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The objective of this paper was to examine the impact of disease-related and other determinants on referral trajectories of older patients with VDB and to investigate, how these trajectories affect the patients\u2019 functioning and health-related quality of life (HRQoL).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Data originate from the longitudinal multicenter study MobilE-TRA, conducted in two German federal states. Referrals to neurologists or ear-nose-throat (ENT) specialists were considered. Referral patterns were visualized using a state sequence analysis. Predictors of referral trajectories were examined using a multinomial logistic regression model. Linear mixed models were calculated to assess the impact of referral patterns on the patients\u2019 HRQoL and functioning.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We identified three patterns of referral trajectories: primary care physician (PCP) only, PCP and neurologist, and PCP and ENT. Chances of referral to a neurologist were higher for patients with a neurological comorbidity (OR\u2009=\u20093.22, 95%-CI [1.003; 10.327]) and lower for patients from Saxony (OR\u2009=\u20090.08, 95%-CI [0.013; 0.419]). Patients with a PCP and neurologist referral pattern had a lower HRQoL and lower functioning at baseline assessment. Patients with unspecific diagnoses also had lower functioning.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Referral trajectories were determined by present comorbidities and the regional healthcare characteristics. Referral trajectories affected patients\u2019 HRQoL. Unspecific VDB diagnoses seem to increase the risk of ineffective management and consequently impaired functioning.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00415-022-11060-8","type":"journal-article","created":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T11:02:38Z","timestamp":1648638158000},"page":"6211-6221","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Referral trajectories in patients with vertigo, dizziness and balance disorders and their impact on health-related quality of life and functioning: results from the longitudinal multicenter study MobilE-TRA"],"prefix":"10.1007","volume":"269","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1043-4104","authenticated-orcid":false,"given":"Benedict","family":"Katzenberger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Koller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Strobl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Kisch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Sanftenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Voigt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Grill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,3,30]]},"reference":[{"key":"11060_CR1","doi-asserted-by":"publisher","first-page":"e32","DOI":"10.1055\/s-0033-1357145","volume":"76","author":"A Rieger","year":"2014","unstructured":"Rieger A, Mansmann U, Maier W, Seitz L, Brandt T, Strupp M, Bayer O (2014) Management of patients with the cardinal symptom dizziness or vertigo. 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Written informed consent was obtained from all participants. The study was performed in accordance with the Declaration of Helsinki principles.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}