More than 12 million Americans annually visit their doctors complaining of headaches. Researchers at Beth Israel Deaconess Medical Center in Boston found that clinicians ordered advanced imaging tests and provided specialist referrals for their patients suffering from headaches instead of talking with them about the pain and advising them about lifestyle changes. This lead to increased medical costs of more than $31 billion per year, while the imaging and referrals did nothing to relieve the patients' headaches.
"To me, this study suggests that the current 20 minute visit-based model of health care is broken," said the study's author, Dr. John N. Mafi. He noted that assessment of headaches depended on identifying the rare instances where underlying causes would justify imaging and specialist referrals. According to Dr. Mafi, evidence-based guidelines should be in place for routine doctor visits to prevent medical waste and fraud.
Dr. Mafi was particularly worried about the trend of ordering more imaging tests, unnecessary medications and endless referrals to other doctors. "We need to move towards promoting and reimbursing innovative solutions [like] doctors and patients electronically collaborating outside the office visit," he said.
The researchers surveyed more than 9,000 physician visits between 1999 and 2010 involving patients who went to be treated for migraines and other headaches. The study analysed 144 million patient visits, finding overuse of low-value, high-cost services such as advanced imaging, prescriptions of opioids and barbiturates, and other medical abuses. The study also found that clinician counselling declined from 23.5 percent of visits in 1999 to 18.5 percent of visits in 2010.
While regular use of acetaminophen and non-steroidal drugs like ibuprofen for migraine held at 16 percent of prescribed headache medications, clinicians tended to prescribe specialised anti-migraine medications like triptans and ergot alkaloids at an increased rate of 15.4 percent.
Preventive therapies, including anti-convulsants, anti-depressants and beta blockers were prescribed at a rate of 15.9 percent. Unlike the trend for treatment of back pain, researchers found no increase in the use of opioids or barbiturates for headaches, which held steady at 18 percent of the total visits analysed.
Tellingly, researchers found that CT scans and MRI scans for headaches increased from 6.7 percent in 1999 to 13.9 percent in 2010. Imaging use rose rapidly among patients with declared "acute symptoms", compared to patients only suffering chronic headaches.
The data reflect a sample of clinical visits for headaches from the National Ambulatory Medical Care Survey and the National Hospital Medical Care Survey. The data excluded doctor visits for proven neurological problems, such as cancer and physical trauma.
The findings of the study have been published online in the Journal of General Internal Medicine.
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