DOI: 10.5061/dryad.d7wm37pzn
title: 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

description: 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&lt;0.001). The mean cost
 difference at 12 months increased to £518 (95% CI £401 to £637,
 p&lt;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&lt;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.
description: The study was an independent single Trust site (at Guy's and
 St Thomas' NHS Foundation Trust) prospective, observational
 study. Patients were recruited either at the neurology department or the
 radiology department. Data was collected by a research
 member at baseline and then quarterly up to 12 months following
 recruitment. Data collection was completed in February 2019. Data at
 baseline was collected before the participant’s initial appointment
 (either neurology appointment or MRI exam) at GSTT. Follow-up data was
 collected as per the participants’ preference, either via phone, email or
 post. The participants’ preference was established at baseline and
 recorded in the case report form. All data was collected using an
 electronic case report form (RedCap) and subsequently exported to
 Microsoft Excel 2013 and analysed using Stata 15.0.
description: Only
 data from participants that withdrew the informed consent was not
 considered in the analyses (intention to treat analysis). A very high
 degree of costing data completeness was expected given the comprehensive
 data collection methodology. However, where data for the estimate of the
 total healthcare costs was missing, mean values from the total sample were
 inputted.