Chronic Headache: Referral to Neurologist vs Direct-access MRI

Dawn O'Shea

October 23, 2020

Direct GP referral for brain MRI may lead to cost-savings and quicker access to care, but patient satisfaction levels are lower when compared with referral to neurology services, according to research published in  BMJ Open.

The single-centre, prospective, observational study compared two clinical pathways in the management of patients with chronic headache: GP referral to the neurology department (neurology group) or directly for a brain MRI (MRI group). No change to clinical practice was involved.

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. Secondary outcomes assessed were: access to care, patient satisfaction, headache burden and self-perceived quality of life using the headache-specific (Migraine Disability Assessment Scale and Headache Impact Test) and the 5-level EQ-5D questionnaires.

Data analysis suggested that the mean (standard deviation) cost at six 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-£413; P<.001). The mean cost difference at 12 months increased to £518 (95% CI, £401-£637; P<.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 with the neurology group (P<.001). However, participants in the neurology group reported higher levels of satisfaction.

This was a single-centre study with participants recruited from one central hospital in London.

Rua T, Mazumder A, Akande Y, Margariti C, Ochulor J, Turville J, Razavi R, Peacock JL, McCrone P, Goh V, Shearer J, Afridi S. Management of chronic headache with referral from primary care to direct access to MRI compared with Neurology services: an observational prospective study in London. BMJ Open. 2020;10(10):e036097. doi: 10.1136/bmjopen-2019-036097. PMID: 33067273 View full text

This article originally appeared on Univadis, part of the Medscape Professional Network.


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