An analysis of referral patterns for dizziness in the primary care setting

Background. The majority of balance disorders are non life-threatening and symptoms will resolve spontaneously. However, some patients require further investigation and many disorders may benefit from specialist treatment It is unclear whether appropriate identification and referral of this group of patients presently occurs. Aim. To review the management of patients with symptoms of dizziness within primary care. Method. A retrospective review of the management of 503 patients who visite d their general practitioner (GPI complaining of dizziness between August 1 993 and July 1995. Management was then compared with local criteria. Results. On average, 2.2% of patients per year at the practices studied con sulted their GP about dizziness, amounting to 0.7% of all consultations The most common GP diagnosis was of an ear, nose, and throat (ENT) disorder (3 3.8%). Similarly, many of the 16% referred were directed to ENT (36%) speci alists. The proportion of patients referred was significantly higher in tho se seeing their GP at least twice, those with symptoms lasting a year or mo re, or where there were additional symptoms associated with the dizziness, indicative of a cardiac, ENT, or neurological disorder. Compared with the l ocal criteria, 17% of management decisions were deemed inappropriate. The m ajor failing was not referring appropriate patients. This group comprised p atients with chronic, non-urgent symptoms, and were significantly older tha n those appropriately referred. Conclusion. Patients-with chronic symptoms of dizziness, particularly the e lderly, are under-referred for specialist consultation and, therefore, do n ot have access to appropriate treatment regimes. This suggests a need for f urther training of GPs and evaluation of therapeutic needs of elderly dirty patients.