PMID- 28944537
OWN - NLM
STAT- MEDLINE
DCOM- 20181011
LR  - 20190301
IS  - 1531-4995 (Electronic)
IS  - 0023-852X (Print)
IS  - 0023-852X (Linking)
VI  - 128
IP  - 3
DP  - 2018 Mar
TI  - Pharmacologic management of voice disorders by general medicine providers and 
      otolaryngologists.
PG  - 682-689
LID - 10.1002/lary.26875 [doi]
AB  - OBJECTIVES: 1) To compare laryngeal diagnoses from general medical providers 
      (GMP) to otolaryngologists following GMP-based medication trial, and 2) to 
      evaluate associations between GMP medication trials and pharmacologic treatment 
      by otolaryngologists. METHODS: Retrospective cohort analysis using large, 
      national administrative U.S. claims database. Patients with laryngeal/voice 
      disorders as per the International Classification of Diseases, Ninth Revision, 
      Clinical Modification codes from January 1, 2010, to December 31, 2012, seen by a 
      GMP and then an otolaryngologist between 2 weeks to 3 months after the GMP visit, 
      were included. Patient demographics, comorbid conditions, medication use, and 
      initial GMP and otolaryngology laryngeal diagnoses were collected. Logistic 
      regression was performed to evaluate the association between GMP and 
      otolaryngologist medication trials. RESULTS: A total of 12,475 unique 
      laryngeal/voice-disordered patients met inclusion criteria. At the initial GMP 
      visit, 15.3% received an antibiotic, 14.0% a proton pump inhibitor (PPI), and 
      7.7% an oral steroid. After the otolaryngology visit, increased diagnoses of 
      vocal fold paralysis/paresis, benign vocal fold/laryngeal pathology, chronic 
      laryngitis, and multiple diagnoses occurred. The adjusted odds for an 
      otolaryngologist prescribing an antibiotic, PPI, or oral steroid, respectively, 
      given that a GMP prescribed an antibiotic, PPI, or oral steroid, was roughly two 
      to three times higher that of a GMP not prescribing the given medication. 
      CONCLUSION: Patients with structural and neuromuscular laryngeal disorders were 
      treated with medications by GMPs, and similar mediations often were repeated 
      after otolaryngology evaluation. These findings suggest potential areas of 
      unnecessary pharmacologic treatment of laryngeal/voice-disordered patients. LEVEL 
      OF EVIDENCE: 2b. Laryngoscope, 128:682-689, 2018.
CI  - (c) 2017 The American Laryngological, Rhinological and Otological Society, Inc.
FAU - Cohen, Seth M
AU  - Cohen SM
AUID- ORCID: 0000-0002-7965-604X
AD  - Duke Voice Care Center, Division of Otolaryngology-Head & Neck Surgery, Duke 
      University Medical Center, Durham, North Carolina.
FAU - Lee, Hui-Jie
AU  - Lee HJ
AD  - Department of Biostatistics and Bioinformatics, Duke University Medical Center, 
      Durham, North Carolina.
FAU - Roy, Nelson
AU  - Roy N
AD  - Department of Communication Sciences and Disorders, Division of 
      Otolaryngology-Head & Neck Surgery (Adjunct), University of Utah, Salt Lake City, 
      Utah.
FAU - Misono, Stephanie
AU  - Misono S
AD  - Lions Voice Clinic, Department of Otolaryngology/Head and Neck Surgery, 
      University of Minnesota, Minneapolis, Minnesota, U.S.A.
LA  - eng
GR  - K23 DC016335/DC/NIDCD NIH HHS/United States
GR  - UL1 RR033183/RR/NCRR NIH HHS/United States
GR  - UL1 TR001117/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20170925
PL  - United States
TA  - Laryngoscope
JT  - The Laryngoscope
JID - 8607378
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Child
MH  - Child, Preschool
MH  - Databases, Factual
MH  - Female
MH  - Follow-Up Studies
MH  - Health Personnel/*statistics & numerical data
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Middle Aged
MH  - Otolaryngologists/*statistics & numerical data
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Voice Disorders/*drug therapy
MH  - Young Adult
PMC - PMC5955694
MID - NIHMS966589
OTO - NOTNLM
OT  - Laryngeal disorders
OT  - dysphonia
OT  - pharmacology
OT  - treatment
OT  - voice
EDAT- 2017/09/26 06:00
MHDA- 2018/10/12 06:00
PMCR- 2019/03/01
CRDT- 2017/09/26 06:00
PHST- 2017/07/24 00:00 [accepted]
PHST- 2017/09/26 06:00 [pubmed]
PHST- 2018/10/12 06:00 [medline]
PHST- 2017/09/26 06:00 [entrez]
PHST- 2019/03/01 00:00 [pmc-release]
AID - 10.1002/lary.26875 [doi]
PST - ppublish
SO  - Laryngoscope. 2018 Mar;128(3):682-689. doi: 10.1002/lary.26875. Epub 2017 Sep 25.