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AUDIT OF HEADACHE REFERRALS FROM PRIMARY CARE TO A REGIONAL HEADACHE SERVICE
  1. Stefanie Zhao Lin Lip,
  2. Sarah Louise Miller,
  3. Alok Tyagi
  1. University of Glasgow; Southern General Hospital

    Abstract

    Introduction Headache is the most common neurological symptom with which patients attend their GPs and is also the commonest reason for referral to neurology outpatient clinics. The Neurological Services Task and Finish Group in Scotland have developed various pathways for headache using SIGN and NHS Quality Improvement Scotland headache standards. Since 2011 management of chronic headache is also a QOF/QP criteria for general practitioners in Greater Glasgow & Clyde health board. Despite the wide distribution of pathways and the presence of QOF guidelines in primary care, referral practice would appear to be unchanged. The aim of this audit was to look at headache referrals to a specialist headache unit in Greater Glasgow and Clyde and compare it to available local QOF guidelines.

    Methods From the 1st June 2012–30th June 2012, data was collected from GP referral letters to obtain the number of referrals for headache, reason for referral, gender, duration of headache, acute treatments given for headache and investigations carried out prior to referral. Data collected was compared to current local QOF guidelines and referral pathways.

    Results A total of 133 patient referral letters were received from primary care during the four week period. Most referrals were routine (122; 91.7%) and there were 11 (8.3%) urgent referrals. Majority of the referrals were for treatment 65 (48.9%) of the headache disorder. The commonest referral diagnosis was migraine 73 (54.9%). There were more females 99 (74.4%) compared to males 34 (25.6%). Patients had complained of headaches for more than 2 years (60; 45.1%), <6 months (30; 22.6%), 1–2 years 17 (12.8%) and <12 months 13 (9.8%). At time of referral almost half (62, 46.6%) were deemed to have medication overuse headache by the vetting Neurologist but only one patient had had an attempt at stopping their overused medications prior to referral. Majority of patients were on prophylactic medication 76 (57.1%) for their headache disorder but when data was compared to current guidelines for referral, only 3 patients (2.3%) matched the criteria for referral for migraine. 34 (25%) patients had had neuroimaging studies done prior to referral.

    Conclusion The majority of referrals to the regional specialist headache service in Glasgow do not follow the referral guidelines. Following this audit an ‘enhanced vetting’ process has been put into place for headache referrals to the unit. The results of this audit was presented at QOF meetings for primary care in August–September 2012 and a repeat audit would be conducted in June 2013.

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