title: Patient characteristics associated with frequent calls to a headache specialty clinic.
abstract: OBJECTIVE
  To identify characteristics of patients who frequently initiate contact with a headache specialty clinic outside of scheduled appointments.
  
  
  METHODS
  We scanned records of all telephone calls received during 1 calendar year at an academic headache clinic to identify frequent callers. High-frequency (HF) callers were defined as established patients who initiated calls on ≥20 days during the year. We compared these patients with a cohort of established low-frequency (LF) callers who initiated no telephone calls during the same year. Clinic records were analyzed for demographic characteristics, diagnoses, and medication use. Additionally, we administered a questionnaire to clinic physicians and administrative staff querying their perception of each patient's demands on clinic resources.
  
  
  RESULTS
  High-frequency (n=26) and LF (n=18) callers did not differ significantly in marital status, ethnicity, diagnosis, or age. There was a trend toward female gender among HF callers and toward being outside of a body mass index range of 19 to 30 kg/m2. The groups were similar in their use of triptans and botulinum toxin treatments, but HF callers were more likely to be opioid users (96% vs 11.1%) and more likely to be taking multiple opioids in substantially higher potency, dosage, and quantity (154.4 mg vs 1.4 mg morphine equivalents/day). More than 80% of each group were migraineurs, but HF callers were more likely to have comorbid psychiatric disorders (P<0.05). High-frequency callers were also more likely to be rated by administrative staff and physicians as demanding and time-consuming.
  
  
  CONCLUSIONS
  In this university-based headache specialty clinic, HF callers were more likely to be opioid users on high morphine-equivalent doses. Compared with LF callers, HF callers placed a greater burden on health care resources as perceived by staff and physicians.
authors.affiliation: Carolina Headache Institute, Chapel Hill, NC 27516, USA.
authors.forename: Karen G
authors.initials: KG
authors.lastname: Fisher
authors.forename: Anne H
authors.initials: AH
authors.lastname: Calhoun
authors.forename: Sutapa
authors.initials: S
authors.lastname: Ford
authors.forename: Amy P
authors.initials: AP
authors.lastname: Pruitt
authors.forename: Alan G
authors.initials: AG
authors.lastname: Finkel
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Mann
mesh_terms: D000328:Adult; D000367:Age Factors; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001071:Appointments and Schedules; D005260:Female; D006261:Headache / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D018710:Pain Clinics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013689:Telephone
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid