title: Acceptability, Feasibility, and Cost of Telemedicine for Nonacute Headaches: A Randomized Study Comparing Video and Traditional Consultations.
abstract: BACKGROUND
  The feasibility of telemedicine in diagnosing and treating nonacute headaches, such as primary headaches (migraine and tension-type) and medication-overuse headaches has not been previously investigated. By eliminating the need of travel to specialists, telemedicine may offer significant time and money savings.
  
  
  OBJECTIVE
  Our objective was to estimate the acceptance of telemedicine and investigate the feasibility and cost savings of telemedicine consultations in diagnosing and treating nonacute headaches.
  
  
  METHODS
  From September 2012 to March 2015, nonacute headache patients from Northern Norway who were referred to neurologists through an electronic application system were consecutively screened and randomized to participate in either telemedicine or traditional specialist visits. All patients were consulted by two neurologists at the neurological department in Tromsø University Hospital. Feasibility outcomes were compared between telemedicine and traditional groups. Baseline characteristics and costs were then compared between rural and urban patients. Travel costs were calculated by using the probabilistic method of the Norwegian traveling agency: the cheapest means of public transport for each study participant. Loss of pay was calculated based on the Norwegian full-time employee's average salary: < 3.5 hours=a half day's salary, > 3.5 hours spent on travel and consultation=one day's salary. Distance and time spent on travel were estimated by using Google Maps.
  
  
  RESULTS
  Of 557 headache patients screened, 479 were found eligible and 402 accepted telemedicine participation (83.9%, 402/479) and were included in the final analyses. Of these, 202 received traditional specialist consultations and 200 received telemedicine. All patients in the telemedicine group were satisfied with the video quality, and 198 (99%, 198/200) were satisfied with the sound quality. The baseline characteristics as well as headache diagnostics and follow-up appointments, and the investigation, advice, and prescription practices were not statistically different between the two randomized groups. In addition, telemedicine consultations were shorter than traditional visits (38.8 vs 43.7 min, P<.001). The travel cost per rural individual (292/402, 73%) was €249, and estimated lost income was €234 per visit. The travel cost in the urban area (110/402, 27%) was €6, and estimated lost income was €117 per visit. The median traveling distance for rural patients was 526 km (range 1892 km), and the median traveling time was 7.8 hours (range 27.3 hours). Rural patients had a longer waiting time than urban patients (64 vs 47 days, P=.001), and fewer women were referred from rural areas (P=.04). Rural women reported higher pain scores than urban women (P=.005).
  
  
  CONCLUSIONS
  Our study shows that telemedicine is an accepted, feasible, time-saving, and cost-saving alternative to traditional specialist consultations for nonacute headaches.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT02270177; http://clinicaltrials.gov/ct2/show/NCT02270177 (Archived by WebCite at http://www.webcitation.org/6hmoHGo9Q).
authors.affiliation: Department of Neurology, University Hospital of North Norway, Tromsø, Norway. kai.ivar.muller@unn.no.
authors.forename: Kai Ivar
authors.identifier: http://orcid.org/0000-0002-8686-4226
authors.initials: KI
authors.lastname: Müller
authors.forename: Karl Bjørnar
authors.identifier: http://orcid.org/0000-0002-0940-3581
authors.initials: KB
authors.lastname: Alstadhaug
authors.forename: Svein Ivar
authors.identifier: http://orcid.org/0000-0002-8464-7199
authors.initials: SI
authors.lastname: Bekkelund
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006261:Headache / Q000191:economics / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data*; D017216:Telemedicine / Q000191:economics* / Q000379:methods*; D014743:Videotape Recording / Q000191:economics / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: burden; consultation; cost; feasibility; headache; management; randomization; rural; telemedicine