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Predictors of Physical Therapy Referral among Persons with Peripheral Vestibular Disorders in the United States
Archives of Physical Medicine and Rehabilitation ( IF 4.3 ) Pub Date : 2020-05-01 , DOI: 10.1016/j.apmr.2020.04.016
Pamela M Dunlap 1 , Samannaaz S Khoja 1 , Susan L Whitney 2 , Janet K Freburger 1
Affiliation  

OBJECTIVE To determine the rate of PT referral and patient and physician characteristics associated with PT referral for benign paroxysmal positional vertigo (BPPV) and other peripheral vestibular disorders (PVDs) in U.S. ambulatory care clinics. DESIGN Cross sectional analysis of the National Ambulatory Medical Care Survey 2004-2015 SETTING: Ambulatory care clinics in the US PARTICIPANTS: We identified 5.6 million weighted adult visits for BPPV [ICD-9-CM: 386.11] and 6.6 million weighted visits for other PVDs [ICD-9-CM: 386.1-386.9, excluding 386.11 and 386.2] made by patients 18 years and older from 2004-2015. INTERVENTIONS Not applicable MAIN OUTCOME MEASURES: Patient, clinical, and physician characteristics were extracted, and descriptive statistics were stratified by referral to PT. Two multivariable logistic regression models were estimated for each diagnostic group (BPPV and other PVDs) to identify predictors of PT referral. RESULTS PT referrals for BPPV increased from 6.2% in 2004-2006 to 12.9% in 2013-2015 while PT referrals for other PVDs decreased from 3.8% in 2004-2006 to 0.5% in 2013-2015. Other insurance coverage (versus private) and neurologists and other specialists (versus otolaryngologists) were associated with a greater odds of PT referral for BPPV. Visits made in the Midwest and West (versus Northeast) and in rural versus metropolitan areas had greater odds of PT referral for BPPV. Relative to otolaryngologists, primary care physicians were less likely to refer to PT for other PVDs. Visits made in metropolitan versus rural areas and visits with 1 or more comorbidities (versus none) had greater odds of PT referral for other PVDs. CONCLUSIONS PT referrals remain low for ambulatory care visits for BPPV and other PVDs in the US. Referral to PT for BPPV and other PVDs varied by insurance type, physician specialty, and office location.

中文翻译:

美国周围性前庭疾病患者转诊物理治疗的预测因素

目的 确定 PT 转诊率以及与 PT 转诊相关的良性阵发性位置性眩晕 (BPPV) 和其他外周前庭障碍 (PVD) 在美国门诊护理诊所中的患者和医生特征。设计 2004-2015 年全国门诊医疗调查的横断面分析 地点:美国的门诊 参与者:我们确定了 560 万 BPPV [ICD-9-CM: 386.11] 加权成人就诊和 660 万其他 PVD ​​加权就诊[ICD-9-CM: 386.1-386.9,不包括 386.11 和 386.2] 由 2004-2015 年 18 岁及以上的患者制作。干预 不适用 主要结局指标:提取患者、临床和医生特征,并通过转诊至 PT 对描述性统计数据进行分层。为每个诊断组(BPPV 和其他 PVD)估计了两个多变量逻辑回归模型,以确定 PT 转诊的预测因素。结果 BPPV 的 PT 转诊率从 2004-2006 年的 6.2% 增加到 2013-2015 年的 12.9%,而其他 PVD ​​的 PT 转诊率从 2004-2006 年的 3.8% 下降到 2013-2015 年的 0.5%。其他保险(相对于私人)和神经科医生和其他专家(相对于耳鼻喉科医生)与 BPPV 的 PT 转诊几率更大有关。在中西部和西部(相对于东北部)以及农村与大都市地区进行的就诊有更高的 BPPV 转诊几率。相对于耳鼻喉科医生,初级保健医生不太可能将 PT 用于其他 PVD。在大都市与农村地区进行的就诊以及有 1 种或多种合并症(与没有)的就诊相比,其他 PVD ​​的 PT 转诊几率更大。结论 在美国,BPPV 和其他 PVD ​​的门诊就诊的 PT 转诊率仍然很低。BPPV 和其他 PVD ​​的 PT 转诊因保险类型、医生专业和办公地点而异。
更新日期:2020-05-01
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