Needs and supporting tools for primary care physicians to improve care of patients with vertigo and dizziness: a national survey

Abstract

BackgroundThe diagnostic workup and treatment decisions for vertigo or dizziness in primary care can be challenging due to the broad range of possible causes and limited time and expertise of physicians. This can lead to delays in treatment and unnecessary tests. We aimed to identify the unmet needs of primary care physicians (PCPs) and strategies to improve care for dizzy patients.Materials and methodsAn online survey was conducted among board-certified PCPs in Switzerland to explore needs in caring for dizzy patients and potential educational approaches.ResultsBased on responses from 152 participating PCPs, satisfaction and confidence were higher in diagnosing (82%) and treating (76%) acute dizziness compared to episodic/chronic cases (63 and 59%, respectively). Younger PCPs had lower diagnostic yield and confidence. Areas for improvement in specialist interactions included communication between physicians (23%/36%; always/often true), shorter waiting times for consultations (19%/40%), more detailed feedback (36%/35%), and consistent patient back referrals (31%/30%). PCPs expressed interest in hands-on courses, workshops, practical guidelines, web-based algorithms, and digital tools such as printed dizzy diaries and apps for follow-up.ConclusionEnhanced dialog between PCPs and specialists is crucial to address the most common unmet needs. Reducing waiting times for referrals and providing clear instructions to specialists for triage are essential. The findings from this survey will guide the development of tools to improve the diagnosis and treatment of dizzy patients. Younger PCPs, who face higher diagnostic uncertainty, should be prioritized for educational approaches such as hands-on courses, workshops, and practical recommendations.

What neuro-otology specialists need for better care of dizzy patients: a national survey

“…In this publication, we focused on current limitations, unmet needs, and strategies to overcome difficulties faced by neurologists and ENT physicians involved in the diagnosis and subsequent care of the dizzy patient. We have previously addressed these aspects using a very similar questionnaire from the perspective of primary care physicians (PCPs) ( 9 , 10 ). By identifying these limitations in both primary care physicians and specialists and by proposing tools to improve their interactions, we aim to develop strategies to enhance the care of dizzy patients overall.…”

“…While various causes could lead to delayed referral to the specialist (including both patient’s delay and doctor’s delay), reducing the number of patients with no clear diagnosis after the initial assessment of the referring physician will be essential. For PCPs, who provide the initial assessment of the majority of dizzy patients ( 1 ), we have discussed potential strategies to address this limitation in a previous publication ( 9 ). With regards to the continuation of care of the dizzy patient (either by the specialist or the referring physician), approximately half of the specialists indicated that they would like to see the referring physician consistently take back patients for further treatment.…”

“…The target population of this survey were board-certified neurologists and ENT physicians working in private practice or (academic/non-academic) hospitals in Switzerland, referred to as “specialists” in this manuscript. For the specialists, we used a slightly modified version of the questionnaire originally developed for the survey of primary care physicians ( 9 , 10 ). Three main sections of the questionnaire were defined to address the pre-specified key aims of the study.…”

“…Based on a survey performed by primary care physicians (PCPs) in Switzerland, we identified several significant limitations in the care of dizzy patients ( 9 , 10 ). This included high rates of unclear cases after initial diagnostic assessment and high referral rates to specialists.…”

What is the current status of care by neuro-otology specialists in Switzerland—A national survey

“…While half of all consultations for dizziness were with primary care physicians (PCPs, 51.9%), significant fractions were seen by specialists such as ear–nose–throat (ENT) physicians (13.3%) and neurologists (9.6%) ( 1 ). Based on a survey performed by primary care physicians in Switzerland, we identified several significant limitations in the care of dizzy patients ( 3 , 4 ). This included infrequent use of state-of-the-art neuro-otological bedside examination techniques, a substantial rate of undiagnosed cases reaching 50% in patients with episodic/chronic dizziness, leading to a high referral rate to specialists both in acutely dizzy patients (30%) and patients with episodic or chronic dizziness (50%), and challenges in the interaction between PCPs and specialists such as long waiting periods ( 4 ).…”