原发性头痛的发作性和慢性偏头痛。
Episodic and Chronic Migraine in Primary Care.
机构信息
Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
出版信息
Headache. 2019 Jul;59(7):1042-1051. doi: 10.1111/head.13543. Epub 2019 Apr 29.
OBJECTIVE
To inform migraine care model development by assessing differences between patients with chronic migraine (CM) and episodic migraine (EM) in the current state of treatment, disability, patient satisfaction, and quality improvement opportunities.
BACKGROUND
Efficient and focused use of scarce resources will be needed to address challenges within large populations of migraine patients.
METHODS
We deployed a cross-sectional survey study of randomly selected migraine patients within a community primary care practice.
RESULTS
There were 516 survey respondents (516/1804 [30%] response rate). CM patients were more likely than EM patients to report care from a neurologist (76/110 [69%] vs 229/406 [56%]; P = .0026), and higher disability according to the Migraine Disability Assessment and Headache Impact Test - 6 questionnaires (P < .0001). CM patients were less likely than EM patients to report overall satisfaction with care (16/110 [38%] vs 156/406 [66%], P = .0002), satisfaction with access to care (17/110 [33%] vs 176/406 [68%], P < .0001), and advice they needed (16/110 [31%] vs 160/406 [62%], P < .0001). Most patients with migraine had been offered triptan medications 377/516 (78%). Overall, 156/516 (31%) of individuals were currently taking any medication for migraine prevention, and 208/516 (40%) including botulinum toxin injections. CM patients were more likely to be taking preventive medication (39/110 [36%] vs 117/406 [29%], P = .0191) and report familiarity with the diagnosis of medication-overuse headache than patients with EM (80/110 [81%] vs 256/406 [69%], P = .0178).
CONCLUSIONS
We observed differences between patients with chronic and EM and expected care delivery improvement opportunities for migraine patients in primary care. CM patients report higher levels of disability and less satisfaction with access to perceived needed medical advice and care. These findings support the need to further develop and study novel care models to efficiently and effectively deliver high-quality care and expertise in limited supply to a diverse migraine population.
目的
通过评估慢性偏头痛（CM）和发作性偏头痛（EM）患者在当前治疗、残疾、患者满意度和质量改进机会方面的差异，为偏头痛护理模式的发展提供信息。
背景
为了解决大量偏头痛患者面临的挑战，需要高效、有针对性地利用稀缺资源。
方法
我们在社区初级保健实践中对随机选择的偏头痛患者进行了横断面调查研究。
结果
共收到 516 份调查问卷（1804 份中的 516 份[30%]的回复率）。与 EM 患者相比，CM 患者更有可能接受神经科医生的治疗（76/110[69%]与 229/406[56%]；P=0.0026），且偏头痛残疾评估量表和头痛影响测试-6 问卷（HIT-6）评分更高（P<0.0001）。与 EM 患者相比，CM 患者对整体护理满意度（16/110[38%]与 156/406[66%]，P=0.0002）、对获得护理的满意度（17/110[33%]与 176/406[68%]，P<0.0001）和他们需要的建议的满意度（16/110[31%]与 160/406[62%]，P<0.0001）较低。大多数偏头痛患者（377/516[78%]）都接受过曲坦类药物治疗。总体而言，156/516（31%）名患者目前正在服用任何偏头痛预防药物，其中 208/516（40%）名患者接受肉毒杆菌毒素注射。CM 患者更有可能服用预防药物（39/110[36%]与 117/406[29%]，P=0.0191），且比 EM 患者更熟悉药物过度使用性头痛的诊断（80/110[81%]与 256/406[69%]，P=0.0178）。
结论
我们观察到慢性偏头痛和发作性偏头痛患者之间存在差异，为初级保健中的偏头痛患者提供了预期的改善护理服务的机会。CM 患者报告的残疾程度更高，对获得所需医疗建议和护理的满意度较低。这些发现支持进一步开发和研究新型护理模式的必要性，以便在有限的供应下高效、有效地为多样化的偏头痛患者提供高质量的护理和专业知识。
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