Department of Neurology, Barrow Neurological Institute, St. Joseph Hospital and Medical Center, Phoenix, AZ, USA.
Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA.
Headache. 2020 Nov;60(10):2192-2201. doi: 10.1111/head.13981. Epub 2020 Oct 16.
Access to headache consultations by a headache specialist is limited. E-consultations are an efficient approach shown to reduce costs and improve continuity of care with the primary care provider. Indications, suitability, and uptake in the headache population are not well studied.
This quality improvement pilot aims to explore the appropriateness of e-consultations for patients referred to a headache specialist. E-consultation feasibility was explored through (1) retrospective review of completed face-to-face consultations; (2) prospective survey of providers to identify face-to-face consultations appropriate for e-consultation; (3) cross-sectional review of the current waiting list to assess theoretical triaging to face-to-face vs e-consultation; and (4) prospective review of all e-consultations requested from an academic headache clinic to improve the understanding of e-consultation feasibility and referral triage.
The retrospective review included 75 face-to-face consultations with a mean (SD) wait time of 33 (39.4) days for consultations, of which 28/75 (37.3%) were deemed to be feasible e-consultations. The prospective survey of providers identified 10 face-to-face consultations that were felt to be theoretically appropriate for e-consultation. The cross-sectional review identified 20 patients on the clinic waiting list, of whom 5/20 (25%) were theoretically triaged to e-consultation. Finally, the prospective review found 12 requested e-consultations, of which 6/12 (50%) were for migraine prophylaxis recommendations. Chart data often lacked details for complete assessments, with 5/12 (41.7%) converted to face-to-face consultations and only 4/12 (33.3%) deemed appropriate for e-consultation.
E-consultation in headache medicine could be considered if appropriately triaged. Pathways are needed to reach patients earlier in their disease course to ensure headache care meets guideline recommendations, and e-consultation is 1 option. However, better communication with primary care is required for system optimization.
头痛专家的就诊机会有限。电子咨询已被证明可以降低成本并提高初级保健提供者的护理连续性。在头痛患者中的适应证、适用性和采用率尚未得到很好的研究。
这项质量改进试点旨在探讨将电子咨询用于转介给头痛专家的患者的适宜性。通过（1）回顾性审查已完成的面对面咨询；（2）前瞻性调查提供者以确定适合电子咨询的面对面咨询；（3）对当前等候名单进行横断面审查，以评估面对面与电子咨询的理论分诊；以及（4）前瞻性审查来自学术头痛诊所的所有电子咨询请求，以提高对电子咨询可行性和转诊分诊的理解。
回顾性审查包括 75 次面对面咨询，平均（SD）咨询等待时间为 33（39.4）天，其中 28/75（37.3%）被认为是可行的电子咨询。对提供者的前瞻性调查确定了 10 次理论上适合电子咨询的面对面咨询。横断面审查确定了诊所等候名单上的 20 名患者，其中 5/20（25%）理论上分诊至电子咨询。最后，前瞻性审查发现 12 次请求的电子咨询，其中 6/12（50%）是偏头痛预防建议。图表数据通常缺乏完整评估的详细信息，其中 5/12（41.7%）转为面对面咨询，只有 4/12（33.3%）被认为适合电子咨询。
如果进行适当的分诊，头痛医学中的电子咨询可以考虑。需要找到更早接触疾病患者的途径，以确保头痛护理符合指南建议，电子咨询是其中一种选择。然而，需要与初级保健更好地沟通以优化系统。
