Effectiveness of a training intervention to improve the management of vertigo in primary care: a multicentre cluster-randomized trial.

Abstract

BackgroundBenign paroxysmal positional vertigo (BPPV) is the most common type of vertigo. While BPPV is best treated with canalicular repositioning maneuvers, they are not routinely performed in primary care (PC). MethodologyObjectives:To evaluate the effectiveness of blended training (online and face-to-face) on the diagnosis and management of vertigo to improve adherence of family doctors to clinical practice guidelines.DesignCommunity multicenters cluster-randomized open-label trial with an intervention (IG) and a control group (GC) of 10 primary care teams (PCTs) each.MeasurementsOutcome variables will be: ICD-10 diagnostic codes (proportion of nonspecific diagnoses such as dizziness and vertigo versus specific diagnoses such as BPPV, vestibular neuritis and Meniere's syndrome); referrals to ENT and neurology specialists; prescription of antivertigo agents; duration of sick leave due to vertigo.Statistical analysis The baseline comparability of the two study groups will be analysed to ensure homogeneity. A description of all baseline variables will be performed. Student’s t-test will be used to evaluate differences between groups. Logistic regression multivariate analysis will be performed to study the relationship between baseline variables of professionals and centers with outcome variables.ClinicalTrials.gov Identifier: NCT04929444. Registered June 18, 2021, https://clinicaltrials.gov/ct2/show/NCT04929444EthicsThis protocol has been approved by the Ethics Committee of the Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) with the code 20/004-P. All patient data will be anonymised in agreement with the 2016/679 European Regulation. Expected results and Applicability With the improvement of the diagnosis and management of vertigo by family doctors after this training we expect: an increase in the proportion of specific diagnoses; a decrease in the prescription of antivertigo agents; a decrease in the request for complementary tests and referrals to other specialists; a reduction in the duration of sick leave due to temporary disability. The blended training will be easily expanded within primary care services, since it is mainly delivered online, with a single face-to-face session to ensure that the maneuvers have been adequately learned.