TABLE 4-1 Diagnosis Clusters That Make Up the Majority of Nonreferred Ambulatory Visits to U.S. Office-Based Physicians, NAMCS, 1989–1990

Rank

Cluster Title

Percent

Cumulative Percent

1.

General medical examination

7.2

7.2

2.

Acute upper respiratory tract infection

6.2

13.4

3.

Hypertension

4.4

17.8

4.

Prenatal care

4.3

22.1

5.

Acute otitis media

3.5

25.6

6.

Acute lower respiratory tract infection

2.7

28.3

7.

Acute sprains and strains

2.7

31.0

8.

Depression and anxiety

2.5

33.5

9.

Diabetes mellitus

2.1

35.6

10.

Lacerations and contusions

1.9

37.5

11.

Malignant neoplasms

1.7

39.2

12.

Degenerative joint disease

1.7

40.9

13.

Acute sinusitis

1.6

42.5

14.

Fractures and dislocations

1.6

44.1

15.

Chronic rhinitis

1.5

45.6

16.

Ischemic heart disease

1.4

47.0

17.

Acne and diseases of sweat glands

1.3

48.3

18.

Low back pain

1.2

49.5

19.

Dermatitis and eczema

1.2

50.7

20.

Urinary tract infection

1.1

51.8

* The estimated number of visits for 1989–1990 (the denominator) is 1,297,334 (in thousands). This is based on 74,390 survey visits. All relative standard errors are less than 30%.

SOURCE: Rosenblatt et al., 1995.

general internal medicine over a 20-day period. He divided the clinical problems that he saw into several broad categories—cardiovascular, psychiatric, gastrointestinal, infectious, and so forth. Barondess concluded that about 10 percent of patients seen in each category of problems had major and often life-threatening disease, some acute and some chronic, some with complications and some without. In addition, within each organ system, some patients had an unusually complex disorder. Overall, he reported that a large number of these patients required sophisticated and complex clinical judgments "related to the identification, clinical course, potential complications, and management of a large number of major organic diseases" (p. 736). Such problems may require the judicious use of available technologies and efforts to enhance comfort and functional status and to forestall hospitalization.



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