Healthcare utilization among patients with vocal cord dysfunction

Nurs Forum. Jul-Sep 2011;46(3):177-85. doi: 10.1111/j.1744-6198.2011.00224.x.

Abstract

Background: Acute asthma-like symptoms are anxiety producing for patients, and improper diagnosis leads to inappropriate use of asthma medications, unnecessary office and emergency room visits and referral to specialists to determine the cause. Vocal cord dysfunction (VCD) is responsible for 15% of referrals for dyspnea on exertion and frequently leads to multiple emergency room visits.

Purpose: The purpose of this study was to explore healthcare utilization among patients with VCD compared to patients with asthma and report the demographic characteristics of patients with these diagnoses receiving outpatient specialty care.

Methods: In this retrospective study, the de-identified electronic medical records of 285 participants receiving outpatient specialty care with a documented diagnosis of VCD, asthma, and VCD and asthma during the years 2007-2009 were explored with descriptive statistics, chi square, and Poisson regression.

Results: Despite the perception of overuse of medical resources among patients with VCD, participants in this study were seen in the outpatient clinic less frequently than participants with asthma, they used less inhaled controller medication, and there were no reported emergency room visits or hospitalizations. Females were more likely to experience this disorder. Patients with VCD were twice as likely to receive medication for anxiety and/or depression, which suggests that mood is a contributor to this disorder. Past or current allergy immunotherapy was utilized by nearly half the sample, which greatly reduces the triggers associated with VCD symptoms and asthma exacerbations. It is surmised that appropriate management including allergy immunotherapy and patient education impacted the use of hospital and outpatient services. Estimated controller inhaler costs for the entire sample were surprisingly high. Use of a controller inhaler, however, was significantly lower among patients with VCD as compared to patients with asthma which is appropriate.

Conclusion: Nurse practitioners and other healthcare providers are challenged to reduce unnecessary inhaler prescribing among patients with VCD without asthma and to seek specialty consultation to confirm or refute the diagnosis of asthma when needed.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Asthma / epidemiology
  • Asthma / therapy
  • Child
  • Child, Preschool
  • Female
  • Health Services / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Nurse Practitioners / statistics & numerical data*
  • Retrospective Studies
  • Vocal Cord Paralysis / epidemiology*
  • Vocal Cord Paralysis / therapy*
  • Young Adult