Usual care and management of fall risk increasing drugs in older dizzy patients in Dutch general practice

Abstract

Objective: For general practitioners (GPs) dizziness is a challenging condition to deal with. Data on the management of dizziness in older patients are mostly lacking. Furthermore, it is unknown whether GPs attempt to decrease Fall Risk Increasing Drugs (FRIDs) use in the management of dizziness in older patients. The aim of this study is to gain more insight into GP’s management of dizziness in older patients, including FRID evaluation and adjustment. Design: Data were derived from electronic medical records, obtained over a 12-month period in 2013. Setting: Forty-six Dutch general practices. Patients: The study sample comprised of 2812 older dizzy patients of 65 years and over. Patients were identified using International Classification of Primary Care codes and free text. Main outcome measures: Usual care was categorized into wait-and-see strategy (no treatment initiated); education and advice; additional testing; medication adjustment; and referral. Results: Frequently applied treatments included a wait-and-see strategy (28.4%) and education and advice (28.0%). Additional testing was performed in 26.8%; 19.0% of the patients were referred. Of the patients 87.2% had at least one FRID prescription. During the observation period, GPs adjusted the use of one or more FRIDs for 11.7% of the patients. Conclusion: This study revealed a wide variety in management strategies for dizziness in older adults. The referral rate for dizziness was high compared to prior research. Although many older dizzy patients use at least one FRID, FRID evaluation and adjustment is scarce. We expect that more FRID adjustments may reduce dizziness and dizziness-related impairment.

Key Points

• It is important to know how general practitioners manage dizziness in older patients in order to assess potential cues for improvement.

• This study revealed a wide variety in management strategies for dizziness in older patients.

• There was a scarcity in Fall Risk Increasing Drug (FRID) evaluation and adjustment.

• The referral rate for dizziness was high compared with previous research.

Keywords:

• Aged
• dizziness
• drug prescriptions
• general practice
• therapy
• The Netherlands

Acknowledgements

The authors wish to thank J.H.K. Joosten for her assistance with the data extraction. Furthermore the authors would like to thank all the GPs who participate in the Academic Network of General Practitioners of the VU University Medical Center.

Ethical approval

The ANH-VUmc database contains anonymized routine health care data. Observational studies based on the ANH-VUmc database are carried out according to Dutch privacy legislation and are exempted from informed consent of patients.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding information

This study was funded by the Netherlands Organisation for Health Research and Development. The funding body did not and will not have any role in the design, collection, analysis, or interpretation of data, nor in the writing of the manuscript.