Assessing Barriers to Chronic Migraine Consultation, Diagnosis, and Treatment: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study.
Assessing Barriers to Chronic Migraine Consultation, Diagnosis, and Treatment: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study.
复制标题
作者：
Dodick DW;Loder EW;Manack Adams A;Buse DC;Fanning KM;Reed ML;Lipton RB
评估对慢性偏头痛的良好医疗护理至关重要的步骤的比率和预测因素，包括：(1)医疗咨询，(2)准确的诊断，(3)最低限度的药物治疗。候选预测因素包括社会经济变量、人口统计变量和头痛相关变量。以前的研究已经确定，对发作性偏头痛进行有效治疗的障碍包括没有医疗保险，缺乏适当的医疗咨询，没有得到准确的诊断，以及没有提供急性和预防性治疗的养生法。慢性偏头痛流行病学和结果研究(CAMEO)是一项基于网络的偏头痛纵向小组研究，包括一个侧重于医疗模式和障碍的横断面模块。符合这项分析的参与者符合慢性偏头痛的研究标准，有头痛相关残疾的证据，并提供有关医疗保险状况的数据。目前分析的主要结果包括受访者因头痛向指定的医疗保健专业人员寻求咨询的比例，自我报告接受了慢性或转化性偏头痛的诊断，以及接受了最低限度的头痛药物治疗，重点是处方的急性和预防治疗。在CAMEO研究中，80783名受访者提供了研究数据，16789名(20.8%)的受访者符合偏头痛的标准，1476名(8.8%的偏头痛患者)满足慢性偏头痛的标准。总共有1254名参与者(85.0%的慢性偏头痛患者)符合这项分析的纳入标准。其中，512名受访者(40.8%)报告称，目前正在咨询医疗保健专业人员以治疗头痛。就诊几率随着年龄(OR 1.02；95%CI 1.01-1.03)、体重指数(OR 1.01；95%CI 1.00-1.03)、偏头痛相关残疾(OR 1.02；95%CI 1.00-1.04)、偏头痛严重程度(OR 1.16；95%CI 1.11-1.22)和有无医疗保险(OR 4.61；95%CI 3.05-6.96)的增加而增加。在咨询医疗保健专业人员的人中，126人(24.6%)得到了准确的诊断，而正确诊断的人中有56人(44.4%)同时接受了急性和预防性药物治疗；女性(OR 1.93；95%CI 1.03-3.61)、偏头痛严重程度较重的人(OR 1.25；95%CI 1.14-1.37)以及正在咨询专家的人(OR 2.38；95%CI 1.54-3.69)被诊断为CM的几率更高。在目前咨询的患者中，没有发现接受适当治疗的预测因素。在我们的慢性偏头痛患者样本中，只有56人(4.5%)成功地跨越了成功治疗慢性偏头痛的三大障碍(即咨询偏头痛的医疗保健专业人员，得到准确的诊断，并接受了最低限度的急性和预防性药物治疗)。我们的发现表明，5%的慢性偏头痛患者在接受头痛护理(咨询、诊断和治疗)时跨越了3个障碍，这代表着在这一人群中改善护理的大量未得到满足的需求。咨询医疗保健专业人员的预测因素包括年龄、是否有医疗保险、偏头痛相关残疾程度更高以及偏头痛症状更严重。在这些咨询中，适当诊断的预测因素包括咨询专家、女性和更严重的偏头痛。需要公共卫生努力，通过一系列旨在提高就诊率、诊断准确性和坚持最低限度药物治疗的干预和教育努力，改善慢性偏头痛患者的预后。
To assess the rates and predictors of traversing steps essential to good medical care for chronic migraine, including: (1) medical consultation, (2) accurate diagnosis, and (3) minimal pharmacologic treatment. Candidate predictors included socioeconomic, demographic, and headache‐specific variables. Previous research has established that barriers to effective management for episodic migraine include the absence of health insurance, lack of appropriate medical consultation, failure to receive an accurate diagnosis, and not being offered a regimen with acute and preventive treatments. The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, a longitudinal web‐based panel study of migraine, included a cross‐sectional module focused on patterns of and barriers to medical care. Participants eligible for this analysis met the study criteria for chronic migraine, had evidence of headache‐related disability, and provided data on health insurance status. The main outcomes in the current analysis included the proportion of respondents who sought consultation for headache with a designated healthcare professional, self‐reported receiving a diagnosis of chronic or transformed migraine, and received minimal pharmacologic treatment for headache with a focus on prescribed acute and preventive treatments. In the CaMEO Study, 80,783 respondents provided study data, 16,789 (20.8% of respondents) met criteria for migraine, and 1476 (8.8% of those with migraine) met chronic migraine criteria. In total, 1254 participants (85.0% of those with chronic migraine) met inclusion criteria for this analysis. Of those, 512 respondents (40.8%) reported currently consulting with a healthcare professional for headache. Odds of consulting increased with increasing age (OR 1.02; 95% CI 1.01–1.03), body mass index (BMI) (OR 1.01; 95% CI 1.00–1.03), migraine‐related disability (OR 1.02; 95% CI 1.00–1.04), and migraine severity (OR 1.16; 95% CI 1.11–1.22) and presence of health insurance (OR 4.61; 95% CI 3.05–6.96). Among those consulting a healthcare professional, 126 (24.6%) received an accurate diagnosis and 56 of those with a correct diagnosis (44.4%) received both acute and preventive pharmacologic treatments; odds of a CM diagnosis were higher for women (OR 1.93; 95% CI 1.03–3.61), those with greater migraine severity (OR 1.25; 95% CI 1.14–1.37), and those currently consulting a specialist (OR 2.38; 95% CI 1.54–3.69). No predictors of receiving appropriate treatment were identified among those currently consulting. Among our sample of people with chronic migraine, only 56 (4.5%) individuals successfully traversed the series of 3 barriers to successful chronic migraine care (ie, consulted a healthcare professional for migraine, received an accurate diagnosis, and were prescribed minimal acute and preventive pharmacologic treatments). Our findings suggest that <5% of persons with chronic migraine traversed 3 barriers to receiving care for headache (consultation, diagnosis, and treatment), representing a large unmet need for improving care in this population. Predictors of consulting a healthcare professional included age, having health insurance, greater migraine‐related disability, and greater migraine symptom severity. Among those consulting, predictors of an appropriate diagnosis included consulting a specialist, female sex, and greater migraine severity. Public health efforts are needed to improve outcomes for patients with chronic migraine by a range of interventions and educational efforts aimed at improving consultation rates, diagnostic accuracy, and adherence to minimal pharmacologic treatment.
登录
查看更多内容
影响因子：
9.9
作者：
Lipton, R. B.;Bigal, M. E.;Stewart, W. F.
通讯作者：
Stewart, W. F.
影响因子：
5
作者：
Gibbs, TS;Fleischer, AB;O'Donovan, CA
通讯作者：
O'Donovan, CA
影响因子：
5
作者：
Lipton, RB;Diamond, S;Stewart, WF
通讯作者：
Stewart, WF
DOI：
10.3899/jrheum.100418
发表时间：
2011-01
期刊：
The Journal of rheumatology
影响因子：
--
作者：
McAdams MA;Maynard JW;Baer AN;Köttgen A;Clipp S;Coresh J;Gelber AC
通讯作者：
Gelber AC
影响因子：
5
作者：
Lipton, Richard B.;Serrano, Daniel;Buse, Dawn C.
通讯作者：
Buse, Dawn C.