Benedict Katzenberger1,2, Daniela Koller3,4, Ralf Strobl3,5, Rebecca Kisch3, Linda Sanftenberg6, Karen Voigt7, Eva Grill3,5. 1. Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany. Benedict.Katzenberger@med.uni-muenchen.de. 2. Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany. Benedict.Katzenberger@med.uni-muenchen.de. 3. Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany. 4. Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany. 5. German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany. 6. Institute of General Practice and Family Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany. 7. Department of General Practice/Medical Clinic III, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
Abstract
BACKGROUND: Due to reported barriers in the management of patients with vertigo, dizziness and balance problems (VDB), referral trajectories starting from primary care might be determined by other factors than medical necessity. The objective of this paper was to examine the impact of disease-related and other determinants on referral trajectories of older patients with VDB and to investigate, how these trajectories affect the patients' functioning and health-related quality of life (HRQoL). METHODS: Data originate from the longitudinal multicenter study MobilE-TRA, conducted in two German federal states. Referrals to neurologists or ear-nose-throat (ENT) specialists were considered. Referral patterns were visualized using a state sequence analysis. Predictors of referral trajectories were examined using a multinomial logistic regression model. Linear mixed models were calculated to assess the impact of referral patterns on the patients' HRQoL and functioning. RESULTS: We identified three patterns of referral trajectories: primary care physician (PCP) only, PCP and neurologist, and PCP and ENT. Chances of referral to a neurologist were higher for patients with a neurological comorbidity (OR = 3.22, 95%-CI [1.003; 10.327]) and lower for patients from Saxony (OR = 0.08, 95%-CI [0.013; 0.419]). Patients with a PCP and neurologist referral pattern had a lower HRQoL and lower functioning at baseline assessment. Patients with unspecific diagnoses also had lower functioning. CONCLUSION: Referral trajectories were determined by present comorbidities and the regional healthcare characteristics. Referral trajectories affected patients' HRQoL. Unspecific VDB diagnoses seem to increase the risk of ineffective management and consequently impaired functioning.
BACKGROUND: Due to reported barriers in the management of patients with vertigo, dizziness and balance problems (VDB), referral trajectories starting from primary care might be determined by other factors than medical necessity. The objective of this paper was to examine the impact of disease-related and other determinants on referral trajectories of older patients with VDB and to investigate, how these trajectories affect the patients' functioning and health-related quality of life (HRQoL). METHODS: Data originate from the longitudinal multicenter study MobilE-TRA, conducted in two German federal states. Referrals to neurologists or ear-nose-throat (ENT) specialists were considered. Referral patterns were visualized using a state sequence analysis. Predictors of referral trajectories were examined using a multinomial logistic regression model. Linear mixed models were calculated to assess the impact of referral patterns on the patients' HRQoL and functioning. RESULTS: We identified three patterns of referral trajectories: primary care physician (PCP) only, PCP and neurologist, and PCP and ENT. Chances of referral to a neurologist were higher for patients with a neurological comorbidity (OR = 3.22, 95%-CI [1.003; 10.327]) and lower for patients from Saxony (OR = 0.08, 95%-CI [0.013; 0.419]). Patients with a PCP and neurologist referral pattern had a lower HRQoL and lower functioning at baseline assessment. Patients with unspecific diagnoses also had lower functioning. CONCLUSION: Referral trajectories were determined by present comorbidities and the regional healthcare characteristics. Referral trajectories affected patients' HRQoL. Unspecific VDB diagnoses seem to increase the risk of ineffective management and consequently impaired functioning.
Authors: Otto R Maarsingh; Jacquelien Dros; François G Schellevis; Henk C van Weert; Danielle A van der Windt; Gerben ter Riet; Henriette E van der Horst Journal: Ann Fam Med Date: 2010 May-Jun Impact factor: 5.166
Authors: Vincent A van Vugt; Gülsün Bas; Johannes C van der Wouden; Jacquelien Dros; Henk C P M van Weert; Lucy Yardley; Jos W R Twisk; Henriëtte E van der Horst; Otto R Maarsingh Journal: Ann Fam Med Date: 2020-03 Impact factor: 5.166
Authors: Christopher B Forrest; Paul A Nutting; Sarah von Schrader; Charles Rohde; Barbara Starfield Journal: Med Decis Making Date: 2006 Jan-Feb Impact factor: 2.583