Abstract
BackgroundAlthough the management of patients presenting with vertigo and dizziness in primary care has been reported to be inefficient, little is known about the primary care providers’ (PCPs) perspectives, needs, and attitudes regarding vertigo management.The objective of this study was to understand which challenges and barriers PCPs see when diagnosing and treating patients presenting with vertigo or dizziness. Specifically, we wanted to identify facilitators and barriers of successful guideline implementation in order to inform the development of targeted interventions.MethodsA theory-based interview structure was developed based on the implementation theory of capability, opportunity, and motivation for behaviour change (COM-B) using questions based on constructs from the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR). Transcripts of the semi-structured interviews were analysed using directed content analysis. The pathways through which guideline characteristics and supportive interventions affect the relationship between the PCPs’ perceived capability, opportunity, and motivation as well as their practice of managing vertigo patients were graphically presented using the COM-B model structure.ResultsTwelve PCPs from Bavaria in Southern Germany participated in semi-structured interviews. Diagnostics posed the biggest challenge in vertigo management to the PCPs. Requirements for an acceptable guideline were stakeholder involvement in the development process, clarity of presentation, and high applicability. Guideline implementation might be effectively supported through educational meetings and sustained by organisational interventions.ConclusionsFrom the PCPs’ perspective, both guideline characteristics and interventions supporting guideline implementation may help resolve challenges in vertigo management in primary care. These results should be used to guide future interventions in the primary care setting to ensure successful and targeted patient management.
Highlights
The management of patients presenting with vertigo and dizziness in primary care has been reported to be inefficient, little is known about the primary care providers’ (PCPs) perspectives, needs, and attitudes regarding vertigo management
If missing capabilities were found to be a major barrier for vertigo guideline implementation, The triad of capability (COM-B) would suggest an intervention mainly focussing on training or enablement, which properly addresses these barriers [16]
Our results indicate that guideline implementation should be supported through educational meetings and organisational change
Summary
The management of patients presenting with vertigo and dizziness in primary care has been reported to be inefficient, little is known about the primary care providers’ (PCPs) perspectives, needs, and attitudes regarding vertigo management. Vertigo and dizziness are symptoms which are encountered frequently in primary care. Peripheral and central vestibular diseases are the most obvious and frequent causes; vertigo and dizziness can be Stephan et al Implementation Science (2018) 13:25. The primary care provider (PCP) decides about the patient’s diagnostic path through the health care system, e.g. to initiate diagnostic procedures and treatment or to refer the patient o the appropriate specialist [4]. There is sound evidence that diagnostic and therapeutic needs of patients with vestibular disease are often unmet [2], leading to chronification and the development of secondary, functional symptoms [5]. As 45% of vertigo and dizziness patients’ first contacts with the health care system occur on the primary care level [6], the PCPs’ expertise is of utmost importance
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