Transcript HA Show - FCM Algorithms

Headache
Diagnosis and Management in Primary Care
Approaches to
Treatment
• Step care
• Staged care
• Stratified care
MIDAS
Migraine Disability
• Validated
• Sensitive to change, so good for followup
• Link to online version of MIDAS
• http://www.migrainedisability.net/About_Midas/questionna
ire5.pdf
HIT-6
• Validated
• Good for differential diagnosis
• Scoring
Mild impairment
Moderate
Severe
50-55
56-59
≥60
Likelihood Ratios
for diagnosis of migraine
Negative LR
0.8
0.4
0
Positive LR
Overall Management
Algorithm
MIPCA Diagnostic
Screening Algorithm
MIPCA Diagnostic
Screening Algorithm
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•
Can we make that
algorithm operate in
the background and
suggest steps in the
Plan?
Hook it to a Headache
Condition Summary?
MIPCA Management
Algorithm
Close-up 1
Close-up 1
Migraine
Prophylaxis...
...Migraine
Prophylaxis
Headache Action
Plans
My choice
Meds
Teaches
Teaches
Diary
Diary
Patient Handouts
PowerChart
Opportunities
• Integrate Diagnosis decision aids into
history-taking
• Migraine Action Plan integrates
PowerChart management orders with
patient handout
Migraine Action Plan
Potential
• Future patient feedback into chart
• Recent HA pattern
• Treatment response
• Adverse effects
Headache Dashboard
Paula Pound DOB: 02/11/1967
MRN: 99 88 77 66 5
ph 573-911-9876 email: [email protected]
Diagnoses
Migraine
Insomnia
Hypothyroidism
Cervical Dysplasia 2002 > cryo
Dysthymia
Allergies & Intolerances
sulfa > as a child
penicillin > hives
Imitrex SC > chest pain, anxiety
(refuses to take again)
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Headache 1
Date / time
Prodrome /
aura
Pain (1-10)
Location / type
of pain
Other
symptoms
Possible
triggers
Medications
amitriptyline 10 mg 3 hs
Meds taken
Did med help?
Med side
effects
Maxalt MLT 10
Aleve 220 4 onset, 2 in 30
min
Headache Pathway
Headache Diary
Other therapies
Did another tx
help?
Headache 2
Headache 3
1.Consult: Hx, Tx history,
education, buy-in
2.Diagnosis: screen for HA
type
3.Severity assessment:
Frequency, Pain severity,
Impact on pt’s life, Non-HA
symptoms, Patient factors
4.Treatment Plan: Establish
goals, Behavioral therapy,
Acute therapy, Possible
prophylactic therapy,
Complementary therapy
5.Follow-up: Assess
outcomes
Headache Dashboard
Paula Pound DOB: 02/11/1967
MRN: 99 88 77 66 5
ph 573-911-9876 email: [email protected]
Diagnoses
Migraine
Insomnia
Hypothyroidism
Cervical Dysplasia 2002 > cryo
Dysthymia
Allergies & Intolerances
sulfa > as a child
penicillin > hives
Imitrex SC > chest pain, anxiety
(refuses to take again)
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•
•
•
Outcome measures
Midas scores
# HA / mo
Missed work days
Non-HA sx
Tabular form for temporal trends
Brought into PowerForm by
nurse at checkin
Medications
amitriptyline 10 mg 3 hs
Maxalt MLT 10
Aleve 220 4 onset, 2 in 30
min
Drugs tried, failed, why
Topamax
Inderal
Headache Pathway
1.Consult: Hx, Tx history,
education, buy-in
2.Diagnosis: screen for HA
type
3.Severity assessment:
Frequency, Pain severity,
Impact on pt’s life, Non-HA
symptoms, Patient factors
4.Treatment Plan: Establish
goals, Behavioral therapy,
Acute therapy, Possible
prophylactic therapy,
Complementary therapy
5.Follow-up: Assess
outcomes
Algorithm formatting
question ...
Allergies & Intolerances
sulfa > as a child
Imitrex SC > chest pain, anxiety (refuses to take again)
penicillin > hives
Allergies & Intolerances
sulfa > as a child
Imitrex SC > chest pain, anxiety (refuses to take again)
penicillin > hives
Allergies & Intolerances
•sulfa > as a child
•Imitrex SC > chest pain, anxiety (refuses to take again)
•penicillin > hives
Allergies & Intolerances
sulfa > as a child
Imitrex SC > chest pain, anxiety (refuses to
take again)
penicillin > hives
Allergies & Intolerances
sulfa > as a child
Imitrex SC > chest pain, anxiety (refuses to
take again)
penicillin > hives
Allergies & Intolerances
•sulfa > as a child
•Imitrex SC > chest pain, anxiety (refuses to
take again)
•penicillin > hives