Quality indicators in headache care: an implementation study in six Italian specialist-care centres

Pellesi, Lanfranco; Benemei, Silvia; Favoni, Valentina; Lupi, Carla; Mampreso, Edoardo; Negro, Andrea; Paolucci, Matteo; Steiner, Timothy J.; Ulivi, Martina; Cevoli, Sabina; Guerzoni, Simona

doi:10.1186/s10194-017-0762-x

Cited by 20 publications

(12 citation statements)

References 13 publications

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“…Variability was also observed in the duration of follow-up, with values ranging from 10-40 minutes and a mean length of 21 minutes. Such heterogeneity in visit duration is consistent with previous studies of headache centres' efficiency in Italy 9 where patients did not perceive visit length as a factor impacting quality of care.…”

Section: Duration Of Visitssupporting

confidence: 90%

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

Kainth¹,

Murphy²,

Rossi³

et al. 2018

European Neurological Review

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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.

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Section: Duration Of Visitssupporting

confidence: 90%

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

Kainth¹,

Murphy²,

Rossi³

et al. 2018

European Neurological Review

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“…Inappropriate ED utilization causes overcrowding and consequently an increase in intervention times, which is one of the main reasons for leaving ED to prematurely [45], especially among patients with headache compliant [46]. This suggests that a healthcare system could reduce ED visits among migraine patients by increasing the availability of urgent care or walk-in appointments [47].…”

Section: Discussionmentioning

confidence: 99%

Rapid referral for headache management from Emergency Department to Headache Centre: four years data

Negro

Spuntarelli

Sciattella

et al. 2020

Preprint

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Background Headache is one of the most common reason for medical consultation to emergency department (ED). Inappropriate use of ED for non-urgent conditions is a problem in terms of crowding emergency facilities, unnecessary testing and treatment, increased medical bills, burden on medical service providers and weaker patient-primary care provider relationships. The aim of this study was to analyzed the different steps of the ED management of patients with headache to detect those deficiencies that can be overcome by a prompt referral to a headache clinic.Methods The study is a retrospective analysis of the electronic medical records (EMRs) of patients discharged from an academic ED between 1 January 2015 and 31 December 2018 and referred to the tertiary level headache centre of the same hospital. We analyzed all the aspects related to the permanence in ED and we also assessed if there was a concordance between ED diagnosis and ours.Results Among our sample of 244 patients, 76.2% were admitted as green tag, 75% underwent a head computed tomography, 19.3% received neurological consultation, 43% did not receive any pharmacological treatment and 62.7% still had headache at discharge. Length in ED stay was associated with the complaint of the first aura ever (p = 0.014) and if patients received consultations (p < 0.001). Concordance analysis shown a significant moderate agreement only for the diagnosis of migraine and only between triage and headache centre.Conclusions The majority of patients who went to the ED complaining of headache received the same therapy regardless of their diagnosis and in many cases the headache had not yet resolved at the time of discharge. Given the several shortcomings of ED management of headaches, a rapid referral to the headache centre is of primary importance to help the patient obtain a definite diagnosis and adequate treatment.

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“…CM management in Italy is largely inadequate and expensive because of clinical and operational issues. Currently, patients with CM in Italy are managed at tertiary referral headache centres, but long waiting lists and the paucity of specialists at each center can hinder timely access to high-quality multidisciplinary care [80].…”

Section: Chronic Migraine Management In Italymentioning

confidence: 99%

Current and emerging evidence-based treatment options in chronic migraine: a narrative review

et al. 2019

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BackgroundChronic migraine is a disabling condition that is currently underdiagnosed and undertreated. In this narrative review, we discuss the future of chronic migraine management in relation to recent progress in evidence-based pharmacological treatment.FindingsPatients with chronic migraine require prophylactic therapy to reduce the frequency of migraine attacks, but the only currently available evidence-based prophylactic treatment options for chronic migraine are topiramate and onabotulinumtoxinA. Improved prophylactic therapy is needed to reduce the high burden of chronic migraine in Italy. Monoclonal antibodies that target the calcitonin gene-related peptide (CGRP) pathway of migraine pathogenesis have been specifically developed for the prophylactic treatment of chronic migraine. These anti-CGRP/R monoclonal antibodies have demonstrated good efficacy and excellent tolerability in phase II and III clinical trials, and offer new hope to patients who are currently not taking any prophylactic therapy or not benefitting from their current treatment.ConclusionsTreatment of chronic migraine is a dynamic and rapidly advancing area of research. New developments in this field have the potential to improve the diagnosis and provide more individualised treatments for this condition. Establishing a culture of prevention is essential for reducing the personal, social and economic burden of chronic migraine.

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Quality indicators in headache care: an implementation study in six Italian specialist-care centres

Cited by 20 publications

References 13 publications

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

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

Rapid referral for headache management from Emergency Department to Headache Centre: four years data

Current and emerging evidence-based treatment options in chronic migraine: a narrative review

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