Objective
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 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 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
149,653 unique patients saw a PCP as an outpatient for a laryngeal/voice disorder with 136,152 (90.9%) only seeing a PCP, 6013 (4.0%) referred by PCP to an otolaryngologist, and 3820 (2.6%) self-referred to an otolaryngologist. Acute laryngitis had a lower hazard ratio (HR) for otolaryngology referral than chronic laryngitis, non-specific dysphonia, and laryngeal cancer. Multiple comorbid conditions had 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.