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Health services utilization of patients with vertigo in primary care: a retrospective cohort study

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Abstract

Vertigo and dizziness count among the most frequent symptoms in outpatient practices. Although most vestibular disorders are manageable, they are often under- and misdiagnosed in primary care. This may result in prolonged absence from work, increased resource use and, potentially, in chronification. Reliable information on health services utilization of patients with vertigo in primary care is scarce. Retrospective cohort study in patients referred to a tertiary care balance clinic. Included patients had a confirmed diagnosis of benign paroxysmal positional vertigo (BPPV), Menière’s disease (MD), vestibular paroxysmia (VP), bilateral vestibulopathy (BVP), vestibular migraine (VM), or psychogenic vertigo (PSY). All previous diagnostic and therapeutic measures prior to the first visit to the clinic were recorded. 2,374 patients were included (19.7 % BPPV, 12.7 % MD, 5.8 % VP, 7.2 % BVP, 14.1 % VM, 40.6 % PSY), 61.3 % with more than two consultations. Most frequent diagnostic measures were magnetic resonance imaging (MRI, 76.2 %, 71 % in BPPV) and electrocardiography (53.5 %). Most frequent therapies were medication (61.0 %) and physical therapy (41.3 %). 37.3 % had received homoeopathic medication (39 % in BPPV), and 25.9 % were treated with betahistine (20 % in BPPV). Patients had undergone on average 3.2 (median 3.0, maximum 6) diagnostic measures, had received 1.8 (median 2.0, maximum 8) therapies and 1.8 (median 1.0, maximum 17) different drugs. Diagnostic subgroups differed significantly regarding number of diagnostic measures, therapies and drugs. The results emphasize the need for establishing systematic training to improve oto-neurological skills in primary care services not specialized on the treatment of dizzy patients.

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Acknowledgments

This project was supported by funds from the German Federal Ministry of Education and Research under the Grant code 01 EO 0901. The authors bear full responsibility for the content of this publication.

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standard

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Authors and Affiliations

  1. Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 17, 81377, Munich, Germany

    Eva Grill & Martin Müller

  2. German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany

    Eva Grill, Michael Strupp, Martin Müller & Klaus Jahn

  3. Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany

    Michael Strupp & Klaus Jahn

Authors
  1. Eva Grill
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  2. Michael Strupp
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  4. Klaus Jahn
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Correspondence to Eva Grill.

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Grill, E., Strupp, M., Müller, M. et al. Health services utilization of patients with vertigo in primary care: a retrospective cohort study. J Neurol 261, 1492–1498 (2014). https://doi.org/10.1007/s00415-014-7367-y

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  • DOI: https://doi.org/10.1007/s00415-014-7367-y

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