The majority of outpatients referred to the neurological clinic mainly fall into only 1 of 5 diagnostic categories, which differ in waiting times, number of tests required and follow-up appointments. This demonstrated the need to ensure improved consistency in access to outpatient neurological care, as shown by the study results published in BMJ Neurology Open.
Since most neurological services in the UK are outpatient clinics, understanding the frequency of diagnoses, how the services are used and patient waiting times can provide a better understanding of these categories of diagnoses. While outpatient visits to neurology were reviewed in previous studies, no waiting times were reported and few provided information on diagnostic tests and follow-up advice.
A team of researchers conducted a retrospective observational study of routinely collected patient data to characterize the number of referrals of patients with different diagnostic categories to neurological clinics in the UK. They rated the number of diagnostic tests and follow-up appointments requested as a measure of ongoing service usage.
During the study, the patients had a total of 1951 initial appointments. The mean age for the entire cohort was 50.0 years, ranging from 43.2 years for seizures / epilepsy to 74.9 years for dementia.
The study researcher recorded 17 different diagnostic categories from around 1200 free text instances. However, only 5 diagnostic categories accounted for 62% of all diagnoses, including headache, seizures / epilepsy, mental / functional disorders, movement disorders, and peripheral nerve / neuromuscular disorders.
At least 1 test was offered to 52% of patients and a follow-up appointment was offered to 35% of patients. It was more likely that at least 1 test was offered as a follow-up appointment in most categories, suggesting that some patients were offered a test and were discharged to the ambulance at the same time.
Of the most common diagnostic categories, seizures / epilepsy had the highest proportion of follow-up appointments (73%) and headache the lowest (11%), suggesting that 89% of patients in the headache disease diagnostic category had only. were discharged 1 appointment.
In contrast, the proportion of patients requiring a test was more balanced across all diagnostic categories, with 52% having seizures / epilepsy and 44% having headaches.
When comparing the routine 18 week referral for treatment, 65% of the patients with seizures / epilepsy were seen within the target waiting times, while only 38% of the patients with movement disorders were seen within the target waiting times. Patients with diagnosed seizures had a significantly different distribution of waiting times compared to all other diagnostic categories and were usually seen much earlier, while the longest waiting times were observed in patients with movement disorders.
“Although we found differences in waiting times for different diagnostic categories, it is unclear how long waiting times can affect clinical outcomes,” the study researchers noted.
They concluded that “This study shows how insights can be derived from routine data; However, in order for these findings to be scaled up, it would be necessary to code outpatient appointments across the UK. ”The researchers added that“ more research is needed to examine how different patient populations experience waiting times and the potential effects of it have extended times on prognosis and treatment “.
Biggin F, Howcroft T, Davies Q, Knight J, Emsley HCA. Variation of waiting times by diagnostic category: an observational study with 1,951 referrals to a neurological outpatient clinic. BMJ Neurol Open. Published online June 3, 2021. doi: 10.1136 / bmjno-2021-000133