Abstract
BackgroundThe primary objective was to describe outpatient treatment of epistaxis among different physicians based on a large patient population over a period of 10 years. The secondary objective was to evaluate the value of the practice fee as an instrument of allocation in patients with epistaxis.MethodsAnonymized statutory health insurance data (AOK Lower Saxony) of patients with a diagnosis of epistaxis treated between 2007 and 2016 were examined. Demographic data, accompanying diagnoses, medication and involved medical groups (general practitioners (GP), pediatricians, ear, nose and throat (ENT) specialists or other) were analyzed. Furthermore, we assessed whether the use of specialist groups changed after abolition of the practice fee in 2013.ResultsEpistaxis was responsible for 302,782 cases (160,963 patients). The distribution of cases was slightly in favor of ENT specialists vs. GP (119,170 vs. 110,352). The cases seen by GP and ENT specialists were comparable with regard to age and sex distribution. Hypertension, atrial fibrillation/flutter and an antithrombotic therapy were slightly more common among cases consulting a GP. The GP recorded more co-diagnoses than the ENT. The use of outpatient care and the proportions of the involved physicians scarcely fluctuated during the study period. Overall, 23,118 patients (14.4%) were diagnosed by both, GP and ENT during a relatively short time period. The practice fee remuneration had no impact on the consultation of the physician groups.ConclusionThe outpatient treatment of epistaxis constitutes a considerable medical and economic burden in Germany. Strengthening the primary medical sector (GP-centered care) is necessary to reach the goal of initially directing patients to primary care, providing specialists more time for severe cases and reducing the impact on public health balance sheets.
Highlights
The primary objective was to describe outpatient treatment of epistaxis among different physicians based on a large patient population over a period of 10 years
With the exception of those treated by pediatricians, the cases seen by general practitioners (GP) and ENT specialists were comparable with regard to the age and sex distribution (52 versus 49 years and 54.1% versus 55.9% men; see Table 1)
With regard to the comorbidities recorded in the quarter of the epistaxis diagnosis, there were no differences between GP and ENT consultations, except for slightly more frequent diagnoses of arterial hypertension and atrial fibrillation/flutter
Summary
The primary objective was to describe outpatient treatment of epistaxis among different physicians based on a large patient population over a period of 10 years. The secondary objective was to evaluate the value of the practice fee as an instrument of allocation in patients with epistaxis. Epistaxis describes different forms of nasal blood loss and is a common symptom that occurs in medical practice. The majority of epistaxis originates from the area of the anterior septum [5, 6]. Bleeding in this respect can be stopped with a few simple methods - in about 65% of cases, compression of the anterior septum and application of decongestant nasal drops are sufficient [2]. Patients with epistaxis may be treated by GP, pediatricians or ear, nose and throat (ENT) specialists, the consultation of an ENT specialist does not always seem to be necessary [1]
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