title: Prescribing patterns of primary care physicians and otolaryngologists in the management of laryngeal disorders.
abstract: OBJECTIVE
  To examine how primary care physicians (PCPs) and otolaryngologists use proton pump inhibitors (PPIs), antibiotics, antihistamines, oral and inhaled steroids, and histamine 2 antagonists in the treatment of laryngeal disorders.
  
  
  METHODS
  Retrospective analysis of data from a large, national administrative US claims database.
  
  
  METHODS
  Patients with laryngeal disorders based on ICD-9-CM codes from January 1, 2004, to December 31, 2008, seen as an outpatient by a PCP, otolaryngologist, or both and continuously enrolled for 12 months were included. Pharmacy claims, age, gender, geographic location, comorbid conditions, provider type, and laryngeal diagnosis were collected. Random-effects logistic regression and multinomial logistic regression analyses were performed.
  
  
  RESULTS
  Of approximately 55 million individuals, 135,973 had a laryngeal diagnosis, 12 months post-index date follow-up, and an outpatient encounter with a PCP, otolaryngologist, or both. Acute laryngitis was one of the most common reasons PCPs prescribed each medication class. Nonspecific dysphonia was the most common reason otolaryngologists prescribed each medication class. Patients seen by a PCP had a higher odds ratio for receiving an antibiotic and antihistamine, and patients seen by an otolaryngologist had a greater odds ratio for receiving a PPI and inhaled steroids. After adjusting for other variables in the model, the probability that a patient seen by a PCP would receive an antibiotic was .55 and a PPI .13. If seeing an otolaryngologist, it was .44 and .22, respectively.
  
  
  CONCLUSIONS
  Differences exist regarding the prescribing patterns of PCPs and otolaryngologists in treating patients with laryngeal disorders.
authors.affiliation: Duke University Medical Center, Durham, North Carolina 27710, USA. seth.cohen@duke.edu
authors.forename: Seth M
authors.initials: SM
authors.lastname: Cohen
authors.forename: Jaewhan
authors.initials: J
authors.lastname: Kim
authors.forename: Nelson
authors.initials: N
authors.lastname: Roy
authors.forename: Mark
authors.initials: M
authors.lastname: Courey
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D007818:Laryngeal Diseases / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010036:Otolaryngology; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians'; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D006633:Histamine Antagonists; D054328:Proton Pump Inhibitors
keywords: dysphonia; laryngeal disorders; medication; prescribing patterns; treatment; voice