M Braschinsky1,2, S Haldre1,2, M Kals3, M Arge4, B Saar4, M Niibek4, Z Katsarava5, T J Steiner6,7. 1. Estonian Headache Society, Tartu, Estonia. 2. Clinic of Neurology, University of Tartu, Tartu, Estonia. 3. Estonian Genome Centre, University of Tartu, Tartu, Estonia. 4. Faculty of Medicine, University of Tartu, Tartu, Estonia. 5. Department of Neurology, University of Duisburg-Essen, Essen, Germany. 6. Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway. 7. Division of Brain Sciences, Imperial College London, London, UK.
Abstract
BACKGROUND AND PURPOSE: Our earlier study showed that structured education of general practitioners (GPs) improved their practice in headache management. Here the duration of this effect was assessed. METHODS: In a follow-up observational study in southern Estonia, subjects were the same six GPs as previously, managing patients presenting with headache as the main complaint. Data reflecting their practice were collected prospectively during a 1-year period commencing 2 years after the educational intervention. The primary outcome measure was referral rate (RR) to neurological services. Comparisons were made with baseline and post-intervention data from the earlier study. RESULTS: In 366 patients consulting during the follow-up period, the RR was 19.9%, lower than at baseline (39.5%; P < 0.0001) or post-intervention (34.7%; P < 0.0001). The RR was diagnosis-dependent: the biggest decline was for migraine. Use of headache diagnostic terms showed changes generally favouring specific terminology. In particular, the proportion of patients given migraine diagnoses greatly increased whilst use of the inappropriate M79.1 (Pericranial) myalgia almost disappeared. Requests for investigations, which had fallen from 26% (of patients seen) at baseline to 4% post-intervention, resurged to 23% (mostly laboratory investigations; requests for X-rays continued to dwindle). Initiation of treatment by the GPs remained at the post-intervention level of just over 80% (up from baseline 58%). CONCLUSIONS: Improvements in GPs' practice after a structured educational programme mostly last for ≥3 years, some showing further betterment. A few measures suggest the beginnings of a decline towards baseline levels. This policy-informing evidence for continuing medical education indicates that the educational programme needs repeating every 2-3 years.
BACKGROUND AND PURPOSE: Our earlier study showed that structured education of general practitioners (GPs) improved their practice in headache management. Here the duration of this effect was assessed. METHODS: In a follow-up observational study in southern Estonia, subjects were the same six GPs as previously, managing patients presenting with headache as the main complaint. Data reflecting their practice were collected prospectively during a 1-year period commencing 2 years after the educational intervention. The primary outcome measure was referral rate (RR) to neurological services. Comparisons were made with baseline and post-intervention data from the earlier study. RESULTS: In 366 patients consulting during the follow-up period, the RR was 19.9%, lower than at baseline (39.5%; P < 0.0001) or post-intervention (34.7%; P < 0.0001). The RR was diagnosis-dependent: the biggest decline was for migraine. Use of headache diagnostic terms showed changes generally favouring specific terminology. In particular, the proportion of patients given migraine diagnoses greatly increased whilst use of the inappropriate M79.1 (Pericranial) myalgia almost disappeared. Requests for investigations, which had fallen from 26% (of patients seen) at baseline to 4% post-intervention, resurged to 23% (mostly laboratory investigations; requests for X-rays continued to dwindle). Initiation of treatment by the GPs remained at the post-intervention level of just over 80% (up from baseline 58%). CONCLUSIONS: Improvements in GPs' practice after a structured educational programme mostly last for ≥3 years, some showing further betterment. A few measures suggest the beginnings of a decline towards baseline levels. This policy-informing evidence for continuing medical education indicates that the educational programme needs repeating every 2-3 years.
Keywords:
continuing medical education; duration of effect; effect measurement; global campaign against headache; headache disorders; management; policy; primary care
Authors: B Lenz; Z Katsarava; R Gil-Gouveia; G Karelis; B Kaynarkaya; L Meksa; E Oliveira; F Palavra; I Rosendo; M Sahin; B Silva; D Uludüz; Y Z Ural; I Varsberga-Apsite; S T Zengin; L Zvaune; T J Steiner Journal: J Headache Pain Date: 2021-04-28 Impact factor: 7.277
Authors: Timothy J Steiner; Rigmor Jensen; Zaza Katsarava; Lars Jacob Stovner; Derya Uluduz; Latifa Adarmouch; Mohammed Al Jumah; Ali M Al Khathaami; Messoud Ashina; Mark Braschinsky; Susan Broner; Jon H Eliasson; Raquel Gil-Gouveia; Juan B Gómez-Galván; Larus S Gudmundsson; Akbar A Herekar; Nfwama Kawatu; Najib Kissani; Girish Baburao Kulkarni; Elena R Lebedeva; Matilde Leonardi; Mattias Linde; Otgonbayar Luvsannorov; Youssoufa Maiga; Ivan Milanov; Dimos D Mitsikostas; Teymur Musayev; Jes Olesen; Vera Osipova; Koen Paemeleire; Mario F P Peres; Guiovanna Quispe; Girish N Rao; Ajay Risal; Elena Ruiz de la Torre; Deanna Saylor; Mansoureh Togha; Sheng-Yuan Yu; Mehila Zebenigus; Yared Zenebe Zewde; Jasna Zidverc-Trajković; Michela Tinelli Journal: J Headache Pain Date: 2021-07-21 Impact factor: 7.277