Challenges to stakeholder engagement in population headache care in an academic health system

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Objective: Create interdisciplinary and inter-professional knowledge networks to focus on cost-effective, best practice headache care with 10 University Community Clinics (CC).

Background: The University of Utah (U of U) serves a catchment area that represents 10% of the continental US. Its UCNS – accredited headache center receives over 400 referrals monthly. The 10 CC comprise an average of 30% of the referral base. Given the current structure of fee for service care, we have found that a busy primary care provider is most likely to treat with pain medication and refer on for neurologic consultation. This motivated an effort to improve the diagnosis and management of headache in primary care.

Design/Methods: We leveraged an existing program within the U of U, Project ECHO (Extension for Community Healthcare Outcomes) to provide expert headache resources to our CC partners. An inter-professional team - including adult and pediatric neurology/headache clinicians, pharmacy, physical therapy, and psychology – participated in bi-weekly sessions, each of which had clinical didactic (10–15 minute) presentations from the team, case presentation from a CC partner, Tele-Edu note completed in our shared EMR and offered 1 hour CME.

Results: 26 ECHO sessions were offered over a 15 month period. Seventeen were attended with an average of four attendees per session in addition to the mentors. 35% of sessions were not attended at all. On retrospective chart review 50% of recommendations from the ECHO sessions were not followed. Of note, 30% of the patients presented at ECHO were still seen in headache clinic. However, despite the generally unfavorable attendance of the ECHO training program, there was also strong evidence of headache care improvement.

Conclusions: This work highlights the difficulties in engaging primary care practitioners above their already busy schedules. But also suggests that the increased awareness associated with out headache-based efforts may result in improved population headache care.