This study aimed to strengthen migraine care for a diverse and underserved population by utilizing the Plan-Do-Study-Act (PDSA) model within a family medicine residency clinic.
Migraines are common but often underdiagnosed and undertreated in primary care due to a combination of inadequate medical school training and patient health disparities. Common barriers include limited provider familiarity with newer therapies, socioeconomic factors, language challenges, and delays in prior authorizations. This project addressed these issues by standardizing care, streamlining referrals, and provider education.
With the PDSA cycle mind the following approaches were utilized for optimal migraine diagnosis and care. A curriculum was developed that included a “migraine day” covering pathophysiology, diagnosis, pharmacology, and billing/coding to improve the physician’s didactic education. Next, all residents had the opportunity to attend monthly case conferences where patients were reviewed by a multidisciplinary team. Patient education was maximized through “drug-boxes” containing patient education/counseling points, prescribers’ information, lifestyle modifications, and use of migraine technology. Furthermore, to improve patients’ access to treatments our prior authorization process was streamlined through workflow redesigns and accountability follow-ups. Finally, we created a custom referral mechanism for migraine treatment services while cross training our clinical team members to process prior authorizations. The key metrics reviewed were number of neurology referrals, number of migraine ICD-10 and changes in prescribing habits.
This quality study resulted in neurology referrals increased from 214 patients the previous year to 317 patients during the study year. Problem lists were updated and migraine diagnosis decreased from 503 the previous year to 411 during the study due to improved diagnosis accuracy. There was a substantial increase in calcitonin gene-related peptide inhibitors being prescribed compared to the previous year (p=0.001).