Primary care management of headaches and how direct-access MRI fits: a qualitative study of UK general practitioners’ views

Abstract

ObjectivesTo develop a better understanding of general practitioners’ (GPs) views and experiences of the management of patients with headaches and use of direct-access MRI scans, and observe outcomes of an educational session offered by a GP with a special interest (GPwSI) to GPs.DesignA qualitative study using semistructured interviews, analysed using thematic analysis. A GPwSI in headaches visited practices delivering a talk on headache medication, diagnosis and management.SettingSixteen (16) primary care family practices in South London, UK.ParticipantsTwenty (20) GPs.ResultsNot all GPs were aware of the availability of direct-access MRI, but all acknowledged having used referral or direct scans to manage patients’ concern about their headaches. A normal scan result helped resolve uncertainty for patient and GP and helped management towards discussion of preventative treatment. However, patients with psychological and/or severe headache symptoms could not necessarily be reassured. GPs reported difficulty interpreting radiology reports, particularly incidental abnormalities. Those who received the educational talk gained knowledge in diagnosis and medication, improving their confidence in management.ConclusionsIncreased access to imaging, training in headache management, addressing physical and psychological symptoms and standardised reporting of scans may improve GPs’ use of direct-access MRI in the future.

Should GPs have direct access to imaging for headache? A qualitative study of patients’ views in the UK

“…Once a serious underlying problem had been eliminated by scanning, an equal number of patients in both neurology and GP pathways focused on the need to relieve pain. According to GPs, this is easier once an underlying concern for serious pathology such as a brain tumour is eliminated 13. Our evidence supports this, but without follow-up interviews this cannot be confirmed in the long run.…”

“…Given that resources and capacity are limited, a fear among policy-makers and providers is that demand for imaging and referral will rise from patients. GPs raised the lack of specialist input as another disadvantage of direct access, which may hinder in reassuring patients after a normal scan 13. In our previous study, we found that added training with an educational course regarding headache and direct imaging increased GP confidence in managing headache 13.…”

“…In order to alleviate GP concerns about explaining complex reports to patients, more available neuroradiology advice could help to increase confidence in accuracy of diagnosis and provide specialist input in cases where needed. For example, the GPs in our previous study were not aware of a dedicated phone number to reach a neuroradiologist available to respond to queries 13. A Canadian study showed that poor GP–radiologist communication about the meaning of MRI reports can impact negatively on patient care 21.…”

“…Semistructured, one-off, qualitative interviews were conducted with 20 patients, purposively recruited, with 10 participants from each referral pathway. Based on our past research13 and qualitative methodology literature,15 we estimated data saturation to occur after 10 participant interviews per referral pathway.…”

Best care for older people with epilepsy: A scoping review

“…Training packages have been tested for headache management in primary care to help combat neurophobia. GPs who took part in the training said they felt more equipped with managing headache [100]. The same process could be evaluated for epilepsy.…”