Improving access to care for patients with migraine in a remote Pacific population.

Objective: To evaluate the efficacy of increasing access to care for patients with migraines in a rural setting. Outcomes include decreased resource utilization, decreased hospitalizations, polypharmacy reduction, and decreased disability in a remote Pacific population.

Methods: Data were collected on all patients presenting to a single neurologist in a deployed military setting for migraines. Access to care was supplemented through health fairs, radio shows, telemedicine, and education of primary care providers.

Results: Over the course of 1 year, 300 providers were educated through public health fairs and telemedicine counseling. This strategy helped reduce consults by 50% and decrease clinic wait times from 2 months to 7 days. Two hundred twenty-one patients with chronic migraine or episodic migraine were seen in the neurology clinic over the course of 1 year. Of these patients, polypharmacy reduction was achieved in 71% of patients with chronic migraines and in 44% of patients with episodic migraines. Over the course of 1 year, only 13% of patients with chronic migraines and 11% of patients with episodic migraines were treated in an acute care setting. Less than 2% of patients had limitations in their work duties because of migraines.

Conclusion: Increased access to care provided benefits in reduction of specialist overutilization, reduction in hospitalizations, and reduction in disability. Patients with chronic migraine did not have increased use of medical resources or decreased productivity in this cohort.