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E-Consultation in Headache Medicine: A Quality Improvement Pilot Study.

Jennifer Robblee1, Amaal J Starling2

  • 1Department of Neurology, Barrow Neurological Institute, St. Joseph Hospital and Medical Center, Phoenix, AZ, USA.

Headache
|October 16, 2020
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Summary

E-consultations show promise for improving headache care access and efficiency. However, careful triage and better primary care communication are essential for successful implementation in headache medicine.

Keywords:
e-consultationheadachequality improvementreferraltelemedicinetriage

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Area of Science:

  • Neurology
  • Health Services Research

Background:

  • Access to specialized headache consultations is limited.
  • E-consultations offer an efficient method to reduce costs and enhance care continuity.
  • The specific indications, suitability, and adoption rates of e-consultations in headache patient populations require further investigation.

Purpose of the Study:

  • To evaluate the appropriateness and feasibility of e-consultations for patients referred to a headache specialist.
  • To explore potential pathways for integrating e-consultations into headache care.
  • To identify challenges and opportunities for optimizing e-consultation services in neurology.

Main Methods:

  • A quality improvement pilot study.
  • Retrospective review of 75 completed face-to-face consultations to assess e-consultation appropriateness.
  • Prospective provider surveys to identify suitable cases for e-consultation.
  • Cross-sectional review of the waiting list for theoretical triage.
  • Prospective review of 12 requested e-consultations.

Main Results:

  • 37.3% of past face-to-face consultations were deemed suitable for e-consultation.
  • Only 25% of patients on the waiting list could be theoretically triaged to e-consultation.
  • Of requested e-consultations, 41.7% required conversion to face-to-face visits, and only 33.3% were fully appropriate.
  • Migraine prophylaxis was a common reason for e-consultation requests (50%).

Conclusions:

  • E-consultation is a viable option for headache medicine if properly triaged.
  • Developing clear referral pathways is crucial for early patient intervention and guideline adherence.
  • Enhanced communication between specialists and primary care providers is necessary for system optimization.