{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T17:17:19Z","timestamp":1779383839669,"version":"3.53.1"},"reference-count":10,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Bulgarian Ministry of Education and Science","award":["BG-RRP-2.004-0006-C03"],"award-info":[{"award-number":["BG-RRP-2.004-0006-C03"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Neurological disorders are a leading cause of disability worldwide, placing increasing strain on healthcare systems. In Eastern Europe, and specifically Bulgaria, there is a significant lack of granular data regarding how ambulatory neurology services are utilized and how clinical workloads are distributed across different diagnostic groups. Objective: In this study, we aimed to analyze the clinical workload, demographic patterns, and diagnostic distribution within a single-center ambulatory neurology setting in Bulgaria, while identifying the primary determinants of patient age stratification. Methods: We conducted a retrospective observational study of 518 consecutive clinical encounters recorded over a one-year period in a specialized outpatient neurology clinic. Data on age, gender, visit type (ambulatory vs. dispensary), and ICD-10 diagnostic groups were analyzed. Inferential analyses included a one-way ANOVA for age differences and multivariable linear regression to identify independent predictors of age patterns, with age modeled as a continuous variable. Results: The clinical workload was highly concentrated, with spine-related disorders accounting for over 40% of all visits, and primary consultative examinations were the predominant service type (65.4%). Statistical analysis revealed significant age differences across diagnostic categories (p &lt; 0.001), with neurodegenerative and cerebrovascular diseases associated with the highest mean age, while spine and headache syndromes involved significantly younger populations. Multivariable modeling confirmed that diagnostic category is the sole independent determinant of age distribution (p &lt; 0.001), whereas gender and visit type showed no significant independent associations. Conclusions: Ambulatory neurology utilization in this setting is characterized by a high-turnover primary consultation model and a heavy concentration of musculoskeletal neurological conditions. These findings suggest that outpatient neurology functions as a critical diagnostic filter and pain management hub. The study underscores the need for diagnosis-specific clinical pathways and targeted resource allocation to optimize service efficiency and improve long-term management of chronic neurological morbidity in a public insurance-driven framework.<\/jats:p>","DOI":"10.3390\/ijerph23050651","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T16:46:18Z","timestamp":1779381978000},"page":"651","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Workload, Demographic Patterns, and Correlations in Neurology Ambulatory Care: A Single-Center Study from Bulgaria"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6082-4376","authenticated-orcid":false,"given":"Christiyan Kirilov","family":"Naydenov","sequence":"first","affiliation":[{"name":"Neurology Department, MHAT-MK \u201cSt. Iv. Rilsky\u201d, Gerasim Papazchev 1 Street, 6000 Stara Zagora, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9901-8504","authenticated-orcid":false,"given":"Antoaneta Petrova","family":"Yordanova","sequence":"additional","affiliation":[{"name":"Department of Social Medicine, Health Management and Disaster Medicine, Medical Faculty, Trakia University, Armeyska 11 Street, 6000 Stara Zagora, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/S1474-4422(18)30499-X","article-title":"Global, regional, and national burden of neurological disorders, 1990\u20132016: A systematic analysis for the Global Burden of Disease Study 2016","volume":"18","author":"Feigin","year":"2019","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Vos","year":"2020","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/j.clineuro.2010.05.011","article-title":"Who is referred to neurology clinics?\u2014The diagnoses made in 3781 new patients","volume":"112","author":"Stone","year":"2010","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_4","unstructured":"Busse, R., Bl\u00fcmel, M., Scheller-Kreinsen, D., and Zentner, A. (2010). Tackling Chronic Disease in Europe: Strategies, Interventions and Challenges, World Health Organization."},{"key":"ref_5","unstructured":"Prince, M.J., Wimo, A., Guerchet, M.M., Ali, G.C., Wu, Y.-T., and Prina, M. (2015). World Alzheimer Report 2015: The Global Impact of Dementia\u2014An Analysis of Prevalence, Incidence, Cost and Trends, Alzheimer\u2019s Disease International. Available online: http:\/\/www.alz.co.uk\/research\/world-report-2015."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Thompson, A.E., Anisimowicz, Y., Miedema, B., Hogg, W., Wodchis, W.P., and Aubrey-Bassler, K. (2016). The influence of gender and other patient characteristics on health care-seeking behaviour: A QUALICOPC study. BMC Fam. 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Hospitals in a Changing Europe, Open University Press."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1146\/annurev.publhealth.23.100901.140546","article-title":"The importance of the normality assumption in large public health data sets","volume":"23","author":"Lumley","year":"2002","journal-title":"Annu. Rev. Public Health"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/5\/651\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T16:47:38Z","timestamp":1779382058000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/5\/651"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":10,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["ijerph23050651"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23050651","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]}}}