Over the past 20 years, the use of telemedicine has increased exponentially. Its fundamental aim is to improve access to care. In this review, we assess the extent to which telemedicine has fulfilled this promise across medical domains. Additionally, we assess whether telemedicine has improved related health outcomes. Finally, we determine who has benefited from this novel form of health care delivery. A review of the literature indicates that ( a) telemedicine has improved access to care for a wide range of clinical conditions ranging from stroke to pregnancy; ( b) telemedicine in select circumstances has demonstrated improved health outcomes; and ( c) telemedicine has addressed geographical, but less so social, barriers to care. For telemedicine to fulfill its promise, additional evidence needs to be gathered on health outcomes and cost savings, the digital divide needs to be bridged, and policy changes that support telemedicine reimbursement need to be enacted.

Objective There has been a rise in urgent care centers throughout the country over the past 10 years, leading to an increase in patients accessing medical care in these locations. These centers advertise an alternative to the Emergency Department (ED) for the evaluation and treatment of urgent medical conditions. The goal of this analysis was to examine the use of urgent care visits for migraine within 2 urgent care centers within a large academic medical system in New York City. We examined the trends in management and treatment of migraine in these urgent care settings, as well as prescriptions and instructions given to this patient population upon discharge. We paid particular attention to whether the medications administered and prescribed on discharge were those recommended by American Headache Society migraine management guidelines. Methods We conducted a retrospective chart review of patients with migraine diagnoses at 2 different urgent care locations within 1 large urban medical center. We determined baseline patient demographics, previous migraine characteristics, frequencies of reasons for urgent care visits as well as various medications administered, medications prescribed on discharge, and characteristics of patient outcomes post‐discharge. Results Of the 78 patients who visited urgent care with a migraine diagnosis, 20 (25.6%) had a known primary care provider within the urgent care centers' healthcare system. More than three‐fourths of all patients (78.2%) had a self‐reported history of either recurrent headache or migraine prior to the urgent care visit. Of those with a documented frequency of prior headaches, 94.1% (32/34) had episodic migraine and 79.4% (27/34) experienced at most 1‐2 headache days per month. Of those presenting to the urgent care during an episode of migraine, 12.3% (9/73) were given intravenous metoclopramide and none were given subcutaneous sumatriptan or intravenous prochlorperazine. Of those with reported nausea or vomiting with their migraine, 46.2% (18/39) received an anti‐emetic at the visit and 33.3% (13/39) were given an anti‐emetic prescription. Only 11.1% (6/54) of patients who did not have a record of previous triptan use were given a triptan prescription at the urgent care visit. Conclusions The majority of patients in our study who sought medical treatment for migraine in these 2 urgent care centers were not established patients within the urgent care centers' healthcare system. While 93.6% (73/78) of patients were experiencing current pain upon presentation to the urgent care centers, only 12.3% (9/73) received administration of the medications with the highest level of evidence by the American Headache Society (Level B) for acute migraine treatment in an ED. In addition, the majority of patients with a migraine history presenting to the urgent care setting were not given triptans or anti‐emetic prescriptions upon discharge from their urgent care visit. Having these migraine‐specific prescriptions may improve self‐treatment at home should a migraine attack recur.

Objective. Increasingly, patients are seeking same-day care at urgent care (UC) facilities. Little is known about the health care utilization patterns of patients who visit UC facilities for headache and migraine. We examined the frequency of headache and migraine visits and revisits at UC facilities. Methods. We conducted a retrospective cohort study of headache not otherwise specified (NOS) and migraine visits from 67 NYC UC facilities over an eight-month period. We report descriptive analyses, the frequency of headache NOS revisits, and the elapsed time to revisits. Results. There were 10,240 patients who visited UC facilities for headache NOS or migraine within the eight-month period. The majority of patients, 6,994 (68.3%), were female, and the mean age (SD) was 35.1 (15.0) years. Most (93.9%) patients (N = 9,613) lived within 60 miles of NYC; 5.5% (N = 564) had at least one revisit, and among re-visitors, there was an average (SD) of 2.2 (0.7) visits to UC facilities during the study period and an average time to revisit (SD) of 61.3 (55.2) days. Conclusions. In just eight months, there were >10,000 headache NOS and migraine visits to UC facilities in NYC, with half of revisits occurring within 90 days. Future work should examine headache management in UC facilities.