Validation of criterion-based patient assignment and treatment effectiveness of a multidisciplinary modularized managed care program for headache

The Journal of Headache and Pain

Original

Christiane Hermann¹  Thomas-Martin Wallasch² 

[1] Department of Clinical Psychology, Justus-Liebig University Giessen, Giessen, Germany;Headache Center Berlin at the Sankt Gertrauden Krankenhaus Berlin, Berlin, Germany;MEDAS Ostschweiz, Interdisciplinary Medicine, Kornhausstr. 3, 9000, St. Gallen, Switzerland;

关键词: Integrated care;    Multidisciplinary modularized treatment program;    Outcome study;    Headache-related disability;    Headache-related quality of life;    Chronic headache;   

DOI  :  10.1007/s10194-012-0453-6

 received in 2012-03-23, accepted in 2012-04-16,  发布年份 2012

来源: Springer

【 摘 要 】

This prospective observational study evaluates the validity of an algorithm for assigning patients to a multidisciplinary modularized managed care headache treatment program. N = 545 chronic headache sufferers [migraine (53.8 %), migraine + tension type (30.1 %), tension type (8.3 %) or medication overuse headache (6.2 %), other primary headaches (1.5 %)] were assigned to one of four treatment modules differing with regard to the number and types of interventions entailed (e.g., medication, psychological intervention, physical therapy, etc.). A rather simple assignment algorithm based on headache frequency, medication use and psychiatric comorbidity was used. Patients in the different modules were compared with regard to the experienced burden of disease. 1-year follow-up outcome data are reported (N = 160). Headache frequency and analgesic consumption differed significantly among patients in the modules. Headache-related disability was highest in patients with high headache frequency with/without medication overuse or psychiatric comorbidity (modules 2/3) compared to patients with low headache frequency and medication (module 0). Physical functioning was lowest in patients with chronic headache regardless of additional problems (modules 1/2/3). Psychological functioning was lowest in patients with severe chronicity with/without additional problems (module 2/3) compared to headache suffers with no/moderate chronicity (module 0/1). Anxiety or depression was highest in patients with severe chronicity. In 1-year follow-up, headache frequency (minus 45.3 %), consumption of attack-aborting drugs (minus 71.4 %) and headache-related disability decreased (minus 35.9 %). Our results demonstrate the clinical effectiveness and the criterion validity of the treatment assignment algorithm based on headache frequency, medication use and psychiatric comorbidity.

【 授权许可】

CC BY   
© The Author(s) 2012