This study aims to evaluate whether direct access from General Practitioners (GPs) to Magnetic Resonance Imaging (MRI) for patients with chronic headache decreases overall NHS costs and increases patient satisfaction compared to clinical practice with referral to Neurology Services.
Headache is the most common symptom reported in the community, affecting more than 90% of the population at some point in their lifetime. Despite the low level of referrals to secondary care (as most patients tend to be managed within primary care), the absolute number of headache episodes (due to its high prevalence) makes headache the most frequently listed reason for referral to the Neurologist and thus, utilises precious capacity that is severely constrained. In order to support future management of this chronic condition, this study aims to evaluate existing clinical pathways in the management of patients with chronic headache - either referral to the Neurology Department or direct access to Imaging. Participants will be followed-up for a period of 12 months after the initial Secondary Care episode (either an MRI scan or Neurology appointment). Costs from the NHS perspective and self-perceived patient quality of life will be assessed and cost per patient and cost-effectiveness analyses will be performed.
Study Type
OBSERVATIONAL
Enrollment
296
MRI head scan to be performed as the first Secondary Care contact.
Outpatient appointment with Neurologist as the first Secondary Care contact
Guy's and St Thomas' NHS Foundation Trust
London, United Kingdom
RECRUITING6-month cost analysis per patient referred to either MRI or Neurology (measured in £ per patient)
The primary objective is to evaluate whether direct access from General Practitioners (GPs) to Magnetic Resonance Imaging (MRI) for patients with chronic headache is associated with cost-savings at 6 months after the initial episode at Secondary Care (either an MRI scan or a Neurology Outpatient appointment) compared to clinical practice with referral to the Neurology Department.
Time frame: 6 months after the initial episode at Secondary Care (either an MRI scan or Neurology Outpatient appointment)
12-month cost analysis per patient referred to either MRI or Neurology (measured in £ per patient)
This secondary objective is aimed at evaluating whether direct access from General Practitioners (GPs) to Magnetic Resonance Imaging (MRI) for patients with chronic headache is associated with cost-savings at 12 months after the initial episode at Secondary Care (either an MRI scan or a Neurology Outpatient appointment) compared to clinical practice with referral to the Neurology Department.
Time frame: 12 months after the initial episode at Secondary Care (either an MRI scan or Neurology Outpatient appointment)
6-month cost-effectiveness analysis per patient referred to either MRI or Neurology (measured in £ per QALY)
This secondary objective is aimed at evaluating whether direct access from General Practitioners (GPs) to Magnetic Resonance Imaging (MRI) for patients with chronic headache is cost-effective at 6 months after the initial episode at Secondary Care (either an MRI scan or a Neurology Outpatient appointment) compared to clinical practice with referral to the Neurology Department.
Time frame: 6 months after the initial episode at Secondary Care (either an MRI scan or Neurology Outpatient appointment)
12-month cost-effectiveness analysis per patient referred to either MRI or Neurology (measured in £ per QALY)
This secondary objective is aimed at evaluating whether direct access from General Practitioners (GPs) to Magnetic Resonance Imaging (MRI) for patients with chronic headache is cost-effective at 12 months after the initial episode at Secondary Care (either an MRI scan or a Neurology Outpatient appointment) compared to clinical practice with referral to the Neurology Department.
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Time frame: 12 months after the initial episode at Secondary Care (either an MRI scan or Neurology Outpatient appointment)
Patient satisfaction associated with both clinical pathways (direct referral to MRI or Neurology)
To evaluate and compare the levels of patient satisfaction associated with the two pathways: i) with direct access to MRI from Primary Care; and ii) with referral to the Neurology Department. A patient satisfaction questionnaire will be used to quantify patient satisfaction at 6 months.
Time frame: 6 months
Patient's self perceived quality of life - measured using EQ-5D-5L questionnaire
This objective aims to evaluate the patient's self-perceived quality of life associated with both pathways using a standard questionnaire (EQ-5D-5L).
Time frame: 6 months
Patient's self perceived quality of life - measured using HIT-6 questionnaire
This objective aims to evaluate the patient's self-perceived quality of life associated with both pathways using a standard headache-specific questionnaire (HIT-6 questionnaire).
Time frame: 6 months
Patient's self perceived quality of life - measured using MIDAS questionnaire
This objective aims to evaluate the patient's self-perceived quality of life associated with both pathways using a standard headache-specific questionnaire (MIDAS questionnaire).
Time frame: 6 months
Time-off work (measured in half days) due to chronic headache
To evaluate the headache burden and time-off work (both measured in half days) due to the chronic headache associated with the pathway with direct access to MRI compared with referral to the Neurology Department.
Time frame: 12 months