gms | German Medical Science

16. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

4. - 6. Oktober 2017, Berlin

Primary care providers’ perspective on challenges in management of patients with dizziness and vertigo

Meeting Abstract

  • Eva Kovacs - Ludwig-Maximilians-Universität München, Munich, Germany
  • Anna-Janina Stephan - Ludwig-Maximilians-Universität München, Munich, Germany
  • Amanda Phillips - Ludwig-Maximilians-Universität München, Munich, Germany
  • Jörg Schelling - Clinical Centre of the Ludwig-Maximilians-Universität, Munich, Munich, Germany
  • Eva Grill - Ludwig-Maximilians-Universität München, Munich, Germany
  • Daniela Koller - Ludwig-Maximilians-Universität München, München, Germany

16. Deutscher Kongress für Versorgungsforschung (DKVF). Berlin, 04.-06.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP133

doi: 10.3205/17dkvf381, urn:nbn:de:0183-17dkvf3811

Veröffentlicht: 26. September 2017

© 2017 Kovacs et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Background: Vertigo and dizziness belong to the most frequent symptoms in outpatient practices. However, under- and misdiagnosis are frequent in primary care resulting in unnecessary prescription and examinations, and delay the effective treatment of the patient.

Aim: The aim of this study is to understand challenges of management of the patient presenting with dizziness or vertigo from the primary care providers’ (PCPs) perspective. Further, we want to map the influence of guidelines and potential supporting interventions, as perceived by the PCPs.

Method: Semi-structured interviews based on the Theoretical Domains Framework and the Consolidated Framework for Implementation Research were performed among PCPs from Bavaria in Southern Germany. All participating PCPs provided verbal consent to the anonymous audio-recording of the interview. The interviews were transcribed verbatim and analysed independently by two researchers using Structuring Content Analysis, segregating transcripts into distinct meaning units with MAXQDA12.

Results: Twelve out of 13 contacted PCPs participated in the interviews (response rate: 92%), eight men and four women. Mean age was 49 years (range: 32-74) and mean time in practice was 14 years (range: 1-43). On average, participating PCPs consulted around 240 patients (range: 75-500) per week. All PCPs indicated that they used evidence-based guidelines for patient treatment at least sometimes.

Challenges in vertigo management in primary care covered four main fields: (1) diagnostics, hindered by the unspecific symptoms, and lack of standardised procedures, especially for the urgent assessment of severity; (2) therapy, with major difficulties in case of extensive co-medication or multimorbidity, and psychogenic vertigo; (3) the health care system by inducing time pressure, missing practice facilities, long waiting times for specialist appointments, and fewer resources in rural regions; and (4) patient-related challenges like limited compliance with diagnostic processes, and therapy.

Expectations of practice guidelines stressed the appropriateness of scope and applicability, PCPs complaining about poor consideration of their everyday reality in the primary care setting. Lack of clarity of presentation and especially the length of a guideline were perceived as a burden. In contrast, providing a diagnostic and therapeutic algorithm and a one-page summary would highly facilitate guideline use.

Regarding guideline implementation interventions, the PCPs preferred educational meetings with interactive involvement, and organisational interventions. Acceptance of patient-mediated interventions, reminders, and financial interventions was also high. Distribution of educational materials, local consensus process and outreach visit, and audits were rated less favourably.

Discussion: Our interviews with PCPs revealed several challenges in vertigo management, mostly attributed to limited time, financial, organisational and workforce resources, perceived as effort-reward imbalance. The priorities of the PCPs included high applicability of guidelines fitted to and providing support for their daily routine, implemented through educational meetings and sustained by organisational interventions, i.e. with those methods reported in the literature to achieve the highest effect on guideline adherence in primary care.

Practical implications: The challenges we mapped specific to the management of patients with vertigo and dizziness, will guide the development of a tailored intervention to improve quality of care. The investment in such solutions may contribute to more effective diagnostic activities in the primary care setting and result in reduced health care costs and increased well-being of the patient.