Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany.
Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany.
J Neurol. 2022 Dec;269(12):6211-6221. doi: 10.1007/s00415-022-11060-8. Epub 2022 Mar 30.
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).
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.
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.
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.
由于报告的眩晕、头晕和平衡问题（VDB）患者管理障碍，从初级保健开始的转诊轨迹可能由医疗需求以外的其他因素决定。本文的目的是检查疾病相关和其他决定因素对老年 VDB 患者转诊轨迹的影响，并探讨这些轨迹如何影响患者的功能和健康相关生活质量（HRQoL）。
数据来自在德国两个联邦州进行的纵向多中心研究 MobilE-TRA。转诊给神经科医生或耳鼻喉科（ENT）专家被认为是转诊。使用状态序列分析可视化转诊模式。使用多项逻辑回归模型检查转诊轨迹的预测因素。计算线性混合模型以评估转诊模式对患者 HRQoL 和功能的影响。
我们确定了三种转诊轨迹模式：仅初级保健医生（PCP）、PCP 和神经科医生以及 PCP 和耳鼻喉科医生。有神经系统合并症的患者转诊到神经科医生的可能性更高（OR=3.22，95%-CI [1.003; 10.327]），而来自萨克森州的患者可能性较低（OR=0.08，95%-CI [0.013; 0.419]）。具有 PCP 和神经科医生转诊模式的患者在基线评估时的 HRQoL 和功能较低。具有非特异性诊断的患者功能也较低。
转诊轨迹由现有合并症和区域医疗保健特征决定。转诊轨迹影响患者的 HRQoL。非特异性 VDB 诊断似乎会增加管理无效和功能受损的风险。
