Proposal of a clinical care pathway for quality and safe management of headache patients: a consensus study report

Abstract

BackgroundHeadache is one of the most prevalent and disabling conditions. Its optimal management requires a coordinated and comprehensive response by health systems, but there is still a wide variability that compromises the quality and safety of the care process.PurposeTo establish the basis for designing a care pathway for headache patients through identifying key subpathways in the care process and setting out quality and clinical safety standards that contribute to providing comprehensive, adequate and safe healthcare.MethodA qualitative research study based on the consensus conference technique. Eleven professionals from the Spanish National Health System participated, seven of them with clinical experience in headache and four specialists in healthcare management and quality. First, identification of the key subpathways in the care process for headache, barriers/limitations for optimal quality of care, and quality and safety standards applied in each subpathway. Second, two consecutive consensus rounds were carried out to assess the content of the subpathway level descriptors, until the expert agreement was reached. Third, findings were assessed by 17 external healthcare professionals to determine their understanding, adequacy and usefulness.ResultsSeven key subpathways were identified: (1) primary care, (2) emergency department, (3) neurology department, (4) specialised headache unit, (5) hospitalisation, (6) outpatients and (7) governance and management. Sixty-seventh barriers were identified, the most frequent being related to diagnostic errors (36,1%), resource deficiency (25%), treatment errors (19,4%), lack of health literacy (13,9%) and inadequate communications with care transitions (5,6%). Fifty-nine quality and 31 safety standards were defined. They were related to evaluation (23.3%), patient safety (21.1%), comprehensive care (12.2%), treatment (12.2%), clinical practice guidelines (7.8%), counselling (6.7%), training (4.4%) and patient satisfaction (3.3%).ConclusionsThis proposal incorporates a set of indicators and standards, which can be used to define a pathway for headache patients and determine the levels of quality.

Migraine treatment: quo vadis? Real-world data study (2015–2022) in Spain

“…In contrast, published estimates of migraine prevalence in Spain are based on population surveys and include undiagnosed migraine cases [ 36 , 37 ]. Nonetheless, when considering both the diagnoses of migraine and treated headaches, we obtain an estimated prevalence of 12.7%, which is closer to the one published in population-based surveys, suggesting possible diagnostic errors, as reported in other studies [ 6 , 45 , 46 ]. Training to physicians, namely in primary care, may be necessary to improve the diagnosis of migraine [ 35 , 45 , 46 ].…”

Complex Patient Navigation by Veteran Patients in the Veterans Health Administration (VHA) for Chronic Headache Disease: A Qualitative Study

“…Further, a better-defined headache care pathway from primary care to headache specialty care may especially help facilitate appropriate referrals and make healthcare navigation easier for patients with headache diseases. Clinical care pathways focusing on care quality and safety in headache management for national healthcare system models have been proposed elsewhere (31). Clear and timely communication between providers who care for patients with headache is essential to improve care coordination and expedite treatment referrals and prescriptions.…”

Understanding the diagnoses and medical care experience of patients with new daily persistent headache: a qualitative study in Spain

“…Moreover, in Spain, the diagnosis and management of NDPH by neurologists may be delayed by the structure of healthcare. 15 When experiencing a headache, the patient first goes to the primary care physician and is subsequently referred to a medical specialist. The neurologist may be one of the options, because the NDPH may not have been identified and the patient may present clinical manifestations that can be confused with other disorders that require other specialists such as anaesthesiologists, orthopedists, etc.…”

“…12 Regarding the management of headache pain, patients first go to their general primary care physician (Family and Community Medicine specialist), and based on their clinical judgement may refer patients to other medical specialists in specialty care for pain management, such as specialists in neurology and anaesthesiologyresuscitation. [13][14][15] For headaches (in the absence of trauma), the specialist of reference is the neurologist. 15 16 Patients may also be referred to special units such as 'Pain units' (run by anaesthesiologists) or 'specialised headache units' (run by neurologists).…”

“…13–15 For headaches (in the absence of trauma), the specialist of reference is the neurologist. 15 16 Patients may also be referred to special units such as ‘Pain units’ (run by anaesthesiologists) or ‘specialised headache units’ (run by neurologists). 16 17 However, traditionally most hospitals do not have specialised units in headache diagnosis and treatment.…”