Health care utilization, prognosis and outcomes of vestibular disease in primary care settings: systematic review.

Eva Grill,Mathias Penger,Erna Kentala

doi:10.1007/s00415-015-7913-2

Abstract

Vertigo and dizziness are frequent complaints in primary care that lead to extensive health care utilization. The objective of this systematic review was to examine health care of patients with vertigo and dizziness in primary care settings. Specifically, we wanted to characterize health care utilization, therapeutic and referral behaviour and to examine the outcomes associated with this. A search of the MEDLINE and EMBASE databases was carried out in May 2015 using the search terms ‘vertigo’ or ‘dizziness’ or ‘vestibular and primary care’ to identify suitable studies. We included all studies that were published in the last 10 years in English with the primary diagnoses of vertigo, dizziness and/or vestibular disease. We excluded drug evaluation studies and reports of adverse drug reactions. Data were extracted and appraised by two independent reviewers; 16 studies with a total of 2828 patients were included. Mean age of patients ranged from 45 to 79 with five studies in older adults aged 65 or older. There were considerable variations in diagnostic criteria, referral and therapy while the included studies failed to show significant improvement of patient-reported outcomes. Studies are needed to investigate current practice of care across countries and health systems in a systematic way and to test primary care-based education and training interventions that improve outcomes.

Highlights

Vertigo and dizziness are frequent complaints in primary care that lead to extensive health care utilization
This systematic review of the recent literature suggests that health care of patients with vertigo and dizziness in primary care settings is still suboptimal
Our review suggests that there is a scarcity of studies, of longitudinal studies investigating the processes and outcomes of usual care of vertigo and dizziness in primary care, and of controlled trials testing the implementation of improved care options

Summary

Introduction

Vertigo and dizziness are frequent complaints in primary care that lead to extensive health care utilization. With a high lifetime prevalence [1] and high burden of disease [2], vertigo and dizziness can be severely disabling because of its high impact on daily life [3] Psychiatric comorbidities such as anxiety, depression, panic disorders, and specific phobias such as agoraphobia or acrophobia may account for avoidance behavior, increased disability [4], and increased health care utilization [5]. Almost 45 % of outpatients with dizziness and vertigo are primarily seen and treated by a primary care physician (PCP) [7] who is often without specific neuro-otological expertise for the diagnosis and management of vestibular disorders. There is evidence that PCPs are referring such ‘‘red flag’’ cases correctly They failed to refer patients to the specialist when referral would have been appropriate [9]. Peripheral vestibular disorders are frequent causes for dizziness and vertigo; benign paroxysmal positioning vertigo (BPPV) is the most frequent form of peripheral

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Conclusion