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Table 6 Future Directions for Headache Care in Urgent Care

From: The role of urgent care centers in headache management: a quality improvement project

Educating UC Providers

-In terms of targeting the specific providers who are most likely to come work in an UC facility, research has shown that most facilities (95.8%) have physicians on staff, and family medicine is the most common specialty (present at about three quarters of the centers) [17].

-Other specialties sometimes staffing them include emergency medicine, internal medicine, and pediatrics. About half also have advanced practice providers (NPs and PAs).

-Thus, there is a continuing need for headache education among primary care and emergency physicians, physician assistants, and nurse practitioners. Given its population prevalence and associated disability, headache is inadequately covered in both emergency medicine and primary care residency curricula. Post-residency, management of headache should be a frequent topic of grand rounds and conference-based educational programs.

-Initiatives similar to the American Headache Society First Contact-Primary Care Initiative which educated PCPs about migraine [18] might be expanded to include urgent care providers.

-The American Academy of Pain Medicine, through its Headache Special Interest Section and its primary care migraine guidelines initiatives, might also help with this effort.

Partnerships with Academic Medical Centers/Neurology Departments/Headache Centers

-There has been a move toward UC facilities partnering with academic healthcare systems as a way of bringing in more patients to the healthcare systems. This has occurred throughout New York City [19, 20].

- These numerous partnerships between UC facilities and big academic health systems can lend themselves to not only UC facilities referring patients appropriate for specialist care, but to partnerships in which neurologists and headache specialists might use these UC facilities to provide acute care e.g. infusion treatments for their headache patients rather than setting up headache specific infusion centers that might require significant staffing needs and/or sending their patients to the ED for such care. This might reduce headache ED repeat visits which have been found to be predominantly due to headache-related acute care [21]. In addition, whereas a prior study found that a substantial number of headache specialists are dissatisfied with the care their patients receive in the ED, in part because they felt that there was little communication between the ED physicians and the primary headache providers [22], such partnerships between UC facilities and neurologists/headache specialists might improve communication between providers in these different settings.

Educating Patients about the Option to Seek Acute Migraine Treatment in UC Facilities

-Future work might educate patients about the difference between care provided at the UC verses the ED, providing a list of nearby UCs, their working hours, resources available and when to triage ED over UC should be a standard part of office visit counseling and coordination of care and should help to off load ED burden by diverting unnecessary patient volume as the patient is more likely to listen to their established provider more than anybody else.

-Headache providers might provide patients with an after-hours/weekend protocol e.g. the Migraine Action Plan [23].

-In addition to outpatient medical providers advising patients of these options, if protocols are put into place, school nurses might be able to evaluate and refer students and their families to UC facilities [24].

Examining Patient Decision-Making to Seek Care in ED versus Urgent Care Facilities

-Future work should examine patient decision making in deciding to visit an ED versus an UC facility for headache with a special focus on examination of race, ethnicity, and socio-economic factors. A cross sectional study of Medicare and Medicaid beneficiaries examined predictors of who were more likely to go to UC versus ED for a non-emergent health condition [13], All those examined lived within a 10-mile radius of 12 UCC locations and have had more than one visit to a UCC, emergency department, or both. The authors of that study found low utilization of the UCCs.

-Demographically, Black participants were more likely to go to the ED compared to White participants, regardless of how close the UCC was to them and the type of insurance they used [13]. The authors concluded that the Black participants felt more comfortable walking into the ED. Also, although there has been an increase in UC facilities across the US, this growth tends to distribute in locations with higher income and more insured patients [25,26,27,28].

-Patients who visit UCs may have better insurance [17] and thus better access to outpatient headache care as well.

-A study found that UC facilities may worsen the disparities within healthcare due to financial interest, especially since refusal of service is allowed if funds are not met by the patient [25]. That said, UC facilities tend to be located in areas with a high proportion of individuals from historically marginalized/non-White populations, possibly to help mitigate the disparities associated with race and ethnicity, prompting some to conclude that the decision to locate UC centers is independent of race and fully considerate of economic advantages [25].