Addressing the Crisis of Diagnosis and Management of Migraine in Primary Care: A Summary of the American Headache Society FrontLine Primary Care Advisory Board.
Addressing the Crisis of Diagnosis and Management of Migraine in Primary Care: A Summary of the American Headache Society FrontLine Primary Care Advisory Board.
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DOI：
10.1111/head.13797
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发表时间：
2020-05
期刊：
影响因子：
5
通讯作者：
Sprouse-Blum A
中科院分区：
文献类型：
--
作者：
Minen MT;Robbins MS;Loder E;Nahas S;Gautreaux J;Litin S;Barch C;Cook C;Smith T;Powers SW;Hasan S;Sbar E;Stika CS;Stone F;Sprouse-Blum A
在美国，偏头痛影响着3600万人，通常从青春期到成年期，是全球第二大致残原因。1超过一半(52.8%)的偏头痛就诊发生在初级保健机构。2然而，许多初级保健提供者很少接受有关头痛医学的正规教育，在这种情况下，偏头痛存在严重的诊断不足和治疗不足。只有28%的PCP熟悉美国神经病学学会偏头痛预防指南，只有40%的PCP熟悉美国内科基金会明智地选择竞选建议来限制偏头痛的阿片类药物和成像。3只有34%的人知道阿片类药物与头痛恶化有关。近40%的成年人偏头痛需要预防性治疗，但实际上只有13%的人接受了预防治疗。4偏头痛诊断和开始预防性药物治疗之间的平均延迟时间为四年，加剧了这一缺陷。5鉴于神经科医生(预计到2025年将短缺18%)6以及全国范围内头痛专家的相对匮乏，7满足头痛人群的紧急专科护理需求是具有挑战性的。因此，一线服务提供者需要具备应对需求的能力。AHS董事会和教育委员会将改善一线-初级保健临床环境中的偏头痛护理作为组织的优先事项。作为第一步，AHS委托成立了一个咨询委员会，以指导制定战略，帮助缩小患者的管理差距。2019年11月21日，在美国头痛学会年度斯科茨代尔头痛研讨会上，由代表头痛医学各个一线领域的健康专业人士组成的顾问委员会召开。咨询委员会成员是通过与美国护士协会、美国妇产科医生学会、美国医师学会和美国家庭实践学会等组织或其代表进行外联来招募的。某些地理区域也被确定为家庭医学和内科住院医师
Migraine affects over 36 million people in the United States, often from adolescence throughout adulthood, and is the second leading cause of disability worldwide. 1 Over half (52.8%) of all visits for migraine take place in primary care settings. 2 However, many primary care providers (PCPs) receive little formal education about headache medicine, and there is substantial under-diagnosis and under-treatment of migraine in this setting. Only 28% of PCPs were familiar with the American Academy of Neurology guidelines for migraine prevention and only 40% were familiar with the American Board of Internal Medicine Foundation Choosing Wisely Campaign recommendations to limit opioids and imaging for migraine. 3 Only 34% were aware that opioids are associated with worsening of headache. Close to 40% of adults with migraine need preventive therapy, but only 13% actually receive it. 4 This deficiency is compounded by an average delay of four years between migraine diagnosis and the start of preventive medication. 5 Given the relative scarcity of neurologists (with a projected shortfall of 18% by 2025) 6 as well as headache specialists nationally, 7 it is challenging to meet the urgent specialty care needs of the headache population. Thus front line providers need to be equipped to begin to address the demands.The AHS Board of Directors and Education Committee established the improvement of migraine care in Front Line-Primary Care clinical settings as an organizational priority. As a first step, AHS commissioned the creation of an advisory board to guide the development of strategies to help close management gaps for patients. On November 21, 2019, an advisory board consisting of health professionals representing various front line fields of headache medicine was convened at the annual Scottsdale Headache Symposium of the American Headache Society. Advisory board members were recruited through outreach to organizations or their representatives including the American Association of Nurse Practitioners, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American Academy of Family Practice. Certain geographic areas were also targeted to identify family medicine and internal medicine residency
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9.9
作者：
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通讯作者：
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DOI：
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