Barriers to Satisfactory Migraine Outcomes. What Have We Learned, Where Do We Stand?
Barriers to Satisfactory Migraine Outcomes. What Have We Learned, Where Do We Stand?
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DOI：
10.1111/j.1526-4610.2009.01410.x
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发表时间：
2009-07-01
期刊：
影响因子：
5
通讯作者：
Lipton, Richard B.
中科院分区：
文献类型：
--
作者：
Bigal, Marcelo;Krymchantowski, Abouch Valenty;Lipton, Richard B.
传统上，实现最佳偏头痛护理的障碍分为几类：偏头痛患者认识不足和咨询不足；卫生保健专业人员诊断不足和治疗不足；缺乏后续行动和治疗优化。这些“传统”壁垒至少在15年前就得到了承认和解决。流行病学研究表明，尽管许多偏头痛患者仍未得到最佳治疗，但偏头痛的会诊、诊断和治疗率已有所提高。在这里，我们重新审视这个问题，回顾进展领域，并扩大对偏头痛治疗障碍的讨论。我们假设疼痛的主观性质和沟通的困难造成了护理的临床和社会障碍。然后，我们回顾了一些传统的护理障碍，对比了过去15年的识别率、诊断率和治疗率。我们接着解决了偏头痛护理的新障碍，这些障碍已经作为在这个过程中获得的知识的功能出现了。
Barriers to optimal migraine care have traditionally been divided into a number of categories: under-recognition and underconsultation by migraine sufferers; underdiagnosis and undertreatment by health care professionals; lack of follow-up and treatment optimization. These "traditional" barriers have been recognized and addressed for at least 15 years. Epidemiologic studies suggest that consultation, diagnosis, and treatment rates for migraine have improved although many migraine sufferers still do not get optimal treatment. Herein, we revisit the problem, review areas of progress, and expand the discussion of barriers to migraine care. We hypothesize that the subjective nature of pain and difficulty in communicating it contributes to clinical and societal barriers to care. We then revisit some of the traditional barriers to care, contrasting rates of recognition, diagnosis, and treatment over the past 15 years. We follow by addressing new barriers to migraine care that have emerged as a function of the knowledge gained in this process.