Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Headache Diagnosis and Management in Primary Care Approaches to Treatment • Step care • Staged care • Stratified care MIDAS Migraine Disability • Validated • Sensitive to change, so good for followup • Link to online version of MIDAS • http://www.migrainedisability.net/About_Midas/questionna ire5.pdf HIT-6 • Validated • Good for differential diagnosis • Scoring Mild impairment Moderate Severe 50-55 56-59 ≥60 Likelihood Ratios for diagnosis of migraine Negative LR 0.8 0.4 0 Positive LR Overall Management Algorithm MIPCA Diagnostic Screening Algorithm MIPCA Diagnostic Screening Algorithm • • Can we make that algorithm operate in the background and suggest steps in the Plan? Hook it to a Headache Condition Summary? MIPCA Management Algorithm Close-up 1 Close-up 1 Migraine Prophylaxis... ...Migraine Prophylaxis Headache Action Plans My choice Meds Teaches Teaches Diary Diary Patient Handouts PowerChart Opportunities • Integrate Diagnosis decision aids into history-taking • Migraine Action Plan integrates PowerChart management orders with patient handout Migraine Action Plan Potential • Future patient feedback into chart • Recent HA pattern • Treatment response • Adverse effects Headache Dashboard Paula Pound DOB: 02/11/1967 MRN: 99 88 77 66 5 ph 573-911-9876 email: [email protected] Diagnoses Migraine Insomnia Hypothyroidism Cervical Dysplasia 2002 > cryo Dysthymia Allergies & Intolerances sulfa > as a child penicillin > hives Imitrex SC > chest pain, anxiety (refuses to take again) • • • • Headache 1 Date / time Prodrome / aura Pain (1-10) Location / type of pain Other symptoms Possible triggers Medications amitriptyline 10 mg 3 hs Meds taken Did med help? Med side effects Maxalt MLT 10 Aleve 220 4 onset, 2 in 30 min Headache Pathway Headache Diary Other therapies Did another tx help? Headache 2 Headache 3 1.Consult: Hx, Tx history, education, buy-in 2.Diagnosis: screen for HA type 3.Severity assessment: Frequency, Pain severity, Impact on pt’s life, Non-HA symptoms, Patient factors 4.Treatment Plan: Establish goals, Behavioral therapy, Acute therapy, Possible prophylactic therapy, Complementary therapy 5.Follow-up: Assess outcomes Headache Dashboard Paula Pound DOB: 02/11/1967 MRN: 99 88 77 66 5 ph 573-911-9876 email: [email protected] Diagnoses Migraine Insomnia Hypothyroidism Cervical Dysplasia 2002 > cryo Dysthymia Allergies & Intolerances sulfa > as a child penicillin > hives Imitrex SC > chest pain, anxiety (refuses to take again) • • • • Outcome measures Midas scores # HA / mo Missed work days Non-HA sx Tabular form for temporal trends Brought into PowerForm by nurse at checkin Medications amitriptyline 10 mg 3 hs Maxalt MLT 10 Aleve 220 4 onset, 2 in 30 min Drugs tried, failed, why Topamax Inderal Headache Pathway 1.Consult: Hx, Tx history, education, buy-in 2.Diagnosis: screen for HA type 3.Severity assessment: Frequency, Pain severity, Impact on pt’s life, Non-HA symptoms, Patient factors 4.Treatment Plan: Establish goals, Behavioral therapy, Acute therapy, Possible prophylactic therapy, Complementary therapy 5.Follow-up: Assess outcomes Algorithm formatting question ... Allergies & Intolerances sulfa > as a child Imitrex SC > chest pain, anxiety (refuses to take again) penicillin > hives Allergies & Intolerances sulfa > as a child Imitrex SC > chest pain, anxiety (refuses to take again) penicillin > hives Allergies & Intolerances •sulfa > as a child •Imitrex SC > chest pain, anxiety (refuses to take again) •penicillin > hives Allergies & Intolerances sulfa > as a child Imitrex SC > chest pain, anxiety (refuses to take again) penicillin > hives Allergies & Intolerances sulfa > as a child Imitrex SC > chest pain, anxiety (refuses to take again) penicillin > hives Allergies & Intolerances •sulfa > as a child •Imitrex SC > chest pain, anxiety (refuses to take again) •penicillin > hives