OBJECTIVE: To evaluate patients satisfaction with a specialist consultation for headache and thus identify subgroups of headache patients more satisfied than others.
DESIGN: A survey of consecutive patients referred to a neurologist for headache.
SETTING: Neurological outpatients clinics in North Norway .
PATIENTS: We included 889 consecutive patients referred to a specialist centre for headache during a period of 2 years. Using a questionnaire, we recorded patients' satisfaction with the potential treatment initiated by the specialist.
RESULTS: Sixty-three percent of migraine patients (95% CI, 0.58 to 0.68) were satisfied with the consultation, compared to 44% of patients with non-migrainous headache (955 CI, 0.40 to 0.70), (p=0.01). Altogether 481 patients had some kind of measure recommended by the neurologist, and 317 of these (66%) were satisfied (95% CI, 0.62 to 0.70). Patients with tension-type headache and those who were not prescribed specific treatment modalities were less satisfied.
CONCLUSION: The study confirms that patients with headache are satisfied with a neurological specialist consideration, especially in the case of migraine.

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頭痛に対する神経専門医への紹介の患者満足度に関する検討

片頭痛患者の 63％が満足(95％ CI, 0.58 to 0.68)したが，非片頭痛患者は44％の満足度(95％, 0.40 to 0.70)であった．481例の患者が神経内科医より勧められた何らかの治療がなされたが，317例(66%)が満足していた(95% CI, 0.62 to 0.70)．緊張型頭痛と特異的な治療がなされなかった頭痛患者においては満足度が低かった．

2) Bekkelund SI, Salvesen R. Are headache patients who initiate their
　 referral to a neurologist satisfied with the consultation?
　 A populationstudy of 927 patients the North Norway Headache Study
　 (NHHS). Family Practice 2001; 18: 524-527

論文抄録

BACKGROUND: Headache is a common problem in primary care.Although most patients are treated by Gps, many are referred to specialist consultation.Knowledge of how the referrals can be improved is therefore an important issue.
OBJECTIVES: The aim of this study was to determine the relationship between self-initiating referral to a neurologist and the patient's satisfaction with the specialist consultation.
METHODS: All patients who had been examined by a neurologist for headache whthin a 2-year period from three neurological centre in North Norway completed a questionnaire.
RESULTS: A total of 1052 patients from a population of 1403 headache patients (75%) returned the questionnaire while 927 patients answered questions about initiating the referral to the specialist. Two hundred and twenty patients (24%) initiated the referral to the neurologist consultation compared with 42% of those referred by the doctor, p =0.002. Chronic headache, tension-type headache (TTH) and daily use of analgesic drugs were associated with dissatisfaction.
CONCLUSIONS: Patients with headache who initiated the referral to a neurologist themselves were less satisfied with the specialist consultation. Selecting referrals containing proper medical information may improve satisfaction in severe headache patients treated in a neurological proactice.

文献 PubMed−ID

11604376

エビデンスレベル

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文献タイトル (日本語)

神経内科医へ紹介された頭痛患者が診察に満足しているであろうか？　 927症例のpopulation study ?北ノルウェー頭痛研究(NHHS)

目的

頭痛はプライマリケアでは commonな疾患である．多くの頭痛患者が一般医で治療を受けているが，多くが頭痛専門医へ紹介されている．神経内科医へ自分自身で紹介を希望した場合の専門家受診での患者満足度について検討した．

研究デザイン

分析疫学的研究

研究施設

北ノルウェーの３つの神経センター

研究期間

1996年7月1日?1998年6月30日(２年間)

対象患者

病院データベースに登録された主病名が頭痛患者連続 1403例に質問票を郵送した．1052例(75%)から質問表が回収され，うち927例が神経内科専門医への紹介理由について回答していた．

介入

神経内科専門医による診断・治療

主要評価項目とそれに用いた統計学的手法

Stat View Graphics (Macintosh)を用いた．Student's t -test, chi-square test

結果

220例(24%)の患者が自ら受診した．自ら専門医を受診した52％が専門医の診察に満足しておらず，医師により紹介された42％が満足していなかった( P =0.002)．慢性頭痛，緊張型頭痛，連日の鎮痛薬使用例が満足していなかった．

結論

自ら神経内科専門医を受診した頭痛患者は，専門医への紹介について満足していなかった．専門医への紹介を選択し，正確な医療情報を提供することで，激しい頭痛患者は，神経学的治療で満足度が改善するであろう．

コメント

質問票を用いた研究

作成者

橋本洋一郎

4) Fitzpatrick R, Hopkins A . Referrals to neurologist for headaches not
　 due to structural disease. J Neurol Neurosug Psychiatry 1981; 44:
　 1061-1067

論文抄録

Patients attending neurological clinics with headaches that proved not to be due to clearly defined structural disease were interviewed before and after the consultation and approximately one year later. Their expectations of the consultation were ill-formed. About two-thirds of the patients had fears about organic disease although few had psychiatric morbidity. These fears were generally dispelled by the consultation. About one-third of the patients were dissatisfied by the consultation, nearly all by what the neurologist said rather than by what technical procedures he did or did not undertake. Women with a long history of migraine, with significant psychiatric morbidity, and who had initiated the referral themselves were particularly to be dissatisfied. Although most patients were still having headaches one year later, visit to the general practitioner for this symptom had greatly declined.

文献 PubMed−ID

7334400

エビデンスレベル

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文献タイトル (日本語)

器質的疾患によらない頭痛患者の神経内科医への紹介に関する検討

目的

器質的疾患によらない頭痛患者が，頭痛を専門とする神経内科クリニックで治療を受ける前後，さらに１年後に調査して紹介の転帰を調査した．

研究デザイン

分析疫学的研究

研究施設

North East and North West Thames Health Regionsの18の神経内科の外来クリニック(英国)

対象患者

器質的疾患によらない頭痛患者 109例

介入

検査と治療

主要評価項目とそれに用いた統計学的手法

片頭痛，緊張型頭痛，片頭痛＋緊張型頭痛，片頭痛様神経痛，その他の頭痛に分けて検討．患者へのインタビュー．

結果

精神科的病態の患者は少なかったが，約２／３の患者は器質的疾患に対する恐れを持っていた．これらの恐れは紹介により一掃された．神経内科医の技術的なことよりもむしろ神経内科医の説明により約１／３の患者が受診に満足していなかった．明らかな精神科的病態を持った病歴の長い片頭痛の女性が特に満足していなかった．多くの患者が１年後も頭痛を持っていたが，頭痛で一般医を受診することは非常に減っていた．

作成者

橋本洋一郎