The majority of outpatients who are referred to the neurology clinic mainly fall into only 1 of 5 diagnostic categories, which vary in wait times, the number of tests needed, and follow-up appointments. This demonstrated the need to ensure improved consistency of access to outpatient neurology care, according to study results published in BMJ Neurology Open.
As neurology services in the UK are vastly comprised of outpatient clinics, understanding the frequency of diagnosis, how services are used, and patient wait times may provide a better understanding of these diagnostic categories. While neurology outpatient visits have been reviewed in previous studies, waiting times have not been reported and only a few have included information on diagnostic test and follow-up rates.
A team of investigators conducted a retrospective observational study using routinely collected patient data to characterize the number of referrals of patients with various diagnostic categories at neurology clinics in the United Kingdom. They assessed the number of diagnostic tests and follow-up appointments requested as a measure of ongoing service use.
During the study, patients attended a total of 1951 first appointments. The mean age for the overall cohort was 50.0 years and ranged from 43.2 years for seizure/epilepsy to 74.9 years for dementia.
Study researcher recorded 17 different diagnostic categories from about 1200 free-text instances. However, only 5 diagnostic categories made up 62% of all diagnoses, including headache, seizure/epilepsy, psychological/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 probable that at least 1 test was offered than a follow-up appointment in most categories, indicating that some patients were offered a test and discharged simultaneously in the outpatient clinic.
Of the most common diagnostic categories, seizure/epilepsy offered the highest proportion of follow-up appointments (73%) and headache offered the lowest proportion (11%), suggesting that 89% of patients in the headache disorders diagnostic category were discharged after only 1 appointment.
In contrast, the proportion of patients that required a test was more leveled across diagnostic categories, with the 52% in seizure/epilepsy and 44% in headache.
In comparing routine 18-week referral to treatment, 65% of patients with seizure/epilepsy were seen within the target wait times, while only 38% of patients with movement disorders were seen in the target wait times. Patients diagnosed with seizures had a significantly different distribution of waiting times compared with all other diagnostic categories and were generally seen much sooner, while the longest wait times were observed for patients with movement disorders.
“Although we identified differences in waiting times for different diagnostic categories, it is unclear how experiencing long waiting times may affect clinical outcomes,” the study researchers noted.
They concluded that “this study shows how insight can be gained from routine data; however, for these insights to be extended to a larger scale, coding of outpatient appointments across the UK would be required.” The researchers added that more “research is needed into how different patient groups experience waiting times, and the potential impact those extended times have on prognosis and treatment.”
Biggin F, Howcroft T, Davies Q, Knight J, Emsley HCA. Variation in waiting times by diagnostic category: an observational study of 1,951 referrals to a neurology outpatient clinic. BMJ Neurol Open. Published online June 3, 2021. doi:10.1136/bmjno-2021-000133