038 Referral patterns to neurology: past, present and future

The safety of using active triage to provide advice rather than a face-to-face neurology outpatient appointment

BACKGROUND

Neurology referrals from primary care are increasing. Actively triaging referrals is one way of providing a better patient-focussed service.

METHODS

We reviewed the safety and cost-effectiveness of 'advice only' rather than face-to-face appointments for neurology patients via active triage. Referrals triaged as 'advice only' were identified over a 6-month period. Data were collected on reason for referral, opinion of triaging neurologist and whether the patient re-presented to neurology within 12 months.

RESULTS

A total of 10% (236 out of 2,445) of referred patients were given advice only after active triage. A total of 71% (n = 167) had no further secondary care presentations in 12 months. The most common presentation was headache (n = 57; 13%). One patient had a major diagnostic change following delayed review.

CONCLUSIONS

'Advice only' allows patients to receive timely advice and management. It appears safe and is likely to be cost effective, although further data are required on whether it provides satisfactory outcomes for patients and general practitioners.

Should GPs have direct access to imaging for headache? A qualitative study of patients' views in the UK

OBJECTIVE

We aimed to describe patients' views of a new referral pathway of general practitioner (GP) direct access to MRI, versus imaging after referral to a specialist.

DESIGN

This qualitative study involved 20 semistructured interviews. Twenty patients (10 from each pathway) were purposively recruited and interviewed to describe their attitudes.

SETTING

A neurology headache clinic and neuroradiology services from the boroughs of Southwark and Lambeth in South London, UK.

PARTICIPANTS

Twenty patients were involved in this study.

RESULTS

Over half of the participants felt relieved once they received their scan results, while some remained uncertain about the underlying cause of their symptoms. Some participants described a long wait to see a specialist. Others described a long wait time to receive scan results, especially from their GP. Spontaneous reduction in headache symptoms occurred for some participants and for others, normal imaging results allowed them to focus more on symptom management.

CONCLUSION

Relief was reported especially when scan results had been explained clearly and without too much delay. Those with continuing pain focused on how to get relief from symptoms. Patient experience might be improved with clearer information from GPs about how patients can access results, standard reporting procedures and closer liaison between neuroradiology and GPs.

Patients' experiences of a behavioural intervention for migraine headache: a qualitative study

BACKGROUND

Migraine headache has a high prevalence and a severe impact on personal, social and work life, forming a significant burden on patients, service providers and society. There is some evidence of the effectiveness of behavioural interventions to supplement drug therapy but a recognised need to identify an effective minimal contact approach to enhance access and provide a model for use in publicly funded health systems. This study uses in-depth interviews to examine patients' experience and responses to a behavioural intervention with relaxation and CBT components delivered in three individual therapist sessions with follow-up.

METHODS

Qualitative study of 20 adults aged 18-75 years in London, UK, with clinically diagnosed migraine and at least four headache days per month. Semi-structured and tape recorded interviews were held post intervention based on a topic guide. Transcripts were coded and charted for all participants and analysed thematically.

RESULTS

The majority of participants cited the impacts of migraine and a desire for additional non-drug treatment as their main reasons for taking part and almost all completed the course. They valued contact with the therapist and almost all reported benefiting from the therapy. Post intervention they used those techniques they found most beneficial and implemented them flexibly in their daily life to reduce stress and risks of migraine or to respond to migraine. Relaxation training (deep breathing) was easily adopted and often used post intervention. The CBT components were mainly viewed positively but regarded as more challenging to learn and implement.

CONCLUSIONS

Patients' selectively identified and employed the techniques learned as 'tools' to assist in preventing and managing their migraines, with reported benefits supporting the development of minimal contact behavioural therapy to increase accessibility for adults with migraine headache and the conduct of a definitive trial.

A pilot study of cognitive behavioural therapy and relaxation for migraine headache: a randomised controlled trial

Headache is being viewed more commonly in a biopsychosocial framework, which introduces the possible utilisation of psychological treatment options, such as cognitive behavioural therapy and relaxation. No such treatments have been trialled in the UK. We conducted a randomised controlled pilot trial, comparing a brief guided self-help CBT and relaxation treatment with standard medical care (SMC), in a UK NHS setting. Participants were recruited from specialist headache clinics across London. Participants were randomised to receive either treatment or standard medical care. Our objective was to provide design information necessary for a future definitive trial of the SHE treatment, including, recruitment/retention rates, acceptability of randomisation, treatment fidelity and estimations of mean and variances of outcome measures. From the initial 275 patients identified, 73 were randomised. There was no difference in drop-out rates between SMC and treatment groups. Of the 36 participants randomised to receive treatment, 72 % attended all sessions. Findings show that a future definitive trial of the SHE treatment is feasible, with small modifications of protocol, within a UK NHS context.