Abstract
BackgroundHeadache disorders are highly prevalent, and have a substantial and negative impact on health worldwide. They are largely treatable, but differences in structure, objectives, organization and delivery affect the quality of headache care. In order to recognize and remedy deficiencies in care, the Global Campaign against Headache, in collaboration with the European Headache Federation, recently developed a set of quality indicators for headache services. These require further assessment to demonstrate fitness for purpose. This is their first implementation to evaluate quality in headache care as a multicentre national study.MethodsBetween September and December 2016, we applied the quality indicators in six Italian specialist headache centres (Bologna, Firenze, Modena, Padova, Roma Campus Bio-Medico and Roma Sapienza). We used five previously developed assessment instruments, translated into Italian according to Lifting The Burden’s translation protocol for hybrid documents. We took data from 360 consecutive patients (60 per centre) by questionnaire and from their medical records, and by different questionnaires from their health-care providers (HCPs), including physicians, nurses, psychologists and nursing assistants.ResultsThe findings, comparable between centres, confirmed the feasibility and practicability of using the quality indicators in Italian specialist headache centres. The questionnaires were easily understood by HCPs and patients, and were not unduly time-consuming. Diagnoses were almost all (> 97%) according to ICHD criteria, and routinely (100%) reviewed during follow-up. Diagnostic diaries were regularly used by 96% of physicians. Referral pathways from primary to specialist care existed in five of the six clinics, as did urgent referral pathways. Instruments to assess disability and quality of life were not used regularly, a deficiency that needs to be addressed.ConclusionThis Italy-wide survey confirmed in six specialist centres that the headache service quality indicators are fit for purpose. By establishing majority practice, identifying commonalities and detecting deficits as a guide to quality improvement, the quality indicators may be used to set benchmarks for quality assessment. The next step is extend use and evaluation of the indicators into non-specialist care.
Highlights
Headache disorders are highly prevalent, and have a substantial and negative impact on health worldwide
In the field of headache disorders, systematic classification and diagnostic criteria have been in place since 1988 [1], no definition of service quality existed until recently [2]
In one centre (Modena), one physician refused to complete the questionnaire; in all other cases, both health-care providers (HCPs) and patients reported that the questionnaires were easy to apply, readily understood and not unduly time consuming
Summary
Headache disorders are highly prevalent, and have a substantial and negative impact on health worldwide. In order to recognize and remedy deficiencies in care, the Global Campaign against Headache, in collaboration with the European Headache Federation, recently developed a set of quality indicators for headache services. These require further assessment to demonstrate fitness for purpose. Headache disorders are highly prevalent, with major negative impacts on health, well-being and productivity worldwide They are treatable, but differences in structure, objectives, organization and delivery affect the quality of medical care provided for them. The Global Campaign against Headache [3, 4], conducted by Lifting the Burden (LTB), a UK-registered non-governmental organization in official relations with the World Health Organization, aims inter alia to remedy deficiencies in headache-care worldwide This requires a means of identifying such deficiencies. In a collaborative project with the European Headache Federation (EHF), LTB used various qualitative research methods to develop, through focus-group consultations and expert consensus, a definition of quality applicable to headache services
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