PO-58 | Pilot protocol to improve the booking and management network for chronic headache in secondary and tertiary care services

A. Granato,¹ L. Bartole,¹ S. Centonze,² A. Lodi,³ M. Lodi Zollia,³ P. Manganotti¹ | ¹Clinical Unit of Neurology, Headache Centre, Department of Medicine, Surgery and Health Sciences, ASUGI, University of Trieste, Trieste, Italy; ²Research & Innovation Unit, ASUGI, University of Trieste, Trieste, Italy; ³Funzione Organizzativa, Gestione Offerte Ambulatoriali, ASUGI, University of Trieste, Trieste, Italy

Background: Headache visits often have long waiting times and are frequently performed in non-specialized services. Aim of the study is to evaluate the access procedures in secondary and tertiary neurological settings in a North-Eastern province of Italy and to activate a pilot protocol to improve the booking and management network for headache visits.

Methods: We retrospectively analysed anonymized data of all neurological visits performed in district and hospital outpatient services of the province of Trieste from 01.01.2024 to 31.03.2024. Neurological visits performed in the Emergency Department, during hospitalization or Day Hospital, in pre- and post-hospitalization were excluded. Services providing the visit, access code priorities (P<120 days; D<30 days; B<10 days; U<72 hours), waiting times and inappropriate visits were analysed with SPSS 25.0.

Results: Out of 15,556 records analysed, 320 patients (73.1% F; mean age 47±18 years) were visited because of headache. Most neurological visits (86.9%) were performed in the public hospitals (Headache Center, 44.1%; general neurological clinic, 42.8%), and low percentage in district public neurological clinics (6.9%) or in private hospitals (6.2%). The priority codes were P (46.3%), D (17.8%), B (32.2%) and U (3.8%). The public general neurological clinic (87.6%) and the private hospitals (77.3%) mainly provided visits in code B and D; instead, the Headache Center mainly provided visits in code P (92.9%). Waiting times were not respected for codes B (24±11 days) and D (111±81days). Forty-four patients (13.7%) had a request for evaluation at the Headache Center but they were visited elsewhere. Our pilot protocol includes activating a chronic headache service with the employment of a dedicated neurologist and nurse specialized in headache, in order to visit chronic headaches with priority B and D and chronic headaches that are incorrectly directed to services other than the Headache Centre. Furthermore, cognitive behavioural and neuromodulation therapies, professional training courses and information campaign for the general population are planned.

Conclusion: Our pilot protocol could reduce waiting times for chronic headache visits with priority B and D, reduce visits requested for the Headache Center and incorrectly referred in other services, increase diagnostic and therapeutic specificity for chronic headache.