Data from: Headache study: The management of chronic headache with referral from primary care to direct access to Magnetic Resonance Imaging (MRI) compared to Neurology services: an observational prospective study in London

Objectives. To evaluate the cost, accessibility and patient satisfaction
implications of two clinical pathways used in the management of chronic
headache. Intervention. Management of chronic headache following referral
from Primary Care that differed in the first appointment, either a
Neurology appointment or an MRI brain scan. Design and setting. A
pragmatic, non-randomised, prospective, single-center study at a Central
Hospital in London. Participants. Adult patients with chronic headache
referred from Primary to Secondary Care. Primary and secondary outcome
measures. Participants’ use of health care services and costs were
estimated using primary and secondary care databases and questionnaires
quarterly up to 12 months post-recruitment. Cost analyses were compared
using generalised linear models (GLM). Secondary outcomes assessed: access
to care, patient satisfaction, headache burden and self-perceived quality
of life using headache-specific (MIDAS, HIT-6) and a generic questionnaire
(EQ-5D-5L). Results. Mean (SD) cost up to 6 months post-recruitment per
participant was £578 (£420) for the Neurology group (n=128) and £245
(£172) for the MRI group (n=95), leading to an estimated mean cost
difference of £333 (95% CI £253 to £413, p<0.001). The mean cost
difference at 12 months increased to £518 (95% CI £401 to £637,
p<0.001). When adjusted for baseline and follow-up imbalances
between groups, this remained statistically significant. The utilisation
of brain MRI improved access to care compared to the Neurology group
(p<0.001). Participants in the Neurology group reported higher
levels of satisfaction associated with the pathway and led to greater
change in care management. Conclusion. Direct referral to brain MRI from
Primary Care led to cost-savings and quicker access to care but lower
satisfaction levels when compared with referral to Neurology services.
Further research into the use of brain MRI for a subset of patient
population more likely to be reassured by a negative brain scan should be
considered.