Tele-Headache Clinic for Service Members
Katharine Ambrose, DPT and Philip Girard, MS
Key Points:
- Headaches are a key factor in the Traumatic Brain Injury (TBI) symptom complex affecting sleep, mood and cognitive function.
- Early management and treatment of headache aides in full recovery and return to duty.
- Access to specialized headache care is limited for service members receiving treatment at military treatment facilities (MTF) within their duty stations.
Background
In 2009 the Defense Veteran’s Brain Injury Center (DVBIC) initiated a Tele-TBI service at several military bases. The purpose of this telemedicine initiative was to improve access to specialized care for injured service members with TBI. One site that DVBIC partnered with was Ireland Army Community Hospital at Ft. Knox, Kentucky. The goal was to treat service members there who had persistent headaches. At that time, Ft. Knox did not have a neurologist or other headache specialist on staff so service members had to travel long distances to receive care at another MTF. This prevented or delayed appropriate treatment in most cases. Treatment at a civilian community- based clinic was possible for some but did not allow access to the military’s medical record system for important integration with other health services. The electronic medical record (EMR) facilitates continuity of care within the military as service members deploy and frequently change duty stations over time.
The Tele-Headache Clinic
The tele-headache clinic utilized the EMR and leveraged clinical resources from several sources. The clinic consisted of TBI trained physician’s assistant (PA) who worked onsite at Ft. Knox. The PA is a member of the Army’s Northern Regional Medical Command’s tele-health network of providers. She performed the initial evaluation onsite and ordered lab work and other tests depending upon the needs of the individual patient. During a follow up visit with the PA, there was an interactive video conference with a DVBIC neurologist who specialized in headache management at Walter Reed Army Medical Center in Washington, D.C. Utilizing the military EMR, the neurologist was able to access and review the notes from the initial visit and any results from the testing that was done in Kentucky.
The interactive visit allowed the patient, the PA and the neurologist to review and discuss the symptoms and goals of treatment. At the end of the video conference, the neurologist worked with the PA to develop a treatment regime. Once the treatment plan was confirmed, the PA would continue to work with the service member to manage his or her headaches until a positive outcome was achieved.
The tele-headache clinic continues to use video conference technology, already in place in many military medical centers, to connect patients in remote locations to distant specialists within the military medical system.
The Tele-Headache Clinic Outcomes
The Tele-headache clinic addressed multiple challenges, including: access to specialized care, need for travel long distances for medical appointments, delays in treatment, and continuity of care within the military system. This expedited access to specialized care overwhelmingly pleased service members involved in this program. Command leadership at Ft. Knox recognized the benefit of the service and was able to evaluate the utilization and clinical outcomes. After approximately six months of providing specialized headache service through telemedicine, Ft. Knox realized the need for a more permanent solution. The workload generated by the tele-headache clinic helped leadership justify hiring a full time neurologist at Ft. Knox who continues to assist patients with TBI today. The tele-headache clinic continues to address access to care difficulties for service members with symptoms related to TBI and is currently being implemented at Ft. Lee, Virginia and other MTF’s.
Katharine Ambrose, DPT and Philip Girard, MS, Defense Veteran’s Brain Injury Center (DVBIC) Office of Telemedicine
DVBIC is a congressionally mandated program headquartered in Washington, D.C., to serve active-duty military and veterans with TBI through state-of-the-art medical care, clinical research and educational programs. DVBIC is comprised of military hospitals from each service branch, VA polytrauma centers, and civilian health programs located in 16 regional offices across the United States and abroad. There are approximately 225 professionals within the DVBIC network representing more than 20 clinical disciplines. DVBIC is the primary operational TBI component of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. For more visit www.DVBIC.org