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| 50th Annual Meeting of the American Headache Society |
Boston, Massachusetts June 26-29, 2008 |
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State-by-State
Headache Care |
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BY ALEC O’NEILL
Contributing Writer |
BOSTON — A state-by-state “report card” of
headache care in the United States suggests that finding
specialized care in most western and southern states can
itself be a major headache, reported Dr. Elizabeth W.
Loder during a June 27 scientific symposium presented at
the 50th Annual Meeting of the American Headache
Society.
For example, while there are 6.84 headache specialists
per million population in New Hampshire, in the much
larger state of Idaho there are exactly none, reported
Dr. Loder, who is chief of the Headache and Pain
Division in the Department of Neurology at Brigham &
Women’s Hospital and an assistant professor of neurology
at Harvard Medical School, both in Boston.
“Headache in general has not been embraced as a
condition in which there has been a tremendous amount of
interest in measuring quality,” she said.
Dr. Loder and her colleagues at Harvard Medical School
and the University of Vermont College of Medicine in
Burlington conducted a study to identify objective
indicators of access to headache care in the US,
evaluating the relative performance of each of the 50
states against benchmark measures of success for each
indicator. (Loder EW et al. Access to Headache Care in
the United States: A National and State-by-State Report
Card. Abstract OR-05.)
They assembled an advisory group of headache experts and
consumers, and using a modified Delphi process had them
identify major domains or indicators of access to
headache care, and develop numerical measures and
quality benchmarks. They used the best datasets
available, including US and state census data, as well
as polling and surveys of headache specialists.
In all, the panel members identified three quality
domains—supply, availability, and affordability.
They found that few states met or exceeded the benchmark
for individual indicators, and many states performed
poorly on all indicators. The top-ranked state was
Connecticut, which scored 70.10 out of a possible 100
points, although the overall ranking was still
considered to be unsatisfactory. The Nutmeg State
excelled for its supply of specialists that exceeded the
benchmark measure: short distances to nearest
specialists, moderate wait times for appointments with
nearby specialists, and a low percentage of uninsured
residents. Connecticut does not, however, have a
multidisciplinary headache programs in the state, which
lowered its overall rankings.
At the bottom end of the scale was Idaho, with no
headache specialists within state lines, no
multidisciplinary hospital programs, long distances to
the nearest specialist, long wait times for
appointments, and a high number of uninsured residents.
The nation as a whole scored just 55.4, a grade of
unsatisfactory.
“By any standard specialized headache care is widely
unavailable across the United States,” said Dr. Loder.
“And even the highest-ranking states like Connecticut
and Massachusetts are not doing very well when you
compare them to some of the important indicators. There
are dramatic geographic disparities that are a real
challenge I think to providing headache care across the
country.” |
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