Non-Compliance with Follow-up Visits: Analysis of the First Year of Patient’s Attendance to a Second Level Headache Centre in Italy

                                          http://austinpublishinggroup.com/clinical-neurology/

Themanagement of headache patients is a complex process where many factors may play a crucial role, as for example, the compliance with follow-up visits. In order to monitor the first 12 months of activity of our secondary headache outpatient clinic, we have analysed the dropout frequency after the first visit. We retrospectively analysed 101 consecutive case records and found a drop-out rate of 45% (12 males, 33 females, mean age 38 ± 13 years, 39% foreigners), mostly not attending the first follow-up visit (74%) and suffering from chronic headache (60%). Migraine without aura was diagnosed in 56% of the patients while neither trigeminal autonomic cephalalgias nor secondary headache was suspected. We conclude that, even though our drop-out rates are similar to those already reported in the licterature and probably due to headache severity and/or language barriers, still we ought to improve in order to deliver better standards of headache care.

The management of headache patients is a complex process that includes many variables such as patient-clinician relationship, complete history collection, general and neurological examination and last, but not least, timely schedule of follow-up visits Recently, a multidimensional definition of quality of headache care has been proposed, where the following criteria ought to be achieved: accurate diagnosis and individualised management, appropriate referral pathways, education of patients about their headache and their management, convenience and comfort, patient’s satisfaction, efficiency and equitability, outcome assessment and safety. Moreover, in order to make a correct headache diagnosis, all patients seen for the first time should be given a follow-up visit after a short period of time (normally no more than two months) in order to check headache diary and eventually be treated with preventive medications. Such interval should be even shorter in case the patients suffer from chronic headache with or without medication overuse.

Therefore,non-compliance with the first follow-up visit can be an important barrier to optimal management of headache patients and contribute to inappropriate multiple uses of other healthcare services. In order to study this possible caveat concerning correct management of our patients, we analysed the dropout frequency after the first visit, during the very first year of activity of our headache outpatient clinic.