Symptom Codes And Opioids: Disconcerting Headache Practice Patterns In Academic Primary Care. (S41.003)

Objective: Characterize headache diagnosis and treatment in the primary care clinics of an academic medical center. Background: Migraine affects 12% of the US population. It is thus a quintessential primary care problem. We asked how headache is diagnosed and treated in the primary care setting. Methods: The University of Utah Electronic Data Warehouse was queried for primary care patient encounters (2008-2010) that contained one of 27 headache-related codes. Results: 16,955 patients were identified, in 50,279 headache encounters at 13 clinics. 55.2% of encounters received a headache symptom code (784.0) rather than a diagnostic code. 41.6% received migraine diagnostic codes (346.xx), 3.2% received another headache diagnosis. 30.1% of all headache encounters were associated with an opiate prescription (range 15.1-62% by clinic). 36.3% of encounters with migraine diagnostic codes received opiates (12.1-75.9%); 19.1% received triptans (10.8-43.9%). Both triptans (OR 5.79, 95%CI 5.37,6.25) and opiates (OR 1.61, 95%CI 1.54,1.68) were more likely to be prescribed at migraine encounters than at headache symptom code encounters. The 9.1% of patients classified as heavy users (蠅7 encounters) generated 45.5% of total headache patient encounters. Heavy users were more likely to be prescribed an opiate (OR 5.19, CI 4.97,5.42), less likely to be prescribed a triptan (OR 0.77, CI 0.71,0.81), and more likely to receive a migraine diagnosis (OR 2.46 CI 2.36,2.55) than light users (≤6 encounters). Heavy opiate prescribers (蠅40 opiate prescriptions) represented 10.5% of the provider population but 65.4% of opiate prescriptions. Conclusions: The frequent use of a symptom code for headache may reflect a discomfort with diagnosing migraine and other primary headaches in primary care. The rate of opiate prescription for headaches is high; conversely the rate of triptan prescription is low, even in migraineurs. These diagnosis and prescribing patterns may be related, and are the subject of an ongoing EMR-based intervention in our primary care clinics. Disclosure: Dr. Brennan has received personal compensation for activities with MAP Pharmaceuticals and Allergan, Inc. as an advisory board member. Dr. Farrell has nothing to disclose. Dr. Keough has nothing to disclose. Dr. Baggaley has nothing to disclose. Dr. Pippitt has nothing to disclose. Dr. Pohl has nothing to disclose. Dr. Gren has nothing to disclose.