Management of Migraine and the Accessibility of Specialist Care – Findings from a Multi-national Assessment of 28 Healthcare Networks

Abstract

Introduction:Migraine is one of the leading reasons for patient access to neurology services. Waiting lists can limit patients’ ability to access specialist care, even at specialised headache centres. Our study aims to investigate this issue, identify possible root causes and also document existing good practices.Methods:We conducted a study in a sample of 28 headache centres and their networks in six countries by performing in-depth interviews with 166 healthcare professionals.Results:The waiting list for new patients and follow-up visits exceeded 3 months in 61% and 36% of centres, respectively. Patients waited on average 6 months for their first consultation, with peaks beyond 12 months. Five areas were identified as common rootcauses:(1) inappropriate referral of patients with low-frequency episodic migraine or patients under acute treatment, (2) lack of triage/priority allocation, (3) limited resource availability or resources dedicated to migraine, (4) limited delegation of activities, and (5) suboptimal management of follow-up visits.Conclusion:Our work highlights a gap between best practices for migraine management proposed in the literature and current real-world practice. Guidelines recommend a “network” approach to bridge different levels of care. Based on our findings, consistency in practice amongst specialised headache clinics and integration with primary care represent an important area for further improvement.

Management of Migraine and the Accessibility of Specialist Care: Findings from an Extended Multinational Survey (My Migraine Center Survey)

“…The archetypes were defined according to setting (general neurology versus dedicated clinic) and resource availability inside the center (number of full-time-equivalent [FTE] HCPs). [14]), consistent with the parent study (52%) [13]. Significant variations were reported across centers, with results ranging from 0 to 90% EM ( Fig.…”

“…Data were collected via field interviews with HCPs. All the interviews were conducted face-to-face according to a 19-question survey developed from the conclusions of the parent study [13]. The interviews were conducted in the local language.…”

“…The five common types of biases in data collection from the parent study [13] were also applicable to the extension study (participant's self-selection bias, single responder bias, single interviewer bias, country interviewer bias, and sponsor bias). Please refer to the previous publication by Kainth et al [13] for details regarding biases in data gathering.…”

“…From analysis of the parent study [13] there emerged five areas ( Fig. 1) along the patient journey into which issues in migraine patient management were grouped.…”

“…In the previously mentioned study by Kainth et al [13], the authors performed an in-depth investigation of the roadblocks impeding access to specialized headache care. This parent study [13] assessed the magnitude of the problem of access to specialized headache care in terms of waiting lists times. It also identified good practices in the management of headache patients across a variety of settings and countries.…”