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Lindsey HM, Goldman RE, Riley SD, Baird S, Burrone L, Grinberg AS, Fenton BT, Sico JJ, Damush TM. Complex Patient Navigation by Veteran Patients in the Veterans Health Administration (VHA) for Chronic Headache Disease: A Qualitative Study. J Patient Exp 2023; 10:23743735231151547. [PMID: 36710997 PMCID: PMC9880564 DOI: 10.1177/23743735231151547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Patients living with headache diseases often have difficulty accessing evidence-based care. Authors conducted a qualitative research study with 20 patients receiving headache care at seven Headache Centers of Excellence within the Veterans Health Administration to examine their experiences navigating headache care. This study employed thematic qualitative analysis and conducted cross-case comparisons. Several key findings emerged. 1) Most patients saw multiple healthcare providers over numerous years before reaching a headache specialist to manage chronic headaches. 2) Receipt of high-quality and comprehensive headache specialty care was associated with high satisfaction. 3) Patients with headache diseases reported oftentimes they experienced an arduous journey across multiple healthcare systems and between several healthcare providers before receiving evidence-based headache treatment that they found acceptable. Results demonstrate that most patients were satisfied with their current specialty headache care in the Veterans Health Administration. Authors discuss implications for future studies and highlight ways to improve patient satisfaction and timely access to appropriate headache care.
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Affiliation(s)
- Hayley M Lindsey
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
- University of Rhode Island, Kingston, RI, USA
- Hayley M Lindsey, VHA Headache Centers of
Excellence Research and Evaluation Center, VA Connecticut Healthcare System 200
Edison Road Orange, CT, 06477, USA; Pain, Research, Informatics, Medical
Comorbidities and Education (PRIME) Center, VA Connecticut Healthcare System,
200 Edison Road Orange, CT, 06477, USA; University of Rhode Island, Kingston,
RI, 02881, USA.
| | - Roberta E Goldman
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
- Warren Alpert Medical School of Brown
University, Providence, RI, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Samantha D Riley
- Veterans Health Administration Health Services Research and
Development (HSR&D) Center for Health Information and Communication and Quality
Enhancement Research Initiative Expanding expertise Through E-health Network
Development (EXTEND) QUERI Centers, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Sean Baird
- Veterans Health Administration Health Services Research and
Development (HSR&D) Center for Health Information and Communication and Quality
Enhancement Research Initiative Expanding expertise Through E-health Network
Development (EXTEND) QUERI Centers, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Laura Burrone
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
| | - Amy S Grinberg
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
| | - Brenda T Fenton
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
| | - Jason J Sico
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Teresa M Damush
- Veterans Health Administration Health Services Research and
Development (HSR&D) Center for Health Information and Communication and Quality
Enhancement Research Initiative Expanding expertise Through E-health Network
Development (EXTEND) QUERI Centers, Roudebush VA Medical Center, Indianapolis, IN, USA
- Indiana University School of
Medicine, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
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Goldman RE, Damush TM, Kuruvilla DE, Lindsey H, Baird S, Riley S, Burrone Bs L, Grinberg AS, Seng EK, Fenton BT, Sico JJ. Essential components of care in a multidisciplinary headache center: Perspectives from headache neurology specialists. Headache 2022; 62:306-318. [PMID: 35293614 DOI: 10.1111/head.14277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVE Comprehensive headache care involves numerous specialties and components that have not been well documented or standardized. This study aimed to elicit best practices and characterize important elements of care to be provided in multidisciplinary headache centers. METHODS Qualitative, semi-structured telephone interviews with a purposive sample of headache neurology specialists from across the US, using open-ended questions. Interviews were recorded, transcribed, and coded. Coded data were further analyzed using immersion/crystallization techniques for final interpretation. RESULTS Mean years providing headache care was 17.7 (SD = 10.6). Twelve of the 13 participants held United Council for Neurologic Subspecialties headache certification. Six described their practice site as providing multidisciplinary headache care. Participants explained most of their patients had seen multiple doctors over many years, and had tried numerous unsuccessful treatments. They noted patients with chronic headache frequently present with comorbidities and become stigmatized. All participants asserted successful care depends on taking time to talk with and listen to patients, gain understanding, and earn trust. All participants believed multidisciplinary care is essential within a comprehensive headache center, along with staffing enough headache specialists, implementing detailed headache intake and follow-up protocols, and providing the newest medications, neuromodulation devices, botulinum toxin injections, monoclonal antibodies, nerve blocks and infusions, and treatment from a health psychologist. Other essential services for a headache center are other behavioral health practitioners providing cognitive behavioral therapy, mindfulness, biofeedback and pain management; and autonomic neurology, neuropsychology, vestibular audiology, sleep medicine, physical therapy, occupational therapy, exercise physiology, speech therapy, nutrition, complementary integrative health modalities, and highly trained support staff. CONCLUSION While headache neurology specialists form the backbone of headache care, experts interviewed for this study maintained their specialty is just one of many types of care needed to adequately treat patients with chronic headache, and this is best provided in a comprehensive, multidisciplinary center.
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Affiliation(s)
- Roberta E Goldman
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA
| | - Teresa M Damush
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, Indiana, USA.,Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Deena E Kuruvilla
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Westport Headache Institute, Westport, Connecticut, USA
| | - Hayley Lindsey
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Sean Baird
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Samantha Riley
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Laura Burrone Bs
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA
| | - Amy S Grinberg
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA
| | - Elizabeth K Seng
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.,The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Brenda T Fenton
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Jason J Sico
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
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Gültekin M, Balci E, İsmaİLOĞULLARI S, Yetkin F, Baydemir R, Erdoğan F, Mİrza M, Özge A. Awareness of Migraine Among Primary Care Physicians in Turkey: A Regional Study. Noro Psikiyatr Ars 2019; 55:354-357. [PMID: 30622393 DOI: 10.5152/npa.2016.19228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/25/2016] [Indexed: 01/03/2023] Open
Abstract
Introduction Migraine is a primary headache that involves genetic and environmental factors. In studies conducted in different countries, migraine was shown to be underdiagnosed, treated insufficiently, and highly related to disability. The primary aim of this study was to identify the competence in making a diagnosis of migraine by primary care physicians who provide basic health care to patients. Methods Primary care physicians (266 individuals) working in the primary health service centers located within the borders of Kayseri province were included in our study. The research was conducted by using techniques such as face-to-face meetings with the primary care physicians and by participants filling in questionnaires. A neurologist evaluated the questionnaire form. The information provided by the participants was evaluated according to the migraine without aura diagnostic criteria prepared by the International Headache Society (ICHD-3 Beta). Results Only 10.5% participants were able to give the complete diagnostic criteria of migraine without aura. The most well-known properties were unilateral (53.4%) and pulsating headaches (47%). Conclusion This study showed that educational programs are required regarding migraines for primary care physicians, supported by complete educational material.
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Affiliation(s)
- Murat Gültekin
- Department of Neurology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Elçin Balci
- Department of Public Health, Erciyes University School of Medicine, Kayseri, Turkey
| | | | - Fatih Yetkin
- Department of Neurology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Recep Baydemir
- Department of Neurology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Füsun Erdoğan
- Department of Neurology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Meral Mİrza
- Department of Neurology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Aynur Özge
- Department of Neurology, Mersin University School of Medicine, Mersin, Turkey
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