A descriptive analysis of ambulatory neurological care demand in Burgos Health Area

Abstract

Introduction and objective

To determine the ambulatory neurological care demand in Burgos Health Area and to describe the demographic, assistance and diagnostic data following recommendations of assessment of disease morbidities and use of health systems at a regional level.

Patients and methods

This is an observational descriptive study that prospectively recorded ambulatory demand of first neurological visits during the year 2008. Demographic, assistance and diagnostic data of the 1,341 patients that attended the neurology clinic were recorded.

Results

The 1,524 visits requested was equivalent to a demand of 15.08 visits per inhabitant older than 14 and per year. Twelve per cent of patients did not attend the requested visit. The mean age of the total sample was 56.29 years, of which 60.99% were women and 42.20% were older than 65 years. A total of 76% were sent by their general practitioner, of which 70% were non-urgent. The most common referral causes were headache (26%) and dementia (15%), and the diagnoses at the end of the neurology visit were headache (27%) and “no neurological disease” (19%). Among patients older than 65 years, dementia and movement disorders made up 34% of neurological diagnoses. After the first visit, 59% of patients were discharged to their general practitioner.

Conclusions

Headache is the most common complaint for referral to neurology in our region. Advanced age increases the demand due to a higher prevalence of neurodegenerative diseases. The high proportion of direct discharges suggests a poor selection of the patients referred from primary care and underlines the need for a more rational patient selection for referral to secondary care.

Resumen

Introducción y objetivo

Conocer la demanda asistencial de primeras visitas en el área sanitaria de Burgos y describir variables demográficas, asistenciales y diagnósticas de las mismas, siguiendo recomendaciones de la OMS que anima a que se realicen estudios de morbilidad y del uso de los sistemas de salud a nivel regional.

Pacientes y métodos

Estudio observacional, prospectivo y descriptivo de la demanda de primeras visitas neurológicas en una consulta durante 12 meses (enero 2008-diciembre 2008). Se registran variables demográficas, asistenciales y diagnósticas de los 1.341 pacientes que acudieron consecutivamente a la consulta.

Resultados

Se demandaron 1.524 consultas. Son 15,08 solicitudes por 1.000 habitantes/año mayores de 14 años. Hubo un 12% de incomparecencias. La edad media es 56,29 años. El 60,99% son mujeres. 42,20% son mayores de 65 años. Un 76% se derivan desde atención primaria. Un 70% se remitieron de modo ordinario. Los motivos de derivación más frecuentes son cefalea (26%) y demencia (15%). Los diagnósticos emitidos con más frecuencia son cefalea (27%) y no neurológico (19%). En mayores de 65 años demencia y trastornos del movimiento aglutinan el 34% de los diagnósticos. Tras la primera consulta se dio alta al 59%.

Conclusiones

La cefalea es el principal motivo de consulta. La edad avanzada condiciona alta demanda por mayor prevalencia de la patología neurodegenerativa. El alto porcentaje de altas tras la primera consulta traduce una escasa selección de las remisiones y la necesidad de racionalizar el acceso de pacientes al segundo nivel asistencial.