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The Collection and Processing of Drug information: National Ambulatory Medical Care Survey United States, 1980 The report describes the method and instru- ments used to collect and process drug infor- mation for the 1980 National Ambulatory Medical Care Survey. It explains in detail the development of the system by which the drug information was classified and coded, and offers a complete set of coding instructions along with an alphabetized list of 7,227 drugs that office-based physicians might prescribe. Finally, it presents the plan for analyzing the drug data and reporting it to potential users. Data Evaluation and Methods Research Series 2, No. 90 DHHS Publication No. (PHS) 82-1364 U.S. Department of Health and Human Services Public Health Service Office of Health Research, Statistics, and Technology National Center for Health Statistics Hyattsville, Md. March 1982 SUGGESTED CITATION National Centarfor Health Statistics, H. Koch: The collection and processing of Drug information: National Ambulatory Medical Care Survey, United States, 1980. Vital and Health Statistics. Saries2, No. 90. DHHSPub. No. (PHS)82-1364. Public Health Sarvice. Washington. U.S. Government Printing Office, March, 1982. Library of Congress Cataloging in Publication Data Koch, Hugo K. The collection and processing cf drug information in the national ambulatory madical care survey, United States, 1980. {Data evaluation and methods research, series 2 ; no. 90) (DHHS publication ; no. (PHS) 82-1 364). Includes biographical references. Supt. of Dots. no.: HE 20.6208:2190 1. Drugs, Prescribing–United States. 2. Drugs, Code numbers. 3. Ambulatory medical care–United States. 4. Health surveys-United States. 1. Campbell, William H. (William Howard), 1842- . II. Vital and health statistics, series 2, Data evaluation and methods research ; no. 90. I I 1. Series: DHHS publication ; no. (PHS) 82-1.364. RA408. U45 no. 90 [RM138] 312’0723s 81-607138 IS8N 0-8406 -0242-1 [615’.1’0723] AACR2 For sale by the Sulwrintendent of Documents, U.S. (Mwrnment I’rinting Office Washington, 1).C. 20402 National Center for Health Statistics DOROTHY P. RICE, Director ROBERT A. ISRAEL, Deputy Director JACOB J. FELDMAN, Ph.D., Associate Director for Analysis and Epidemiology GAIL F. FISHER, Ph.D.,Associate Director for the Coopemtive Health Statistics System GARRIE J. LOSEE, Associate Director for Data Processing and Sewices ALVAN O. ZARATE, Ph.D., Assistant Director for International Statistics E. EARL BRYANT, Associate Director for Interview and Examination Statistics ROBERT C. HUBER, Associate Director for Management MONROE G. SIRKEN, Ph.D., Associate Director for Researchand Methodology PETER L. HURLEY, Associate Director for Vitaland Health C27reStatistics ALICE HAYWOOD,Information Officer Division of Health Care Statistics W. EDWARD BACON, Ph.D., Director JOAN F. VAN NOSTRAND, Deputy Director JAMES E. DELOZIER, (%ie~ Ambulatory CareStatistics Branch MANOOCHEHR K. NOZARY, Chief Technical Services Branch Acknowledgements The authors acknowledge a special debt to P. May Douglas, Coordinator for the Drug Data Processing Systems and Services of the American Society of Hospital Pharmacists, for her advice on this project. We are also grateful for the contributions of the following persons: Walter Anyan, M.D. James L Hudson, M.D. David W. Bailey, M.D. Arthur P. Herrmann, Jr., Charles E. Brackett, M.D. Pharm. D. Saul Boyarsky, M.D. Deane E. Knapp, Ph.D. Herbert Brendler, M.D. Ralph E. Kauffman, M.D. John C. Byrne, M.D. Charles E. Lewis, M.D. Lynn P. Carmichael, M.D. Robert H. Moser, M.D. John A. D. Cooper, M.D. Ervin E. Nichols, M.D. Edward P. Crowell, D.0, Nelson G. Richards, M.D. John P, Connelly, M.D. C. H. William Ruhe, M.D. Robert H. Drachman, M.D. Melvin Sabshin, M.D. Mary B. Forbes David L. Starbuck, M.D. Todd M. Frazier Hugh C. Thompson, M.D. Hwriette Gibson James B. Tenney, M.D. Charles Given, Ph.D. Richard A Terselic Irving D. Goldberg Herb L. Tindall, M.D. Birt Harvey, M.D. Peyton E. Weary, M.D. Reginald T. Harris, M.D. Kerr L. White, M.D. Richard J. Hannigan Maurice Wood, M.D. Charles V, Heck, M.D. .. Ill ... Acknowledgements . ...0. ..0..... ...0 . ...0.... Ill Background . 1 Drug identification anddescription . ...,... 8 Classifying and coding device . 11 Coding process..,...,..,,..,,. 16 Appendixes Contents, , . ., .,, ,,, ., ..,,,... ... ,. .O, .OO. ,,, ,, . ..O. ,. ... .. O...... .OO 21 1, Responsetoprecoded questionson evaluation interview . 22 Il. Inventory ofgenericnames . .. OO. OO. .. O. 25 111.Medication Code List, NAMCS 1980 . 32 lV. Coding proceduresfor medication entries, NAMCS 1980 . 73 V, American Hospital Formulary Servica classification system andtharapeutic catagory codes . 90 Listoftextfigurw 1. Patient Record,1978 ,! ..,...0 . 2 2, Patient Racord, Version A,1980 . 3 3. Patient Record, Version B,1980 . 4 4, Patient Record andlnstruction inpatient Record jacket . 7 5, Analysis plan: potential contrasts 0 .,,.,,,. 20 List of text tables A, DPIFracord format......,..,.. 12 B. NAMCSdrug fiieformat . ,. .,,,,.. , 13 C, Coding choicas provided andusad, MCL1980 . 19 v The Collection and Processing of Drug Information: National Ambulatory Medical Care Suwey by Hugo Koch, M, H,A,, Division of Health Care Statistics and I William H, Campbell, Ph.D., School of Pharmacy, University I of Washington at Seattle cian time and effort. The approach, typified by the Background 1978 Record, has been as indicated below. 1. To ensure that the record format does not exceed one side of one page, the overall number of items This report describes the method and instruments must be limited. used to collect and process drug information for the 1980 National Ambulatory Medical Care Survey 2, To make sure that the items are as self-explana- (NAMCS). In this report, the term drug is inter- tory as possible, or place clarifying information changeable with the term medication and includes all on the face of the Record form. If necessary, immunizing and desensitizing agents. The use of the special instructions or definitions are made term prescribing a drug or of the physician’s prescrib- readily available to the recording physician by ing habits, is used in its broader sense, namely to either printing them directly on the jacket in mean the ordering or provision of any medication– which the Patient Records are filed or on a card prescription (Rx) or nonprescription (OTC)–in the which is inserted in the jacket. course of the office visit, The relationship between 3. To hold write-in responses to a minimum, placing prescribing and using drugs is inferential, subject to relatively more reliance on the checkbox. —___ the patient’s compliance with the doctor’s decision. Until the 1980 NAMCS, every Patient Record The purpose of NAMCS is to collect and report contained checkbox items for nonspecific drug descriptive data about the medical care provided in therapy ordered or provided during the visit. In the physician’s office. Each year beginning with brevity and content, all the items closely resembled 1973, NAMCS has sampled 3,000 of the Nation’s the drug question that appeared on the 1978 Record roughly 200,000 doctors of medicine and osteopathy under Item 12. Two subitems, Item 12.2 and 12,3, who are principally engaged in office-based, patient- elicit relevant drug response. care practice. The sample excludes: physicians who Though this approach to gathering drug informa- are federally employed; physicians who practice in tion agreed with the NAMCS tradition by requiring a Alaska and Hawaii; and physicians who, though laudable economy of respondent effort, it unfortu- office-based, specialize in anesthesiology, pathology, nately resulted in a regrettable paucity of descriptive or radiology, Among eligible physicians, NAMCS uses detail about the role played by drugs in office-based a multistage probability design that distributes its medical care. For example, statements such as this sample geographically by primary sampling units could be made. (PSU’S) and functionally by the specialties of the physicians who practice within the PSU’S, Sampled “In 1978 there were an estimated physicians complete records (figure 1) for a system- 348,262,000 drug visits (visits at which at least atic random sample of their office visits over a weekly one drug was prescribed). Drug visits amounted reporting period. In 1978, the year of the Patient to about 60 percent of all office visits.” Record shown in figure 1, sampled physicians It could be shown how the frequency of drug responded at a rate of 72.8 percent. This produced a visits varied with such influencing factors as physician raw data base of 47,291 patient records, from which specialty, primary diagnosis, age or race of patient, an estimated 584,498,000 total visits was projected. etc. But beyond this limited description, additional In designing the Patient Record each year, the information about the drug therapy was not available. prime motivating factor has been to spare the physi- For example, specific drug products could not be 1 ASSURANCE OF CON FIDENTIALITY-AII information which would permit identification of an individual, a practice, or an establishment will be held confidential, will bO used only by persons engaged In and for the purposes of the survey and will not be disclosed or rekmd to other Der%onsor wed fo, a“y other purpos. D 610431 1. DATE OF VISIT PATlENT RECORD NATIONAL AMBULATORY MEDICAL CARE SURVEY * 2. DATE OF BIRTH 3. SEX $. cOLOR OR 5. WAS PATlENT 6. PATIENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER RACE REFERREo FOR REASON(S) FOR THIS VISIT THIS VISIT BY (In patientk own words) 1 ❑ WHITE ANOTHER ❑ 1 FEMALE ~ ❑ NEGRO/ PHYSICIAN? a. MOST * IMPORTANT TIME OF ❑ B LACK ❑ ~ MALE ❑ 1 YES VISIT 3 OTHER b. OTHER ❑ 2UN0 — ~ UNKNOWN *.m 7. TIME SINCE ONSET 8. PHYSICIAN’S DIAGNOSES 9. HAVE YOU SEEN It). SERIOUSNESS OF OF COMPLAINTI PATlENT BEFORE? CONOITION IN SYMPTOM IN ITEM Ba a. PRINCIPAL DIAGNOSIS/PROSLEM ASSOCIATED WITH ITEM 88 (Check one] pm (Check one) ITEM 6e 1 ❑ YES ~nNO 1 D VERY SERIOUS ❑ + w.m.

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