Association of Health Care Utilization and Handicaps in Daily Living in Vertigo Patients – Results from the DizzyReg Patient Registry

Background:

With a lifetime prevalence of 30% vertigo and dizziness are among the most common chief complaints when patients seek medical advice. Although specific diagnostic and therapeutic options exist, many patients will be misdiagnosed in primary care. Misdiagnosis might increase the number of consultations and leads to a prolonged time with inadequate treatment. The negative impact of the number of consultations on patients' quality of life and functioning is high but not sufficiently understood.

Methods:

Data originates from the Munich patient registry for patients treated at the tertiary outpatient clinic of the German Center for Vertigo and Balance Disorders (DSGZ) at the Munich university hospital. We included all patients presenting at the center in 2016 who gave informed consent. Information of health care utilization was self-reported. Functioning was measured with the Dizziness Handicap Inventory (DHI). The DHI measures the self-perceived impact of vertigo with 25 items in three dimensions using a physical, functional, and emotional subscale with higher scores indicating worse handicap.

Results:

A total of 747 patients were included (mean age 52.1 years, 55.2% female), 220 (30.6%) had vertigo or dizziness for 5 years or longer and had consulted in median four different physicians with 122 (16.4%) consulting six or more. General practitioner and otolaryngologist were the most frequently seen at first consultation. Sixteen percent of patients had received no therapy, 59% medication, 37% physical therapy. Adjusted for age and sex, higher frequency of consultations and therapies was associated with higher emotional distress (0.99, CI =[0.51; 1.48]; 0.58, CI =[0.18; 0.98]). Higher frequency of therapies was associated with higher physical and functional impairment (0.61, CI =[0.24; 0.98]; 1.56, CI =[0.93; 2.20]).

Conclusion:

Frequency of health services utilization in vertigo was associated with higher emotional, physical and functional impairment. To what extent misdiagnosis contributes to this association has to be investigated in further studies.