Assessing factors related to the pharmacologic management of laryngeal diseases and disorders

Abstract

Objective To examine how age, gender, comorbidity, geography, provider type, and laryngeal pathology influence the use of pharmacological treatment in managing patients with laryngeal disorders. Study Design Retrospective analysis of data from a large, nationally representative administrative U.S. claims database. Methods Patients with a laryngeal disorder based on ICD-9-CM codes from January 1, 2004 to December 31, 2008, seen as an outpatient by a primary care physician (PCP), otolaryngologist, or both, and continuously enrolled for 12 months were included. Data regarding pharmacy claims, age, gender, geographic location, comorbid conditions, provider type, and laryngeal diagnosis were collected. To identify factors that influenced whether a patient received a medication or not, a logistic regression was performed. Results Of almost 55 million individuals in the database, 258,705 had a laryngeal diagnosis, 12 months post-index date follow-up, and an outpatient encounter with a PCP, otolaryngologist, or both. 135,973 (52.6%) unique patients, mean age 47.4 years (22.2 SD) with 61.9% female, received a medication, and 122,732 (47.4%), mean age 47.4 (19.8 SD) with 65.8% female, did not. Higher odds ratios (ORs) for medication treatment were associated with PCPs versus otolaryngologists, acute laryngitis, the south region, and patients with comorbid conditions. Variable prescription patterns were also observed for age and gender. Conclusion Multiple factors are associated with the use of medical treatment for laryngeal disorders.

Associations between Community‐Acquired Pneumonia and Proton Pump Inhibitors in the Laryngeal/Voice‐Disordered Population

“…This high rate of PPI use is consistent with prior survey studies and real-world evaluations of practice patterns among GMPs and otolaryngologists. 2, 4, 6, 19, 20 The pervasiveness of PPI treatment however may expose laryngeal/voice disordered patients to adverse effects. In a recent survey of internist members of the American College of Physicians, 98% reported having some concern about adverse effects of PPIs with 63% altering the dose, 52% switching to H2 blockers, and 44% discontinuing the PPI.…”

“…Half of all patients presenting to general medical providers (GMPs) and otolaryngologists for voice-related complaints undergo medication trials, of which PPIs are common. 1, 2 Furthermore, the frequent use of PPIs is associated with significant health care costs, accounting for 10% of the direct costs in the evaluation and management of patients with laryngeal/voice disorders. 3 Yet, when caring for patients with laryngeal/voice disorders, practice patterns of GMPs and otolaryngologists suggest uncertainty surrounding the indications for PPI use, with the subsequent potential for inappropriate use.…”

Otolaryngology utilization of speech‐language pathology services for voice disorders

“…Within this age category, nonspecific dysphonia is the most prevalent otolaryngology‐provided laryngeal diagnosis, a diagnosis that may reflect ambiguity surrounding the etiology of the voice disturbance . Furthermore, medication use, which was more expensive than SLP evaluation and treatment, was most common among the 35‐ to 64‐year‐old age group, with the odds of proton pump inhibitor treatment, the most costly medication, increasing with age . Thus, this cohort seems most likely to benefit from multidisciplinary evaluation and treatment with SLP colleagues.…”

Correlation between Reflux and multichannel intraluminal impedance pH monitoring in untreated volunteers

“…5 In spite of lack of efficacy data supporting the use of PPIs, 46.2% of patients with a diagnosis of chronic laryngitis receive medication. 6 Although reflux with laryngeal manifestations (laryngopharyngeal reflux [LPR]) may be an activator of laryngeal inflammation, the extent to which the effects of LPR alone contribute to the clinical picture of chronic laryngitis is unknown.…”

“…Gastroesophageal reflux disease (GERD) has been implicated as a probable etiologic factor for chronic laryngitis, though treatment with proton pump inhibitors (PPIs), the current standard of care for GERD, demonstrates a nonsignificant benefit over placebo . In spite of lack of efficacy data supporting the use of PPIs, 46.2% of patients with a diagnosis of chronic laryngitis receive medication . Although reflux with laryngeal manifestations (laryngopharyngeal reflux [LPR]) may be an activator of laryngeal inflammation, the extent to which the effects of LPR alone contribute to the clinical picture of chronic laryngitis is unknown.…”