties of anesthesiology radiologyand pathology who were classified bythe American Medical Association(AMA) and the American OsteopathicAssociation (AOA) as lsquolsquooffice-basedpatient carersquorsquo Visits to privatenonhospital-based clinics and healthmaintenance organizations (HMOs) werewithin the scope of the survey but thosethat occurred in federally operatedfacilities and hospital-based outpatientdepartments were not Telephonecontacts and visits made outside thephysicianrsquos office were also excluded

The NAMCS utilizes a multistageprobability sample design involvingsamples of 112 geographic primarysampling units (PSUs) physicianpractices within PSUs and patient visitswithin physician practices The PSUsare counties groups of counties countyequivalents (such as parishes orindependent cities) or towns andtownships for some PSUs in NewEngland A sample of physicians wasselected from the master files of AMAand AOA 1936 were in scope (eligibleto participate in the survey) Of these1281 physicians participated inNAMCS for an unweighted responserate of 66 percent Sample physicianswere asked to complete Patient Recordforms (see lsquolsquoTechnical Notesrsquorsquo) for asystematic random sample of

approximately 30 office visits occurringduring a randomly assigned 1-weekreporting period The number of PatientRecord forms completed was 25665Some physicians did not provide theexpected number of visit recordsthereby reducing the unweighted totalvisit response rate to 615 percent

The US Census Bureau acting asthe data collection agent for the surveyprovided training to field representatives(FRs) throughout the Nation FRsoversaw data collection at thephysicianrsquos office They contactedphysicians for induction into the surveyafter an advance letter was mailed byNCHS notifying the physicians of theirselection in the survey In many casesphysicians or their staff completed theinformation requested on the PatientRecord forms However in 519 percentof the weighted visits FRs abstractedthe data from medical records orcomputer printouts either alone or withthe doctor or office staff

Data processing and medical codingwere performed by Constella GroupInc Durham North Carolina As part ofthe quality assurance procedure a10-percent quality control sample ofsurvey records was independently keyedand coded Coding error rates rangedbetween 03 and 45 percent for varioussurvey items

Medical data collected in the surveywere coded as follows

+ Patientrsquos reason for visitmdashThepatientrsquos main complaint symptomor reason for visiting the physicianrsquosoffice was coded according to AReason for Visit Classification forAmbulatory Care (RVC) (22) Up tothree reasons could be coded pervisit

+ Physicianrsquos diagnosismdashPhysicians ortheir staff were asked to record theprimary diagnosis or problemassociated with the patientrsquos mostimportant reason for the current visitand any other significant currentdiagnoses Up to three diagnoseswere coded according to theInternational Classification ofDiseases 9th Revision ClinicalModification (ICDndash9ndashCM) (23)

+ Injury poisoning adverse effect ofmedical treatmentmdashAlthough there is

a separate item on the Patient Recordform to indicate whether the visit wasfor an injury poisoning or adverseeffect of medical treatmentsometimes an injury reason for visitor an injury diagnosis is recordedwithout the injury item beingchecked Therefore the visit iscounted as an injury visit if the injuryitem is marked or if any of the threereasons for visit were in the injurymodule or any of the three diagnoseswere in the injury or poisoningchapter of the ICDndash9ndashCM (24)

+ MedicationsmdashPhysicians or their staffwere instructed to record all new orcontinued medications orderedsupplied or administered at the visitThis included prescription andnonprescription preparationsimmunizations desensitizing agentsand anesthetics In this surveyrecorded medications are referred toas drug mentions and are codedaccording to a classification systemdeveloped at NCHS (25) As used inthe NAMCS the term lsquolsquodrugrsquorsquo isinterchangeable with the termlsquolsquomedicationrsquorsquo The termlsquolsquoprescribingrsquorsquo is used broadly tomean ordering or providing anymedication whether prescription orover-the-counter Visits with one ormore drug mentions are termed lsquolsquodrugvisitsrsquorsquo in NAMCS Therapeuticclassification of drugs is based on the4-digit therapeutic categories used inthe National Drug Code Directory1995 edition (26) Drugs may havemore than one therapeutic applicationand in NAMCS up to threetherapeutic drug classes are includedfor each drug For the first time since1993ndash94 providers in 2005 wereasked to indicate whether medicationswere new or continued

Physician specialty groups

This report classifies specificphysician specialties into two generalcategorical schemes physician specialtyand type of specialty The NAMCSsurvey design groups physicians into 15strata or specialty groups for samplingpurposes One stratum doctors ofosteopathy was based on informationfrom the AOA The lsquolsquophysician

8 Advance Data No 387 + June 29 2007

specialtyrsquorsquo classification includes thesame strata as used for samplingpurposes with the exception of thedoctors of osteopathy stratum which iscombined with doctors of medicine inthe following 14 categories general andfamily practice internal medicinepediatrics general surgery obstetricsand gynecology orthopedic surgerycardiovascular diseases dermatologyurology psychiatry neurologyophthalmology otolaryngology and aresidual category of other specialtiesThe lsquolsquophysician specialtyrsquorsquo classificationis created using updated informationfrom the AMA as well as informationprovided by sampled physiciansSpecific physician specialties in each of

Text box A

Physicianspecialty

General practice Family medicine family practice

Internal medicine Internal medicine

Pediatrics Adolescent medicine critical care(pediatrics) neurodevelopmentalcardiology pediatric endocrinologpediatric gastroenterology pedia

General surgery General surgery

Obstetrics andgynecology

Gynecological oncology gynecolgynecology) reproductive endoc

Orthopedic surgery Adult reconstructive orthopedicsmedicine (orthopedic surgery) o

Cardiovasculardiseases

Cardiovascular diseases

Dermatology Dermatology

Urology Urology pediatric urology

Psychiatry Addiction psychiatry child psych

Neurology Child neurology clinical neuroph

Ophthalmology Ophthalmology pediatric ophthal

Otolaryngology Otology-neurotology otolaryngolo

Other Allergy addiction medicine allerg(internal medicine) abdominal susurgery clinical genetics clinicalimmunology diabetes dermatolotoxicology (emergency medicine)surgery hematologyoncology hamedicinediagnostic lab immunomanagement medical geneticsmedicine oral amp maxillofacial surmedicine pediatric cardiothoracicphlebology public healthgeneralrehabilitation pain medicine spoplastic surgery within the head ampmedicine spinal cord injury sleeundersea medicine vascular me

the 14 categories are defined in text boxA

In this classification a pediatriccardiothoracic physician for example isgrouped with other pediatricians On theother hand the lsquolsquospecialty typersquorsquoclassification divides AMA specialtiesinto three major categories primarycare surgical specialties and medicalspecialties and puts more emphasis onspecialization type For examplepediatric cardiothoracic physician areclassified as a surgical specialty in thisclassification The specific physicianspecialties included in each of the threespecialty types are provided in text boxB

It should be noted that lsquolsquoprimarycare specialistrsquorsquo as defined in the textbox

Specific physician specialty

(geriatric medicine) sports medicine (family practice) gen

pediatrics developmental-behavioral pediatrics internaldisabilities (psychiatry amp neurology) neonatal-perinatal my pediatric infectious diseases pediatric pulmonology m

tric hematologyoncology pediatric nephrology pediatric r

ogy maternal amp fetal medicine obstetrics amp gynecology orinology

foot and ankle orthopedics musculoskeletal oncology perthopedic surgery of the spine orthopedic trauma

iatry neuropsychiatry psychiatry forensic psychiatry psyc

ysiology endovascular surgical neuroradiology neurology

mology

gy pediatric otolaryngology

y and immunology allergy amp immunologydiagnostic labrgery clinical biochemical genetics clinical cytogeneticsmolecular genetics colon and rectal surgery cosmetic sugic surgery emergency medicine endocrinology epidemi facial plastic surgery gastroenterology general preventind surgery interventional cardiology cardiac electrophysi

logy geriatric medicine (internal medicine) sports medicinnephrology neurological surgery nuclear cardiology pedigery osteopathic manipulative medicine medical oncologsurgery pediatric surgery pediatric emergency medicine

preventive medicine pediatricdiagnostic lab immunologrts medicine (physical medicine and rehabilitation) pediatneck medical toxicology (preventive medicine) pulmona

p medicine surgical oncology traumatic surgery thoracicdicine vascular surgery other specialty unspecified

differs from lsquolsquoprimary care physician orprovider (PCP)rsquorsquo which is reported bythe survey respondent based on thequestion lsquolsquoAre you the patientrsquos primarycare physicianrsquorsquo (see lsquolsquoTechnicalNotesrsquorsquo) A PCP coordinates thecomprehensive health care of the patientand serves as the entry point for all ofthe patientrsquos health care needs PCPs areadvocates for the patient in coordinatingthe use of the entire health care systemto benefit the patient (27) TypicallyPCP visits include physicians in generaland family practice internal medicinepediatrics or obstetrics and gynecologyIn the NAMCS a checkbox defines aPCP visit therefore these visits mayalso include specialist physicians ornonphysicians such as physicianassistants and nurse practitioners

eral practice

medicinepediatrics neurodevelopmental disabilitiesedicine pediatrics pediatric allergy pediatricedical toxicology pediatric emergency medicineheumatology sports medicine (pediatrics)

bstetrics critical care medicine (obstetrics and

diatric orthopedics orthopedic surgery sports

hoanalysis geriatric psychiatry

(diagnostic radiology) vascular neurology

immunology aerospace medicine adolescent medicinecritical care medicine critical care surgery craniofacialrgery dermatological immunologydiagnostic labology sports medicine (emergency medicine) medicalve medicine hematology hepatology head and neckology infectious diseases immunology internale (internal medicine) legal medicine medical

atric surgery (neurology) nutrition occupationaly clinical pharmacology pulmonary critical care(emergency medicine) pharmaceutical medicine

y palliative medicine physical medicine andric rehabilitation medicine proctology plastic surgeryry diseases rheumatology pediatric rehabilitationsurgery transplant surgery urgent care medicine

Text box B

Physicianspecialty type Specific physician specialty

Primary carespecialties

Family practice geriatric medicine (family practice) sports medicine (family practice) general practice internal medicine internal medicine(pediatrics) adolescent medicine (internal medicine) geriatric medicine (internal medicine) adolescent medicine pediatrics pediatric sportsmedicine gynecology maternal and fetal medicine obstetrics and gynecology obstetrics

Surgicalspecialties

General surgery gynecological oncology critical care medicine (obstetrics and gynecology) hand surgery (orthopedic surgery) adultreconstructive orthopedics foot and ankle orthopedics musculoskeletal oncology pediatric orthopedics orthopedic surgery sports medicine(orthopedic surgery) orthopedic surgery of the spine orthopedic trauma urology pediatric urology ophthalmology pediatric ophthalmologyotology and neurotology otology otolaryngology pediatric otolaryngology abdominal surgery cardiovascular surgery colon and rectal surgerycardiothoracic surgery craniofacial surgery critical care surgery dermatologic surgery facial plastic surgery head and neck surgery handsurgery (plastic surgery) hand surgery (surgery) critical care (neurological surgery) neurological surgery pediatric surgery (neurology) pediatriccardiothoracic surgery pediatric surgery plastic surgery surgical oncology thoracic surgery transplant surgery traumatic surgery vascularsurgery

Medicalspecialties

Critical care pediatrics developmental-behavioral pediatrics neurodevelopmental disabilities (pediatrics) neurodevelopmental disabilities(psychiatry amp neurology) neonatal-perinatal medicine pediatric allergy pediatric cardiology pediatric endocrinology pediatric infectious diseasespediatric pulmonology medical toxicology (pediatrics) pediatric emergency medicine pediatric gastroenterology pediatric hematology andoncology pediatric nephrology pediatric rehabilitation medicine pediatric rheumatology reproductive endocrinology cardiovascular diseasesdermatology psychiatry addiction psychiatry child psychiatry forensic psychiatry psychoanalysis geriatric psychiatry neurology child neurologyclinical neurophysiology neurology (diagnostic radiology) addiction medicine aerospace medicine allergy allergy and immunology anddiagnostic laboratory immunology cardiac electrophysiology clinical genetics clinical biochemical genetics clinical molecular genetics criticalcare medicine dermatological immunology diagnostic laboratory immunology diabetes emergency medicine epidemiology endocrinologygastroenterology general preventive medicine hematology hematology and oncology infectious diseases internal medicine and diagnosticlaboratory immunology interventional cardiology legal medicine medical management medical genetics medical toxicology (emergencymedicine) medical oncology nephrology neurodevelopmental disabilities (pediatrics) nuclear cardiology nutrition occupational medicineosteopathic manipulative medicine pain medicine palliative medicine pediatric emergency medicine (emergency medicine) pediatric anddiagnostic laboratory immunology pharmaceutical medicine phlebology public health public health and general preventive medicine clinicalpharmacology physical medicine and rehabilitation pulmonary critical care medicine pulmonary diseases sports medicine (emergencymedicine) sports medicine (physical medicine and rehabilitation) rheumatology spinal cord injury sleep medicine undersea medicine vascularmedicine vascular neurology

Advance Data No 387 + June 29 2007 9

Estimation

Because of the complex multistagedesign of NAMCS a sample weight iscomputed for each sample visit thattakes all stages of design into accountThe survey data are inflated or weightedto produce unbiased national annualestimates The visit weight includes fourbasic components inflation byreciprocals of selection probabilitiesadjustment for nonresponse populationratio adjustments and weightsmoothing For the first time in 2004changes were made to the nonresponseadjustment factor to account for theseasonality of the reporting period

Starting with 2003 data thenonresponse adjustment additionallyaccounts for nonresponse fromphysicians by weekly visit volume andfor the variability in number of weeksparticipating physicians saw patientsduring the year (28) In previous yearsthe nonresponse adjustment accountedonly for nonresponse by physicianspecialty geographic region andmetropolitan statistical area status

The standard error is primarily ameasure of the sampling variability thatoccurs by chance because only a samplerather than an entire universe issurveyed Estimates of the sampling

variability for this report were calculatedusing Taylor approximations inSUDAAN which take into account thecomplex sample design of NAMCS Adescription of the software and itsapproach has been published (29) Thestandard errors of statistics presented inthis report are included in each of thetables

Tests of significance

In this report the determination ofstatistical inference is based on thetwo-tailed t-test The Bonferroniinequality was used to establish thecritical value for statistically significantdifferences (005 level of significance)based on the number of possiblecomparisons within a particular variable(or combination of variables) of interestA weighted least-squares regressionanalysis was used to determine thesignificance of trends at the 005 level

Nonsampling errors

As in any survey results are subjectto both sampling and nonsamplingerrors Nonsampling errors includereporting and processing errors as wellas biases due to nonresponse andincomplete response The magnitude ofthe nonsampling errors cannot be

computed However these errors werekept to a minimum by procedures builtinto the operation of the survey Toeliminate ambiguities and to encourageuniform reporting attention was givento the phrasing of items terms anddefinitions Also pretesting of most dataitems and survey procedures wasperformed Quality control proceduresand consistency and edit checks reducederrors in data coding and processing

The weighted response rate for the2005 NAMCS was 625 percentTable 31 presents weightedcharacteristics of NAMCS respondentsand nonrespondents along withweighted response rates Respondingversus nonresponding distributions weresimilar with the exception of highercooperation among female physiciansand pediatricians while cooperation wasless likely from male physicians andneurologists The effect of thisdifferential response is minimized in thevisit estimates in most cases as NAMCSuses a nonresponse adjustment factorthat takes annual visit volume specialtygeographic region and MSA intoaccount

Item nonresponse rates in theNAMCS are generally low (5 percent orless) However levels of nonresponsecan vary considerably in the survey

10 Advance Data No 387 + June 29 2007

Most nonresponse occurs when theneeded information is not available inthe medical record or is unknown to theperson filling out the survey instrumentNonresponse can also result when theinformation is available but surveyprocedures are not followed and theitem is left blank In this report thetables include a combined entry ofunknown or blank to display missingdata For items where combined itemnonresponse is between 30 and50 percent percent distributions are notdiscussed in the text However theinformation is shown in the tablesThese data should be interpreted withcaution If nonresponse is random theobserved distribution for the reporteditem (ie excluding cases for which theinformation is unknown) would be closeto the true distribution However ifnonresponse is not random the observeddistribution could vary significantlyfrom the actual distribution Researchersneed to decide how best to treat itemswith high levels of missing responsesFor items with nonresponse greater than50 percent data are not presented

Weighted item nonresponse rates(ie if the item was left blank or thelsquolsquounknownrsquorsquo box was marked) were50 percent or less for data items withthe following exceptions was visit forinjurypoisoningadverse effect ofmedical treatment (77 percent) andstatus of patient enrollment in a diseasemanagement program (240 percent)

For some items missing valueswere imputed by randomly assigning avalue from a Patient Record form withsimilar characteristics and were basedon physician specialty geographicregion and 3-digit ICDndash9ndashCM codes forprimary diagnosis Imputations wereperformed for the following variablesbirth year (19 percent) sex(10 percent) ethnicity (249 percent)race (208 percent) patient seen beforein practice (31 percent) how many pastvisits in last 12 months (55 percent)and time spent with physician(136 percent) Blank or otherwisemissing responses are noted in the dataEthnicity was imputed by randomlyassigning a value from a Patient Recordform with similar characteristics basedon physician specialty state and 3-digitICDndash9ndashCM codes for primary diagnosis

Use of tables

First-listed reason for visit anddiagnosis are presented in the tables Itshould be noted that estimates differingin ranked order may not be significantlydifferent from each other For itemsrelated to diagnostic and screeningservices procedures providers seen anddisposition physician office staff wasasked to check all of the applicablecategories for each item Thereforemultiple responses could be coded foreach visit

In this report estimates are notpresented if they are based on fewerthan 30 cases in the sample data onlyan asterisk () appears in the tables Therelative standard error (RSE) of anestimate is obtained by dividing thestandard error by the estimate itself Theresult is then expressed as a percentageof the estimate Estimates based on 30or more cases include an asterisk () ifthe RSE of the estimate exceeds30 percent

In the tables estimates of officevisits have been rounded to the nearestthousand Consequently estimates willnot always add to totals Rates andpercentages were calculated fromoriginal unrounded figures and do notnecessarily agree with figures calculatedfrom rounded data

Estimates presented in the tables forspecific race categories reflect visitswhere only a single race was reportedDenominators used in computingestimates of visit rates by expectedsource of payment were obtained fromthe 2005 National Health InterviewSurvey (NHIS) Individuals reportingmultiple insurance categories in theNHIS were counted in each categorythey reported with the exception ofMedicaid and SCHIP which werecombined into a single category

References1 Burt CW McCaig LF Rechtsteiner

EA Ambulatory medical careutilization estimates for 2005Advance data from vital and healthstatistics no 388 Hyattsville MDNational Center for Health Statistics2007 Available from httpwwwcdcgovnchsdataadad388pdf

2 Centers for Medicare and MedicaidServices and Office of the AssistantSecretary for Planning andEvaluation An Overview of the USHealth Care System Chart BookAvailable from httpwwwcmshhsgovTheChartSeriesdownloadsus_health_chap1_ppdf

3 Hing E Burt CW Characteristics ofoffice-based physicians and theirpractices United States 2003ndash2004National Center for Health StatisticsVital Health Stat 13(164) 2006

4 Hing E Cherry DK Woodwell DANational Ambulatory Medical CareSurvey 2004 summary Advancedata from vital and health statisticsno 374 Hyattsville MD NationalCenter for Health Statistics 2006

5 Middleton KR Hing E Xu JNational Hospital AmbulatoryMedical Care Survey 2005outpatient department summaryAdvance data from vital and healthstatistics no 389 Hyattsville MDNational Center for Health Statistics2007 Available from httpwwwcdcgovnchsdataadad389pdf

6 Nawar E Niska R NationalHospital Ambulatory Medical CareSurvey 2005 emergency departmentsummary Advance data from vitaland health statistics no 386Hyattsville MD National Center forHealth Statistics 2007 Availablefrom httpwwwcdcgovnchsdataadad386pdf

7 Raofi S Schappert S MedicationTherapy in Ambulatory MedicalCare United States 2003ndash2004National Center for Health StatisticsVital Health Stat 13(163) 2006

8 Niska R Burt CW Training forterrorism-related conditions inhospitals United States 2003ndash2004Advance data from vital and healthstatistics no 380 Hyattsville MDNational Center for Health Statistics2006

9 Burt CW McCaig LF Staffingcapacity and ambulance diversion inemergency departments UnitedStates 2003ndash2004 Advance datafrom vital and health statistics no376 Hyattsville MD NationalCenter for Health Statistics 2006

10 Altman KW Stephens RM LyttleCS Changing impact ofgastroesophageal reflux in medicaland otolaryngology practiceLaryngoscope 115(7)1145ndash53 2005

11 Fiscella K Franks P Does thecontent of primary care visits differ

+

+

+

+

0

5

10

15

20

25

30 20051995

ObesityHypertension1Diabetes1Depression1COPD12Chronic renal failure1

Arthritis

Per

cent

of v

isits

1Significant differences in percentages between 1995 and 2005 (p lt 005)

2COPD is chronic obstructive pulmonary disease

Chronic condition

182 175

07 15

60 4973

10478

119

199

281

87 83

SOURCE CDCNCHS National Ambulatory Medical Care Survey

Figure 3 Percentage of office visits by adults 18 years and over with selected chronic conditions United States 1995 and 2005

Advance Data No 387 + June 29 2007 5

frequent counseling or educationprovided at office visits related to dietor nutrition (148 percent) andexercise (109 percent) Injuryprevention counseling was morelikely to be given at visits made bymales (53 percent) compared withfemales (36 percent) while all othergender comparisons for healtheducation visits were equivalent

+ Nonmedication treatment was orderedor provided at 177 percent of visits(Table 21) Physical therapy andexcision of tissue were bothmentioned at 24 percent of visitsfollowed by psychotherapy(23 percent) and wound care(21 percent)

+ Durable medical equipment homehealth care and speech oroccupational therapy were ordered orprovided at 73 25 and 19 millionvisits respectively (Table 21)

+ An estimated 659 million surgicalprocedures were ordered or providedduring office visits (Table 22) Atleast one surgical procedure wasordered or performed at 62 percentof office visits The two mostcommon procedures were related tointegumentary (355 percent ofprocedures) and digestive systems(217 percent of procedures)

Medications

+ Medications were providedprescribed or continued (referred to

the physician and patient

as drug mentions) at 6792 millionoffice visits accounting for705 percent of all office visits(Table 23) At 402 percent of allvisits 2ndash7 drugs were recorded whileat 56 percent of visits eight or moredrug mentions were recordedDuring 2005 there were about 20billion drugs mentioned resulting inan overall drug mention rate of 2107mentions per 100 visits (Table 24)The percent of visits with at least onedrug mention ranged from901 percent for psychiatrists to408 percent for general surgeonsDrug mentions are displayed bytherapeutic class in Table 25Antidepressants were the leading drugsubclass indicated in 53 percent ofall drug mentions followed closelyby antihypertensive agents(52 percent) hyperlipidemia drugs(50 percent) antiarthritics(42 percent) and antiasthmatics orbronchodilators (41 percent)Aspirin was the most frequentlymentioned generic equivalent used indrugs ordered or supplied at officevisits occurring in 26 percent ofdrug mentions (Table 26) This wasfollowed by atorvastatin calciumlevothyroxine metoprolol andalbuterolFor a majority of the 20 mostfrequently occurring genericequivalents the patient was instructedto continue taking the drug howeveramoxicillin was more likely to be

new (854 percent) while ibuprofenand acetaminophen were just as likelyto be associated with a new orcontinued drug (Table 26)

+ Overall drugs were more likely to becontinued rather than new (698versus 256 percent) (Table 26)Figure 4 shows that as patient ageincreased drugs were more likely tobe continued

Providers seen dispositionand duration

+ Overall 962 percent of visits wereattended by a physician (Table 27)Nurses (registered and licensedpractical nurses) were seen at280 percent of office visits Mid-level providers such as physicianassistants nurse practitioners andmidwives were seen at 61 percent ofoffice visits

+ At about two-thirds of visits(647 percent) patients were told toreturn to the office by appointment(Table 28) lsquolsquoReturn if neededrsquorsquo andlsquolsquono follow up plannedrsquorsquo wereindicated at 275 and 64 percent ofvisits respectively Patients werereferred to other physicians at67 percent of visits

+ In 2005 896 percent of office visitswith face-to-face contact between thephysician and patient had a durationof 6ndash30 minutes (Table 29) At 367million visits or 38 percent therewas no face-to-face contact between

NewContinued

Per

cent

of d

rug

men

tions

NOTES Linear trends by age are significant (p lt 005) for percentage new and continued New or continued status was unknown for about 45 percent of all drug mentions

Patient age in years

0

20

40

60

80

100

75 and over65ndash7445ndash6425ndash4415ndash24Under 15All ages

698

256328

600

451495

575

372

753

207

820

146

839

117

SOURCE CDCNCHS National Ambulatory Medical Care Survey

Figure 4 Percentage of drugs mentioned at office visits that were new or continued by patient age United States 2005

6 Advance Data No 387 + June 29 2007

+ Overall the mean time spent with aphysician was 197 minutes(Table 30) The visit duration forpsychiatrists had the largestvariability a difference of 299minutes between the third and firstquartiles

+ Although the overall mean time spentwith a physician excludingpsychiatrists has not changedsignificantly since 1995 there havebeen variations in certain blocks oftime Specifically visits lasting 6ndash10minutes decreased by 28 while

0

10

20

30

40

6ndash1011ndash5

20051995

Per

cent

of v

isits

1Difference between 1995 and 2005 percentage is significant NOTES Percent distributions do not include visits to psychia187 minutes respectively)

40 27

242

17

SOURCE CDCNCHS National Ambulatory Medical Care Su

Figure 5 Percent distribution of office visits w2005

visits lasting 16ndash30 minutes increasedby 20 (Figure 5)

Methods

Data source

The data presented in this report arefrom the 2005 NAMCS a nationalprobability sample survey of nonfederaloffice-based physicians conducted bythe Centers for Disease Control andPreventionrsquos National Center for HealthStatistics Division of Health CareStatistics The survey was conducted

16ndash30111ndash15

(p lt 005)trists Mean time spent with physician in 2005 was not significantly d

Duration in minutes

4

339361

307

368

rvey

here a physician was seen by duration of visit

from December 27 2004 throughDecember 25 2005 The NAMCS datacollection is authorized under Section306 of the Public Health Service Act(Title 42 US Code) 242k Participationis voluntary In April 2003 the PrivacyRule of the Health Insurance Portabilityand Accountability Act (HIPAA) wasimplemented to establish minimumFederal standards for safeguarding theprivacy of individually identifiablehealth information

Data collected in the NAMCS areconsistent with the Privacy Rule of the

61 and over131ndash60

ifferent from mean time in 1995 (193 versus

63 65

09 04

according to year United States 1995 and

Advance Data No 387 + June 29 2007 7

Health Insurance Portability andAccountability Act (HIPAA) Nopersonally identifying information suchas patientrsquos name address or SocialSecurity number is collected in theNAMCS All information collected isheld in the strictest confidenceaccording to law [Section 308(d) of thePublic Health Service Act (42 USCode 242m (d))] and the ConfidentialInformation Protection and StatisticalEfficiency Act (Title 5 of PL 107ndash347)Approval for the NAMCS protocol wasrenewed by the NCHS Research EthicsReview Board in February 2005Waivers of the requirements to obtaininformed consent of patients and patientauthorization for release of patientmedical record data by health careproviders were granted

The target universe of NAMCSincludes visits made in the United Statesto the offices of nonfederally employedphysicians excluding those in thespecialties of anesthesiology radiologyand pathology who were classified bythe American Medical Association(AMA) and the American OsteopathicAssociation (AOA) as lsquolsquooffice-basedpatient carersquorsquo Visits to privatenonhospital-based clinics and healthmaintenance organizations (HMOs) werewithin the scope of the survey but thosethat occurred in federally operatedfacilities and hospital-based outpatientdepartments were not Telephonecontacts and visits made outside thephysicianrsquos office were also excluded

The NAMCS utilizes a multistageprobability sample design involvingsamples of 112 geographic primarysampling units (PSUs) physicianpractices within PSUs and patient visitswithin physician practices The PSUsare counties groups of counties countyequivalents (such as parishes orindependent cities) or towns andtownships for some PSUs in NewEngland A sample of physicians wasselected from the master files of AMAand AOA 1936 were in scope (eligibleto participate in the survey) Of these1281 physicians participated inNAMCS for an unweighted responserate of 66 percent Sample physicianswere asked to complete Patient Recordforms (see lsquolsquoTechnical Notesrsquorsquo) for asystematic random sample of

approximately 30 office visits occurringduring a randomly assigned 1-weekreporting period The number of PatientRecord forms completed was 25665Some physicians did not provide theexpected number of visit recordsthereby reducing the unweighted totalvisit response rate to 615 percent

The US Census Bureau acting asthe data collection agent for the surveyprovided training to field representatives(FRs) throughout the Nation FRsoversaw data collection at thephysicianrsquos office They contactedphysicians for induction into the surveyafter an advance letter was mailed byNCHS notifying the physicians of theirselection in the survey In many casesphysicians or their staff completed theinformation requested on the PatientRecord forms However in 519 percentof the weighted visits FRs abstractedthe data from medical records orcomputer printouts either alone or withthe doctor or office staff

Data processing and medical codingwere performed by Constella GroupInc Durham North Carolina As part ofthe quality assurance procedure a10-percent quality control sample ofsurvey records was independently keyedand coded Coding error rates rangedbetween 03 and 45 percent for varioussurvey items

Medical data collected in the surveywere coded as follows

+ Patientrsquos reason for visitmdashThepatientrsquos main complaint symptomor reason for visiting the physicianrsquosoffice was coded according to AReason for Visit Classification forAmbulatory Care (RVC) (22) Up tothree reasons could be coded pervisit

+ Physicianrsquos diagnosismdashPhysicians ortheir staff were asked to record theprimary diagnosis or problemassociated with the patientrsquos mostimportant reason for the current visitand any other significant currentdiagnoses Up to three diagnoseswere coded according to theInternational Classification ofDiseases 9th Revision ClinicalModification (ICDndash9ndashCM) (23)

+ Injury poisoning adverse effect ofmedical treatmentmdashAlthough there is

a separate item on the Patient Recordform to indicate whether the visit wasfor an injury poisoning or adverseeffect of medical treatmentsometimes an injury reason for visitor an injury diagnosis is recordedwithout the injury item beingchecked Therefore the visit iscounted as an injury visit if the injuryitem is marked or if any of the threereasons for visit were in the injurymodule or any of the three diagnoseswere in the injury or poisoningchapter of the ICDndash9ndashCM (24)

+ MedicationsmdashPhysicians or their staffwere instructed to record all new orcontinued medications orderedsupplied or administered at the visitThis included prescription andnonprescription preparationsimmunizations desensitizing agentsand anesthetics In this surveyrecorded medications are referred toas drug mentions and are codedaccording to a classification systemdeveloped at NCHS (25) As used inthe NAMCS the term lsquolsquodrugrsquorsquo isinterchangeable with the termlsquolsquomedicationrsquorsquo The termlsquolsquoprescribingrsquorsquo is used broadly tomean ordering or providing anymedication whether prescription orover-the-counter Visits with one ormore drug mentions are termed lsquolsquodrugvisitsrsquorsquo in NAMCS Therapeuticclassification of drugs is based on the4-digit therapeutic categories used inthe National Drug Code Directory1995 edition (26) Drugs may havemore than one therapeutic applicationand in NAMCS up to threetherapeutic drug classes are includedfor each drug For the first time since1993ndash94 providers in 2005 wereasked to indicate whether medicationswere new or continued

Physician specialty groups

This report classifies specificphysician specialties into two generalcategorical schemes physician specialtyand type of specialty The NAMCSsurvey design groups physicians into 15strata or specialty groups for samplingpurposes One stratum doctors ofosteopathy was based on informationfrom the AOA The lsquolsquophysician

8 Advance Data No 387 + June 29 2007

specialtyrsquorsquo classification includes thesame strata as used for samplingpurposes with the exception of thedoctors of osteopathy stratum which iscombined with doctors of medicine inthe following 14 categories general andfamily practice internal medicinepediatrics general surgery obstetricsand gynecology orthopedic surgerycardiovascular diseases dermatologyurology psychiatry neurologyophthalmology otolaryngology and aresidual category of other specialtiesThe lsquolsquophysician specialtyrsquorsquo classificationis created using updated informationfrom the AMA as well as informationprovided by sampled physiciansSpecific physician specialties in each of

Text box A

Physicianspecialty

General practice Family medicine family practice

Internal medicine Internal medicine

Pediatrics Adolescent medicine critical care(pediatrics) neurodevelopmentalcardiology pediatric endocrinologpediatric gastroenterology pedia

General surgery General surgery

Obstetrics andgynecology

Gynecological oncology gynecolgynecology) reproductive endoc

Orthopedic surgery Adult reconstructive orthopedicsmedicine (orthopedic surgery) o

Cardiovasculardiseases

Cardiovascular diseases

Dermatology Dermatology

Urology Urology pediatric urology

Psychiatry Addiction psychiatry child psych

Neurology Child neurology clinical neuroph

Ophthalmology Ophthalmology pediatric ophthal

Otolaryngology Otology-neurotology otolaryngolo

Other Allergy addiction medicine allerg(internal medicine) abdominal susurgery clinical genetics clinicalimmunology diabetes dermatolotoxicology (emergency medicine)surgery hematologyoncology hamedicinediagnostic lab immunomanagement medical geneticsmedicine oral amp maxillofacial surmedicine pediatric cardiothoracicphlebology public healthgeneralrehabilitation pain medicine spoplastic surgery within the head ampmedicine spinal cord injury sleeundersea medicine vascular me

the 14 categories are defined in text boxA

In this classification a pediatriccardiothoracic physician for example isgrouped with other pediatricians On theother hand the lsquolsquospecialty typersquorsquoclassification divides AMA specialtiesinto three major categories primarycare surgical specialties and medicalspecialties and puts more emphasis onspecialization type For examplepediatric cardiothoracic physician areclassified as a surgical specialty in thisclassification The specific physicianspecialties included in each of the threespecialty types are provided in text boxB

It should be noted that lsquolsquoprimarycare specialistrsquorsquo as defined in the textbox

Specific physician specialty

(geriatric medicine) sports medicine (family practice) gen

pediatrics developmental-behavioral pediatrics internaldisabilities (psychiatry amp neurology) neonatal-perinatal my pediatric infectious diseases pediatric pulmonology m

tric hematologyoncology pediatric nephrology pediatric r

ogy maternal amp fetal medicine obstetrics amp gynecology orinology

foot and ankle orthopedics musculoskeletal oncology perthopedic surgery of the spine orthopedic trauma

iatry neuropsychiatry psychiatry forensic psychiatry psyc

ysiology endovascular surgical neuroradiology neurology

mology

gy pediatric otolaryngology

y and immunology allergy amp immunologydiagnostic labrgery clinical biochemical genetics clinical cytogeneticsmolecular genetics colon and rectal surgery cosmetic sugic surgery emergency medicine endocrinology epidemi facial plastic surgery gastroenterology general preventind surgery interventional cardiology cardiac electrophysi

logy geriatric medicine (internal medicine) sports medicinnephrology neurological surgery nuclear cardiology pedigery osteopathic manipulative medicine medical oncologsurgery pediatric surgery pediatric emergency medicine

preventive medicine pediatricdiagnostic lab immunologrts medicine (physical medicine and rehabilitation) pediatneck medical toxicology (preventive medicine) pulmona

p medicine surgical oncology traumatic surgery thoracicdicine vascular surgery other specialty unspecified

differs from lsquolsquoprimary care physician orprovider (PCP)rsquorsquo which is reported bythe survey respondent based on thequestion lsquolsquoAre you the patientrsquos primarycare physicianrsquorsquo (see lsquolsquoTechnicalNotesrsquorsquo) A PCP coordinates thecomprehensive health care of the patientand serves as the entry point for all ofthe patientrsquos health care needs PCPs areadvocates for the patient in coordinatingthe use of the entire health care systemto benefit the patient (27) TypicallyPCP visits include physicians in generaland family practice internal medicinepediatrics or obstetrics and gynecologyIn the NAMCS a checkbox defines aPCP visit therefore these visits mayalso include specialist physicians ornonphysicians such as physicianassistants and nurse practitioners

eral practice

medicinepediatrics neurodevelopmental disabilitiesedicine pediatrics pediatric allergy pediatricedical toxicology pediatric emergency medicineheumatology sports medicine (pediatrics)

bstetrics critical care medicine (obstetrics and

diatric orthopedics orthopedic surgery sports

hoanalysis geriatric psychiatry

(diagnostic radiology) vascular neurology

immunology aerospace medicine adolescent medicinecritical care medicine critical care surgery craniofacialrgery dermatological immunologydiagnostic labology sports medicine (emergency medicine) medicalve medicine hematology hepatology head and neckology infectious diseases immunology internale (internal medicine) legal medicine medical

atric surgery (neurology) nutrition occupationaly clinical pharmacology pulmonary critical care(emergency medicine) pharmaceutical medicine

y palliative medicine physical medicine andric rehabilitation medicine proctology plastic surgeryry diseases rheumatology pediatric rehabilitationsurgery transplant surgery urgent care medicine

Text box B

Physicianspecialty type Specific physician specialty

Primary carespecialties

Family practice geriatric medicine (family practice) sports medicine (family practice) general practice internal medicine internal medicine(pediatrics) adolescent medicine (internal medicine) geriatric medicine (internal medicine) adolescent medicine pediatrics pediatric sportsmedicine gynecology maternal and fetal medicine obstetrics and gynecology obstetrics

Surgicalspecialties

General surgery gynecological oncology critical care medicine (obstetrics and gynecology) hand surgery (orthopedic surgery) adultreconstructive orthopedics foot and ankle orthopedics musculoskeletal oncology pediatric orthopedics orthopedic surgery sports medicine(orthopedic surgery) orthopedic surgery of the spine orthopedic trauma urology pediatric urology ophthalmology pediatric ophthalmologyotology and neurotology otology otolaryngology pediatric otolaryngology abdominal surgery cardiovascular surgery colon and rectal surgerycardiothoracic surgery craniofacial surgery critical care surgery dermatologic surgery facial plastic surgery head and neck surgery handsurgery (plastic surgery) hand surgery (surgery) critical care (neurological surgery) neurological surgery pediatric surgery (neurology) pediatriccardiothoracic surgery pediatric surgery plastic surgery surgical oncology thoracic surgery transplant surgery traumatic surgery vascularsurgery

Medicalspecialties

Critical care pediatrics developmental-behavioral pediatrics neurodevelopmental disabilities (pediatrics) neurodevelopmental disabilities(psychiatry amp neurology) neonatal-perinatal medicine pediatric allergy pediatric cardiology pediatric endocrinology pediatric infectious diseasespediatric pulmonology medical toxicology (pediatrics) pediatric emergency medicine pediatric gastroenterology pediatric hematology andoncology pediatric nephrology pediatric rehabilitation medicine pediatric rheumatology reproductive endocrinology cardiovascular diseasesdermatology psychiatry addiction psychiatry child psychiatry forensic psychiatry psychoanalysis geriatric psychiatry neurology child neurologyclinical neurophysiology neurology (diagnostic radiology) addiction medicine aerospace medicine allergy allergy and immunology anddiagnostic laboratory immunology cardiac electrophysiology clinical genetics clinical biochemical genetics clinical molecular genetics criticalcare medicine dermatological immunology diagnostic laboratory immunology diabetes emergency medicine epidemiology endocrinologygastroenterology general preventive medicine hematology hematology and oncology infectious diseases internal medicine and diagnosticlaboratory immunology interventional cardiology legal medicine medical management medical genetics medical toxicology (emergencymedicine) medical oncology nephrology neurodevelopmental disabilities (pediatrics) nuclear cardiology nutrition occupational medicineosteopathic manipulative medicine pain medicine palliative medicine pediatric emergency medicine (emergency medicine) pediatric anddiagnostic laboratory immunology pharmaceutical medicine phlebology public health public health and general preventive medicine clinicalpharmacology physical medicine and rehabilitation pulmonary critical care medicine pulmonary diseases sports medicine (emergencymedicine) sports medicine (physical medicine and rehabilitation) rheumatology spinal cord injury sleep medicine undersea medicine vascularmedicine vascular neurology

Advance Data No 387 + June 29 2007 9

Estimation

Because of the complex multistagedesign of NAMCS a sample weight iscomputed for each sample visit thattakes all stages of design into accountThe survey data are inflated or weightedto produce unbiased national annualestimates The visit weight includes fourbasic components inflation byreciprocals of selection probabilitiesadjustment for nonresponse populationratio adjustments and weightsmoothing For the first time in 2004changes were made to the nonresponseadjustment factor to account for theseasonality of the reporting period

Starting with 2003 data thenonresponse adjustment additionallyaccounts for nonresponse fromphysicians by weekly visit volume andfor the variability in number of weeksparticipating physicians saw patientsduring the year (28) In previous yearsthe nonresponse adjustment accountedonly for nonresponse by physicianspecialty geographic region andmetropolitan statistical area status

The standard error is primarily ameasure of the sampling variability thatoccurs by chance because only a samplerather than an entire universe issurveyed Estimates of the sampling

variability for this report were calculatedusing Taylor approximations inSUDAAN which take into account thecomplex sample design of NAMCS Adescription of the software and itsapproach has been published (29) Thestandard errors of statistics presented inthis report are included in each of thetables

Tests of significance

In this report the determination ofstatistical inference is based on thetwo-tailed t-test The Bonferroniinequality was used to establish thecritical value for statistically significantdifferences (005 level of significance)based on the number of possiblecomparisons within a particular variable(or combination of variables) of interestA weighted least-squares regressionanalysis was used to determine thesignificance of trends at the 005 level

Nonsampling errors

As in any survey results are subjectto both sampling and nonsamplingerrors Nonsampling errors includereporting and processing errors as wellas biases due to nonresponse andincomplete response The magnitude ofthe nonsampling errors cannot be

computed However these errors werekept to a minimum by procedures builtinto the operation of the survey Toeliminate ambiguities and to encourageuniform reporting attention was givento the phrasing of items terms anddefinitions Also pretesting of most dataitems and survey procedures wasperformed Quality control proceduresand consistency and edit checks reducederrors in data coding and processing

The weighted response rate for the2005 NAMCS was 625 percentTable 31 presents weightedcharacteristics of NAMCS respondentsand nonrespondents along withweighted response rates Respondingversus nonresponding distributions weresimilar with the exception of highercooperation among female physiciansand pediatricians while cooperation wasless likely from male physicians andneurologists The effect of thisdifferential response is minimized in thevisit estimates in most cases as NAMCSuses a nonresponse adjustment factorthat takes annual visit volume specialtygeographic region and MSA intoaccount

Item nonresponse rates in theNAMCS are generally low (5 percent orless) However levels of nonresponsecan vary considerably in the survey

10 Advance Data No 387 + June 29 2007

Most nonresponse occurs when theneeded information is not available inthe medical record or is unknown to theperson filling out the survey instrumentNonresponse can also result when theinformation is available but surveyprocedures are not followed and theitem is left blank In this report thetables include a combined entry ofunknown or blank to display missingdata For items where combined itemnonresponse is between 30 and50 percent percent distributions are notdiscussed in the text However theinformation is shown in the tablesThese data should be interpreted withcaution If nonresponse is random theobserved distribution for the reporteditem (ie excluding cases for which theinformation is unknown) would be closeto the true distribution However ifnonresponse is not random the observeddistribution could vary significantlyfrom the actual distribution Researchersneed to decide how best to treat itemswith high levels of missing responsesFor items with nonresponse greater than50 percent data are not presented

Weighted item nonresponse rates(ie if the item was left blank or thelsquolsquounknownrsquorsquo box was marked) were50 percent or less for data items withthe following exceptions was visit forinjurypoisoningadverse effect ofmedical treatment (77 percent) andstatus of patient enrollment in a diseasemanagement program (240 percent)

For some items missing valueswere imputed by randomly assigning avalue from a Patient Record form withsimilar characteristics and were basedon physician specialty geographicregion and 3-digit ICDndash9ndashCM codes forprimary diagnosis Imputations wereperformed for the following variablesbirth year (19 percent) sex(10 percent) ethnicity (249 percent)race (208 percent) patient seen beforein practice (31 percent) how many pastvisits in last 12 months (55 percent)and time spent with physician(136 percent) Blank or otherwisemissing responses are noted in the dataEthnicity was imputed by randomlyassigning a value from a Patient Recordform with similar characteristics basedon physician specialty state and 3-digitICDndash9ndashCM codes for primary diagnosis

Use of tables

First-listed reason for visit anddiagnosis are presented in the tables Itshould be noted that estimates differingin ranked order may not be significantlydifferent from each other For itemsrelated to diagnostic and screeningservices procedures providers seen anddisposition physician office staff wasasked to check all of the applicablecategories for each item Thereforemultiple responses could be coded foreach visit

In this report estimates are notpresented if they are based on fewerthan 30 cases in the sample data onlyan asterisk () appears in the tables Therelative standard error (RSE) of anestimate is obtained by dividing thestandard error by the estimate itself Theresult is then expressed as a percentageof the estimate Estimates based on 30or more cases include an asterisk () ifthe RSE of the estimate exceeds30 percent

In the tables estimates of officevisits have been rounded to the nearestthousand Consequently estimates willnot always add to totals Rates andpercentages were calculated fromoriginal unrounded figures and do notnecessarily agree with figures calculatedfrom rounded data

Estimates presented in the tables forspecific race categories reflect visitswhere only a single race was reportedDenominators used in computingestimates of visit rates by expectedsource of payment were obtained fromthe 2005 National Health InterviewSurvey (NHIS) Individuals reportingmultiple insurance categories in theNHIS were counted in each categorythey reported with the exception ofMedicaid and SCHIP which werecombined into a single category

References1 Burt CW McCaig LF Rechtsteiner

EA Ambulatory medical careutilization estimates for 2005Advance data from vital and healthstatistics no 388 Hyattsville MDNational Center for Health Statistics2007 Available from httpwwwcdcgovnchsdataadad388pdf

2 Centers for Medicare and MedicaidServices and Office of the AssistantSecretary for Planning andEvaluation An Overview of the USHealth Care System Chart BookAvailable from httpwwwcmshhsgovTheChartSeriesdownloadsus_health_chap1_ppdf

3 Hing E Burt CW Characteristics ofoffice-based physicians and theirpractices United States 2003ndash2004National Center for Health StatisticsVital Health Stat 13(164) 2006

4 Hing E Cherry DK Woodwell DANational Ambulatory Medical CareSurvey 2004 summary Advancedata from vital and health statisticsno 374 Hyattsville MD NationalCenter for Health Statistics 2006

5 Middleton KR Hing E Xu JNational Hospital AmbulatoryMedical Care Survey 2005outpatient department summaryAdvance data from vital and healthstatistics no 389 Hyattsville MDNational Center for Health Statistics2007 Available from httpwwwcdcgovnchsdataadad389pdf

6 Nawar E Niska R NationalHospital Ambulatory Medical CareSurvey 2005 emergency departmentsummary Advance data from vitaland health statistics no 386Hyattsville MD National Center forHealth Statistics 2007 Availablefrom httpwwwcdcgovnchsdataadad386pdf

7 Raofi S Schappert S MedicationTherapy in Ambulatory MedicalCare United States 2003ndash2004National Center for Health StatisticsVital Health Stat 13(163) 2006

8 Niska R Burt CW Training forterrorism-related conditions inhospitals United States 2003ndash2004Advance data from vital and healthstatistics no 380 Hyattsville MDNational Center for Health Statistics2006

9 Burt CW McCaig LF Staffingcapacity and ambulance diversion inemergency departments UnitedStates 2003ndash2004 Advance datafrom vital and health statistics no376 Hyattsville MD NationalCenter for Health Statistics 2006

10 Altman KW Stephens RM LyttleCS Changing impact ofgastroesophageal reflux in medicaland otolaryngology practiceLaryngoscope 115(7)1145ndash53 2005

11 Fiscella K Franks P Does thecontent of primary care visits differ

NewContinued

Per

cent

of d

rug

men

tions

NOTES Linear trends by age are significant (p lt 005) for percentage new and continued New or continued status was unknown for about 45 percent of all drug mentions

Patient age in years

0

20

40

60

80

100

75 and over65ndash7445ndash6425ndash4415ndash24Under 15All ages

698

256328

600

451495

575

372

753

207

820

146

839

117

SOURCE CDCNCHS National Ambulatory Medical Care Survey

Figure 4 Percentage of drugs mentioned at office visits that were new or continued by patient age United States 2005

6 Advance Data No 387 + June 29 2007

+ Overall the mean time spent with aphysician was 197 minutes(Table 30) The visit duration forpsychiatrists had the largestvariability a difference of 299minutes between the third and firstquartiles

+ Although the overall mean time spentwith a physician excludingpsychiatrists has not changedsignificantly since 1995 there havebeen variations in certain blocks oftime Specifically visits lasting 6ndash10minutes decreased by 28 while

0

10

20

30

40

6ndash1011ndash5

20051995

Per

cent

of v

isits

1Difference between 1995 and 2005 percentage is significant NOTES Percent distributions do not include visits to psychia187 minutes respectively)

40 27

242

17

SOURCE CDCNCHS National Ambulatory Medical Care Su

Figure 5 Percent distribution of office visits w2005

visits lasting 16ndash30 minutes increasedby 20 (Figure 5)

Methods

Data source

The data presented in this report arefrom the 2005 NAMCS a nationalprobability sample survey of nonfederaloffice-based physicians conducted bythe Centers for Disease Control andPreventionrsquos National Center for HealthStatistics Division of Health CareStatistics The survey was conducted

16ndash30111ndash15

(p lt 005)trists Mean time spent with physician in 2005 was not significantly d

Duration in minutes

4

339361

307

368

rvey

here a physician was seen by duration of visit

from December 27 2004 throughDecember 25 2005 The NAMCS datacollection is authorized under Section306 of the Public Health Service Act(Title 42 US Code) 242k Participationis voluntary In April 2003 the PrivacyRule of the Health Insurance Portabilityand Accountability Act (HIPAA) wasimplemented to establish minimumFederal standards for safeguarding theprivacy of individually identifiablehealth information

Data collected in the NAMCS areconsistent with the Privacy Rule of the

61 and over131ndash60

ifferent from mean time in 1995 (193 versus

63 65

09 04

according to year United States 1995 and

Advance Data No 387 + June 29 2007 7

Health Insurance Portability andAccountability Act (HIPAA) Nopersonally identifying information suchas patientrsquos name address or SocialSecurity number is collected in theNAMCS All information collected isheld in the strictest confidenceaccording to law [Section 308(d) of thePublic Health Service Act (42 USCode 242m (d))] and the ConfidentialInformation Protection and StatisticalEfficiency Act (Title 5 of PL 107ndash347)Approval for the NAMCS protocol wasrenewed by the NCHS Research EthicsReview Board in February 2005Waivers of the requirements to obtaininformed consent of patients and patientauthorization for release of patientmedical record data by health careproviders were granted

The target universe of NAMCSincludes visits made in the United Statesto the offices of nonfederally employedphysicians excluding those in thespecialties of anesthesiology radiologyand pathology who were classified bythe American Medical Association(AMA) and the American OsteopathicAssociation (AOA) as lsquolsquooffice-basedpatient carersquorsquo Visits to privatenonhospital-based clinics and healthmaintenance organizations (HMOs) werewithin the scope of the survey but thosethat occurred in federally operatedfacilities and hospital-based outpatientdepartments were not Telephonecontacts and visits made outside thephysicianrsquos office were also excluded

The NAMCS utilizes a multistageprobability sample design involvingsamples of 112 geographic primarysampling units (PSUs) physicianpractices within PSUs and patient visitswithin physician practices The PSUsare counties groups of counties countyequivalents (such as parishes orindependent cities) or towns andtownships for some PSUs in NewEngland A sample of physicians wasselected from the master files of AMAand AOA 1936 were in scope (eligibleto participate in the survey) Of these1281 physicians participated inNAMCS for an unweighted responserate of 66 percent Sample physicianswere asked to complete Patient Recordforms (see lsquolsquoTechnical Notesrsquorsquo) for asystematic random sample of

approximately 30 office visits occurringduring a randomly assigned 1-weekreporting period The number of PatientRecord forms completed was 25665Some physicians did not provide theexpected number of visit recordsthereby reducing the unweighted totalvisit response rate to 615 percent

The US Census Bureau acting asthe data collection agent for the surveyprovided training to field representatives(FRs) throughout the Nation FRsoversaw data collection at thephysicianrsquos office They contactedphysicians for induction into the surveyafter an advance letter was mailed byNCHS notifying the physicians of theirselection in the survey In many casesphysicians or their staff completed theinformation requested on the PatientRecord forms However in 519 percentof the weighted visits FRs abstractedthe data from medical records orcomputer printouts either alone or withthe doctor or office staff

Data processing and medical codingwere performed by Constella GroupInc Durham North Carolina As part ofthe quality assurance procedure a10-percent quality control sample ofsurvey records was independently keyedand coded Coding error rates rangedbetween 03 and 45 percent for varioussurvey items

Medical data collected in the surveywere coded as follows

+ Patientrsquos reason for visitmdashThepatientrsquos main complaint symptomor reason for visiting the physicianrsquosoffice was coded according to AReason for Visit Classification forAmbulatory Care (RVC) (22) Up tothree reasons could be coded pervisit

+ Physicianrsquos diagnosismdashPhysicians ortheir staff were asked to record theprimary diagnosis or problemassociated with the patientrsquos mostimportant reason for the current visitand any other significant currentdiagnoses Up to three diagnoseswere coded according to theInternational Classification ofDiseases 9th Revision ClinicalModification (ICDndash9ndashCM) (23)

+ Injury poisoning adverse effect ofmedical treatmentmdashAlthough there is

a separate item on the Patient Recordform to indicate whether the visit wasfor an injury poisoning or adverseeffect of medical treatmentsometimes an injury reason for visitor an injury diagnosis is recordedwithout the injury item beingchecked Therefore the visit iscounted as an injury visit if the injuryitem is marked or if any of the threereasons for visit were in the injurymodule or any of the three diagnoseswere in the injury or poisoningchapter of the ICDndash9ndashCM (24)

+ MedicationsmdashPhysicians or their staffwere instructed to record all new orcontinued medications orderedsupplied or administered at the visitThis included prescription andnonprescription preparationsimmunizations desensitizing agentsand anesthetics In this surveyrecorded medications are referred toas drug mentions and are codedaccording to a classification systemdeveloped at NCHS (25) As used inthe NAMCS the term lsquolsquodrugrsquorsquo isinterchangeable with the termlsquolsquomedicationrsquorsquo The termlsquolsquoprescribingrsquorsquo is used broadly tomean ordering or providing anymedication whether prescription orover-the-counter Visits with one ormore drug mentions are termed lsquolsquodrugvisitsrsquorsquo in NAMCS Therapeuticclassification of drugs is based on the4-digit therapeutic categories used inthe National Drug Code Directory1995 edition (26) Drugs may havemore than one therapeutic applicationand in NAMCS up to threetherapeutic drug classes are includedfor each drug For the first time since1993ndash94 providers in 2005 wereasked to indicate whether medicationswere new or continued

Physician specialty groups

This report classifies specificphysician specialties into two generalcategorical schemes physician specialtyand type of specialty The NAMCSsurvey design groups physicians into 15strata or specialty groups for samplingpurposes One stratum doctors ofosteopathy was based on informationfrom the AOA The lsquolsquophysician

8 Advance Data No 387 + June 29 2007

specialtyrsquorsquo classification includes thesame strata as used for samplingpurposes with the exception of thedoctors of osteopathy stratum which iscombined with doctors of medicine inthe following 14 categories general andfamily practice internal medicinepediatrics general surgery obstetricsand gynecology orthopedic surgerycardiovascular diseases dermatologyurology psychiatry neurologyophthalmology otolaryngology and aresidual category of other specialtiesThe lsquolsquophysician specialtyrsquorsquo classificationis created using updated informationfrom the AMA as well as informationprovided by sampled physiciansSpecific physician specialties in each of

Text box A

Physicianspecialty

General practice Family medicine family practice

Internal medicine Internal medicine

Pediatrics Adolescent medicine critical care(pediatrics) neurodevelopmentalcardiology pediatric endocrinologpediatric gastroenterology pedia

General surgery General surgery

Obstetrics andgynecology

Gynecological oncology gynecolgynecology) reproductive endoc

Orthopedic surgery Adult reconstructive orthopedicsmedicine (orthopedic surgery) o

Cardiovasculardiseases

Cardiovascular diseases

Dermatology Dermatology

Urology Urology pediatric urology

Psychiatry Addiction psychiatry child psych

Neurology Child neurology clinical neuroph

Ophthalmology Ophthalmology pediatric ophthal

Otolaryngology Otology-neurotology otolaryngolo

Other Allergy addiction medicine allerg(internal medicine) abdominal susurgery clinical genetics clinicalimmunology diabetes dermatolotoxicology (emergency medicine)surgery hematologyoncology hamedicinediagnostic lab immunomanagement medical geneticsmedicine oral amp maxillofacial surmedicine pediatric cardiothoracicphlebology public healthgeneralrehabilitation pain medicine spoplastic surgery within the head ampmedicine spinal cord injury sleeundersea medicine vascular me

the 14 categories are defined in text boxA

In this classification a pediatriccardiothoracic physician for example isgrouped with other pediatricians On theother hand the lsquolsquospecialty typersquorsquoclassification divides AMA specialtiesinto three major categories primarycare surgical specialties and medicalspecialties and puts more emphasis onspecialization type For examplepediatric cardiothoracic physician areclassified as a surgical specialty in thisclassification The specific physicianspecialties included in each of the threespecialty types are provided in text boxB

It should be noted that lsquolsquoprimarycare specialistrsquorsquo as defined in the textbox

Specific physician specialty

(geriatric medicine) sports medicine (family practice) gen

pediatrics developmental-behavioral pediatrics internaldisabilities (psychiatry amp neurology) neonatal-perinatal my pediatric infectious diseases pediatric pulmonology m

tric hematologyoncology pediatric nephrology pediatric r

ogy maternal amp fetal medicine obstetrics amp gynecology orinology

foot and ankle orthopedics musculoskeletal oncology perthopedic surgery of the spine orthopedic trauma

iatry neuropsychiatry psychiatry forensic psychiatry psyc

ysiology endovascular surgical neuroradiology neurology

mology

gy pediatric otolaryngology

y and immunology allergy amp immunologydiagnostic labrgery clinical biochemical genetics clinical cytogeneticsmolecular genetics colon and rectal surgery cosmetic sugic surgery emergency medicine endocrinology epidemi facial plastic surgery gastroenterology general preventind surgery interventional cardiology cardiac electrophysi

logy geriatric medicine (internal medicine) sports medicinnephrology neurological surgery nuclear cardiology pedigery osteopathic manipulative medicine medical oncologsurgery pediatric surgery pediatric emergency medicine

preventive medicine pediatricdiagnostic lab immunologrts medicine (physical medicine and rehabilitation) pediatneck medical toxicology (preventive medicine) pulmona

p medicine surgical oncology traumatic surgery thoracicdicine vascular surgery other specialty unspecified

differs from lsquolsquoprimary care physician orprovider (PCP)rsquorsquo which is reported bythe survey respondent based on thequestion lsquolsquoAre you the patientrsquos primarycare physicianrsquorsquo (see lsquolsquoTechnicalNotesrsquorsquo) A PCP coordinates thecomprehensive health care of the patientand serves as the entry point for all ofthe patientrsquos health care needs PCPs areadvocates for the patient in coordinatingthe use of the entire health care systemto benefit the patient (27) TypicallyPCP visits include physicians in generaland family practice internal medicinepediatrics or obstetrics and gynecologyIn the NAMCS a checkbox defines aPCP visit therefore these visits mayalso include specialist physicians ornonphysicians such as physicianassistants and nurse practitioners

eral practice

medicinepediatrics neurodevelopmental disabilitiesedicine pediatrics pediatric allergy pediatricedical toxicology pediatric emergency medicineheumatology sports medicine (pediatrics)

bstetrics critical care medicine (obstetrics and

diatric orthopedics orthopedic surgery sports

hoanalysis geriatric psychiatry

(diagnostic radiology) vascular neurology

immunology aerospace medicine adolescent medicinecritical care medicine critical care surgery craniofacialrgery dermatological immunologydiagnostic labology sports medicine (emergency medicine) medicalve medicine hematology hepatology head and neckology infectious diseases immunology internale (internal medicine) legal medicine medical

atric surgery (neurology) nutrition occupationaly clinical pharmacology pulmonary critical care(emergency medicine) pharmaceutical medicine

y palliative medicine physical medicine andric rehabilitation medicine proctology plastic surgeryry diseases rheumatology pediatric rehabilitationsurgery transplant surgery urgent care medicine

Text box B

Physicianspecialty type Specific physician specialty

Primary carespecialties

Family practice geriatric medicine (family practice) sports medicine (family practice) general practice internal medicine internal medicine(pediatrics) adolescent medicine (internal medicine) geriatric medicine (internal medicine) adolescent medicine pediatrics pediatric sportsmedicine gynecology maternal and fetal medicine obstetrics and gynecology obstetrics

Surgicalspecialties

General surgery gynecological oncology critical care medicine (obstetrics and gynecology) hand surgery (orthopedic surgery) adultreconstructive orthopedics foot and ankle orthopedics musculoskeletal oncology pediatric orthopedics orthopedic surgery sports medicine(orthopedic surgery) orthopedic surgery of the spine orthopedic trauma urology pediatric urology ophthalmology pediatric ophthalmologyotology and neurotology otology otolaryngology pediatric otolaryngology abdominal surgery cardiovascular surgery colon and rectal surgerycardiothoracic surgery craniofacial surgery critical care surgery dermatologic surgery facial plastic surgery head and neck surgery handsurgery (plastic surgery) hand surgery (surgery) critical care (neurological surgery) neurological surgery pediatric surgery (neurology) pediatriccardiothoracic surgery pediatric surgery plastic surgery surgical oncology thoracic surgery transplant surgery traumatic surgery vascularsurgery

Medicalspecialties

Critical care pediatrics developmental-behavioral pediatrics neurodevelopmental disabilities (pediatrics) neurodevelopmental disabilities(psychiatry amp neurology) neonatal-perinatal medicine pediatric allergy pediatric cardiology pediatric endocrinology pediatric infectious diseasespediatric pulmonology medical toxicology (pediatrics) pediatric emergency medicine pediatric gastroenterology pediatric hematology andoncology pediatric nephrology pediatric rehabilitation medicine pediatric rheumatology reproductive endocrinology cardiovascular diseasesdermatology psychiatry addiction psychiatry child psychiatry forensic psychiatry psychoanalysis geriatric psychiatry neurology child neurologyclinical neurophysiology neurology (diagnostic radiology) addiction medicine aerospace medicine allergy allergy and immunology anddiagnostic laboratory immunology cardiac electrophysiology clinical genetics clinical biochemical genetics clinical molecular genetics criticalcare medicine dermatological immunology diagnostic laboratory immunology diabetes emergency medicine epidemiology endocrinologygastroenterology general preventive medicine hematology hematology and oncology infectious diseases internal medicine and diagnosticlaboratory immunology interventional cardiology legal medicine medical management medical genetics medical toxicology (emergencymedicine) medical oncology nephrology neurodevelopmental disabilities (pediatrics) nuclear cardiology nutrition occupational medicineosteopathic manipulative medicine pain medicine palliative medicine pediatric emergency medicine (emergency medicine) pediatric anddiagnostic laboratory immunology pharmaceutical medicine phlebology public health public health and general preventive medicine clinicalpharmacology physical medicine and rehabilitation pulmonary critical care medicine pulmonary diseases sports medicine (emergencymedicine) sports medicine (physical medicine and rehabilitation) rheumatology spinal cord injury sleep medicine undersea medicine vascularmedicine vascular neurology

Advance Data No 387 + June 29 2007 9

Estimation

Because of the complex multistagedesign of NAMCS a sample weight iscomputed for each sample visit thattakes all stages of design into accountThe survey data are inflated or weightedto produce unbiased national annualestimates The visit weight includes fourbasic components inflation byreciprocals of selection probabilitiesadjustment for nonresponse populationratio adjustments and weightsmoothing For the first time in 2004changes were made to the nonresponseadjustment factor to account for theseasonality of the reporting period

Starting with 2003 data thenonresponse adjustment additionallyaccounts for nonresponse fromphysicians by weekly visit volume andfor the variability in number of weeksparticipating physicians saw patientsduring the year (28) In previous yearsthe nonresponse adjustment accountedonly for nonresponse by physicianspecialty geographic region andmetropolitan statistical area status

The standard error is primarily ameasure of the sampling variability thatoccurs by chance because only a samplerather than an entire universe issurveyed Estimates of the sampling

variability for this report were calculatedusing Taylor approximations inSUDAAN which take into account thecomplex sample design of NAMCS Adescription of the software and itsapproach has been published (29) Thestandard errors of statistics presented inthis report are included in each of thetables

Tests of significance

In this report the determination ofstatistical inference is based on thetwo-tailed t-test The Bonferroniinequality was used to establish thecritical value for statistically significantdifferences (005 level of significance)based on the number of possiblecomparisons within a particular variable(or combination of variables) of interestA weighted least-squares regressionanalysis was used to determine thesignificance of trends at the 005 level

Nonsampling errors

As in any survey results are subjectto both sampling and nonsamplingerrors Nonsampling errors includereporting and processing errors as wellas biases due to nonresponse andincomplete response The magnitude ofthe nonsampling errors cannot be

computed However these errors werekept to a minimum by procedures builtinto the operation of the survey Toeliminate ambiguities and to encourageuniform reporting attention was givento the phrasing of items terms anddefinitions Also pretesting of most dataitems and survey procedures wasperformed Quality control proceduresand consistency and edit checks reducederrors in data coding and processing

The weighted response rate for the2005 NAMCS was 625 percentTable 31 presents weightedcharacteristics of NAMCS respondentsand nonrespondents along withweighted response rates Respondingversus nonresponding distributions weresimilar with the exception of highercooperation among female physiciansand pediatricians while cooperation wasless likely from male physicians andneurologists The effect of thisdifferential response is minimized in thevisit estimates in most cases as NAMCSuses a nonresponse adjustment factorthat takes annual visit volume specialtygeographic region and MSA intoaccount

Item nonresponse rates in theNAMCS are generally low (5 percent orless) However levels of nonresponsecan vary considerably in the survey

10 Advance Data No 387 + June 29 2007

Most nonresponse occurs when theneeded information is not available inthe medical record or is unknown to theperson filling out the survey instrumentNonresponse can also result when theinformation is available but surveyprocedures are not followed and theitem is left blank In this report thetables include a combined entry ofunknown or blank to display missingdata For items where combined itemnonresponse is between 30 and50 percent percent distributions are notdiscussed in the text However theinformation is shown in the tablesThese data should be interpreted withcaution If nonresponse is random theobserved distribution for the reporteditem (ie excluding cases for which theinformation is unknown) would be closeto the true distribution However ifnonresponse is not random the observeddistribution could vary significantlyfrom the actual distribution Researchersneed to decide how best to treat itemswith high levels of missing responsesFor items with nonresponse greater than50 percent data are not presented

Weighted item nonresponse rates(ie if the item was left blank or thelsquolsquounknownrsquorsquo box was marked) were50 percent or less for data items withthe following exceptions was visit forinjurypoisoningadverse effect ofmedical treatment (77 percent) andstatus of patient enrollment in a diseasemanagement program (240 percent)

For some items missing valueswere imputed by randomly assigning avalue from a Patient Record form withsimilar characteristics and were basedon physician specialty geographicregion and 3-digit ICDndash9ndashCM codes forprimary diagnosis Imputations wereperformed for the following variablesbirth year (19 percent) sex(10 percent) ethnicity (249 percent)race (208 percent) patient seen beforein practice (31 percent) how many pastvisits in last 12 months (55 percent)and time spent with physician(136 percent) Blank or otherwisemissing responses are noted in the dataEthnicity was imputed by randomlyassigning a value from a Patient Recordform with similar characteristics basedon physician specialty state and 3-digitICDndash9ndashCM codes for primary diagnosis

Use of tables

First-listed reason for visit anddiagnosis are presented in the tables Itshould be noted that estimates differingin ranked order may not be significantlydifferent from each other For itemsrelated to diagnostic and screeningservices procedures providers seen anddisposition physician office staff wasasked to check all of the applicablecategories for each item Thereforemultiple responses could be coded foreach visit

In this report estimates are notpresented if they are based on fewerthan 30 cases in the sample data onlyan asterisk () appears in the tables Therelative standard error (RSE) of anestimate is obtained by dividing thestandard error by the estimate itself Theresult is then expressed as a percentageof the estimate Estimates based on 30or more cases include an asterisk () ifthe RSE of the estimate exceeds30 percent

In the tables estimates of officevisits have been rounded to the nearestthousand Consequently estimates willnot always add to totals Rates andpercentages were calculated fromoriginal unrounded figures and do notnecessarily agree with figures calculatedfrom rounded data

Estimates presented in the tables forspecific race categories reflect visitswhere only a single race was reportedDenominators used in computingestimates of visit rates by expectedsource of payment were obtained fromthe 2005 National Health InterviewSurvey (NHIS) Individuals reportingmultiple insurance categories in theNHIS were counted in each categorythey reported with the exception ofMedicaid and SCHIP which werecombined into a single category

References1 Burt CW McCaig LF Rechtsteiner

EA Ambulatory medical careutilization estimates for 2005Advance data from vital and healthstatistics no 388 Hyattsville MDNational Center for Health Statistics2007 Available from httpwwwcdcgovnchsdataadad388pdf

2 Centers for Medicare and MedicaidServices and Office of the AssistantSecretary for Planning andEvaluation An Overview of the USHealth Care System Chart BookAvailable from httpwwwcmshhsgovTheChartSeriesdownloadsus_health_chap1_ppdf

3 Hing E Burt CW Characteristics ofoffice-based physicians and theirpractices United States 2003ndash2004National Center for Health StatisticsVital Health Stat 13(164) 2006

4 Hing E Cherry DK Woodwell DANational Ambulatory Medical CareSurvey 2004 summary Advancedata from vital and health statisticsno 374 Hyattsville MD NationalCenter for Health Statistics 2006

5 Middleton KR Hing E Xu JNational Hospital AmbulatoryMedical Care Survey 2005outpatient department summaryAdvance data from vital and healthstatistics no 389 Hyattsville MDNational Center for Health Statistics2007 Available from httpwwwcdcgovnchsdataadad389pdf

6 Nawar E Niska R NationalHospital Ambulatory Medical CareSurvey 2005 emergency departmentsummary Advance data from vitaland health statistics no 386Hyattsville MD National Center forHealth Statistics 2007 Availablefrom httpwwwcdcgovnchsdataadad386pdf

7 Raofi S Schappert S MedicationTherapy in Ambulatory MedicalCare United States 2003ndash2004National Center for Health StatisticsVital Health Stat 13(163) 2006

8 Niska R Burt CW Training forterrorism-related conditions inhospitals United States 2003ndash2004Advance data from vital and healthstatistics no 380 Hyattsville MDNational Center for Health Statistics2006

9 Burt CW McCaig LF Staffingcapacity and ambulance diversion inemergency departments UnitedStates 2003ndash2004 Advance datafrom vital and health statistics no376 Hyattsville MD NationalCenter for Health Statistics 2006

10 Altman KW Stephens RM LyttleCS Changing impact ofgastroesophageal reflux in medicaland otolaryngology practiceLaryngoscope 115(7)1145ndash53 2005

11 Fiscella K Franks P Does thecontent of primary care visits differ

Advance Data No 387 + June 29 2007 7

Health Insurance Portability andAccountability Act (HIPAA) Nopersonally identifying information suchas patientrsquos name address or SocialSecurity number is collected in theNAMCS All information collected isheld in the strictest confidenceaccording to law [Section 308(d) of thePublic Health Service Act (42 USCode 242m (d))] and the ConfidentialInformation Protection and StatisticalEfficiency Act (Title 5 of PL 107ndash347)Approval for the NAMCS protocol wasrenewed by the NCHS Research EthicsReview Board in February 2005Waivers of the requirements to obtaininformed consent of patients and patientauthorization for release of patientmedical record data by health careproviders were granted

The target universe of NAMCSincludes visits made in the United Statesto the offices of nonfederally employedphysicians excluding those in thespecialties of anesthesiology radiologyand pathology who were classified bythe American Medical Association(AMA) and the American OsteopathicAssociation (AOA) as lsquolsquooffice-basedpatient carersquorsquo Visits to privatenonhospital-based clinics and healthmaintenance organizations (HMOs) werewithin the scope of the survey but thosethat occurred in federally operatedfacilities and hospital-based outpatientdepartments were not Telephonecontacts and visits made outside thephysicianrsquos office were also excluded

The NAMCS utilizes a multistageprobability sample design involvingsamples of 112 geographic primarysampling units (PSUs) physicianpractices within PSUs and patient visitswithin physician practices The PSUsare counties groups of counties countyequivalents (such as parishes orindependent cities) or towns andtownships for some PSUs in NewEngland A sample of physicians wasselected from the master files of AMAand AOA 1936 were in scope (eligibleto participate in the survey) Of these1281 physicians participated inNAMCS for an unweighted responserate of 66 percent Sample physicianswere asked to complete Patient Recordforms (see lsquolsquoTechnical Notesrsquorsquo) for asystematic random sample of

approximately 30 office visits occurringduring a randomly assigned 1-weekreporting period The number of PatientRecord forms completed was 25665Some physicians did not provide theexpected number of visit recordsthereby reducing the unweighted totalvisit response rate to 615 percent

The US Census Bureau acting asthe data collection agent for the surveyprovided training to field representatives(FRs) throughout the Nation FRsoversaw data collection at thephysicianrsquos office They contactedphysicians for induction into the surveyafter an advance letter was mailed byNCHS notifying the physicians of theirselection in the survey In many casesphysicians or their staff completed theinformation requested on the PatientRecord forms However in 519 percentof the weighted visits FRs abstractedthe data from medical records orcomputer printouts either alone or withthe doctor or office staff

Data processing and medical codingwere performed by Constella GroupInc Durham North Carolina As part ofthe quality assurance procedure a10-percent quality control sample ofsurvey records was independently keyedand coded Coding error rates rangedbetween 03 and 45 percent for varioussurvey items

Medical data collected in the surveywere coded as follows

+ Patientrsquos reason for visitmdashThepatientrsquos main complaint symptomor reason for visiting the physicianrsquosoffice was coded according to AReason for Visit Classification forAmbulatory Care (RVC) (22) Up tothree reasons could be coded pervisit

+ Physicianrsquos diagnosismdashPhysicians ortheir staff were asked to record theprimary diagnosis or problemassociated with the patientrsquos mostimportant reason for the current visitand any other significant currentdiagnoses Up to three diagnoseswere coded according to theInternational Classification ofDiseases 9th Revision ClinicalModification (ICDndash9ndashCM) (23)

+ Injury poisoning adverse effect ofmedical treatmentmdashAlthough there is

a separate item on the Patient Recordform to indicate whether the visit wasfor an injury poisoning or adverseeffect of medical treatmentsometimes an injury reason for visitor an injury diagnosis is recordedwithout the injury item beingchecked Therefore the visit iscounted as an injury visit if the injuryitem is marked or if any of the threereasons for visit were in the injurymodule or any of the three diagnoseswere in the injury or poisoningchapter of the ICDndash9ndashCM (24)

+ MedicationsmdashPhysicians or their staffwere instructed to record all new orcontinued medications orderedsupplied or administered at the visitThis included prescription andnonprescription preparationsimmunizations desensitizing agentsand anesthetics In this surveyrecorded medications are referred toas drug mentions and are codedaccording to a classification systemdeveloped at NCHS (25) As used inthe NAMCS the term lsquolsquodrugrsquorsquo isinterchangeable with the termlsquolsquomedicationrsquorsquo The termlsquolsquoprescribingrsquorsquo is used broadly tomean ordering or providing anymedication whether prescription orover-the-counter Visits with one ormore drug mentions are termed lsquolsquodrugvisitsrsquorsquo in NAMCS Therapeuticclassification of drugs is based on the4-digit therapeutic categories used inthe National Drug Code Directory1995 edition (26) Drugs may havemore than one therapeutic applicationand in NAMCS up to threetherapeutic drug classes are includedfor each drug For the first time since1993ndash94 providers in 2005 wereasked to indicate whether medicationswere new or continued

Physician specialty groups

This report classifies specificphysician specialties into two generalcategorical schemes physician specialtyand type of specialty The NAMCSsurvey design groups physicians into 15strata or specialty groups for samplingpurposes One stratum doctors ofosteopathy was based on informationfrom the AOA The lsquolsquophysician

8 Advance Data No 387 + June 29 2007

specialtyrsquorsquo classification includes thesame strata as used for samplingpurposes with the exception of thedoctors of osteopathy stratum which iscombined with doctors of medicine inthe following 14 categories general andfamily practice internal medicinepediatrics general surgery obstetricsand gynecology orthopedic surgerycardiovascular diseases dermatologyurology psychiatry neurologyophthalmology otolaryngology and aresidual category of other specialtiesThe lsquolsquophysician specialtyrsquorsquo classificationis created using updated informationfrom the AMA as well as informationprovided by sampled physiciansSpecific physician specialties in each of

Text box A

Physicianspecialty

General practice Family medicine family practice

Internal medicine Internal medicine

Pediatrics Adolescent medicine critical care(pediatrics) neurodevelopmentalcardiology pediatric endocrinologpediatric gastroenterology pedia

General surgery General surgery

Obstetrics andgynecology

Gynecological oncology gynecolgynecology) reproductive endoc

Orthopedic surgery Adult reconstructive orthopedicsmedicine (orthopedic surgery) o

Cardiovasculardiseases

Cardiovascular diseases

Dermatology Dermatology

Urology Urology pediatric urology

Psychiatry Addiction psychiatry child psych

Neurology Child neurology clinical neuroph

Ophthalmology Ophthalmology pediatric ophthal

Otolaryngology Otology-neurotology otolaryngolo

Other Allergy addiction medicine allerg(internal medicine) abdominal susurgery clinical genetics clinicalimmunology diabetes dermatolotoxicology (emergency medicine)surgery hematologyoncology hamedicinediagnostic lab immunomanagement medical geneticsmedicine oral amp maxillofacial surmedicine pediatric cardiothoracicphlebology public healthgeneralrehabilitation pain medicine spoplastic surgery within the head ampmedicine spinal cord injury sleeundersea medicine vascular me

the 14 categories are defined in text boxA

In this classification a pediatriccardiothoracic physician for example isgrouped with other pediatricians On theother hand the lsquolsquospecialty typersquorsquoclassification divides AMA specialtiesinto three major categories primarycare surgical specialties and medicalspecialties and puts more emphasis onspecialization type For examplepediatric cardiothoracic physician areclassified as a surgical specialty in thisclassification The specific physicianspecialties included in each of the threespecialty types are provided in text boxB

It should be noted that lsquolsquoprimarycare specialistrsquorsquo as defined in the textbox

Specific physician specialty

(geriatric medicine) sports medicine (family practice) gen

pediatrics developmental-behavioral pediatrics internaldisabilities (psychiatry amp neurology) neonatal-perinatal my pediatric infectious diseases pediatric pulmonology m

tric hematologyoncology pediatric nephrology pediatric r

ogy maternal amp fetal medicine obstetrics amp gynecology orinology

foot and ankle orthopedics musculoskeletal oncology perthopedic surgery of the spine orthopedic trauma

iatry neuropsychiatry psychiatry forensic psychiatry psyc

ysiology endovascular surgical neuroradiology neurology

mology

gy pediatric otolaryngology

y and immunology allergy amp immunologydiagnostic labrgery clinical biochemical genetics clinical cytogeneticsmolecular genetics colon and rectal surgery cosmetic sugic surgery emergency medicine endocrinology epidemi facial plastic surgery gastroenterology general preventind surgery interventional cardiology cardiac electrophysi

logy geriatric medicine (internal medicine) sports medicinnephrology neurological surgery nuclear cardiology pedigery osteopathic manipulative medicine medical oncologsurgery pediatric surgery pediatric emergency medicine

preventive medicine pediatricdiagnostic lab immunologrts medicine (physical medicine and rehabilitation) pediatneck medical toxicology (preventive medicine) pulmona

p medicine surgical oncology traumatic surgery thoracicdicine vascular surgery other specialty unspecified

differs from lsquolsquoprimary care physician orprovider (PCP)rsquorsquo which is reported bythe survey respondent based on thequestion lsquolsquoAre you the patientrsquos primarycare physicianrsquorsquo (see lsquolsquoTechnicalNotesrsquorsquo) A PCP coordinates thecomprehensive health care of the patientand serves as the entry point for all ofthe patientrsquos health care needs PCPs areadvocates for the patient in coordinatingthe use of the entire health care systemto benefit the patient (27) TypicallyPCP visits include physicians in generaland family practice internal medicinepediatrics or obstetrics and gynecologyIn the NAMCS a checkbox defines aPCP visit therefore these visits mayalso include specialist physicians ornonphysicians such as physicianassistants and nurse practitioners

eral practice

medicinepediatrics neurodevelopmental disabilitiesedicine pediatrics pediatric allergy pediatricedical toxicology pediatric emergency medicineheumatology sports medicine (pediatrics)

bstetrics critical care medicine (obstetrics and

diatric orthopedics orthopedic surgery sports

hoanalysis geriatric psychiatry

(diagnostic radiology) vascular neurology

immunology aerospace medicine adolescent medicinecritical care medicine critical care surgery craniofacialrgery dermatological immunologydiagnostic labology sports medicine (emergency medicine) medicalve medicine hematology hepatology head and neckology infectious diseases immunology internale (internal medicine) legal medicine medical

atric surgery (neurology) nutrition occupationaly clinical pharmacology pulmonary critical care(emergency medicine) pharmaceutical medicine

y palliative medicine physical medicine andric rehabilitation medicine proctology plastic surgeryry diseases rheumatology pediatric rehabilitationsurgery transplant surgery urgent care medicine

Text box B

Physicianspecialty type Specific physician specialty

Primary carespecialties

Family practice geriatric medicine (family practice) sports medicine (family practice) general practice internal medicine internal medicine(pediatrics) adolescent medicine (internal medicine) geriatric medicine (internal medicine) adolescent medicine pediatrics pediatric sportsmedicine gynecology maternal and fetal medicine obstetrics and gynecology obstetrics

Surgicalspecialties

General surgery gynecological oncology critical care medicine (obstetrics and gynecology) hand surgery (orthopedic surgery) adultreconstructive orthopedics foot and ankle orthopedics musculoskeletal oncology pediatric orthopedics orthopedic surgery sports medicine(orthopedic surgery) orthopedic surgery of the spine orthopedic trauma urology pediatric urology ophthalmology pediatric ophthalmologyotology and neurotology otology otolaryngology pediatric otolaryngology abdominal surgery cardiovascular surgery colon and rectal surgerycardiothoracic surgery craniofacial surgery critical care surgery dermatologic surgery facial plastic surgery head and neck surgery handsurgery (plastic surgery) hand surgery (surgery) critical care (neurological surgery) neurological surgery pediatric surgery (neurology) pediatriccardiothoracic surgery pediatric surgery plastic surgery surgical oncology thoracic surgery transplant surgery traumatic surgery vascularsurgery

Medicalspecialties

Critical care pediatrics developmental-behavioral pediatrics neurodevelopmental disabilities (pediatrics) neurodevelopmental disabilities(psychiatry amp neurology) neonatal-perinatal medicine pediatric allergy pediatric cardiology pediatric endocrinology pediatric infectious diseasespediatric pulmonology medical toxicology (pediatrics) pediatric emergency medicine pediatric gastroenterology pediatric hematology andoncology pediatric nephrology pediatric rehabilitation medicine pediatric rheumatology reproductive endocrinology cardiovascular diseasesdermatology psychiatry addiction psychiatry child psychiatry forensic psychiatry psychoanalysis geriatric psychiatry neurology child neurologyclinical neurophysiology neurology (diagnostic radiology) addiction medicine aerospace medicine allergy allergy and immunology anddiagnostic laboratory immunology cardiac electrophysiology clinical genetics clinical biochemical genetics clinical molecular genetics criticalcare medicine dermatological immunology diagnostic laboratory immunology diabetes emergency medicine epidemiology endocrinologygastroenterology general preventive medicine hematology hematology and oncology infectious diseases internal medicine and diagnosticlaboratory immunology interventional cardiology legal medicine medical management medical genetics medical toxicology (emergencymedicine) medical oncology nephrology neurodevelopmental disabilities (pediatrics) nuclear cardiology nutrition occupational medicineosteopathic manipulative medicine pain medicine palliative medicine pediatric emergency medicine (emergency medicine) pediatric anddiagnostic laboratory immunology pharmaceutical medicine phlebology public health public health and general preventive medicine clinicalpharmacology physical medicine and rehabilitation pulmonary critical care medicine pulmonary diseases sports medicine (emergencymedicine) sports medicine (physical medicine and rehabilitation) rheumatology spinal cord injury sleep medicine undersea medicine vascularmedicine vascular neurology

Advance Data No 387 + June 29 2007 9

Estimation

Because of the complex multistagedesign of NAMCS a sample weight iscomputed for each sample visit thattakes all stages of design into accountThe survey data are inflated or weightedto produce unbiased national annualestimates The visit weight includes fourbasic components inflation byreciprocals of selection probabilitiesadjustment for nonresponse populationratio adjustments and weightsmoothing For the first time in 2004changes were made to the nonresponseadjustment factor to account for theseasonality of the reporting period

Starting with 2003 data thenonresponse adjustment additionallyaccounts for nonresponse fromphysicians by weekly visit volume andfor the variability in number of weeksparticipating physicians saw patientsduring the year (28) In previous yearsthe nonresponse adjustment accountedonly for nonresponse by physicianspecialty geographic region andmetropolitan statistical area status

The standard error is primarily ameasure of the sampling variability thatoccurs by chance because only a samplerather than an entire universe issurveyed Estimates of the sampling

variability for this report were calculatedusing Taylor approximations inSUDAAN which take into account thecomplex sample design of NAMCS Adescription of the software and itsapproach has been published (29) Thestandard errors of statistics presented inthis report are included in each of thetables

Tests of significance

In this report the determination ofstatistical inference is based on thetwo-tailed t-test The Bonferroniinequality was used to establish thecritical value for statistically significantdifferences (005 level of significance)based on the number of possiblecomparisons within a particular variable(or combination of variables) of interestA weighted least-squares regressionanalysis was used to determine thesignificance of trends at the 005 level

Nonsampling errors

As in any survey results are subjectto both sampling and nonsamplingerrors Nonsampling errors includereporting and processing errors as wellas biases due to nonresponse andincomplete response The magnitude ofthe nonsampling errors cannot be

computed However these errors werekept to a minimum by procedures builtinto the operation of the survey Toeliminate ambiguities and to encourageuniform reporting attention was givento the phrasing of items terms anddefinitions Also pretesting of most dataitems and survey procedures wasperformed Quality control proceduresand consistency and edit checks reducederrors in data coding and processing

The weighted response rate for the2005 NAMCS was 625 percentTable 31 presents weightedcharacteristics of NAMCS respondentsand nonrespondents along withweighted response rates Respondingversus nonresponding distributions weresimilar with the exception of highercooperation among female physiciansand pediatricians while cooperation wasless likely from male physicians andneurologists The effect of thisdifferential response is minimized in thevisit estimates in most cases as NAMCSuses a nonresponse adjustment factorthat takes annual visit volume specialtygeographic region and MSA intoaccount

Item nonresponse rates in theNAMCS are generally low (5 percent orless) However levels of nonresponsecan vary considerably in the survey

10 Advance Data No 387 + June 29 2007

Most nonresponse occurs when theneeded information is not available inthe medical record or is unknown to theperson filling out the survey instrumentNonresponse can also result when theinformation is available but surveyprocedures are not followed and theitem is left blank In this report thetables include a combined entry ofunknown or blank to display missingdata For items where combined itemnonresponse is between 30 and50 percent percent distributions are notdiscussed in the text However theinformation is shown in the tablesThese data should be interpreted withcaution If nonresponse is random theobserved distribution for the reporteditem (ie excluding cases for which theinformation is unknown) would be closeto the true distribution However ifnonresponse is not random the observeddistribution could vary significantlyfrom the actual distribution Researchersneed to decide how best to treat itemswith high levels of missing responsesFor items with nonresponse greater than50 percent data are not presented

Weighted item nonresponse rates(ie if the item was left blank or thelsquolsquounknownrsquorsquo box was marked) were50 percent or less for data items withthe following exceptions was visit forinjurypoisoningadverse effect ofmedical treatment (77 percent) andstatus of patient enrollment in a diseasemanagement program (240 percent)

For some items missing valueswere imputed by randomly assigning avalue from a Patient Record form withsimilar characteristics and were basedon physician specialty geographicregion and 3-digit ICDndash9ndashCM codes forprimary diagnosis Imputations wereperformed for the following variablesbirth year (19 percent) sex(10 percent) ethnicity (249 percent)race (208 percent) patient seen beforein practice (31 percent) how many pastvisits in last 12 months (55 percent)and time spent with physician(136 percent) Blank or otherwisemissing responses are noted in the dataEthnicity was imputed by randomlyassigning a value from a Patient Recordform with similar characteristics basedon physician specialty state and 3-digitICDndash9ndashCM codes for primary diagnosis

Use of tables

First-listed reason for visit anddiagnosis are presented in the tables Itshould be noted that estimates differingin ranked order may not be significantlydifferent from each other For itemsrelated to diagnostic and screeningservices procedures providers seen anddisposition physician office staff wasasked to check all of the applicablecategories for each item Thereforemultiple responses could be coded foreach visit

In this report estimates are notpresented if they are based on fewerthan 30 cases in the sample data onlyan asterisk () appears in the tables Therelative standard error (RSE) of anestimate is obtained by dividing thestandard error by the estimate itself Theresult is then expressed as a percentageof the estimate Estimates based on 30or more cases include an asterisk () ifthe RSE of the estimate exceeds30 percent

In the tables estimates of officevisits have been rounded to the nearestthousand Consequently estimates willnot always add to totals Rates andpercentages were calculated fromoriginal unrounded figures and do notnecessarily agree with figures calculatedfrom rounded data

Estimates presented in the tables forspecific race categories reflect visitswhere only a single race was reportedDenominators used in computingestimates of visit rates by expectedsource of payment were obtained fromthe 2005 National Health InterviewSurvey (NHIS) Individuals reportingmultiple insurance categories in theNHIS were counted in each categorythey reported with the exception ofMedicaid and SCHIP which werecombined into a single category

References1 Burt CW McCaig LF Rechtsteiner

EA Ambulatory medical careutilization estimates for 2005Advance data from vital and healthstatistics no 388 Hyattsville MDNational Center for Health Statistics2007 Available from httpwwwcdcgovnchsdataadad388pdf

2 Centers for Medicare and MedicaidServices and Office of the AssistantSecretary for Planning andEvaluation An Overview of the USHealth Care System Chart BookAvailable from httpwwwcmshhsgovTheChartSeriesdownloadsus_health_chap1_ppdf

3 Hing E Burt CW Characteristics ofoffice-based physicians and theirpractices United States 2003ndash2004National Center for Health StatisticsVital Health Stat 13(164) 2006

4 Hing E Cherry DK Woodwell DANational Ambulatory Medical CareSurvey 2004 summary Advancedata from vital and health statisticsno 374 Hyattsville MD NationalCenter for Health Statistics 2006

5 Middleton KR Hing E Xu JNational Hospital AmbulatoryMedical Care Survey 2005outpatient department summaryAdvance data from vital and healthstatistics no 389 Hyattsville MDNational Center for Health Statistics2007 Available from httpwwwcdcgovnchsdataadad389pdf

6 Nawar E Niska R NationalHospital Ambulatory Medical CareSurvey 2005 emergency departmentsummary Advance data from vitaland health statistics no 386Hyattsville MD National Center forHealth Statistics 2007 Availablefrom httpwwwcdcgovnchsdataadad386pdf

7 Raofi S Schappert S MedicationTherapy in Ambulatory MedicalCare United States 2003ndash2004National Center for Health StatisticsVital Health Stat 13(163) 2006

8 Niska R Burt CW Training forterrorism-related conditions inhospitals United States 2003ndash2004Advance data from vital and healthstatistics no 380 Hyattsville MDNational Center for Health Statistics2006

9 Burt CW McCaig LF Staffingcapacity and ambulance diversion inemergency departments UnitedStates 2003ndash2004 Advance datafrom vital and health statistics no376 Hyattsville MD NationalCenter for Health Statistics 2006

10 Altman KW Stephens RM LyttleCS Changing impact ofgastroesophageal reflux in medicaland otolaryngology practiceLaryngoscope 115(7)1145ndash53 2005

11 Fiscella K Franks P Does thecontent of primary care visits differ

8 Advance Data No 387 + June 29 2007

specialtyrsquorsquo classification includes thesame strata as used for samplingpurposes with the exception of thedoctors of osteopathy stratum which iscombined with doctors of medicine inthe following 14 categories general andfamily practice internal medicinepediatrics general surgery obstetricsand gynecology orthopedic surgerycardiovascular diseases dermatologyurology psychiatry neurologyophthalmology otolaryngology and aresidual category of other specialtiesThe lsquolsquophysician specialtyrsquorsquo classificationis created using updated informationfrom the AMA as well as informationprovided by sampled physiciansSpecific physician specialties in each of

Text box A

Physicianspecialty

General practice Family medicine family practice

Internal medicine Internal medicine

Pediatrics Adolescent medicine critical care(pediatrics) neurodevelopmentalcardiology pediatric endocrinologpediatric gastroenterology pedia

General surgery General surgery

Obstetrics andgynecology

Gynecological oncology gynecolgynecology) reproductive endoc

Orthopedic surgery Adult reconstructive orthopedicsmedicine (orthopedic surgery) o

Cardiovasculardiseases

Cardiovascular diseases

Dermatology Dermatology

Urology Urology pediatric urology

Psychiatry Addiction psychiatry child psych

Neurology Child neurology clinical neuroph

Ophthalmology Ophthalmology pediatric ophthal

Otolaryngology Otology-neurotology otolaryngolo

Other Allergy addiction medicine allerg(internal medicine) abdominal susurgery clinical genetics clinicalimmunology diabetes dermatolotoxicology (emergency medicine)surgery hematologyoncology hamedicinediagnostic lab immunomanagement medical geneticsmedicine oral amp maxillofacial surmedicine pediatric cardiothoracicphlebology public healthgeneralrehabilitation pain medicine spoplastic surgery within the head ampmedicine spinal cord injury sleeundersea medicine vascular me

the 14 categories are defined in text boxA

In this classification a pediatriccardiothoracic physician for example isgrouped with other pediatricians On theother hand the lsquolsquospecialty typersquorsquoclassification divides AMA specialtiesinto three major categories primarycare surgical specialties and medicalspecialties and puts more emphasis onspecialization type For examplepediatric cardiothoracic physician areclassified as a surgical specialty in thisclassification The specific physicianspecialties included in each of the threespecialty types are provided in text boxB

It should be noted that lsquolsquoprimarycare specialistrsquorsquo as defined in the textbox

Specific physician specialty

(geriatric medicine) sports medicine (family practice) gen

pediatrics developmental-behavioral pediatrics internaldisabilities (psychiatry amp neurology) neonatal-perinatal my pediatric infectious diseases pediatric pulmonology m

tric hematologyoncology pediatric nephrology pediatric r

ogy maternal amp fetal medicine obstetrics amp gynecology orinology

foot and ankle orthopedics musculoskeletal oncology perthopedic surgery of the spine orthopedic trauma

iatry neuropsychiatry psychiatry forensic psychiatry psyc

ysiology endovascular surgical neuroradiology neurology

mology

gy pediatric otolaryngology

y and immunology allergy amp immunologydiagnostic labrgery clinical biochemical genetics clinical cytogeneticsmolecular genetics colon and rectal surgery cosmetic sugic surgery emergency medicine endocrinology epidemi facial plastic surgery gastroenterology general preventind surgery interventional cardiology cardiac electrophysi

logy geriatric medicine (internal medicine) sports medicinnephrology neurological surgery nuclear cardiology pedigery osteopathic manipulative medicine medical oncologsurgery pediatric surgery pediatric emergency medicine

preventive medicine pediatricdiagnostic lab immunologrts medicine (physical medicine and rehabilitation) pediatneck medical toxicology (preventive medicine) pulmona

p medicine surgical oncology traumatic surgery thoracicdicine vascular surgery other specialty unspecified

differs from lsquolsquoprimary care physician orprovider (PCP)rsquorsquo which is reported bythe survey respondent based on thequestion lsquolsquoAre you the patientrsquos primarycare physicianrsquorsquo (see lsquolsquoTechnicalNotesrsquorsquo) A PCP coordinates thecomprehensive health care of the patientand serves as the entry point for all ofthe patientrsquos health care needs PCPs areadvocates for the patient in coordinatingthe use of the entire health care systemto benefit the patient (27) TypicallyPCP visits include physicians in generaland family practice internal medicinepediatrics or obstetrics and gynecologyIn the NAMCS a checkbox defines aPCP visit therefore these visits mayalso include specialist physicians ornonphysicians such as physicianassistants and nurse practitioners

eral practice

medicinepediatrics neurodevelopmental disabilitiesedicine pediatrics pediatric allergy pediatricedical toxicology pediatric emergency medicineheumatology sports medicine (pediatrics)

bstetrics critical care medicine (obstetrics and

diatric orthopedics orthopedic surgery sports

hoanalysis geriatric psychiatry

(diagnostic radiology) vascular neurology

immunology aerospace medicine adolescent medicinecritical care medicine critical care surgery craniofacialrgery dermatological immunologydiagnostic labology sports medicine (emergency medicine) medicalve medicine hematology hepatology head and neckology infectious diseases immunology internale (internal medicine) legal medicine medical

atric surgery (neurology) nutrition occupationaly clinical pharmacology pulmonary critical care(emergency medicine) pharmaceutical medicine

y palliative medicine physical medicine andric rehabilitation medicine proctology plastic surgeryry diseases rheumatology pediatric rehabilitationsurgery transplant surgery urgent care medicine

Text box B

Physicianspecialty type Specific physician specialty

Primary carespecialties

Family practice geriatric medicine (family practice) sports medicine (family practice) general practice internal medicine internal medicine(pediatrics) adolescent medicine (internal medicine) geriatric medicine (internal medicine) adolescent medicine pediatrics pediatric sportsmedicine gynecology maternal and fetal medicine obstetrics and gynecology obstetrics

Surgicalspecialties

General surgery gynecological oncology critical care medicine (obstetrics and gynecology) hand surgery (orthopedic surgery) adultreconstructive orthopedics foot and ankle orthopedics musculoskeletal oncology pediatric orthopedics orthopedic surgery sports medicine(orthopedic surgery) orthopedic surgery of the spine orthopedic trauma urology pediatric urology ophthalmology pediatric ophthalmologyotology and neurotology otology otolaryngology pediatric otolaryngology abdominal surgery cardiovascular surgery colon and rectal surgerycardiothoracic surgery craniofacial surgery critical care surgery dermatologic surgery facial plastic surgery head and neck surgery handsurgery (plastic surgery) hand surgery (surgery) critical care (neurological surgery) neurological surgery pediatric surgery (neurology) pediatriccardiothoracic surgery pediatric surgery plastic surgery surgical oncology thoracic surgery transplant surgery traumatic surgery vascularsurgery

Medicalspecialties

Critical care pediatrics developmental-behavioral pediatrics neurodevelopmental disabilities (pediatrics) neurodevelopmental disabilities(psychiatry amp neurology) neonatal-perinatal medicine pediatric allergy pediatric cardiology pediatric endocrinology pediatric infectious diseasespediatric pulmonology medical toxicology (pediatrics) pediatric emergency medicine pediatric gastroenterology pediatric hematology andoncology pediatric nephrology pediatric rehabilitation medicine pediatric rheumatology reproductive endocrinology cardiovascular diseasesdermatology psychiatry addiction psychiatry child psychiatry forensic psychiatry psychoanalysis geriatric psychiatry neurology child neurologyclinical neurophysiology neurology (diagnostic radiology) addiction medicine aerospace medicine allergy allergy and immunology anddiagnostic laboratory immunology cardiac electrophysiology clinical genetics clinical biochemical genetics clinical molecular genetics criticalcare medicine dermatological immunology diagnostic laboratory immunology diabetes emergency medicine epidemiology endocrinologygastroenterology general preventive medicine hematology hematology and oncology infectious diseases internal medicine and diagnosticlaboratory immunology interventional cardiology legal medicine medical management medical genetics medical toxicology (emergencymedicine) medical oncology nephrology neurodevelopmental disabilities (pediatrics) nuclear cardiology nutrition occupational medicineosteopathic manipulative medicine pain medicine palliative medicine pediatric emergency medicine (emergency medicine) pediatric anddiagnostic laboratory immunology pharmaceutical medicine phlebology public health public health and general preventive medicine clinicalpharmacology physical medicine and rehabilitation pulmonary critical care medicine pulmonary diseases sports medicine (emergencymedicine) sports medicine (physical medicine and rehabilitation) rheumatology spinal cord injury sleep medicine undersea medicine vascularmedicine vascular neurology

Advance Data No 387 + June 29 2007 9

Estimation

Because of the complex multistagedesign of NAMCS a sample weight iscomputed for each sample visit thattakes all stages of design into accountThe survey data are inflated or weightedto produce unbiased national annualestimates The visit weight includes fourbasic components inflation byreciprocals of selection probabilitiesadjustment for nonresponse populationratio adjustments and weightsmoothing For the first time in 2004changes were made to the nonresponseadjustment factor to account for theseasonality of the reporting period

Starting with 2003 data thenonresponse adjustment additionallyaccounts for nonresponse fromphysicians by weekly visit volume andfor the variability in number of weeksparticipating physicians saw patientsduring the year (28) In previous yearsthe nonresponse adjustment accountedonly for nonresponse by physicianspecialty geographic region andmetropolitan statistical area status

The standard error is primarily ameasure of the sampling variability thatoccurs by chance because only a samplerather than an entire universe issurveyed Estimates of the sampling

variability for this report were calculatedusing Taylor approximations inSUDAAN which take into account thecomplex sample design of NAMCS Adescription of the software and itsapproach has been published (29) Thestandard errors of statistics presented inthis report are included in each of thetables

Tests of significance

In this report the determination ofstatistical inference is based on thetwo-tailed t-test The Bonferroniinequality was used to establish thecritical value for statistically significantdifferences (005 level of significance)based on the number of possiblecomparisons within a particular variable(or combination of variables) of interestA weighted least-squares regressionanalysis was used to determine thesignificance of trends at the 005 level

Nonsampling errors

As in any survey results are subjectto both sampling and nonsamplingerrors Nonsampling errors includereporting and processing errors as wellas biases due to nonresponse andincomplete response The magnitude ofthe nonsampling errors cannot be

computed However these errors werekept to a minimum by procedures builtinto the operation of the survey Toeliminate ambiguities and to encourageuniform reporting attention was givento the phrasing of items terms anddefinitions Also pretesting of most dataitems and survey procedures wasperformed Quality control proceduresand consistency and edit checks reducederrors in data coding and processing

The weighted response rate for the2005 NAMCS was 625 percentTable 31 presents weightedcharacteristics of NAMCS respondentsand nonrespondents along withweighted response rates Respondingversus nonresponding distributions weresimilar with the exception of highercooperation among female physiciansand pediatricians while cooperation wasless likely from male physicians andneurologists The effect of thisdifferential response is minimized in thevisit estimates in most cases as NAMCSuses a nonresponse adjustment factorthat takes annual visit volume specialtygeographic region and MSA intoaccount

Item nonresponse rates in theNAMCS are generally low (5 percent orless) However levels of nonresponsecan vary considerably in the survey

10 Advance Data No 387 + June 29 2007

Most nonresponse occurs when theneeded information is not available inthe medical record or is unknown to theperson filling out the survey instrumentNonresponse can also result when theinformation is available but surveyprocedures are not followed and theitem is left blank In this report thetables include a combined entry ofunknown or blank to display missingdata For items where combined itemnonresponse is between 30 and50 percent percent distributions are notdiscussed in the text However theinformation is shown in the tablesThese data should be interpreted withcaution If nonresponse is random theobserved distribution for the reporteditem (ie excluding cases for which theinformation is unknown) would be closeto the true distribution However ifnonresponse is not random the observeddistribution could vary significantlyfrom the actual distribution Researchersneed to decide how best to treat itemswith high levels of missing responsesFor items with nonresponse greater than50 percent data are not presented

Weighted item nonresponse rates(ie if the item was left blank or thelsquolsquounknownrsquorsquo box was marked) were50 percent or less for data items withthe following exceptions was visit forinjurypoisoningadverse effect ofmedical treatment (77 percent) andstatus of patient enrollment in a diseasemanagement program (240 percent)

For some items missing valueswere imputed by randomly assigning avalue from a Patient Record form withsimilar characteristics and were basedon physician specialty geographicregion and 3-digit ICDndash9ndashCM codes forprimary diagnosis Imputations wereperformed for the following variablesbirth year (19 percent) sex(10 percent) ethnicity (249 percent)race (208 percent) patient seen beforein practice (31 percent) how many pastvisits in last 12 months (55 percent)and time spent with physician(136 percent) Blank or otherwisemissing responses are noted in the dataEthnicity was imputed by randomlyassigning a value from a Patient Recordform with similar characteristics basedon physician specialty state and 3-digitICDndash9ndashCM codes for primary diagnosis

Use of tables

First-listed reason for visit anddiagnosis are presented in the tables Itshould be noted that estimates differingin ranked order may not be significantlydifferent from each other For itemsrelated to diagnostic and screeningservices procedures providers seen anddisposition physician office staff wasasked to check all of the applicablecategories for each item Thereforemultiple responses could be coded foreach visit

In this report estimates are notpresented if they are based on fewerthan 30 cases in the sample data onlyan asterisk () appears in the tables Therelative standard error (RSE) of anestimate is obtained by dividing thestandard error by the estimate itself Theresult is then expressed as a percentageof the estimate Estimates based on 30or more cases include an asterisk () ifthe RSE of the estimate exceeds30 percent

In the tables estimates of officevisits have been rounded to the nearestthousand Consequently estimates willnot always add to totals Rates andpercentages were calculated fromoriginal unrounded figures and do notnecessarily agree with figures calculatedfrom rounded data

Estimates presented in the tables forspecific race categories reflect visitswhere only a single race was reportedDenominators used in computingestimates of visit rates by expectedsource of payment were obtained fromthe 2005 National Health InterviewSurvey (NHIS) Individuals reportingmultiple insurance categories in theNHIS were counted in each categorythey reported with the exception ofMedicaid and SCHIP which werecombined into a single category

References1 Burt CW McCaig LF Rechtsteiner

EA Ambulatory medical careutilization estimates for 2005Advance data from vital and healthstatistics no 388 Hyattsville MDNational Center for Health Statistics2007 Available from httpwwwcdcgovnchsdataadad388pdf

2 Centers for Medicare and MedicaidServices and Office of the AssistantSecretary for Planning andEvaluation An Overview of the USHealth Care System Chart BookAvailable from httpwwwcmshhsgovTheChartSeriesdownloadsus_health_chap1_ppdf

3 Hing E Burt CW Characteristics ofoffice-based physicians and theirpractices United States 2003ndash2004National Center for Health StatisticsVital Health Stat 13(164) 2006

4 Hing E Cherry DK Woodwell DANational Ambulatory Medical CareSurvey 2004 summary Advancedata from vital and health statisticsno 374 Hyattsville MD NationalCenter for Health Statistics 2006

5 Middleton KR Hing E Xu JNational Hospital AmbulatoryMedical Care Survey 2005outpatient department summaryAdvance data from vital and healthstatistics no 389 Hyattsville MDNational Center for Health Statistics2007 Available from httpwwwcdcgovnchsdataadad389pdf

6 Nawar E Niska R NationalHospital Ambulatory Medical CareSurvey 2005 emergency departmentsummary Advance data from vitaland health statistics no 386Hyattsville MD National Center forHealth Statistics 2007 Availablefrom httpwwwcdcgovnchsdataadad386pdf

7 Raofi S Schappert S MedicationTherapy in Ambulatory MedicalCare United States 2003ndash2004National Center for Health StatisticsVital Health Stat 13(163) 2006

8 Niska R Burt CW Training forterrorism-related conditions inhospitals United States 2003ndash2004Advance data from vital and healthstatistics no 380 Hyattsville MDNational Center for Health Statistics2006

9 Burt CW McCaig LF Staffingcapacity and ambulance diversion inemergency departments UnitedStates 2003ndash2004 Advance datafrom vital and health statistics no376 Hyattsville MD NationalCenter for Health Statistics 2006

10 Altman KW Stephens RM LyttleCS Changing impact ofgastroesophageal reflux in medicaland otolaryngology practiceLaryngoscope 115(7)1145ndash53 2005

11 Fiscella K Franks P Does thecontent of primary care visits differ

Text box B

Physicianspecialty type Specific physician specialty

Primary carespecialties

Family practice geriatric medicine (family practice) sports medicine (family practice) general practice internal medicine internal medicine(pediatrics) adolescent medicine (internal medicine) geriatric medicine (internal medicine) adolescent medicine pediatrics pediatric sportsmedicine gynecology maternal and fetal medicine obstetrics and gynecology obstetrics

Surgicalspecialties

General surgery gynecological oncology critical care medicine (obstetrics and gynecology) hand surgery (orthopedic surgery) adultreconstructive orthopedics foot and ankle orthopedics musculoskeletal oncology pediatric orthopedics orthopedic surgery sports medicine(orthopedic surgery) orthopedic surgery of the spine orthopedic trauma urology pediatric urology ophthalmology pediatric ophthalmologyotology and neurotology otology otolaryngology pediatric otolaryngology abdominal surgery cardiovascular surgery colon and rectal surgerycardiothoracic surgery craniofacial surgery critical care surgery dermatologic surgery facial plastic surgery head and neck surgery handsurgery (plastic surgery) hand surgery (surgery) critical care (neurological surgery) neurological surgery pediatric surgery (neurology) pediatriccardiothoracic surgery pediatric surgery plastic surgery surgical oncology thoracic surgery transplant surgery traumatic surgery vascularsurgery

Medicalspecialties

Critical care pediatrics developmental-behavioral pediatrics neurodevelopmental disabilities (pediatrics) neurodevelopmental disabilities(psychiatry amp neurology) neonatal-perinatal medicine pediatric allergy pediatric cardiology pediatric endocrinology pediatric infectious diseasespediatric pulmonology medical toxicology (pediatrics) pediatric emergency medicine pediatric gastroenterology pediatric hematology andoncology pediatric nephrology pediatric rehabilitation medicine pediatric rheumatology reproductive endocrinology cardiovascular diseasesdermatology psychiatry addiction psychiatry child psychiatry forensic psychiatry psychoanalysis geriatric psychiatry neurology child neurologyclinical neurophysiology neurology (diagnostic radiology) addiction medicine aerospace medicine allergy allergy and immunology anddiagnostic laboratory immunology cardiac electrophysiology clinical genetics clinical biochemical genetics clinical molecular genetics criticalcare medicine dermatological immunology diagnostic laboratory immunology diabetes emergency medicine epidemiology endocrinologygastroenterology general preventive medicine hematology hematology and oncology infectious diseases internal medicine and diagnosticlaboratory immunology interventional cardiology legal medicine medical management medical genetics medical toxicology (emergencymedicine) medical oncology nephrology neurodevelopmental disabilities (pediatrics) nuclear cardiology nutrition occupational medicineosteopathic manipulative medicine pain medicine palliative medicine pediatric emergency medicine (emergency medicine) pediatric anddiagnostic laboratory immunology pharmaceutical medicine phlebology public health public health and general preventive medicine clinicalpharmacology physical medicine and rehabilitation pulmonary critical care medicine pulmonary diseases sports medicine (emergencymedicine) sports medicine (physical medicine and rehabilitation) rheumatology spinal cord injury sleep medicine undersea medicine vascularmedicine vascular neurology

Advance Data No 387 + June 29 2007 9

Estimation

Because of the complex multistagedesign of NAMCS a sample weight iscomputed for each sample visit thattakes all stages of design into accountThe survey data are inflated or weightedto produce unbiased national annualestimates The visit weight includes fourbasic components inflation byreciprocals of selection probabilitiesadjustment for nonresponse populationratio adjustments and weightsmoothing For the first time in 2004changes were made to the nonresponseadjustment factor to account for theseasonality of the reporting period

Starting with 2003 data thenonresponse adjustment additionallyaccounts for nonresponse fromphysicians by weekly visit volume andfor the variability in number of weeksparticipating physicians saw patientsduring the year (28) In previous yearsthe nonresponse adjustment accountedonly for nonresponse by physicianspecialty geographic region andmetropolitan statistical area status

The standard error is primarily ameasure of the sampling variability thatoccurs by chance because only a samplerather than an entire universe issurveyed Estimates of the sampling

variability for this report were calculatedusing Taylor approximations inSUDAAN which take into account thecomplex sample design of NAMCS Adescription of the software and itsapproach has been published (29) Thestandard errors of statistics presented inthis report are included in each of thetables

Tests of significance

In this report the determination ofstatistical inference is based on thetwo-tailed t-test The Bonferroniinequality was used to establish thecritical value for statistically significantdifferences (005 level of significance)based on the number of possiblecomparisons within a particular variable(or combination of variables) of interestA weighted least-squares regressionanalysis was used to determine thesignificance of trends at the 005 level

Nonsampling errors

As in any survey results are subjectto both sampling and nonsamplingerrors Nonsampling errors includereporting and processing errors as wellas biases due to nonresponse andincomplete response The magnitude ofthe nonsampling errors cannot be

computed However these errors werekept to a minimum by procedures builtinto the operation of the survey Toeliminate ambiguities and to encourageuniform reporting attention was givento the phrasing of items terms anddefinitions Also pretesting of most dataitems and survey procedures wasperformed Quality control proceduresand consistency and edit checks reducederrors in data coding and processing

The weighted response rate for the2005 NAMCS was 625 percentTable 31 presents weightedcharacteristics of NAMCS respondentsand nonrespondents along withweighted response rates Respondingversus nonresponding distributions weresimilar with the exception of highercooperation among female physiciansand pediatricians while cooperation wasless likely from male physicians andneurologists The effect of thisdifferential response is minimized in thevisit estimates in most cases as NAMCSuses a nonresponse adjustment factorthat takes annual visit volume specialtygeographic region and MSA intoaccount

Item nonresponse rates in theNAMCS are generally low (5 percent orless) However levels of nonresponsecan vary considerably in the survey

10 Advance Data No 387 + June 29 2007

Most nonresponse occurs when theneeded information is not available inthe medical record or is unknown to theperson filling out the survey instrumentNonresponse can also result when theinformation is available but surveyprocedures are not followed and theitem is left blank In this report thetables include a combined entry ofunknown or blank to display missingdata For items where combined itemnonresponse is between 30 and50 percent percent distributions are notdiscussed in the text However theinformation is shown in the tablesThese data should be interpreted withcaution If nonresponse is random theobserved distribution for the reporteditem (ie excluding cases for which theinformation is unknown) would be closeto the true distribution However ifnonresponse is not random the observeddistribution could vary significantlyfrom the actual distribution Researchersneed to decide how best to treat itemswith high levels of missing responsesFor items with nonresponse greater than50 percent data are not presented

Weighted item nonresponse rates(ie if the item was left blank or thelsquolsquounknownrsquorsquo box was marked) were50 percent or less for data items withthe following exceptions was visit forinjurypoisoningadverse effect ofmedical treatment (77 percent) andstatus of patient enrollment in a diseasemanagement program (240 percent)

For some items missing valueswere imputed by randomly assigning avalue from a Patient Record form withsimilar characteristics and were basedon physician specialty geographicregion and 3-digit ICDndash9ndashCM codes forprimary diagnosis Imputations wereperformed for the following variablesbirth year (19 percent) sex(10 percent) ethnicity (249 percent)race (208 percent) patient seen beforein practice (31 percent) how many pastvisits in last 12 months (55 percent)and time spent with physician(136 percent) Blank or otherwisemissing responses are noted in the dataEthnicity was imputed by randomlyassigning a value from a Patient Recordform with similar characteristics basedon physician specialty state and 3-digitICDndash9ndashCM codes for primary diagnosis

Use of tables

First-listed reason for visit anddiagnosis are presented in the tables Itshould be noted that estimates differingin ranked order may not be significantlydifferent from each other For itemsrelated to diagnostic and screeningservices procedures providers seen anddisposition physician office staff wasasked to check all of the applicablecategories for each item Thereforemultiple responses could be coded foreach visit

In this report estimates are notpresented if they are based on fewerthan 30 cases in the sample data onlyan asterisk () appears in the tables Therelative standard error (RSE) of anestimate is obtained by dividing thestandard error by the estimate itself Theresult is then expressed as a percentageof the estimate Estimates based on 30or more cases include an asterisk () ifthe RSE of the estimate exceeds30 percent

In the tables estimates of officevisits have been rounded to the nearestthousand Consequently estimates willnot always add to totals Rates andpercentages were calculated fromoriginal unrounded figures and do notnecessarily agree with figures calculatedfrom rounded data

Estimates presented in the tables forspecific race categories reflect visitswhere only a single race was reportedDenominators used in computingestimates of visit rates by expectedsource of payment were obtained fromthe 2005 National Health InterviewSurvey (NHIS) Individuals reportingmultiple insurance categories in theNHIS were counted in each categorythey reported with the exception ofMedicaid and SCHIP which werecombined into a single category

References1 Burt CW McCaig LF Rechtsteiner

EA Ambulatory medical careutilization estimates for 2005Advance data from vital and healthstatistics no 388 Hyattsville MDNational Center for Health Statistics2007 Available from httpwwwcdcgovnchsdataadad388pdf

2 Centers for Medicare and MedicaidServices and Office of the AssistantSecretary for Planning andEvaluation An Overview of the USHealth Care System Chart BookAvailable from httpwwwcmshhsgovTheChartSeriesdownloadsus_health_chap1_ppdf

3 Hing E Burt CW Characteristics ofoffice-based physicians and theirpractices United States 2003ndash2004National Center for Health StatisticsVital Health Stat 13(164) 2006

4 Hing E Cherry DK Woodwell DANational Ambulatory Medical CareSurvey 2004 summary Advancedata from vital and health statisticsno 374 Hyattsville MD NationalCenter for Health Statistics 2006

5 Middleton KR Hing E Xu JNational Hospital AmbulatoryMedical Care Survey 2005outpatient department summaryAdvance data from vital and healthstatistics no 389 Hyattsville MDNational Center for Health Statistics2007 Available from httpwwwcdcgovnchsdataadad389pdf

6 Nawar E Niska R NationalHospital Ambulatory Medical CareSurvey 2005 emergency departmentsummary Advance data from vitaland health statistics no 386Hyattsville MD National Center forHealth Statistics 2007 Availablefrom httpwwwcdcgovnchsdataadad386pdf

7 Raofi S Schappert S MedicationTherapy in Ambulatory MedicalCare United States 2003ndash2004National Center for Health StatisticsVital Health Stat 13(163) 2006

8 Niska R Burt CW Training forterrorism-related conditions inhospitals United States 2003ndash2004Advance data from vital and healthstatistics no 380 Hyattsville MDNational Center for Health Statistics2006

9 Burt CW McCaig LF Staffingcapacity and ambulance diversion inemergency departments UnitedStates 2003ndash2004 Advance datafrom vital and health statistics no376 Hyattsville MD NationalCenter for Health Statistics 2006

10 Altman KW Stephens RM LyttleCS Changing impact ofgastroesophageal reflux in medicaland otolaryngology practiceLaryngoscope 115(7)1145ndash53 2005

11 Fiscella K Franks P Does thecontent of primary care visits differ

10 Advance Data No 387 + June 29 2007

Most nonresponse occurs when theneeded information is not available inthe medical record or is unknown to theperson filling out the survey instrumentNonresponse can also result when theinformation is available but surveyprocedures are not followed and theitem is left blank In this report thetables include a combined entry ofunknown or blank to display missingdata For items where combined itemnonresponse is between 30 and50 percent percent distributions are notdiscussed in the text However theinformation is shown in the tablesThese data should be interpreted withcaution If nonresponse is random theobserved distribution for the reporteditem (ie excluding cases for which theinformation is unknown) would be closeto the true distribution However ifnonresponse is not random the observeddistribution could vary significantlyfrom the actual distribution Researchersneed to decide how best to treat itemswith high levels of missing responsesFor items with nonresponse greater than50 percent data are not presented

Weighted item nonresponse rates(ie if the item was left blank or thelsquolsquounknownrsquorsquo box was marked) were50 percent or less for data items withthe following exceptions was visit forinjurypoisoningadverse effect ofmedical treatment (77 percent) andstatus of patient enrollment in a diseasemanagement program (240 percent)

For some items missing valueswere imputed by randomly assigning avalue from a Patient Record form withsimilar characteristics and were basedon physician specialty geographicregion and 3-digit ICDndash9ndashCM codes forprimary diagnosis Imputations wereperformed for the following variablesbirth year (19 percent) sex(10 percent) ethnicity (249 percent)race (208 percent) patient seen beforein practice (31 percent) how many pastvisits in last 12 months (55 percent)and time spent with physician(136 percent) Blank or otherwisemissing responses are noted in the dataEthnicity was imputed by randomlyassigning a value from a Patient Recordform with similar characteristics basedon physician specialty state and 3-digitICDndash9ndashCM codes for primary diagnosis

Use of tables

First-listed reason for visit anddiagnosis are presented in the tables Itshould be noted that estimates differingin ranked order may not be significantlydifferent from each other For itemsrelated to diagnostic and screeningservices procedures providers seen anddisposition physician office staff wasasked to check all of the applicablecategories for each item Thereforemultiple responses could be coded foreach visit

In this report estimates are notpresented if they are based on fewerthan 30 cases in the sample data onlyan asterisk () appears in the tables Therelative standard error (RSE) of anestimate is obtained by dividing thestandard error by the estimate itself Theresult is then expressed as a percentageof the estimate Estimates based on 30or more cases include an asterisk () ifthe RSE of the estimate exceeds30 percent

In the tables estimates of officevisits have been rounded to the nearestthousand Consequently estimates willnot always add to totals Rates andpercentages were calculated fromoriginal unrounded figures and do notnecessarily agree with figures calculatedfrom rounded data

Estimates presented in the tables forspecific race categories reflect visitswhere only a single race was reportedDenominators used in computingestimates of visit rates by expectedsource of payment were obtained fromthe 2005 National Health InterviewSurvey (NHIS) Individuals reportingmultiple insurance categories in theNHIS were counted in each categorythey reported with the exception ofMedicaid and SCHIP which werecombined into a single category

References1 Burt CW McCaig LF Rechtsteiner

EA Ambulatory medical careutilization estimates for 2005Advance data from vital and healthstatistics no 388 Hyattsville MDNational Center for Health Statistics2007 Available from httpwwwcdcgovnchsdataadad388pdf

2 Centers for Medicare and MedicaidServices and Office of the AssistantSecretary for Planning andEvaluation An Overview of the USHealth Care System Chart BookAvailable from httpwwwcmshhsgovTheChartSeriesdownloadsus_health_chap1_ppdf

3 Hing E Burt CW Characteristics ofoffice-based physicians and theirpractices United States 2003ndash2004National Center for Health StatisticsVital Health Stat 13(164) 2006

4 Hing E Cherry DK Woodwell DANational Ambulatory Medical CareSurvey 2004 summary Advancedata from vital and health statisticsno 374 Hyattsville MD NationalCenter for Health Statistics 2006

5 Middleton KR Hing E Xu JNational Hospital AmbulatoryMedical Care Survey 2005outpatient department summaryAdvance data from vital and healthstatistics no 389 Hyattsville MDNational Center for Health Statistics2007 Available from httpwwwcdcgovnchsdataadad389pdf

6 Nawar E Niska R NationalHospital Ambulatory Medical CareSurvey 2005 emergency departmentsummary Advance data from vitaland health statistics no 386Hyattsville MD National Center forHealth Statistics 2007 Availablefrom httpwwwcdcgovnchsdataadad386pdf

7 Raofi S Schappert S MedicationTherapy in Ambulatory MedicalCare United States 2003ndash2004National Center for Health StatisticsVital Health Stat 13(163) 2006

8 Niska R Burt CW Training forterrorism-related conditions inhospitals United States 2003ndash2004Advance data from vital and healthstatistics no 380 Hyattsville MDNational Center for Health Statistics2006

9 Burt CW McCaig LF Staffingcapacity and ambulance diversion inemergency departments UnitedStates 2003ndash2004 Advance datafrom vital and health statistics no376 Hyattsville MD NationalCenter for Health Statistics 2006

10 Altman KW Stephens RM LyttleCS Changing impact ofgastroesophageal reflux in medicaland otolaryngology practiceLaryngoscope 115(7)1145ndash53 2005

11 Fiscella K Franks P Does thecontent of primary care visits differ

Advance Data No 387 + June 29 2007 11

by the racial composition ofphysiciansrsquo practices Am J Med119(4)348ndash53 2006

12 Hare ME Gaur AH Somes GW etal Does it really take longer not toprescribe antibiotics for viralrespiratory tract infections inchildren Ambul Pediatr 6(3)152ndash62006

13 Hing E Brett KM Changes in USprescribing patterns of menopausalhormone therapy 2001ndash2003 Obstetamp Gynecol 108(1)33ndash40 2006

14 Kallen AJ Welch HG Sirovich BECurrent antibiotic therapy for isolatedurinary tract infections in womenArch Intern Med 166(6)635ndash9 2006

15 Merenstein D Daumit GL PoweNR Use and costs ofnonrecommended tests during routinepreventive health exams Am J PrevMed 30(6)521ndash7 2006

16 Olfson M Blanco C Liu L MorenoC Laje G National trends in theoutpatient treatment of children andadolescents with antipsychotic drugsArch Gen Psychiatry 63(6)679ndash852006

17 Scales CD Jr Curtis LH Norris RDSchulman KA Albala DM Moul JWProstate specific antigen testing inmen older than 75 years in theUnited States J Urol 176(2)511ndash42006

18 Won JU Dembe AE Servicesprovided by family physicians forpatients with occupational injuriesand illnesses Ann Fam Med4(2)138ndash47 2006

19 Young SE Mainous AG 3rd DiazVA Everett CJ Practice patterns insildenafil prescribing Fam Med38(2)110ndash5 2006

20 Smart D Physician characteristicsand distribution in the US 2007edition Department of Data Qualityand Measurement Division of Dataand Operations Am Med Assoc2007

21 Chobanian AV Bokris GL BlackHR et al Seventh report of the JointNational Committee on preventiondetection evaluation and treatmentof high blood pressure Hypertension421206ndash52 2003

22 Schneider D Appleton L McLemoreT A reason for visit classification forambulatory care National Center forHealth Statistics Vital Health Stat2(78) 1979

23 Public Health Service and HealthCare Financing AdministrationInternational Classification of

Diseases Ninth Revision ClinicalModification 6th ed WashingtonPublic Health Service 1998

24 Burt CW Fingerhut LA Injury visitsto hospital emergency departmentsUnited States 1992ndash1995 NationalCenter for Health Statistics VitalHealth Stat 13(131) 1998 Availablefrom httpwwwcdcgovnchsdataseriessr_13sr13_131pdf

25 Koch H Campbell W Thecollection and processing of druginformation National AmbulatoryMedical Care Survey United States1980 National Center for HealthStatistics Vital Health Stat 2(90)1982

26 Food and Drug AdministrationNational Drug Code Directory 1995edition Washington Public HealthService 1995

27 American Academy of FamilyPhysicians 2007 Available fromhttpwwwaafporgonlineenhomepolicypoliciespprimarycarehtml

28 Shimizu I Revised specification forNAMCS statistics for 2003+unpublished memo random datedMarch 16 2005

29 Research Triangle InstituteSUDAAN Userrsquos Manual Release901 Research Triangle Park NCResearch Triangle Institute 2005

Table 1 Number percent distribution and annual rate of office visits with corresponding standard errors by selected physiciancharacteristics United States 2005

Physician characteristics

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year12

Standarderror of

rate

All visits 963617 40611 1000 3310 139

Physician specialty3

General and family practice 215866 16229 224 15 741 56Internal medicine 167628 19431 174 16 576 67Pediatrics 128986 11227 134 11 421274 185Obstetrics and gynecology 64110 7003 67 08 55385 59Ophthalmology 59025 7466 61 07 203 26Orthopedic surgery 45815 5680 48 06 157 20Dermatology 32442 4910 34 05 111 17Psychiatry 28125 3547 29 04 97 12Cardiovascular diseases 26939 3913 28 04 93 13General surgery 24057 3590 25 04 83 12Otolaryngology 22452 2888 23 03 77 10Urology 18922 2181 20 02 65 07Neurology 13030 1677 14 02 45 06All other specialties 116220 14857 121 14 399 51

Professional identity

Doctor of medicine 885844 40050 919 09 3043 138Doctor of osteopathy 77774 8694 81 09 267 30

Specialty type3

Primary care 573169 30799 595 17 1969 106Surgical specialty 200217 14169 208 13 688 49Medical specialty 190232 14476 197 13 653 50

Geographic region

Northeast 187205 14866 194 15 3478 276Midwest 229301 20523 238 20 3530 316South 356685 30303 370 24 3390 288West 190426 16481 198 16 2835 245

Metropolitan status6

MSA 839184 39906 871 19 3419 163Non-MSA 124434 19170 129 19 2722 419

Category not applicable1Visit rates for age sex race and region are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2Population estimates of metropolitan statistical area status are based on data from the 2005 National Health Interview Survey National Center for Health Statistics adjusted to the US CensusBureau definition of core-based statistical areas as of November 2004 See httpwwwcensusgov populationwwwestimatesmetrodefhtml for more about metropolitan statistical definitions3Physician specialty and specialty type defined in the lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo4Number of visits (numerator) and population estimate (denominator) include children under 15 years of age5Number of visits (numerator) and population estimate (denominator) include females 15 years old and over6MSA is metropolitan statistical area

NOTE Numbers may not add to totals because of rounding

12 Advance Data No 387 + June 29 2007

Table 2 Number and percent distribution of office visits with corresponding standard errors by selected physician practicecharacteristics United States 2005

Physician practice characteristics

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Employment status

Owner 728977 40700 757 22Employee 213904 20109 222 21Contractor 20736 5954 22 06

Ownership

Physician or group 841853 41220 874 15Other health care corporation 39146 8959 41 09Other hospital 24909 6476 26 07HMO1 24584 6833 26 07Medical or academic health center 17949 5146 19 05Other2 15175 5289 16 06

Practice size

Solo 378469 27960 393 21Partner 112440 14370 117 133ndash5 242716 18473 252 186ndash10 135608 15527 141 1511 or more 91764 12402 95 13Blank 2621 1699 03 02

Type of practice

Single-specialty group 369614 26058 384 22Multispecialty group 215535 19148 224 19Solo 378469 27960 393 21

Office type

Private practice 870399 41427 903 13Clinic or urgicenter 52783 9431 55 10Other3 40435 8009 42 08

Electronic medical records

Yesmdashall electronic 113229 16943 118 17Yesmdashpart paper and part electronic 131053 16640 136 16No 707221 36888 734 20Unknown or blank 12115 4677 13 05

Practice submits claims electronically

Yes 808282 37292 839 18No 118790 16701 123 16Unknown or blank 36545 8057 38 08

Category not applicable Figure does not meet standards of reliability or precision1HMO is health maintenance organization2lsquolsquoOtherrsquorsquo includes owners such as local government (state county or city) and charitable organizations3lsquolsquoOtherrsquorsquo includes the following office types HMO nonfederal government clinic mental health center federally qualified health center and faculty practice plan

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 13

Table 3 Number percent distribution and annual rate of office visits with corresponding standard errors by patient characteristicsUnited States 2005

Patient characteristics

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror of

rate

All visits 963617 40611 1000 3310 139

Age

Under 15 years 160552 11524 167 11 2647 190Under 1 year 32070 3406 33 03 7816 8301ndash4 years 50400 4582 52 04 3112 2835ndash14 years 78082 4849 81 05 1935 120

15ndash24 years 70583 4028 73 04 1720 9825ndash44 years 201619 10521 209 08 2459 12845ndash64 years 283180 13998 294 06 3914 19365 years and over 247683 15541 257 10 7047 442

65ndash74 years 119061 7460 124 05 6472 40675 years and over 128623 8954 133 06 7677 534

Sex and age

Female 560355 24487 582 06 3768 165Under 15 years 72804 5166 76 05 2457 17415ndash24 years 44654 2787 46 03 2200 13725ndash44 years 129588 7056 134 06 3130 17045ndash64 years 166275 8738 173 04 4469 23565ndash74 years 66993 4419 70 03 6713 44375 years and over 80042 5958 83 04 7846 584

Male 403262 18050 418 06 2831 127Under 15 years 87748 6819 91 06 2829 22015ndash24 years 25930 2065 27 02 1251 10025ndash44 years 72031 4732 75 04 1775 11745ndash64 years 116905 6384 121 04 3327 18265ndash74 years 52068 3600 54 03 6186 42875 years and over 48581 3377 50 03 7414 515

Race and age2

White 832038 36280 863 09 3553 155Under 15 years 135236 10166 140 09 2921 22015ndash24 years 61148 3670 63 03 1917 11525ndash44 years 171737 9367 178 07 2638 14445ndash64 years 247043 12658 256 06 4102 21065ndash74 years 103554 6580 107 05 6560 41775 years and over 113320 8057 118 06 7625 542

Black or African American 88930 7582 92 07 2434 208Under 15 years 16288 2519 17 03 1751 27115ndash24 years 6960 1007 07 01 1156 16725ndash44 years 19847 2235 21 02 1911 21545ndash64 years 25669 2956 27 03 3261 37665ndash74 years 10034 1357 10 01 5885 79675 years and over 10132 1283 11 01 8063 1021

All other races2

Asian 33259 5374 35 05 2636 426Native Hawaiian or Other Pacific Islander 3520 1359 04 01 6934 2678American Indian or Alaska Native 3046 704 03 01 1084 250Mutiple races 2824 392 03 00 624 87

Ethnicity2

Hispanic or Latino 98904 9332 103 09 2345 221Not Hispanic or Latino 864714 37628 897 09 3473 151

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2The race groups White Black or African American Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races include persons of Hispanic and notHispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data on Raceand Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typically found forself-reported race in household surveys

NOTE Numbers may not add to totals because of rounding

14 Advance Data No 387 + June 29 2007

Table 4 Number and percentage of office visits with corresponding standard errors by expected sources of payment United States2005

Expected sources of payment

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Private insurance 608219 27808 631 12Medicare 231655 15483 240 10

Medicare and Medicaid 19002 2854 20 03Medicaid or SCHIP2 108601 8545 113 07No insurance3 43435 4232 45 04

Self-pay 39172 3935 41 04No charge or charity 4518 1361 05 01

Workerrsquos compensation 10014 1643 10 02Other 24122 3454 25 04Unknown or blank 16948 2259 18 02

Category not applicable Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit2SCHIP is State Childrenrsquos Health Insurance Program3No insurance is defined as having only self-pay no charge or charity as payment sources

NOTE More than one category could be indicated

Table 5 Number and percent distribution of office visits with corresponding standard errors by selected visit characteristics accordingto prior-visit status United States 2005

Prior-visit status primary care provider and referral status

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Visit to PCP1 485400 29737 504 18Visit to non-PCP1 438002 21738 455 17

Referred for this visit 135616 10767 141 10Not referred for this visit 235086 15238 244 13Unknown if referred 34830 4324 37 05

Unknown if PCP1 visit 40215 6156 42 06

Established patient

All visits 841424 36855 873 06

Visit to PCP1 463044 28985 550 19Visit to non-PCP1 346613 17760 412 17

Referred for this visit 82619 7925 98 09Not referred for this visit 212104 13959 252 14Unknown if referred 24848 3045 30 04

Unknown if PCP1 visit 31766 5139 38 06

New patient

All visits 122193 7282 127 06

Visit to PCP1 22356 2286 183 18Visit to non-PCP1 91389 6478 748 20

Referred for this visit 52997 4089 434 24Not referred for this visit 22981 3070 188 19Unknown if referred 9982 1845 82 15

Unknown if PCP1visit 8449 1397 69 11

Category not applicable1PCP is patientrsquos primary care provider as indicated by a positive response to the question lsquolsquoAre you the patientrsquos primary care physicianproviderrsquorsquo

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 15

Table 6 Percent distribution of office visits with corresponding standard errors by primary care provider and referral status accordingto physician specialty United States 2005

Physician specialty TotalVisit

to PCP1

Visit to non-PCP12

Referredby otherphysician

Not referredby otherphysician

Unknownif referred

Unknown ifPCP1 visit

Percent distribution

All visits 1000 504 141 244 70 42

General and family practice 1000 871 12 42 19 56Internal medicine 1000 831 41 37 32 59Pediatrics 1000 890 13 43 20 32Obstetrics and gynecology 1000 163 163 464 145 65Ophthalmology 1000 42 148 619 166 25Orthopedic surgery 1000 11 301 485 171 32Dermatology 1000 38 253 530 152 28Psychiatry 1000 93 183 535 155 33Cardiovascular diseases 1000 251 274 343 97 34General surgery 1000 108 538 273 54 27Otolaryngology 1000 25 388 458 106 23Urology 1000 23 302 533 126 16Neurology 1000 14 493 331 118 43All other specialties 1000 132 318 457 74 19

Standard error of percent

All visits 18 10 13 06 06

General and family practice 21 02 11 05 15Internal medicine 38 14 14 13 20Pediatrics 22 05 11 06 14Obstetrics and gynecology 44 39 45 37 21Ophthalmology 35 27 48 40 06Orthopedic surgery 08 34 55 42 11Dermatology 20 43 54 36 13Psychiatry 53 54 59 39 12Cardiovascular diseases 58 56 68 28 14General surgery 48 57 44 13 11Otolaryngology 15 48 47 24 07Urology 15 30 39 23 04Neurology 05 61 53 39 15All other specialties 39 46 51 15 06

Figure does not meet standards of reliability or precision Category not applicable1PCP is patientrsquos primary care provider as indicated by a positive response to question lsquolsquoAre you the patientrsquos primary care physicianproviderrsquorsquo2Referral status only asked for visits to nonprimary care physicians or providers

NOTE Numbers may not add to totals because of rounding

16 Advance Data No 387 + June 29 2007

Table 7 Number and percent distribution of office visits with corresponding standard errors by continuity-of-care visit characteristics according to specialty type United States2005

Continuity-of-care visit characteristicsAll

specialties

Specialty type1

Allspecialties

Specialty type1

Primarycare

Surgicalspecialties

Medicalspecialties

Primarycare

Surgicalspecialties

Medicalspecialties

Number of visits in thousands Standard error in thousands

All visits 963617 573169 200217 190232 40611 30799 14169 14476

Prior-visit status and number of visits in last 12 months

Established patient 841424 519718 159887 161819 36855 28457 11684 12617None 55122 29404 15949 9768 3566 2560 1676 17911ndash2 visits 283537 161363 65878 56296 15225 10389 5578 45773ndash5 visits 275063 176109 49094 49860 13875 11038 4108 42976 or more visits 227702 152842 28966 45894 12916 11188 3277 5610

New patient 122193 53451 40330 28413 7282 5179 3178 3251

Percent distribution Standard error of percent

All visits 1000 1000 1000 1000

Prior-visit status and number of visits in last 12 months

Established patient 873 907 799 851 06 08 09 13None 57 51 80 51 03 03 07 081ndash2 visits 294 282 329 296 08 10 13 143ndash5 visits 285 307 245 262 06 09 10 116 or more visits 236 267 145 241 11 14 13 21

New patient 127 93 201 149 06 08 09 13

Category not applicable1Specialty type defined in lsquolsquoPhysician specialty groupsrsquorsquo section in lsquolsquoMethodsrsquorsquo

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200717

Table 8 Number and percent distribution of office visits with corresponding standard errors by patientrsquos principal reason for visitmodule United States 2005

Principal reason for visit module and RVC code1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Symptom module S001ndashS999 457871 21644 475 10General symptoms S001ndashS099 52745 3722 55 03Symptoms referable to psychological and mental disorders S100ndashS199 29642 2934 31 03Symptoms referable to the nervous system (excluding sense organs) S200ndashS259 24074 1987 25 02Symptoms referable to the cardiovascular and lymphatic system S260ndashS299 4465 708 05 01Symptoms referable to the eyes and ears S300ndashS399 48487 3638 50 03Symptoms referable to the respiratory system S400ndashS499 95792 6343 99 05Symptoms referable to the digestive system S500ndashS639 33341 2513 35 02Symptoms referable to the genitourinary system S640ndashS829 30560 1915 32 02Symptoms referable to the skin hair and nails S830ndashS899 43807 3147 45 03Symptoms referable to the musculoskeletal system S900ndashS999 94956 6794 99 05

Disease module D001ndashD999 125461 9100 130 08Diagnostic screening and preventive module X100ndashX599 179769 10984 187 08Treatment module T100ndashT899 136372 8939 142 07Injuries and adverse effects module J001ndashJ999 24173 2060 25 02Test results module R100ndashR700 23508 1778 24 02Administrative module A100ndashA140 7457 1187 08 01Other2 U990ndashU999 9007 1595 09 02

Category not applicable1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (22)2Includes problems and complaints not elsewhere classified entries of lsquolsquononersquorsquo blanks and illegible entries

NOTE Numbers may not add to totals because of rounding

Table 9 Number and percent distribution of office visits with corresponding standard errors by the 20 principal reasons for visit mostfrequently mentioned by patients according to patientrsquos sex United States 2005

Principal reason for visit and RVC code1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

General medical examination X100 71392 5674 74 04 64 05 88 06Progress visit not otherwise specified T800 42201 4035 44 04 42 04 47 04Cough S440 32482 2842 34 02 30 02 39 04Postoperative visit T205 31985 3811 33 04 33 04 34 05Medication other and unspecified kinds T115 19896 2306 21 02 19 02 23 03Gynecological examination X225 18254 2709 19 03 33 05 Hypertension D510 16988 2478 18 02 16 02 20 04Prenatal examination routine X205 16759 2771 17 03 30 05 Symptoms referable to throat S455 16440 1892 17 02 16 02 18 02Knee symptoms S925 16076 1801 17 02 18 02 15 02Well-baby examination X105 15268 2037 16 02 13 02 20 03Back symptoms S905 14643 1599 15 01 16 02 14 02Vision dysfunctions S305 13556 1872 14 02 15 02 13 02For other and unspecified test results R700 13211 1377 14 01 13 02 15 02Nasal congestion S400 13164 2137 14 02 10 02 19 03Eye examination X230 12528 2709 13 03 14 03 12 03Skin rash S860 12527 1188 13 01 12 02 14 01Diabetes mellitus D205 12192 1981 13 02 12 02 13 02Depression S110 12062 1511 13 02 13 02 11 02Earache or ear infection S355 11805 1107 12 01 10 01 15 02All other reasons 550190 24483 571 09 571 10 571 10

Category not applicable1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (22)2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

18 Advance Data No 387 + June 29 2007

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Number of visits in thousands

All visits 963617 319330 290545 89843 70669 174387 18845

Age

Under 15 years 160552 76704 18243 8527 3397 51622 2058Under 1 year 32070 11996 1282 17289 1ndash4 years 50400 25199 4182 2462 1081 16723 5ndash14 years 78082 39509 12779 5103 2125 17610

15ndash24 years 70583 27679 12350 5140 4873 19403 113825ndash44 years 201619 69933 51314 18727 16156 41942 354745ndash64 years 283180 84793 103754 29448 22047 37770 536865 years and over 247683 60221 104885 28000 24195 23650 6733

65ndash74 years 119061 28774 48255 14213 11487 12652 368075 years and over 128623 31447 56630 13787 12708 10998 3053

Sex

Female 560355 178477 168169 52297 39506 110589 11316Male 403262 140853 122376 37545 31162 63798 7528

Race2

White 832038 277587 251698 78452 62031 146794 15476Black or African American 88930 27098 27399 8154 6909 18139 1231Other 42649 14645 11449 3236 1728 9454 2137

Ethnicity2

Hispanic or Latino 98904 35026 26216 7016 6382 21039 3225Not Hispanic or Latino 864714 284304 264330 82827 64286 153348 15620

Expected source of payment3

Private insurance 608219 208219 174252 55707 40982 119864 9194Medicare 231655 56954 98344 27824 20905 22276 5352

Medicare and Medicaid 19002 4404 8958 2163 1140 1688 Medicaid or SCHIP4 108601 36794 28674 10323 5343 25488 1979Self-pay no charge or charity 49026 17446 14718 3220 6622 6110 Other5 51083 15679 15540 4763 6528 7160 1415

Standard error in thousands

All visits 40611 15701 14938 7475 6580 11005 3568

Age

Under 15 years 11524 6511 2408 1135 582 4532 514Under 1 year 3406 1587 367 2064 1ndash4 years 4582 2644 907 431 247 1972 5ndash14 years 4849 3142 1599 725 374 1605

15ndash24 years 4028 1901 1015 893 862 2191 37725ndash44 years 10521 4664 3704 1797 1918 3739 84745ndash64 years 13998 4755 5941 2571 2298 4309 115065 years and over 15541 4688 7577 3112 2856 2762 175065ndash74 years 7460 2206 3752 1771 1566 1469 132675 years and over 8954 2980 4464 1660 1618 1567 636

Sex

Female 24487 8994 9764 5246 3977 7175 2026Male 18050 7589 6501 2822 3371 5494 1651

Race2

White 36280 14035 13292 6241 5742 9867 3097Black or African American 7582 3077 3048 1522 1296 2275 341Other 5779 2563 2343 811 427 1345 1545

See footnotes at end of table

Advance Data No 387 + June 29 2007 19

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Ethnicity2 Standard error in thousands

Hispanic or Latino 9332 3572 3770 1275 1052 2615 801Not Hispanic or Latino 37628 14683 13732 6857 6029 10180 3091

Expected source of payment3

Private insurance 27808 10683 9568 5365 4542 8544 1727Medicare 15483 4596 7563 2961 2760 2869 1225

Medicare and Medicaid 2854 874 1554 556 394 581 Medicaid or SCHIP4 8545 3808 3239 1294 670 3275 638Self-pay no charge or charity 4662 2448 1495 488 1921 881 Other5 4411 1581 1950 606 1079 1238 426

Percent distribution

All visits 1000 331 302 93 73 181 20

Age

Under 15 years 1000 478 114 53 21 322 13Under 1 year 1000 374 40 30 06 539 111ndash4 years 1000 500 83 49 21 332 155ndash14 years 1000 506 164 65 27 226 12

15ndash24 years 1000 392 175 73 69 275 1625ndash44 years 1000 347 255 93 80 208 1845ndash64 years 1000 299 366 104 78 133 1965 years and over 1000 243 423 113 98 95 27

65ndash74 years 1000 242 405 119 96 106 3175 years and over 1000 244 440 107 99 86 24

Sex

Female 1000 319 300 93 71 197 20Male 1000 349 303 93 77 158 19

Race2

White 1000 334 303 94 75 176 19Black or African American 1000 305 308 92 78 204 14Other 1000 343 268 76 41 222 50

Ethnicity2

Hispanic or Latino 1000 354 265 71 65 213 33Not Hispanic or Latino 1000 329 306 96 74 177 18

Expected source of payment3

Private insurance 1000 342 286 92 67 197 15Medicare 1000 246 425 120 90 96 23

Medicare and Medicaid 1000 232 471 114 60 89 34Medicaid or SCHIP4 1000 339 264 95 49 235 18Self-pay no charge or charity 1000 356 300 66 135 125 19Other5 1000 307 304 93 128 140 28

Standard error of percent

All visits 09 10 06 06 08 04

Age

Under 15 years 17 14 06 04 15 03Under 1 year 26 11 07 05 26 041ndash4 years 27 16 07 05 24 055ndash14 years 21 18 08 05 17 04

15ndash24 years 22 12 11 12 23 0525ndash44 years 14 14 07 09 15 0445ndash64 years 10 14 07 07 12 0465 years and over 11 17 09 10 10 07

65ndash74 years 13 20 12 11 11 1175 years and over 14 18 10 11 11 05

See footnotes at end of table

20 Advance Data No 387 + June 29 2007

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Sex Standard error of percent

Female 10 12 07 07 10 03Male 11 12 06 08 10 04

Race2

White 09 11 05 06 08 04Black or African American 20 21 15 14 22 04Other 30 35 18 10 28 34

Ethnicity2

Hispanic or Latino 22 23 10 09 21 07Not Hispanic or Latino 09 11 06 07 08 03

Expected source of payment3

Private insurance 10 12 07 07 09 03Medicare 11 17 09 10 11 05

Medicare and Medicaid 26 42 25 19 28 12Medicaid or SCHIP4 21 23 09 06 23 06Self-pay no charge or charity 30 26 08 34 17 06Other5 19 22 10 18 21 08

Figure does not meet standards of reliability or precision Category not applicable1Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)2Other race includes visits by Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories inlcude visits by persons of Hispanic andnot Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data onRace and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple race indicated is small and lower than what is typically found forself-reported race in household surveys3Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit4SCHIP is State Childrenrsquos Health Insurance Program5Other includes workerrsquos compensation unknown or blank and payments not classified elsewhere

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 21

Table 11 Number percent distribution and annual rate of preventive care office visits and percent of visits to primary care specialistswith corresponding standard errors by selected patient and visit characteristics United States 2005

Patient and visit characteristics

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror

of rate

Percent ofpreventive carevisits made toprimary carespecialists2

Standarderror ofpercent

All preventive care visits3 174387 11005 1000 599 38 853 16

Age

Under 15 years 51622 4532 296 22 851 75 973 11Under 1 year 17289 2064 99 11 4214 503 998 011ndash4 years 16723 1972 96 10 1033 122 980 125ndash14 years 17610 1605 101 08 436 40 943 22

15ndash24 years 19403 2191 111 11 473 53 952 1725ndash44 years 41942 3739 241 16 512 46 903 1945ndash64 years 37770 4309 217 17 522 60 765 3065 years and over 23650 2762 136 13 673 79 561 45

65ndash74 years 12652 1469 73 07 688 80 609 4475 years and over 10998 1567 63 08 656 94 506 59

Sex and age

Female 110589 7175 634 18 744 48 870 16Under 15 years 23224 2063 133 10 784 70 979 0815ndash24 years 15134 1874 87 10 746 92 971 0825ndash44 years 33658 3258 193 16 813 79 929 1745ndash64 years 23897 2473 137 10 642 66 777 3065ndash74 years 7748 980 44 05 776 98 657 5275 years and over 6929 1030 40 05 679 101 552 57

Male 63798 5494 366 18 448 39 824 20Under 15 years 28399 2848 163 14 915 92 969 1515ndash24 years 4269 731 24 04 206 35 883 5825ndash44 years 8284 1244 48 06 204 31 796 4345ndash64 years 13873 2561 80 13 395 73 745 5065ndash74 years 4904 724 28 04 583 86 532 5875 years and over 4069 708 23 04 621 108 427 82

Race4

White 146794 9867 842 15 627 42 843 18Black or African American 18139 2275 104 12 496 62 906 21Other 9454 1345 54 07 462 66 915 29

Ethnicity4

Hispanic or Latino 21039 2615 121 14 499 62 914 20Not Hispanic or Latino 153348 10180 879 14 616 41 845 17

Expected source(s) of payment5

Private insurance 119864 8544 687 20 619 44 866 16Medicare 22276 2869 128 13 592 76 591 48

Medicare and Medicaid 1688 581 10 03 599 156MedicaidSCHIP6 25488 3275 146 17 795 102 928 19Self-pay no charge or charity7 6110 881 35 05 146 21 810 47Other8 7160 1238 41 07 767 56

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau Visit rates for expected source(s) of payment are based on the 2005 National Health Interview Survey estimates of health insurance2Primary care specialty defined in specialty type classification found in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo3Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)4Other race includes Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic and notHispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data on Raceand Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typically found forself-reported race in household surveys5Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit6SCHIP is State Childrenrsquos Health Insurance Program7The visit rate was calculated using lsquolsquouninsuredrsquorsquo as the denominator from the 2005 estimates of health insurance coverage from the National Health Inteview Survey8Other includes workerrsquos compensation unknown or blank and sources not elsewhere classified

NOTE Numbers may not add to totals because of rounding

22 Advance Data No 387 + June 29 2007

Table 12 Number and percent distribution of office visits with corresponding standard errors by physicianrsquos primary diagnosisUnited States 2005

Major disease category and ICDndash9ndashCM code range1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Infectious and parasitic diseases 001ndash139 26720 2062 28 02Neoplasms 140ndash239 39200 5285 41 05Endocrine nutritional and metabolic diseases and immunity disorders 240ndash279 56408 4655 59 04Mental disorders 290ndash319 47094 3777 49 04Diseases of the nervous system and sense organs 320ndash389 86128 6644 89 05Diseases of the circulatory system 390ndash459 81836 6683 85 06Diseases of the respiratory system 460ndash519 110999 7670 115 07Diseases of the digestive system 520ndash579 28678 2225 30 02Diseases of the genitourinary system 580ndash629 42256 3131 44 03Diseases of the skin and subcutaneous tissue 680ndash709 44443 3189 46 03Diseases of the musculoskeletal system and connective tissue 710ndash739 80601 6320 84 05Symptoms signs and ill-defined conditions 780ndash799 60536 3916 63 03Injury and poisoning 800ndash999 45137 3087 47 03Supplementary classification V01ndashV82 179276 11124 186 09All other diagnoses2 25609 3533 27 03Unknown3 8697 1645 09 02

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23)2Includes diseases of the blood and blood-forming organs (280ndash289) complications of pregnancy childbirth and the puerperium (630ndash677) congenital anomalies (740ndash759) certain conditionsoriginating in the perinatal period (760ndash779) and entries not codable to the ICDndash9ndashCM (eg illegible entries left against medical advice transferred entries of lsquolsquononersquorsquo or lsquolsquono diagnosesrsquorsquo)3Includes blank diagnoses

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 23

Table 13 Number and percent distribution of office visits with corresponding standard errors by the 20 leading primary diagnosis groups according to patientrsquos sexUnited States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

Essential hypertension 401 44670 4318 46 04 44 04 50 05Routine infant or child health check V202 41816 4044 43 04 33 03 57 06Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 36372 2875 38 03 33 03 45 04Arthropathies and related disorders 710ndash719 34299 4200 36 04 42 06 27 03Malignant neoplasms 140ndash208230ndash234 28709 5644 30 06 30 07 30 04Diabetes mellitus 250 25451 2730 26 03 25 03 29 03Spinal disorders 720ndash724 22732 2523 24 02 24 02 23 03Rheumatism excluding back 725ndash729 18580 1580 19 01 19 02 19 02General medical examination V70 17007 2377 18 02 15 02 22 03Follow up examination V67 16249 2573 17 02 17 03 16 03Specific procedures and aftercare V50ndashV599 15662 2000 16 02 17 02 15 03Normal pregnancy V22 15509 2534 16 03 28 05 Gynecological examination V723 15067 2378 16 02 27 04 Otitis media and eustachian tube disorders 381ndash382 14399 1517 15 01 12 01 19 02Asthma 493 12823 2102 13 02 11 02 16 04Disorders of lipoid metabolism 272 12650 1416 13 01 11 02 16 02Chronic sinusitis 473 12621 1302 13 01 12 01 14 02Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 11473 1490 12 01 10 01 15 02Acute pharyngitis 462 11064 1941 11 02 11 02 13 03Allergic rhinitis 477 11028 2099 11 02 11 02 12 03All other diagnoses 545437 23756 566 08 568 10 564 10

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to form larger categories that better describe the utilization of ambulatory care services2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

24A

dvanceD

ataN

o387+

June292007

Table 14 Number percent distribution and annual rate of office visits with corresponding standard errors by patientrsquos age accordingto the five leading primary diagnosis groups United States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year2

Standarderror of

rate

All visits 963617 40611 1000 3310 139

Under 1 year

All visits 32070 3406 1000 7816 830Routine infant or child health check V202 14528 1965 453 31 3541 479Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 3442 593 107 16 839 145Otitis media and eustachian tube disorders 381ndash382 2541 559 79 15 619 136Certain conditions originating in the perinatal period 760ndash779 34 08 269 65Unspecified viral and chlamydial infection 799 19 07 148 64All other diagnoses 9847 1134 307 22 2400 276

1ndash12 years

All visits 112241 8094 1000 2337 169Routine infant or child health check V202 21953 2294 196 14 457 48Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 12310 1705 110 11 256 36Otitis media and eustachian tube disorders 381ndash382 7901 843 70 07 165 18Asthma 493 4252 1126 38 10 89 23Acute pharyngitis 462 4203 868 37 07 88 18All other diagnoses 61622 4491 549 15 1283 94

13ndash21 years

All visits 66533 3594 1000 1785 96Routine infant or child health check V202 5334 803 80 11 143 22Normal pregnancy V22 3331 830 50 12 3182 45Acne 7060ndash7061 2931 560 44 08 79 15Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 2915 501 44 07 78 13Acute pharyngitis 462 2248 597 34 09 60 16All other diagnoses 49774 2793 748 18 1335 75

22ndash49 years

All visits 290199 14182 1000 2490 122Normal pregnancy V22 12178 1924 42 07 4207 33Spinal disorders 720ndash724 10148 1340 35 04 87 12Arthropathies and related disorders 710ndash719 9874 1767 34 06 85 15Gynecological examination V723 9496 1431 33 05 4161 24Essential hypertension 401 9361 1362 32 04 80 12All other diagnoses 239141 12253 824 11 2052 105

50ndash64 years

All visits 214891 10973 1000 4292 219Essential hypertension 401 15519 1884 72 08 310 38Arthropathies and related disorders 710ndash719 11162 1512 52 06 223 30Diabetes mellitus 250 9272 1048 43 04 185 21Malignant neoplasms 140ndash208230ndash234 8870 1861 41 08 177 37Spinal disorders 720ndash724 6530 935 30 04 130 19All other diagnoses 163538 8317 761 11 3266 166

65 years and over

All visits 247683 15541 1000 7047 442Essential hypertension 401 19129 2184 77 08 544 62Malignant neoplasms 140ndash208230ndash234 15679 3215 63 12 446 91Arthropathies and related disorders 710ndash719 11814 1815 48 06 336 52Diabetes mellitus 250 11253 1594 45 06 320 45Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 7824 1167 32 04 223 33All other diagnoses 181986 11408 735 12 5177 325

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth RevisionClinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to better describe the use ofambulatory care services2Visit rates for age are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Populations Division US Census Bureau3The population used for this rate is based on visits by females 13ndash21 years of age For males in this age group the leading diagnosis was routine infant or child health check (155 visits per 100males 13ndash21 years SE=31)4The population used for this rate is based on visits by females 22ndash49 years of age For males in this age group the leading diagnosis was essential hypertension (84 visits per 100 males 22ndash49years SE=15)

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 25

Table 15 Number percent distribution and annual rate of injury-related office visits with corresponding standard errors by selectedpatient characteristics United States 2005

Patient characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror of

rate

All injury-related visits2 89412 5466 1000 307 19

Age

Under 15 years 11556 1126 129 11 191 19Under 1 year 07 03 157 611ndash4 years 3191 495 36 06 197 315ndash14 years 7721 853 86 08 191 21

15ndash24 years 10006 973 112 09 244 2425ndash44 years 23053 1919 258 13 281 2345ndash64 years 28197 2050 315 13 390 2865 years and over 16600 1684 186 14 472 48

65ndash74 years 8111 976 91 09 441 5375 years and over 8489 937 95 08 507 56

Sex and age

Female 44177 2711 494 13 297 18Under 15 years 5017 622 56 07 169 2115ndash24 years 4610 575 52 06 227 2825ndash44 years 10286 921 115 08 248 2245ndash64 years 14917 1251 167 11 401 3465ndash74 years 4364 692 49 07 437 6975 years and over 4983 598 56 06 489 59

Male 45235 3233 506 13 318 23Under 15 years 6539 754 73 08 211 2415ndash24 years 5396 670 60 06 260 3225ndash44 years 12767 1329 143 11 315 3345ndash64 years 13280 1232 149 10 378 3565ndash74 years 3747 590 42 06 445 7075 years and over 3505 600 39 06 535 92

Race3

White 79208 4958 886 11 338 21Black or African American 6838 979 76 10 187 27Other 3365 602 38 06 164 29

Ethnicity

Hispanic or Latino 10578 1562 118 15 251 37Not Hispanic or Latino 78834 4812 882 15 317 19

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2Injury visits represent 93 percent (SE=04) of all office visits3Other race includes visits by Asians Native Hawaiians or Other Pacific Islanders American Indians or Alaska Natives and multiple races All race categories include visits by persons of Hispanicorigin and not Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for FederalData on Race and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typicallyfound for self-reported race in household surveys

NOTE Numbers may not add to totals because of rounding

Table 16 Number and percent distribution of injury-related office visits with corresponding standard errors by intent United States2005

Intent

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All injury-related visits 89412 5466 1000 Unintentional injuries 40934 4147 458 26Intentional injuries 1805 338 20 04Adverse effect of medical or surgical care or adverse effect of medicinal drug 8264 922 92 10Injuries of undetermined intent 32853 2362 367 24Unknown or blank 5556 993 62 11

Category not applicable

NOTE Numbers may not add to totals because of rounding

26 Advance Data No 387 + June 29 2007

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Number of visits in thousands

All visits 963617 432754 283180 119061 128623 560355 403262

At least one condition 507390 121891 187209 94472 103818 298366 209024None 422515 295386 85466 21112 20551 242189 180327Blank 33712 15476 10505 3477 4254 19800 13911

Hypertension 219476 23060 84640 52131 59646 127072 92404Arthritis 137942 20861 51744 27168 38169 91610 46332Hyperlipidemia 130053 12806 55561 31658 30028 68208 61845Diabetes 94359 10387 38628 23810 21534 50625 43733Depression 84610 30935 35059 8538 10078 59418 25192Obesity 68201 24275 29574 9298 5054 45028 23173Cancer 57025 4817 18809 15014 18384 32384 24640Asthma 54545 28913 14491 5764 5376 33276 21269COPD2 40754 7746 11425 10818 10764 22458 18295Ischemic heart disease 39559 1472 10179 12092 15815 16245 23314Osteoporosis 27977 6466 8050 12096 24842 3136Cerebrovascular disease 18319 731 4322 5489 7777 9000 9319CHF3 15692 3589 3409 8392 8950 6742Chronic renal failure 11486 2741 3039 4969 5633 5852

Standard error in thousands

All visits 40611 19288 13998 7460 8954 24487 18050

At least one condition 26734 6497 10543 6419 7920 16807 10964None 20054 14902 5424 1860 2135 11620 9940Blank 3749 1854 1445 668 650 2377 1724

Hypertension 14790 1976 5958 4176 5097 8906 6596Arthritis 9990 1930 4317 2357 3632 7470 3168Hyperlipidemia 9484 1139 4425 2773 3051 5051 4972Diabetes 6585 1133 3024 1939 2203 3811 3366Depression 6884 2367 3465 1084 1288 5082 2137Obesity 5885 2496 2961 1225 842 4156 2401Cancer 6483 782 2373 2149 2161 4421 2379Asthma 3877 2528 1350 712 814 2466 2012COPD2 3794 1054 1259 1356 1583 2332 1790Ischemic heart disease 3659 321 1097 1274 1920 1831 2301Osteoporosis 2821 892 1015 1413 2419 608Cerebrovascular disease 2290 188 717 844 1165 1187 1330CHF3 2054 768 561 1365 1351 1076Chronic renal failure 1713 799 609 890 829 1151

Percent distribution

All visits 1000 1000 1000 1000 1000 1000 100

At least one condition 527 282 661 793 807 532 518None 438 683 302 177 160 432 447Blank 35 36 37 29 33 35 34

Hypertension 228 53 299 438 464 227 229Arthritis 143 48 183 228 297 163 115Hyperlipidemia 135 30 196 266 233 122 153Diabetes 98 24 136 200 167 90 108Depression 88 71 124 72 78 106 62Obesity 71 56 104 78 39 80 57Cancer 59 11 66 126 143 58 61Asthma 57 67 51 48 42 59 53COPD2 42 18 40 91 84 40 45Ischemic heart disease 41 03 36 102 123 29 58Osteoporosis 29 03 23 68 94 44 08Cerebrovascular disease 19 02 15 46 60 16 23CHF3 16 01 13 29 65 16 17Chronic renal failure 12 02 10 26 39 10 15

See footnotes at end of table

Advance Data No 387 + June 29 2007 27

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005mdashCon

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Standard error of percent

All visits

At least one condition 13 10 13 13 15 14 14None 12 11 13 12 14 13 14Blank 04 04 05 06 05 04 04

Hypertension 10 04 13 19 17 11 11Arthritis 07 04 11 13 17 09 06Hyperlipidemia 08 03 12 17 16 08 10Diabetes 05 03 07 11 10 05 06Depression 06 05 10 09 09 08 05Obesity 05 05 09 09 06 06 05Cancer 06 02 08 14 13 07 05Asthma 03 05 04 06 06 04 05COPD2 03 02 04 10 10 03 04Ischemic heart disease 03 01 03 08 10 03 05Osteoporosis 02 01 03 08 08 03 01Cerebrovascular disease 02 00 02 06 07 02 03CHF3 02 00 03 04 09 02 03Chronic renal failure 02 01 03 05 06 01 03

Figure does not meet standards of reliability or precision Category not applicable1Presence of chronic conditions regardless of visit diagnosis were based on checkbox responses2COPD is chronic obstructive pulmonary disease3CHF is congestive heart failure

NOTE Numbers may not add to totals because more than one condition may be reported per visit

28 Advance Data No 387 + June 29 2007

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 3 Number percent distribution and annual rate of office visits with corresponding standard errors by patient characteristicsUnited States 2005

Patient characteristics

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror of

rate

All visits 963617 40611 1000 3310 139

Age

Under 15 years 160552 11524 167 11 2647 190Under 1 year 32070 3406 33 03 7816 8301ndash4 years 50400 4582 52 04 3112 2835ndash14 years 78082 4849 81 05 1935 120

15ndash24 years 70583 4028 73 04 1720 9825ndash44 years 201619 10521 209 08 2459 12845ndash64 years 283180 13998 294 06 3914 19365 years and over 247683 15541 257 10 7047 442

65ndash74 years 119061 7460 124 05 6472 40675 years and over 128623 8954 133 06 7677 534

Sex and age

Female 560355 24487 582 06 3768 165Under 15 years 72804 5166 76 05 2457 17415ndash24 years 44654 2787 46 03 2200 13725ndash44 years 129588 7056 134 06 3130 17045ndash64 years 166275 8738 173 04 4469 23565ndash74 years 66993 4419 70 03 6713 44375 years and over 80042 5958 83 04 7846 584

Male 403262 18050 418 06 2831 127Under 15 years 87748 6819 91 06 2829 22015ndash24 years 25930 2065 27 02 1251 10025ndash44 years 72031 4732 75 04 1775 11745ndash64 years 116905 6384 121 04 3327 18265ndash74 years 52068 3600 54 03 6186 42875 years and over 48581 3377 50 03 7414 515

Race and age2

White 832038 36280 863 09 3553 155Under 15 years 135236 10166 140 09 2921 22015ndash24 years 61148 3670 63 03 1917 11525ndash44 years 171737 9367 178 07 2638 14445ndash64 years 247043 12658 256 06 4102 21065ndash74 years 103554 6580 107 05 6560 41775 years and over 113320 8057 118 06 7625 542

Black or African American 88930 7582 92 07 2434 208Under 15 years 16288 2519 17 03 1751 27115ndash24 years 6960 1007 07 01 1156 16725ndash44 years 19847 2235 21 02 1911 21545ndash64 years 25669 2956 27 03 3261 37665ndash74 years 10034 1357 10 01 5885 79675 years and over 10132 1283 11 01 8063 1021

All other races2

Asian 33259 5374 35 05 2636 426Native Hawaiian or Other Pacific Islander 3520 1359 04 01 6934 2678American Indian or Alaska Native 3046 704 03 01 1084 250Mutiple races 2824 392 03 00 624 87

Ethnicity2

Hispanic or Latino 98904 9332 103 09 2345 221Not Hispanic or Latino 864714 37628 897 09 3473 151

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2The race groups White Black or African American Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races include persons of Hispanic and notHispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data on Raceand Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typically found forself-reported race in household surveys

NOTE Numbers may not add to totals because of rounding

14 Advance Data No 387 + June 29 2007

Table 4 Number and percentage of office visits with corresponding standard errors by expected sources of payment United States2005

Expected sources of payment

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Private insurance 608219 27808 631 12Medicare 231655 15483 240 10

Medicare and Medicaid 19002 2854 20 03Medicaid or SCHIP2 108601 8545 113 07No insurance3 43435 4232 45 04

Self-pay 39172 3935 41 04No charge or charity 4518 1361 05 01

Workerrsquos compensation 10014 1643 10 02Other 24122 3454 25 04Unknown or blank 16948 2259 18 02

Category not applicable Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit2SCHIP is State Childrenrsquos Health Insurance Program3No insurance is defined as having only self-pay no charge or charity as payment sources

NOTE More than one category could be indicated

Table 5 Number and percent distribution of office visits with corresponding standard errors by selected visit characteristics accordingto prior-visit status United States 2005

Prior-visit status primary care provider and referral status

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Visit to PCP1 485400 29737 504 18Visit to non-PCP1 438002 21738 455 17

Referred for this visit 135616 10767 141 10Not referred for this visit 235086 15238 244 13Unknown if referred 34830 4324 37 05

Unknown if PCP1 visit 40215 6156 42 06

Established patient

All visits 841424 36855 873 06

Visit to PCP1 463044 28985 550 19Visit to non-PCP1 346613 17760 412 17

Referred for this visit 82619 7925 98 09Not referred for this visit 212104 13959 252 14Unknown if referred 24848 3045 30 04

Unknown if PCP1 visit 31766 5139 38 06

New patient

All visits 122193 7282 127 06

Visit to PCP1 22356 2286 183 18Visit to non-PCP1 91389 6478 748 20

Referred for this visit 52997 4089 434 24Not referred for this visit 22981 3070 188 19Unknown if referred 9982 1845 82 15

Unknown if PCP1visit 8449 1397 69 11

Category not applicable1PCP is patientrsquos primary care provider as indicated by a positive response to the question lsquolsquoAre you the patientrsquos primary care physicianproviderrsquorsquo

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 15

Table 6 Percent distribution of office visits with corresponding standard errors by primary care provider and referral status accordingto physician specialty United States 2005

Physician specialty TotalVisit

to PCP1

Visit to non-PCP12

Referredby otherphysician

Not referredby otherphysician

Unknownif referred

Unknown ifPCP1 visit

Percent distribution

All visits 1000 504 141 244 70 42

General and family practice 1000 871 12 42 19 56Internal medicine 1000 831 41 37 32 59Pediatrics 1000 890 13 43 20 32Obstetrics and gynecology 1000 163 163 464 145 65Ophthalmology 1000 42 148 619 166 25Orthopedic surgery 1000 11 301 485 171 32Dermatology 1000 38 253 530 152 28Psychiatry 1000 93 183 535 155 33Cardiovascular diseases 1000 251 274 343 97 34General surgery 1000 108 538 273 54 27Otolaryngology 1000 25 388 458 106 23Urology 1000 23 302 533 126 16Neurology 1000 14 493 331 118 43All other specialties 1000 132 318 457 74 19

Standard error of percent

All visits 18 10 13 06 06

General and family practice 21 02 11 05 15Internal medicine 38 14 14 13 20Pediatrics 22 05 11 06 14Obstetrics and gynecology 44 39 45 37 21Ophthalmology 35 27 48 40 06Orthopedic surgery 08 34 55 42 11Dermatology 20 43 54 36 13Psychiatry 53 54 59 39 12Cardiovascular diseases 58 56 68 28 14General surgery 48 57 44 13 11Otolaryngology 15 48 47 24 07Urology 15 30 39 23 04Neurology 05 61 53 39 15All other specialties 39 46 51 15 06

Figure does not meet standards of reliability or precision Category not applicable1PCP is patientrsquos primary care provider as indicated by a positive response to question lsquolsquoAre you the patientrsquos primary care physicianproviderrsquorsquo2Referral status only asked for visits to nonprimary care physicians or providers

NOTE Numbers may not add to totals because of rounding

16 Advance Data No 387 + June 29 2007

Table 7 Number and percent distribution of office visits with corresponding standard errors by continuity-of-care visit characteristics according to specialty type United States2005

Continuity-of-care visit characteristicsAll

specialties

Specialty type1

Allspecialties

Specialty type1

Primarycare

Surgicalspecialties

Medicalspecialties

Primarycare

Surgicalspecialties

Medicalspecialties

Number of visits in thousands Standard error in thousands

All visits 963617 573169 200217 190232 40611 30799 14169 14476

Prior-visit status and number of visits in last 12 months

Established patient 841424 519718 159887 161819 36855 28457 11684 12617None 55122 29404 15949 9768 3566 2560 1676 17911ndash2 visits 283537 161363 65878 56296 15225 10389 5578 45773ndash5 visits 275063 176109 49094 49860 13875 11038 4108 42976 or more visits 227702 152842 28966 45894 12916 11188 3277 5610

New patient 122193 53451 40330 28413 7282 5179 3178 3251

Percent distribution Standard error of percent

All visits 1000 1000 1000 1000

Prior-visit status and number of visits in last 12 months

Established patient 873 907 799 851 06 08 09 13None 57 51 80 51 03 03 07 081ndash2 visits 294 282 329 296 08 10 13 143ndash5 visits 285 307 245 262 06 09 10 116 or more visits 236 267 145 241 11 14 13 21

New patient 127 93 201 149 06 08 09 13

Category not applicable1Specialty type defined in lsquolsquoPhysician specialty groupsrsquorsquo section in lsquolsquoMethodsrsquorsquo

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200717

Table 8 Number and percent distribution of office visits with corresponding standard errors by patientrsquos principal reason for visitmodule United States 2005

Principal reason for visit module and RVC code1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Symptom module S001ndashS999 457871 21644 475 10General symptoms S001ndashS099 52745 3722 55 03Symptoms referable to psychological and mental disorders S100ndashS199 29642 2934 31 03Symptoms referable to the nervous system (excluding sense organs) S200ndashS259 24074 1987 25 02Symptoms referable to the cardiovascular and lymphatic system S260ndashS299 4465 708 05 01Symptoms referable to the eyes and ears S300ndashS399 48487 3638 50 03Symptoms referable to the respiratory system S400ndashS499 95792 6343 99 05Symptoms referable to the digestive system S500ndashS639 33341 2513 35 02Symptoms referable to the genitourinary system S640ndashS829 30560 1915 32 02Symptoms referable to the skin hair and nails S830ndashS899 43807 3147 45 03Symptoms referable to the musculoskeletal system S900ndashS999 94956 6794 99 05

Disease module D001ndashD999 125461 9100 130 08Diagnostic screening and preventive module X100ndashX599 179769 10984 187 08Treatment module T100ndashT899 136372 8939 142 07Injuries and adverse effects module J001ndashJ999 24173 2060 25 02Test results module R100ndashR700 23508 1778 24 02Administrative module A100ndashA140 7457 1187 08 01Other2 U990ndashU999 9007 1595 09 02

Category not applicable1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (22)2Includes problems and complaints not elsewhere classified entries of lsquolsquononersquorsquo blanks and illegible entries

NOTE Numbers may not add to totals because of rounding

Table 9 Number and percent distribution of office visits with corresponding standard errors by the 20 principal reasons for visit mostfrequently mentioned by patients according to patientrsquos sex United States 2005

Principal reason for visit and RVC code1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

General medical examination X100 71392 5674 74 04 64 05 88 06Progress visit not otherwise specified T800 42201 4035 44 04 42 04 47 04Cough S440 32482 2842 34 02 30 02 39 04Postoperative visit T205 31985 3811 33 04 33 04 34 05Medication other and unspecified kinds T115 19896 2306 21 02 19 02 23 03Gynecological examination X225 18254 2709 19 03 33 05 Hypertension D510 16988 2478 18 02 16 02 20 04Prenatal examination routine X205 16759 2771 17 03 30 05 Symptoms referable to throat S455 16440 1892 17 02 16 02 18 02Knee symptoms S925 16076 1801 17 02 18 02 15 02Well-baby examination X105 15268 2037 16 02 13 02 20 03Back symptoms S905 14643 1599 15 01 16 02 14 02Vision dysfunctions S305 13556 1872 14 02 15 02 13 02For other and unspecified test results R700 13211 1377 14 01 13 02 15 02Nasal congestion S400 13164 2137 14 02 10 02 19 03Eye examination X230 12528 2709 13 03 14 03 12 03Skin rash S860 12527 1188 13 01 12 02 14 01Diabetes mellitus D205 12192 1981 13 02 12 02 13 02Depression S110 12062 1511 13 02 13 02 11 02Earache or ear infection S355 11805 1107 12 01 10 01 15 02All other reasons 550190 24483 571 09 571 10 571 10

Category not applicable1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (22)2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

18 Advance Data No 387 + June 29 2007

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Number of visits in thousands

All visits 963617 319330 290545 89843 70669 174387 18845

Age

Under 15 years 160552 76704 18243 8527 3397 51622 2058Under 1 year 32070 11996 1282 17289 1ndash4 years 50400 25199 4182 2462 1081 16723 5ndash14 years 78082 39509 12779 5103 2125 17610

15ndash24 years 70583 27679 12350 5140 4873 19403 113825ndash44 years 201619 69933 51314 18727 16156 41942 354745ndash64 years 283180 84793 103754 29448 22047 37770 536865 years and over 247683 60221 104885 28000 24195 23650 6733

65ndash74 years 119061 28774 48255 14213 11487 12652 368075 years and over 128623 31447 56630 13787 12708 10998 3053

Sex

Female 560355 178477 168169 52297 39506 110589 11316Male 403262 140853 122376 37545 31162 63798 7528

Race2

White 832038 277587 251698 78452 62031 146794 15476Black or African American 88930 27098 27399 8154 6909 18139 1231Other 42649 14645 11449 3236 1728 9454 2137

Ethnicity2

Hispanic or Latino 98904 35026 26216 7016 6382 21039 3225Not Hispanic or Latino 864714 284304 264330 82827 64286 153348 15620

Expected source of payment3

Private insurance 608219 208219 174252 55707 40982 119864 9194Medicare 231655 56954 98344 27824 20905 22276 5352

Medicare and Medicaid 19002 4404 8958 2163 1140 1688 Medicaid or SCHIP4 108601 36794 28674 10323 5343 25488 1979Self-pay no charge or charity 49026 17446 14718 3220 6622 6110 Other5 51083 15679 15540 4763 6528 7160 1415

Standard error in thousands

All visits 40611 15701 14938 7475 6580 11005 3568

Age

Under 15 years 11524 6511 2408 1135 582 4532 514Under 1 year 3406 1587 367 2064 1ndash4 years 4582 2644 907 431 247 1972 5ndash14 years 4849 3142 1599 725 374 1605

15ndash24 years 4028 1901 1015 893 862 2191 37725ndash44 years 10521 4664 3704 1797 1918 3739 84745ndash64 years 13998 4755 5941 2571 2298 4309 115065 years and over 15541 4688 7577 3112 2856 2762 175065ndash74 years 7460 2206 3752 1771 1566 1469 132675 years and over 8954 2980 4464 1660 1618 1567 636

Sex

Female 24487 8994 9764 5246 3977 7175 2026Male 18050 7589 6501 2822 3371 5494 1651

Race2

White 36280 14035 13292 6241 5742 9867 3097Black or African American 7582 3077 3048 1522 1296 2275 341Other 5779 2563 2343 811 427 1345 1545

See footnotes at end of table

Advance Data No 387 + June 29 2007 19

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Ethnicity2 Standard error in thousands

Hispanic or Latino 9332 3572 3770 1275 1052 2615 801Not Hispanic or Latino 37628 14683 13732 6857 6029 10180 3091

Expected source of payment3

Private insurance 27808 10683 9568 5365 4542 8544 1727Medicare 15483 4596 7563 2961 2760 2869 1225

Medicare and Medicaid 2854 874 1554 556 394 581 Medicaid or SCHIP4 8545 3808 3239 1294 670 3275 638Self-pay no charge or charity 4662 2448 1495 488 1921 881 Other5 4411 1581 1950 606 1079 1238 426

Percent distribution

All visits 1000 331 302 93 73 181 20

Age

Under 15 years 1000 478 114 53 21 322 13Under 1 year 1000 374 40 30 06 539 111ndash4 years 1000 500 83 49 21 332 155ndash14 years 1000 506 164 65 27 226 12

15ndash24 years 1000 392 175 73 69 275 1625ndash44 years 1000 347 255 93 80 208 1845ndash64 years 1000 299 366 104 78 133 1965 years and over 1000 243 423 113 98 95 27

65ndash74 years 1000 242 405 119 96 106 3175 years and over 1000 244 440 107 99 86 24

Sex

Female 1000 319 300 93 71 197 20Male 1000 349 303 93 77 158 19

Race2

White 1000 334 303 94 75 176 19Black or African American 1000 305 308 92 78 204 14Other 1000 343 268 76 41 222 50

Ethnicity2

Hispanic or Latino 1000 354 265 71 65 213 33Not Hispanic or Latino 1000 329 306 96 74 177 18

Expected source of payment3

Private insurance 1000 342 286 92 67 197 15Medicare 1000 246 425 120 90 96 23

Medicare and Medicaid 1000 232 471 114 60 89 34Medicaid or SCHIP4 1000 339 264 95 49 235 18Self-pay no charge or charity 1000 356 300 66 135 125 19Other5 1000 307 304 93 128 140 28

Standard error of percent

All visits 09 10 06 06 08 04

Age

Under 15 years 17 14 06 04 15 03Under 1 year 26 11 07 05 26 041ndash4 years 27 16 07 05 24 055ndash14 years 21 18 08 05 17 04

15ndash24 years 22 12 11 12 23 0525ndash44 years 14 14 07 09 15 0445ndash64 years 10 14 07 07 12 0465 years and over 11 17 09 10 10 07

65ndash74 years 13 20 12 11 11 1175 years and over 14 18 10 11 11 05

See footnotes at end of table

20 Advance Data No 387 + June 29 2007

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Sex Standard error of percent

Female 10 12 07 07 10 03Male 11 12 06 08 10 04

Race2

White 09 11 05 06 08 04Black or African American 20 21 15 14 22 04Other 30 35 18 10 28 34

Ethnicity2

Hispanic or Latino 22 23 10 09 21 07Not Hispanic or Latino 09 11 06 07 08 03

Expected source of payment3

Private insurance 10 12 07 07 09 03Medicare 11 17 09 10 11 05

Medicare and Medicaid 26 42 25 19 28 12Medicaid or SCHIP4 21 23 09 06 23 06Self-pay no charge or charity 30 26 08 34 17 06Other5 19 22 10 18 21 08

Figure does not meet standards of reliability or precision Category not applicable1Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)2Other race includes visits by Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories inlcude visits by persons of Hispanic andnot Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data onRace and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple race indicated is small and lower than what is typically found forself-reported race in household surveys3Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit4SCHIP is State Childrenrsquos Health Insurance Program5Other includes workerrsquos compensation unknown or blank and payments not classified elsewhere

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 21

Table 11 Number percent distribution and annual rate of preventive care office visits and percent of visits to primary care specialistswith corresponding standard errors by selected patient and visit characteristics United States 2005

Patient and visit characteristics

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror

of rate

Percent ofpreventive carevisits made toprimary carespecialists2

Standarderror ofpercent

All preventive care visits3 174387 11005 1000 599 38 853 16

Age

Under 15 years 51622 4532 296 22 851 75 973 11Under 1 year 17289 2064 99 11 4214 503 998 011ndash4 years 16723 1972 96 10 1033 122 980 125ndash14 years 17610 1605 101 08 436 40 943 22

15ndash24 years 19403 2191 111 11 473 53 952 1725ndash44 years 41942 3739 241 16 512 46 903 1945ndash64 years 37770 4309 217 17 522 60 765 3065 years and over 23650 2762 136 13 673 79 561 45

65ndash74 years 12652 1469 73 07 688 80 609 4475 years and over 10998 1567 63 08 656 94 506 59

Sex and age

Female 110589 7175 634 18 744 48 870 16Under 15 years 23224 2063 133 10 784 70 979 0815ndash24 years 15134 1874 87 10 746 92 971 0825ndash44 years 33658 3258 193 16 813 79 929 1745ndash64 years 23897 2473 137 10 642 66 777 3065ndash74 years 7748 980 44 05 776 98 657 5275 years and over 6929 1030 40 05 679 101 552 57

Male 63798 5494 366 18 448 39 824 20Under 15 years 28399 2848 163 14 915 92 969 1515ndash24 years 4269 731 24 04 206 35 883 5825ndash44 years 8284 1244 48 06 204 31 796 4345ndash64 years 13873 2561 80 13 395 73 745 5065ndash74 years 4904 724 28 04 583 86 532 5875 years and over 4069 708 23 04 621 108 427 82

Race4

White 146794 9867 842 15 627 42 843 18Black or African American 18139 2275 104 12 496 62 906 21Other 9454 1345 54 07 462 66 915 29

Ethnicity4

Hispanic or Latino 21039 2615 121 14 499 62 914 20Not Hispanic or Latino 153348 10180 879 14 616 41 845 17

Expected source(s) of payment5

Private insurance 119864 8544 687 20 619 44 866 16Medicare 22276 2869 128 13 592 76 591 48

Medicare and Medicaid 1688 581 10 03 599 156MedicaidSCHIP6 25488 3275 146 17 795 102 928 19Self-pay no charge or charity7 6110 881 35 05 146 21 810 47Other8 7160 1238 41 07 767 56

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau Visit rates for expected source(s) of payment are based on the 2005 National Health Interview Survey estimates of health insurance2Primary care specialty defined in specialty type classification found in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo3Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)4Other race includes Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic and notHispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data on Raceand Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typically found forself-reported race in household surveys5Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit6SCHIP is State Childrenrsquos Health Insurance Program7The visit rate was calculated using lsquolsquouninsuredrsquorsquo as the denominator from the 2005 estimates of health insurance coverage from the National Health Inteview Survey8Other includes workerrsquos compensation unknown or blank and sources not elsewhere classified

NOTE Numbers may not add to totals because of rounding

22 Advance Data No 387 + June 29 2007

Table 12 Number and percent distribution of office visits with corresponding standard errors by physicianrsquos primary diagnosisUnited States 2005

Major disease category and ICDndash9ndashCM code range1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Infectious and parasitic diseases 001ndash139 26720 2062 28 02Neoplasms 140ndash239 39200 5285 41 05Endocrine nutritional and metabolic diseases and immunity disorders 240ndash279 56408 4655 59 04Mental disorders 290ndash319 47094 3777 49 04Diseases of the nervous system and sense organs 320ndash389 86128 6644 89 05Diseases of the circulatory system 390ndash459 81836 6683 85 06Diseases of the respiratory system 460ndash519 110999 7670 115 07Diseases of the digestive system 520ndash579 28678 2225 30 02Diseases of the genitourinary system 580ndash629 42256 3131 44 03Diseases of the skin and subcutaneous tissue 680ndash709 44443 3189 46 03Diseases of the musculoskeletal system and connective tissue 710ndash739 80601 6320 84 05Symptoms signs and ill-defined conditions 780ndash799 60536 3916 63 03Injury and poisoning 800ndash999 45137 3087 47 03Supplementary classification V01ndashV82 179276 11124 186 09All other diagnoses2 25609 3533 27 03Unknown3 8697 1645 09 02

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23)2Includes diseases of the blood and blood-forming organs (280ndash289) complications of pregnancy childbirth and the puerperium (630ndash677) congenital anomalies (740ndash759) certain conditionsoriginating in the perinatal period (760ndash779) and entries not codable to the ICDndash9ndashCM (eg illegible entries left against medical advice transferred entries of lsquolsquononersquorsquo or lsquolsquono diagnosesrsquorsquo)3Includes blank diagnoses

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 23

Table 13 Number and percent distribution of office visits with corresponding standard errors by the 20 leading primary diagnosis groups according to patientrsquos sexUnited States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

Essential hypertension 401 44670 4318 46 04 44 04 50 05Routine infant or child health check V202 41816 4044 43 04 33 03 57 06Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 36372 2875 38 03 33 03 45 04Arthropathies and related disorders 710ndash719 34299 4200 36 04 42 06 27 03Malignant neoplasms 140ndash208230ndash234 28709 5644 30 06 30 07 30 04Diabetes mellitus 250 25451 2730 26 03 25 03 29 03Spinal disorders 720ndash724 22732 2523 24 02 24 02 23 03Rheumatism excluding back 725ndash729 18580 1580 19 01 19 02 19 02General medical examination V70 17007 2377 18 02 15 02 22 03Follow up examination V67 16249 2573 17 02 17 03 16 03Specific procedures and aftercare V50ndashV599 15662 2000 16 02 17 02 15 03Normal pregnancy V22 15509 2534 16 03 28 05 Gynecological examination V723 15067 2378 16 02 27 04 Otitis media and eustachian tube disorders 381ndash382 14399 1517 15 01 12 01 19 02Asthma 493 12823 2102 13 02 11 02 16 04Disorders of lipoid metabolism 272 12650 1416 13 01 11 02 16 02Chronic sinusitis 473 12621 1302 13 01 12 01 14 02Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 11473 1490 12 01 10 01 15 02Acute pharyngitis 462 11064 1941 11 02 11 02 13 03Allergic rhinitis 477 11028 2099 11 02 11 02 12 03All other diagnoses 545437 23756 566 08 568 10 564 10

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to form larger categories that better describe the utilization of ambulatory care services2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

24A

dvanceD

ataN

o387+

June292007

Table 14 Number percent distribution and annual rate of office visits with corresponding standard errors by patientrsquos age accordingto the five leading primary diagnosis groups United States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year2

Standarderror of

rate

All visits 963617 40611 1000 3310 139

Under 1 year

All visits 32070 3406 1000 7816 830Routine infant or child health check V202 14528 1965 453 31 3541 479Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 3442 593 107 16 839 145Otitis media and eustachian tube disorders 381ndash382 2541 559 79 15 619 136Certain conditions originating in the perinatal period 760ndash779 34 08 269 65Unspecified viral and chlamydial infection 799 19 07 148 64All other diagnoses 9847 1134 307 22 2400 276

1ndash12 years

All visits 112241 8094 1000 2337 169Routine infant or child health check V202 21953 2294 196 14 457 48Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 12310 1705 110 11 256 36Otitis media and eustachian tube disorders 381ndash382 7901 843 70 07 165 18Asthma 493 4252 1126 38 10 89 23Acute pharyngitis 462 4203 868 37 07 88 18All other diagnoses 61622 4491 549 15 1283 94

13ndash21 years

All visits 66533 3594 1000 1785 96Routine infant or child health check V202 5334 803 80 11 143 22Normal pregnancy V22 3331 830 50 12 3182 45Acne 7060ndash7061 2931 560 44 08 79 15Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 2915 501 44 07 78 13Acute pharyngitis 462 2248 597 34 09 60 16All other diagnoses 49774 2793 748 18 1335 75

22ndash49 years

All visits 290199 14182 1000 2490 122Normal pregnancy V22 12178 1924 42 07 4207 33Spinal disorders 720ndash724 10148 1340 35 04 87 12Arthropathies and related disorders 710ndash719 9874 1767 34 06 85 15Gynecological examination V723 9496 1431 33 05 4161 24Essential hypertension 401 9361 1362 32 04 80 12All other diagnoses 239141 12253 824 11 2052 105

50ndash64 years

All visits 214891 10973 1000 4292 219Essential hypertension 401 15519 1884 72 08 310 38Arthropathies and related disorders 710ndash719 11162 1512 52 06 223 30Diabetes mellitus 250 9272 1048 43 04 185 21Malignant neoplasms 140ndash208230ndash234 8870 1861 41 08 177 37Spinal disorders 720ndash724 6530 935 30 04 130 19All other diagnoses 163538 8317 761 11 3266 166

65 years and over

All visits 247683 15541 1000 7047 442Essential hypertension 401 19129 2184 77 08 544 62Malignant neoplasms 140ndash208230ndash234 15679 3215 63 12 446 91Arthropathies and related disorders 710ndash719 11814 1815 48 06 336 52Diabetes mellitus 250 11253 1594 45 06 320 45Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 7824 1167 32 04 223 33All other diagnoses 181986 11408 735 12 5177 325

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth RevisionClinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to better describe the use ofambulatory care services2Visit rates for age are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Populations Division US Census Bureau3The population used for this rate is based on visits by females 13ndash21 years of age For males in this age group the leading diagnosis was routine infant or child health check (155 visits per 100males 13ndash21 years SE=31)4The population used for this rate is based on visits by females 22ndash49 years of age For males in this age group the leading diagnosis was essential hypertension (84 visits per 100 males 22ndash49years SE=15)

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 25

Table 15 Number percent distribution and annual rate of injury-related office visits with corresponding standard errors by selectedpatient characteristics United States 2005

Patient characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror of

rate

All injury-related visits2 89412 5466 1000 307 19

Age

Under 15 years 11556 1126 129 11 191 19Under 1 year 07 03 157 611ndash4 years 3191 495 36 06 197 315ndash14 years 7721 853 86 08 191 21

15ndash24 years 10006 973 112 09 244 2425ndash44 years 23053 1919 258 13 281 2345ndash64 years 28197 2050 315 13 390 2865 years and over 16600 1684 186 14 472 48

65ndash74 years 8111 976 91 09 441 5375 years and over 8489 937 95 08 507 56

Sex and age

Female 44177 2711 494 13 297 18Under 15 years 5017 622 56 07 169 2115ndash24 years 4610 575 52 06 227 2825ndash44 years 10286 921 115 08 248 2245ndash64 years 14917 1251 167 11 401 3465ndash74 years 4364 692 49 07 437 6975 years and over 4983 598 56 06 489 59

Male 45235 3233 506 13 318 23Under 15 years 6539 754 73 08 211 2415ndash24 years 5396 670 60 06 260 3225ndash44 years 12767 1329 143 11 315 3345ndash64 years 13280 1232 149 10 378 3565ndash74 years 3747 590 42 06 445 7075 years and over 3505 600 39 06 535 92

Race3

White 79208 4958 886 11 338 21Black or African American 6838 979 76 10 187 27Other 3365 602 38 06 164 29

Ethnicity

Hispanic or Latino 10578 1562 118 15 251 37Not Hispanic or Latino 78834 4812 882 15 317 19

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2Injury visits represent 93 percent (SE=04) of all office visits3Other race includes visits by Asians Native Hawaiians or Other Pacific Islanders American Indians or Alaska Natives and multiple races All race categories include visits by persons of Hispanicorigin and not Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for FederalData on Race and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typicallyfound for self-reported race in household surveys

NOTE Numbers may not add to totals because of rounding

Table 16 Number and percent distribution of injury-related office visits with corresponding standard errors by intent United States2005

Intent

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All injury-related visits 89412 5466 1000 Unintentional injuries 40934 4147 458 26Intentional injuries 1805 338 20 04Adverse effect of medical or surgical care or adverse effect of medicinal drug 8264 922 92 10Injuries of undetermined intent 32853 2362 367 24Unknown or blank 5556 993 62 11

Category not applicable

NOTE Numbers may not add to totals because of rounding

26 Advance Data No 387 + June 29 2007

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Number of visits in thousands

All visits 963617 432754 283180 119061 128623 560355 403262

At least one condition 507390 121891 187209 94472 103818 298366 209024None 422515 295386 85466 21112 20551 242189 180327Blank 33712 15476 10505 3477 4254 19800 13911

Hypertension 219476 23060 84640 52131 59646 127072 92404Arthritis 137942 20861 51744 27168 38169 91610 46332Hyperlipidemia 130053 12806 55561 31658 30028 68208 61845Diabetes 94359 10387 38628 23810 21534 50625 43733Depression 84610 30935 35059 8538 10078 59418 25192Obesity 68201 24275 29574 9298 5054 45028 23173Cancer 57025 4817 18809 15014 18384 32384 24640Asthma 54545 28913 14491 5764 5376 33276 21269COPD2 40754 7746 11425 10818 10764 22458 18295Ischemic heart disease 39559 1472 10179 12092 15815 16245 23314Osteoporosis 27977 6466 8050 12096 24842 3136Cerebrovascular disease 18319 731 4322 5489 7777 9000 9319CHF3 15692 3589 3409 8392 8950 6742Chronic renal failure 11486 2741 3039 4969 5633 5852

Standard error in thousands

All visits 40611 19288 13998 7460 8954 24487 18050

At least one condition 26734 6497 10543 6419 7920 16807 10964None 20054 14902 5424 1860 2135 11620 9940Blank 3749 1854 1445 668 650 2377 1724

Hypertension 14790 1976 5958 4176 5097 8906 6596Arthritis 9990 1930 4317 2357 3632 7470 3168Hyperlipidemia 9484 1139 4425 2773 3051 5051 4972Diabetes 6585 1133 3024 1939 2203 3811 3366Depression 6884 2367 3465 1084 1288 5082 2137Obesity 5885 2496 2961 1225 842 4156 2401Cancer 6483 782 2373 2149 2161 4421 2379Asthma 3877 2528 1350 712 814 2466 2012COPD2 3794 1054 1259 1356 1583 2332 1790Ischemic heart disease 3659 321 1097 1274 1920 1831 2301Osteoporosis 2821 892 1015 1413 2419 608Cerebrovascular disease 2290 188 717 844 1165 1187 1330CHF3 2054 768 561 1365 1351 1076Chronic renal failure 1713 799 609 890 829 1151

Percent distribution

All visits 1000 1000 1000 1000 1000 1000 100

At least one condition 527 282 661 793 807 532 518None 438 683 302 177 160 432 447Blank 35 36 37 29 33 35 34

Hypertension 228 53 299 438 464 227 229Arthritis 143 48 183 228 297 163 115Hyperlipidemia 135 30 196 266 233 122 153Diabetes 98 24 136 200 167 90 108Depression 88 71 124 72 78 106 62Obesity 71 56 104 78 39 80 57Cancer 59 11 66 126 143 58 61Asthma 57 67 51 48 42 59 53COPD2 42 18 40 91 84 40 45Ischemic heart disease 41 03 36 102 123 29 58Osteoporosis 29 03 23 68 94 44 08Cerebrovascular disease 19 02 15 46 60 16 23CHF3 16 01 13 29 65 16 17Chronic renal failure 12 02 10 26 39 10 15

See footnotes at end of table

Advance Data No 387 + June 29 2007 27

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005mdashCon

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Standard error of percent

All visits

At least one condition 13 10 13 13 15 14 14None 12 11 13 12 14 13 14Blank 04 04 05 06 05 04 04

Hypertension 10 04 13 19 17 11 11Arthritis 07 04 11 13 17 09 06Hyperlipidemia 08 03 12 17 16 08 10Diabetes 05 03 07 11 10 05 06Depression 06 05 10 09 09 08 05Obesity 05 05 09 09 06 06 05Cancer 06 02 08 14 13 07 05Asthma 03 05 04 06 06 04 05COPD2 03 02 04 10 10 03 04Ischemic heart disease 03 01 03 08 10 03 05Osteoporosis 02 01 03 08 08 03 01Cerebrovascular disease 02 00 02 06 07 02 03CHF3 02 00 03 04 09 02 03Chronic renal failure 02 01 03 05 06 01 03

Figure does not meet standards of reliability or precision Category not applicable1Presence of chronic conditions regardless of visit diagnosis were based on checkbox responses2COPD is chronic obstructive pulmonary disease3CHF is congestive heart failure

NOTE Numbers may not add to totals because more than one condition may be reported per visit

28 Advance Data No 387 + June 29 2007

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 4 Number and percentage of office visits with corresponding standard errors by expected sources of payment United States2005

Expected sources of payment

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Private insurance 608219 27808 631 12Medicare 231655 15483 240 10

Medicare and Medicaid 19002 2854 20 03Medicaid or SCHIP2 108601 8545 113 07No insurance3 43435 4232 45 04

Self-pay 39172 3935 41 04No charge or charity 4518 1361 05 01

Workerrsquos compensation 10014 1643 10 02Other 24122 3454 25 04Unknown or blank 16948 2259 18 02

Category not applicable Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit2SCHIP is State Childrenrsquos Health Insurance Program3No insurance is defined as having only self-pay no charge or charity as payment sources

NOTE More than one category could be indicated

Table 5 Number and percent distribution of office visits with corresponding standard errors by selected visit characteristics accordingto prior-visit status United States 2005

Prior-visit status primary care provider and referral status

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Visit to PCP1 485400 29737 504 18Visit to non-PCP1 438002 21738 455 17

Referred for this visit 135616 10767 141 10Not referred for this visit 235086 15238 244 13Unknown if referred 34830 4324 37 05

Unknown if PCP1 visit 40215 6156 42 06

Established patient

All visits 841424 36855 873 06

Visit to PCP1 463044 28985 550 19Visit to non-PCP1 346613 17760 412 17

Referred for this visit 82619 7925 98 09Not referred for this visit 212104 13959 252 14Unknown if referred 24848 3045 30 04

Unknown if PCP1 visit 31766 5139 38 06

New patient

All visits 122193 7282 127 06

Visit to PCP1 22356 2286 183 18Visit to non-PCP1 91389 6478 748 20

Referred for this visit 52997 4089 434 24Not referred for this visit 22981 3070 188 19Unknown if referred 9982 1845 82 15

Unknown if PCP1visit 8449 1397 69 11

Category not applicable1PCP is patientrsquos primary care provider as indicated by a positive response to the question lsquolsquoAre you the patientrsquos primary care physicianproviderrsquorsquo

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 15

Table 6 Percent distribution of office visits with corresponding standard errors by primary care provider and referral status accordingto physician specialty United States 2005

Physician specialty TotalVisit

to PCP1

Visit to non-PCP12

Referredby otherphysician

Not referredby otherphysician

Unknownif referred

Unknown ifPCP1 visit

Percent distribution

All visits 1000 504 141 244 70 42

General and family practice 1000 871 12 42 19 56Internal medicine 1000 831 41 37 32 59Pediatrics 1000 890 13 43 20 32Obstetrics and gynecology 1000 163 163 464 145 65Ophthalmology 1000 42 148 619 166 25Orthopedic surgery 1000 11 301 485 171 32Dermatology 1000 38 253 530 152 28Psychiatry 1000 93 183 535 155 33Cardiovascular diseases 1000 251 274 343 97 34General surgery 1000 108 538 273 54 27Otolaryngology 1000 25 388 458 106 23Urology 1000 23 302 533 126 16Neurology 1000 14 493 331 118 43All other specialties 1000 132 318 457 74 19

Standard error of percent

All visits 18 10 13 06 06

General and family practice 21 02 11 05 15Internal medicine 38 14 14 13 20Pediatrics 22 05 11 06 14Obstetrics and gynecology 44 39 45 37 21Ophthalmology 35 27 48 40 06Orthopedic surgery 08 34 55 42 11Dermatology 20 43 54 36 13Psychiatry 53 54 59 39 12Cardiovascular diseases 58 56 68 28 14General surgery 48 57 44 13 11Otolaryngology 15 48 47 24 07Urology 15 30 39 23 04Neurology 05 61 53 39 15All other specialties 39 46 51 15 06

Figure does not meet standards of reliability or precision Category not applicable1PCP is patientrsquos primary care provider as indicated by a positive response to question lsquolsquoAre you the patientrsquos primary care physicianproviderrsquorsquo2Referral status only asked for visits to nonprimary care physicians or providers

NOTE Numbers may not add to totals because of rounding

16 Advance Data No 387 + June 29 2007

Table 7 Number and percent distribution of office visits with corresponding standard errors by continuity-of-care visit characteristics according to specialty type United States2005

Continuity-of-care visit characteristicsAll

specialties

Specialty type1

Allspecialties

Specialty type1

Primarycare

Surgicalspecialties

Medicalspecialties

Primarycare

Surgicalspecialties

Medicalspecialties

Number of visits in thousands Standard error in thousands

All visits 963617 573169 200217 190232 40611 30799 14169 14476

Prior-visit status and number of visits in last 12 months

Established patient 841424 519718 159887 161819 36855 28457 11684 12617None 55122 29404 15949 9768 3566 2560 1676 17911ndash2 visits 283537 161363 65878 56296 15225 10389 5578 45773ndash5 visits 275063 176109 49094 49860 13875 11038 4108 42976 or more visits 227702 152842 28966 45894 12916 11188 3277 5610

New patient 122193 53451 40330 28413 7282 5179 3178 3251

Percent distribution Standard error of percent

All visits 1000 1000 1000 1000

Prior-visit status and number of visits in last 12 months

Established patient 873 907 799 851 06 08 09 13None 57 51 80 51 03 03 07 081ndash2 visits 294 282 329 296 08 10 13 143ndash5 visits 285 307 245 262 06 09 10 116 or more visits 236 267 145 241 11 14 13 21

New patient 127 93 201 149 06 08 09 13

Category not applicable1Specialty type defined in lsquolsquoPhysician specialty groupsrsquorsquo section in lsquolsquoMethodsrsquorsquo

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200717

Table 8 Number and percent distribution of office visits with corresponding standard errors by patientrsquos principal reason for visitmodule United States 2005

Principal reason for visit module and RVC code1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Symptom module S001ndashS999 457871 21644 475 10General symptoms S001ndashS099 52745 3722 55 03Symptoms referable to psychological and mental disorders S100ndashS199 29642 2934 31 03Symptoms referable to the nervous system (excluding sense organs) S200ndashS259 24074 1987 25 02Symptoms referable to the cardiovascular and lymphatic system S260ndashS299 4465 708 05 01Symptoms referable to the eyes and ears S300ndashS399 48487 3638 50 03Symptoms referable to the respiratory system S400ndashS499 95792 6343 99 05Symptoms referable to the digestive system S500ndashS639 33341 2513 35 02Symptoms referable to the genitourinary system S640ndashS829 30560 1915 32 02Symptoms referable to the skin hair and nails S830ndashS899 43807 3147 45 03Symptoms referable to the musculoskeletal system S900ndashS999 94956 6794 99 05

Disease module D001ndashD999 125461 9100 130 08Diagnostic screening and preventive module X100ndashX599 179769 10984 187 08Treatment module T100ndashT899 136372 8939 142 07Injuries and adverse effects module J001ndashJ999 24173 2060 25 02Test results module R100ndashR700 23508 1778 24 02Administrative module A100ndashA140 7457 1187 08 01Other2 U990ndashU999 9007 1595 09 02

Category not applicable1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (22)2Includes problems and complaints not elsewhere classified entries of lsquolsquononersquorsquo blanks and illegible entries

NOTE Numbers may not add to totals because of rounding

Table 9 Number and percent distribution of office visits with corresponding standard errors by the 20 principal reasons for visit mostfrequently mentioned by patients according to patientrsquos sex United States 2005

Principal reason for visit and RVC code1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

General medical examination X100 71392 5674 74 04 64 05 88 06Progress visit not otherwise specified T800 42201 4035 44 04 42 04 47 04Cough S440 32482 2842 34 02 30 02 39 04Postoperative visit T205 31985 3811 33 04 33 04 34 05Medication other and unspecified kinds T115 19896 2306 21 02 19 02 23 03Gynecological examination X225 18254 2709 19 03 33 05 Hypertension D510 16988 2478 18 02 16 02 20 04Prenatal examination routine X205 16759 2771 17 03 30 05 Symptoms referable to throat S455 16440 1892 17 02 16 02 18 02Knee symptoms S925 16076 1801 17 02 18 02 15 02Well-baby examination X105 15268 2037 16 02 13 02 20 03Back symptoms S905 14643 1599 15 01 16 02 14 02Vision dysfunctions S305 13556 1872 14 02 15 02 13 02For other and unspecified test results R700 13211 1377 14 01 13 02 15 02Nasal congestion S400 13164 2137 14 02 10 02 19 03Eye examination X230 12528 2709 13 03 14 03 12 03Skin rash S860 12527 1188 13 01 12 02 14 01Diabetes mellitus D205 12192 1981 13 02 12 02 13 02Depression S110 12062 1511 13 02 13 02 11 02Earache or ear infection S355 11805 1107 12 01 10 01 15 02All other reasons 550190 24483 571 09 571 10 571 10

Category not applicable1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (22)2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

18 Advance Data No 387 + June 29 2007

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Number of visits in thousands

All visits 963617 319330 290545 89843 70669 174387 18845

Age

Under 15 years 160552 76704 18243 8527 3397 51622 2058Under 1 year 32070 11996 1282 17289 1ndash4 years 50400 25199 4182 2462 1081 16723 5ndash14 years 78082 39509 12779 5103 2125 17610

15ndash24 years 70583 27679 12350 5140 4873 19403 113825ndash44 years 201619 69933 51314 18727 16156 41942 354745ndash64 years 283180 84793 103754 29448 22047 37770 536865 years and over 247683 60221 104885 28000 24195 23650 6733

65ndash74 years 119061 28774 48255 14213 11487 12652 368075 years and over 128623 31447 56630 13787 12708 10998 3053

Sex

Female 560355 178477 168169 52297 39506 110589 11316Male 403262 140853 122376 37545 31162 63798 7528

Race2

White 832038 277587 251698 78452 62031 146794 15476Black or African American 88930 27098 27399 8154 6909 18139 1231Other 42649 14645 11449 3236 1728 9454 2137

Ethnicity2

Hispanic or Latino 98904 35026 26216 7016 6382 21039 3225Not Hispanic or Latino 864714 284304 264330 82827 64286 153348 15620

Expected source of payment3

Private insurance 608219 208219 174252 55707 40982 119864 9194Medicare 231655 56954 98344 27824 20905 22276 5352

Medicare and Medicaid 19002 4404 8958 2163 1140 1688 Medicaid or SCHIP4 108601 36794 28674 10323 5343 25488 1979Self-pay no charge or charity 49026 17446 14718 3220 6622 6110 Other5 51083 15679 15540 4763 6528 7160 1415

Standard error in thousands

All visits 40611 15701 14938 7475 6580 11005 3568

Age

Under 15 years 11524 6511 2408 1135 582 4532 514Under 1 year 3406 1587 367 2064 1ndash4 years 4582 2644 907 431 247 1972 5ndash14 years 4849 3142 1599 725 374 1605

15ndash24 years 4028 1901 1015 893 862 2191 37725ndash44 years 10521 4664 3704 1797 1918 3739 84745ndash64 years 13998 4755 5941 2571 2298 4309 115065 years and over 15541 4688 7577 3112 2856 2762 175065ndash74 years 7460 2206 3752 1771 1566 1469 132675 years and over 8954 2980 4464 1660 1618 1567 636

Sex

Female 24487 8994 9764 5246 3977 7175 2026Male 18050 7589 6501 2822 3371 5494 1651

Race2

White 36280 14035 13292 6241 5742 9867 3097Black or African American 7582 3077 3048 1522 1296 2275 341Other 5779 2563 2343 811 427 1345 1545

See footnotes at end of table

Advance Data No 387 + June 29 2007 19

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Ethnicity2 Standard error in thousands

Hispanic or Latino 9332 3572 3770 1275 1052 2615 801Not Hispanic or Latino 37628 14683 13732 6857 6029 10180 3091

Expected source of payment3

Private insurance 27808 10683 9568 5365 4542 8544 1727Medicare 15483 4596 7563 2961 2760 2869 1225

Medicare and Medicaid 2854 874 1554 556 394 581 Medicaid or SCHIP4 8545 3808 3239 1294 670 3275 638Self-pay no charge or charity 4662 2448 1495 488 1921 881 Other5 4411 1581 1950 606 1079 1238 426

Percent distribution

All visits 1000 331 302 93 73 181 20

Age

Under 15 years 1000 478 114 53 21 322 13Under 1 year 1000 374 40 30 06 539 111ndash4 years 1000 500 83 49 21 332 155ndash14 years 1000 506 164 65 27 226 12

15ndash24 years 1000 392 175 73 69 275 1625ndash44 years 1000 347 255 93 80 208 1845ndash64 years 1000 299 366 104 78 133 1965 years and over 1000 243 423 113 98 95 27

65ndash74 years 1000 242 405 119 96 106 3175 years and over 1000 244 440 107 99 86 24

Sex

Female 1000 319 300 93 71 197 20Male 1000 349 303 93 77 158 19

Race2

White 1000 334 303 94 75 176 19Black or African American 1000 305 308 92 78 204 14Other 1000 343 268 76 41 222 50

Ethnicity2

Hispanic or Latino 1000 354 265 71 65 213 33Not Hispanic or Latino 1000 329 306 96 74 177 18

Expected source of payment3

Private insurance 1000 342 286 92 67 197 15Medicare 1000 246 425 120 90 96 23

Medicare and Medicaid 1000 232 471 114 60 89 34Medicaid or SCHIP4 1000 339 264 95 49 235 18Self-pay no charge or charity 1000 356 300 66 135 125 19Other5 1000 307 304 93 128 140 28

Standard error of percent

All visits 09 10 06 06 08 04

Age

Under 15 years 17 14 06 04 15 03Under 1 year 26 11 07 05 26 041ndash4 years 27 16 07 05 24 055ndash14 years 21 18 08 05 17 04

15ndash24 years 22 12 11 12 23 0525ndash44 years 14 14 07 09 15 0445ndash64 years 10 14 07 07 12 0465 years and over 11 17 09 10 10 07

65ndash74 years 13 20 12 11 11 1175 years and over 14 18 10 11 11 05

See footnotes at end of table

20 Advance Data No 387 + June 29 2007

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Sex Standard error of percent

Female 10 12 07 07 10 03Male 11 12 06 08 10 04

Race2

White 09 11 05 06 08 04Black or African American 20 21 15 14 22 04Other 30 35 18 10 28 34

Ethnicity2

Hispanic or Latino 22 23 10 09 21 07Not Hispanic or Latino 09 11 06 07 08 03

Expected source of payment3

Private insurance 10 12 07 07 09 03Medicare 11 17 09 10 11 05

Medicare and Medicaid 26 42 25 19 28 12Medicaid or SCHIP4 21 23 09 06 23 06Self-pay no charge or charity 30 26 08 34 17 06Other5 19 22 10 18 21 08

Figure does not meet standards of reliability or precision Category not applicable1Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)2Other race includes visits by Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories inlcude visits by persons of Hispanic andnot Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data onRace and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple race indicated is small and lower than what is typically found forself-reported race in household surveys3Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit4SCHIP is State Childrenrsquos Health Insurance Program5Other includes workerrsquos compensation unknown or blank and payments not classified elsewhere

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 21

Table 11 Number percent distribution and annual rate of preventive care office visits and percent of visits to primary care specialistswith corresponding standard errors by selected patient and visit characteristics United States 2005

Patient and visit characteristics

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror

of rate

Percent ofpreventive carevisits made toprimary carespecialists2

Standarderror ofpercent

All preventive care visits3 174387 11005 1000 599 38 853 16

Age

Under 15 years 51622 4532 296 22 851 75 973 11Under 1 year 17289 2064 99 11 4214 503 998 011ndash4 years 16723 1972 96 10 1033 122 980 125ndash14 years 17610 1605 101 08 436 40 943 22

15ndash24 years 19403 2191 111 11 473 53 952 1725ndash44 years 41942 3739 241 16 512 46 903 1945ndash64 years 37770 4309 217 17 522 60 765 3065 years and over 23650 2762 136 13 673 79 561 45

65ndash74 years 12652 1469 73 07 688 80 609 4475 years and over 10998 1567 63 08 656 94 506 59

Sex and age

Female 110589 7175 634 18 744 48 870 16Under 15 years 23224 2063 133 10 784 70 979 0815ndash24 years 15134 1874 87 10 746 92 971 0825ndash44 years 33658 3258 193 16 813 79 929 1745ndash64 years 23897 2473 137 10 642 66 777 3065ndash74 years 7748 980 44 05 776 98 657 5275 years and over 6929 1030 40 05 679 101 552 57

Male 63798 5494 366 18 448 39 824 20Under 15 years 28399 2848 163 14 915 92 969 1515ndash24 years 4269 731 24 04 206 35 883 5825ndash44 years 8284 1244 48 06 204 31 796 4345ndash64 years 13873 2561 80 13 395 73 745 5065ndash74 years 4904 724 28 04 583 86 532 5875 years and over 4069 708 23 04 621 108 427 82

Race4

White 146794 9867 842 15 627 42 843 18Black or African American 18139 2275 104 12 496 62 906 21Other 9454 1345 54 07 462 66 915 29

Ethnicity4

Hispanic or Latino 21039 2615 121 14 499 62 914 20Not Hispanic or Latino 153348 10180 879 14 616 41 845 17

Expected source(s) of payment5

Private insurance 119864 8544 687 20 619 44 866 16Medicare 22276 2869 128 13 592 76 591 48

Medicare and Medicaid 1688 581 10 03 599 156MedicaidSCHIP6 25488 3275 146 17 795 102 928 19Self-pay no charge or charity7 6110 881 35 05 146 21 810 47Other8 7160 1238 41 07 767 56

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau Visit rates for expected source(s) of payment are based on the 2005 National Health Interview Survey estimates of health insurance2Primary care specialty defined in specialty type classification found in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo3Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)4Other race includes Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic and notHispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data on Raceand Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typically found forself-reported race in household surveys5Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit6SCHIP is State Childrenrsquos Health Insurance Program7The visit rate was calculated using lsquolsquouninsuredrsquorsquo as the denominator from the 2005 estimates of health insurance coverage from the National Health Inteview Survey8Other includes workerrsquos compensation unknown or blank and sources not elsewhere classified

NOTE Numbers may not add to totals because of rounding

22 Advance Data No 387 + June 29 2007

Table 12 Number and percent distribution of office visits with corresponding standard errors by physicianrsquos primary diagnosisUnited States 2005

Major disease category and ICDndash9ndashCM code range1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Infectious and parasitic diseases 001ndash139 26720 2062 28 02Neoplasms 140ndash239 39200 5285 41 05Endocrine nutritional and metabolic diseases and immunity disorders 240ndash279 56408 4655 59 04Mental disorders 290ndash319 47094 3777 49 04Diseases of the nervous system and sense organs 320ndash389 86128 6644 89 05Diseases of the circulatory system 390ndash459 81836 6683 85 06Diseases of the respiratory system 460ndash519 110999 7670 115 07Diseases of the digestive system 520ndash579 28678 2225 30 02Diseases of the genitourinary system 580ndash629 42256 3131 44 03Diseases of the skin and subcutaneous tissue 680ndash709 44443 3189 46 03Diseases of the musculoskeletal system and connective tissue 710ndash739 80601 6320 84 05Symptoms signs and ill-defined conditions 780ndash799 60536 3916 63 03Injury and poisoning 800ndash999 45137 3087 47 03Supplementary classification V01ndashV82 179276 11124 186 09All other diagnoses2 25609 3533 27 03Unknown3 8697 1645 09 02

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23)2Includes diseases of the blood and blood-forming organs (280ndash289) complications of pregnancy childbirth and the puerperium (630ndash677) congenital anomalies (740ndash759) certain conditionsoriginating in the perinatal period (760ndash779) and entries not codable to the ICDndash9ndashCM (eg illegible entries left against medical advice transferred entries of lsquolsquononersquorsquo or lsquolsquono diagnosesrsquorsquo)3Includes blank diagnoses

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 23

Table 13 Number and percent distribution of office visits with corresponding standard errors by the 20 leading primary diagnosis groups according to patientrsquos sexUnited States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

Essential hypertension 401 44670 4318 46 04 44 04 50 05Routine infant or child health check V202 41816 4044 43 04 33 03 57 06Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 36372 2875 38 03 33 03 45 04Arthropathies and related disorders 710ndash719 34299 4200 36 04 42 06 27 03Malignant neoplasms 140ndash208230ndash234 28709 5644 30 06 30 07 30 04Diabetes mellitus 250 25451 2730 26 03 25 03 29 03Spinal disorders 720ndash724 22732 2523 24 02 24 02 23 03Rheumatism excluding back 725ndash729 18580 1580 19 01 19 02 19 02General medical examination V70 17007 2377 18 02 15 02 22 03Follow up examination V67 16249 2573 17 02 17 03 16 03Specific procedures and aftercare V50ndashV599 15662 2000 16 02 17 02 15 03Normal pregnancy V22 15509 2534 16 03 28 05 Gynecological examination V723 15067 2378 16 02 27 04 Otitis media and eustachian tube disorders 381ndash382 14399 1517 15 01 12 01 19 02Asthma 493 12823 2102 13 02 11 02 16 04Disorders of lipoid metabolism 272 12650 1416 13 01 11 02 16 02Chronic sinusitis 473 12621 1302 13 01 12 01 14 02Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 11473 1490 12 01 10 01 15 02Acute pharyngitis 462 11064 1941 11 02 11 02 13 03Allergic rhinitis 477 11028 2099 11 02 11 02 12 03All other diagnoses 545437 23756 566 08 568 10 564 10

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to form larger categories that better describe the utilization of ambulatory care services2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

24A

dvanceD

ataN

o387+

June292007

Table 14 Number percent distribution and annual rate of office visits with corresponding standard errors by patientrsquos age accordingto the five leading primary diagnosis groups United States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year2

Standarderror of

rate

All visits 963617 40611 1000 3310 139

Under 1 year

All visits 32070 3406 1000 7816 830Routine infant or child health check V202 14528 1965 453 31 3541 479Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 3442 593 107 16 839 145Otitis media and eustachian tube disorders 381ndash382 2541 559 79 15 619 136Certain conditions originating in the perinatal period 760ndash779 34 08 269 65Unspecified viral and chlamydial infection 799 19 07 148 64All other diagnoses 9847 1134 307 22 2400 276

1ndash12 years

All visits 112241 8094 1000 2337 169Routine infant or child health check V202 21953 2294 196 14 457 48Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 12310 1705 110 11 256 36Otitis media and eustachian tube disorders 381ndash382 7901 843 70 07 165 18Asthma 493 4252 1126 38 10 89 23Acute pharyngitis 462 4203 868 37 07 88 18All other diagnoses 61622 4491 549 15 1283 94

13ndash21 years

All visits 66533 3594 1000 1785 96Routine infant or child health check V202 5334 803 80 11 143 22Normal pregnancy V22 3331 830 50 12 3182 45Acne 7060ndash7061 2931 560 44 08 79 15Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 2915 501 44 07 78 13Acute pharyngitis 462 2248 597 34 09 60 16All other diagnoses 49774 2793 748 18 1335 75

22ndash49 years

All visits 290199 14182 1000 2490 122Normal pregnancy V22 12178 1924 42 07 4207 33Spinal disorders 720ndash724 10148 1340 35 04 87 12Arthropathies and related disorders 710ndash719 9874 1767 34 06 85 15Gynecological examination V723 9496 1431 33 05 4161 24Essential hypertension 401 9361 1362 32 04 80 12All other diagnoses 239141 12253 824 11 2052 105

50ndash64 years

All visits 214891 10973 1000 4292 219Essential hypertension 401 15519 1884 72 08 310 38Arthropathies and related disorders 710ndash719 11162 1512 52 06 223 30Diabetes mellitus 250 9272 1048 43 04 185 21Malignant neoplasms 140ndash208230ndash234 8870 1861 41 08 177 37Spinal disorders 720ndash724 6530 935 30 04 130 19All other diagnoses 163538 8317 761 11 3266 166

65 years and over

All visits 247683 15541 1000 7047 442Essential hypertension 401 19129 2184 77 08 544 62Malignant neoplasms 140ndash208230ndash234 15679 3215 63 12 446 91Arthropathies and related disorders 710ndash719 11814 1815 48 06 336 52Diabetes mellitus 250 11253 1594 45 06 320 45Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 7824 1167 32 04 223 33All other diagnoses 181986 11408 735 12 5177 325

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth RevisionClinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to better describe the use ofambulatory care services2Visit rates for age are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Populations Division US Census Bureau3The population used for this rate is based on visits by females 13ndash21 years of age For males in this age group the leading diagnosis was routine infant or child health check (155 visits per 100males 13ndash21 years SE=31)4The population used for this rate is based on visits by females 22ndash49 years of age For males in this age group the leading diagnosis was essential hypertension (84 visits per 100 males 22ndash49years SE=15)

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 25

Table 15 Number percent distribution and annual rate of injury-related office visits with corresponding standard errors by selectedpatient characteristics United States 2005

Patient characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror of

rate

All injury-related visits2 89412 5466 1000 307 19

Age

Under 15 years 11556 1126 129 11 191 19Under 1 year 07 03 157 611ndash4 years 3191 495 36 06 197 315ndash14 years 7721 853 86 08 191 21

15ndash24 years 10006 973 112 09 244 2425ndash44 years 23053 1919 258 13 281 2345ndash64 years 28197 2050 315 13 390 2865 years and over 16600 1684 186 14 472 48

65ndash74 years 8111 976 91 09 441 5375 years and over 8489 937 95 08 507 56

Sex and age

Female 44177 2711 494 13 297 18Under 15 years 5017 622 56 07 169 2115ndash24 years 4610 575 52 06 227 2825ndash44 years 10286 921 115 08 248 2245ndash64 years 14917 1251 167 11 401 3465ndash74 years 4364 692 49 07 437 6975 years and over 4983 598 56 06 489 59

Male 45235 3233 506 13 318 23Under 15 years 6539 754 73 08 211 2415ndash24 years 5396 670 60 06 260 3225ndash44 years 12767 1329 143 11 315 3345ndash64 years 13280 1232 149 10 378 3565ndash74 years 3747 590 42 06 445 7075 years and over 3505 600 39 06 535 92

Race3

White 79208 4958 886 11 338 21Black or African American 6838 979 76 10 187 27Other 3365 602 38 06 164 29

Ethnicity

Hispanic or Latino 10578 1562 118 15 251 37Not Hispanic or Latino 78834 4812 882 15 317 19

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2Injury visits represent 93 percent (SE=04) of all office visits3Other race includes visits by Asians Native Hawaiians or Other Pacific Islanders American Indians or Alaska Natives and multiple races All race categories include visits by persons of Hispanicorigin and not Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for FederalData on Race and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typicallyfound for self-reported race in household surveys

NOTE Numbers may not add to totals because of rounding

Table 16 Number and percent distribution of injury-related office visits with corresponding standard errors by intent United States2005

Intent

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All injury-related visits 89412 5466 1000 Unintentional injuries 40934 4147 458 26Intentional injuries 1805 338 20 04Adverse effect of medical or surgical care or adverse effect of medicinal drug 8264 922 92 10Injuries of undetermined intent 32853 2362 367 24Unknown or blank 5556 993 62 11

Category not applicable

NOTE Numbers may not add to totals because of rounding

26 Advance Data No 387 + June 29 2007

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Number of visits in thousands

All visits 963617 432754 283180 119061 128623 560355 403262

At least one condition 507390 121891 187209 94472 103818 298366 209024None 422515 295386 85466 21112 20551 242189 180327Blank 33712 15476 10505 3477 4254 19800 13911

Hypertension 219476 23060 84640 52131 59646 127072 92404Arthritis 137942 20861 51744 27168 38169 91610 46332Hyperlipidemia 130053 12806 55561 31658 30028 68208 61845Diabetes 94359 10387 38628 23810 21534 50625 43733Depression 84610 30935 35059 8538 10078 59418 25192Obesity 68201 24275 29574 9298 5054 45028 23173Cancer 57025 4817 18809 15014 18384 32384 24640Asthma 54545 28913 14491 5764 5376 33276 21269COPD2 40754 7746 11425 10818 10764 22458 18295Ischemic heart disease 39559 1472 10179 12092 15815 16245 23314Osteoporosis 27977 6466 8050 12096 24842 3136Cerebrovascular disease 18319 731 4322 5489 7777 9000 9319CHF3 15692 3589 3409 8392 8950 6742Chronic renal failure 11486 2741 3039 4969 5633 5852

Standard error in thousands

All visits 40611 19288 13998 7460 8954 24487 18050

At least one condition 26734 6497 10543 6419 7920 16807 10964None 20054 14902 5424 1860 2135 11620 9940Blank 3749 1854 1445 668 650 2377 1724

Hypertension 14790 1976 5958 4176 5097 8906 6596Arthritis 9990 1930 4317 2357 3632 7470 3168Hyperlipidemia 9484 1139 4425 2773 3051 5051 4972Diabetes 6585 1133 3024 1939 2203 3811 3366Depression 6884 2367 3465 1084 1288 5082 2137Obesity 5885 2496 2961 1225 842 4156 2401Cancer 6483 782 2373 2149 2161 4421 2379Asthma 3877 2528 1350 712 814 2466 2012COPD2 3794 1054 1259 1356 1583 2332 1790Ischemic heart disease 3659 321 1097 1274 1920 1831 2301Osteoporosis 2821 892 1015 1413 2419 608Cerebrovascular disease 2290 188 717 844 1165 1187 1330CHF3 2054 768 561 1365 1351 1076Chronic renal failure 1713 799 609 890 829 1151

Percent distribution

All visits 1000 1000 1000 1000 1000 1000 100

At least one condition 527 282 661 793 807 532 518None 438 683 302 177 160 432 447Blank 35 36 37 29 33 35 34

Hypertension 228 53 299 438 464 227 229Arthritis 143 48 183 228 297 163 115Hyperlipidemia 135 30 196 266 233 122 153Diabetes 98 24 136 200 167 90 108Depression 88 71 124 72 78 106 62Obesity 71 56 104 78 39 80 57Cancer 59 11 66 126 143 58 61Asthma 57 67 51 48 42 59 53COPD2 42 18 40 91 84 40 45Ischemic heart disease 41 03 36 102 123 29 58Osteoporosis 29 03 23 68 94 44 08Cerebrovascular disease 19 02 15 46 60 16 23CHF3 16 01 13 29 65 16 17Chronic renal failure 12 02 10 26 39 10 15

See footnotes at end of table

Advance Data No 387 + June 29 2007 27

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005mdashCon

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Standard error of percent

All visits

At least one condition 13 10 13 13 15 14 14None 12 11 13 12 14 13 14Blank 04 04 05 06 05 04 04

Hypertension 10 04 13 19 17 11 11Arthritis 07 04 11 13 17 09 06Hyperlipidemia 08 03 12 17 16 08 10Diabetes 05 03 07 11 10 05 06Depression 06 05 10 09 09 08 05Obesity 05 05 09 09 06 06 05Cancer 06 02 08 14 13 07 05Asthma 03 05 04 06 06 04 05COPD2 03 02 04 10 10 03 04Ischemic heart disease 03 01 03 08 10 03 05Osteoporosis 02 01 03 08 08 03 01Cerebrovascular disease 02 00 02 06 07 02 03CHF3 02 00 03 04 09 02 03Chronic renal failure 02 01 03 05 06 01 03

Figure does not meet standards of reliability or precision Category not applicable1Presence of chronic conditions regardless of visit diagnosis were based on checkbox responses2COPD is chronic obstructive pulmonary disease3CHF is congestive heart failure

NOTE Numbers may not add to totals because more than one condition may be reported per visit

28 Advance Data No 387 + June 29 2007

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 6 Percent distribution of office visits with corresponding standard errors by primary care provider and referral status accordingto physician specialty United States 2005

Physician specialty TotalVisit

to PCP1

Visit to non-PCP12

Referredby otherphysician

Not referredby otherphysician

Unknownif referred

Unknown ifPCP1 visit

Percent distribution

All visits 1000 504 141 244 70 42

General and family practice 1000 871 12 42 19 56Internal medicine 1000 831 41 37 32 59Pediatrics 1000 890 13 43 20 32Obstetrics and gynecology 1000 163 163 464 145 65Ophthalmology 1000 42 148 619 166 25Orthopedic surgery 1000 11 301 485 171 32Dermatology 1000 38 253 530 152 28Psychiatry 1000 93 183 535 155 33Cardiovascular diseases 1000 251 274 343 97 34General surgery 1000 108 538 273 54 27Otolaryngology 1000 25 388 458 106 23Urology 1000 23 302 533 126 16Neurology 1000 14 493 331 118 43All other specialties 1000 132 318 457 74 19

Standard error of percent

All visits 18 10 13 06 06

General and family practice 21 02 11 05 15Internal medicine 38 14 14 13 20Pediatrics 22 05 11 06 14Obstetrics and gynecology 44 39 45 37 21Ophthalmology 35 27 48 40 06Orthopedic surgery 08 34 55 42 11Dermatology 20 43 54 36 13Psychiatry 53 54 59 39 12Cardiovascular diseases 58 56 68 28 14General surgery 48 57 44 13 11Otolaryngology 15 48 47 24 07Urology 15 30 39 23 04Neurology 05 61 53 39 15All other specialties 39 46 51 15 06

Figure does not meet standards of reliability or precision Category not applicable1PCP is patientrsquos primary care provider as indicated by a positive response to question lsquolsquoAre you the patientrsquos primary care physicianproviderrsquorsquo2Referral status only asked for visits to nonprimary care physicians or providers

NOTE Numbers may not add to totals because of rounding

16 Advance Data No 387 + June 29 2007

Table 7 Number and percent distribution of office visits with corresponding standard errors by continuity-of-care visit characteristics according to specialty type United States2005

Continuity-of-care visit characteristicsAll

specialties

Specialty type1

Allspecialties

Specialty type1

Primarycare

Surgicalspecialties

Medicalspecialties

Primarycare

Surgicalspecialties

Medicalspecialties

Number of visits in thousands Standard error in thousands

All visits 963617 573169 200217 190232 40611 30799 14169 14476

Prior-visit status and number of visits in last 12 months

Established patient 841424 519718 159887 161819 36855 28457 11684 12617None 55122 29404 15949 9768 3566 2560 1676 17911ndash2 visits 283537 161363 65878 56296 15225 10389 5578 45773ndash5 visits 275063 176109 49094 49860 13875 11038 4108 42976 or more visits 227702 152842 28966 45894 12916 11188 3277 5610

New patient 122193 53451 40330 28413 7282 5179 3178 3251

Percent distribution Standard error of percent

All visits 1000 1000 1000 1000

Prior-visit status and number of visits in last 12 months

Established patient 873 907 799 851 06 08 09 13None 57 51 80 51 03 03 07 081ndash2 visits 294 282 329 296 08 10 13 143ndash5 visits 285 307 245 262 06 09 10 116 or more visits 236 267 145 241 11 14 13 21

New patient 127 93 201 149 06 08 09 13

Category not applicable1Specialty type defined in lsquolsquoPhysician specialty groupsrsquorsquo section in lsquolsquoMethodsrsquorsquo

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200717

Table 8 Number and percent distribution of office visits with corresponding standard errors by patientrsquos principal reason for visitmodule United States 2005

Principal reason for visit module and RVC code1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Symptom module S001ndashS999 457871 21644 475 10General symptoms S001ndashS099 52745 3722 55 03Symptoms referable to psychological and mental disorders S100ndashS199 29642 2934 31 03Symptoms referable to the nervous system (excluding sense organs) S200ndashS259 24074 1987 25 02Symptoms referable to the cardiovascular and lymphatic system S260ndashS299 4465 708 05 01Symptoms referable to the eyes and ears S300ndashS399 48487 3638 50 03Symptoms referable to the respiratory system S400ndashS499 95792 6343 99 05Symptoms referable to the digestive system S500ndashS639 33341 2513 35 02Symptoms referable to the genitourinary system S640ndashS829 30560 1915 32 02Symptoms referable to the skin hair and nails S830ndashS899 43807 3147 45 03Symptoms referable to the musculoskeletal system S900ndashS999 94956 6794 99 05

Disease module D001ndashD999 125461 9100 130 08Diagnostic screening and preventive module X100ndashX599 179769 10984 187 08Treatment module T100ndashT899 136372 8939 142 07Injuries and adverse effects module J001ndashJ999 24173 2060 25 02Test results module R100ndashR700 23508 1778 24 02Administrative module A100ndashA140 7457 1187 08 01Other2 U990ndashU999 9007 1595 09 02

Category not applicable1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (22)2Includes problems and complaints not elsewhere classified entries of lsquolsquononersquorsquo blanks and illegible entries

NOTE Numbers may not add to totals because of rounding

Table 9 Number and percent distribution of office visits with corresponding standard errors by the 20 principal reasons for visit mostfrequently mentioned by patients according to patientrsquos sex United States 2005

Principal reason for visit and RVC code1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

General medical examination X100 71392 5674 74 04 64 05 88 06Progress visit not otherwise specified T800 42201 4035 44 04 42 04 47 04Cough S440 32482 2842 34 02 30 02 39 04Postoperative visit T205 31985 3811 33 04 33 04 34 05Medication other and unspecified kinds T115 19896 2306 21 02 19 02 23 03Gynecological examination X225 18254 2709 19 03 33 05 Hypertension D510 16988 2478 18 02 16 02 20 04Prenatal examination routine X205 16759 2771 17 03 30 05 Symptoms referable to throat S455 16440 1892 17 02 16 02 18 02Knee symptoms S925 16076 1801 17 02 18 02 15 02Well-baby examination X105 15268 2037 16 02 13 02 20 03Back symptoms S905 14643 1599 15 01 16 02 14 02Vision dysfunctions S305 13556 1872 14 02 15 02 13 02For other and unspecified test results R700 13211 1377 14 01 13 02 15 02Nasal congestion S400 13164 2137 14 02 10 02 19 03Eye examination X230 12528 2709 13 03 14 03 12 03Skin rash S860 12527 1188 13 01 12 02 14 01Diabetes mellitus D205 12192 1981 13 02 12 02 13 02Depression S110 12062 1511 13 02 13 02 11 02Earache or ear infection S355 11805 1107 12 01 10 01 15 02All other reasons 550190 24483 571 09 571 10 571 10

Category not applicable1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (22)2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

18 Advance Data No 387 + June 29 2007

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Number of visits in thousands

All visits 963617 319330 290545 89843 70669 174387 18845

Age

Under 15 years 160552 76704 18243 8527 3397 51622 2058Under 1 year 32070 11996 1282 17289 1ndash4 years 50400 25199 4182 2462 1081 16723 5ndash14 years 78082 39509 12779 5103 2125 17610

15ndash24 years 70583 27679 12350 5140 4873 19403 113825ndash44 years 201619 69933 51314 18727 16156 41942 354745ndash64 years 283180 84793 103754 29448 22047 37770 536865 years and over 247683 60221 104885 28000 24195 23650 6733

65ndash74 years 119061 28774 48255 14213 11487 12652 368075 years and over 128623 31447 56630 13787 12708 10998 3053

Sex

Female 560355 178477 168169 52297 39506 110589 11316Male 403262 140853 122376 37545 31162 63798 7528

Race2

White 832038 277587 251698 78452 62031 146794 15476Black or African American 88930 27098 27399 8154 6909 18139 1231Other 42649 14645 11449 3236 1728 9454 2137

Ethnicity2

Hispanic or Latino 98904 35026 26216 7016 6382 21039 3225Not Hispanic or Latino 864714 284304 264330 82827 64286 153348 15620

Expected source of payment3

Private insurance 608219 208219 174252 55707 40982 119864 9194Medicare 231655 56954 98344 27824 20905 22276 5352

Medicare and Medicaid 19002 4404 8958 2163 1140 1688 Medicaid or SCHIP4 108601 36794 28674 10323 5343 25488 1979Self-pay no charge or charity 49026 17446 14718 3220 6622 6110 Other5 51083 15679 15540 4763 6528 7160 1415

Standard error in thousands

All visits 40611 15701 14938 7475 6580 11005 3568

Age

Under 15 years 11524 6511 2408 1135 582 4532 514Under 1 year 3406 1587 367 2064 1ndash4 years 4582 2644 907 431 247 1972 5ndash14 years 4849 3142 1599 725 374 1605

15ndash24 years 4028 1901 1015 893 862 2191 37725ndash44 years 10521 4664 3704 1797 1918 3739 84745ndash64 years 13998 4755 5941 2571 2298 4309 115065 years and over 15541 4688 7577 3112 2856 2762 175065ndash74 years 7460 2206 3752 1771 1566 1469 132675 years and over 8954 2980 4464 1660 1618 1567 636

Sex

Female 24487 8994 9764 5246 3977 7175 2026Male 18050 7589 6501 2822 3371 5494 1651

Race2

White 36280 14035 13292 6241 5742 9867 3097Black or African American 7582 3077 3048 1522 1296 2275 341Other 5779 2563 2343 811 427 1345 1545

See footnotes at end of table

Advance Data No 387 + June 29 2007 19

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Ethnicity2 Standard error in thousands

Hispanic or Latino 9332 3572 3770 1275 1052 2615 801Not Hispanic or Latino 37628 14683 13732 6857 6029 10180 3091

Expected source of payment3

Private insurance 27808 10683 9568 5365 4542 8544 1727Medicare 15483 4596 7563 2961 2760 2869 1225

Medicare and Medicaid 2854 874 1554 556 394 581 Medicaid or SCHIP4 8545 3808 3239 1294 670 3275 638Self-pay no charge or charity 4662 2448 1495 488 1921 881 Other5 4411 1581 1950 606 1079 1238 426

Percent distribution

All visits 1000 331 302 93 73 181 20

Age

Under 15 years 1000 478 114 53 21 322 13Under 1 year 1000 374 40 30 06 539 111ndash4 years 1000 500 83 49 21 332 155ndash14 years 1000 506 164 65 27 226 12

15ndash24 years 1000 392 175 73 69 275 1625ndash44 years 1000 347 255 93 80 208 1845ndash64 years 1000 299 366 104 78 133 1965 years and over 1000 243 423 113 98 95 27

65ndash74 years 1000 242 405 119 96 106 3175 years and over 1000 244 440 107 99 86 24

Sex

Female 1000 319 300 93 71 197 20Male 1000 349 303 93 77 158 19

Race2

White 1000 334 303 94 75 176 19Black or African American 1000 305 308 92 78 204 14Other 1000 343 268 76 41 222 50

Ethnicity2

Hispanic or Latino 1000 354 265 71 65 213 33Not Hispanic or Latino 1000 329 306 96 74 177 18

Expected source of payment3

Private insurance 1000 342 286 92 67 197 15Medicare 1000 246 425 120 90 96 23

Medicare and Medicaid 1000 232 471 114 60 89 34Medicaid or SCHIP4 1000 339 264 95 49 235 18Self-pay no charge or charity 1000 356 300 66 135 125 19Other5 1000 307 304 93 128 140 28

Standard error of percent

All visits 09 10 06 06 08 04

Age

Under 15 years 17 14 06 04 15 03Under 1 year 26 11 07 05 26 041ndash4 years 27 16 07 05 24 055ndash14 years 21 18 08 05 17 04

15ndash24 years 22 12 11 12 23 0525ndash44 years 14 14 07 09 15 0445ndash64 years 10 14 07 07 12 0465 years and over 11 17 09 10 10 07

65ndash74 years 13 20 12 11 11 1175 years and over 14 18 10 11 11 05

See footnotes at end of table

20 Advance Data No 387 + June 29 2007

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Sex Standard error of percent

Female 10 12 07 07 10 03Male 11 12 06 08 10 04

Race2

White 09 11 05 06 08 04Black or African American 20 21 15 14 22 04Other 30 35 18 10 28 34

Ethnicity2

Hispanic or Latino 22 23 10 09 21 07Not Hispanic or Latino 09 11 06 07 08 03

Expected source of payment3

Private insurance 10 12 07 07 09 03Medicare 11 17 09 10 11 05

Medicare and Medicaid 26 42 25 19 28 12Medicaid or SCHIP4 21 23 09 06 23 06Self-pay no charge or charity 30 26 08 34 17 06Other5 19 22 10 18 21 08

Figure does not meet standards of reliability or precision Category not applicable1Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)2Other race includes visits by Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories inlcude visits by persons of Hispanic andnot Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data onRace and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple race indicated is small and lower than what is typically found forself-reported race in household surveys3Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit4SCHIP is State Childrenrsquos Health Insurance Program5Other includes workerrsquos compensation unknown or blank and payments not classified elsewhere

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 21

Table 11 Number percent distribution and annual rate of preventive care office visits and percent of visits to primary care specialistswith corresponding standard errors by selected patient and visit characteristics United States 2005

Patient and visit characteristics

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror

of rate

Percent ofpreventive carevisits made toprimary carespecialists2

Standarderror ofpercent

All preventive care visits3 174387 11005 1000 599 38 853 16

Age

Under 15 years 51622 4532 296 22 851 75 973 11Under 1 year 17289 2064 99 11 4214 503 998 011ndash4 years 16723 1972 96 10 1033 122 980 125ndash14 years 17610 1605 101 08 436 40 943 22

15ndash24 years 19403 2191 111 11 473 53 952 1725ndash44 years 41942 3739 241 16 512 46 903 1945ndash64 years 37770 4309 217 17 522 60 765 3065 years and over 23650 2762 136 13 673 79 561 45

65ndash74 years 12652 1469 73 07 688 80 609 4475 years and over 10998 1567 63 08 656 94 506 59

Sex and age

Female 110589 7175 634 18 744 48 870 16Under 15 years 23224 2063 133 10 784 70 979 0815ndash24 years 15134 1874 87 10 746 92 971 0825ndash44 years 33658 3258 193 16 813 79 929 1745ndash64 years 23897 2473 137 10 642 66 777 3065ndash74 years 7748 980 44 05 776 98 657 5275 years and over 6929 1030 40 05 679 101 552 57

Male 63798 5494 366 18 448 39 824 20Under 15 years 28399 2848 163 14 915 92 969 1515ndash24 years 4269 731 24 04 206 35 883 5825ndash44 years 8284 1244 48 06 204 31 796 4345ndash64 years 13873 2561 80 13 395 73 745 5065ndash74 years 4904 724 28 04 583 86 532 5875 years and over 4069 708 23 04 621 108 427 82

Race4

White 146794 9867 842 15 627 42 843 18Black or African American 18139 2275 104 12 496 62 906 21Other 9454 1345 54 07 462 66 915 29

Ethnicity4

Hispanic or Latino 21039 2615 121 14 499 62 914 20Not Hispanic or Latino 153348 10180 879 14 616 41 845 17

Expected source(s) of payment5

Private insurance 119864 8544 687 20 619 44 866 16Medicare 22276 2869 128 13 592 76 591 48

Medicare and Medicaid 1688 581 10 03 599 156MedicaidSCHIP6 25488 3275 146 17 795 102 928 19Self-pay no charge or charity7 6110 881 35 05 146 21 810 47Other8 7160 1238 41 07 767 56

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau Visit rates for expected source(s) of payment are based on the 2005 National Health Interview Survey estimates of health insurance2Primary care specialty defined in specialty type classification found in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo3Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)4Other race includes Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic and notHispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data on Raceand Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typically found forself-reported race in household surveys5Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit6SCHIP is State Childrenrsquos Health Insurance Program7The visit rate was calculated using lsquolsquouninsuredrsquorsquo as the denominator from the 2005 estimates of health insurance coverage from the National Health Inteview Survey8Other includes workerrsquos compensation unknown or blank and sources not elsewhere classified

NOTE Numbers may not add to totals because of rounding

22 Advance Data No 387 + June 29 2007

Table 12 Number and percent distribution of office visits with corresponding standard errors by physicianrsquos primary diagnosisUnited States 2005

Major disease category and ICDndash9ndashCM code range1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Infectious and parasitic diseases 001ndash139 26720 2062 28 02Neoplasms 140ndash239 39200 5285 41 05Endocrine nutritional and metabolic diseases and immunity disorders 240ndash279 56408 4655 59 04Mental disorders 290ndash319 47094 3777 49 04Diseases of the nervous system and sense organs 320ndash389 86128 6644 89 05Diseases of the circulatory system 390ndash459 81836 6683 85 06Diseases of the respiratory system 460ndash519 110999 7670 115 07Diseases of the digestive system 520ndash579 28678 2225 30 02Diseases of the genitourinary system 580ndash629 42256 3131 44 03Diseases of the skin and subcutaneous tissue 680ndash709 44443 3189 46 03Diseases of the musculoskeletal system and connective tissue 710ndash739 80601 6320 84 05Symptoms signs and ill-defined conditions 780ndash799 60536 3916 63 03Injury and poisoning 800ndash999 45137 3087 47 03Supplementary classification V01ndashV82 179276 11124 186 09All other diagnoses2 25609 3533 27 03Unknown3 8697 1645 09 02

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23)2Includes diseases of the blood and blood-forming organs (280ndash289) complications of pregnancy childbirth and the puerperium (630ndash677) congenital anomalies (740ndash759) certain conditionsoriginating in the perinatal period (760ndash779) and entries not codable to the ICDndash9ndashCM (eg illegible entries left against medical advice transferred entries of lsquolsquononersquorsquo or lsquolsquono diagnosesrsquorsquo)3Includes blank diagnoses

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 23

Table 13 Number and percent distribution of office visits with corresponding standard errors by the 20 leading primary diagnosis groups according to patientrsquos sexUnited States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

Essential hypertension 401 44670 4318 46 04 44 04 50 05Routine infant or child health check V202 41816 4044 43 04 33 03 57 06Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 36372 2875 38 03 33 03 45 04Arthropathies and related disorders 710ndash719 34299 4200 36 04 42 06 27 03Malignant neoplasms 140ndash208230ndash234 28709 5644 30 06 30 07 30 04Diabetes mellitus 250 25451 2730 26 03 25 03 29 03Spinal disorders 720ndash724 22732 2523 24 02 24 02 23 03Rheumatism excluding back 725ndash729 18580 1580 19 01 19 02 19 02General medical examination V70 17007 2377 18 02 15 02 22 03Follow up examination V67 16249 2573 17 02 17 03 16 03Specific procedures and aftercare V50ndashV599 15662 2000 16 02 17 02 15 03Normal pregnancy V22 15509 2534 16 03 28 05 Gynecological examination V723 15067 2378 16 02 27 04 Otitis media and eustachian tube disorders 381ndash382 14399 1517 15 01 12 01 19 02Asthma 493 12823 2102 13 02 11 02 16 04Disorders of lipoid metabolism 272 12650 1416 13 01 11 02 16 02Chronic sinusitis 473 12621 1302 13 01 12 01 14 02Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 11473 1490 12 01 10 01 15 02Acute pharyngitis 462 11064 1941 11 02 11 02 13 03Allergic rhinitis 477 11028 2099 11 02 11 02 12 03All other diagnoses 545437 23756 566 08 568 10 564 10

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to form larger categories that better describe the utilization of ambulatory care services2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

24A

dvanceD

ataN

o387+

June292007

Table 14 Number percent distribution and annual rate of office visits with corresponding standard errors by patientrsquos age accordingto the five leading primary diagnosis groups United States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year2

Standarderror of

rate

All visits 963617 40611 1000 3310 139

Under 1 year

All visits 32070 3406 1000 7816 830Routine infant or child health check V202 14528 1965 453 31 3541 479Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 3442 593 107 16 839 145Otitis media and eustachian tube disorders 381ndash382 2541 559 79 15 619 136Certain conditions originating in the perinatal period 760ndash779 34 08 269 65Unspecified viral and chlamydial infection 799 19 07 148 64All other diagnoses 9847 1134 307 22 2400 276

1ndash12 years

All visits 112241 8094 1000 2337 169Routine infant or child health check V202 21953 2294 196 14 457 48Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 12310 1705 110 11 256 36Otitis media and eustachian tube disorders 381ndash382 7901 843 70 07 165 18Asthma 493 4252 1126 38 10 89 23Acute pharyngitis 462 4203 868 37 07 88 18All other diagnoses 61622 4491 549 15 1283 94

13ndash21 years

All visits 66533 3594 1000 1785 96Routine infant or child health check V202 5334 803 80 11 143 22Normal pregnancy V22 3331 830 50 12 3182 45Acne 7060ndash7061 2931 560 44 08 79 15Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 2915 501 44 07 78 13Acute pharyngitis 462 2248 597 34 09 60 16All other diagnoses 49774 2793 748 18 1335 75

22ndash49 years

All visits 290199 14182 1000 2490 122Normal pregnancy V22 12178 1924 42 07 4207 33Spinal disorders 720ndash724 10148 1340 35 04 87 12Arthropathies and related disorders 710ndash719 9874 1767 34 06 85 15Gynecological examination V723 9496 1431 33 05 4161 24Essential hypertension 401 9361 1362 32 04 80 12All other diagnoses 239141 12253 824 11 2052 105

50ndash64 years

All visits 214891 10973 1000 4292 219Essential hypertension 401 15519 1884 72 08 310 38Arthropathies and related disorders 710ndash719 11162 1512 52 06 223 30Diabetes mellitus 250 9272 1048 43 04 185 21Malignant neoplasms 140ndash208230ndash234 8870 1861 41 08 177 37Spinal disorders 720ndash724 6530 935 30 04 130 19All other diagnoses 163538 8317 761 11 3266 166

65 years and over

All visits 247683 15541 1000 7047 442Essential hypertension 401 19129 2184 77 08 544 62Malignant neoplasms 140ndash208230ndash234 15679 3215 63 12 446 91Arthropathies and related disorders 710ndash719 11814 1815 48 06 336 52Diabetes mellitus 250 11253 1594 45 06 320 45Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 7824 1167 32 04 223 33All other diagnoses 181986 11408 735 12 5177 325

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth RevisionClinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to better describe the use ofambulatory care services2Visit rates for age are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Populations Division US Census Bureau3The population used for this rate is based on visits by females 13ndash21 years of age For males in this age group the leading diagnosis was routine infant or child health check (155 visits per 100males 13ndash21 years SE=31)4The population used for this rate is based on visits by females 22ndash49 years of age For males in this age group the leading diagnosis was essential hypertension (84 visits per 100 males 22ndash49years SE=15)

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 25

Table 15 Number percent distribution and annual rate of injury-related office visits with corresponding standard errors by selectedpatient characteristics United States 2005

Patient characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror of

rate

All injury-related visits2 89412 5466 1000 307 19

Age

Under 15 years 11556 1126 129 11 191 19Under 1 year 07 03 157 611ndash4 years 3191 495 36 06 197 315ndash14 years 7721 853 86 08 191 21

15ndash24 years 10006 973 112 09 244 2425ndash44 years 23053 1919 258 13 281 2345ndash64 years 28197 2050 315 13 390 2865 years and over 16600 1684 186 14 472 48

65ndash74 years 8111 976 91 09 441 5375 years and over 8489 937 95 08 507 56

Sex and age

Female 44177 2711 494 13 297 18Under 15 years 5017 622 56 07 169 2115ndash24 years 4610 575 52 06 227 2825ndash44 years 10286 921 115 08 248 2245ndash64 years 14917 1251 167 11 401 3465ndash74 years 4364 692 49 07 437 6975 years and over 4983 598 56 06 489 59

Male 45235 3233 506 13 318 23Under 15 years 6539 754 73 08 211 2415ndash24 years 5396 670 60 06 260 3225ndash44 years 12767 1329 143 11 315 3345ndash64 years 13280 1232 149 10 378 3565ndash74 years 3747 590 42 06 445 7075 years and over 3505 600 39 06 535 92

Race3

White 79208 4958 886 11 338 21Black or African American 6838 979 76 10 187 27Other 3365 602 38 06 164 29

Ethnicity

Hispanic or Latino 10578 1562 118 15 251 37Not Hispanic or Latino 78834 4812 882 15 317 19

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2Injury visits represent 93 percent (SE=04) of all office visits3Other race includes visits by Asians Native Hawaiians or Other Pacific Islanders American Indians or Alaska Natives and multiple races All race categories include visits by persons of Hispanicorigin and not Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for FederalData on Race and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typicallyfound for self-reported race in household surveys

NOTE Numbers may not add to totals because of rounding

Table 16 Number and percent distribution of injury-related office visits with corresponding standard errors by intent United States2005

Intent

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All injury-related visits 89412 5466 1000 Unintentional injuries 40934 4147 458 26Intentional injuries 1805 338 20 04Adverse effect of medical or surgical care or adverse effect of medicinal drug 8264 922 92 10Injuries of undetermined intent 32853 2362 367 24Unknown or blank 5556 993 62 11

Category not applicable

NOTE Numbers may not add to totals because of rounding

26 Advance Data No 387 + June 29 2007

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Number of visits in thousands

All visits 963617 432754 283180 119061 128623 560355 403262

At least one condition 507390 121891 187209 94472 103818 298366 209024None 422515 295386 85466 21112 20551 242189 180327Blank 33712 15476 10505 3477 4254 19800 13911

Hypertension 219476 23060 84640 52131 59646 127072 92404Arthritis 137942 20861 51744 27168 38169 91610 46332Hyperlipidemia 130053 12806 55561 31658 30028 68208 61845Diabetes 94359 10387 38628 23810 21534 50625 43733Depression 84610 30935 35059 8538 10078 59418 25192Obesity 68201 24275 29574 9298 5054 45028 23173Cancer 57025 4817 18809 15014 18384 32384 24640Asthma 54545 28913 14491 5764 5376 33276 21269COPD2 40754 7746 11425 10818 10764 22458 18295Ischemic heart disease 39559 1472 10179 12092 15815 16245 23314Osteoporosis 27977 6466 8050 12096 24842 3136Cerebrovascular disease 18319 731 4322 5489 7777 9000 9319CHF3 15692 3589 3409 8392 8950 6742Chronic renal failure 11486 2741 3039 4969 5633 5852

Standard error in thousands

All visits 40611 19288 13998 7460 8954 24487 18050

At least one condition 26734 6497 10543 6419 7920 16807 10964None 20054 14902 5424 1860 2135 11620 9940Blank 3749 1854 1445 668 650 2377 1724

Hypertension 14790 1976 5958 4176 5097 8906 6596Arthritis 9990 1930 4317 2357 3632 7470 3168Hyperlipidemia 9484 1139 4425 2773 3051 5051 4972Diabetes 6585 1133 3024 1939 2203 3811 3366Depression 6884 2367 3465 1084 1288 5082 2137Obesity 5885 2496 2961 1225 842 4156 2401Cancer 6483 782 2373 2149 2161 4421 2379Asthma 3877 2528 1350 712 814 2466 2012COPD2 3794 1054 1259 1356 1583 2332 1790Ischemic heart disease 3659 321 1097 1274 1920 1831 2301Osteoporosis 2821 892 1015 1413 2419 608Cerebrovascular disease 2290 188 717 844 1165 1187 1330CHF3 2054 768 561 1365 1351 1076Chronic renal failure 1713 799 609 890 829 1151

Percent distribution

All visits 1000 1000 1000 1000 1000 1000 100

At least one condition 527 282 661 793 807 532 518None 438 683 302 177 160 432 447Blank 35 36 37 29 33 35 34

Hypertension 228 53 299 438 464 227 229Arthritis 143 48 183 228 297 163 115Hyperlipidemia 135 30 196 266 233 122 153Diabetes 98 24 136 200 167 90 108Depression 88 71 124 72 78 106 62Obesity 71 56 104 78 39 80 57Cancer 59 11 66 126 143 58 61Asthma 57 67 51 48 42 59 53COPD2 42 18 40 91 84 40 45Ischemic heart disease 41 03 36 102 123 29 58Osteoporosis 29 03 23 68 94 44 08Cerebrovascular disease 19 02 15 46 60 16 23CHF3 16 01 13 29 65 16 17Chronic renal failure 12 02 10 26 39 10 15

See footnotes at end of table

Advance Data No 387 + June 29 2007 27

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005mdashCon

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Standard error of percent

All visits

At least one condition 13 10 13 13 15 14 14None 12 11 13 12 14 13 14Blank 04 04 05 06 05 04 04

Hypertension 10 04 13 19 17 11 11Arthritis 07 04 11 13 17 09 06Hyperlipidemia 08 03 12 17 16 08 10Diabetes 05 03 07 11 10 05 06Depression 06 05 10 09 09 08 05Obesity 05 05 09 09 06 06 05Cancer 06 02 08 14 13 07 05Asthma 03 05 04 06 06 04 05COPD2 03 02 04 10 10 03 04Ischemic heart disease 03 01 03 08 10 03 05Osteoporosis 02 01 03 08 08 03 01Cerebrovascular disease 02 00 02 06 07 02 03CHF3 02 00 03 04 09 02 03Chronic renal failure 02 01 03 05 06 01 03

Figure does not meet standards of reliability or precision Category not applicable1Presence of chronic conditions regardless of visit diagnosis were based on checkbox responses2COPD is chronic obstructive pulmonary disease3CHF is congestive heart failure

NOTE Numbers may not add to totals because more than one condition may be reported per visit

28 Advance Data No 387 + June 29 2007

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 7 Number and percent distribution of office visits with corresponding standard errors by continuity-of-care visit characteristics according to specialty type United States2005

Continuity-of-care visit characteristicsAll

specialties

Specialty type1

Allspecialties

Specialty type1

Primarycare

Surgicalspecialties

Medicalspecialties

Primarycare

Surgicalspecialties

Medicalspecialties

Number of visits in thousands Standard error in thousands

All visits 963617 573169 200217 190232 40611 30799 14169 14476

Prior-visit status and number of visits in last 12 months

Established patient 841424 519718 159887 161819 36855 28457 11684 12617None 55122 29404 15949 9768 3566 2560 1676 17911ndash2 visits 283537 161363 65878 56296 15225 10389 5578 45773ndash5 visits 275063 176109 49094 49860 13875 11038 4108 42976 or more visits 227702 152842 28966 45894 12916 11188 3277 5610

New patient 122193 53451 40330 28413 7282 5179 3178 3251

Percent distribution Standard error of percent

All visits 1000 1000 1000 1000

Prior-visit status and number of visits in last 12 months

Established patient 873 907 799 851 06 08 09 13None 57 51 80 51 03 03 07 081ndash2 visits 294 282 329 296 08 10 13 143ndash5 visits 285 307 245 262 06 09 10 116 or more visits 236 267 145 241 11 14 13 21

New patient 127 93 201 149 06 08 09 13

Category not applicable1Specialty type defined in lsquolsquoPhysician specialty groupsrsquorsquo section in lsquolsquoMethodsrsquorsquo

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200717

Table 8 Number and percent distribution of office visits with corresponding standard errors by patientrsquos principal reason for visitmodule United States 2005

Principal reason for visit module and RVC code1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Symptom module S001ndashS999 457871 21644 475 10General symptoms S001ndashS099 52745 3722 55 03Symptoms referable to psychological and mental disorders S100ndashS199 29642 2934 31 03Symptoms referable to the nervous system (excluding sense organs) S200ndashS259 24074 1987 25 02Symptoms referable to the cardiovascular and lymphatic system S260ndashS299 4465 708 05 01Symptoms referable to the eyes and ears S300ndashS399 48487 3638 50 03Symptoms referable to the respiratory system S400ndashS499 95792 6343 99 05Symptoms referable to the digestive system S500ndashS639 33341 2513 35 02Symptoms referable to the genitourinary system S640ndashS829 30560 1915 32 02Symptoms referable to the skin hair and nails S830ndashS899 43807 3147 45 03Symptoms referable to the musculoskeletal system S900ndashS999 94956 6794 99 05

Disease module D001ndashD999 125461 9100 130 08Diagnostic screening and preventive module X100ndashX599 179769 10984 187 08Treatment module T100ndashT899 136372 8939 142 07Injuries and adverse effects module J001ndashJ999 24173 2060 25 02Test results module R100ndashR700 23508 1778 24 02Administrative module A100ndashA140 7457 1187 08 01Other2 U990ndashU999 9007 1595 09 02

Category not applicable1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (22)2Includes problems and complaints not elsewhere classified entries of lsquolsquononersquorsquo blanks and illegible entries

NOTE Numbers may not add to totals because of rounding

Table 9 Number and percent distribution of office visits with corresponding standard errors by the 20 principal reasons for visit mostfrequently mentioned by patients according to patientrsquos sex United States 2005

Principal reason for visit and RVC code1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

General medical examination X100 71392 5674 74 04 64 05 88 06Progress visit not otherwise specified T800 42201 4035 44 04 42 04 47 04Cough S440 32482 2842 34 02 30 02 39 04Postoperative visit T205 31985 3811 33 04 33 04 34 05Medication other and unspecified kinds T115 19896 2306 21 02 19 02 23 03Gynecological examination X225 18254 2709 19 03 33 05 Hypertension D510 16988 2478 18 02 16 02 20 04Prenatal examination routine X205 16759 2771 17 03 30 05 Symptoms referable to throat S455 16440 1892 17 02 16 02 18 02Knee symptoms S925 16076 1801 17 02 18 02 15 02Well-baby examination X105 15268 2037 16 02 13 02 20 03Back symptoms S905 14643 1599 15 01 16 02 14 02Vision dysfunctions S305 13556 1872 14 02 15 02 13 02For other and unspecified test results R700 13211 1377 14 01 13 02 15 02Nasal congestion S400 13164 2137 14 02 10 02 19 03Eye examination X230 12528 2709 13 03 14 03 12 03Skin rash S860 12527 1188 13 01 12 02 14 01Diabetes mellitus D205 12192 1981 13 02 12 02 13 02Depression S110 12062 1511 13 02 13 02 11 02Earache or ear infection S355 11805 1107 12 01 10 01 15 02All other reasons 550190 24483 571 09 571 10 571 10

Category not applicable1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (22)2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

18 Advance Data No 387 + June 29 2007

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Number of visits in thousands

All visits 963617 319330 290545 89843 70669 174387 18845

Age

Under 15 years 160552 76704 18243 8527 3397 51622 2058Under 1 year 32070 11996 1282 17289 1ndash4 years 50400 25199 4182 2462 1081 16723 5ndash14 years 78082 39509 12779 5103 2125 17610

15ndash24 years 70583 27679 12350 5140 4873 19403 113825ndash44 years 201619 69933 51314 18727 16156 41942 354745ndash64 years 283180 84793 103754 29448 22047 37770 536865 years and over 247683 60221 104885 28000 24195 23650 6733

65ndash74 years 119061 28774 48255 14213 11487 12652 368075 years and over 128623 31447 56630 13787 12708 10998 3053

Sex

Female 560355 178477 168169 52297 39506 110589 11316Male 403262 140853 122376 37545 31162 63798 7528

Race2

White 832038 277587 251698 78452 62031 146794 15476Black or African American 88930 27098 27399 8154 6909 18139 1231Other 42649 14645 11449 3236 1728 9454 2137

Ethnicity2

Hispanic or Latino 98904 35026 26216 7016 6382 21039 3225Not Hispanic or Latino 864714 284304 264330 82827 64286 153348 15620

Expected source of payment3

Private insurance 608219 208219 174252 55707 40982 119864 9194Medicare 231655 56954 98344 27824 20905 22276 5352

Medicare and Medicaid 19002 4404 8958 2163 1140 1688 Medicaid or SCHIP4 108601 36794 28674 10323 5343 25488 1979Self-pay no charge or charity 49026 17446 14718 3220 6622 6110 Other5 51083 15679 15540 4763 6528 7160 1415

Standard error in thousands

All visits 40611 15701 14938 7475 6580 11005 3568

Age

Under 15 years 11524 6511 2408 1135 582 4532 514Under 1 year 3406 1587 367 2064 1ndash4 years 4582 2644 907 431 247 1972 5ndash14 years 4849 3142 1599 725 374 1605

15ndash24 years 4028 1901 1015 893 862 2191 37725ndash44 years 10521 4664 3704 1797 1918 3739 84745ndash64 years 13998 4755 5941 2571 2298 4309 115065 years and over 15541 4688 7577 3112 2856 2762 175065ndash74 years 7460 2206 3752 1771 1566 1469 132675 years and over 8954 2980 4464 1660 1618 1567 636

Sex

Female 24487 8994 9764 5246 3977 7175 2026Male 18050 7589 6501 2822 3371 5494 1651

Race2

White 36280 14035 13292 6241 5742 9867 3097Black or African American 7582 3077 3048 1522 1296 2275 341Other 5779 2563 2343 811 427 1345 1545

See footnotes at end of table

Advance Data No 387 + June 29 2007 19

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Ethnicity2 Standard error in thousands

Hispanic or Latino 9332 3572 3770 1275 1052 2615 801Not Hispanic or Latino 37628 14683 13732 6857 6029 10180 3091

Expected source of payment3

Private insurance 27808 10683 9568 5365 4542 8544 1727Medicare 15483 4596 7563 2961 2760 2869 1225

Medicare and Medicaid 2854 874 1554 556 394 581 Medicaid or SCHIP4 8545 3808 3239 1294 670 3275 638Self-pay no charge or charity 4662 2448 1495 488 1921 881 Other5 4411 1581 1950 606 1079 1238 426

Percent distribution

All visits 1000 331 302 93 73 181 20

Age

Under 15 years 1000 478 114 53 21 322 13Under 1 year 1000 374 40 30 06 539 111ndash4 years 1000 500 83 49 21 332 155ndash14 years 1000 506 164 65 27 226 12

15ndash24 years 1000 392 175 73 69 275 1625ndash44 years 1000 347 255 93 80 208 1845ndash64 years 1000 299 366 104 78 133 1965 years and over 1000 243 423 113 98 95 27

65ndash74 years 1000 242 405 119 96 106 3175 years and over 1000 244 440 107 99 86 24

Sex

Female 1000 319 300 93 71 197 20Male 1000 349 303 93 77 158 19

Race2

White 1000 334 303 94 75 176 19Black or African American 1000 305 308 92 78 204 14Other 1000 343 268 76 41 222 50

Ethnicity2

Hispanic or Latino 1000 354 265 71 65 213 33Not Hispanic or Latino 1000 329 306 96 74 177 18

Expected source of payment3

Private insurance 1000 342 286 92 67 197 15Medicare 1000 246 425 120 90 96 23

Medicare and Medicaid 1000 232 471 114 60 89 34Medicaid or SCHIP4 1000 339 264 95 49 235 18Self-pay no charge or charity 1000 356 300 66 135 125 19Other5 1000 307 304 93 128 140 28

Standard error of percent

All visits 09 10 06 06 08 04

Age

Under 15 years 17 14 06 04 15 03Under 1 year 26 11 07 05 26 041ndash4 years 27 16 07 05 24 055ndash14 years 21 18 08 05 17 04

15ndash24 years 22 12 11 12 23 0525ndash44 years 14 14 07 09 15 0445ndash64 years 10 14 07 07 12 0465 years and over 11 17 09 10 10 07

65ndash74 years 13 20 12 11 11 1175 years and over 14 18 10 11 11 05

See footnotes at end of table

20 Advance Data No 387 + June 29 2007

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Sex Standard error of percent

Female 10 12 07 07 10 03Male 11 12 06 08 10 04

Race2

White 09 11 05 06 08 04Black or African American 20 21 15 14 22 04Other 30 35 18 10 28 34

Ethnicity2

Hispanic or Latino 22 23 10 09 21 07Not Hispanic or Latino 09 11 06 07 08 03

Expected source of payment3

Private insurance 10 12 07 07 09 03Medicare 11 17 09 10 11 05

Medicare and Medicaid 26 42 25 19 28 12Medicaid or SCHIP4 21 23 09 06 23 06Self-pay no charge or charity 30 26 08 34 17 06Other5 19 22 10 18 21 08

Figure does not meet standards of reliability or precision Category not applicable1Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)2Other race includes visits by Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories inlcude visits by persons of Hispanic andnot Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data onRace and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple race indicated is small and lower than what is typically found forself-reported race in household surveys3Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit4SCHIP is State Childrenrsquos Health Insurance Program5Other includes workerrsquos compensation unknown or blank and payments not classified elsewhere

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 21

Table 11 Number percent distribution and annual rate of preventive care office visits and percent of visits to primary care specialistswith corresponding standard errors by selected patient and visit characteristics United States 2005

Patient and visit characteristics

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror

of rate

Percent ofpreventive carevisits made toprimary carespecialists2

Standarderror ofpercent

All preventive care visits3 174387 11005 1000 599 38 853 16

Age

Under 15 years 51622 4532 296 22 851 75 973 11Under 1 year 17289 2064 99 11 4214 503 998 011ndash4 years 16723 1972 96 10 1033 122 980 125ndash14 years 17610 1605 101 08 436 40 943 22

15ndash24 years 19403 2191 111 11 473 53 952 1725ndash44 years 41942 3739 241 16 512 46 903 1945ndash64 years 37770 4309 217 17 522 60 765 3065 years and over 23650 2762 136 13 673 79 561 45

65ndash74 years 12652 1469 73 07 688 80 609 4475 years and over 10998 1567 63 08 656 94 506 59

Sex and age

Female 110589 7175 634 18 744 48 870 16Under 15 years 23224 2063 133 10 784 70 979 0815ndash24 years 15134 1874 87 10 746 92 971 0825ndash44 years 33658 3258 193 16 813 79 929 1745ndash64 years 23897 2473 137 10 642 66 777 3065ndash74 years 7748 980 44 05 776 98 657 5275 years and over 6929 1030 40 05 679 101 552 57

Male 63798 5494 366 18 448 39 824 20Under 15 years 28399 2848 163 14 915 92 969 1515ndash24 years 4269 731 24 04 206 35 883 5825ndash44 years 8284 1244 48 06 204 31 796 4345ndash64 years 13873 2561 80 13 395 73 745 5065ndash74 years 4904 724 28 04 583 86 532 5875 years and over 4069 708 23 04 621 108 427 82

Race4

White 146794 9867 842 15 627 42 843 18Black or African American 18139 2275 104 12 496 62 906 21Other 9454 1345 54 07 462 66 915 29

Ethnicity4

Hispanic or Latino 21039 2615 121 14 499 62 914 20Not Hispanic or Latino 153348 10180 879 14 616 41 845 17

Expected source(s) of payment5

Private insurance 119864 8544 687 20 619 44 866 16Medicare 22276 2869 128 13 592 76 591 48

Medicare and Medicaid 1688 581 10 03 599 156MedicaidSCHIP6 25488 3275 146 17 795 102 928 19Self-pay no charge or charity7 6110 881 35 05 146 21 810 47Other8 7160 1238 41 07 767 56

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau Visit rates for expected source(s) of payment are based on the 2005 National Health Interview Survey estimates of health insurance2Primary care specialty defined in specialty type classification found in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo3Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)4Other race includes Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic and notHispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data on Raceand Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typically found forself-reported race in household surveys5Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit6SCHIP is State Childrenrsquos Health Insurance Program7The visit rate was calculated using lsquolsquouninsuredrsquorsquo as the denominator from the 2005 estimates of health insurance coverage from the National Health Inteview Survey8Other includes workerrsquos compensation unknown or blank and sources not elsewhere classified

NOTE Numbers may not add to totals because of rounding

22 Advance Data No 387 + June 29 2007

Table 12 Number and percent distribution of office visits with corresponding standard errors by physicianrsquos primary diagnosisUnited States 2005

Major disease category and ICDndash9ndashCM code range1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Infectious and parasitic diseases 001ndash139 26720 2062 28 02Neoplasms 140ndash239 39200 5285 41 05Endocrine nutritional and metabolic diseases and immunity disorders 240ndash279 56408 4655 59 04Mental disorders 290ndash319 47094 3777 49 04Diseases of the nervous system and sense organs 320ndash389 86128 6644 89 05Diseases of the circulatory system 390ndash459 81836 6683 85 06Diseases of the respiratory system 460ndash519 110999 7670 115 07Diseases of the digestive system 520ndash579 28678 2225 30 02Diseases of the genitourinary system 580ndash629 42256 3131 44 03Diseases of the skin and subcutaneous tissue 680ndash709 44443 3189 46 03Diseases of the musculoskeletal system and connective tissue 710ndash739 80601 6320 84 05Symptoms signs and ill-defined conditions 780ndash799 60536 3916 63 03Injury and poisoning 800ndash999 45137 3087 47 03Supplementary classification V01ndashV82 179276 11124 186 09All other diagnoses2 25609 3533 27 03Unknown3 8697 1645 09 02

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23)2Includes diseases of the blood and blood-forming organs (280ndash289) complications of pregnancy childbirth and the puerperium (630ndash677) congenital anomalies (740ndash759) certain conditionsoriginating in the perinatal period (760ndash779) and entries not codable to the ICDndash9ndashCM (eg illegible entries left against medical advice transferred entries of lsquolsquononersquorsquo or lsquolsquono diagnosesrsquorsquo)3Includes blank diagnoses

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 23

Table 13 Number and percent distribution of office visits with corresponding standard errors by the 20 leading primary diagnosis groups according to patientrsquos sexUnited States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

Essential hypertension 401 44670 4318 46 04 44 04 50 05Routine infant or child health check V202 41816 4044 43 04 33 03 57 06Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 36372 2875 38 03 33 03 45 04Arthropathies and related disorders 710ndash719 34299 4200 36 04 42 06 27 03Malignant neoplasms 140ndash208230ndash234 28709 5644 30 06 30 07 30 04Diabetes mellitus 250 25451 2730 26 03 25 03 29 03Spinal disorders 720ndash724 22732 2523 24 02 24 02 23 03Rheumatism excluding back 725ndash729 18580 1580 19 01 19 02 19 02General medical examination V70 17007 2377 18 02 15 02 22 03Follow up examination V67 16249 2573 17 02 17 03 16 03Specific procedures and aftercare V50ndashV599 15662 2000 16 02 17 02 15 03Normal pregnancy V22 15509 2534 16 03 28 05 Gynecological examination V723 15067 2378 16 02 27 04 Otitis media and eustachian tube disorders 381ndash382 14399 1517 15 01 12 01 19 02Asthma 493 12823 2102 13 02 11 02 16 04Disorders of lipoid metabolism 272 12650 1416 13 01 11 02 16 02Chronic sinusitis 473 12621 1302 13 01 12 01 14 02Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 11473 1490 12 01 10 01 15 02Acute pharyngitis 462 11064 1941 11 02 11 02 13 03Allergic rhinitis 477 11028 2099 11 02 11 02 12 03All other diagnoses 545437 23756 566 08 568 10 564 10

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to form larger categories that better describe the utilization of ambulatory care services2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

24A

dvanceD

ataN

o387+

June292007

Table 14 Number percent distribution and annual rate of office visits with corresponding standard errors by patientrsquos age accordingto the five leading primary diagnosis groups United States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year2

Standarderror of

rate

All visits 963617 40611 1000 3310 139

Under 1 year

All visits 32070 3406 1000 7816 830Routine infant or child health check V202 14528 1965 453 31 3541 479Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 3442 593 107 16 839 145Otitis media and eustachian tube disorders 381ndash382 2541 559 79 15 619 136Certain conditions originating in the perinatal period 760ndash779 34 08 269 65Unspecified viral and chlamydial infection 799 19 07 148 64All other diagnoses 9847 1134 307 22 2400 276

1ndash12 years

All visits 112241 8094 1000 2337 169Routine infant or child health check V202 21953 2294 196 14 457 48Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 12310 1705 110 11 256 36Otitis media and eustachian tube disorders 381ndash382 7901 843 70 07 165 18Asthma 493 4252 1126 38 10 89 23Acute pharyngitis 462 4203 868 37 07 88 18All other diagnoses 61622 4491 549 15 1283 94

13ndash21 years

All visits 66533 3594 1000 1785 96Routine infant or child health check V202 5334 803 80 11 143 22Normal pregnancy V22 3331 830 50 12 3182 45Acne 7060ndash7061 2931 560 44 08 79 15Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 2915 501 44 07 78 13Acute pharyngitis 462 2248 597 34 09 60 16All other diagnoses 49774 2793 748 18 1335 75

22ndash49 years

All visits 290199 14182 1000 2490 122Normal pregnancy V22 12178 1924 42 07 4207 33Spinal disorders 720ndash724 10148 1340 35 04 87 12Arthropathies and related disorders 710ndash719 9874 1767 34 06 85 15Gynecological examination V723 9496 1431 33 05 4161 24Essential hypertension 401 9361 1362 32 04 80 12All other diagnoses 239141 12253 824 11 2052 105

50ndash64 years

All visits 214891 10973 1000 4292 219Essential hypertension 401 15519 1884 72 08 310 38Arthropathies and related disorders 710ndash719 11162 1512 52 06 223 30Diabetes mellitus 250 9272 1048 43 04 185 21Malignant neoplasms 140ndash208230ndash234 8870 1861 41 08 177 37Spinal disorders 720ndash724 6530 935 30 04 130 19All other diagnoses 163538 8317 761 11 3266 166

65 years and over

All visits 247683 15541 1000 7047 442Essential hypertension 401 19129 2184 77 08 544 62Malignant neoplasms 140ndash208230ndash234 15679 3215 63 12 446 91Arthropathies and related disorders 710ndash719 11814 1815 48 06 336 52Diabetes mellitus 250 11253 1594 45 06 320 45Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 7824 1167 32 04 223 33All other diagnoses 181986 11408 735 12 5177 325

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth RevisionClinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to better describe the use ofambulatory care services2Visit rates for age are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Populations Division US Census Bureau3The population used for this rate is based on visits by females 13ndash21 years of age For males in this age group the leading diagnosis was routine infant or child health check (155 visits per 100males 13ndash21 years SE=31)4The population used for this rate is based on visits by females 22ndash49 years of age For males in this age group the leading diagnosis was essential hypertension (84 visits per 100 males 22ndash49years SE=15)

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 25

Table 15 Number percent distribution and annual rate of injury-related office visits with corresponding standard errors by selectedpatient characteristics United States 2005

Patient characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror of

rate

All injury-related visits2 89412 5466 1000 307 19

Age

Under 15 years 11556 1126 129 11 191 19Under 1 year 07 03 157 611ndash4 years 3191 495 36 06 197 315ndash14 years 7721 853 86 08 191 21

15ndash24 years 10006 973 112 09 244 2425ndash44 years 23053 1919 258 13 281 2345ndash64 years 28197 2050 315 13 390 2865 years and over 16600 1684 186 14 472 48

65ndash74 years 8111 976 91 09 441 5375 years and over 8489 937 95 08 507 56

Sex and age

Female 44177 2711 494 13 297 18Under 15 years 5017 622 56 07 169 2115ndash24 years 4610 575 52 06 227 2825ndash44 years 10286 921 115 08 248 2245ndash64 years 14917 1251 167 11 401 3465ndash74 years 4364 692 49 07 437 6975 years and over 4983 598 56 06 489 59

Male 45235 3233 506 13 318 23Under 15 years 6539 754 73 08 211 2415ndash24 years 5396 670 60 06 260 3225ndash44 years 12767 1329 143 11 315 3345ndash64 years 13280 1232 149 10 378 3565ndash74 years 3747 590 42 06 445 7075 years and over 3505 600 39 06 535 92

Race3

White 79208 4958 886 11 338 21Black or African American 6838 979 76 10 187 27Other 3365 602 38 06 164 29

Ethnicity

Hispanic or Latino 10578 1562 118 15 251 37Not Hispanic or Latino 78834 4812 882 15 317 19

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2Injury visits represent 93 percent (SE=04) of all office visits3Other race includes visits by Asians Native Hawaiians or Other Pacific Islanders American Indians or Alaska Natives and multiple races All race categories include visits by persons of Hispanicorigin and not Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for FederalData on Race and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typicallyfound for self-reported race in household surveys

NOTE Numbers may not add to totals because of rounding

Table 16 Number and percent distribution of injury-related office visits with corresponding standard errors by intent United States2005

Intent

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All injury-related visits 89412 5466 1000 Unintentional injuries 40934 4147 458 26Intentional injuries 1805 338 20 04Adverse effect of medical or surgical care or adverse effect of medicinal drug 8264 922 92 10Injuries of undetermined intent 32853 2362 367 24Unknown or blank 5556 993 62 11

Category not applicable

NOTE Numbers may not add to totals because of rounding

26 Advance Data No 387 + June 29 2007

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Number of visits in thousands

All visits 963617 432754 283180 119061 128623 560355 403262

At least one condition 507390 121891 187209 94472 103818 298366 209024None 422515 295386 85466 21112 20551 242189 180327Blank 33712 15476 10505 3477 4254 19800 13911

Hypertension 219476 23060 84640 52131 59646 127072 92404Arthritis 137942 20861 51744 27168 38169 91610 46332Hyperlipidemia 130053 12806 55561 31658 30028 68208 61845Diabetes 94359 10387 38628 23810 21534 50625 43733Depression 84610 30935 35059 8538 10078 59418 25192Obesity 68201 24275 29574 9298 5054 45028 23173Cancer 57025 4817 18809 15014 18384 32384 24640Asthma 54545 28913 14491 5764 5376 33276 21269COPD2 40754 7746 11425 10818 10764 22458 18295Ischemic heart disease 39559 1472 10179 12092 15815 16245 23314Osteoporosis 27977 6466 8050 12096 24842 3136Cerebrovascular disease 18319 731 4322 5489 7777 9000 9319CHF3 15692 3589 3409 8392 8950 6742Chronic renal failure 11486 2741 3039 4969 5633 5852

Standard error in thousands

All visits 40611 19288 13998 7460 8954 24487 18050

At least one condition 26734 6497 10543 6419 7920 16807 10964None 20054 14902 5424 1860 2135 11620 9940Blank 3749 1854 1445 668 650 2377 1724

Hypertension 14790 1976 5958 4176 5097 8906 6596Arthritis 9990 1930 4317 2357 3632 7470 3168Hyperlipidemia 9484 1139 4425 2773 3051 5051 4972Diabetes 6585 1133 3024 1939 2203 3811 3366Depression 6884 2367 3465 1084 1288 5082 2137Obesity 5885 2496 2961 1225 842 4156 2401Cancer 6483 782 2373 2149 2161 4421 2379Asthma 3877 2528 1350 712 814 2466 2012COPD2 3794 1054 1259 1356 1583 2332 1790Ischemic heart disease 3659 321 1097 1274 1920 1831 2301Osteoporosis 2821 892 1015 1413 2419 608Cerebrovascular disease 2290 188 717 844 1165 1187 1330CHF3 2054 768 561 1365 1351 1076Chronic renal failure 1713 799 609 890 829 1151

Percent distribution

All visits 1000 1000 1000 1000 1000 1000 100

At least one condition 527 282 661 793 807 532 518None 438 683 302 177 160 432 447Blank 35 36 37 29 33 35 34

Hypertension 228 53 299 438 464 227 229Arthritis 143 48 183 228 297 163 115Hyperlipidemia 135 30 196 266 233 122 153Diabetes 98 24 136 200 167 90 108Depression 88 71 124 72 78 106 62Obesity 71 56 104 78 39 80 57Cancer 59 11 66 126 143 58 61Asthma 57 67 51 48 42 59 53COPD2 42 18 40 91 84 40 45Ischemic heart disease 41 03 36 102 123 29 58Osteoporosis 29 03 23 68 94 44 08Cerebrovascular disease 19 02 15 46 60 16 23CHF3 16 01 13 29 65 16 17Chronic renal failure 12 02 10 26 39 10 15

See footnotes at end of table

Advance Data No 387 + June 29 2007 27

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005mdashCon

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Standard error of percent

All visits

At least one condition 13 10 13 13 15 14 14None 12 11 13 12 14 13 14Blank 04 04 05 06 05 04 04

Hypertension 10 04 13 19 17 11 11Arthritis 07 04 11 13 17 09 06Hyperlipidemia 08 03 12 17 16 08 10Diabetes 05 03 07 11 10 05 06Depression 06 05 10 09 09 08 05Obesity 05 05 09 09 06 06 05Cancer 06 02 08 14 13 07 05Asthma 03 05 04 06 06 04 05COPD2 03 02 04 10 10 03 04Ischemic heart disease 03 01 03 08 10 03 05Osteoporosis 02 01 03 08 08 03 01Cerebrovascular disease 02 00 02 06 07 02 03CHF3 02 00 03 04 09 02 03Chronic renal failure 02 01 03 05 06 01 03

Figure does not meet standards of reliability or precision Category not applicable1Presence of chronic conditions regardless of visit diagnosis were based on checkbox responses2COPD is chronic obstructive pulmonary disease3CHF is congestive heart failure

NOTE Numbers may not add to totals because more than one condition may be reported per visit

28 Advance Data No 387 + June 29 2007

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 8 Number and percent distribution of office visits with corresponding standard errors by patientrsquos principal reason for visitmodule United States 2005

Principal reason for visit module and RVC code1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Symptom module S001ndashS999 457871 21644 475 10General symptoms S001ndashS099 52745 3722 55 03Symptoms referable to psychological and mental disorders S100ndashS199 29642 2934 31 03Symptoms referable to the nervous system (excluding sense organs) S200ndashS259 24074 1987 25 02Symptoms referable to the cardiovascular and lymphatic system S260ndashS299 4465 708 05 01Symptoms referable to the eyes and ears S300ndashS399 48487 3638 50 03Symptoms referable to the respiratory system S400ndashS499 95792 6343 99 05Symptoms referable to the digestive system S500ndashS639 33341 2513 35 02Symptoms referable to the genitourinary system S640ndashS829 30560 1915 32 02Symptoms referable to the skin hair and nails S830ndashS899 43807 3147 45 03Symptoms referable to the musculoskeletal system S900ndashS999 94956 6794 99 05

Disease module D001ndashD999 125461 9100 130 08Diagnostic screening and preventive module X100ndashX599 179769 10984 187 08Treatment module T100ndashT899 136372 8939 142 07Injuries and adverse effects module J001ndashJ999 24173 2060 25 02Test results module R100ndashR700 23508 1778 24 02Administrative module A100ndashA140 7457 1187 08 01Other2 U990ndashU999 9007 1595 09 02

Category not applicable1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (22)2Includes problems and complaints not elsewhere classified entries of lsquolsquononersquorsquo blanks and illegible entries

NOTE Numbers may not add to totals because of rounding

Table 9 Number and percent distribution of office visits with corresponding standard errors by the 20 principal reasons for visit mostfrequently mentioned by patients according to patientrsquos sex United States 2005

Principal reason for visit and RVC code1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

General medical examination X100 71392 5674 74 04 64 05 88 06Progress visit not otherwise specified T800 42201 4035 44 04 42 04 47 04Cough S440 32482 2842 34 02 30 02 39 04Postoperative visit T205 31985 3811 33 04 33 04 34 05Medication other and unspecified kinds T115 19896 2306 21 02 19 02 23 03Gynecological examination X225 18254 2709 19 03 33 05 Hypertension D510 16988 2478 18 02 16 02 20 04Prenatal examination routine X205 16759 2771 17 03 30 05 Symptoms referable to throat S455 16440 1892 17 02 16 02 18 02Knee symptoms S925 16076 1801 17 02 18 02 15 02Well-baby examination X105 15268 2037 16 02 13 02 20 03Back symptoms S905 14643 1599 15 01 16 02 14 02Vision dysfunctions S305 13556 1872 14 02 15 02 13 02For other and unspecified test results R700 13211 1377 14 01 13 02 15 02Nasal congestion S400 13164 2137 14 02 10 02 19 03Eye examination X230 12528 2709 13 03 14 03 12 03Skin rash S860 12527 1188 13 01 12 02 14 01Diabetes mellitus D205 12192 1981 13 02 12 02 13 02Depression S110 12062 1511 13 02 13 02 11 02Earache or ear infection S355 11805 1107 12 01 10 01 15 02All other reasons 550190 24483 571 09 571 10 571 10

Category not applicable1Based on A Reason for Visit Classification for Ambulatory Care (RVC) (22)2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

18 Advance Data No 387 + June 29 2007

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Number of visits in thousands

All visits 963617 319330 290545 89843 70669 174387 18845

Age

Under 15 years 160552 76704 18243 8527 3397 51622 2058Under 1 year 32070 11996 1282 17289 1ndash4 years 50400 25199 4182 2462 1081 16723 5ndash14 years 78082 39509 12779 5103 2125 17610

15ndash24 years 70583 27679 12350 5140 4873 19403 113825ndash44 years 201619 69933 51314 18727 16156 41942 354745ndash64 years 283180 84793 103754 29448 22047 37770 536865 years and over 247683 60221 104885 28000 24195 23650 6733

65ndash74 years 119061 28774 48255 14213 11487 12652 368075 years and over 128623 31447 56630 13787 12708 10998 3053

Sex

Female 560355 178477 168169 52297 39506 110589 11316Male 403262 140853 122376 37545 31162 63798 7528

Race2

White 832038 277587 251698 78452 62031 146794 15476Black or African American 88930 27098 27399 8154 6909 18139 1231Other 42649 14645 11449 3236 1728 9454 2137

Ethnicity2

Hispanic or Latino 98904 35026 26216 7016 6382 21039 3225Not Hispanic or Latino 864714 284304 264330 82827 64286 153348 15620

Expected source of payment3

Private insurance 608219 208219 174252 55707 40982 119864 9194Medicare 231655 56954 98344 27824 20905 22276 5352

Medicare and Medicaid 19002 4404 8958 2163 1140 1688 Medicaid or SCHIP4 108601 36794 28674 10323 5343 25488 1979Self-pay no charge or charity 49026 17446 14718 3220 6622 6110 Other5 51083 15679 15540 4763 6528 7160 1415

Standard error in thousands

All visits 40611 15701 14938 7475 6580 11005 3568

Age

Under 15 years 11524 6511 2408 1135 582 4532 514Under 1 year 3406 1587 367 2064 1ndash4 years 4582 2644 907 431 247 1972 5ndash14 years 4849 3142 1599 725 374 1605

15ndash24 years 4028 1901 1015 893 862 2191 37725ndash44 years 10521 4664 3704 1797 1918 3739 84745ndash64 years 13998 4755 5941 2571 2298 4309 115065 years and over 15541 4688 7577 3112 2856 2762 175065ndash74 years 7460 2206 3752 1771 1566 1469 132675 years and over 8954 2980 4464 1660 1618 1567 636

Sex

Female 24487 8994 9764 5246 3977 7175 2026Male 18050 7589 6501 2822 3371 5494 1651

Race2

White 36280 14035 13292 6241 5742 9867 3097Black or African American 7582 3077 3048 1522 1296 2275 341Other 5779 2563 2343 811 427 1345 1545

See footnotes at end of table

Advance Data No 387 + June 29 2007 19

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Ethnicity2 Standard error in thousands

Hispanic or Latino 9332 3572 3770 1275 1052 2615 801Not Hispanic or Latino 37628 14683 13732 6857 6029 10180 3091

Expected source of payment3

Private insurance 27808 10683 9568 5365 4542 8544 1727Medicare 15483 4596 7563 2961 2760 2869 1225

Medicare and Medicaid 2854 874 1554 556 394 581 Medicaid or SCHIP4 8545 3808 3239 1294 670 3275 638Self-pay no charge or charity 4662 2448 1495 488 1921 881 Other5 4411 1581 1950 606 1079 1238 426

Percent distribution

All visits 1000 331 302 93 73 181 20

Age

Under 15 years 1000 478 114 53 21 322 13Under 1 year 1000 374 40 30 06 539 111ndash4 years 1000 500 83 49 21 332 155ndash14 years 1000 506 164 65 27 226 12

15ndash24 years 1000 392 175 73 69 275 1625ndash44 years 1000 347 255 93 80 208 1845ndash64 years 1000 299 366 104 78 133 1965 years and over 1000 243 423 113 98 95 27

65ndash74 years 1000 242 405 119 96 106 3175 years and over 1000 244 440 107 99 86 24

Sex

Female 1000 319 300 93 71 197 20Male 1000 349 303 93 77 158 19

Race2

White 1000 334 303 94 75 176 19Black or African American 1000 305 308 92 78 204 14Other 1000 343 268 76 41 222 50

Ethnicity2

Hispanic or Latino 1000 354 265 71 65 213 33Not Hispanic or Latino 1000 329 306 96 74 177 18

Expected source of payment3

Private insurance 1000 342 286 92 67 197 15Medicare 1000 246 425 120 90 96 23

Medicare and Medicaid 1000 232 471 114 60 89 34Medicaid or SCHIP4 1000 339 264 95 49 235 18Self-pay no charge or charity 1000 356 300 66 135 125 19Other5 1000 307 304 93 128 140 28

Standard error of percent

All visits 09 10 06 06 08 04

Age

Under 15 years 17 14 06 04 15 03Under 1 year 26 11 07 05 26 041ndash4 years 27 16 07 05 24 055ndash14 years 21 18 08 05 17 04

15ndash24 years 22 12 11 12 23 0525ndash44 years 14 14 07 09 15 0445ndash64 years 10 14 07 07 12 0465 years and over 11 17 09 10 10 07

65ndash74 years 13 20 12 11 11 1175 years and over 14 18 10 11 11 05

See footnotes at end of table

20 Advance Data No 387 + June 29 2007

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Sex Standard error of percent

Female 10 12 07 07 10 03Male 11 12 06 08 10 04

Race2

White 09 11 05 06 08 04Black or African American 20 21 15 14 22 04Other 30 35 18 10 28 34

Ethnicity2

Hispanic or Latino 22 23 10 09 21 07Not Hispanic or Latino 09 11 06 07 08 03

Expected source of payment3

Private insurance 10 12 07 07 09 03Medicare 11 17 09 10 11 05

Medicare and Medicaid 26 42 25 19 28 12Medicaid or SCHIP4 21 23 09 06 23 06Self-pay no charge or charity 30 26 08 34 17 06Other5 19 22 10 18 21 08

Figure does not meet standards of reliability or precision Category not applicable1Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)2Other race includes visits by Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories inlcude visits by persons of Hispanic andnot Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data onRace and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple race indicated is small and lower than what is typically found forself-reported race in household surveys3Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit4SCHIP is State Childrenrsquos Health Insurance Program5Other includes workerrsquos compensation unknown or blank and payments not classified elsewhere

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 21

Table 11 Number percent distribution and annual rate of preventive care office visits and percent of visits to primary care specialistswith corresponding standard errors by selected patient and visit characteristics United States 2005

Patient and visit characteristics

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror

of rate

Percent ofpreventive carevisits made toprimary carespecialists2

Standarderror ofpercent

All preventive care visits3 174387 11005 1000 599 38 853 16

Age

Under 15 years 51622 4532 296 22 851 75 973 11Under 1 year 17289 2064 99 11 4214 503 998 011ndash4 years 16723 1972 96 10 1033 122 980 125ndash14 years 17610 1605 101 08 436 40 943 22

15ndash24 years 19403 2191 111 11 473 53 952 1725ndash44 years 41942 3739 241 16 512 46 903 1945ndash64 years 37770 4309 217 17 522 60 765 3065 years and over 23650 2762 136 13 673 79 561 45

65ndash74 years 12652 1469 73 07 688 80 609 4475 years and over 10998 1567 63 08 656 94 506 59

Sex and age

Female 110589 7175 634 18 744 48 870 16Under 15 years 23224 2063 133 10 784 70 979 0815ndash24 years 15134 1874 87 10 746 92 971 0825ndash44 years 33658 3258 193 16 813 79 929 1745ndash64 years 23897 2473 137 10 642 66 777 3065ndash74 years 7748 980 44 05 776 98 657 5275 years and over 6929 1030 40 05 679 101 552 57

Male 63798 5494 366 18 448 39 824 20Under 15 years 28399 2848 163 14 915 92 969 1515ndash24 years 4269 731 24 04 206 35 883 5825ndash44 years 8284 1244 48 06 204 31 796 4345ndash64 years 13873 2561 80 13 395 73 745 5065ndash74 years 4904 724 28 04 583 86 532 5875 years and over 4069 708 23 04 621 108 427 82

Race4

White 146794 9867 842 15 627 42 843 18Black or African American 18139 2275 104 12 496 62 906 21Other 9454 1345 54 07 462 66 915 29

Ethnicity4

Hispanic or Latino 21039 2615 121 14 499 62 914 20Not Hispanic or Latino 153348 10180 879 14 616 41 845 17

Expected source(s) of payment5

Private insurance 119864 8544 687 20 619 44 866 16Medicare 22276 2869 128 13 592 76 591 48

Medicare and Medicaid 1688 581 10 03 599 156MedicaidSCHIP6 25488 3275 146 17 795 102 928 19Self-pay no charge or charity7 6110 881 35 05 146 21 810 47Other8 7160 1238 41 07 767 56

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau Visit rates for expected source(s) of payment are based on the 2005 National Health Interview Survey estimates of health insurance2Primary care specialty defined in specialty type classification found in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo3Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)4Other race includes Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic and notHispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data on Raceand Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typically found forself-reported race in household surveys5Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit6SCHIP is State Childrenrsquos Health Insurance Program7The visit rate was calculated using lsquolsquouninsuredrsquorsquo as the denominator from the 2005 estimates of health insurance coverage from the National Health Inteview Survey8Other includes workerrsquos compensation unknown or blank and sources not elsewhere classified

NOTE Numbers may not add to totals because of rounding

22 Advance Data No 387 + June 29 2007

Table 12 Number and percent distribution of office visits with corresponding standard errors by physicianrsquos primary diagnosisUnited States 2005

Major disease category and ICDndash9ndashCM code range1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Infectious and parasitic diseases 001ndash139 26720 2062 28 02Neoplasms 140ndash239 39200 5285 41 05Endocrine nutritional and metabolic diseases and immunity disorders 240ndash279 56408 4655 59 04Mental disorders 290ndash319 47094 3777 49 04Diseases of the nervous system and sense organs 320ndash389 86128 6644 89 05Diseases of the circulatory system 390ndash459 81836 6683 85 06Diseases of the respiratory system 460ndash519 110999 7670 115 07Diseases of the digestive system 520ndash579 28678 2225 30 02Diseases of the genitourinary system 580ndash629 42256 3131 44 03Diseases of the skin and subcutaneous tissue 680ndash709 44443 3189 46 03Diseases of the musculoskeletal system and connective tissue 710ndash739 80601 6320 84 05Symptoms signs and ill-defined conditions 780ndash799 60536 3916 63 03Injury and poisoning 800ndash999 45137 3087 47 03Supplementary classification V01ndashV82 179276 11124 186 09All other diagnoses2 25609 3533 27 03Unknown3 8697 1645 09 02

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23)2Includes diseases of the blood and blood-forming organs (280ndash289) complications of pregnancy childbirth and the puerperium (630ndash677) congenital anomalies (740ndash759) certain conditionsoriginating in the perinatal period (760ndash779) and entries not codable to the ICDndash9ndashCM (eg illegible entries left against medical advice transferred entries of lsquolsquononersquorsquo or lsquolsquono diagnosesrsquorsquo)3Includes blank diagnoses

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 23

Table 13 Number and percent distribution of office visits with corresponding standard errors by the 20 leading primary diagnosis groups according to patientrsquos sexUnited States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

Essential hypertension 401 44670 4318 46 04 44 04 50 05Routine infant or child health check V202 41816 4044 43 04 33 03 57 06Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 36372 2875 38 03 33 03 45 04Arthropathies and related disorders 710ndash719 34299 4200 36 04 42 06 27 03Malignant neoplasms 140ndash208230ndash234 28709 5644 30 06 30 07 30 04Diabetes mellitus 250 25451 2730 26 03 25 03 29 03Spinal disorders 720ndash724 22732 2523 24 02 24 02 23 03Rheumatism excluding back 725ndash729 18580 1580 19 01 19 02 19 02General medical examination V70 17007 2377 18 02 15 02 22 03Follow up examination V67 16249 2573 17 02 17 03 16 03Specific procedures and aftercare V50ndashV599 15662 2000 16 02 17 02 15 03Normal pregnancy V22 15509 2534 16 03 28 05 Gynecological examination V723 15067 2378 16 02 27 04 Otitis media and eustachian tube disorders 381ndash382 14399 1517 15 01 12 01 19 02Asthma 493 12823 2102 13 02 11 02 16 04Disorders of lipoid metabolism 272 12650 1416 13 01 11 02 16 02Chronic sinusitis 473 12621 1302 13 01 12 01 14 02Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 11473 1490 12 01 10 01 15 02Acute pharyngitis 462 11064 1941 11 02 11 02 13 03Allergic rhinitis 477 11028 2099 11 02 11 02 12 03All other diagnoses 545437 23756 566 08 568 10 564 10

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to form larger categories that better describe the utilization of ambulatory care services2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

24A

dvanceD

ataN

o387+

June292007

Table 14 Number percent distribution and annual rate of office visits with corresponding standard errors by patientrsquos age accordingto the five leading primary diagnosis groups United States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year2

Standarderror of

rate

All visits 963617 40611 1000 3310 139

Under 1 year

All visits 32070 3406 1000 7816 830Routine infant or child health check V202 14528 1965 453 31 3541 479Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 3442 593 107 16 839 145Otitis media and eustachian tube disorders 381ndash382 2541 559 79 15 619 136Certain conditions originating in the perinatal period 760ndash779 34 08 269 65Unspecified viral and chlamydial infection 799 19 07 148 64All other diagnoses 9847 1134 307 22 2400 276

1ndash12 years

All visits 112241 8094 1000 2337 169Routine infant or child health check V202 21953 2294 196 14 457 48Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 12310 1705 110 11 256 36Otitis media and eustachian tube disorders 381ndash382 7901 843 70 07 165 18Asthma 493 4252 1126 38 10 89 23Acute pharyngitis 462 4203 868 37 07 88 18All other diagnoses 61622 4491 549 15 1283 94

13ndash21 years

All visits 66533 3594 1000 1785 96Routine infant or child health check V202 5334 803 80 11 143 22Normal pregnancy V22 3331 830 50 12 3182 45Acne 7060ndash7061 2931 560 44 08 79 15Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 2915 501 44 07 78 13Acute pharyngitis 462 2248 597 34 09 60 16All other diagnoses 49774 2793 748 18 1335 75

22ndash49 years

All visits 290199 14182 1000 2490 122Normal pregnancy V22 12178 1924 42 07 4207 33Spinal disorders 720ndash724 10148 1340 35 04 87 12Arthropathies and related disorders 710ndash719 9874 1767 34 06 85 15Gynecological examination V723 9496 1431 33 05 4161 24Essential hypertension 401 9361 1362 32 04 80 12All other diagnoses 239141 12253 824 11 2052 105

50ndash64 years

All visits 214891 10973 1000 4292 219Essential hypertension 401 15519 1884 72 08 310 38Arthropathies and related disorders 710ndash719 11162 1512 52 06 223 30Diabetes mellitus 250 9272 1048 43 04 185 21Malignant neoplasms 140ndash208230ndash234 8870 1861 41 08 177 37Spinal disorders 720ndash724 6530 935 30 04 130 19All other diagnoses 163538 8317 761 11 3266 166

65 years and over

All visits 247683 15541 1000 7047 442Essential hypertension 401 19129 2184 77 08 544 62Malignant neoplasms 140ndash208230ndash234 15679 3215 63 12 446 91Arthropathies and related disorders 710ndash719 11814 1815 48 06 336 52Diabetes mellitus 250 11253 1594 45 06 320 45Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 7824 1167 32 04 223 33All other diagnoses 181986 11408 735 12 5177 325

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth RevisionClinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to better describe the use ofambulatory care services2Visit rates for age are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Populations Division US Census Bureau3The population used for this rate is based on visits by females 13ndash21 years of age For males in this age group the leading diagnosis was routine infant or child health check (155 visits per 100males 13ndash21 years SE=31)4The population used for this rate is based on visits by females 22ndash49 years of age For males in this age group the leading diagnosis was essential hypertension (84 visits per 100 males 22ndash49years SE=15)

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 25

Table 15 Number percent distribution and annual rate of injury-related office visits with corresponding standard errors by selectedpatient characteristics United States 2005

Patient characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror of

rate

All injury-related visits2 89412 5466 1000 307 19

Age

Under 15 years 11556 1126 129 11 191 19Under 1 year 07 03 157 611ndash4 years 3191 495 36 06 197 315ndash14 years 7721 853 86 08 191 21

15ndash24 years 10006 973 112 09 244 2425ndash44 years 23053 1919 258 13 281 2345ndash64 years 28197 2050 315 13 390 2865 years and over 16600 1684 186 14 472 48

65ndash74 years 8111 976 91 09 441 5375 years and over 8489 937 95 08 507 56

Sex and age

Female 44177 2711 494 13 297 18Under 15 years 5017 622 56 07 169 2115ndash24 years 4610 575 52 06 227 2825ndash44 years 10286 921 115 08 248 2245ndash64 years 14917 1251 167 11 401 3465ndash74 years 4364 692 49 07 437 6975 years and over 4983 598 56 06 489 59

Male 45235 3233 506 13 318 23Under 15 years 6539 754 73 08 211 2415ndash24 years 5396 670 60 06 260 3225ndash44 years 12767 1329 143 11 315 3345ndash64 years 13280 1232 149 10 378 3565ndash74 years 3747 590 42 06 445 7075 years and over 3505 600 39 06 535 92

Race3

White 79208 4958 886 11 338 21Black or African American 6838 979 76 10 187 27Other 3365 602 38 06 164 29

Ethnicity

Hispanic or Latino 10578 1562 118 15 251 37Not Hispanic or Latino 78834 4812 882 15 317 19

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2Injury visits represent 93 percent (SE=04) of all office visits3Other race includes visits by Asians Native Hawaiians or Other Pacific Islanders American Indians or Alaska Natives and multiple races All race categories include visits by persons of Hispanicorigin and not Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for FederalData on Race and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typicallyfound for self-reported race in household surveys

NOTE Numbers may not add to totals because of rounding

Table 16 Number and percent distribution of injury-related office visits with corresponding standard errors by intent United States2005

Intent

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All injury-related visits 89412 5466 1000 Unintentional injuries 40934 4147 458 26Intentional injuries 1805 338 20 04Adverse effect of medical or surgical care or adverse effect of medicinal drug 8264 922 92 10Injuries of undetermined intent 32853 2362 367 24Unknown or blank 5556 993 62 11

Category not applicable

NOTE Numbers may not add to totals because of rounding

26 Advance Data No 387 + June 29 2007

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Number of visits in thousands

All visits 963617 432754 283180 119061 128623 560355 403262

At least one condition 507390 121891 187209 94472 103818 298366 209024None 422515 295386 85466 21112 20551 242189 180327Blank 33712 15476 10505 3477 4254 19800 13911

Hypertension 219476 23060 84640 52131 59646 127072 92404Arthritis 137942 20861 51744 27168 38169 91610 46332Hyperlipidemia 130053 12806 55561 31658 30028 68208 61845Diabetes 94359 10387 38628 23810 21534 50625 43733Depression 84610 30935 35059 8538 10078 59418 25192Obesity 68201 24275 29574 9298 5054 45028 23173Cancer 57025 4817 18809 15014 18384 32384 24640Asthma 54545 28913 14491 5764 5376 33276 21269COPD2 40754 7746 11425 10818 10764 22458 18295Ischemic heart disease 39559 1472 10179 12092 15815 16245 23314Osteoporosis 27977 6466 8050 12096 24842 3136Cerebrovascular disease 18319 731 4322 5489 7777 9000 9319CHF3 15692 3589 3409 8392 8950 6742Chronic renal failure 11486 2741 3039 4969 5633 5852

Standard error in thousands

All visits 40611 19288 13998 7460 8954 24487 18050

At least one condition 26734 6497 10543 6419 7920 16807 10964None 20054 14902 5424 1860 2135 11620 9940Blank 3749 1854 1445 668 650 2377 1724

Hypertension 14790 1976 5958 4176 5097 8906 6596Arthritis 9990 1930 4317 2357 3632 7470 3168Hyperlipidemia 9484 1139 4425 2773 3051 5051 4972Diabetes 6585 1133 3024 1939 2203 3811 3366Depression 6884 2367 3465 1084 1288 5082 2137Obesity 5885 2496 2961 1225 842 4156 2401Cancer 6483 782 2373 2149 2161 4421 2379Asthma 3877 2528 1350 712 814 2466 2012COPD2 3794 1054 1259 1356 1583 2332 1790Ischemic heart disease 3659 321 1097 1274 1920 1831 2301Osteoporosis 2821 892 1015 1413 2419 608Cerebrovascular disease 2290 188 717 844 1165 1187 1330CHF3 2054 768 561 1365 1351 1076Chronic renal failure 1713 799 609 890 829 1151

Percent distribution

All visits 1000 1000 1000 1000 1000 1000 100

At least one condition 527 282 661 793 807 532 518None 438 683 302 177 160 432 447Blank 35 36 37 29 33 35 34

Hypertension 228 53 299 438 464 227 229Arthritis 143 48 183 228 297 163 115Hyperlipidemia 135 30 196 266 233 122 153Diabetes 98 24 136 200 167 90 108Depression 88 71 124 72 78 106 62Obesity 71 56 104 78 39 80 57Cancer 59 11 66 126 143 58 61Asthma 57 67 51 48 42 59 53COPD2 42 18 40 91 84 40 45Ischemic heart disease 41 03 36 102 123 29 58Osteoporosis 29 03 23 68 94 44 08Cerebrovascular disease 19 02 15 46 60 16 23CHF3 16 01 13 29 65 16 17Chronic renal failure 12 02 10 26 39 10 15

See footnotes at end of table

Advance Data No 387 + June 29 2007 27

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005mdashCon

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Standard error of percent

All visits

At least one condition 13 10 13 13 15 14 14None 12 11 13 12 14 13 14Blank 04 04 05 06 05 04 04

Hypertension 10 04 13 19 17 11 11Arthritis 07 04 11 13 17 09 06Hyperlipidemia 08 03 12 17 16 08 10Diabetes 05 03 07 11 10 05 06Depression 06 05 10 09 09 08 05Obesity 05 05 09 09 06 06 05Cancer 06 02 08 14 13 07 05Asthma 03 05 04 06 06 04 05COPD2 03 02 04 10 10 03 04Ischemic heart disease 03 01 03 08 10 03 05Osteoporosis 02 01 03 08 08 03 01Cerebrovascular disease 02 00 02 06 07 02 03CHF3 02 00 03 04 09 02 03Chronic renal failure 02 01 03 05 06 01 03

Figure does not meet standards of reliability or precision Category not applicable1Presence of chronic conditions regardless of visit diagnosis were based on checkbox responses2COPD is chronic obstructive pulmonary disease3CHF is congestive heart failure

NOTE Numbers may not add to totals because more than one condition may be reported per visit

28 Advance Data No 387 + June 29 2007

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Number of visits in thousands

All visits 963617 319330 290545 89843 70669 174387 18845

Age

Under 15 years 160552 76704 18243 8527 3397 51622 2058Under 1 year 32070 11996 1282 17289 1ndash4 years 50400 25199 4182 2462 1081 16723 5ndash14 years 78082 39509 12779 5103 2125 17610

15ndash24 years 70583 27679 12350 5140 4873 19403 113825ndash44 years 201619 69933 51314 18727 16156 41942 354745ndash64 years 283180 84793 103754 29448 22047 37770 536865 years and over 247683 60221 104885 28000 24195 23650 6733

65ndash74 years 119061 28774 48255 14213 11487 12652 368075 years and over 128623 31447 56630 13787 12708 10998 3053

Sex

Female 560355 178477 168169 52297 39506 110589 11316Male 403262 140853 122376 37545 31162 63798 7528

Race2

White 832038 277587 251698 78452 62031 146794 15476Black or African American 88930 27098 27399 8154 6909 18139 1231Other 42649 14645 11449 3236 1728 9454 2137

Ethnicity2

Hispanic or Latino 98904 35026 26216 7016 6382 21039 3225Not Hispanic or Latino 864714 284304 264330 82827 64286 153348 15620

Expected source of payment3

Private insurance 608219 208219 174252 55707 40982 119864 9194Medicare 231655 56954 98344 27824 20905 22276 5352

Medicare and Medicaid 19002 4404 8958 2163 1140 1688 Medicaid or SCHIP4 108601 36794 28674 10323 5343 25488 1979Self-pay no charge or charity 49026 17446 14718 3220 6622 6110 Other5 51083 15679 15540 4763 6528 7160 1415

Standard error in thousands

All visits 40611 15701 14938 7475 6580 11005 3568

Age

Under 15 years 11524 6511 2408 1135 582 4532 514Under 1 year 3406 1587 367 2064 1ndash4 years 4582 2644 907 431 247 1972 5ndash14 years 4849 3142 1599 725 374 1605

15ndash24 years 4028 1901 1015 893 862 2191 37725ndash44 years 10521 4664 3704 1797 1918 3739 84745ndash64 years 13998 4755 5941 2571 2298 4309 115065 years and over 15541 4688 7577 3112 2856 2762 175065ndash74 years 7460 2206 3752 1771 1566 1469 132675 years and over 8954 2980 4464 1660 1618 1567 636

Sex

Female 24487 8994 9764 5246 3977 7175 2026Male 18050 7589 6501 2822 3371 5494 1651

Race2

White 36280 14035 13292 6241 5742 9867 3097Black or African American 7582 3077 3048 1522 1296 2275 341Other 5779 2563 2343 811 427 1345 1545

See footnotes at end of table

Advance Data No 387 + June 29 2007 19

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Ethnicity2 Standard error in thousands

Hispanic or Latino 9332 3572 3770 1275 1052 2615 801Not Hispanic or Latino 37628 14683 13732 6857 6029 10180 3091

Expected source of payment3

Private insurance 27808 10683 9568 5365 4542 8544 1727Medicare 15483 4596 7563 2961 2760 2869 1225

Medicare and Medicaid 2854 874 1554 556 394 581 Medicaid or SCHIP4 8545 3808 3239 1294 670 3275 638Self-pay no charge or charity 4662 2448 1495 488 1921 881 Other5 4411 1581 1950 606 1079 1238 426

Percent distribution

All visits 1000 331 302 93 73 181 20

Age

Under 15 years 1000 478 114 53 21 322 13Under 1 year 1000 374 40 30 06 539 111ndash4 years 1000 500 83 49 21 332 155ndash14 years 1000 506 164 65 27 226 12

15ndash24 years 1000 392 175 73 69 275 1625ndash44 years 1000 347 255 93 80 208 1845ndash64 years 1000 299 366 104 78 133 1965 years and over 1000 243 423 113 98 95 27

65ndash74 years 1000 242 405 119 96 106 3175 years and over 1000 244 440 107 99 86 24

Sex

Female 1000 319 300 93 71 197 20Male 1000 349 303 93 77 158 19

Race2

White 1000 334 303 94 75 176 19Black or African American 1000 305 308 92 78 204 14Other 1000 343 268 76 41 222 50

Ethnicity2

Hispanic or Latino 1000 354 265 71 65 213 33Not Hispanic or Latino 1000 329 306 96 74 177 18

Expected source of payment3

Private insurance 1000 342 286 92 67 197 15Medicare 1000 246 425 120 90 96 23

Medicare and Medicaid 1000 232 471 114 60 89 34Medicaid or SCHIP4 1000 339 264 95 49 235 18Self-pay no charge or charity 1000 356 300 66 135 125 19Other5 1000 307 304 93 128 140 28

Standard error of percent

All visits 09 10 06 06 08 04

Age

Under 15 years 17 14 06 04 15 03Under 1 year 26 11 07 05 26 041ndash4 years 27 16 07 05 24 055ndash14 years 21 18 08 05 17 04

15ndash24 years 22 12 11 12 23 0525ndash44 years 14 14 07 09 15 0445ndash64 years 10 14 07 07 12 0465 years and over 11 17 09 10 10 07

65ndash74 years 13 20 12 11 11 1175 years and over 14 18 10 11 11 05

See footnotes at end of table

20 Advance Data No 387 + June 29 2007

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Sex Standard error of percent

Female 10 12 07 07 10 03Male 11 12 06 08 10 04

Race2

White 09 11 05 06 08 04Black or African American 20 21 15 14 22 04Other 30 35 18 10 28 34

Ethnicity2

Hispanic or Latino 22 23 10 09 21 07Not Hispanic or Latino 09 11 06 07 08 03

Expected source of payment3

Private insurance 10 12 07 07 09 03Medicare 11 17 09 10 11 05

Medicare and Medicaid 26 42 25 19 28 12Medicaid or SCHIP4 21 23 09 06 23 06Self-pay no charge or charity 30 26 08 34 17 06Other5 19 22 10 18 21 08

Figure does not meet standards of reliability or precision Category not applicable1Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)2Other race includes visits by Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories inlcude visits by persons of Hispanic andnot Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data onRace and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple race indicated is small and lower than what is typically found forself-reported race in household surveys3Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit4SCHIP is State Childrenrsquos Health Insurance Program5Other includes workerrsquos compensation unknown or blank and payments not classified elsewhere

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 21

Table 11 Number percent distribution and annual rate of preventive care office visits and percent of visits to primary care specialistswith corresponding standard errors by selected patient and visit characteristics United States 2005

Patient and visit characteristics

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror

of rate

Percent ofpreventive carevisits made toprimary carespecialists2

Standarderror ofpercent

All preventive care visits3 174387 11005 1000 599 38 853 16

Age

Under 15 years 51622 4532 296 22 851 75 973 11Under 1 year 17289 2064 99 11 4214 503 998 011ndash4 years 16723 1972 96 10 1033 122 980 125ndash14 years 17610 1605 101 08 436 40 943 22

15ndash24 years 19403 2191 111 11 473 53 952 1725ndash44 years 41942 3739 241 16 512 46 903 1945ndash64 years 37770 4309 217 17 522 60 765 3065 years and over 23650 2762 136 13 673 79 561 45

65ndash74 years 12652 1469 73 07 688 80 609 4475 years and over 10998 1567 63 08 656 94 506 59

Sex and age

Female 110589 7175 634 18 744 48 870 16Under 15 years 23224 2063 133 10 784 70 979 0815ndash24 years 15134 1874 87 10 746 92 971 0825ndash44 years 33658 3258 193 16 813 79 929 1745ndash64 years 23897 2473 137 10 642 66 777 3065ndash74 years 7748 980 44 05 776 98 657 5275 years and over 6929 1030 40 05 679 101 552 57

Male 63798 5494 366 18 448 39 824 20Under 15 years 28399 2848 163 14 915 92 969 1515ndash24 years 4269 731 24 04 206 35 883 5825ndash44 years 8284 1244 48 06 204 31 796 4345ndash64 years 13873 2561 80 13 395 73 745 5065ndash74 years 4904 724 28 04 583 86 532 5875 years and over 4069 708 23 04 621 108 427 82

Race4

White 146794 9867 842 15 627 42 843 18Black or African American 18139 2275 104 12 496 62 906 21Other 9454 1345 54 07 462 66 915 29

Ethnicity4

Hispanic or Latino 21039 2615 121 14 499 62 914 20Not Hispanic or Latino 153348 10180 879 14 616 41 845 17

Expected source(s) of payment5

Private insurance 119864 8544 687 20 619 44 866 16Medicare 22276 2869 128 13 592 76 591 48

Medicare and Medicaid 1688 581 10 03 599 156MedicaidSCHIP6 25488 3275 146 17 795 102 928 19Self-pay no charge or charity7 6110 881 35 05 146 21 810 47Other8 7160 1238 41 07 767 56

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau Visit rates for expected source(s) of payment are based on the 2005 National Health Interview Survey estimates of health insurance2Primary care specialty defined in specialty type classification found in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo3Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)4Other race includes Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic and notHispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data on Raceand Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typically found forself-reported race in household surveys5Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit6SCHIP is State Childrenrsquos Health Insurance Program7The visit rate was calculated using lsquolsquouninsuredrsquorsquo as the denominator from the 2005 estimates of health insurance coverage from the National Health Inteview Survey8Other includes workerrsquos compensation unknown or blank and sources not elsewhere classified

NOTE Numbers may not add to totals because of rounding

22 Advance Data No 387 + June 29 2007

Table 12 Number and percent distribution of office visits with corresponding standard errors by physicianrsquos primary diagnosisUnited States 2005

Major disease category and ICDndash9ndashCM code range1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Infectious and parasitic diseases 001ndash139 26720 2062 28 02Neoplasms 140ndash239 39200 5285 41 05Endocrine nutritional and metabolic diseases and immunity disorders 240ndash279 56408 4655 59 04Mental disorders 290ndash319 47094 3777 49 04Diseases of the nervous system and sense organs 320ndash389 86128 6644 89 05Diseases of the circulatory system 390ndash459 81836 6683 85 06Diseases of the respiratory system 460ndash519 110999 7670 115 07Diseases of the digestive system 520ndash579 28678 2225 30 02Diseases of the genitourinary system 580ndash629 42256 3131 44 03Diseases of the skin and subcutaneous tissue 680ndash709 44443 3189 46 03Diseases of the musculoskeletal system and connective tissue 710ndash739 80601 6320 84 05Symptoms signs and ill-defined conditions 780ndash799 60536 3916 63 03Injury and poisoning 800ndash999 45137 3087 47 03Supplementary classification V01ndashV82 179276 11124 186 09All other diagnoses2 25609 3533 27 03Unknown3 8697 1645 09 02

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23)2Includes diseases of the blood and blood-forming organs (280ndash289) complications of pregnancy childbirth and the puerperium (630ndash677) congenital anomalies (740ndash759) certain conditionsoriginating in the perinatal period (760ndash779) and entries not codable to the ICDndash9ndashCM (eg illegible entries left against medical advice transferred entries of lsquolsquononersquorsquo or lsquolsquono diagnosesrsquorsquo)3Includes blank diagnoses

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 23

Table 13 Number and percent distribution of office visits with corresponding standard errors by the 20 leading primary diagnosis groups according to patientrsquos sexUnited States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

Essential hypertension 401 44670 4318 46 04 44 04 50 05Routine infant or child health check V202 41816 4044 43 04 33 03 57 06Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 36372 2875 38 03 33 03 45 04Arthropathies and related disorders 710ndash719 34299 4200 36 04 42 06 27 03Malignant neoplasms 140ndash208230ndash234 28709 5644 30 06 30 07 30 04Diabetes mellitus 250 25451 2730 26 03 25 03 29 03Spinal disorders 720ndash724 22732 2523 24 02 24 02 23 03Rheumatism excluding back 725ndash729 18580 1580 19 01 19 02 19 02General medical examination V70 17007 2377 18 02 15 02 22 03Follow up examination V67 16249 2573 17 02 17 03 16 03Specific procedures and aftercare V50ndashV599 15662 2000 16 02 17 02 15 03Normal pregnancy V22 15509 2534 16 03 28 05 Gynecological examination V723 15067 2378 16 02 27 04 Otitis media and eustachian tube disorders 381ndash382 14399 1517 15 01 12 01 19 02Asthma 493 12823 2102 13 02 11 02 16 04Disorders of lipoid metabolism 272 12650 1416 13 01 11 02 16 02Chronic sinusitis 473 12621 1302 13 01 12 01 14 02Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 11473 1490 12 01 10 01 15 02Acute pharyngitis 462 11064 1941 11 02 11 02 13 03Allergic rhinitis 477 11028 2099 11 02 11 02 12 03All other diagnoses 545437 23756 566 08 568 10 564 10

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to form larger categories that better describe the utilization of ambulatory care services2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

24A

dvanceD

ataN

o387+

June292007

Table 14 Number percent distribution and annual rate of office visits with corresponding standard errors by patientrsquos age accordingto the five leading primary diagnosis groups United States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year2

Standarderror of

rate

All visits 963617 40611 1000 3310 139

Under 1 year

All visits 32070 3406 1000 7816 830Routine infant or child health check V202 14528 1965 453 31 3541 479Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 3442 593 107 16 839 145Otitis media and eustachian tube disorders 381ndash382 2541 559 79 15 619 136Certain conditions originating in the perinatal period 760ndash779 34 08 269 65Unspecified viral and chlamydial infection 799 19 07 148 64All other diagnoses 9847 1134 307 22 2400 276

1ndash12 years

All visits 112241 8094 1000 2337 169Routine infant or child health check V202 21953 2294 196 14 457 48Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 12310 1705 110 11 256 36Otitis media and eustachian tube disorders 381ndash382 7901 843 70 07 165 18Asthma 493 4252 1126 38 10 89 23Acute pharyngitis 462 4203 868 37 07 88 18All other diagnoses 61622 4491 549 15 1283 94

13ndash21 years

All visits 66533 3594 1000 1785 96Routine infant or child health check V202 5334 803 80 11 143 22Normal pregnancy V22 3331 830 50 12 3182 45Acne 7060ndash7061 2931 560 44 08 79 15Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 2915 501 44 07 78 13Acute pharyngitis 462 2248 597 34 09 60 16All other diagnoses 49774 2793 748 18 1335 75

22ndash49 years

All visits 290199 14182 1000 2490 122Normal pregnancy V22 12178 1924 42 07 4207 33Spinal disorders 720ndash724 10148 1340 35 04 87 12Arthropathies and related disorders 710ndash719 9874 1767 34 06 85 15Gynecological examination V723 9496 1431 33 05 4161 24Essential hypertension 401 9361 1362 32 04 80 12All other diagnoses 239141 12253 824 11 2052 105

50ndash64 years

All visits 214891 10973 1000 4292 219Essential hypertension 401 15519 1884 72 08 310 38Arthropathies and related disorders 710ndash719 11162 1512 52 06 223 30Diabetes mellitus 250 9272 1048 43 04 185 21Malignant neoplasms 140ndash208230ndash234 8870 1861 41 08 177 37Spinal disorders 720ndash724 6530 935 30 04 130 19All other diagnoses 163538 8317 761 11 3266 166

65 years and over

All visits 247683 15541 1000 7047 442Essential hypertension 401 19129 2184 77 08 544 62Malignant neoplasms 140ndash208230ndash234 15679 3215 63 12 446 91Arthropathies and related disorders 710ndash719 11814 1815 48 06 336 52Diabetes mellitus 250 11253 1594 45 06 320 45Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 7824 1167 32 04 223 33All other diagnoses 181986 11408 735 12 5177 325

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth RevisionClinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to better describe the use ofambulatory care services2Visit rates for age are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Populations Division US Census Bureau3The population used for this rate is based on visits by females 13ndash21 years of age For males in this age group the leading diagnosis was routine infant or child health check (155 visits per 100males 13ndash21 years SE=31)4The population used for this rate is based on visits by females 22ndash49 years of age For males in this age group the leading diagnosis was essential hypertension (84 visits per 100 males 22ndash49years SE=15)

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 25

Table 15 Number percent distribution and annual rate of injury-related office visits with corresponding standard errors by selectedpatient characteristics United States 2005

Patient characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror of

rate

All injury-related visits2 89412 5466 1000 307 19

Age

Under 15 years 11556 1126 129 11 191 19Under 1 year 07 03 157 611ndash4 years 3191 495 36 06 197 315ndash14 years 7721 853 86 08 191 21

15ndash24 years 10006 973 112 09 244 2425ndash44 years 23053 1919 258 13 281 2345ndash64 years 28197 2050 315 13 390 2865 years and over 16600 1684 186 14 472 48

65ndash74 years 8111 976 91 09 441 5375 years and over 8489 937 95 08 507 56

Sex and age

Female 44177 2711 494 13 297 18Under 15 years 5017 622 56 07 169 2115ndash24 years 4610 575 52 06 227 2825ndash44 years 10286 921 115 08 248 2245ndash64 years 14917 1251 167 11 401 3465ndash74 years 4364 692 49 07 437 6975 years and over 4983 598 56 06 489 59

Male 45235 3233 506 13 318 23Under 15 years 6539 754 73 08 211 2415ndash24 years 5396 670 60 06 260 3225ndash44 years 12767 1329 143 11 315 3345ndash64 years 13280 1232 149 10 378 3565ndash74 years 3747 590 42 06 445 7075 years and over 3505 600 39 06 535 92

Race3

White 79208 4958 886 11 338 21Black or African American 6838 979 76 10 187 27Other 3365 602 38 06 164 29

Ethnicity

Hispanic or Latino 10578 1562 118 15 251 37Not Hispanic or Latino 78834 4812 882 15 317 19

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2Injury visits represent 93 percent (SE=04) of all office visits3Other race includes visits by Asians Native Hawaiians or Other Pacific Islanders American Indians or Alaska Natives and multiple races All race categories include visits by persons of Hispanicorigin and not Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for FederalData on Race and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typicallyfound for self-reported race in household surveys

NOTE Numbers may not add to totals because of rounding

Table 16 Number and percent distribution of injury-related office visits with corresponding standard errors by intent United States2005

Intent

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All injury-related visits 89412 5466 1000 Unintentional injuries 40934 4147 458 26Intentional injuries 1805 338 20 04Adverse effect of medical or surgical care or adverse effect of medicinal drug 8264 922 92 10Injuries of undetermined intent 32853 2362 367 24Unknown or blank 5556 993 62 11

Category not applicable

NOTE Numbers may not add to totals because of rounding

26 Advance Data No 387 + June 29 2007

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Number of visits in thousands

All visits 963617 432754 283180 119061 128623 560355 403262

At least one condition 507390 121891 187209 94472 103818 298366 209024None 422515 295386 85466 21112 20551 242189 180327Blank 33712 15476 10505 3477 4254 19800 13911

Hypertension 219476 23060 84640 52131 59646 127072 92404Arthritis 137942 20861 51744 27168 38169 91610 46332Hyperlipidemia 130053 12806 55561 31658 30028 68208 61845Diabetes 94359 10387 38628 23810 21534 50625 43733Depression 84610 30935 35059 8538 10078 59418 25192Obesity 68201 24275 29574 9298 5054 45028 23173Cancer 57025 4817 18809 15014 18384 32384 24640Asthma 54545 28913 14491 5764 5376 33276 21269COPD2 40754 7746 11425 10818 10764 22458 18295Ischemic heart disease 39559 1472 10179 12092 15815 16245 23314Osteoporosis 27977 6466 8050 12096 24842 3136Cerebrovascular disease 18319 731 4322 5489 7777 9000 9319CHF3 15692 3589 3409 8392 8950 6742Chronic renal failure 11486 2741 3039 4969 5633 5852

Standard error in thousands

All visits 40611 19288 13998 7460 8954 24487 18050

At least one condition 26734 6497 10543 6419 7920 16807 10964None 20054 14902 5424 1860 2135 11620 9940Blank 3749 1854 1445 668 650 2377 1724

Hypertension 14790 1976 5958 4176 5097 8906 6596Arthritis 9990 1930 4317 2357 3632 7470 3168Hyperlipidemia 9484 1139 4425 2773 3051 5051 4972Diabetes 6585 1133 3024 1939 2203 3811 3366Depression 6884 2367 3465 1084 1288 5082 2137Obesity 5885 2496 2961 1225 842 4156 2401Cancer 6483 782 2373 2149 2161 4421 2379Asthma 3877 2528 1350 712 814 2466 2012COPD2 3794 1054 1259 1356 1583 2332 1790Ischemic heart disease 3659 321 1097 1274 1920 1831 2301Osteoporosis 2821 892 1015 1413 2419 608Cerebrovascular disease 2290 188 717 844 1165 1187 1330CHF3 2054 768 561 1365 1351 1076Chronic renal failure 1713 799 609 890 829 1151

Percent distribution

All visits 1000 1000 1000 1000 1000 1000 100

At least one condition 527 282 661 793 807 532 518None 438 683 302 177 160 432 447Blank 35 36 37 29 33 35 34

Hypertension 228 53 299 438 464 227 229Arthritis 143 48 183 228 297 163 115Hyperlipidemia 135 30 196 266 233 122 153Diabetes 98 24 136 200 167 90 108Depression 88 71 124 72 78 106 62Obesity 71 56 104 78 39 80 57Cancer 59 11 66 126 143 58 61Asthma 57 67 51 48 42 59 53COPD2 42 18 40 91 84 40 45Ischemic heart disease 41 03 36 102 123 29 58Osteoporosis 29 03 23 68 94 44 08Cerebrovascular disease 19 02 15 46 60 16 23CHF3 16 01 13 29 65 16 17Chronic renal failure 12 02 10 26 39 10 15

See footnotes at end of table

Advance Data No 387 + June 29 2007 27

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005mdashCon

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Standard error of percent

All visits

At least one condition 13 10 13 13 15 14 14None 12 11 13 12 14 13 14Blank 04 04 05 06 05 04 04

Hypertension 10 04 13 19 17 11 11Arthritis 07 04 11 13 17 09 06Hyperlipidemia 08 03 12 17 16 08 10Diabetes 05 03 07 11 10 05 06Depression 06 05 10 09 09 08 05Obesity 05 05 09 09 06 06 05Cancer 06 02 08 14 13 07 05Asthma 03 05 04 06 06 04 05COPD2 03 02 04 10 10 03 04Ischemic heart disease 03 01 03 08 10 03 05Osteoporosis 02 01 03 08 08 03 01Cerebrovascular disease 02 00 02 06 07 02 03CHF3 02 00 03 04 09 02 03Chronic renal failure 02 01 03 05 06 01 03

Figure does not meet standards of reliability or precision Category not applicable1Presence of chronic conditions regardless of visit diagnosis were based on checkbox responses2COPD is chronic obstructive pulmonary disease3CHF is congestive heart failure

NOTE Numbers may not add to totals because more than one condition may be reported per visit

28 Advance Data No 387 + June 29 2007

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Ethnicity2 Standard error in thousands

Hispanic or Latino 9332 3572 3770 1275 1052 2615 801Not Hispanic or Latino 37628 14683 13732 6857 6029 10180 3091

Expected source of payment3

Private insurance 27808 10683 9568 5365 4542 8544 1727Medicare 15483 4596 7563 2961 2760 2869 1225

Medicare and Medicaid 2854 874 1554 556 394 581 Medicaid or SCHIP4 8545 3808 3239 1294 670 3275 638Self-pay no charge or charity 4662 2448 1495 488 1921 881 Other5 4411 1581 1950 606 1079 1238 426

Percent distribution

All visits 1000 331 302 93 73 181 20

Age

Under 15 years 1000 478 114 53 21 322 13Under 1 year 1000 374 40 30 06 539 111ndash4 years 1000 500 83 49 21 332 155ndash14 years 1000 506 164 65 27 226 12

15ndash24 years 1000 392 175 73 69 275 1625ndash44 years 1000 347 255 93 80 208 1845ndash64 years 1000 299 366 104 78 133 1965 years and over 1000 243 423 113 98 95 27

65ndash74 years 1000 242 405 119 96 106 3175 years and over 1000 244 440 107 99 86 24

Sex

Female 1000 319 300 93 71 197 20Male 1000 349 303 93 77 158 19

Race2

White 1000 334 303 94 75 176 19Black or African American 1000 305 308 92 78 204 14Other 1000 343 268 76 41 222 50

Ethnicity2

Hispanic or Latino 1000 354 265 71 65 213 33Not Hispanic or Latino 1000 329 306 96 74 177 18

Expected source of payment3

Private insurance 1000 342 286 92 67 197 15Medicare 1000 246 425 120 90 96 23

Medicare and Medicaid 1000 232 471 114 60 89 34Medicaid or SCHIP4 1000 339 264 95 49 235 18Self-pay no charge or charity 1000 356 300 66 135 125 19Other5 1000 307 304 93 128 140 28

Standard error of percent

All visits 09 10 06 06 08 04

Age

Under 15 years 17 14 06 04 15 03Under 1 year 26 11 07 05 26 041ndash4 years 27 16 07 05 24 055ndash14 years 21 18 08 05 17 04

15ndash24 years 22 12 11 12 23 0525ndash44 years 14 14 07 09 15 0445ndash64 years 10 14 07 07 12 0465 years and over 11 17 09 10 10 07

65ndash74 years 13 20 12 11 11 1175 years and over 14 18 10 11 11 05

See footnotes at end of table

20 Advance Data No 387 + June 29 2007

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Sex Standard error of percent

Female 10 12 07 07 10 03Male 11 12 06 08 10 04

Race2

White 09 11 05 06 08 04Black or African American 20 21 15 14 22 04Other 30 35 18 10 28 34

Ethnicity2

Hispanic or Latino 22 23 10 09 21 07Not Hispanic or Latino 09 11 06 07 08 03

Expected source of payment3

Private insurance 10 12 07 07 09 03Medicare 11 17 09 10 11 05

Medicare and Medicaid 26 42 25 19 28 12Medicaid or SCHIP4 21 23 09 06 23 06Self-pay no charge or charity 30 26 08 34 17 06Other5 19 22 10 18 21 08

Figure does not meet standards of reliability or precision Category not applicable1Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)2Other race includes visits by Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories inlcude visits by persons of Hispanic andnot Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data onRace and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple race indicated is small and lower than what is typically found forself-reported race in household surveys3Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit4SCHIP is State Childrenrsquos Health Insurance Program5Other includes workerrsquos compensation unknown or blank and payments not classified elsewhere

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 21

Table 11 Number percent distribution and annual rate of preventive care office visits and percent of visits to primary care specialistswith corresponding standard errors by selected patient and visit characteristics United States 2005

Patient and visit characteristics

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror

of rate

Percent ofpreventive carevisits made toprimary carespecialists2

Standarderror ofpercent

All preventive care visits3 174387 11005 1000 599 38 853 16

Age

Under 15 years 51622 4532 296 22 851 75 973 11Under 1 year 17289 2064 99 11 4214 503 998 011ndash4 years 16723 1972 96 10 1033 122 980 125ndash14 years 17610 1605 101 08 436 40 943 22

15ndash24 years 19403 2191 111 11 473 53 952 1725ndash44 years 41942 3739 241 16 512 46 903 1945ndash64 years 37770 4309 217 17 522 60 765 3065 years and over 23650 2762 136 13 673 79 561 45

65ndash74 years 12652 1469 73 07 688 80 609 4475 years and over 10998 1567 63 08 656 94 506 59

Sex and age

Female 110589 7175 634 18 744 48 870 16Under 15 years 23224 2063 133 10 784 70 979 0815ndash24 years 15134 1874 87 10 746 92 971 0825ndash44 years 33658 3258 193 16 813 79 929 1745ndash64 years 23897 2473 137 10 642 66 777 3065ndash74 years 7748 980 44 05 776 98 657 5275 years and over 6929 1030 40 05 679 101 552 57

Male 63798 5494 366 18 448 39 824 20Under 15 years 28399 2848 163 14 915 92 969 1515ndash24 years 4269 731 24 04 206 35 883 5825ndash44 years 8284 1244 48 06 204 31 796 4345ndash64 years 13873 2561 80 13 395 73 745 5065ndash74 years 4904 724 28 04 583 86 532 5875 years and over 4069 708 23 04 621 108 427 82

Race4

White 146794 9867 842 15 627 42 843 18Black or African American 18139 2275 104 12 496 62 906 21Other 9454 1345 54 07 462 66 915 29

Ethnicity4

Hispanic or Latino 21039 2615 121 14 499 62 914 20Not Hispanic or Latino 153348 10180 879 14 616 41 845 17

Expected source(s) of payment5

Private insurance 119864 8544 687 20 619 44 866 16Medicare 22276 2869 128 13 592 76 591 48

Medicare and Medicaid 1688 581 10 03 599 156MedicaidSCHIP6 25488 3275 146 17 795 102 928 19Self-pay no charge or charity7 6110 881 35 05 146 21 810 47Other8 7160 1238 41 07 767 56

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau Visit rates for expected source(s) of payment are based on the 2005 National Health Interview Survey estimates of health insurance2Primary care specialty defined in specialty type classification found in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo3Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)4Other race includes Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic and notHispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data on Raceand Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typically found forself-reported race in household surveys5Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit6SCHIP is State Childrenrsquos Health Insurance Program7The visit rate was calculated using lsquolsquouninsuredrsquorsquo as the denominator from the 2005 estimates of health insurance coverage from the National Health Inteview Survey8Other includes workerrsquos compensation unknown or blank and sources not elsewhere classified

NOTE Numbers may not add to totals because of rounding

22 Advance Data No 387 + June 29 2007

Table 12 Number and percent distribution of office visits with corresponding standard errors by physicianrsquos primary diagnosisUnited States 2005

Major disease category and ICDndash9ndashCM code range1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Infectious and parasitic diseases 001ndash139 26720 2062 28 02Neoplasms 140ndash239 39200 5285 41 05Endocrine nutritional and metabolic diseases and immunity disorders 240ndash279 56408 4655 59 04Mental disorders 290ndash319 47094 3777 49 04Diseases of the nervous system and sense organs 320ndash389 86128 6644 89 05Diseases of the circulatory system 390ndash459 81836 6683 85 06Diseases of the respiratory system 460ndash519 110999 7670 115 07Diseases of the digestive system 520ndash579 28678 2225 30 02Diseases of the genitourinary system 580ndash629 42256 3131 44 03Diseases of the skin and subcutaneous tissue 680ndash709 44443 3189 46 03Diseases of the musculoskeletal system and connective tissue 710ndash739 80601 6320 84 05Symptoms signs and ill-defined conditions 780ndash799 60536 3916 63 03Injury and poisoning 800ndash999 45137 3087 47 03Supplementary classification V01ndashV82 179276 11124 186 09All other diagnoses2 25609 3533 27 03Unknown3 8697 1645 09 02

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23)2Includes diseases of the blood and blood-forming organs (280ndash289) complications of pregnancy childbirth and the puerperium (630ndash677) congenital anomalies (740ndash759) certain conditionsoriginating in the perinatal period (760ndash779) and entries not codable to the ICDndash9ndashCM (eg illegible entries left against medical advice transferred entries of lsquolsquononersquorsquo or lsquolsquono diagnosesrsquorsquo)3Includes blank diagnoses

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 23

Table 13 Number and percent distribution of office visits with corresponding standard errors by the 20 leading primary diagnosis groups according to patientrsquos sexUnited States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

Essential hypertension 401 44670 4318 46 04 44 04 50 05Routine infant or child health check V202 41816 4044 43 04 33 03 57 06Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 36372 2875 38 03 33 03 45 04Arthropathies and related disorders 710ndash719 34299 4200 36 04 42 06 27 03Malignant neoplasms 140ndash208230ndash234 28709 5644 30 06 30 07 30 04Diabetes mellitus 250 25451 2730 26 03 25 03 29 03Spinal disorders 720ndash724 22732 2523 24 02 24 02 23 03Rheumatism excluding back 725ndash729 18580 1580 19 01 19 02 19 02General medical examination V70 17007 2377 18 02 15 02 22 03Follow up examination V67 16249 2573 17 02 17 03 16 03Specific procedures and aftercare V50ndashV599 15662 2000 16 02 17 02 15 03Normal pregnancy V22 15509 2534 16 03 28 05 Gynecological examination V723 15067 2378 16 02 27 04 Otitis media and eustachian tube disorders 381ndash382 14399 1517 15 01 12 01 19 02Asthma 493 12823 2102 13 02 11 02 16 04Disorders of lipoid metabolism 272 12650 1416 13 01 11 02 16 02Chronic sinusitis 473 12621 1302 13 01 12 01 14 02Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 11473 1490 12 01 10 01 15 02Acute pharyngitis 462 11064 1941 11 02 11 02 13 03Allergic rhinitis 477 11028 2099 11 02 11 02 12 03All other diagnoses 545437 23756 566 08 568 10 564 10

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to form larger categories that better describe the utilization of ambulatory care services2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

24A

dvanceD

ataN

o387+

June292007

Table 14 Number percent distribution and annual rate of office visits with corresponding standard errors by patientrsquos age accordingto the five leading primary diagnosis groups United States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year2

Standarderror of

rate

All visits 963617 40611 1000 3310 139

Under 1 year

All visits 32070 3406 1000 7816 830Routine infant or child health check V202 14528 1965 453 31 3541 479Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 3442 593 107 16 839 145Otitis media and eustachian tube disorders 381ndash382 2541 559 79 15 619 136Certain conditions originating in the perinatal period 760ndash779 34 08 269 65Unspecified viral and chlamydial infection 799 19 07 148 64All other diagnoses 9847 1134 307 22 2400 276

1ndash12 years

All visits 112241 8094 1000 2337 169Routine infant or child health check V202 21953 2294 196 14 457 48Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 12310 1705 110 11 256 36Otitis media and eustachian tube disorders 381ndash382 7901 843 70 07 165 18Asthma 493 4252 1126 38 10 89 23Acute pharyngitis 462 4203 868 37 07 88 18All other diagnoses 61622 4491 549 15 1283 94

13ndash21 years

All visits 66533 3594 1000 1785 96Routine infant or child health check V202 5334 803 80 11 143 22Normal pregnancy V22 3331 830 50 12 3182 45Acne 7060ndash7061 2931 560 44 08 79 15Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 2915 501 44 07 78 13Acute pharyngitis 462 2248 597 34 09 60 16All other diagnoses 49774 2793 748 18 1335 75

22ndash49 years

All visits 290199 14182 1000 2490 122Normal pregnancy V22 12178 1924 42 07 4207 33Spinal disorders 720ndash724 10148 1340 35 04 87 12Arthropathies and related disorders 710ndash719 9874 1767 34 06 85 15Gynecological examination V723 9496 1431 33 05 4161 24Essential hypertension 401 9361 1362 32 04 80 12All other diagnoses 239141 12253 824 11 2052 105

50ndash64 years

All visits 214891 10973 1000 4292 219Essential hypertension 401 15519 1884 72 08 310 38Arthropathies and related disorders 710ndash719 11162 1512 52 06 223 30Diabetes mellitus 250 9272 1048 43 04 185 21Malignant neoplasms 140ndash208230ndash234 8870 1861 41 08 177 37Spinal disorders 720ndash724 6530 935 30 04 130 19All other diagnoses 163538 8317 761 11 3266 166

65 years and over

All visits 247683 15541 1000 7047 442Essential hypertension 401 19129 2184 77 08 544 62Malignant neoplasms 140ndash208230ndash234 15679 3215 63 12 446 91Arthropathies and related disorders 710ndash719 11814 1815 48 06 336 52Diabetes mellitus 250 11253 1594 45 06 320 45Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 7824 1167 32 04 223 33All other diagnoses 181986 11408 735 12 5177 325

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth RevisionClinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to better describe the use ofambulatory care services2Visit rates for age are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Populations Division US Census Bureau3The population used for this rate is based on visits by females 13ndash21 years of age For males in this age group the leading diagnosis was routine infant or child health check (155 visits per 100males 13ndash21 years SE=31)4The population used for this rate is based on visits by females 22ndash49 years of age For males in this age group the leading diagnosis was essential hypertension (84 visits per 100 males 22ndash49years SE=15)

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 25

Table 15 Number percent distribution and annual rate of injury-related office visits with corresponding standard errors by selectedpatient characteristics United States 2005

Patient characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror of

rate

All injury-related visits2 89412 5466 1000 307 19

Age

Under 15 years 11556 1126 129 11 191 19Under 1 year 07 03 157 611ndash4 years 3191 495 36 06 197 315ndash14 years 7721 853 86 08 191 21

15ndash24 years 10006 973 112 09 244 2425ndash44 years 23053 1919 258 13 281 2345ndash64 years 28197 2050 315 13 390 2865 years and over 16600 1684 186 14 472 48

65ndash74 years 8111 976 91 09 441 5375 years and over 8489 937 95 08 507 56

Sex and age

Female 44177 2711 494 13 297 18Under 15 years 5017 622 56 07 169 2115ndash24 years 4610 575 52 06 227 2825ndash44 years 10286 921 115 08 248 2245ndash64 years 14917 1251 167 11 401 3465ndash74 years 4364 692 49 07 437 6975 years and over 4983 598 56 06 489 59

Male 45235 3233 506 13 318 23Under 15 years 6539 754 73 08 211 2415ndash24 years 5396 670 60 06 260 3225ndash44 years 12767 1329 143 11 315 3345ndash64 years 13280 1232 149 10 378 3565ndash74 years 3747 590 42 06 445 7075 years and over 3505 600 39 06 535 92

Race3

White 79208 4958 886 11 338 21Black or African American 6838 979 76 10 187 27Other 3365 602 38 06 164 29

Ethnicity

Hispanic or Latino 10578 1562 118 15 251 37Not Hispanic or Latino 78834 4812 882 15 317 19

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2Injury visits represent 93 percent (SE=04) of all office visits3Other race includes visits by Asians Native Hawaiians or Other Pacific Islanders American Indians or Alaska Natives and multiple races All race categories include visits by persons of Hispanicorigin and not Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for FederalData on Race and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typicallyfound for self-reported race in household surveys

NOTE Numbers may not add to totals because of rounding

Table 16 Number and percent distribution of injury-related office visits with corresponding standard errors by intent United States2005

Intent

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All injury-related visits 89412 5466 1000 Unintentional injuries 40934 4147 458 26Intentional injuries 1805 338 20 04Adverse effect of medical or surgical care or adverse effect of medicinal drug 8264 922 92 10Injuries of undetermined intent 32853 2362 367 24Unknown or blank 5556 993 62 11

Category not applicable

NOTE Numbers may not add to totals because of rounding

26 Advance Data No 387 + June 29 2007

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Number of visits in thousands

All visits 963617 432754 283180 119061 128623 560355 403262

At least one condition 507390 121891 187209 94472 103818 298366 209024None 422515 295386 85466 21112 20551 242189 180327Blank 33712 15476 10505 3477 4254 19800 13911

Hypertension 219476 23060 84640 52131 59646 127072 92404Arthritis 137942 20861 51744 27168 38169 91610 46332Hyperlipidemia 130053 12806 55561 31658 30028 68208 61845Diabetes 94359 10387 38628 23810 21534 50625 43733Depression 84610 30935 35059 8538 10078 59418 25192Obesity 68201 24275 29574 9298 5054 45028 23173Cancer 57025 4817 18809 15014 18384 32384 24640Asthma 54545 28913 14491 5764 5376 33276 21269COPD2 40754 7746 11425 10818 10764 22458 18295Ischemic heart disease 39559 1472 10179 12092 15815 16245 23314Osteoporosis 27977 6466 8050 12096 24842 3136Cerebrovascular disease 18319 731 4322 5489 7777 9000 9319CHF3 15692 3589 3409 8392 8950 6742Chronic renal failure 11486 2741 3039 4969 5633 5852

Standard error in thousands

All visits 40611 19288 13998 7460 8954 24487 18050

At least one condition 26734 6497 10543 6419 7920 16807 10964None 20054 14902 5424 1860 2135 11620 9940Blank 3749 1854 1445 668 650 2377 1724

Hypertension 14790 1976 5958 4176 5097 8906 6596Arthritis 9990 1930 4317 2357 3632 7470 3168Hyperlipidemia 9484 1139 4425 2773 3051 5051 4972Diabetes 6585 1133 3024 1939 2203 3811 3366Depression 6884 2367 3465 1084 1288 5082 2137Obesity 5885 2496 2961 1225 842 4156 2401Cancer 6483 782 2373 2149 2161 4421 2379Asthma 3877 2528 1350 712 814 2466 2012COPD2 3794 1054 1259 1356 1583 2332 1790Ischemic heart disease 3659 321 1097 1274 1920 1831 2301Osteoporosis 2821 892 1015 1413 2419 608Cerebrovascular disease 2290 188 717 844 1165 1187 1330CHF3 2054 768 561 1365 1351 1076Chronic renal failure 1713 799 609 890 829 1151

Percent distribution

All visits 1000 1000 1000 1000 1000 1000 100

At least one condition 527 282 661 793 807 532 518None 438 683 302 177 160 432 447Blank 35 36 37 29 33 35 34

Hypertension 228 53 299 438 464 227 229Arthritis 143 48 183 228 297 163 115Hyperlipidemia 135 30 196 266 233 122 153Diabetes 98 24 136 200 167 90 108Depression 88 71 124 72 78 106 62Obesity 71 56 104 78 39 80 57Cancer 59 11 66 126 143 58 61Asthma 57 67 51 48 42 59 53COPD2 42 18 40 91 84 40 45Ischemic heart disease 41 03 36 102 123 29 58Osteoporosis 29 03 23 68 94 44 08Cerebrovascular disease 19 02 15 46 60 16 23CHF3 16 01 13 29 65 16 17Chronic renal failure 12 02 10 26 39 10 15

See footnotes at end of table

Advance Data No 387 + June 29 2007 27

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005mdashCon

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Standard error of percent

All visits

At least one condition 13 10 13 13 15 14 14None 12 11 13 12 14 13 14Blank 04 04 05 06 05 04 04

Hypertension 10 04 13 19 17 11 11Arthritis 07 04 11 13 17 09 06Hyperlipidemia 08 03 12 17 16 08 10Diabetes 05 03 07 11 10 05 06Depression 06 05 10 09 09 08 05Obesity 05 05 09 09 06 06 05Cancer 06 02 08 14 13 07 05Asthma 03 05 04 06 06 04 05COPD2 03 02 04 10 10 03 04Ischemic heart disease 03 01 03 08 10 03 05Osteoporosis 02 01 03 08 08 03 01Cerebrovascular disease 02 00 02 06 07 02 03CHF3 02 00 03 04 09 02 03Chronic renal failure 02 01 03 05 06 01 03

Figure does not meet standards of reliability or precision Category not applicable1Presence of chronic conditions regardless of visit diagnosis were based on checkbox responses2COPD is chronic obstructive pulmonary disease3CHF is congestive heart failure

NOTE Numbers may not add to totals because more than one condition may be reported per visit

28 Advance Data No 387 + June 29 2007

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 10 Number and percent distribution of office visits with corresponding standard errors by major reason for visit according toselected patient and visit characteristics United States 2005mdashCon

Patient and visit characteristics TotalNew

problem

Chronicproblemroutine

Chronicproblemflare-up

Pre- or post-surgery

Preventivecare1

Unknownor blank

Sex Standard error of percent

Female 10 12 07 07 10 03Male 11 12 06 08 10 04

Race2

White 09 11 05 06 08 04Black or African American 20 21 15 14 22 04Other 30 35 18 10 28 34

Ethnicity2

Hispanic or Latino 22 23 10 09 21 07Not Hispanic or Latino 09 11 06 07 08 03

Expected source of payment3

Private insurance 10 12 07 07 09 03Medicare 11 17 09 10 11 05

Medicare and Medicaid 26 42 25 19 28 12Medicaid or SCHIP4 21 23 09 06 23 06Self-pay no charge or charity 30 26 08 34 17 06Other5 19 22 10 18 21 08

Figure does not meet standards of reliability or precision Category not applicable1Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)2Other race includes visits by Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories inlcude visits by persons of Hispanic andnot Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data onRace and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple race indicated is small and lower than what is typically found forself-reported race in household surveys3Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit4SCHIP is State Childrenrsquos Health Insurance Program5Other includes workerrsquos compensation unknown or blank and payments not classified elsewhere

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 21

Table 11 Number percent distribution and annual rate of preventive care office visits and percent of visits to primary care specialistswith corresponding standard errors by selected patient and visit characteristics United States 2005

Patient and visit characteristics

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror

of rate

Percent ofpreventive carevisits made toprimary carespecialists2

Standarderror ofpercent

All preventive care visits3 174387 11005 1000 599 38 853 16

Age

Under 15 years 51622 4532 296 22 851 75 973 11Under 1 year 17289 2064 99 11 4214 503 998 011ndash4 years 16723 1972 96 10 1033 122 980 125ndash14 years 17610 1605 101 08 436 40 943 22

15ndash24 years 19403 2191 111 11 473 53 952 1725ndash44 years 41942 3739 241 16 512 46 903 1945ndash64 years 37770 4309 217 17 522 60 765 3065 years and over 23650 2762 136 13 673 79 561 45

65ndash74 years 12652 1469 73 07 688 80 609 4475 years and over 10998 1567 63 08 656 94 506 59

Sex and age

Female 110589 7175 634 18 744 48 870 16Under 15 years 23224 2063 133 10 784 70 979 0815ndash24 years 15134 1874 87 10 746 92 971 0825ndash44 years 33658 3258 193 16 813 79 929 1745ndash64 years 23897 2473 137 10 642 66 777 3065ndash74 years 7748 980 44 05 776 98 657 5275 years and over 6929 1030 40 05 679 101 552 57

Male 63798 5494 366 18 448 39 824 20Under 15 years 28399 2848 163 14 915 92 969 1515ndash24 years 4269 731 24 04 206 35 883 5825ndash44 years 8284 1244 48 06 204 31 796 4345ndash64 years 13873 2561 80 13 395 73 745 5065ndash74 years 4904 724 28 04 583 86 532 5875 years and over 4069 708 23 04 621 108 427 82

Race4

White 146794 9867 842 15 627 42 843 18Black or African American 18139 2275 104 12 496 62 906 21Other 9454 1345 54 07 462 66 915 29

Ethnicity4

Hispanic or Latino 21039 2615 121 14 499 62 914 20Not Hispanic or Latino 153348 10180 879 14 616 41 845 17

Expected source(s) of payment5

Private insurance 119864 8544 687 20 619 44 866 16Medicare 22276 2869 128 13 592 76 591 48

Medicare and Medicaid 1688 581 10 03 599 156MedicaidSCHIP6 25488 3275 146 17 795 102 928 19Self-pay no charge or charity7 6110 881 35 05 146 21 810 47Other8 7160 1238 41 07 767 56

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau Visit rates for expected source(s) of payment are based on the 2005 National Health Interview Survey estimates of health insurance2Primary care specialty defined in specialty type classification found in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo3Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)4Other race includes Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic and notHispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data on Raceand Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typically found forself-reported race in household surveys5Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit6SCHIP is State Childrenrsquos Health Insurance Program7The visit rate was calculated using lsquolsquouninsuredrsquorsquo as the denominator from the 2005 estimates of health insurance coverage from the National Health Inteview Survey8Other includes workerrsquos compensation unknown or blank and sources not elsewhere classified

NOTE Numbers may not add to totals because of rounding

22 Advance Data No 387 + June 29 2007

Table 12 Number and percent distribution of office visits with corresponding standard errors by physicianrsquos primary diagnosisUnited States 2005

Major disease category and ICDndash9ndashCM code range1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Infectious and parasitic diseases 001ndash139 26720 2062 28 02Neoplasms 140ndash239 39200 5285 41 05Endocrine nutritional and metabolic diseases and immunity disorders 240ndash279 56408 4655 59 04Mental disorders 290ndash319 47094 3777 49 04Diseases of the nervous system and sense organs 320ndash389 86128 6644 89 05Diseases of the circulatory system 390ndash459 81836 6683 85 06Diseases of the respiratory system 460ndash519 110999 7670 115 07Diseases of the digestive system 520ndash579 28678 2225 30 02Diseases of the genitourinary system 580ndash629 42256 3131 44 03Diseases of the skin and subcutaneous tissue 680ndash709 44443 3189 46 03Diseases of the musculoskeletal system and connective tissue 710ndash739 80601 6320 84 05Symptoms signs and ill-defined conditions 780ndash799 60536 3916 63 03Injury and poisoning 800ndash999 45137 3087 47 03Supplementary classification V01ndashV82 179276 11124 186 09All other diagnoses2 25609 3533 27 03Unknown3 8697 1645 09 02

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23)2Includes diseases of the blood and blood-forming organs (280ndash289) complications of pregnancy childbirth and the puerperium (630ndash677) congenital anomalies (740ndash759) certain conditionsoriginating in the perinatal period (760ndash779) and entries not codable to the ICDndash9ndashCM (eg illegible entries left against medical advice transferred entries of lsquolsquononersquorsquo or lsquolsquono diagnosesrsquorsquo)3Includes blank diagnoses

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 23

Table 13 Number and percent distribution of office visits with corresponding standard errors by the 20 leading primary diagnosis groups according to patientrsquos sexUnited States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

Essential hypertension 401 44670 4318 46 04 44 04 50 05Routine infant or child health check V202 41816 4044 43 04 33 03 57 06Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 36372 2875 38 03 33 03 45 04Arthropathies and related disorders 710ndash719 34299 4200 36 04 42 06 27 03Malignant neoplasms 140ndash208230ndash234 28709 5644 30 06 30 07 30 04Diabetes mellitus 250 25451 2730 26 03 25 03 29 03Spinal disorders 720ndash724 22732 2523 24 02 24 02 23 03Rheumatism excluding back 725ndash729 18580 1580 19 01 19 02 19 02General medical examination V70 17007 2377 18 02 15 02 22 03Follow up examination V67 16249 2573 17 02 17 03 16 03Specific procedures and aftercare V50ndashV599 15662 2000 16 02 17 02 15 03Normal pregnancy V22 15509 2534 16 03 28 05 Gynecological examination V723 15067 2378 16 02 27 04 Otitis media and eustachian tube disorders 381ndash382 14399 1517 15 01 12 01 19 02Asthma 493 12823 2102 13 02 11 02 16 04Disorders of lipoid metabolism 272 12650 1416 13 01 11 02 16 02Chronic sinusitis 473 12621 1302 13 01 12 01 14 02Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 11473 1490 12 01 10 01 15 02Acute pharyngitis 462 11064 1941 11 02 11 02 13 03Allergic rhinitis 477 11028 2099 11 02 11 02 12 03All other diagnoses 545437 23756 566 08 568 10 564 10

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to form larger categories that better describe the utilization of ambulatory care services2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

24A

dvanceD

ataN

o387+

June292007

Table 14 Number percent distribution and annual rate of office visits with corresponding standard errors by patientrsquos age accordingto the five leading primary diagnosis groups United States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year2

Standarderror of

rate

All visits 963617 40611 1000 3310 139

Under 1 year

All visits 32070 3406 1000 7816 830Routine infant or child health check V202 14528 1965 453 31 3541 479Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 3442 593 107 16 839 145Otitis media and eustachian tube disorders 381ndash382 2541 559 79 15 619 136Certain conditions originating in the perinatal period 760ndash779 34 08 269 65Unspecified viral and chlamydial infection 799 19 07 148 64All other diagnoses 9847 1134 307 22 2400 276

1ndash12 years

All visits 112241 8094 1000 2337 169Routine infant or child health check V202 21953 2294 196 14 457 48Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 12310 1705 110 11 256 36Otitis media and eustachian tube disorders 381ndash382 7901 843 70 07 165 18Asthma 493 4252 1126 38 10 89 23Acute pharyngitis 462 4203 868 37 07 88 18All other diagnoses 61622 4491 549 15 1283 94

13ndash21 years

All visits 66533 3594 1000 1785 96Routine infant or child health check V202 5334 803 80 11 143 22Normal pregnancy V22 3331 830 50 12 3182 45Acne 7060ndash7061 2931 560 44 08 79 15Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 2915 501 44 07 78 13Acute pharyngitis 462 2248 597 34 09 60 16All other diagnoses 49774 2793 748 18 1335 75

22ndash49 years

All visits 290199 14182 1000 2490 122Normal pregnancy V22 12178 1924 42 07 4207 33Spinal disorders 720ndash724 10148 1340 35 04 87 12Arthropathies and related disorders 710ndash719 9874 1767 34 06 85 15Gynecological examination V723 9496 1431 33 05 4161 24Essential hypertension 401 9361 1362 32 04 80 12All other diagnoses 239141 12253 824 11 2052 105

50ndash64 years

All visits 214891 10973 1000 4292 219Essential hypertension 401 15519 1884 72 08 310 38Arthropathies and related disorders 710ndash719 11162 1512 52 06 223 30Diabetes mellitus 250 9272 1048 43 04 185 21Malignant neoplasms 140ndash208230ndash234 8870 1861 41 08 177 37Spinal disorders 720ndash724 6530 935 30 04 130 19All other diagnoses 163538 8317 761 11 3266 166

65 years and over

All visits 247683 15541 1000 7047 442Essential hypertension 401 19129 2184 77 08 544 62Malignant neoplasms 140ndash208230ndash234 15679 3215 63 12 446 91Arthropathies and related disorders 710ndash719 11814 1815 48 06 336 52Diabetes mellitus 250 11253 1594 45 06 320 45Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 7824 1167 32 04 223 33All other diagnoses 181986 11408 735 12 5177 325

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth RevisionClinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to better describe the use ofambulatory care services2Visit rates for age are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Populations Division US Census Bureau3The population used for this rate is based on visits by females 13ndash21 years of age For males in this age group the leading diagnosis was routine infant or child health check (155 visits per 100males 13ndash21 years SE=31)4The population used for this rate is based on visits by females 22ndash49 years of age For males in this age group the leading diagnosis was essential hypertension (84 visits per 100 males 22ndash49years SE=15)

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 25

Table 15 Number percent distribution and annual rate of injury-related office visits with corresponding standard errors by selectedpatient characteristics United States 2005

Patient characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror of

rate

All injury-related visits2 89412 5466 1000 307 19

Age

Under 15 years 11556 1126 129 11 191 19Under 1 year 07 03 157 611ndash4 years 3191 495 36 06 197 315ndash14 years 7721 853 86 08 191 21

15ndash24 years 10006 973 112 09 244 2425ndash44 years 23053 1919 258 13 281 2345ndash64 years 28197 2050 315 13 390 2865 years and over 16600 1684 186 14 472 48

65ndash74 years 8111 976 91 09 441 5375 years and over 8489 937 95 08 507 56

Sex and age

Female 44177 2711 494 13 297 18Under 15 years 5017 622 56 07 169 2115ndash24 years 4610 575 52 06 227 2825ndash44 years 10286 921 115 08 248 2245ndash64 years 14917 1251 167 11 401 3465ndash74 years 4364 692 49 07 437 6975 years and over 4983 598 56 06 489 59

Male 45235 3233 506 13 318 23Under 15 years 6539 754 73 08 211 2415ndash24 years 5396 670 60 06 260 3225ndash44 years 12767 1329 143 11 315 3345ndash64 years 13280 1232 149 10 378 3565ndash74 years 3747 590 42 06 445 7075 years and over 3505 600 39 06 535 92

Race3

White 79208 4958 886 11 338 21Black or African American 6838 979 76 10 187 27Other 3365 602 38 06 164 29

Ethnicity

Hispanic or Latino 10578 1562 118 15 251 37Not Hispanic or Latino 78834 4812 882 15 317 19

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2Injury visits represent 93 percent (SE=04) of all office visits3Other race includes visits by Asians Native Hawaiians or Other Pacific Islanders American Indians or Alaska Natives and multiple races All race categories include visits by persons of Hispanicorigin and not Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for FederalData on Race and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typicallyfound for self-reported race in household surveys

NOTE Numbers may not add to totals because of rounding

Table 16 Number and percent distribution of injury-related office visits with corresponding standard errors by intent United States2005

Intent

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All injury-related visits 89412 5466 1000 Unintentional injuries 40934 4147 458 26Intentional injuries 1805 338 20 04Adverse effect of medical or surgical care or adverse effect of medicinal drug 8264 922 92 10Injuries of undetermined intent 32853 2362 367 24Unknown or blank 5556 993 62 11

Category not applicable

NOTE Numbers may not add to totals because of rounding

26 Advance Data No 387 + June 29 2007

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Number of visits in thousands

All visits 963617 432754 283180 119061 128623 560355 403262

At least one condition 507390 121891 187209 94472 103818 298366 209024None 422515 295386 85466 21112 20551 242189 180327Blank 33712 15476 10505 3477 4254 19800 13911

Hypertension 219476 23060 84640 52131 59646 127072 92404Arthritis 137942 20861 51744 27168 38169 91610 46332Hyperlipidemia 130053 12806 55561 31658 30028 68208 61845Diabetes 94359 10387 38628 23810 21534 50625 43733Depression 84610 30935 35059 8538 10078 59418 25192Obesity 68201 24275 29574 9298 5054 45028 23173Cancer 57025 4817 18809 15014 18384 32384 24640Asthma 54545 28913 14491 5764 5376 33276 21269COPD2 40754 7746 11425 10818 10764 22458 18295Ischemic heart disease 39559 1472 10179 12092 15815 16245 23314Osteoporosis 27977 6466 8050 12096 24842 3136Cerebrovascular disease 18319 731 4322 5489 7777 9000 9319CHF3 15692 3589 3409 8392 8950 6742Chronic renal failure 11486 2741 3039 4969 5633 5852

Standard error in thousands

All visits 40611 19288 13998 7460 8954 24487 18050

At least one condition 26734 6497 10543 6419 7920 16807 10964None 20054 14902 5424 1860 2135 11620 9940Blank 3749 1854 1445 668 650 2377 1724

Hypertension 14790 1976 5958 4176 5097 8906 6596Arthritis 9990 1930 4317 2357 3632 7470 3168Hyperlipidemia 9484 1139 4425 2773 3051 5051 4972Diabetes 6585 1133 3024 1939 2203 3811 3366Depression 6884 2367 3465 1084 1288 5082 2137Obesity 5885 2496 2961 1225 842 4156 2401Cancer 6483 782 2373 2149 2161 4421 2379Asthma 3877 2528 1350 712 814 2466 2012COPD2 3794 1054 1259 1356 1583 2332 1790Ischemic heart disease 3659 321 1097 1274 1920 1831 2301Osteoporosis 2821 892 1015 1413 2419 608Cerebrovascular disease 2290 188 717 844 1165 1187 1330CHF3 2054 768 561 1365 1351 1076Chronic renal failure 1713 799 609 890 829 1151

Percent distribution

All visits 1000 1000 1000 1000 1000 1000 100

At least one condition 527 282 661 793 807 532 518None 438 683 302 177 160 432 447Blank 35 36 37 29 33 35 34

Hypertension 228 53 299 438 464 227 229Arthritis 143 48 183 228 297 163 115Hyperlipidemia 135 30 196 266 233 122 153Diabetes 98 24 136 200 167 90 108Depression 88 71 124 72 78 106 62Obesity 71 56 104 78 39 80 57Cancer 59 11 66 126 143 58 61Asthma 57 67 51 48 42 59 53COPD2 42 18 40 91 84 40 45Ischemic heart disease 41 03 36 102 123 29 58Osteoporosis 29 03 23 68 94 44 08Cerebrovascular disease 19 02 15 46 60 16 23CHF3 16 01 13 29 65 16 17Chronic renal failure 12 02 10 26 39 10 15

See footnotes at end of table

Advance Data No 387 + June 29 2007 27

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005mdashCon

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Standard error of percent

All visits

At least one condition 13 10 13 13 15 14 14None 12 11 13 12 14 13 14Blank 04 04 05 06 05 04 04

Hypertension 10 04 13 19 17 11 11Arthritis 07 04 11 13 17 09 06Hyperlipidemia 08 03 12 17 16 08 10Diabetes 05 03 07 11 10 05 06Depression 06 05 10 09 09 08 05Obesity 05 05 09 09 06 06 05Cancer 06 02 08 14 13 07 05Asthma 03 05 04 06 06 04 05COPD2 03 02 04 10 10 03 04Ischemic heart disease 03 01 03 08 10 03 05Osteoporosis 02 01 03 08 08 03 01Cerebrovascular disease 02 00 02 06 07 02 03CHF3 02 00 03 04 09 02 03Chronic renal failure 02 01 03 05 06 01 03

Figure does not meet standards of reliability or precision Category not applicable1Presence of chronic conditions regardless of visit diagnosis were based on checkbox responses2COPD is chronic obstructive pulmonary disease3CHF is congestive heart failure

NOTE Numbers may not add to totals because more than one condition may be reported per visit

28 Advance Data No 387 + June 29 2007

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 11 Number percent distribution and annual rate of preventive care office visits and percent of visits to primary care specialistswith corresponding standard errors by selected patient and visit characteristics United States 2005

Patient and visit characteristics

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror

of rate

Percent ofpreventive carevisits made toprimary carespecialists2

Standarderror ofpercent

All preventive care visits3 174387 11005 1000 599 38 853 16

Age

Under 15 years 51622 4532 296 22 851 75 973 11Under 1 year 17289 2064 99 11 4214 503 998 011ndash4 years 16723 1972 96 10 1033 122 980 125ndash14 years 17610 1605 101 08 436 40 943 22

15ndash24 years 19403 2191 111 11 473 53 952 1725ndash44 years 41942 3739 241 16 512 46 903 1945ndash64 years 37770 4309 217 17 522 60 765 3065 years and over 23650 2762 136 13 673 79 561 45

65ndash74 years 12652 1469 73 07 688 80 609 4475 years and over 10998 1567 63 08 656 94 506 59

Sex and age

Female 110589 7175 634 18 744 48 870 16Under 15 years 23224 2063 133 10 784 70 979 0815ndash24 years 15134 1874 87 10 746 92 971 0825ndash44 years 33658 3258 193 16 813 79 929 1745ndash64 years 23897 2473 137 10 642 66 777 3065ndash74 years 7748 980 44 05 776 98 657 5275 years and over 6929 1030 40 05 679 101 552 57

Male 63798 5494 366 18 448 39 824 20Under 15 years 28399 2848 163 14 915 92 969 1515ndash24 years 4269 731 24 04 206 35 883 5825ndash44 years 8284 1244 48 06 204 31 796 4345ndash64 years 13873 2561 80 13 395 73 745 5065ndash74 years 4904 724 28 04 583 86 532 5875 years and over 4069 708 23 04 621 108 427 82

Race4

White 146794 9867 842 15 627 42 843 18Black or African American 18139 2275 104 12 496 62 906 21Other 9454 1345 54 07 462 66 915 29

Ethnicity4

Hispanic or Latino 21039 2615 121 14 499 62 914 20Not Hispanic or Latino 153348 10180 879 14 616 41 845 17

Expected source(s) of payment5

Private insurance 119864 8544 687 20 619 44 866 16Medicare 22276 2869 128 13 592 76 591 48

Medicare and Medicaid 1688 581 10 03 599 156MedicaidSCHIP6 25488 3275 146 17 795 102 928 19Self-pay no charge or charity7 6110 881 35 05 146 21 810 47Other8 7160 1238 41 07 767 56

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau Visit rates for expected source(s) of payment are based on the 2005 National Health Interview Survey estimates of health insurance2Primary care specialty defined in specialty type classification found in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo3Preventive care includes routine prenatal well-baby screening insurance and general exams (see question 4c in lsquolsquoTechnical Notesrsquorsquo)4Other race includes Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic and notHispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for Federal Data on Raceand Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typically found forself-reported race in household surveys5Total exceeds lsquolsquoAll visitsrsquorsquo because more than one source of payment may be reported per visit6SCHIP is State Childrenrsquos Health Insurance Program7The visit rate was calculated using lsquolsquouninsuredrsquorsquo as the denominator from the 2005 estimates of health insurance coverage from the National Health Inteview Survey8Other includes workerrsquos compensation unknown or blank and sources not elsewhere classified

NOTE Numbers may not add to totals because of rounding

22 Advance Data No 387 + June 29 2007

Table 12 Number and percent distribution of office visits with corresponding standard errors by physicianrsquos primary diagnosisUnited States 2005

Major disease category and ICDndash9ndashCM code range1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Infectious and parasitic diseases 001ndash139 26720 2062 28 02Neoplasms 140ndash239 39200 5285 41 05Endocrine nutritional and metabolic diseases and immunity disorders 240ndash279 56408 4655 59 04Mental disorders 290ndash319 47094 3777 49 04Diseases of the nervous system and sense organs 320ndash389 86128 6644 89 05Diseases of the circulatory system 390ndash459 81836 6683 85 06Diseases of the respiratory system 460ndash519 110999 7670 115 07Diseases of the digestive system 520ndash579 28678 2225 30 02Diseases of the genitourinary system 580ndash629 42256 3131 44 03Diseases of the skin and subcutaneous tissue 680ndash709 44443 3189 46 03Diseases of the musculoskeletal system and connective tissue 710ndash739 80601 6320 84 05Symptoms signs and ill-defined conditions 780ndash799 60536 3916 63 03Injury and poisoning 800ndash999 45137 3087 47 03Supplementary classification V01ndashV82 179276 11124 186 09All other diagnoses2 25609 3533 27 03Unknown3 8697 1645 09 02

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23)2Includes diseases of the blood and blood-forming organs (280ndash289) complications of pregnancy childbirth and the puerperium (630ndash677) congenital anomalies (740ndash759) certain conditionsoriginating in the perinatal period (760ndash779) and entries not codable to the ICDndash9ndashCM (eg illegible entries left against medical advice transferred entries of lsquolsquononersquorsquo or lsquolsquono diagnosesrsquorsquo)3Includes blank diagnoses

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 23

Table 13 Number and percent distribution of office visits with corresponding standard errors by the 20 leading primary diagnosis groups according to patientrsquos sexUnited States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

Essential hypertension 401 44670 4318 46 04 44 04 50 05Routine infant or child health check V202 41816 4044 43 04 33 03 57 06Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 36372 2875 38 03 33 03 45 04Arthropathies and related disorders 710ndash719 34299 4200 36 04 42 06 27 03Malignant neoplasms 140ndash208230ndash234 28709 5644 30 06 30 07 30 04Diabetes mellitus 250 25451 2730 26 03 25 03 29 03Spinal disorders 720ndash724 22732 2523 24 02 24 02 23 03Rheumatism excluding back 725ndash729 18580 1580 19 01 19 02 19 02General medical examination V70 17007 2377 18 02 15 02 22 03Follow up examination V67 16249 2573 17 02 17 03 16 03Specific procedures and aftercare V50ndashV599 15662 2000 16 02 17 02 15 03Normal pregnancy V22 15509 2534 16 03 28 05 Gynecological examination V723 15067 2378 16 02 27 04 Otitis media and eustachian tube disorders 381ndash382 14399 1517 15 01 12 01 19 02Asthma 493 12823 2102 13 02 11 02 16 04Disorders of lipoid metabolism 272 12650 1416 13 01 11 02 16 02Chronic sinusitis 473 12621 1302 13 01 12 01 14 02Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 11473 1490 12 01 10 01 15 02Acute pharyngitis 462 11064 1941 11 02 11 02 13 03Allergic rhinitis 477 11028 2099 11 02 11 02 12 03All other diagnoses 545437 23756 566 08 568 10 564 10

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to form larger categories that better describe the utilization of ambulatory care services2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

24A

dvanceD

ataN

o387+

June292007

Table 14 Number percent distribution and annual rate of office visits with corresponding standard errors by patientrsquos age accordingto the five leading primary diagnosis groups United States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year2

Standarderror of

rate

All visits 963617 40611 1000 3310 139

Under 1 year

All visits 32070 3406 1000 7816 830Routine infant or child health check V202 14528 1965 453 31 3541 479Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 3442 593 107 16 839 145Otitis media and eustachian tube disorders 381ndash382 2541 559 79 15 619 136Certain conditions originating in the perinatal period 760ndash779 34 08 269 65Unspecified viral and chlamydial infection 799 19 07 148 64All other diagnoses 9847 1134 307 22 2400 276

1ndash12 years

All visits 112241 8094 1000 2337 169Routine infant or child health check V202 21953 2294 196 14 457 48Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 12310 1705 110 11 256 36Otitis media and eustachian tube disorders 381ndash382 7901 843 70 07 165 18Asthma 493 4252 1126 38 10 89 23Acute pharyngitis 462 4203 868 37 07 88 18All other diagnoses 61622 4491 549 15 1283 94

13ndash21 years

All visits 66533 3594 1000 1785 96Routine infant or child health check V202 5334 803 80 11 143 22Normal pregnancy V22 3331 830 50 12 3182 45Acne 7060ndash7061 2931 560 44 08 79 15Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 2915 501 44 07 78 13Acute pharyngitis 462 2248 597 34 09 60 16All other diagnoses 49774 2793 748 18 1335 75

22ndash49 years

All visits 290199 14182 1000 2490 122Normal pregnancy V22 12178 1924 42 07 4207 33Spinal disorders 720ndash724 10148 1340 35 04 87 12Arthropathies and related disorders 710ndash719 9874 1767 34 06 85 15Gynecological examination V723 9496 1431 33 05 4161 24Essential hypertension 401 9361 1362 32 04 80 12All other diagnoses 239141 12253 824 11 2052 105

50ndash64 years

All visits 214891 10973 1000 4292 219Essential hypertension 401 15519 1884 72 08 310 38Arthropathies and related disorders 710ndash719 11162 1512 52 06 223 30Diabetes mellitus 250 9272 1048 43 04 185 21Malignant neoplasms 140ndash208230ndash234 8870 1861 41 08 177 37Spinal disorders 720ndash724 6530 935 30 04 130 19All other diagnoses 163538 8317 761 11 3266 166

65 years and over

All visits 247683 15541 1000 7047 442Essential hypertension 401 19129 2184 77 08 544 62Malignant neoplasms 140ndash208230ndash234 15679 3215 63 12 446 91Arthropathies and related disorders 710ndash719 11814 1815 48 06 336 52Diabetes mellitus 250 11253 1594 45 06 320 45Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 7824 1167 32 04 223 33All other diagnoses 181986 11408 735 12 5177 325

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth RevisionClinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to better describe the use ofambulatory care services2Visit rates for age are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Populations Division US Census Bureau3The population used for this rate is based on visits by females 13ndash21 years of age For males in this age group the leading diagnosis was routine infant or child health check (155 visits per 100males 13ndash21 years SE=31)4The population used for this rate is based on visits by females 22ndash49 years of age For males in this age group the leading diagnosis was essential hypertension (84 visits per 100 males 22ndash49years SE=15)

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 25

Table 15 Number percent distribution and annual rate of injury-related office visits with corresponding standard errors by selectedpatient characteristics United States 2005

Patient characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror of

rate

All injury-related visits2 89412 5466 1000 307 19

Age

Under 15 years 11556 1126 129 11 191 19Under 1 year 07 03 157 611ndash4 years 3191 495 36 06 197 315ndash14 years 7721 853 86 08 191 21

15ndash24 years 10006 973 112 09 244 2425ndash44 years 23053 1919 258 13 281 2345ndash64 years 28197 2050 315 13 390 2865 years and over 16600 1684 186 14 472 48

65ndash74 years 8111 976 91 09 441 5375 years and over 8489 937 95 08 507 56

Sex and age

Female 44177 2711 494 13 297 18Under 15 years 5017 622 56 07 169 2115ndash24 years 4610 575 52 06 227 2825ndash44 years 10286 921 115 08 248 2245ndash64 years 14917 1251 167 11 401 3465ndash74 years 4364 692 49 07 437 6975 years and over 4983 598 56 06 489 59

Male 45235 3233 506 13 318 23Under 15 years 6539 754 73 08 211 2415ndash24 years 5396 670 60 06 260 3225ndash44 years 12767 1329 143 11 315 3345ndash64 years 13280 1232 149 10 378 3565ndash74 years 3747 590 42 06 445 7075 years and over 3505 600 39 06 535 92

Race3

White 79208 4958 886 11 338 21Black or African American 6838 979 76 10 187 27Other 3365 602 38 06 164 29

Ethnicity

Hispanic or Latino 10578 1562 118 15 251 37Not Hispanic or Latino 78834 4812 882 15 317 19

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2Injury visits represent 93 percent (SE=04) of all office visits3Other race includes visits by Asians Native Hawaiians or Other Pacific Islanders American Indians or Alaska Natives and multiple races All race categories include visits by persons of Hispanicorigin and not Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for FederalData on Race and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typicallyfound for self-reported race in household surveys

NOTE Numbers may not add to totals because of rounding

Table 16 Number and percent distribution of injury-related office visits with corresponding standard errors by intent United States2005

Intent

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All injury-related visits 89412 5466 1000 Unintentional injuries 40934 4147 458 26Intentional injuries 1805 338 20 04Adverse effect of medical or surgical care or adverse effect of medicinal drug 8264 922 92 10Injuries of undetermined intent 32853 2362 367 24Unknown or blank 5556 993 62 11

Category not applicable

NOTE Numbers may not add to totals because of rounding

26 Advance Data No 387 + June 29 2007

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Number of visits in thousands

All visits 963617 432754 283180 119061 128623 560355 403262

At least one condition 507390 121891 187209 94472 103818 298366 209024None 422515 295386 85466 21112 20551 242189 180327Blank 33712 15476 10505 3477 4254 19800 13911

Hypertension 219476 23060 84640 52131 59646 127072 92404Arthritis 137942 20861 51744 27168 38169 91610 46332Hyperlipidemia 130053 12806 55561 31658 30028 68208 61845Diabetes 94359 10387 38628 23810 21534 50625 43733Depression 84610 30935 35059 8538 10078 59418 25192Obesity 68201 24275 29574 9298 5054 45028 23173Cancer 57025 4817 18809 15014 18384 32384 24640Asthma 54545 28913 14491 5764 5376 33276 21269COPD2 40754 7746 11425 10818 10764 22458 18295Ischemic heart disease 39559 1472 10179 12092 15815 16245 23314Osteoporosis 27977 6466 8050 12096 24842 3136Cerebrovascular disease 18319 731 4322 5489 7777 9000 9319CHF3 15692 3589 3409 8392 8950 6742Chronic renal failure 11486 2741 3039 4969 5633 5852

Standard error in thousands

All visits 40611 19288 13998 7460 8954 24487 18050

At least one condition 26734 6497 10543 6419 7920 16807 10964None 20054 14902 5424 1860 2135 11620 9940Blank 3749 1854 1445 668 650 2377 1724

Hypertension 14790 1976 5958 4176 5097 8906 6596Arthritis 9990 1930 4317 2357 3632 7470 3168Hyperlipidemia 9484 1139 4425 2773 3051 5051 4972Diabetes 6585 1133 3024 1939 2203 3811 3366Depression 6884 2367 3465 1084 1288 5082 2137Obesity 5885 2496 2961 1225 842 4156 2401Cancer 6483 782 2373 2149 2161 4421 2379Asthma 3877 2528 1350 712 814 2466 2012COPD2 3794 1054 1259 1356 1583 2332 1790Ischemic heart disease 3659 321 1097 1274 1920 1831 2301Osteoporosis 2821 892 1015 1413 2419 608Cerebrovascular disease 2290 188 717 844 1165 1187 1330CHF3 2054 768 561 1365 1351 1076Chronic renal failure 1713 799 609 890 829 1151

Percent distribution

All visits 1000 1000 1000 1000 1000 1000 100

At least one condition 527 282 661 793 807 532 518None 438 683 302 177 160 432 447Blank 35 36 37 29 33 35 34

Hypertension 228 53 299 438 464 227 229Arthritis 143 48 183 228 297 163 115Hyperlipidemia 135 30 196 266 233 122 153Diabetes 98 24 136 200 167 90 108Depression 88 71 124 72 78 106 62Obesity 71 56 104 78 39 80 57Cancer 59 11 66 126 143 58 61Asthma 57 67 51 48 42 59 53COPD2 42 18 40 91 84 40 45Ischemic heart disease 41 03 36 102 123 29 58Osteoporosis 29 03 23 68 94 44 08Cerebrovascular disease 19 02 15 46 60 16 23CHF3 16 01 13 29 65 16 17Chronic renal failure 12 02 10 26 39 10 15

See footnotes at end of table

Advance Data No 387 + June 29 2007 27

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005mdashCon

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Standard error of percent

All visits

At least one condition 13 10 13 13 15 14 14None 12 11 13 12 14 13 14Blank 04 04 05 06 05 04 04

Hypertension 10 04 13 19 17 11 11Arthritis 07 04 11 13 17 09 06Hyperlipidemia 08 03 12 17 16 08 10Diabetes 05 03 07 11 10 05 06Depression 06 05 10 09 09 08 05Obesity 05 05 09 09 06 06 05Cancer 06 02 08 14 13 07 05Asthma 03 05 04 06 06 04 05COPD2 03 02 04 10 10 03 04Ischemic heart disease 03 01 03 08 10 03 05Osteoporosis 02 01 03 08 08 03 01Cerebrovascular disease 02 00 02 06 07 02 03CHF3 02 00 03 04 09 02 03Chronic renal failure 02 01 03 05 06 01 03

Figure does not meet standards of reliability or precision Category not applicable1Presence of chronic conditions regardless of visit diagnosis were based on checkbox responses2COPD is chronic obstructive pulmonary disease3CHF is congestive heart failure

NOTE Numbers may not add to totals because more than one condition may be reported per visit

28 Advance Data No 387 + June 29 2007

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 12 Number and percent distribution of office visits with corresponding standard errors by physicianrsquos primary diagnosisUnited States 2005

Major disease category and ICDndash9ndashCM code range1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000

Infectious and parasitic diseases 001ndash139 26720 2062 28 02Neoplasms 140ndash239 39200 5285 41 05Endocrine nutritional and metabolic diseases and immunity disorders 240ndash279 56408 4655 59 04Mental disorders 290ndash319 47094 3777 49 04Diseases of the nervous system and sense organs 320ndash389 86128 6644 89 05Diseases of the circulatory system 390ndash459 81836 6683 85 06Diseases of the respiratory system 460ndash519 110999 7670 115 07Diseases of the digestive system 520ndash579 28678 2225 30 02Diseases of the genitourinary system 580ndash629 42256 3131 44 03Diseases of the skin and subcutaneous tissue 680ndash709 44443 3189 46 03Diseases of the musculoskeletal system and connective tissue 710ndash739 80601 6320 84 05Symptoms signs and ill-defined conditions 780ndash799 60536 3916 63 03Injury and poisoning 800ndash999 45137 3087 47 03Supplementary classification V01ndashV82 179276 11124 186 09All other diagnoses2 25609 3533 27 03Unknown3 8697 1645 09 02

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23)2Includes diseases of the blood and blood-forming organs (280ndash289) complications of pregnancy childbirth and the puerperium (630ndash677) congenital anomalies (740ndash759) certain conditionsoriginating in the perinatal period (760ndash779) and entries not codable to the ICDndash9ndashCM (eg illegible entries left against medical advice transferred entries of lsquolsquononersquorsquo or lsquolsquono diagnosesrsquorsquo)3Includes blank diagnoses

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 23

Table 13 Number and percent distribution of office visits with corresponding standard errors by the 20 leading primary diagnosis groups according to patientrsquos sexUnited States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

Essential hypertension 401 44670 4318 46 04 44 04 50 05Routine infant or child health check V202 41816 4044 43 04 33 03 57 06Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 36372 2875 38 03 33 03 45 04Arthropathies and related disorders 710ndash719 34299 4200 36 04 42 06 27 03Malignant neoplasms 140ndash208230ndash234 28709 5644 30 06 30 07 30 04Diabetes mellitus 250 25451 2730 26 03 25 03 29 03Spinal disorders 720ndash724 22732 2523 24 02 24 02 23 03Rheumatism excluding back 725ndash729 18580 1580 19 01 19 02 19 02General medical examination V70 17007 2377 18 02 15 02 22 03Follow up examination V67 16249 2573 17 02 17 03 16 03Specific procedures and aftercare V50ndashV599 15662 2000 16 02 17 02 15 03Normal pregnancy V22 15509 2534 16 03 28 05 Gynecological examination V723 15067 2378 16 02 27 04 Otitis media and eustachian tube disorders 381ndash382 14399 1517 15 01 12 01 19 02Asthma 493 12823 2102 13 02 11 02 16 04Disorders of lipoid metabolism 272 12650 1416 13 01 11 02 16 02Chronic sinusitis 473 12621 1302 13 01 12 01 14 02Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 11473 1490 12 01 10 01 15 02Acute pharyngitis 462 11064 1941 11 02 11 02 13 03Allergic rhinitis 477 11028 2099 11 02 11 02 12 03All other diagnoses 545437 23756 566 08 568 10 564 10

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to form larger categories that better describe the utilization of ambulatory care services2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

24A

dvanceD

ataN

o387+

June292007

Table 14 Number percent distribution and annual rate of office visits with corresponding standard errors by patientrsquos age accordingto the five leading primary diagnosis groups United States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year2

Standarderror of

rate

All visits 963617 40611 1000 3310 139

Under 1 year

All visits 32070 3406 1000 7816 830Routine infant or child health check V202 14528 1965 453 31 3541 479Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 3442 593 107 16 839 145Otitis media and eustachian tube disorders 381ndash382 2541 559 79 15 619 136Certain conditions originating in the perinatal period 760ndash779 34 08 269 65Unspecified viral and chlamydial infection 799 19 07 148 64All other diagnoses 9847 1134 307 22 2400 276

1ndash12 years

All visits 112241 8094 1000 2337 169Routine infant or child health check V202 21953 2294 196 14 457 48Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 12310 1705 110 11 256 36Otitis media and eustachian tube disorders 381ndash382 7901 843 70 07 165 18Asthma 493 4252 1126 38 10 89 23Acute pharyngitis 462 4203 868 37 07 88 18All other diagnoses 61622 4491 549 15 1283 94

13ndash21 years

All visits 66533 3594 1000 1785 96Routine infant or child health check V202 5334 803 80 11 143 22Normal pregnancy V22 3331 830 50 12 3182 45Acne 7060ndash7061 2931 560 44 08 79 15Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 2915 501 44 07 78 13Acute pharyngitis 462 2248 597 34 09 60 16All other diagnoses 49774 2793 748 18 1335 75

22ndash49 years

All visits 290199 14182 1000 2490 122Normal pregnancy V22 12178 1924 42 07 4207 33Spinal disorders 720ndash724 10148 1340 35 04 87 12Arthropathies and related disorders 710ndash719 9874 1767 34 06 85 15Gynecological examination V723 9496 1431 33 05 4161 24Essential hypertension 401 9361 1362 32 04 80 12All other diagnoses 239141 12253 824 11 2052 105

50ndash64 years

All visits 214891 10973 1000 4292 219Essential hypertension 401 15519 1884 72 08 310 38Arthropathies and related disorders 710ndash719 11162 1512 52 06 223 30Diabetes mellitus 250 9272 1048 43 04 185 21Malignant neoplasms 140ndash208230ndash234 8870 1861 41 08 177 37Spinal disorders 720ndash724 6530 935 30 04 130 19All other diagnoses 163538 8317 761 11 3266 166

65 years and over

All visits 247683 15541 1000 7047 442Essential hypertension 401 19129 2184 77 08 544 62Malignant neoplasms 140ndash208230ndash234 15679 3215 63 12 446 91Arthropathies and related disorders 710ndash719 11814 1815 48 06 336 52Diabetes mellitus 250 11253 1594 45 06 320 45Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 7824 1167 32 04 223 33All other diagnoses 181986 11408 735 12 5177 325

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth RevisionClinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to better describe the use ofambulatory care services2Visit rates for age are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Populations Division US Census Bureau3The population used for this rate is based on visits by females 13ndash21 years of age For males in this age group the leading diagnosis was routine infant or child health check (155 visits per 100males 13ndash21 years SE=31)4The population used for this rate is based on visits by females 22ndash49 years of age For males in this age group the leading diagnosis was essential hypertension (84 visits per 100 males 22ndash49years SE=15)

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 25

Table 15 Number percent distribution and annual rate of injury-related office visits with corresponding standard errors by selectedpatient characteristics United States 2005

Patient characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror of

rate

All injury-related visits2 89412 5466 1000 307 19

Age

Under 15 years 11556 1126 129 11 191 19Under 1 year 07 03 157 611ndash4 years 3191 495 36 06 197 315ndash14 years 7721 853 86 08 191 21

15ndash24 years 10006 973 112 09 244 2425ndash44 years 23053 1919 258 13 281 2345ndash64 years 28197 2050 315 13 390 2865 years and over 16600 1684 186 14 472 48

65ndash74 years 8111 976 91 09 441 5375 years and over 8489 937 95 08 507 56

Sex and age

Female 44177 2711 494 13 297 18Under 15 years 5017 622 56 07 169 2115ndash24 years 4610 575 52 06 227 2825ndash44 years 10286 921 115 08 248 2245ndash64 years 14917 1251 167 11 401 3465ndash74 years 4364 692 49 07 437 6975 years and over 4983 598 56 06 489 59

Male 45235 3233 506 13 318 23Under 15 years 6539 754 73 08 211 2415ndash24 years 5396 670 60 06 260 3225ndash44 years 12767 1329 143 11 315 3345ndash64 years 13280 1232 149 10 378 3565ndash74 years 3747 590 42 06 445 7075 years and over 3505 600 39 06 535 92

Race3

White 79208 4958 886 11 338 21Black or African American 6838 979 76 10 187 27Other 3365 602 38 06 164 29

Ethnicity

Hispanic or Latino 10578 1562 118 15 251 37Not Hispanic or Latino 78834 4812 882 15 317 19

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2Injury visits represent 93 percent (SE=04) of all office visits3Other race includes visits by Asians Native Hawaiians or Other Pacific Islanders American Indians or Alaska Natives and multiple races All race categories include visits by persons of Hispanicorigin and not Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for FederalData on Race and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typicallyfound for self-reported race in household surveys

NOTE Numbers may not add to totals because of rounding

Table 16 Number and percent distribution of injury-related office visits with corresponding standard errors by intent United States2005

Intent

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All injury-related visits 89412 5466 1000 Unintentional injuries 40934 4147 458 26Intentional injuries 1805 338 20 04Adverse effect of medical or surgical care or adverse effect of medicinal drug 8264 922 92 10Injuries of undetermined intent 32853 2362 367 24Unknown or blank 5556 993 62 11

Category not applicable

NOTE Numbers may not add to totals because of rounding

26 Advance Data No 387 + June 29 2007

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Number of visits in thousands

All visits 963617 432754 283180 119061 128623 560355 403262

At least one condition 507390 121891 187209 94472 103818 298366 209024None 422515 295386 85466 21112 20551 242189 180327Blank 33712 15476 10505 3477 4254 19800 13911

Hypertension 219476 23060 84640 52131 59646 127072 92404Arthritis 137942 20861 51744 27168 38169 91610 46332Hyperlipidemia 130053 12806 55561 31658 30028 68208 61845Diabetes 94359 10387 38628 23810 21534 50625 43733Depression 84610 30935 35059 8538 10078 59418 25192Obesity 68201 24275 29574 9298 5054 45028 23173Cancer 57025 4817 18809 15014 18384 32384 24640Asthma 54545 28913 14491 5764 5376 33276 21269COPD2 40754 7746 11425 10818 10764 22458 18295Ischemic heart disease 39559 1472 10179 12092 15815 16245 23314Osteoporosis 27977 6466 8050 12096 24842 3136Cerebrovascular disease 18319 731 4322 5489 7777 9000 9319CHF3 15692 3589 3409 8392 8950 6742Chronic renal failure 11486 2741 3039 4969 5633 5852

Standard error in thousands

All visits 40611 19288 13998 7460 8954 24487 18050

At least one condition 26734 6497 10543 6419 7920 16807 10964None 20054 14902 5424 1860 2135 11620 9940Blank 3749 1854 1445 668 650 2377 1724

Hypertension 14790 1976 5958 4176 5097 8906 6596Arthritis 9990 1930 4317 2357 3632 7470 3168Hyperlipidemia 9484 1139 4425 2773 3051 5051 4972Diabetes 6585 1133 3024 1939 2203 3811 3366Depression 6884 2367 3465 1084 1288 5082 2137Obesity 5885 2496 2961 1225 842 4156 2401Cancer 6483 782 2373 2149 2161 4421 2379Asthma 3877 2528 1350 712 814 2466 2012COPD2 3794 1054 1259 1356 1583 2332 1790Ischemic heart disease 3659 321 1097 1274 1920 1831 2301Osteoporosis 2821 892 1015 1413 2419 608Cerebrovascular disease 2290 188 717 844 1165 1187 1330CHF3 2054 768 561 1365 1351 1076Chronic renal failure 1713 799 609 890 829 1151

Percent distribution

All visits 1000 1000 1000 1000 1000 1000 100

At least one condition 527 282 661 793 807 532 518None 438 683 302 177 160 432 447Blank 35 36 37 29 33 35 34

Hypertension 228 53 299 438 464 227 229Arthritis 143 48 183 228 297 163 115Hyperlipidemia 135 30 196 266 233 122 153Diabetes 98 24 136 200 167 90 108Depression 88 71 124 72 78 106 62Obesity 71 56 104 78 39 80 57Cancer 59 11 66 126 143 58 61Asthma 57 67 51 48 42 59 53COPD2 42 18 40 91 84 40 45Ischemic heart disease 41 03 36 102 123 29 58Osteoporosis 29 03 23 68 94 44 08Cerebrovascular disease 19 02 15 46 60 16 23CHF3 16 01 13 29 65 16 17Chronic renal failure 12 02 10 26 39 10 15

See footnotes at end of table

Advance Data No 387 + June 29 2007 27

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005mdashCon

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Standard error of percent

All visits

At least one condition 13 10 13 13 15 14 14None 12 11 13 12 14 13 14Blank 04 04 05 06 05 04 04

Hypertension 10 04 13 19 17 11 11Arthritis 07 04 11 13 17 09 06Hyperlipidemia 08 03 12 17 16 08 10Diabetes 05 03 07 11 10 05 06Depression 06 05 10 09 09 08 05Obesity 05 05 09 09 06 06 05Cancer 06 02 08 14 13 07 05Asthma 03 05 04 06 06 04 05COPD2 03 02 04 10 10 03 04Ischemic heart disease 03 01 03 08 10 03 05Osteoporosis 02 01 03 08 08 03 01Cerebrovascular disease 02 00 02 06 07 02 03CHF3 02 00 03 04 09 02 03Chronic renal failure 02 01 03 05 06 01 03

Figure does not meet standards of reliability or precision Category not applicable1Presence of chronic conditions regardless of visit diagnosis were based on checkbox responses2COPD is chronic obstructive pulmonary disease3CHF is congestive heart failure

NOTE Numbers may not add to totals because more than one condition may be reported per visit

28 Advance Data No 387 + June 29 2007

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 13 Number and percent distribution of office visits with corresponding standard errors by the 20 leading primary diagnosis groups according to patientrsquos sexUnited States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female2 Male3

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

All visits 963617 40611 1000 1000 1000

Essential hypertension 401 44670 4318 46 04 44 04 50 05Routine infant or child health check V202 41816 4044 43 04 33 03 57 06Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 36372 2875 38 03 33 03 45 04Arthropathies and related disorders 710ndash719 34299 4200 36 04 42 06 27 03Malignant neoplasms 140ndash208230ndash234 28709 5644 30 06 30 07 30 04Diabetes mellitus 250 25451 2730 26 03 25 03 29 03Spinal disorders 720ndash724 22732 2523 24 02 24 02 23 03Rheumatism excluding back 725ndash729 18580 1580 19 01 19 02 19 02General medical examination V70 17007 2377 18 02 15 02 22 03Follow up examination V67 16249 2573 17 02 17 03 16 03Specific procedures and aftercare V50ndashV599 15662 2000 16 02 17 02 15 03Normal pregnancy V22 15509 2534 16 03 28 05 Gynecological examination V723 15067 2378 16 02 27 04 Otitis media and eustachian tube disorders 381ndash382 14399 1517 15 01 12 01 19 02Asthma 493 12823 2102 13 02 11 02 16 04Disorders of lipoid metabolism 272 12650 1416 13 01 11 02 16 02Chronic sinusitis 473 12621 1302 13 01 12 01 14 02Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 11473 1490 12 01 10 01 15 02Acute pharyngitis 462 11064 1941 11 02 11 02 13 03Allergic rhinitis 477 11028 2099 11 02 11 02 12 03All other diagnoses 545437 23756 566 08 568 10 564 10

Category not applicable1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to form larger categories that better describe the utilization of ambulatory care services2Based on 560355000 visits made by females3Based on 403262000 visits made by males

NOTE Numbers may not add to totals because of rounding

24A

dvanceD

ataN

o387+

June292007

Table 14 Number percent distribution and annual rate of office visits with corresponding standard errors by patientrsquos age accordingto the five leading primary diagnosis groups United States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year2

Standarderror of

rate

All visits 963617 40611 1000 3310 139

Under 1 year

All visits 32070 3406 1000 7816 830Routine infant or child health check V202 14528 1965 453 31 3541 479Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 3442 593 107 16 839 145Otitis media and eustachian tube disorders 381ndash382 2541 559 79 15 619 136Certain conditions originating in the perinatal period 760ndash779 34 08 269 65Unspecified viral and chlamydial infection 799 19 07 148 64All other diagnoses 9847 1134 307 22 2400 276

1ndash12 years

All visits 112241 8094 1000 2337 169Routine infant or child health check V202 21953 2294 196 14 457 48Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 12310 1705 110 11 256 36Otitis media and eustachian tube disorders 381ndash382 7901 843 70 07 165 18Asthma 493 4252 1126 38 10 89 23Acute pharyngitis 462 4203 868 37 07 88 18All other diagnoses 61622 4491 549 15 1283 94

13ndash21 years

All visits 66533 3594 1000 1785 96Routine infant or child health check V202 5334 803 80 11 143 22Normal pregnancy V22 3331 830 50 12 3182 45Acne 7060ndash7061 2931 560 44 08 79 15Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 2915 501 44 07 78 13Acute pharyngitis 462 2248 597 34 09 60 16All other diagnoses 49774 2793 748 18 1335 75

22ndash49 years

All visits 290199 14182 1000 2490 122Normal pregnancy V22 12178 1924 42 07 4207 33Spinal disorders 720ndash724 10148 1340 35 04 87 12Arthropathies and related disorders 710ndash719 9874 1767 34 06 85 15Gynecological examination V723 9496 1431 33 05 4161 24Essential hypertension 401 9361 1362 32 04 80 12All other diagnoses 239141 12253 824 11 2052 105

50ndash64 years

All visits 214891 10973 1000 4292 219Essential hypertension 401 15519 1884 72 08 310 38Arthropathies and related disorders 710ndash719 11162 1512 52 06 223 30Diabetes mellitus 250 9272 1048 43 04 185 21Malignant neoplasms 140ndash208230ndash234 8870 1861 41 08 177 37Spinal disorders 720ndash724 6530 935 30 04 130 19All other diagnoses 163538 8317 761 11 3266 166

65 years and over

All visits 247683 15541 1000 7047 442Essential hypertension 401 19129 2184 77 08 544 62Malignant neoplasms 140ndash208230ndash234 15679 3215 63 12 446 91Arthropathies and related disorders 710ndash719 11814 1815 48 06 336 52Diabetes mellitus 250 11253 1594 45 06 320 45Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 7824 1167 32 04 223 33All other diagnoses 181986 11408 735 12 5177 325

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth RevisionClinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to better describe the use ofambulatory care services2Visit rates for age are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Populations Division US Census Bureau3The population used for this rate is based on visits by females 13ndash21 years of age For males in this age group the leading diagnosis was routine infant or child health check (155 visits per 100males 13ndash21 years SE=31)4The population used for this rate is based on visits by females 22ndash49 years of age For males in this age group the leading diagnosis was essential hypertension (84 visits per 100 males 22ndash49years SE=15)

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 25

Table 15 Number percent distribution and annual rate of injury-related office visits with corresponding standard errors by selectedpatient characteristics United States 2005

Patient characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror of

rate

All injury-related visits2 89412 5466 1000 307 19

Age

Under 15 years 11556 1126 129 11 191 19Under 1 year 07 03 157 611ndash4 years 3191 495 36 06 197 315ndash14 years 7721 853 86 08 191 21

15ndash24 years 10006 973 112 09 244 2425ndash44 years 23053 1919 258 13 281 2345ndash64 years 28197 2050 315 13 390 2865 years and over 16600 1684 186 14 472 48

65ndash74 years 8111 976 91 09 441 5375 years and over 8489 937 95 08 507 56

Sex and age

Female 44177 2711 494 13 297 18Under 15 years 5017 622 56 07 169 2115ndash24 years 4610 575 52 06 227 2825ndash44 years 10286 921 115 08 248 2245ndash64 years 14917 1251 167 11 401 3465ndash74 years 4364 692 49 07 437 6975 years and over 4983 598 56 06 489 59

Male 45235 3233 506 13 318 23Under 15 years 6539 754 73 08 211 2415ndash24 years 5396 670 60 06 260 3225ndash44 years 12767 1329 143 11 315 3345ndash64 years 13280 1232 149 10 378 3565ndash74 years 3747 590 42 06 445 7075 years and over 3505 600 39 06 535 92

Race3

White 79208 4958 886 11 338 21Black or African American 6838 979 76 10 187 27Other 3365 602 38 06 164 29

Ethnicity

Hispanic or Latino 10578 1562 118 15 251 37Not Hispanic or Latino 78834 4812 882 15 317 19

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2Injury visits represent 93 percent (SE=04) of all office visits3Other race includes visits by Asians Native Hawaiians or Other Pacific Islanders American Indians or Alaska Natives and multiple races All race categories include visits by persons of Hispanicorigin and not Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for FederalData on Race and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typicallyfound for self-reported race in household surveys

NOTE Numbers may not add to totals because of rounding

Table 16 Number and percent distribution of injury-related office visits with corresponding standard errors by intent United States2005

Intent

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All injury-related visits 89412 5466 1000 Unintentional injuries 40934 4147 458 26Intentional injuries 1805 338 20 04Adverse effect of medical or surgical care or adverse effect of medicinal drug 8264 922 92 10Injuries of undetermined intent 32853 2362 367 24Unknown or blank 5556 993 62 11

Category not applicable

NOTE Numbers may not add to totals because of rounding

26 Advance Data No 387 + June 29 2007

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Number of visits in thousands

All visits 963617 432754 283180 119061 128623 560355 403262

At least one condition 507390 121891 187209 94472 103818 298366 209024None 422515 295386 85466 21112 20551 242189 180327Blank 33712 15476 10505 3477 4254 19800 13911

Hypertension 219476 23060 84640 52131 59646 127072 92404Arthritis 137942 20861 51744 27168 38169 91610 46332Hyperlipidemia 130053 12806 55561 31658 30028 68208 61845Diabetes 94359 10387 38628 23810 21534 50625 43733Depression 84610 30935 35059 8538 10078 59418 25192Obesity 68201 24275 29574 9298 5054 45028 23173Cancer 57025 4817 18809 15014 18384 32384 24640Asthma 54545 28913 14491 5764 5376 33276 21269COPD2 40754 7746 11425 10818 10764 22458 18295Ischemic heart disease 39559 1472 10179 12092 15815 16245 23314Osteoporosis 27977 6466 8050 12096 24842 3136Cerebrovascular disease 18319 731 4322 5489 7777 9000 9319CHF3 15692 3589 3409 8392 8950 6742Chronic renal failure 11486 2741 3039 4969 5633 5852

Standard error in thousands

All visits 40611 19288 13998 7460 8954 24487 18050

At least one condition 26734 6497 10543 6419 7920 16807 10964None 20054 14902 5424 1860 2135 11620 9940Blank 3749 1854 1445 668 650 2377 1724

Hypertension 14790 1976 5958 4176 5097 8906 6596Arthritis 9990 1930 4317 2357 3632 7470 3168Hyperlipidemia 9484 1139 4425 2773 3051 5051 4972Diabetes 6585 1133 3024 1939 2203 3811 3366Depression 6884 2367 3465 1084 1288 5082 2137Obesity 5885 2496 2961 1225 842 4156 2401Cancer 6483 782 2373 2149 2161 4421 2379Asthma 3877 2528 1350 712 814 2466 2012COPD2 3794 1054 1259 1356 1583 2332 1790Ischemic heart disease 3659 321 1097 1274 1920 1831 2301Osteoporosis 2821 892 1015 1413 2419 608Cerebrovascular disease 2290 188 717 844 1165 1187 1330CHF3 2054 768 561 1365 1351 1076Chronic renal failure 1713 799 609 890 829 1151

Percent distribution

All visits 1000 1000 1000 1000 1000 1000 100

At least one condition 527 282 661 793 807 532 518None 438 683 302 177 160 432 447Blank 35 36 37 29 33 35 34

Hypertension 228 53 299 438 464 227 229Arthritis 143 48 183 228 297 163 115Hyperlipidemia 135 30 196 266 233 122 153Diabetes 98 24 136 200 167 90 108Depression 88 71 124 72 78 106 62Obesity 71 56 104 78 39 80 57Cancer 59 11 66 126 143 58 61Asthma 57 67 51 48 42 59 53COPD2 42 18 40 91 84 40 45Ischemic heart disease 41 03 36 102 123 29 58Osteoporosis 29 03 23 68 94 44 08Cerebrovascular disease 19 02 15 46 60 16 23CHF3 16 01 13 29 65 16 17Chronic renal failure 12 02 10 26 39 10 15

See footnotes at end of table

Advance Data No 387 + June 29 2007 27

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005mdashCon

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Standard error of percent

All visits

At least one condition 13 10 13 13 15 14 14None 12 11 13 12 14 13 14Blank 04 04 05 06 05 04 04

Hypertension 10 04 13 19 17 11 11Arthritis 07 04 11 13 17 09 06Hyperlipidemia 08 03 12 17 16 08 10Diabetes 05 03 07 11 10 05 06Depression 06 05 10 09 09 08 05Obesity 05 05 09 09 06 06 05Cancer 06 02 08 14 13 07 05Asthma 03 05 04 06 06 04 05COPD2 03 02 04 10 10 03 04Ischemic heart disease 03 01 03 08 10 03 05Osteoporosis 02 01 03 08 08 03 01Cerebrovascular disease 02 00 02 06 07 02 03CHF3 02 00 03 04 09 02 03Chronic renal failure 02 01 03 05 06 01 03

Figure does not meet standards of reliability or precision Category not applicable1Presence of chronic conditions regardless of visit diagnosis were based on checkbox responses2COPD is chronic obstructive pulmonary disease3CHF is congestive heart failure

NOTE Numbers may not add to totals because more than one condition may be reported per visit

28 Advance Data No 387 + June 29 2007

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 14 Number percent distribution and annual rate of office visits with corresponding standard errors by patientrsquos age accordingto the five leading primary diagnosis groups United States 2005

Primary diagnosis group and ICDndash9ndashCM code(s)1

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year2

Standarderror of

rate

All visits 963617 40611 1000 3310 139

Under 1 year

All visits 32070 3406 1000 7816 830Routine infant or child health check V202 14528 1965 453 31 3541 479Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 3442 593 107 16 839 145Otitis media and eustachian tube disorders 381ndash382 2541 559 79 15 619 136Certain conditions originating in the perinatal period 760ndash779 34 08 269 65Unspecified viral and chlamydial infection 799 19 07 148 64All other diagnoses 9847 1134 307 22 2400 276

1ndash12 years

All visits 112241 8094 1000 2337 169Routine infant or child health check V202 21953 2294 196 14 457 48Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 12310 1705 110 11 256 36Otitis media and eustachian tube disorders 381ndash382 7901 843 70 07 165 18Asthma 493 4252 1126 38 10 89 23Acute pharyngitis 462 4203 868 37 07 88 18All other diagnoses 61622 4491 549 15 1283 94

13ndash21 years

All visits 66533 3594 1000 1785 96Routine infant or child health check V202 5334 803 80 11 143 22Normal pregnancy V22 3331 830 50 12 3182 45Acne 7060ndash7061 2931 560 44 08 79 15Acute upper respiratory infections excluding pharyngitis 460ndash461463ndash466 2915 501 44 07 78 13Acute pharyngitis 462 2248 597 34 09 60 16All other diagnoses 49774 2793 748 18 1335 75

22ndash49 years

All visits 290199 14182 1000 2490 122Normal pregnancy V22 12178 1924 42 07 4207 33Spinal disorders 720ndash724 10148 1340 35 04 87 12Arthropathies and related disorders 710ndash719 9874 1767 34 06 85 15Gynecological examination V723 9496 1431 33 05 4161 24Essential hypertension 401 9361 1362 32 04 80 12All other diagnoses 239141 12253 824 11 2052 105

50ndash64 years

All visits 214891 10973 1000 4292 219Essential hypertension 401 15519 1884 72 08 310 38Arthropathies and related disorders 710ndash719 11162 1512 52 06 223 30Diabetes mellitus 250 9272 1048 43 04 185 21Malignant neoplasms 140ndash208230ndash234 8870 1861 41 08 177 37Spinal disorders 720ndash724 6530 935 30 04 130 19All other diagnoses 163538 8317 761 11 3266 166

65 years and over

All visits 247683 15541 1000 7047 442Essential hypertension 401 19129 2184 77 08 544 62Malignant neoplasms 140ndash208230ndash234 15679 3215 63 12 446 91Arthropathies and related disorders 710ndash719 11814 1815 48 06 336 52Diabetes mellitus 250 11253 1594 45 06 320 45Heart disease excluding ischemic 391ndash3920393ndash398402404415ndash416420ndash429 7824 1167 32 04 223 33All other diagnoses 181986 11408 735 12 5177 325

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth RevisionClinical Modification (ICDndash9ndashCM) (23) However certain codes have been combined in this table to better describe the use ofambulatory care services2Visit rates for age are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Populations Division US Census Bureau3The population used for this rate is based on visits by females 13ndash21 years of age For males in this age group the leading diagnosis was routine infant or child health check (155 visits per 100males 13ndash21 years SE=31)4The population used for this rate is based on visits by females 22ndash49 years of age For males in this age group the leading diagnosis was essential hypertension (84 visits per 100 males 22ndash49years SE=15)

NOTE Numbers may not add to totals because of rounding

Advance Data No 387 + June 29 2007 25

Table 15 Number percent distribution and annual rate of injury-related office visits with corresponding standard errors by selectedpatient characteristics United States 2005

Patient characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror of

rate

All injury-related visits2 89412 5466 1000 307 19

Age

Under 15 years 11556 1126 129 11 191 19Under 1 year 07 03 157 611ndash4 years 3191 495 36 06 197 315ndash14 years 7721 853 86 08 191 21

15ndash24 years 10006 973 112 09 244 2425ndash44 years 23053 1919 258 13 281 2345ndash64 years 28197 2050 315 13 390 2865 years and over 16600 1684 186 14 472 48

65ndash74 years 8111 976 91 09 441 5375 years and over 8489 937 95 08 507 56

Sex and age

Female 44177 2711 494 13 297 18Under 15 years 5017 622 56 07 169 2115ndash24 years 4610 575 52 06 227 2825ndash44 years 10286 921 115 08 248 2245ndash64 years 14917 1251 167 11 401 3465ndash74 years 4364 692 49 07 437 6975 years and over 4983 598 56 06 489 59

Male 45235 3233 506 13 318 23Under 15 years 6539 754 73 08 211 2415ndash24 years 5396 670 60 06 260 3225ndash44 years 12767 1329 143 11 315 3345ndash64 years 13280 1232 149 10 378 3565ndash74 years 3747 590 42 06 445 7075 years and over 3505 600 39 06 535 92

Race3

White 79208 4958 886 11 338 21Black or African American 6838 979 76 10 187 27Other 3365 602 38 06 164 29

Ethnicity

Hispanic or Latino 10578 1562 118 15 251 37Not Hispanic or Latino 78834 4812 882 15 317 19

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2Injury visits represent 93 percent (SE=04) of all office visits3Other race includes visits by Asians Native Hawaiians or Other Pacific Islanders American Indians or Alaska Natives and multiple races All race categories include visits by persons of Hispanicorigin and not Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for FederalData on Race and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typicallyfound for self-reported race in household surveys

NOTE Numbers may not add to totals because of rounding

Table 16 Number and percent distribution of injury-related office visits with corresponding standard errors by intent United States2005

Intent

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All injury-related visits 89412 5466 1000 Unintentional injuries 40934 4147 458 26Intentional injuries 1805 338 20 04Adverse effect of medical or surgical care or adverse effect of medicinal drug 8264 922 92 10Injuries of undetermined intent 32853 2362 367 24Unknown or blank 5556 993 62 11

Category not applicable

NOTE Numbers may not add to totals because of rounding

26 Advance Data No 387 + June 29 2007

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Number of visits in thousands

All visits 963617 432754 283180 119061 128623 560355 403262

At least one condition 507390 121891 187209 94472 103818 298366 209024None 422515 295386 85466 21112 20551 242189 180327Blank 33712 15476 10505 3477 4254 19800 13911

Hypertension 219476 23060 84640 52131 59646 127072 92404Arthritis 137942 20861 51744 27168 38169 91610 46332Hyperlipidemia 130053 12806 55561 31658 30028 68208 61845Diabetes 94359 10387 38628 23810 21534 50625 43733Depression 84610 30935 35059 8538 10078 59418 25192Obesity 68201 24275 29574 9298 5054 45028 23173Cancer 57025 4817 18809 15014 18384 32384 24640Asthma 54545 28913 14491 5764 5376 33276 21269COPD2 40754 7746 11425 10818 10764 22458 18295Ischemic heart disease 39559 1472 10179 12092 15815 16245 23314Osteoporosis 27977 6466 8050 12096 24842 3136Cerebrovascular disease 18319 731 4322 5489 7777 9000 9319CHF3 15692 3589 3409 8392 8950 6742Chronic renal failure 11486 2741 3039 4969 5633 5852

Standard error in thousands

All visits 40611 19288 13998 7460 8954 24487 18050

At least one condition 26734 6497 10543 6419 7920 16807 10964None 20054 14902 5424 1860 2135 11620 9940Blank 3749 1854 1445 668 650 2377 1724

Hypertension 14790 1976 5958 4176 5097 8906 6596Arthritis 9990 1930 4317 2357 3632 7470 3168Hyperlipidemia 9484 1139 4425 2773 3051 5051 4972Diabetes 6585 1133 3024 1939 2203 3811 3366Depression 6884 2367 3465 1084 1288 5082 2137Obesity 5885 2496 2961 1225 842 4156 2401Cancer 6483 782 2373 2149 2161 4421 2379Asthma 3877 2528 1350 712 814 2466 2012COPD2 3794 1054 1259 1356 1583 2332 1790Ischemic heart disease 3659 321 1097 1274 1920 1831 2301Osteoporosis 2821 892 1015 1413 2419 608Cerebrovascular disease 2290 188 717 844 1165 1187 1330CHF3 2054 768 561 1365 1351 1076Chronic renal failure 1713 799 609 890 829 1151

Percent distribution

All visits 1000 1000 1000 1000 1000 1000 100

At least one condition 527 282 661 793 807 532 518None 438 683 302 177 160 432 447Blank 35 36 37 29 33 35 34

Hypertension 228 53 299 438 464 227 229Arthritis 143 48 183 228 297 163 115Hyperlipidemia 135 30 196 266 233 122 153Diabetes 98 24 136 200 167 90 108Depression 88 71 124 72 78 106 62Obesity 71 56 104 78 39 80 57Cancer 59 11 66 126 143 58 61Asthma 57 67 51 48 42 59 53COPD2 42 18 40 91 84 40 45Ischemic heart disease 41 03 36 102 123 29 58Osteoporosis 29 03 23 68 94 44 08Cerebrovascular disease 19 02 15 46 60 16 23CHF3 16 01 13 29 65 16 17Chronic renal failure 12 02 10 26 39 10 15

See footnotes at end of table

Advance Data No 387 + June 29 2007 27

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005mdashCon

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Standard error of percent

All visits

At least one condition 13 10 13 13 15 14 14None 12 11 13 12 14 13 14Blank 04 04 05 06 05 04 04

Hypertension 10 04 13 19 17 11 11Arthritis 07 04 11 13 17 09 06Hyperlipidemia 08 03 12 17 16 08 10Diabetes 05 03 07 11 10 05 06Depression 06 05 10 09 09 08 05Obesity 05 05 09 09 06 06 05Cancer 06 02 08 14 13 07 05Asthma 03 05 04 06 06 04 05COPD2 03 02 04 10 10 03 04Ischemic heart disease 03 01 03 08 10 03 05Osteoporosis 02 01 03 08 08 03 01Cerebrovascular disease 02 00 02 06 07 02 03CHF3 02 00 03 04 09 02 03Chronic renal failure 02 01 03 05 06 01 03

Figure does not meet standards of reliability or precision Category not applicable1Presence of chronic conditions regardless of visit diagnosis were based on checkbox responses2COPD is chronic obstructive pulmonary disease3CHF is congestive heart failure

NOTE Numbers may not add to totals because more than one condition may be reported per visit

28 Advance Data No 387 + June 29 2007

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 15 Number percent distribution and annual rate of injury-related office visits with corresponding standard errors by selectedpatient characteristics United States 2005

Patient characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number ofvisits per

100 personsper year1

Standarderror of

rate

All injury-related visits2 89412 5466 1000 307 19

Age

Under 15 years 11556 1126 129 11 191 19Under 1 year 07 03 157 611ndash4 years 3191 495 36 06 197 315ndash14 years 7721 853 86 08 191 21

15ndash24 years 10006 973 112 09 244 2425ndash44 years 23053 1919 258 13 281 2345ndash64 years 28197 2050 315 13 390 2865 years and over 16600 1684 186 14 472 48

65ndash74 years 8111 976 91 09 441 5375 years and over 8489 937 95 08 507 56

Sex and age

Female 44177 2711 494 13 297 18Under 15 years 5017 622 56 07 169 2115ndash24 years 4610 575 52 06 227 2825ndash44 years 10286 921 115 08 248 2245ndash64 years 14917 1251 167 11 401 3465ndash74 years 4364 692 49 07 437 6975 years and over 4983 598 56 06 489 59

Male 45235 3233 506 13 318 23Under 15 years 6539 754 73 08 211 2415ndash24 years 5396 670 60 06 260 3225ndash44 years 12767 1329 143 11 315 3345ndash64 years 13280 1232 149 10 378 3565ndash74 years 3747 590 42 06 445 7075 years and over 3505 600 39 06 535 92

Race3

White 79208 4958 886 11 338 21Black or African American 6838 979 76 10 187 27Other 3365 602 38 06 164 29

Ethnicity

Hispanic or Latino 10578 1562 118 15 251 37Not Hispanic or Latino 78834 4812 882 15 317 19

Category not applicable Figure does not meet standards of reliability or precision1Visit rates for age sex race and ethnicity are based on the July 1 2005 set of estimates of the civilian noninstitutional population of the United States as developed by the Population DivisionUS Census Bureau2Injury visits represent 93 percent (SE=04) of all office visits3Other race includes visits by Asians Native Hawaiians or Other Pacific Islanders American Indians or Alaska Natives and multiple races All race categories include visits by persons of Hispanicorigin and not Hispanic origin Persons of Hispanic origin may be of any race Starting with data year 1999 race-specific estimates have been tabulated according to 1997 Standards for FederalData on Race and Ethnicity and are not strictly comparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than what is typicallyfound for self-reported race in household surveys

NOTE Numbers may not add to totals because of rounding

Table 16 Number and percent distribution of injury-related office visits with corresponding standard errors by intent United States2005

Intent

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All injury-related visits 89412 5466 1000 Unintentional injuries 40934 4147 458 26Intentional injuries 1805 338 20 04Adverse effect of medical or surgical care or adverse effect of medicinal drug 8264 922 92 10Injuries of undetermined intent 32853 2362 367 24Unknown or blank 5556 993 62 11

Category not applicable

NOTE Numbers may not add to totals because of rounding

26 Advance Data No 387 + June 29 2007

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Number of visits in thousands

All visits 963617 432754 283180 119061 128623 560355 403262

At least one condition 507390 121891 187209 94472 103818 298366 209024None 422515 295386 85466 21112 20551 242189 180327Blank 33712 15476 10505 3477 4254 19800 13911

Hypertension 219476 23060 84640 52131 59646 127072 92404Arthritis 137942 20861 51744 27168 38169 91610 46332Hyperlipidemia 130053 12806 55561 31658 30028 68208 61845Diabetes 94359 10387 38628 23810 21534 50625 43733Depression 84610 30935 35059 8538 10078 59418 25192Obesity 68201 24275 29574 9298 5054 45028 23173Cancer 57025 4817 18809 15014 18384 32384 24640Asthma 54545 28913 14491 5764 5376 33276 21269COPD2 40754 7746 11425 10818 10764 22458 18295Ischemic heart disease 39559 1472 10179 12092 15815 16245 23314Osteoporosis 27977 6466 8050 12096 24842 3136Cerebrovascular disease 18319 731 4322 5489 7777 9000 9319CHF3 15692 3589 3409 8392 8950 6742Chronic renal failure 11486 2741 3039 4969 5633 5852

Standard error in thousands

All visits 40611 19288 13998 7460 8954 24487 18050

At least one condition 26734 6497 10543 6419 7920 16807 10964None 20054 14902 5424 1860 2135 11620 9940Blank 3749 1854 1445 668 650 2377 1724

Hypertension 14790 1976 5958 4176 5097 8906 6596Arthritis 9990 1930 4317 2357 3632 7470 3168Hyperlipidemia 9484 1139 4425 2773 3051 5051 4972Diabetes 6585 1133 3024 1939 2203 3811 3366Depression 6884 2367 3465 1084 1288 5082 2137Obesity 5885 2496 2961 1225 842 4156 2401Cancer 6483 782 2373 2149 2161 4421 2379Asthma 3877 2528 1350 712 814 2466 2012COPD2 3794 1054 1259 1356 1583 2332 1790Ischemic heart disease 3659 321 1097 1274 1920 1831 2301Osteoporosis 2821 892 1015 1413 2419 608Cerebrovascular disease 2290 188 717 844 1165 1187 1330CHF3 2054 768 561 1365 1351 1076Chronic renal failure 1713 799 609 890 829 1151

Percent distribution

All visits 1000 1000 1000 1000 1000 1000 100

At least one condition 527 282 661 793 807 532 518None 438 683 302 177 160 432 447Blank 35 36 37 29 33 35 34

Hypertension 228 53 299 438 464 227 229Arthritis 143 48 183 228 297 163 115Hyperlipidemia 135 30 196 266 233 122 153Diabetes 98 24 136 200 167 90 108Depression 88 71 124 72 78 106 62Obesity 71 56 104 78 39 80 57Cancer 59 11 66 126 143 58 61Asthma 57 67 51 48 42 59 53COPD2 42 18 40 91 84 40 45Ischemic heart disease 41 03 36 102 123 29 58Osteoporosis 29 03 23 68 94 44 08Cerebrovascular disease 19 02 15 46 60 16 23CHF3 16 01 13 29 65 16 17Chronic renal failure 12 02 10 26 39 10 15

See footnotes at end of table

Advance Data No 387 + June 29 2007 27

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005mdashCon

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Standard error of percent

All visits

At least one condition 13 10 13 13 15 14 14None 12 11 13 12 14 13 14Blank 04 04 05 06 05 04 04

Hypertension 10 04 13 19 17 11 11Arthritis 07 04 11 13 17 09 06Hyperlipidemia 08 03 12 17 16 08 10Diabetes 05 03 07 11 10 05 06Depression 06 05 10 09 09 08 05Obesity 05 05 09 09 06 06 05Cancer 06 02 08 14 13 07 05Asthma 03 05 04 06 06 04 05COPD2 03 02 04 10 10 03 04Ischemic heart disease 03 01 03 08 10 03 05Osteoporosis 02 01 03 08 08 03 01Cerebrovascular disease 02 00 02 06 07 02 03CHF3 02 00 03 04 09 02 03Chronic renal failure 02 01 03 05 06 01 03

Figure does not meet standards of reliability or precision Category not applicable1Presence of chronic conditions regardless of visit diagnosis were based on checkbox responses2COPD is chronic obstructive pulmonary disease3CHF is congestive heart failure

NOTE Numbers may not add to totals because more than one condition may be reported per visit

28 Advance Data No 387 + June 29 2007

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Number of visits in thousands

All visits 963617 432754 283180 119061 128623 560355 403262

At least one condition 507390 121891 187209 94472 103818 298366 209024None 422515 295386 85466 21112 20551 242189 180327Blank 33712 15476 10505 3477 4254 19800 13911

Hypertension 219476 23060 84640 52131 59646 127072 92404Arthritis 137942 20861 51744 27168 38169 91610 46332Hyperlipidemia 130053 12806 55561 31658 30028 68208 61845Diabetes 94359 10387 38628 23810 21534 50625 43733Depression 84610 30935 35059 8538 10078 59418 25192Obesity 68201 24275 29574 9298 5054 45028 23173Cancer 57025 4817 18809 15014 18384 32384 24640Asthma 54545 28913 14491 5764 5376 33276 21269COPD2 40754 7746 11425 10818 10764 22458 18295Ischemic heart disease 39559 1472 10179 12092 15815 16245 23314Osteoporosis 27977 6466 8050 12096 24842 3136Cerebrovascular disease 18319 731 4322 5489 7777 9000 9319CHF3 15692 3589 3409 8392 8950 6742Chronic renal failure 11486 2741 3039 4969 5633 5852

Standard error in thousands

All visits 40611 19288 13998 7460 8954 24487 18050

At least one condition 26734 6497 10543 6419 7920 16807 10964None 20054 14902 5424 1860 2135 11620 9940Blank 3749 1854 1445 668 650 2377 1724

Hypertension 14790 1976 5958 4176 5097 8906 6596Arthritis 9990 1930 4317 2357 3632 7470 3168Hyperlipidemia 9484 1139 4425 2773 3051 5051 4972Diabetes 6585 1133 3024 1939 2203 3811 3366Depression 6884 2367 3465 1084 1288 5082 2137Obesity 5885 2496 2961 1225 842 4156 2401Cancer 6483 782 2373 2149 2161 4421 2379Asthma 3877 2528 1350 712 814 2466 2012COPD2 3794 1054 1259 1356 1583 2332 1790Ischemic heart disease 3659 321 1097 1274 1920 1831 2301Osteoporosis 2821 892 1015 1413 2419 608Cerebrovascular disease 2290 188 717 844 1165 1187 1330CHF3 2054 768 561 1365 1351 1076Chronic renal failure 1713 799 609 890 829 1151

Percent distribution

All visits 1000 1000 1000 1000 1000 1000 100

At least one condition 527 282 661 793 807 532 518None 438 683 302 177 160 432 447Blank 35 36 37 29 33 35 34

Hypertension 228 53 299 438 464 227 229Arthritis 143 48 183 228 297 163 115Hyperlipidemia 135 30 196 266 233 122 153Diabetes 98 24 136 200 167 90 108Depression 88 71 124 72 78 106 62Obesity 71 56 104 78 39 80 57Cancer 59 11 66 126 143 58 61Asthma 57 67 51 48 42 59 53COPD2 42 18 40 91 84 40 45Ischemic heart disease 41 03 36 102 123 29 58Osteoporosis 29 03 23 68 94 44 08Cerebrovascular disease 19 02 15 46 60 16 23CHF3 16 01 13 29 65 16 17Chronic renal failure 12 02 10 26 39 10 15

See footnotes at end of table

Advance Data No 387 + June 29 2007 27

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005mdashCon

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Standard error of percent

All visits

At least one condition 13 10 13 13 15 14 14None 12 11 13 12 14 13 14Blank 04 04 05 06 05 04 04

Hypertension 10 04 13 19 17 11 11Arthritis 07 04 11 13 17 09 06Hyperlipidemia 08 03 12 17 16 08 10Diabetes 05 03 07 11 10 05 06Depression 06 05 10 09 09 08 05Obesity 05 05 09 09 06 06 05Cancer 06 02 08 14 13 07 05Asthma 03 05 04 06 06 04 05COPD2 03 02 04 10 10 03 04Ischemic heart disease 03 01 03 08 10 03 05Osteoporosis 02 01 03 08 08 03 01Cerebrovascular disease 02 00 02 06 07 02 03CHF3 02 00 03 04 09 02 03Chronic renal failure 02 01 03 05 06 01 03

Figure does not meet standards of reliability or precision Category not applicable1Presence of chronic conditions regardless of visit diagnosis were based on checkbox responses2COPD is chronic obstructive pulmonary disease3CHF is congestive heart failure

NOTE Numbers may not add to totals because more than one condition may be reported per visit

28 Advance Data No 387 + June 29 2007

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 17 Number and percent distribution of office visits with corresponding standard errors by selected chronic conditions accordingto patient age and sex United States 2005mdashCon

Chronic conditions1 Total

Patient age Patient sex

Under45 years

45ndash64years

65ndash74years

75 yearsand over Female Male

Standard error of percent

All visits

At least one condition 13 10 13 13 15 14 14None 12 11 13 12 14 13 14Blank 04 04 05 06 05 04 04

Hypertension 10 04 13 19 17 11 11Arthritis 07 04 11 13 17 09 06Hyperlipidemia 08 03 12 17 16 08 10Diabetes 05 03 07 11 10 05 06Depression 06 05 10 09 09 08 05Obesity 05 05 09 09 06 06 05Cancer 06 02 08 14 13 07 05Asthma 03 05 04 06 06 04 05COPD2 03 02 04 10 10 03 04Ischemic heart disease 03 01 03 08 10 03 05Osteoporosis 02 01 03 08 08 03 01Cerebrovascular disease 02 00 02 06 07 02 03CHF3 02 00 03 04 09 02 03Chronic renal failure 02 01 03 05 06 01 03

Figure does not meet standards of reliability or precision Category not applicable1Presence of chronic conditions regardless of visit diagnosis were based on checkbox responses2COPD is chronic obstructive pulmonary disease3CHF is congestive heart failure

NOTE Numbers may not add to totals because more than one condition may be reported per visit

28 Advance Data No 387 + June 29 2007

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 18 Number and percentage of office visits with corresponding standard errors by diagnostic and screening services ordered orprovided according to patients sex United States 2005

Diagnostic and screening services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 00 582 06 418 06One or more diagnostic and screening service ordered or provided 839283 37329 871 10 877 10 862 13None 112370 10292 117 09 110 09 125 12Blank 11964 3066 12 03 12 03 12 04

Examinations

Skin 121633 10325 126 09 133 11 117 08Breast 56775 4512 59 04 97 07 06 01Pelvic 56287 4925 58 05 96 08 06 01Rectal 32869 3286 34 03 35 04 32 04Depression screening 19855 3632 21 04 25 04 14 03

Vital signs

Weight 653666 31671 678 16 684 16 670 18Blood pressure 571844 30556 593 15 616 15 561 17Height 419328 25434 435 18 436 19 434 19Temperature 353206 24793 367 19 346 20 395 21

Blood tests

CBC4 118978 9838 123 09 130 09 115 09LipidsCholesterol 74930 6465 78 06 73 06 84 06Glucose 57151 5615 59 05 58 06 61 06Electrolytes 55319 7028 57 07 59 07 55 07HgbA1C5 25020 2378 26 02 22 02 31 03PSA6 16853 1727 17 02 42 04Other blood test 113054 8464 117 07 124 08 108 08

Other tests

Urinalysis 61529 4691 64 04 70 06 55 04EKGECG7 30707 3579 32 03 29 03 35 04PAP testCervical cytology 29074 3215 30 03 52 05 Any scope procedure 18643 1717 19 02 19 02 19 02

SigmoidoscopyColonoscopy 9358 1240 10 01 10 01 09 01Cystoscopy 2119 349 02 00 02 00 03 01

Biopsy 11071 1632 11 02 12 02 11 02Chlamydia test 5424 1018 06 01 09 02 01 00SpirometryPulmonary function test 6391 2026 07 02 05 02 08 03Other test or service 139637 13335 145 12 143 12 147 13

Imaging

Any imaging 129786 8106 135 06 149 07 115 07X-ray 56131 4077 58 04 52 04 66 05Ultrasound 29646 3421 31 03 39 05 19 03MRICTPET8 23937 2216 25 02 25 02 25 02Mammography 18346 1903 19 02 33 03 Bone mineral density 5428 870 06 01 08 01 02 01Other imaging 14690 1740 15 02 16 02 14 02

Category not applicable00 Quantity more than zero but less than 005 Figure does not meet standards of reliability or precision1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one service may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males4CBC is complete blood count5HgbA1C is glycohemoglobin6PSA is prostate-specific antigen7EKGECG is electrocardiogram8MRI is magnetic resonance imaging CT is computed tomography PET is positron emission tomography

Advance Data No 387 + June 29 2007 29

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 19 Percent distribution of initial blood pressure measurements for adults 18 years and over at physician office visits where bloodpressure was taken with corresponding standard errors by selected patient characteristics United States 2005

Patient characteristics

Number ofvisits in

thousands Total Low NormalMildlyhigh

Initial blood pressure1

Mildlyhigh

Moderatelyhigh

Severelyhigh

Moderatelyhigh

Severelyhigh Low Normal

Percent distribution Standard error of percent

All visits2 523206 1000 40 213 471 203 74 03 08 09 06 05

Age

18ndash24 years 29850 1000 123 376 393 75 32 20 23 26 12 1025ndash44 years 138046 1000 48 306 464 140 42 06 13 13 09 0545ndash64 years 191650 1000 29 187 492 218 74 04 10 12 10 0565ndash74 years 78817 1000 20 128 483 266 104 04 12 16 16 1175 years and over 84844 1000 41 140 453 255 111 06 10 18 14 11

Sex

Female 321489 1000 49 238 454 189 70 04 09 10 08 06Male 201718 1000 26 173 499 223 79 03 10 12 08 06

Race3

White 447420 1000 40 213 473 201 73 03 08 09 06 05Black 49463 1000 35 199 442 231 94 09 19 19 18 11Asian 21222 1000 38 240 497 172 53 13 35 43 32 12Other 5101 1000 59 245 486 176 33 22 85 61 45 18

Ethnicity

Hispanic or Latino 48580 1000 47 236 455 190 72 10 21 22 16 10Not Hispanic or Latino 474626 1000 39 210 473 204 74 03 08 09 07 05

Figure does not meet standards of reliability or precision1Blood pressure levels were categorized using the following hierarchical definitions Severely high blood pressure is defined as 160 mm Hg systolic or above or 100 mm Hg diastolic or aboveModerately high blood pressure is defined as 140ndash159 mm Hg systolic or 90ndash99 mm Hg diastolic Mildly high blood pressure is defined as 120ndash139 mm Hg systolic or 80ndash89 mm Hg diastolic Lowblood pressure is defined as less than 100 mm Hg systolic or less than 60 mm Hg diastolic Normal blood pressure is defined as 100ndash119 mm Hg systolic and 60ndash79 mm Hg diastolic2Visits where blood pressure was taken represent 672 percent (SE=16) of all office visits made by adults (18+ years of age) In 262 percent (SE=18) of visits by children (0ndash17 years of age) ablood pressure was recorded Blood pressure classification was based on the Seventh Report of the Joint National Committee on prevention detection evaluation and treatmetn of high bloodpressure (21)3Other race includes visits by Native Hawaiian or Other Pacific Islander American Indian or Alaska Native and multiple races All race categories include visits by persons of Hispanic or notHispanic origin Starting with data year 1999 race- and ethnicity-specific estimates have been tabulated according to 1997 Standards for Federal Data on Race and Ethnicity and are not strictlycomparable with estimates for earlier years The percentage of visit records with multiple races indicated is small and lower than in household surveys

NOTE Numbers may not add to totals because of rounding

Table 20 Number and percentage of office visits with corresponding standard errors by health education services ordered or providedaccording to patientrsquos sex United States 2005

Health education services ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

Female2 Male3

Percentof visits

Standarderror ofpercent

Percentof visits

Standarderror ofpercent

All visits 963617 40611 One or more health education services ordered or provided 370313 23688 384 16 385 17 383 17None 569663 26336 591 16 590 16 593 17Blank 23641 4326 25 04 25 04 24 05

Dietnutrition 142622 10513 148 09 151 09 144 09Exercise 104805 9166 109 08 111 08 106 09Weight reduction 43820 4632 45 04 50 05 40 04Injury prevention 41365 5307 43 05 36 05 53 06Stress management 39794 5616 41 05 46 06 34 05Growthdevelopment 38410 4801 40 05 35 05 46 06Tobacco useexposure 32302 3099 34 03 31 03 37 03Asthma education 13609 1778 14 02 12 02 17 03Other 165120 15773 171 13 177 14 164 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one type of health education may be reported per visit2Based on 560355000 visits made by females3Based on 403262000 visits made by males

30 Advance Data No 387 + June 29 2007

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 21 Number and percentage of office visits with corresponding standard errors by nonmedication treament ordered or providedUnited States 2005

Nonmedication treatment ordered or provided

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

One or more nonmedication teatments ordered or provided 170481 9938 177 08None 792675 35714 823 08Blank

Physical therapy 22850 2764 24 03Exicision of tissue 22698 3112 24 03Psychotherapy 21985 2920 23 03Wound care 19853 2579 21 03Orthopedic care 18621 3076 19 03Other mental health counseling 13959 2034 14 02Durable medical equipment 7286 1335 08 01Complementary alternative medicine (CAM) 5333 1416 06 01Home health care 2476 584 03 01Speech or occupational therapy 1894 448 02 00Hospice care

Category not applicable Figure does not meet standards of reliability or precision00 Quantity more than zero but less than 0051Total exceeds lsquolsquoAll visitsrsquorsquo because more than one treatment may be reported per visit

Table 22 Number and percent distribution of write-in surgical procedures ordered or performed with corresponding standard errors byprocedure category United States 2005

Procedure or operation category and ICDndash9ndashCM code range1

Number ofprocedures

in thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All write-in procedures 65919 4636 1000 Nervous system 01ndash05 1893 547 29 08Eye 08ndash16 5228 1126 79 17Ear 18ndash20 1192 340 18 05Nose mouth and pharynx 21ndash29 1836 383 28 06Cardiovascular system 35ndash39 2365 500 36 08Digestive system 42ndash54 14276 1816 217 25Urinary system 55ndash59 3174 521 48 08Male genital organs 60ndash64 717 125 11 02Female genital organs 65ndash71 2303 625 35 09Obstetrical procedures 72ndash75 2254 984 34 14Musculoskeletal system 76ndash84 5717 736 87 12Integumentary system 85ndash86 23392 3422 355 36Other procedures2 1573 378 24 06

Category not applicable Figure does not meet standards of reliability or precision1Based on the International Classification of Diseases Ninth Revision Clinical Modification (ICDndash9ndashCM) (23) At least one surgical procedure was ordered or performed at 62 percent of office visits2Includes operations on the endocrine system (ICDndash9ndashCM codes 06ndash07) operations on the respiratory system (ICDndash9ndashCM codes 30ndash34) and operations on the hemic and lymphatic system(ICDndash9ndashCM codes 40ndash41)

NOTE Included are responses to the write-in fields on the Patient Record form under DiagnosticScreening Services (item 724 Scope procedures and item 727 Other testservice) and Non-Medication Treatment (item 913 and 914 Procedures) Up to two procedures could be coded for each category for a total of eight procedures per visit In addition to the surgical procedures shownin this table there were an additional 202779000 nonsurgical procedures reported (ICDndash9ndashCM Volume 3 codes 00 87ndash99)

Advance Data No 387 + June 29 2007 31

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 23 Number and percent distribution of office visits with corresponding standard errors by medication therapy and number ofmedications provided or prescribed according to patientrsquos sex United States 2005

Visit characteristic

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Female1 Male2

Percentdistribution

Standarderror ofpercent

Percentdistribution

Standarderror ofpercent

Medication therapy3

All visits 963617 40611 1000 1000 1000 Visits with mention of medication4 679249 31173 705 12 709 13 699 12Visits without mention of medication 284368 16115 295 12 291 13 301 12

Number of medications providedor prescribed by a physician

All visits 963617 40611 1000 1000 1000 0 284368 16115 295 12 291 13 301 121 237110 11222 246 09 249 09 242 102 142934 6964 148 04 140 05 159 053 90068 5103 93 04 92 04 96 044 55508 3546 58 03 62 03 52 035 41549 3437 43 03 44 03 42 046 31060 2833 32 02 34 03 30 037 26673 2736 28 02 29 03 26 038 54347 6467 56 06 60 06 52 06

Category not applicable1Based on 560355000 visits made by females2Based on 403262000 visits made by males3Includes prescription drugs over-the-counter preparations immunizations and desensitizing agents4Also defined as drug visits

NOTE Numbers may not add to totals because of rounding

32 Advance Data No 387 + June 29 2007

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 24 Number and percent distribution of drug visits and drug mentions percentage of drug visits and drug mention rates per 100 visits with corresponding standard errorsby physician specialty United States 2005

Physician specialty

Drug visits1 Drug mentions2 Percent of drug visits3 Drug mention rates4

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Number inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent Percent

Standarderror ofpercent

Number ofdrug mentionsper 100 visits

Standarderror of

rate

All specialties 679249 31173 1000 2030804 128474 1000 705 12 2107 81General and family practice 176536 13695 260 17 557673 51341 275 22 818 15 2583 125Internal medicine 138027 16858 203 19 504591 76345 248 27 823 30 3010 234Pediatrics 87944 7606 129 11 162989 15300 80 08 682 16 1264 59Obstetrics and gynecology 35111 4196 52 07 58653 9861 29 05 548 30 915 107Ophthalmology 30324 5266 45 07 71404 14230 35 06 514 46 1210 165Psychiatry 25346 3556 37 05 64563 10842 32 05 901 21 2296 175Cardiovascular diseases 23014 3431 34 05 115620 17028 57 08 854 40 4292 309Dermatology 22517 3789 33 06 50428 11595 25 06 694 44 1554 205Orthopedic surgery 19171 3021 28 04 40792 9070 20 04 418 35 890 140Otolaryngology 11397 1887 17 03 23052 5178 11 03 508 48 1027 184Urology 10487 1340 15 02 25562 4421 13 02 554 36 1351 187Neurology 10217 1437 15 02 31781 6235 16 03 784 31 2439 293General surgery 9804 1890 14 03 28114 5423 14 03 408 44 1169 158All other specialties 79355 11512 117 16 295581 52537 146 23 683 38 2543 255

Category not applicable1Visits at which one or more drugs were provided or prescribed by the physician2Number of drugs mentioned at visits (up to eight per visit)3Percentage of visits that included one or more drug mentions (number of drug visits divided by number of office visits multiplied by 100)4Average number of drugs that were mentioned per 100 visits (number of drug mentions divided by total number of visits multiplied by 100)

NOTE Numbers may not add to totals because of rounding

Advance

Data

No387

+June

29200733

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 25 Number and percentage of drug mentions for the 20 most frequently occurring therapeutic classes at office visits withcorresponding standard errors United States 2005

Therapeutic class1

Number ofoccurrencesin thousands

Standarderror in

thousandsPercent of

drug mentions2

Standarderror ofpercent

Antidepressants 107070 8999 53 03Antihypertensive agents 105295 9577 52 02Hyperlipidemia 101004 8633 50 02Antiarthritics 85511 7856 42 02Antiasthmatics or bronchodilators 83741 6971 41 02Nonnarcotic analgesics 83560 6782 41 02Antipyretics 75381 6582 37 02Acid or peptic disorders 75346 6633 37 02NSAIDs3 75277 6063 37 02Blood glucose regulators 72535 6488 36 02Vitamins or minerals 65973 5260 32 02Antihistamines 65516 4613 32 01Beta blockers 62726 5300 31 02Vaccines or antisera 61155 7649 30 04ACE inhibitors4 59474 5100 29 01Diuretics 58671 5488 29 02Narcotic analgesics 55001 5818 27 02Calcium channel blockers 49135 4340 24 01Adrenal corticosteroids 42751 3735 21 01Thyroid or antithyroid 41745 4261 21 01

1Based on the standard four-digit drug classification used in the National Drug Code Directory 1995 edition (26)2Based on an estimated 2030804000 drug mentions at office visits in 20053NSAIDs are nonsteriodal anti-inflammatory drugs4ACE is angiotensin-converting enzyme

34 Advance Data No 387 + June 29 2007

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 26 Number percent distribution and therapeutic classes of the 20 most frequently mentioned generic equivalents at office visits by new or continued drug status withcorresponding standard errors United States 2005

Generic equivalent1

Number ofmentions inthousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

Percent distribution Standard error of percent

Thearapeutic class2Total New Continued Unknown New Continued Unknown

All drug mentions 2030804 128474 1000 1000 256 698 45 11 11 04

Aspirin 53668 5278 26 02 1000 57 907 37 09 12 08 Nonnarcotic analgesics antiarthritics antipyreticsAtorvastatin calcium 44207 3793 22 01 1000 51 927 23 09 11 07 HyperlipidemiaLevothyroxine 38749 3976 19 01 1000 47 925 28 10 12 07 Thyroid or antithyroidMetoprolol 34179 3521 17 01 1000 80 888 32 13 15 10 Beta blockersAlbuterol 28111 2283 14 01 1000 239 712 49 27 30 14 Antiasthmatics or bronchodilatorsLisinopril 27854 3023 14 01 1000 81 876 42 16 19 13 ACE inhibitors3

Ibuprofen 24474 2192 12 01 1000 470 464 66 32 37 15 NSAIDs4

Furosemide 23633 2500 12 01 1000 82 879 39 15 17 09 DiureticsAcetaminophen 23339 2636 11 01 1000 512 420 69 37 41 18 Nonnarcotic analgesics antipyreticsHydrochlorothiazide 23114 2227 11 01 1000 78 903 19 15 17 08 DiureticsAcetaminophen with hydrocodone 22897 2843 11 01 1000 348 604 48 46 45 30 Narcotic analgesicsSimvastatin 19855 2397 10 01 1000 54 915 31 14 19 13 HyperlipidemiaMetformin 19813 2105 10 01 1000 77 875 48 18 23 13 Blood glucose regulatorsAmlodipine 19715 2130 10 01 1000 65 912 22 13 15 08 Calcium channel blockersAtenolol 19348 1659 10 01 1000 63 916 21 18 19 05 Beta blockersAmoxicillin 19252 1705 09 01 1000 854 103 43 25 20 14 PenicillinsPrednisone 18479 2471 09 01 1000 285 696 19 38 39 07 Adrenal corticosteroidsEsomeprazole magnesium 17621 2200 09 01 1000 170 810 20 32 32 08 Acid and peptic disordersWarfarin sodium 16846 2117 08 01 1000 45 926 29 15 18 09 Anticoagulants and thrombolyticsAlprazolam 16331 2511 08 01 1000 126 847 27 23 25 09 Antianxiety agentsOther 1519319 92101 748 06 1000 286 666 49 12 12 04

Category not applicable Figure does not meet standards of reliability or precision1A generic equivalent of a drug is the combination of ingredients that make up the drug For example Anexsia Bancap HC and Dolacet all have the generic equivalent lsquolsquoAcetaminophen with hydrocodonersquorsquo Thus the number of drug mentions forlsquolsquoAcetaminiphen with hydrocodonersquorsquo is the sum of all drug mentions that have this generic equivalent2Based on the standard drug classification used in the National Drug Code Directory (NDC) 1995 edition (26) In the NDC therapeutic classes are assigned to drugs using 21 broad categories (two-digit level) and into specific categories (four-digit level)within each broad group In the NAMCS up to three therapeutic classes can be coded for each drug Drugs are counted in each class where they may occur3ACE is angiotensin-converting enzyme4NSAIDs are nonseteroidal anit-inflammatory drugs

Advance

Data

No387

+June

29200735

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 27 Number and percentage of office visits with corresponding standard errors by providers seen United States 2005

Type of provider

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Physician 926951 38537 962 06RN2 or LPN3 269455 27784 280 23Physician assistant 41102 7109 43 07Nurse practitioner or midwife 17568 4895 18 05Other provider 153419 14738 159 14

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one provider may be reported per visit2RN is registered nurse3LPN is licensed practical nurse

Table 28 Number and percentage of office visits with corresponding standard errors by visit disposition United States 2005

Disposition

Number ofvisits in

thousands1

Standarderror in

thousandsPercentof visits

Standarderror ofpercent

All visits 963617 40611

Return at specified time 623680 29296 647 13Return if needed PRN2 264778 19345 275 14Refer to other physician 64150 5295 67 04No followup planned 61658 5299 64 05Telephone follow-up planned 18637 3289 19 03Admit to hospital 4253 1207 04 01Refer to emergency department 2014 502 02 01Other disposition 10746 1442 11 02Blank 20499 4448 21 05

Category not applicable1Total exceeds lsquolsquoAll visitsrsquorsquo because more than one disposition may be reported per visit2PRN is lsquolsquoas neededrsquorsquo

Table 29 Number and percent distribution of office visits with corresponding standard errors by time spent with physicianUnited States 2005

Time spent with physician

Number ofvisits in

thousands

Standarderror in

thousandsPercent

distribution

Standarderror ofpercent

All visits 963617 40611 1000 Visits at which no physician was seen 36667 6352 38 06Visits at which a physician was seen 926951 38537 962 06

Total 926951 38537 1000 1ndash5 minutes 23935 3754 26 046ndash10 minutes 157951 11577 170 1111ndash15 minutes 331723 19543 358 1316ndash30 minutes 341258 19375 368 1331ndash60 minutes 67880 6396 73 0761 minutes and over 4205 853 05 01

Category not applicable

NOTE Numbers may not add to totals because of rounding

36 Advance Data No 387 + June 29 2007

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 30 Mean time spent with physician with corresponding standard errors and percentiles by physician specialty United States2005

Physician specialty

Mean timein minutesspent withphysician1

Standarderror inof mean

25thpercentile Median

75thpercentile

All visits 197 03 141 148 241

Psychiatry 314 16 146 293 445Neurology 268 13 146 198 298Internal medicine 215 11 137 149 251General and family practice 199 06 142 149 243Cardiovascular diseases 193 09 143 149 200Obstetrics and gynecology 190 08 141 149 215General surgery 190 11 97 147 200Otolaryngology 181 08 99 145 198Urology 181 06 141 147 198Ophthalmology 179 10 96 146 240Orthopedic surgery 178 09 99 146 197Pediatrics 163 05 98 145 194Dermatology 162 09 96 143 170All other specialties 205 12 141 150 238

1Only visits where a physician was seen are included

Advance Data No 387 + June 29 2007 37

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Table 31 Characteristics of the 2005 National Ambulatory Medical Care Survey physician respondents and nonrespondents

Physician characteristic1

Number ofsampledin-scope

physicians2

Total samplepercent

distribution3

(weighted)

Respondingphysician percent

distribution4

(weighted)

Nonrespondingphysician percent

distribution5

(weighted)

Weightedresponse

rate6

All office-based physicians 1936 1000 1000 1000 0625

Age

Under 50 years 892 477 477 477 062650 years and over 1044 523 523 523 0625

Sex7

Male 1555 770 747 809 0606Female 381 230 253 191 0689

RegionNortheast 433 209 220 191 0657Midwest 426 214 203 233 0592South 642 349 345 356 0618West 435 227 232 219 0638

Metropolitan status8

MSA 1736 889 885 894 0623Not MSA 200 111 115 106 0644

Type of doctor

Doctor of medicine 1781 939 944 929 0629Doctor of osteopathy 155 61 56 71 0567

Physician specialty79

General and family practice 295 184 179 193 0607Internal medicine 121 154 139 181 0562Pediatrics 128 104 121 74 0731General surgery 114 37 41 31 0689Obstetrics and gynecology 106 71 74 67 0649Orthopedic surgery 109 47 45 51 0598Cardiovascular diseases 154 41 35 52 0532Dermatology 90 22 24 18 0685Urology 110 20 22 18 0672Psychiatry 157 57 54 63 0587Neurology 155 21 16 28 0494Ophthalmology 103 42 43 40 0641Otolaryngology 108 19 19 20 0620All other specialties 186 180 189 165 0655

Specialty type9

Primary care 644 509 507 513 0622Surgical 595 216 220 207 0640Medical 697 275 273 279 0620

Practice type

Solo 548 276 263 298 0595Two physicans 119 64 63 65 0619Group or HMO10 814 406 415 391 0639Medical school or government 31 14 19 07 0821Other 33 14 14 12 0662Unclassified 391 226 226 227 0624

Annual visit volume11

Low 645 323 342 292 0662Medium 644 315 298 343 0592High 647 362 361 366 0622

1Characteristic information is from the master files of the American Medical Association and the American Osteopathic Association2In-scope physicians are those who verified that they were nonfederal and involved in direct patient care in an office-based setting excluding the specialities of radiology pathology andanesthesiology3Total physicians are those who were selected from the master files of the American Medical Association and the American Osteopathic Association and determined to be in-scope4Responding physicians are those who were in-scope and agreed to participate in the NAMCS5Nonresponding physicians are those who were in-scope and refused to participate in the NAMCS6Numerator is the number of in-scope physicians who participated in the NAMCS or who did not see any patients during their sampled reporting week Denominator is all in-scope sampledphysicians7Chi-square test of association is significant at p lt 0058MSA is metropolitan statistical area9Physician specialty and specialty type are defined in lsquolsquoPhysician specialty groupsrsquorsquo section of lsquolsquoMethodsrsquorsquo10HMO is health maintenance organization11Low is the lowest third of annual visit volume medium is the middle third and high is the highest third

38 Advance Data No 387 + June 29 2007

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Technical Notes

Advance Data No 387 + June 29 2007 39

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284

Suggested citation

Cherry DK Woodwell DA Rechtsteiner EANational Ambulatory Medical Care Survey2005 Summary Advance data from vital andhealth statistics no 387 Hyattsville MDNational Center for Health Statistics 2007

Copyright information

All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission citation as tosource however is appreciated

National Center for Health Statistics

DirectorEdward J Sondik PhD

Acting Co-Deputy DirectorsJennifer H Madans PhD

Michael H Sadagursky

US DEPARTMENT OFHEALTH amp HUMAN SERVICES

Centers for Disease Control and PreventionNational Center for Health Statistics3311 Toledo RoadHyattsville MD 20782

OFFICIAL BUSINESSPENALTY FOR PRIVATE USE $300

To receive this publication regularly contactthe National Center for Health Statistics bycalling 1-800-232-4636E-mail nchsquerycdcgovInternet wwwcdcgovnchs

CS108823 (62007)T28627DHHS Publication No (PHS) 2007-1250

40 Advance Data No 387 + June 29 2007

MEDIA MAILPOSTAGE amp FEES PAID

CDCNCHSPERMIT NO G-284