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Their intended application includes all levels of care. Here we assess their implementation in primary care.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We included 28 primary-care clinics in Germany (4), Turkey (4), Latvia (5) and Portugal (15). To implement the indicators, we interviewed 111 doctors, 92 nurses and medical assistants, 70 secretaries, 27 service managers and 493 patients, using the questionnaires developed by LTB and EHF. In addition, we evaluated 675 patients\u2019 records. Enquiries were in nine domains: diagnosis, individualized management, referral pathways, patient education and reassurance, convenience and comfort, patient satisfaction, equity and efficiency of headache care, outcome assessment and safety.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The principal finding was that Implementation proved feasible and practical in primary care. In the process, we identified significant quality deficits. Almost everywhere, histories of headache, especially temporal profiles, were captured and\/or assessed inaccurately. A substantial proportion (20%) of patients received non-specific ICD codes such as R51 (\u201cheadache\u201d) rather than specific headache diagnoses. Headache-related disability and quality of life were not part of routine clinical enquiry. Headache diaries and calendars were not in use. Waiting times were long (e.g., about 60\u2009min in Germany). Nevertheless, most patients (&gt;\u200985%) expressed satisfaction with their care. Almost all the participating clinics provided equitable and easy access to treatment, and follow-up for most headache patients, without unnecessary barriers.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The study demonstrated that headache service quality indicators can be used in primary care, proving both practical and fit for purpose. It also uncovered quality deficits leading to suboptimal treatment, often due to a lack of knowledge among the general practitioners. There were failures of process also. These findings signal the need for additional training in headache diagnosis and management in primary care, where most headache patients are necessarily treated. More generally, they underline the importance of headache service quality evaluation in primary care, not only to identify-quality failings but also to guide improvements.<\/jats:p>\n                <jats:p>This study also demonstrated that patients\u2019 satisfaction is not, on its own, a good indicator of service quality.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s10194-021-01236-4","type":"journal-article","created":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T09:03:58Z","timestamp":1619600638000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Headache service quality evaluation: implementation of quality indicators in primary care in Europe"],"prefix":"10.1186","volume":"22","author":[{"name":"on behalf of European Headache Federation and Lifting The Burden: the Global Campaign against Headache","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6948-5171","authenticated-orcid":false,"given":"B.","family":"Lenz","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9932-1159","authenticated-orcid":false,"given":"Z.","family":"Katsarava","sequence":"additional","affiliation":[]},{"given":"R.","family":"Gil-Gouveia","sequence":"additional","affiliation":[]},{"given":"G.","family":"Karelis","sequence":"additional","affiliation":[]},{"given":"B.","family":"Kaynarkaya","sequence":"additional","affiliation":[]},{"given":"L.","family":"Meksa","sequence":"additional","affiliation":[]},{"given":"E.","family":"Oliveira","sequence":"additional","affiliation":[]},{"given":"F.","family":"Palavra","sequence":"additional","affiliation":[]},{"given":"I.","family":"Rosendo","sequence":"additional","affiliation":[]},{"given":"M.","family":"Sahin","sequence":"additional","affiliation":[]},{"given":"B.","family":"Silva","sequence":"additional","affiliation":[]},{"given":"D.","family":"Ulud\u00fcz","sequence":"additional","affiliation":[]},{"given":"Y. 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Approvals were not required in Turkey or Latvia for projects with the primary purpose of service improvement.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consents to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"TJS and ZK are Directors and Trustees of <i>Lifting The Burden<\/i>. ZK is President of the European Headache Federation. Other than these, no author has competing interests relevant to the subject matter of this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"33"}}