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耳鸣对荷兰全科医疗实践的影响:一项使用常规医疗保健数据的回顾性研究。

The impact of tinnitus on Dutch general practices: A retrospective study using routine healthcare data.

机构信息

Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.

Tilburg School of Social and Behavioral Sciences TSB: Tranzo, Tilburg University, Tilburg, The Netherlands.

出版信息

PLoS One. 2024 Nov 15;19(11):e0313630. doi: 10.1371/journal.pone.0313630. eCollection 2024.

Abstract

PURPOSE

Global prevalence of tinnitus (15%) is rising, indicating an increase in patients seeking help for this common symptom and potentially affecting the accessibility of care. The aim of this retrospective study is twofold; describing the morbidity trends and healthcare utilization among patients with recorded tinnitus at Dutch general practices (GP), and comparing overall healthcare utilization before and after tinnitus to similar patients without recorded tinnitus.

PATIENTS AND METHODS

Routine electronic health records data from general practices participating in Nivel Primary Care Database were used to describe trends in age- and sex-specific incidence, contact prevalence and healthcare utilization (contacts, prescriptions, and referrals to secondary care) for tinnitus from 2012 to 2021. Patients with tinnitus were matched (on sex, age, general practice) to patients without tinnitus (1:2). Healthcare use one year before and after a first GP contact for tinnitus (period) was analyzed with negative binominal (number of contacts) and logistic regression (prescriptions or referrals).

RESULTS

Between 2012 and 2021, tinnitus incidence increased by 33% (3.3 to 4.4 per 1000 person-years). The largest increase was observed among 20-44-years (2.6 to 3.8 per 1000 person-years). One year after the first GP contact for tinnitus, patients with tinnitus utilized healthcare more frequently than patients without tinnitus. The referral rate increased the most (OR 1.99, 95%CI 1.83-2.16). The year before tinnitus at the GP, patients with tinnitus had more often GP consultations (IRR 1.16, 95%CI 1.12-1.19) and referrals (OR 1.09, 95%CI 1.01-1.18) than patients without tinnitus.

CONCLUSION

Although GPs saw an increased number of patients with tinnitus, absolute numbers of patients remained low. Patients' healthcare use increased after the first tinnitus complaint at the GP, mainly for secondary care. Yet, they already used healthcare services more frequently than similar patients without tinnitus. Insight into possible explanations for these health disparities could contribute to targeted prevention.

摘要

目的

全球耳鸣患病率(15%)不断上升,表明寻求这种常见症状治疗的患者数量增加,这可能会影响到护理的可及性。本回顾性研究旨在描述荷兰全科诊所(GP)记录的耳鸣患者的发病率趋势和医疗保健利用情况,并比较耳鸣患者与无记录耳鸣患者的整体医疗保健利用情况。

方法

使用参与 Nivel 初级保健数据库的全科诊所的常规电子健康记录数据,描述 2012 年至 2021 年耳鸣的年龄和性别特异性发病率、接触患病率和医疗保健利用(接触、处方和转诊至二级保健)趋势。将有耳鸣的患者(按性别、年龄、全科诊所)与无耳鸣的患者(1:2)进行匹配。分析耳鸣首次 GP 就诊前一年和后一年(期间)的医疗保健使用情况,采用负二项式(接触次数)和逻辑回归(处方或转诊)。

结果

2012 年至 2021 年间,耳鸣发病率增加了 33%(每 1000 人年 3.3 至 4.4 例)。20-44 岁人群的发病率增幅最大(每 1000 人年 2.6 至 3.8 例)。耳鸣首次 GP 就诊后一年,耳鸣患者的医疗保健利用率高于无耳鸣患者。转诊率增幅最大(比值比 1.99,95%置信区间 1.83-2.16)。在 GP 看耳鸣的前一年,耳鸣患者的 GP 就诊次数(发病率比 1.16,95%置信区间 1.12-1.19)和转诊(比值比 1.09,95%置信区间 1.01-1.18)均高于无耳鸣患者。

结论

尽管全科医生接诊的耳鸣患者人数有所增加,但绝对人数仍较低。耳鸣患者在首次向 GP 抱怨耳鸣后,其医疗保健利用增加,主要用于二级保健。然而,他们已经比类似的无耳鸣患者更频繁地使用医疗保健服务。深入了解这些健康差异的可能原因,有助于针对性预防。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a3c8/11567631/1690d20365ac/pone.0313630.g001.jpg

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