Utilizing the National Ambulatory Medical Care Survey to assess counseling and education services provided during physician office visits

Document Type


Publication Date


Date Added



Conducted annually by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), the National Ambulatory Medical Care Survey (NAMCS) is the major source of data used to depict nationally what is happening within primary care settings, including the provision of clinical preventive services and counseling and education on health behaviors. The federal government has made a significant investment, in terms of time and monetary resources in the collection of data on the health of the nation as a whole and on our health care system. By utilizing a national data set commonly analyzed for and considered in the development of national health care policy, the study explored the utility of the data source and collection methods to examine the influence that health care system and practice setting characteristics might have on the provision of counseling and education on health behaviors during a primary care physician office visit. Data sources for the study included NAMCS data and documentation for the years 1997 and 1998, NAMCS, debriefing report on a cognitive assessment of the survey instrument, unstructured interviews with NAMCS staff, and semi-structured interviews with a small non-probability sample of physicians and their office staff. Factors which showed evidence of some impact on counseling and education included the designation of whether payment for the visit was capitated and whether the visit occurred in a practice owned by a health maintenance organization (HMO). Other system and practice setting characteristics were not found to be significant factors. The limitations of the NAMCS are discussed, especially with respect to the survey instruments inability to adequately capture the complexity of the counseling and education process as a prevention service. The limitations which are discussed include construct validity of selected measures, inter-rater reliability affected by the differences in knowledge and familiarity among persons gathering the survey data and factors which may affect sampling. The strength of the NAMCS data, however, is in the reliability of its measures, collected year after year, providing a longitudinal perspective from which some changes might be tracked and possibly linked to policy change.






Public Health


University of Maryland, College Park