RESUMO
BACKGROUND: Primary care clinicians play a critical role in diagnosis and treatment of migraine, yet barriers exist. This national survey assessed barriers to diagnosis and treatment of migraine, preferred approaches to receiving migraine education, and familiarity with recent therapeutic innovations. METHODS: The survey was created by the American Academy of Family Physicians (AAFP) and Eli Lilly and Company and distributed to a national sample through the AAFP National Research Network and affiliated PBRNs from mid-April through the end of May 2021. Initial analyses were descriptive statistics, ANOVAs, and Chi-Square tests. Individual and multivariate models were completed for: adult patients seen in a week; respondent years since residency; and adult patients with migraine seen in a week. RESULTS: Respondents who saw fewer patients were more likely to indicate unclear patient histories were a barrier to diagnosing. Respondents who saw more patients with migraine were more likely to indicate the priority of other comorbidities and insufficient time were barriers to diagnosing. Respondents who had been out of residency longer were more likely to change a treatment plan due to attack impact, quality of life, and medication cost. Respondents who had been out of residency shorter were more likely to prefer to learn from migraine/headache research scientists and use paper headache diaries. CONCLUSIONS: Results demonstrate differences in familiarity with migraine diagnosis and treatment options based on patients seen and years since residency. To maximise appropriate diagnosis within primary care, targeted efforts to increase familiarity and decrease barriers to migraine care should be implemented.
RESUMO
BACKGROUND: Due to the COVID-19 pandemic, medical evaluations for asylum are being performed predominantly remotely. We sought to describe these evaluations and identify barriers. METHODOLOGY: This study utilized an online survey to assess clinician perspectives and experiences regarding remote asylum evaluations. RESULTS: Clinicians reported positive experiences regarding remote interpretation (85%, 51/60), history taking (82.4%, 61/74), rapport building (81.3%, 61/75), and conducting the psychiatric exam (65.7%, 44/67). Concerns were more frequently reported with performing remote physical examinations (83.3%, 15/18). Although the majority denied challenges with technology (62.5%, 45/72), internet (60.8%, 45/74) or clients having difficulty acquiring technology (58.6%, 41/70) or finding private spaces (54.2%, 39/72), these aspects did represent barriers. DISCUSSION: Remote evaluations were relatively easy to perform and acceptable to clinicians. This may facilitate easier access for asylum seekers beyond the pandemic.
