Abstract
Background and objective
The number of neurological second opinions (SO) and tertiary referrals (TR) is increasing. The main purpose of this study was to assess whether a day-care admission made a meaningful contribution to standard neurological outpatient care, for a wide range of second opinions and tertiary referrals.
Methods
All new patients attending an academic neurological day-care clinic in a 6-month period were investigated. Before admission, all previous medical correspondence and ancillary investigations were reviewed. On the day of admission, extensive time was available for clinical evaluation and additional ancillary investigations and an attempt was made to come to a final diagnosis. Demographic characteristics, duration of symptoms, patient satisfaction, new diagnoses and treatment consequences were studied.
Results
300 patients (183 SO and 117 TR) were evaluated. In total 103 patients (35 %) received a new diagnosis (26 % SO vs. 48 % TR, p < 0.001) and 69 (67 %) of these had therapeutic implications. A new treatment advice was given to a total of 149 patients (50 %), which was similar in both groups (48 % vs. 53 %). Second opinions were considered medically less relevant than tertiary referrals (39 % vs. 64 %, p < 0.001). The number of new diagnoses differed largely between various diagnosis categories. Especially somatoform disorders and radicular syndromes were often newly diagnosed.
Conclusion
A high number of second opinion and tertiary referral patients benefits from a day-care admission in a neurological outpatient clinic. Careful selection for referral of patients who will benefit from daycare admission may even enlarge the diagnostic and therapeutic yield.
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References
Bekkelund SI, Salvesen R (2001) Are headache patients who initiate their referral to a neurologist satisfied with the consultation? A population study of 927 patients – the North Norway Headache Study (NNHS). Fam Pract 18:524–527
Benbadis SR, Herrera M, Orazi U (2002) Does the neurologist contribute to the care of patients with chronic back pain? Eur Neurol 48:61–64
Carson AJ, Best S, Postma K, Stone J, Warlow C, Sharpe M (2003) The outcome of neurology outpatients with medically unexplained symptoms: a prospective cohort study. J Neurol Neurosurg Psychiatry 74:897–900
Carson AJ, Ringbauer B, MacKenzie L, Warlow C, Sharpe M (2000) Neurological disease, emotional disorder, and disability: they are related: a study of 300 consecutive new referrals to a neurology outpatient department. J Neurol Neurosurg Psychiatry 68:202–206
Carson AJ, Ringbauer B, Stone J, McKenzie L, Warlow C, Sharpe M (2000) Do medically unexplained symptoms matter? A prospective cohort study of 300 new referrals to neurology outpatient clinics. J Neurol Neurosurg Psychiatry 68:207–210
Carson AJ, Stone J, Warlow C, Sharpe M (2004) Patients whom neurologists find difficult to help. J Neurol Neurosurg Psychiatry 75:1776–1778
Costello DJ, Renganathan R, O’Hare A, Murray B, Lynch T (2005) Audit of an inpatient neurology consultation service in a tertiary referral centre: value of the consulting neurologist. Ir Med J 98:134–137
Crimlisk HL, Bhatia KP, Cope H, David AS, Marsden D, Ron MA (2000) Patterns of referral in patients with medically unexplained motor symptoms. J Psychosom Res 49:217–219
De Jonge P, Huyse FJ, Herzog T, Lobo A, Malt U, Opmeer BC, Kuiper B, Krabbendam A (2001) Referral pattern of neurological patients to psychiatric Consultation-Liaison Services in 33 European hospitals. Gen Hosp Psychiatry 23:152–157
Ekstrand JR, O’Malley PG, Labutta RJ, Jackson JL (2004) The presence of psychiatric disorders reduces the likelihood of neurologic disease among referrals to a neurology clinic. J Psychosom Res 57:11–16
Ewald H, Rogne T, Ewald K, Fink P (1994) Somatization in patients newly admitted to a neurological department. Acta Psychiatr Scand 89:174–179
Fink P, Hansen MS, Sondergaard L, Frydenberg M (2003) Mental illness in new neurological patients. J Neurol Neurosurg Psychiatry 74:817–819
McGivern JG (2006) Targeting N-type and T-type calcium channels for the treatment of pain. Drug Discov Today 11:245–253
Meeuwesen L, Huyse FJ, Koopmans GT, Heimans JJ (1996) Supervised integrated screening of low-back pain patients by a neurologist. A randomized clinical trial. Gen Hosp Psychiatry 18:385–394
Mellink WA, Dulmen AM, Wiggers T, Spreeuwenberg PM, Eggermont AM, Bensing JM (2003) Cancer patients seeking a second surgical opinion: results of a study on motives, needs, and expectations. J Clin Oncol 21:1492–1497
Moumjid N, Gafni A, Bremond A, Carrere MO (2007) Seeking a second opinion: do patients need a second opinion when practice guidelines exist? Health Policy 80:43–50
Snijders TJ, de Leeuw FE, Klumpers UM, Kappelle LJ, van Gijn J (2004) Prevalence and predictors of unexplained neurological symptoms in an academic neurology outpatient clinic – an observational study. J Neurol 251:66–71
Sutherland LR, Verhoef MJ (1994) Why do patients seek a second opinion or alternative medicine? J Clin Gastroenterol 19:194–197
Sutherland LR, Verhoef MJ (1989) Patients who seek a second opinion: are they different from the typical referral? J Clin Gastroenterol 11:308–313
Van Dalen I, Groothoff J, Stewart R, Spreeuwenberg P, Groenewegen P, van Horn J (2001) Motives for seeking a second opinion in orthopaedic surgery. J Health Serv Res Policy 6:195–201
Van de Lande S, van Everdingen JJ, Krol LJ (1993) In search of a second opinion. Ned Tijdschr Geneeskd 137:1836–1840 (in Dutch)
Williams LS, Jones WJ, Shen J, Robinson RL, Weinberger M, Kroenke K (2003) Prevalence and impact of depression and pain in neurology outpatients. J Neurol Neurosurg Psychiatry 74:1587–1589
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Wieske, L., Wijers, D., Richard, E. et al. Second opinions and tertiary referrals in neurology. J Neurol 255, 1743–1749 (2008). https://doi.org/10.1007/s00415-008-0019-3
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DOI: https://doi.org/10.1007/s00415-008-0019-3