Assessment of Health Care Utilization for Dizziness in Ambulatory Care Settings in the United States.

ABSTRACT

OBJECTIVE: Describe patient and physician characteristics, and physician recommendations for ambulatory care visits for dizziness in the US. STUDY DESIGN: Cross-sectional analysis of visits for dizziness from the National Ambulatory Medical Care Survey (2013-2015). SETTING: Ambulatory care clinics in the US. PATIENTS 20.6 million weighted adult visits [mean age 58.7 (1.0)] for dizziness, identified using ICD-9-CM codes (386.00-386.90, 780.40). MAIN OUTCOME MEASURES: Patient, clinical, and physician characteristics and physician diagnostic and treatment recommendations. Prevalence rates for benign paroxysmal positional vertigo (BPPV), unspecified dizziness, and other vestibular disorders were estimated, and descriptive statistics were used to characterize patients, physicians, and physicians' recommendations. RESULTS: The prevalence rate for dizziness visits was 8.8 per 1,000 (95% confidence interval [CI] 7.5, 10.3). Most visits were for unspecified dizziness (75%), made by women (65%), whites (79%), and were insured by private insurance (50%). Visits for dizziness were to primary care physicians (51.9%), otolaryngologists (13.3%), and neurologists (9.6%). Imaging was ordered and medication prescription was provided in 5.5% and 20.1% of visits. Physical therapy (PT) was used for a higher percentage of BPPV visits (12.9%), than for other diagnoses (<1.0%). Physician treatment recommendations for vestibular diagnoses varied by physician specialty. CONCLUSIONS: A large percentage of visits had an unspecified diagnosis. A low number of visits for vestibular disorders were referred to PT. There are opportunities to improve care by using specific diagnoses and increasing the utilization of effective interventions for vestibular disorders.