Factors influencing referral of patients with voice disorders from primary care to otolaryngology

Authors

  • Seth M. Cohen MD, MPH,

    Corresponding author
    1. Duke Voice Care Center, Division of Otolaryngology–Head & Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
    • Send correspondence to Seth Cohen, MD, MPH, DUMC Box 3805, Durham, NC, 27710. E-mail: seth.cohen@duke.edu

    Search for more papers by this author
  • Jaewhan Kim PhD,

    1. Division of Public Health & Study Design and Biostatistics Center, University of Utah, Salt Lake City, Utah, U.S.A.
    Search for more papers by this author
  • Nelson Roy PhD, CCC-SLP,

    1. University of Utah, Salt Lake City, Utah, U.S.A.
    Search for more papers by this author
  • Mark Courey MD

    1. Duke Voice Care Center, Division of Otolaryngology–Head & Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
    2. Department of Otolaryngology–Head & Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A.
    Search for more papers by this author

  • This study was funded by the American Academy of Otolaryngology–Head & Neck Surgery and supported in part by funding from the National Institutes of Health grant 1KM1CA156723 (j.k.).

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

To evaluate the frequency, timing, and factors that influence referral of patients with laryngeal/voice disorders to otolaryngology following initial evaluation by a primary care physician (PCP).

Study Design

Retrospective analysis of a large, national administrative US claims database.

Methods

Patients with a laryngeal disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by a PCP as an outpatient (with or without otolaryngology involvement), and continuously enrolled for 12 months were included. Patient age, gender, geographic region, last PCP laryngeal diagnosis, comorbid conditions, time from first PCP visit to first otolaryngology visit, number of PCP outpatient visits, and number of PCP laryngeal diagnoses were collected. Cox and generalized linear regressions were performed.

Results

A total of 149,653 unique patients saw a PCP as an outpatient for a laryngeal/voice disorder, with 136,152 (90.9%) only seeing a PCP, 6,013 (4.0%) referred by a PCP to an otolaryngologist, and 3,820 (2.6%) self-referred to an otolaryngologist. Acute laryngitis had a lower hazard ratio (HR) for otolaryngology referral than chronic laryngitis, nonspecific dysphonia, and laryngeal cancer. Having multiple comorbid conditions was associated with a greater HR for otolaryngology referral than having no comorbidities. Patient age, gender, and geographic region also affected otolaryngology referral. The time to otolaryngology evaluation ranged from <1 month to >3 months. PCP-referred patients had less time to the otolaryngology evaluation than self-referred patients.

Conclusions

Multiple factors affected otolaryngology referral for patients with laryngeal/voice disorders. Further education of PCPs regarding appropriate otolaryngology referral for laryngeal/voice disorders is needed.

Level of Evidence

2b. Laryngoscope, 124:214–220, 2014

Ancillary