Vazirian Samra, Ho Travis, Weideman Rick A, Salinas Meagen R, Hurd Paul W, Stuve Olaf
Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Pharmacy Service, VA North Texas Health Care System, Dallas, TX, USA.
J Cent Nerv Syst Dis. 2022 Jul 13;14:11795735221113102. doi: 10.1177/11795735221113102. eCollection 2022.
Recent data indicate that the three-month prevalence of severe headaches or migraines in the US general population is close to 25%. Participation of primary care providers will therefore be critical in providing care to affected individuals.
To determine the number of headache disorder consult requests to a neurology outpatient service in a tertiary medical center, the appropriateness of the consult requests, and the effectiveness of a lecture series on headache diagnosis and management in preventing inappropriate consult requests from non-neurology providers.
Clinical data on US Veterans is captured and documented in the Veterans Health Information Systems and Technology Architecture (VISTA). The Computerized Patient Record System (CPRS) electronic medical record (EMR) was used for data entry and retrieval. All consult requests for the study period within the VA North Texas Health Care System were identified in VISTA, and the clinical information reviewed in CPRS. Based on a defined algorithm, headache consult request were categorized as appropriate or inappropriate. A board-certified neurologist provided four in-person/virtual lectures to ambulatory care providers, primary care providers, internal medicine residents, and emergency room providers within the VA North Texas Health Care System on the diagnosis and management of headaches. Prior and post the lecture series, the total number of headache consults per day was assessed over 45-day periods.
The number of daily headache consult requests in the 45-day period prior to the lecture series was 3.6 per day (standard deviation 2.7), and 6.0 per day after the lecture series (standard deviation 2.1). The difference was not statistically significant. There were as many inappropriate headache consult requests after the lecture series as appropriate ones (50% each).
We found that a short-term educational initiative that instructed primary care providers on the diagnosis and management of common headache disorders did not reduce the number of consultation requests and, surprisingly, it did not improve the appropriateness of the consults. Given the prevalence of headaches in the general population, better training of all primary care providers in headache management should be pursued.
近期数据表明，美国普通人群中严重头痛或偏头痛的三个月患病率接近25%。因此，初级保健提供者的参与对于为受影响个体提供护理至关重要。
确定三级医疗中心神经科门诊服务中头痛障碍会诊请求的数量、会诊请求的适当性，以及关于头痛诊断和管理的系列讲座在防止非神经科提供者提出不适当会诊请求方面的有效性。
在美国退伍军人健康信息系统和技术架构（VISTA）中收集并记录美国退伍军人的临床数据。使用计算机化患者记录系统（CPRS）电子病历（EMR）进行数据录入和检索。在VISTA中识别出德克萨斯州北部退伍军人医疗保健系统内研究期间的所有会诊请求，并在CPRS中审查临床信息。根据既定算法，将头痛会诊请求分类为适当或不适当。一位获得董事会认证的神经科医生为德克萨斯州北部退伍军人医疗保健系统内的门诊护理提供者、初级保健提供者、内科住院医师和急诊室提供者进行了四次面对面/虚拟讲座，内容是关于头痛的诊断和管理。在系列讲座前后，在45天的时间段内评估每日头痛会诊的总数。
系列讲座前45天期间每日头痛会诊请求的数量为每天3.6次（标准差2.7），系列讲座后为每天6.0次（标准差2.1）。差异无统计学意义。系列讲座后不适当的头痛会诊请求与适当的请求数量相同（各占50%）。
我们发现，一项指导初级保健提供者进行常见头痛障碍诊断和管理的短期教育举措并未减少会诊请求的数量，而且令人惊讶的是，它并未提高会诊的适当性。鉴于普通人群中头痛的患病率，应加强对所有初级保健提供者在头痛管理方面的培训。
