Primary care clinicians' perspectives on migraine management in Aotearoa New Zealand: a qualitative study.

Abstract

Introduction: Despite being a common and disabling neurological disease, migraine is often underdiagnosed and undertreated. Although most patients with migraine can be effectively managed in primary care, people with migraine in Aotearoa New Zealand (NZ) report multiple barriers to care and negative impacts of migraine on physical and mental health, work and quality of life.

Aim: This study aimed to describe the experience of primary care clinicians with managing migraine disease in NZ and identify enablers and barriers to effective care.

Methods: Clinicians were recruited through advertisements in an online newsletter and a regional email network. Semi-structured interviews were completed via phone or Zoom. Inductive thematic analysis was undertaken to identify key themes.

Results: Five general practitioners and three nurse practitioners were interviewed. Themes related to the clinician, healthcare system and societal factors were identified across the patient journey of seeking health care (cultural safety, primary care accessibility, awareness and health literacy), diagnosis (diagnostic knowledge, secondary care and diagnostic test accessibility and diagnostic overshadowing) and management (treatment knowledge, communication and patient education, access to ongoing care, role of other health professionals and stigma of chronic disease).

Discussion: Significant barriers to migraine health care related to accessibility of primary care, particularly cost, wait times and availability. Advice from neurology was a valued resource, but access to in-person consultations for patients with migraine was limited. Clinician knowledge about migraine diagnosis and treatment was well supported by online and educational resources. Involving the wider primary care team in migraine management could help improve care.