Telemedicine Offers Migraine Care to Remote Areas
An interview with Timothy R. Smith, MD
Migraines are one of the most common neurological diseases affecting millions of Americans. Unfortunately, in the United States many patients live in rural or remote areas far from a formal health care center, which makes in-office visits to their doctor infeasible.
Telemedicine may be a valuable tool in these cases. It uses telecommunication to put patients, no matter their location, in contact with a dedicated health care professional, and recent studies are showing it can effectively get patients the proper, evidence-based acute and preventative treatments they need for their migraines.
An example of this technology in action can be found at the Mercy Virtual Care Center in St. Louis, Missouri, a dedicated virtual health care facility where doctors are treating patients directly by phone.
“Our TeleHeadache program is a live two-way real-time encounter between a clinician and a patient, assisted by a telehealth facilitator, usually a nurse or medical assistant, who helps get everything set up and activated on the patient end,” explained Timothy R. Smith, MD, a practitioner at the Mercy Clinic Headache Center/Mercy Virtual.
There are no automated menus or voice-controlled surveys for patients to fret with – just human interaction with a health care provider, and according to new research led by Dr. Smith, the TeleHeadache program seems to be making a difference in getting remote patients proper evidence-based treatments.
Mercy Virtual’s Observational Study
At this year’s annual meeting of the American Headache Society (AHS), the results of a prospective, observational study were presented, showing how 31 patients, who were ICD-9 diagnosed with migraine, received care through the TeleHeadache program. Another group of 200 patients receiving care locally served as controls.1
Using hierarchal logistic regression, the study found that TeleHeadache patients were much more likely to receive evidence-based acute and preventative medication compared to patients receiving their care locally, at 77.4% compared to 27.0%, respectively.
However, the concern could be that these patients, while more likely to receive prescriptions or recommendations by phone, may not be getting the right treatments, necessarily. According to Dr. Smith, it’s a viable concern, but one that shouldn’t overshadow the utility telemedicine inherently has for reaching those migraine patients who happen to live in remote areas.
“We don’t make the assertion that telemedicine is more accurate. It has its limitations and we recognize that an in-person evaluation has clear advantages over telemedicine, and probably always will.
“But it is our position that a telemedicine evaluation with an experienced specialist can significantly help in the management of chronic illness presentations in rural communities, where no specialty encounters could be performed otherwise. The telemedicine encounter does not supplant, but rather complements the primary care relationship.”
Furthermore, some may question the study’s strength based on the uneven weight of its study groups, with a relatively small amount of TeleHeadache patients (n=31) being matched to a large control cohort (n=200). Dr. Smith noted this was a limitation of the study, caused by the relatively small number of encounters in the local rural area the study took place.
“If we had done a formal propensity matching exercise, we probably could have come up with a more stringent analysis. But the limitations of the observational data create other threats to validity that become even greater limitations. Larger sample sizes will help these analyses, but will take time to accrue.”
The Utilities of Telemedicine
TeleHeadache isn’t the only program of its kind, though. Also at the AHS meeting, a randomized study conducted by researchers at the University of Texas Southwestern Medical Center and the University of Rochester also found telemedicine was effective at treating patients with migraine, specifically as a follow-up evaluation tool.
Given it shows such a high degree of patient satisfaction, telemedicine could be able to cut health care costs, facilitating more convenient follow-up evaluations and limiting the need for excessive in-office visits once a patient starts their migraine treatment. According to Dr. Smith, Telemedicine’s utility has extended even further into other settings as well, like post-operative care.
“In my practice, it has its greatest value in reaching remote patients who might have difficulty obtaining specialty care otherwise. But we have seen the medium used for convenience purposes as well,” like using live video streaming to inspect a patient’s post-operative wounds during their recovery process.
When doctors need to triage whether a patient requires transfer back to a health care center, relieving those patients of unnecessary travel back-and-forth to their evaluations could be highly beneficial in terms of convenience and expediency. There are even telehealth programs being utilized for emergency departments (EDs), like Telestroke, which affords EDs instant access to a neurologist through audio and visual communication.
Getting patients ease-of-access to specialized care is a significant challenge, especially when so much of the country is comprised of rural, isolated areas. But most Americans do have phones, and as of 2013, over 80% have internet access.2 Telemedicine could be an important tool for overcoming geographic barriers, affording quality care to all Americans, regardless of where they live.
Both of the studies were presented at the 57th Annual Scientific Meeting of the American Headache Society. There were no conflicts of interest provided by the authors.