ABSTRACT: Structured education to improve primary-care management of headache: how long do the benefits last?
Our earlier study showed that structured education of general practitioners (GPs) improved their practice in headache management. Here we assess duration of this effect.
In a follow-up observational study in Southern Estonia, subjects were the same six GPs as previously, managing patients presenting with headache as the main complaint. Data reflecting their practice were collected prospectively during a 1-year period commencing 2 years after the educational intervention. The primary outcome measure was referral rate (RR) to neurological services. Comparisons were made with baseline and post-intervention data from the earlier study.
In 366 patients consulting during the follow-up period, RR was 19.9%, lower than at baseline (39.5%; p<0.0001) or post-intervention (34.7%; p<0.0001). RR was diagnosis-dependent: the biggest decline was for migraine. Usage of headache diagnostic terms showed changes generally favouring specific terminology. In particular, the proportion of patients given migraine diagnoses greatly increased while use of the inappropriate M79.1 (Pericranial) myalgia almost disappeared. Requests for investigations, which had fallen from 26% (of patients seen) at baseline to 4% post-intervention , resurged to 23% (mostly laboratory investigations: requests for x-rays continued to dwindle). Initiation of treatment by the GPs remained at the post-intervention level of just over 80% (up from baseline 58%).
Improvements in GPs’ practice after a structured educational programme mostly last for ≥3 years, some showing further betterment. A few measures suggest the beginnings of decline towards baseline levels. This policy-informing evidence for continuing medical education indicates that the educational programme needs repeating every 2-3 years. This article is protected by copyright. All rights reserved.