Treating epistaxis – who cares for a bleeding nose? A secondary data analysis of primary and secondary care

BMC Family Practice

Jonas Lüske¹  Ulrike Arendt²  Michael H. Freitag²  Annina E. Althaus³  Falk Hoffmann⁴  Kathrin Jobski⁴  Michael Dörks⁴ 

[1] Department of Audiology and Phoniatrics, Charité - Universitätsmedizin Berlin, Berlin, Germany;Division of General Practice and Family Medicine, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany;Division of General Practice and Family Medicine, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany;Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany;Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany;

关键词: Epistaxis;    Nosebleed;    Outpatient management;    GP-centered care;    Economic impact;    Allocation;   

DOI  :  10.1186/s12875-021-01411-1

来源: Springer

【 摘 要 】

BackgroundThe primary objective was to describe outpatient treatment of epistaxis among different physicians based on a large patient population over a period of 10 years. The secondary objective was to evaluate the value of the practice fee as an instrument of allocation in patients with epistaxis.MethodsAnonymized statutory health insurance data (AOK Lower Saxony) of patients with a diagnosis of epistaxis treated between 2007 and 2016 were examined. Demographic data, accompanying diagnoses, medication and involved medical groups (general practitioners (GP), pediatricians, ear, nose and throat (ENT) specialists or other) were analyzed. Furthermore, we assessed whether the use of specialist groups changed after abolition of the practice fee in 2013.ResultsEpistaxis was responsible for 302,782 cases (160,963 patients). The distribution of cases was slightly in favor of ENT specialists vs. GP (119,170 vs. 110,352). The cases seen by GP and ENT specialists were comparable with regard to age and sex distribution. Hypertension, atrial fibrillation/flutter and an antithrombotic therapy were slightly more common among cases consulting a GP. The GP recorded more co-diagnoses than the ENT. The use of outpatient care and the proportions of the involved physicians scarcely fluctuated during the study period. Overall, 23,118 patients (14.4%) were diagnosed by both, GP and ENT during a relatively short time period. The practice fee remuneration had no impact on the consultation of the physician groups.ConclusionThe outpatient treatment of epistaxis constitutes a considerable medical and economic burden in Germany. Strengthening the primary medical sector (GP-centered care) is necessary to reach the goal of initially directing patients to primary care, providing specialists more time for severe cases and reducing the impact on public health balance sheets.

【 授权许可】

CC BY