title: Impact of a group-based model of disease management for headache.
abstract: OBJECTIVE
  To assess the impact of a group-based model of disease management for patients with headache.
  
  
  BACKGROUND
  Despite advances in the acute and preventive treatment of migraine, many patients with headache remain misdiagnosed and undertreated. Models of care that incorporate principles of disease management may improve headache care.
  
  
  METHODS
  This was a prospective, open-label, observational study. Patients with headache were referred by physicians or identified from emergency department records. Patients attended a group session led by a registered nurse practitioner, and later had follow-up consultation. Charts and computer records were reviewed to document triptan costs and headache-related visits for 6 months before and after the intervention. Changes in headache frequency and severity were assessed.
  
  
  RESULTS
  Triptan costs for 264 patients and chart review for 250 were available. Six-month triptan costs increased $5423 US dollars(19%), headache-related visits were reduced by 32%, and headache-related emergency department visits were reduced by 49%. Severe headache frequency was reduced in 62 (86%) of 72 patients who initially had severe headaches more than 2 days per week. Patients identified by emergency department screening accounted for 21% of the study group, 31% of the baseline triptan costs, and 46% of the baseline visits. For the entire study group, reduced visits yielded a net savings of $18,757 US dollars despite increased triptan costs.
  
  
  CONCLUSIONS
  Implementation of this group-based model produced a reduction in emergency department and clinic visits, significant clinical improvement, a small increase in pharmacy costs, and overall cost reduction. The greatest improvement in each outcome measure was seen in patients most severely afflicted at baseline. Our results suggest that the principles of disease management may be applied effectively to a headache population, with a positive financial impact on a managed care organization.
authors.affiliation: Department of Family Practice, Kaiser Permanente, 56012 De Soto Avenue, Woodland Hills, CA 91367, USA.
authors.forename: Morris
authors.initials: M
authors.lastname: Maizels
authors.forename: Valerie
authors.initials: V
authors.lastname: Saenz
authors.forename: Jonathan
authors.initials: J
authors.lastname: Wirjo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002648:Child; D019468:Disease Management; D005260:Female; D006126:Group Processes; D020773:Headache Disorders / Q000188:drug therapy* / Q000191:economics*; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017366:Serotonin Receptor Agonists / Q000191:economics / Q000627:therapeutic use
chemical_list: D017366:Serotonin Receptor Agonists