The use of Botulinum Toxin Type A in patients in out-of-hospital intensive care in Germany—results from a multidisciplinary online survey

Introduction In Germany, approximately 23.000 patients live in of out-of-hospital intensive care settings. About 80% suffer from neurological diseases and are prone to spasticity and sialorrhea, both of which can be effectively treated with Botulinum Toxin Type A (BoNT-A). This study investigates the utilization, barriers, and training needs associated with BoNT-A application. Methods An online questionnaire with 10 questions was developed by the German Interdisciplinary Society for Out-of-Hospital Ventilation and Intensive Care (DIGAB). The survey was distributed via the mailing lists of the DIGAB, the German Society for Respiratory Therapy, and the nursing supervisors of the Deutsche Fachpflege nursing service, as well as to speech and language therapists through a private mailing list. Results The survey was sent to 702 recipients, with 41 healthcare professionals completing the survey. Only 160 (20%) of 789 patients with spasticity and 111 (14%) of 816 patients with sialorrhea or salivary aspiration received BoNT-A treatment. Barriers included the lack of trained providers, logistical challenges, and uncertainty regarding cost coverage. Participants emphasized the importance of staff training, availability of medical specialists and treatment in the home environment. Conclusion Despite its potential to facilitate care, to improve quality of life, and to promote participation in out-of-hospital intensive care, BoNT-A remains underused. Key requirements include education on multidisciplinary treatment of spasticity and sialorrhea, adequate reimbursement for BoNT-A administration, a coordinating role for the neurologist in the regulatory framework of out-of-hospital intensive care, and integration of BoNT-A in treatment guidelines are required. Further research should collect patient-level data on spasticity, dystonia, sialorrhea, and BoNT-A treatment, and examine healthcare delivery across different healthcare structures.