An interdisciplinary integrated specialized one-stop outpatient clinic for idiopathic intracranial hypertension-a comprehensive assessment of clinical outcome

Abstract

Background and purpose: Management of idiopathic intracranial hypertension (IIH) is complex requiring multiple specialized disciplines. In practice, this creates considerable organizational and communicational challenges for healthcare professionals and patients. Thus, an interdisciplinary integrated outpatient clinic for IIH (comprising neurology, neuroophthalmology, neuroradiology, neurosurgery and endocrinology) was established with central coordination and a one-stop concept. Here, the aim was to evaluate the effects of this one-stop concept on objective clinical outcome.

Methods: In a retrospective cohort study, the one-stop era with integrated care (IC) (1 July 2021 to 31 December 2022) was compared to a reference group receiving standard care (SC) (1 July 2018 to 31 December 2019) regarding visual impairment/worsening and headache improvement/freedom 6 months after diagnosis. Multivariate binary logistic regression models were used to adjust for confounders.

Results: Baseline characteristics of the IC group (n = 85) and SC group (n = 81) were comparable (female 90.6% vs. 90.1%; mean age 33.6 vs. 32.8 years; median body mass index 31.8 vs. 33.0; median cerebrospinal fluid opening pressure 32 vs. 34 cmH₂O; at diagnosis, visual impairment was present in 71.8% vs. 69.1% and chronic headache in 55.3% vs. 56.8% in IC vs. SC). IC was associated with a higher likelihood of achieving both headache improvement (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.52-4.33, p < 0.001) and headache freedom (OR 1.75, 95% CI 1.11-3.09, p = 0.031). Regarding the risk of visual impairment and visual worsening IC was superior numerically but not statistically significantly (OR 0.87, 95% CI 0.69-1.16, p = 0.231, and OR 0.67, 95% CI 0.41-1.25, p = 0.354).

Conclusions: Interdisciplinary integrated care of IIH is favourably associated with headache outcomes and potentially also visual outcomes.

Keywords: endocrinology; frequency; headache; idiopathic intracranial hypertension; impairment; neurology; neuroophthalmology; neuroradiology; neurosurgery; outpatient clinic; severity; vision; worsening.

FIGURE 1

Structural process of the interdisciplinary integrative IIH outpatient clinic in Vienna.

FIGURE 2

Impact of integrated care on clinical outcome in the overall cohort and in subgroups with migration background and language barrier. Calculated using binary‐logistic bias‐reduced logistic regression models according to Firth with clinical endpoints as the dependent variable and group affiliation as the independent variable (integrated specialized outpatient clinic vs. standard care). Values above 1 indicate outcome favouring care in the integrated interdisciplinary one‐stop shop compared to standard care.