Department of Neuroradiology, Institute of Neurological Sciences, Southern General Hospital, Glasgow.
Br J Gen Pract. 2010 Dec;60(581):897-901. doi: 10.3399/bjgp10X544069.
Chronic daily headache is a major healthcare problem, with significant resource implications for specialist services. Since 1999, GPs in Greater Glasgow have had direct access to computerised tomography (CT) for investigation of chronic daily headache.
The purpose of this study is to assess the significance of pathology, impact of the service, and GP satisfaction.
The direct-access CT findings in patients between 1999 and 2007 were reviewed. Radiological reports were reviewed for abnormal findings by a radiologist. A neurologist reviewed those cases with abnormalities to assess their potential causation in presenting symptoms. A questionnaire was sent to the referring GP for every patient referred for direct-access CT. Data from the Information Services Division of NHS National Services Scotland was used to estimate potential cost benefits.
A total of 4404 CT scans were performed. Abnormal findings were reported in 461 (10.5%), and the reported abnormalities were considered a potential causative factor for the presenting symptoms in 60 patients (1.4%). Other abnormalities mostly resulted from established cerebrovascular disease and atrophy; 986 GP questionnaires were analysed. The major body of GP opinion (n = 460, 47%) indicated that direct-access CT was their preferred choice for referral of chronic daily headache. If direct-access CT was not available, neurology (n = 448, 45%) and general medicine (n = 379, 38%) would be the commonest referral choices. This study also reveals that 86% did not require further specialist referral. Projecting the GP questionnaire data to the study group gave an approximate cost saving of at least £86 681.81.
Direct-access CT is now the preferred choice of management for patients with chronic daily headache in primary care. Patients and GPs are reassured by a normal scan in the majority of cases. There may be cost savings, although confirmation of cost-effectiveness would require further study.
慢性每日头痛是一个主要的医疗保健问题，给专科服务带来了巨大的资源压力。自 1999 年以来，大格拉斯哥的全科医生已经可以直接进行计算机断层扫描（CT）来诊断慢性每日头痛。
本研究旨在评估病理学意义、服务影响和全科医生满意度。
回顾了 1999 年至 2007 年间接受直接访问 CT 的患者的 CT 结果。放射科医生对放射报告中的异常结果进行了回顾。神经科医生对有异常的病例进行了评估，以确定其在现有症状中的潜在病因。向每一位接受直接访问 CT 的转诊患者的转诊全科医生发送了一份问卷。NHS 苏格兰国家服务信息服务部的数据用于估计潜在的成本效益。
共进行了 4404 次 CT 扫描。报告了 461 例异常（10.5%），报告的异常被认为是 60 例（1.4%）现有症状的潜在病因。其他异常主要是由已确立的脑血管疾病和萎缩引起的；分析了 986 份全科医生问卷。大多数全科医生（n=460，47%）的主要意见是，直接访问 CT 是他们转诊慢性每日头痛的首选。如果无法进行直接访问 CT，则最常选择神经科（n=448，45%）和普通内科（n=379，38%）转诊。本研究还表明，86%的患者无需进一步的专科转诊。将全科医生问卷数据投射到研究组中，估计至少节省了 86681.81 英镑的成本。
直接访问 CT 现在是初级保健中慢性每日头痛患者的首选治疗方法。在大多数情况下，正常扫描使患者和全科医生感到安心。虽然进一步的研究需要确认成本效益，但可能会有成本节约。
