Low-value care practice in headache: a Spanish mixed methods research study

Abstract

Background: Headache is one of the most prevalent diseases. The Global Burden of Disease Study ranks it as the seventh most common disease overall and the second largest neurological cause of disability in the world. The "Do Not Do" recommendations are a strategy for increasing the quality of care and reducing the cost of care for headache. This study aimed to identify specific low-value practices in headache care, determine their frequency, and estimate the cost overrun that they represent, in order to establish "Do not Do" recommendations specifically for headache by consensus and according to scientific evidence. Methods: This was a mixed methods research study that combined qualitative consensus-building techniques, involving a multidisciplinary panel of experts to define the "Do Not Do" recommendations in headache care, and a retrospective observational study with review of a randomized set of patient records from the past 6 months in four hospitals, to quantify the frequency of these "Do Not Do" practices. We calculated the sum of direct costs of medical consultations, medicines, and unnecessary diagnostic tests. Results: Seven "Do Not Do" recommendations were established for headache. In total, 3507 medical records were randomly reviewed. Low-value practices had a highly variable occurrence, depending on the hospital and type of headache. Overall, 34.1% of low-value practices were related to treatment, 21% were related to overuse of imaging in consultation, and 19% were related to emergency care. The estimated cost of low-value practices in the four hospitals was 203,520.47 euros per 1000 patients. Conclusions: This study identified low-value headache practices that need to be eradicated and provided data on their frequency and cost overruns.

Multicomponent processes to identify and prioritise low-value care in hospital settings: a scoping review

“…Three of 27 studies targeted paediatric hospitals or health services specifically 40–42. The entire continuum of care (primary care to specialist care or healthcare system) was covered by six records 19 43–47. Four of 27 records focused on practice by a specific profession or discipline40 48–50 with two records targeting practice by the allied health disciplines of nutrition50 and physical therapy 49.…”

“…There was variability in the order of the components applied across studies. Of the records that included expert consensus, committee member or stakeholder engagement activities, participants were mostly clinicians and sample sizes ranged from n=646 55 57 to n=22 48. Where reported, sample sizes in studies that accessed patient record data to identify the extent of the low-value care ranged from 1012 records in four participating hospitals55 to 62 314 admissions 51.…”

“…In addition to cost, one record11 also used a budgetary impact filter to prioritise candidate technologies. Benefit, waste, acceptance (eg, foreseeable acceptance by the professional community),46 burden of disease (years lived with disability and disability-adjusted life-years)15 and variability58 were rarely considered as part of processes to identify low-value care.…”

“…Further, no articles reported developing resources or a toolkit as part of the multicomponent process that involved identifying low-value care. Five records used, or made reference to potential use of, seven theories, models or frameworks19 45 46 50 59–61 as shown in figure 3.…”

Migraine treatment: quo vadis? Real-world data study (2015–2022) in Spain

“…A decade ago, a study reported that only a small proportion of migraine patients received specific medications or preventive treatment in Spain, despite high levels of disability [ 38 ]. Our study findings suggest that undertreatment of migraine remains an issue, with only half of the patients receiving any treatment for migraine in the past 24 months [ 6 , 39 , 46 , 56 , 57 ]. In those who were treated, many were prescribed several acute and preventive treatments, suggesting an inadequate control.…”