Seth M Cohen1, Hui-Jie Lee2, Nelson Roy3, Stephanie Misono4. 1. Duke Voice Care Center, Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, North Carolina. 2. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina. 3. Department of Communication Sciences and Disorders, Division of Otolaryngology-Head & Neck Surgery (Adjunct), University of Utah, Salt Lake City, Utah. 4. Lions Voice Clinic, Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A.
Abstract
OBJECTIVES: 1) To compare laryngeal diagnoses from general medical providers (GMP) to otolaryngologists following GMP-based medication trial, and 2) to evaluate associations between GMP medication trials and pharmacologic treatment by otolaryngologists. METHODS: Retrospective cohort analysis using large, national administrative U.S. claims database. Patients with laryngeal/voice disorders as per the International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2010, to December 31, 2012, seen by a GMP and then an otolaryngologist between 2 weeks to 3 months after the GMP visit, were included. Patient demographics, comorbid conditions, medication use, and initial GMP and otolaryngology laryngeal diagnoses were collected. Logistic regression was performed to evaluate the association between GMP and otolaryngologist medication trials. RESULTS: A total of 12,475 unique laryngeal/voice-disordered patients met inclusion criteria. At the initial GMP visit, 15.3% received an antibiotic, 14.0% a proton pump inhibitor (PPI), and 7.7% an oral steroid. After the otolaryngology visit, increased diagnoses of vocal fold paralysis/paresis, benign vocal fold/laryngeal pathology, chronic laryngitis, and multiple diagnoses occurred. The adjusted odds for an otolaryngologist prescribing an antibiotic, PPI, or oral steroid, respectively, given that a GMP prescribed an antibiotic, PPI, or oral steroid, was roughly two to three times higher that of a GMP not prescribing the given medication. CONCLUSION: Patients with structural and neuromuscular laryngeal disorders were treated with medications by GMPs, and similar mediations often were repeated after otolaryngology evaluation. These findings suggest potential areas of unnecessary pharmacologic treatment of laryngeal/voice-disordered patients. LEVEL OF EVIDENCE: 2b. Laryngoscope, 128:682-689, 2018.
OBJECTIVES: 1) To compare laryngeal diagnoses from general medical providers (GMP) to otolaryngologists following GMP-based medication trial, and 2) to evaluate associations between GMP medication trials and pharmacologic treatment by otolaryngologists. METHODS: Retrospective cohort analysis using large, national administrative U.S. claims database. Patients with laryngeal/voice disorders as per the International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2010, to December 31, 2012, seen by a GMP and then an otolaryngologist between 2 weeks to 3 months after the GMP visit, were included. Patient demographics, comorbid conditions, medication use, and initial GMP and otolaryngology laryngeal diagnoses were collected. Logistic regression was performed to evaluate the association between GMP and otolaryngologist medication trials. RESULTS: A total of 12,475 unique laryngeal/voice-disorderedpatients met inclusion criteria. At the initial GMP visit, 15.3% received an antibiotic, 14.0% a proton pump inhibitor (PPI), and 7.7% an oral steroid. After the otolaryngology visit, increased diagnoses of vocal fold paralysis/paresis, benign vocal fold/laryngeal pathology, chronic laryngitis, and multiple diagnoses occurred. The adjusted odds for an otolaryngologist prescribing an antibiotic, PPI, or oral steroid, respectively, given that a GMP prescribed an antibiotic, PPI, or oral steroid, was roughly two to three times higher that of a GMP not prescribing the given medication. CONCLUSION:Patients with structural and neuromuscular laryngeal disorders were treated with medications by GMPs, and similar mediations often were repeated after otolaryngology evaluation. These findings suggest potential areas of unnecessary pharmacologic treatment of laryngeal/voice-disorderedpatients. LEVEL OF EVIDENCE: 2b. Laryngoscope, 128:682-689, 2018.
Authors: Zhen Gooi; Stacey L Ishman; Jonathan M Bock; Joel H Blumin; Lee M Akst Journal: Ann Otol Rhinol Laryngol Date: 2015-06-19 Impact factor: 1.547
Authors: Mark A Fritz; Michael J Persky; Yixin Fang; C Blake Simpson; Milan R Amin; Lee M Akst; Gregory N Postma Journal: Otolaryngol Head Neck Surg Date: 2016-06-14 Impact factor: 3.497
Authors: Stephanie Shintani Smith; Robert C Kern; Rakesh K Chandra; Bruce K Tan; Charlesnika T Evans Journal: Otolaryngol Head Neck Surg Date: 2013-03-05 Impact factor: 3.497
Authors: Guillermo V Sanchez; Rebecca M Roberts; Alison P Albert; Darcia D Johnson; Lauri A Hicks Journal: Emerg Infect Dis Date: 2014-12 Impact factor: 6.883
Authors: Seth M Cohen; Hui-Jie Lee; David A Leiman; Nelson Roy; Stephanie Misono Journal: Otolaryngol Head Neck Surg Date: 2018-11-13 Impact factor: 3.497
Authors: Chang Hwan Ryu; Seung Jin Lee; Jae-Gu Cho; Ik Joon Choi; Yoon Seok Choi; Yong Tae Hong; Soo Yeon Jung; Ji Won Kim; Doh Young Lee; Dong Kun Lee; GIljoon Lee; Sang Joon Lee; Young Chan Lee; Yong Sang Lee; Inn Chul Nam; Ki Nam Park; Young Min Park; Eui-Suk Sung; Hee Young Son; In Hyo Seo; Byung-Joo Lee; Jae-Yol Lim Journal: Clin Exp Otorhinolaryngol Date: 2021-06-01 Impact factor: 3.372