A migraine management training program for primary care providers: An overview of a survey and pilot study findings, lessons learned, and considerations for further research.
A migraine management training program for primary care providers: An overview of a survey and pilot study findings, lessons learned, and considerations for further research.
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DOI：
10.1111/head.12803
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发表时间：
2016-04
期刊：
影响因子：
5
通讯作者：
Silbersweig D
中科院分区：
文献类型：
--
作者：
Minen M;Shome A;Halpern A;Tishler L;Brennan KC;Loder E;Lipton R;Silbersweig D
在美国，每年有500万到900万人因偏头痛而到初级保健诊所就诊。然而，偏头痛护理往往是次优的初级保健设置。先前的一项研究表明，初级保健医生（PCP）希望与头痛专家直接接触，以改善他们提供的偏头痛护理。我们试图进一步检查PCP偏头痛管理的知识，并评估PCP多模式偏头痛教育计划的可行性。我们进行了一项调查，评估PCP对偏头痛的知识。然后，我们举办了三场现场教育课程，并为PCP开发了电子邮件咨询服务，以提交他们对偏头痛的问题。我们报告定量和定性的结果。有21名PCP完成了调查。他们通常熟悉偏头痛的流行病学（报告的偏头痛平均患病率为12.6%±10.1）、精神共病（共病抑郁的平均患病率为24.5%±16.7，共病焦虑的平均患病率为24.6%±18.3）和循证行为治疗。五十六%的人引用认知行为疗法，78%的人引用生物反馈，61%的人引用放松疗法作为循证治疗。虽然大多数人都知道精神科合并症的患病率，但他们并没有对这些疾病进行常规评估（43%没有对焦虑进行常规评估，29%没有对抑郁进行常规评估）。PCP报告经常将患者转诊为非A级循证治疗：特殊饮食（60%），针灸（50%），物理治疗（30%）和精神分析（20%）。放松疗法是40%的PCP推荐的疗法。只有10%的人提到了认知行为疗法或生物反馈。19%的人很少或根本没有使用偏头痛预防药物。72%的人不知道或只是稍微知道美国神经病学学会偏头痛指南。教育课程的出席率各不相同（第1次会议N=22，第2次会议N = 6，第3次会议N = 15）。很少有PCP使用电子邮件咨询服务（N=4）。虽然PCP熟悉偏头痛护理的许多方面，但仍有改进的需要和机会。三次现场会议的出席人数很少，电子邮件咨询服务也很少使用。我们提供了一个深入的讨论教育干预的目标领域，在制定偏头痛的PCP教育计划的挑战，以及未来的研究领域。
There are five to nine million primary care office visits a year for migraine in the United States. However, migraine care is often suboptimal in the primary care setting. A prior study indicated that primary care physicians (PCPs) wanted direct contact with headache specialists to improve the migraine care they provide. We sought to further examine PCPs’ knowledge of migraine management and assess the feasibility of a multimodal migraine education program for PCPs. We conducted a survey assessing PCPs’ knowledge about migraine. We then held three live educational sessions and developed an email consultative service for PCPs to submit questions they had about migraine. We report both quantitative and qualitative findings. Twenty-one PCPs completed the survey. They were generally familiar with the epidemiology of migraine (mean prevalence of migraine reported was 12.6%±10.1), the psychiatric comorbidities (mean prevalence of comorbid depression was 24.5%±16.7, mean prevalence of comorbid anxiety was 24.6%±18.3), and evidence-based behavioral treatments. Fifty-six percent cited cognitive behavioral therapy, 78% cited biofeedback, and 61% cited relaxation therapy as evidence based treatments. Though most were aware of the prevalence of psychiatric comorbidities, they did not routinely assess for them (43% did not routinely assess for anxiety, 29% did not routinely assess for depression). PCPs reported frequently referring patients for non-level A evidence based treatments: special diets (60%), acupuncture (50%), physical therapy (30%), and psychoanalysis (20%). Relaxation therapy was a therapy recommended by 40% of the PCPs. Only 10% reported referring for cognitive behavioral therapy or biofeedback. Nineteen percent made minimal or no use of migraine preventive medications. Seventy-two percent were unaware of or only slightly aware of the American Academy of Neurology guidelines for migraine. There was variable attendance at the educational sessions (N=22 at 1st session, 6 at 2nd session, 15 at 3rd session). Very few PCPs used the email consultative service (N=4). Though PCPs are familiar with many aspects of migraine care, there is a need and opportunity for improvement. The three live sessions were poorly attended and the email consultative service was rarely used. We provide an in depth discussion of targeted areas for educational intervention, of the challenges in developing a migraine educational program for PCPs, and areas for future study.