Expected impact – direct referral to MRI Evaluation of direct access from GPs to MRI for the management of patients with chronic headache Background Headaches affect over 90% of the population at some point in their lifetime, placing a considerable burden both on the NHS and on society; The majority of headaches are benign as less than 0.1% of the lifetime prevalence is associated with a life-threatening condition. Nevertheless: A significant proportion of patients tend to return continuously to the GP, afraid that they might have an underlying serious condition, such as brain cancer. GPs acknowledge that they have made referrals for secondary care in situations where they were unable to reassure the patient. The capacity challenge: Over 4% of adults consult their GP with headache each year; Headache is mainly managed within Primary Care but accounts for up to 25% of GPs referrals to neurologists; GPs and Neurology consultation rates due to chronic headache have steadily increased over the past years. The current management of patients with chronic headache will be inadequate to cope with the ever increasing demand, both from the primary care and the secondary/tertiary care perspectives. Aims TOHETI aims to evaluate whether direct access from General Practitioners (GPs) to Magnetic Resonance Imaging (MRI) for patients with chronic headache is cost-saving at 6 months after the initial episode at Secondary Care compared to the initial referral to Neurology. In the vast majority of cases where patients are directly referred to MRI, no serious underlying pathology will be found, enabling earlier GP and patient reassurance. For the few patients with worrying pathology, this will speed up the diagnostic pathway to tertiary care. Quantitative Arm Referral to Neurology Waits and delays Referrals Evidence-based value TIME GP consultation Referral to Secondary Care Neurology appointment Wait for Imaging Test Wait for Neurology follow-up appointment Referral to Primary Care Repetition cycle Wait for GP appointment Wait for follow-up GP appointment Wait for Neurology appointment Referral to Imaging Test Imaging Test Neurology follow-up appointment Single centre non-randomised, non-blinded, prospective observational study; Study duration: 25 months (1 month to enrol 1st patient + 12 months to enrol all required patients + 12 months follow-up for the last patient). GP consultation Wait for MRI exam Referral to Primary Care Wait for GP appointment Referral to Imaging Test MRI exam Repetition cycle Wait for follow-up GP appointment Direct referral to MRI: Direct referral to MRI enables: Reduction of waiting times (categorised as waste under the Lean methodology); Reduction of Neurology appointments (only patients with positive MRI findings will require an appointment); Reduction of subsequent GP utilisation rates due to the MRI reassurance effect. Qualitative Arm The qualitative arm will focus on GP’s views on direct access to MRI scanning for patients with chronic headache, versus referral to neurology. GP interviews – understanding current patterns of service use; GP confidence in diagnosis and management of headache; Experience of managing patients on both pathways; Attitudes towards change in ways of working. Expected impact – direct referral to MRI GP and patient experience and satisfaction Earlier patient reassurance that no serious underlying pathology is found. This fact enhances patient management within the primary care setting Higher GP satisfaction with the proposed pathway Quality of care Faster diagnosis and treatment in patients with brain cancer Efficiency Reduced number of referrals to Neurology as a result of direct access to MRI exams Reduced number of GP appointments for headache (prior and subsequent to the MRI exam) due to patient reassurance following a negative MRI exam TOHETI Headache app Filling in a symptoms diary over the length of a study can be an arduous task for study participants, and it is easy to forget to do during the course of a busy day! The TOHETI app allows patients to quickly and conveniently keep a note of their daily symptoms. The app also sends daily reminders, and there has been a positive uptake and response to its use so far from patients recruited to our studies. We hope it will mean a better experience for patients, and better data for us! "These are exciting times for this project, and for our patients. Not only are we evaluating how our patients can best access the cutting edge 3T MRI scanners, but we have also developed a downloadable smartphone app to further assist our chronic headache patients in recording their headache diary electronically. Embracing technology in this real-world way will enable us to develop better treatment plans with patients, potentially across a range of chronic conditions.“ Asif Mazumder, Consultant Neuroradiologist and Principal Investigator CONTACT US: Project Manager: Yvonne Akande Ext. 89578 Yvonne.Akande@kcl.ac.uk