Rushed Office Visits May Lead To Poor Headache Management

John N. Mafi, M.D. Fellow, Harvard Combined Program in General Medicine Beth Israel Deaconess Medical Center Brookline, MA 02446MedicalResearch.com Interview with:
John N. Mafi, M.D.

Fellow, Harvard Combined Program in General Medicine
Beth Israel Deaconess Medical Center
Brookline, MA 02446

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Mafi: Headache costs our healthcare system over 30 billion dollars annually. Clinical guidelines recommend conservative treatments for uncomplicated headache, such as counseling on dietary trigger avoidance. The Choosing Wisely Campaign of the American Board of Internal Medicine has in turn identified advanced imaging (e.g. CT or MRI) and opioid or barbiturate medications as low value treatments in the management of headache. In this context we used a nationally representative database to evaluate trends in physician practice patterns on headache management. We found a doubling in use of advanced imaging, referrals to other physicians and no change in opioid/barbiturate medications, although these continued to be used at high rates (18%). We also found a decline in life-style modification counseling, meant to prevent headaches from starting.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Mafi: The management of headache represents an important opportunity for lowering costs and improving quality in the U.S. healthcare system. Additionally, the rise in advanced imaging, referrals to other physicians, and the decline in counseling reflects a general and troubling trend in American healthcare, and to me suggests that the 20-minute visit-based model of healthcare is broken. We need to rapidly pass legislation towards reimbursing doctors to care for patients outside the confines of the office visit, such as doctors and patients using technology to collaborate on their medical records or manage chronic conditions.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Mafi: Future research should assess to what degree does “being rushed” during an office visit impact doctors’ behavior in ordering high cost imaging or specialty referrals. More research needs to also evaluate novel interventions using technology or innovative payment models to promote high value care and eliminating high cost and wasteful healthcare services

Citation:

Trends in the Ambulatory Management of Headache: Analysis of NAMCS and NHAMCS Data 1999–2010

John N. Mafi M.D. Samuel T. Edwards M.D., Nigel P. Pedersen M.B., B.S.,
Roger B. Davis Sc.D., Ellen P. McCarthy Ph.D., M.P.H., Bruce E. Landon M.D., M.B.A., M.Sc.

Journal of General Internal Medicine January 2015 Date: 08 Jan 2015

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