Early Impact of the COVID-19 Pandemic on Outpatient Migraine Care in Hawaii: Results of a Quality Improvement Survey
Maiya Smith*1, Max Nakamoto1, Julie Crocker1, Frances Tiffany Morden1, Keke Liu1, Enze Ma1, Ariel Chong2, Nicholas Van2, Vimala Vajjala3, Enrique Carrazana4, Jason Viereck4, Kore Kai Liow4
1University of Hawaii John Burns School of Medicine, Honolulu, HI, USA
2University of Hawaii at Manoa, Honolulu, HI, USA
3Headache & Facial Pain Center, Hawaii Pacific Neuroscience, Honolulu, HI, USA
4Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawaii Pacific Neuroscience, Honolulu, HI, USA
Citations: Smith M, Nakamoto M, Crocker J, Morden FT, Liu K et al (2021) Early Impact of the COVID-19 Pandemic on Outpatient Migraine Care in Hawaii: Results of a Quality Improvement Survey. SciTech Central COVID-19.
Received: December 29, 2020 Accepted: January 14, 2021 Published: January 16, 2021
Objective: A survey was implemented for early assessment of pandemic-related practice processes and quality improvement.
Background: In response to the public health measures in Hawaii to curtail the COVID-19 pandemic, Hawaii Pacific Neuroscience (HPN) adapted their patient care to ensure continuity of neurological treatment.
Methods: The telephone survey was conducted on patients seen at HPN during the period of 4/22-5/18/2020 to address four areas related to patients’ outpatient experience: delivery of care, general well-being, experience with telemedicine, and disease-specific questions.
Results: 928 patients were contacted of which 429 (46.2%) patients responded and 367 (85.5%) agreed to participate. 133 patients with migraine and 234 patients with other neurological conditions provided responses. Our migraine patients’ survey responses suggest that their well-being was disproportionately negatively affected by the pandemic. Survey respondents with migraine were significantly more likely than their non-migraine peers to report worsening anxiety and sleep problems [62/132 (47.0%) vs. 78/234 (33.3%), χ² = 6.64, P = 0.010, and 64/132 (48.5%) vs. 73/234 (31.2%), χ² = 10.77, P = 0.001]; migraine patients also reported worsening of depression as a result of the pandemic more than patients with other diagnoses, though this was not statistically significant [44/132 (33.3%) vs. 57/234 (24.4%), χ² = 3.40, P = 0.065]. In regard to access to healthcare, significantly more migraine patients reported running out of medications than those with other diagnoses [20/133 (15.0%) vs. 18/234 (7.7%), χ² = 4.93, P = 0.026]. More avoided seeking medical help for new health problems because of the pandemic [30/133 (22.6%) vs. 30/234 (12.8%), χ² = 5.88, P = 0.015]. Migraine patients were also significantly impacted economically by the pandemic; 43/132 (32.4%) of migraine patients reported losing their jobs as the result of the pandemic versus 34/234 (14.5%) of their peers (χ² = 11.20, P < 0.001). An increase in headache severity or frequency was reported in 39/118 (33.1%) of respondents and 19/118 (16.1%) reported to using more abortive therapy than usual. Telemedicine was well received by almost all patients who took advantage of the option. Most of those patients found telemedicine to be easy to use and as valuable as an in-person visit. Migraine patients indicated with more frequency that without the telemedicine option, they would have missed their medical appointments [37/68 (54.4%) vs. 56/144 (38.6%), χ² = 4.31, P = 0.038]; a majority would prefer or consider telemedicine for future appointments over in-person visits.
Conclusions: Insights gained from this quality improvement survey to the practice’s new pandemic-related processes include stressing lifestyle modification, optimizing treatment plans, and continuing the option of telemedicine.
Keywords: Coronavirus 2019, Migraine, Neurology, Telemedicine