John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
Undergraduate Education, University of Hawaii at Manoa, Honolulu, HI, USA.
Headache. 2021 Jan;61(1):149-156. doi: 10.1111/head.14030. Epub 2020 Dec 14.
A survey was implemented for early assessment of pandemic-related practice processes and quality improvement (QI).
In response to the public health measures in Hawaii to curtail the coronavirus 2019 pandemic, Hawaii Pacific Neuroscience (HPN) adapted their patient care to ensure continuity of neurological treatment.
The telephone survey was conducted on patients seen at HPN during the period of April 22, 2020-May 18, 2020 to address four areas related to patients' outpatient experience: delivery of care, general well-being, experience with telemedicine, and disease-specific questions.
A total of 928 patients were contacted of which 429 (46.2%) patients responded and 367 (85.5%) agreed to participate. A total of 133 patients with migraine and 234 patients with other neurological conditions provided responses. Our migraine patients' survey responses suggest that their well-being was disproportionately negatively affected by the pandemic. Survey respondents with migraine were significantly more likely than their non-migraine peers to report worsening anxiety and sleep problems [62/132 (47.0%) vs. 78/234 (33.3%), χ = 6.64, p = 0.010, and 64/132 (48.5%) vs. 73/234 (31.2%), χ = 10.77, p = 0.001]; migraine patients also reported worsening of depression as a result of the pandemic more than patients with other diagnoses, though this was not statistically significant [44/132 (33.3%) vs. 57/234 (24.4%), χ = 3.40, p = 0.065]. In regard to access to healthcare, significantly more migraine patients reported running out of medications than those with other diagnoses [20/133 (15.0%) vs. 18/234 (7.7%), χ = 4.93, p = 0.026]. More avoided seeking medical help for new health problems because of the pandemic [30/133 (22.6%) vs. 30/234 (12.8%), χ = 5.88, p = 0.015]. Migraine patients were also significantly impacted economically by the pandemic; 43/132 (32.4%) of migraine patients reported losing their jobs as the result of the pandemic versus 34/234 (14.5%) of their peers (χ = 11.20, p < 0.001). An increase in headache severity or frequency was reported in 39/118 (33.1%) of respondents and 19/118 (16.1%) reported to using more abortive therapy than usual. Telemedicine was well received by almost all patients who took advantage of the option. Most of those patients found telemedicine to be easy to use and as valuable as an in-person visit. Migraine patients indicated with more frequency that without the telemedicine option, they would have missed their medical appointments [37/68 (54.4%) vs. 56/144 (38.6%), χ = 4.31, p = 0.038]; a majority would prefer or consider telemedicine for future appointments over in-person visits.
Insights gained from this QI survey to the practice's new pandemic-related processes include stressing lifestyle modification, optimizing treatment plans, and continuing the option of telemedicine.
进行了一项调查，以早期评估与大流行相关的实践流程和质量改进（QI）。
为了应对夏威夷遏制 2019 年冠状病毒大流行的公共卫生措施，夏威夷太平洋神经科学（HPN）调整了他们的患者护理，以确保神经治疗的连续性。
2020 年 4 月 22 日至 2020 年 5 月 18 日期间，对 HPN 就诊的患者进行了电话调查，以解决与患者门诊体验相关的四个领域：护理提供、一般健康状况、远程医疗体验和疾病特异性问题。
共联系了 928 名患者，其中 429 名（46.2%）患者做出了回应，367 名（85.5%）同意参与。共有 133 名偏头痛患者和 234 名其他神经科疾病患者提供了回复。我们的偏头痛患者的调查结果表明，他们的幸福感受到大流行的不成比例的负面影响。偏头痛患者与非偏头痛患者相比，报告焦虑和睡眠问题恶化的可能性显著更高[62/132（47.0%）比 78/234（33.3%）， χ ²=6.64，p=0.010；64/132（48.5%）比 73/234（31.2%）， χ ²=10.77，p=0.001]；偏头痛患者也报告由于大流行导致抑郁恶化的比例高于其他诊断患者，尽管这没有统计学意义[44/132（33.3%）比 57/234（24.4%）， χ ²=3.40，p=0.065]。关于获得医疗保健的机会，偏头痛患者报告药物用完的比例明显高于其他诊断患者[20/133（15.0%）比 18/234（7.7%）， χ ²=4.93，p=0.026]。更多的人因为大流行而避免寻求新的健康问题的医疗帮助[30/133（22.6%）比 30/234（12.8%）， χ ²=5.88，p=0.015]。偏头痛患者也受到了大流行的严重经济影响；43/132（32.4%）的偏头痛患者报告因大流行而失业，而其同行中只有 34/234（14.5%）（ χ ²=11.20，p<0.001）。118 名受访者中有 39 名（33.1%）报告头痛严重程度或频率增加，19 名（16.1%）报告比平时更多地使用发作性治疗。几乎所有利用这一选择的患者都对远程医疗表示欢迎。大多数患者发现远程医疗像面对面就诊一样易于使用和有价值。偏头痛患者更频繁地表示，如果没有远程医疗选择，他们将错过他们的医疗预约[37/68（54.4%）比 56/144（38.6%）， χ ²=4.31，p=0.038]；大多数人更喜欢或考虑将来的预约选择远程医疗而不是面对面就诊。
从这项 QI 调查中获得的关于与大流行相关的新实践流程的见解包括强调生活方式的改变、优化治疗计划以及继续提供远程医疗服务。
