发作性和慢性偏头痛患者就诊的障碍：来自慢性偏头痛流行病学和结局研究的结果。

Barriers to care in episodic and chronic migraine: Results from the Chronic Migraine Epidemiology and Outcomes Study.

机构信息

Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.

Department of Neurology, University of Michigan, Ann Arbor, MI, USA.

出版信息

Headache. 2021 Apr;61(4):628-641. doi: 10.1111/head.14103. Epub 2021 Apr 1.

DOI:10.1111/head.14103

PMID:33797078

Abstract

OBJECTIVE

To assess rates of and factors associated with traversing fundamental barriers to good medical outcomes and pharmacologic care in individuals with episodic migraine (EM) and chronic migraine (CM), including socioeconomic status and race.

BACKGROUND

Barriers to good outcomes in migraine include the lack of appropriate medical consultation, failure to receive an accurate diagnosis, not being offered a regimen with acute and preventive pharmacologic treatments (if indicated), and not avoiding medication overuse.

METHODS

The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study was a longitudinal Internet-based survey. Respondents who met criteria for migraine consistent with the International Classification of Headache Disorders, 3rd edition, had a Migraine Disability Assessment score ≥ 6, and provided health insurance coverage status were included in this analysis. Successfully traversing each barrier to care and the effects of sociodemographic characteristics were examined.

RESULTS

Among 16,789 respondents with migraine, 9184 (54.7%; EM: 7930; CM: 1254) were eligible. Current headache consultation was reported by 27.6% (2187/7930) of EM and 40.8% (512/1254) of CM respondents. Among consulters, 75.7% (1655/2187) with EM and 32.8% (168/512) with CM were accurately diagnosed. Among diagnosed consulters, 59.9% (992/1655) with EM and 54.2% (91/168) with CM reported minimally appropriate acute and preventive pharmacologic treatment. Among diagnosed and treated consulters, in the EM group 31.8% (315/992) and in the CM group 74.7% (68/91) met medication overuse criteria. Only 8.5% (677/7930) of EM and 1.8% (23/1254) of CM respondents traversed all four barriers. Higher income was positively associated with likelihood of traversing each barrier. Blacks and/or African Americans had higher rates of consultation than other racial groups. Blacks and/or African Americans and multiracial people had higher rates of acute medication overuse.

CONCLUSIONS

Efforts to improve care should focus on increasing consultation and diagnosis rates, improving the delivery of all appropriate guideline-based treatment, and avoidance of medication overuse.

摘要

目的

评估在发作性偏头痛（EM）和慢性偏头痛（CM）患者中，与良好医疗结局和药物治疗相关的基本障碍的发生率和相关因素，包括社会经济地位和种族。

背景

偏头痛治疗效果不佳的障碍包括：未进行适当的医疗咨询、未能做出准确的诊断、未提供急性和预防性药物治疗方案（如果需要）、以及未避免药物滥用。

方法

慢性偏头痛流行病学和结局（CaMEO）研究是一项基于互联网的纵向调查。符合国际头痛疾病分类第 3 版偏头痛标准、偏头痛残疾评估量表评分≥6 分且提供健康保险覆盖情况的应答者纳入本分析。本研究检查了成功克服每个治疗障碍的情况，以及社会人口学特征的影响。

结果

在 16789 名偏头痛应答者中，有 9184 名（54.7%；EM：7930 名；CM：1254 名）符合条件。目前接受头痛咨询的 EM 应答者占 27.6%（2187/7930），CM 应答者占 40.8%（512/1254）。在咨询者中，75.7%（1655/2187）的 EM 患者和 32.8%（168/512）的 CM 患者得到了准确诊断。在确诊的咨询者中，59.9%（992/1655）的 EM 患者和 54.2%（91/168）的 CM 患者接受了最小适当的急性和预防性药物治疗。在确诊和治疗的咨询者中，EM 组有 31.8%（315/992）和 CM 组有 74.7%（68/91）符合药物过度使用标准。只有 8.5%（677/7930）的 EM 患者和 1.8%（23/1254）的 CM 患者成功克服了所有 4 个障碍。较高的收入与克服每个障碍的可能性呈正相关。黑人或非裔美国人的咨询率高于其他种族群体。黑人和/或非裔美国人以及多种族人群的急性药物过度使用率更高。