Headache pathway with GP open access to MRI scans

1. Headache pathway with GP open access to MRI scans • Audit • - The first 100 GP referrals were audited • - These were compared to previous standard • practice and previously published data • 100 MRI requests for patients with headache • from out-patients were also used for comparison • Patient satisfaction was also assessed Background -Headache referrals account for 1/3 of neurology out- patient attendances in the UK -many are to obtain imaging to reassure clinician and patient that no serious pathology is being missed -Most primary headaches are migraine, with tension headaches the next most common. Medicine overuse and cluster headaches also need to be considered Method -A headache pathway was therefore agreed between primary care, neurologists and neuro-radiologists. It covered all GP’s in NHS Nottingham City PCT (62 practices) -it involved algorithms to assist diagnosis, and then a second section to advice on best practice treatments -MRI was chosen over CT scanning as it is more sensitive, but as it picks up more non significant abnormalities great care was taken to ensure reporting was done in a way suitable for GP’s - It was approved by the PCT and area prescribing Committee -Funding was identified as an Invest to Save project • Results • GP referrals were generally older than those from neurology clinic (mean age 48.5 vs 39.6) • GP’s referred slightly more female patients • 61% of GP scan were completely normal vs 72% from neurology out-patients • 14% of GP scans and 13% of out-patient scans showed incidental findings – the majority of these were sinus or mastoid disease • 24% of GP scans and 23% of out-patient scans showed either small vessel ischaemia of non specific white matter lesions which are markers of CVD risk (and not picked up using CT scans) • 9% of GP scans showed significant abnormalities – cerebellar tumour, Chiari 1 malformation, vasculitis and benign intracranial hypertension • 4% of out-patient scans showed significant abnormalities – pineal cyst, intracranial hypertension and global atrophic changes in a young patient Patient Satisfaction with Service -91% of Scans were done within 4 weeks -86% of patients agreed the referral and MRI process was smooth and uncomplicated The Future -Service expanding to cover next door PCT -Ongoing audit of referrals with feedback to GP’s Work on future funding given rebundling of tariffs – scans cost approx £180 each Hugh Porter : University of Nottingham Health Service 2010