Patterns of medical diagnosis and treatment of migraine and probable migraine in a health plan
Patterns of medical diagnosis and treatment of migraine and probable migraine in a health plan
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DOI：
10.1111/j.1468-2982.2005.00988.x
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发表时间：
2006-01-01
期刊：
影响因子：
4.9
通讯作者：
Lipton, RB
中科院分区：
文献类型：
--
作者：
Bigal, ME;Kolodner, KB;Lipton, RB
本研究的目的是评估在健康计划中接受医学诊断或特定治疗的严重偏头痛（SM，有或无先兆的偏头痛）、可能偏头痛（PM）和所有偏头痛（AM、SM和PM合并）受试者的比例。符合条件的参与者是非营利性健康维护组织（HMO）的18-55岁参与者，他们在过去一年内接受过医生的门诊，急诊或住院治疗。我们使用了一个有效的计算机辅助电话访谈（CATI）调查，以确定SM，PM和对照组（接受门诊，急诊科，或住院治疗的医生在过去一年内的任何原因，但没有SM或PM）。24个月期间的医疗和处方药报销与参与人档案相关联。在8579名受访者中，我们确定了1265名SM患者和1252名PM患者，并与960名随机选择的对照组进行了比较。只有194 SM，21人（1.7%）PM，215（8.5%）AM患者在过去24个月内接受了住院或门诊原发性偏头痛索赔，而在过去24个月内，240名（18.9%）SM、39名（3.1%）PM、279名（11.1%）AM患者和8名（0.6%）对照者接受了任何偏头痛索赔。偏头痛药物（曲坦类或麦角类化合物的ICD-9代码）仅用于140名（11.1%）SM和34名（2.7%）PM患者，偏头痛镇痛药（丁他比妥和异美烯化合物）用于6.3% SM和2.2% PM患者（对照组的0.7%）。偏头痛预防药物用于更多的SM和PM患者（19.6%和13.1%），但也用于对照组（10.5%），表明它们可能用于其他医学原因。SM和PM在健康计划中诊断不足和治疗不足。教育策略应侧重于医生教育，解决诊断偏头痛的全谱和偏头痛的医生管理与特定的偏头痛治疗在适当的患者。
The objectives of this study were to assess the proportion of subjects with strict migraine (SM, migraine with and without aura), probable migraine (PM), and all migraine (AM, SM and PM pooled together), who receive a medical diagnosis or a specific treatment within a health plan. Eligible participants were 18-55-year participants of a non-profit health maintenance organization (HMO) who had received out-patient, emergency department, or in-patient care from a physician within the past year. We used a validated computer-assisted telephone interview (CATI) survey to identify SM, PM and controls (received out-patient, emergency department, or in-patient care from a physician for any reason within the past year, but did not have SM or PM). Medical and prescription drug claims for the 24-month period were linked to participant files. Among 8579 respondents, we identified 1265 SM sufferers and 1252 PM sufferers, which were compared with 960 randomly selected controls. Just 194 (15.3%) SM, 21 (1.7%) PM, and 215 (8.5%) AM sufferers received an in-patient or out-patient primary migraine claim in the previous 24 months, compared with six (0.5%) controls; 240 (18.9%) SM, 39 (3.1%) PM, 279 (11.1%) AM sufferers, and eight controls (0.6%) received any migraine claim. There were claims for migraine drugs (ICD-9 code for triptans or ergot compounds) for just 140 (11.1%) SM and 34 (2.7%) PM sufferers, and migraine analgesics (butalbital and isomethepthene compounds), for 6.3% SM and 2.2% PM sufferers (0.7% of the controls). Migraine preventives were used for a larger number of SM and PM sufferers (19.6% and 13.1%), but also for controls (10.5%), indicating that they were probably used for other medical reasons. Both SM and PM are underdiagnosed and undertreated within a health plan. Educational strategies should focus on physician education addressing diagnosing the full spectrum of migraine and physician management of migraine with specific migraine therapy in appropriate patients.