scholarly journals Current clinical practice in disabling and chronic migraine in the primary care setting: results from the European My-LIFE anamnesis survey

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Philippe Ryvlin ◽  
Kirill Skorobogatykh ◽  
Andrea Negro ◽  
Rainel Sanchez- De La Rosa ◽  
Heike Israel-Willner ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Migraine ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Headache Disorder ◽  
Episodic Migraine ◽  
Patient Diary ◽  
The Uk

Abstract Background Migraine is a prevalent and disabling headache disorder that affects more than 1.04 billion individuals world-wide. It can result in reduction in quality of life, increased disability, and high socio-economic burden. Nevertheless, and despite the availability of evidence-based national and international guidelines, the management of migraine patients often remains suboptimal, especially for chronic migraine (CM) patients. Methods My-LIFE anamnesis project surveyed 201 General practitioners (GPs) from 5 European countries (France, Germany, Italy, Spain, and the UK) with the aim of understanding chronic migraine (CM) patients’ management in the primary care setting. Results In our survey, GPs diagnosed episodic migraine (EM) more often than CM (87% vs 61%, p < 0.001). We found that many CM patients were not properly managed or referred to specialists, in contrast to guidelines recommendations. The main tools used by primary-care physicians included clinical interview, anamnesis guide, and patient diary. Tools used at the first visit differed from those used at follow-up visits. Up to 82% of GPs reported being responsible for management of patients diagnosed with disabling or CM and did not refer them to a specialist. Even when the GP had reported referring CM patients to a specialist, 97% of them were responsible for their follow-up. Moreover, the treatment prescribed, both acute and preventive, was not in accordance with local and international recommendations. GPs reported that they evaluated the efficacy of the treatment prescribed mainly through patient perception, and the frequency of follow-up visits was not clearly established in the primary care setting. These results suggest that CM is underdiagnosed and undertreated; thereby its management is suboptimal in the primary care. Conclusions There is a need of guidance in the primary care setting to both leverage the management of CM patients and earlier referral to specialists, when appropriate.

scholarly journals Need of guidance in disabling and chronic migraine identification in the primary care setting, results from the european MyLife anamnesis survey

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Angel L. Guerrero ◽  
Andrea Negro ◽  
Philippe Ryvlin ◽  
Kirill Skorobogatykh ◽  
Rainel Sanchez-De La Rosa ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Migraine ◽  
Western Europe ◽  
Online Survey ◽  
Care Setting ◽  
Preventive Treatment ◽  
Societal Burden ◽  
Patient Diary ◽  
Preventive Medication ◽  
The Uk

Abstract Background Migraine affects 80.8 million people in Western Europe and is the first cause of disability among people between ages 15 and 49 worldwide. Despite being a highly prevalent and disabling condition, migraine remains under-diagnosed and poorly managed. Methods An international, online survey was conducted among 201 general practitioners (GPs) from 5 European countries (France, Germany, Italy, Spain and the UK) who are experienced in the management of headache disorders. Results The majority of GPs (82%) did not refer patients with chronic migraine (CM) to migraine specialists. Among those patients, the participants estimated that around 55% received preventive medication. Some differences between countries were observed regarding referral rate and prescription of preventive treatment. Most GPs (87%) reported a lack of training or the need to be updated on CM management. Accordingly, 95% of GPs considered that a migraine anamnesis guide could be of use. Overall, more than 95% of GPs favoured the use of a patient diary, a validated diagnostic tool and a validated scale to assess impact of migraine on patients’ daily life. Similarly, 96% of the GPs considered that the inclusion of warning features (red flags) in an anamnesis guide would be useful and 90% favoured inclusion of referral recommendations. Conclusions The results from this survey indicate that more education on diagnosis and management of CM is needed in primary care. Better knowledge on the recognition and management of migraine in primary care would improve both prognosis and diagnosis and reduce impact of migraine on patients’ lives, healthcare utilization and societal burden.

Combined Hemimandibular Hyperplasia and Elongation: the Orthodontic-Surgical Management

2020 ◽  
Vol 13 (3) ◽  
pp. 134-140
Author(s):  
Ciarán Devine ◽  
Anna Sayan ◽  
Velupillai Ilankovan
Keyword(s):  
Primary Care ◽  
Surgical Treatment ◽  
Surgical Management ◽  
Clinical Relevance ◽  
Care Setting ◽  
Primary Care Setting ◽  
Diagnostic Techniques ◽  
Mandibular Asymmetry ◽  
Contemporary Management

Patients commonly present to orthodontists with complaints of facial and/or mandibular asymmetry. It is important that all asymmetry complaints are taken seriously and further investigated. Orthodontists play an important role in the diagnosis, management and follow-up of these conditions. For condylar hyperactivity, management is generally in a multidisciplinary setting. Clinicians who practice orthodontics in a primary care setting need to be aware of the correct terminology and the appropriate investigations required for diagnosis and the management of this condition. This paper aims to describe the contemporary management of condylar hyperactivity and presents a case of combined orthodontic-surgical treatment. CPD/Clinical Relevance: Condylar hyperactivity can lead to severe orofacial deformities and severe malocclusions. The orthodontist must understand the terminology, diagnostic techniques and treatment of this condition in order to offer the most appropriate management. The entire dental team may be involved in cases of condylar hyperactivity from diagnosis through to follow-up. Increased awareness may therefore improve diagnosis and ensure appropriate early referrals are made, thus potentially improving outcomes.

An Examination of the Prescription Renewal Process and Implications for Primary Care Physicians and Community Pharmacists

2018 ◽  
Vol 33 (2) ◽  
pp. 187-191
Author(s):  
Anthony J. Pattin ◽  
Nathan Devore ◽  
Jonathan Fowler ◽  
David Weldy
Keyword(s):  
Primary Care ◽  
Renewal Process ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Community Pharmacists ◽  
Effective Management ◽  
Physician Practices ◽  
Staff Members ◽  
Inappropriate Medications

In physician practices and pharmacies, staff members work to process prescription renewals so that patients receive a steady supply of medications. These functions are essential to ensure patients have continuous access to medications and remain adherent to prescribed therapies. Despite the incorporation of e-prescribing software programs to ease management of these processes, barriers to effective management of the prescription renewal process exist. Mismanagement of pharmacy adherence programs can ultimately lead to patients receiving inappropriate medications and excessive use of staff resources. The objective of this article is to examine the prescription renewal process in both the primary care setting and the pharmacy and report challenges associated with the process. A literature review was conducted to find studies that describe pharmacists’ and physicians’ handlings of prescription renewals, use of e-prescribing software, and benefits and barriers to using these technologies. Although studies report e-prescribing software improves efficiency in the prescription renewal process, there is a need to reduce technological problems that create challenges in use. It is recommended that staff within physician practices and pharmacies standardize prescription renewal processes and educate patients about the prescription renewal process.

Efficacy of Using Physical Activity Mentors to Increase the Daily Steps of Older Adults in the Primary Care Setting: A Pilot Study

2014 ◽  
Vol 22 (1) ◽  
pp. 16-24 ◽  
Author(s):  
Karen A. Croteau ◽  
Vijiayurani Suresh ◽  
Elanna Farnham
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Primary Care ◽  
Pilot Study ◽  
Repeated Measures ◽  
Care Setting ◽  
Primary Care Setting ◽  
Chronic Illnesses ◽  
Main Effects

The purpose of this pilot study was to determine if using physical activity (PA) mentors has any additional impact on daily steps of older adults participating in the Maine in Motion (MIM) program in the primary care setting. Participants were randomly assigned to a MIM-only group (n= 14) or a MIM+ mentor group (n= 14). The MIM intervention lasted 6 months with follow-up at 12 months. Average age of participants was 64 ± 8.8 years and most participants had multiple chronic illnesses. At baseline, mean body mass index (BMI) was 32.2 ± 5.1 and average daily steps were 4,236 ± 2,266. Repeated-measures ANOVA revealed significant main effects for steps,F(2.324, 59.104) = 4.168,p= .015, but no main effects for group,F(1, 25) = 2.988,p= .096, or time-by-group interaction,F(2.324, 59.104) = 0.905,p= .151. All participants significantly increased daily steps over the course of the intervention, with MIM+ participants maintaining increases at follow-up. No significant findings were found for BMI.

scholarly journals Barriers to End-of-life Discussions in the Primary Care Setting

2020 ◽  
pp. 12-15
Author(s):  
Devon Boydstun ◽  
Shandra Basil ◽  
JIll Porter ◽  
Anand Gupta
Keyword(s):  
Primary Care ◽  
End Of Life ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Age Difference ◽  
Advanced Directives ◽  
Healthcare Facilities ◽  
Number Of Patients ◽  
Study Population

Background: The Patient Self Determination Act was passed in 1991 and requires healthcare facilities to present patients with information regarding advanced directives. Since that time, there has been no improvement in the number of patients reported to have had such discussions. Numerous barriers to these discussions exist both on the patient and provider side. This study aims to identify barriers to end of life discussions among providers in the primary care setting. Methods: The study population included practicing primary care physicians in the OhioHealth system. They were administered an anonymous questionnaire addressing demographic information and questions specific to end of life discussions and what barriers exist. Results: A majority of primary care physicians reported engaging in end of life discussions with their patients. A majority of physicians cited lack of time as a barrier to having these discussions. There was a statistically significant age difference among primary care physicians who reported they have end of life discussions with their patients and among these physicians there was a statistically significant increase in their level of comfort having these discussions. Conclusion: Primary care physicians further into their career reported having end of life discussions more frequently and felt more comfortable doing so. Additionally, physicians cite lack of time as the most common barrier to holding end of life discussions.

scholarly journals Impact of a diabetes disease management program on quality of care and costs: propensity score-matched real-world data from Switzerland.

2020 ◽  
Author(s):  
Maria Carlander ◽  
Marc Hoeglinger ◽  
Maria Trottmann ◽  
Birgitta Rhomberg ◽  
Cornelia Caviglia ◽  
...  
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Propensity Score ◽  
Guideline Adherence ◽  
Care Setting ◽  
Primary Care Setting ◽  
Management Program ◽  
Control Group

Objectives Structured treatment programs have been recommended for management of patients with chronic conditions to overcome ill-coordinated care. We aimed to evaluate a disease management program (DMP) with for diabetes mellitus in Switzerland. Methods We performed a prospective observational study with a propensity score-matched usual care control group from a claims database. We included type-1 and type-2 diabetes patients from a primary care setting. The DMP (intervention) comprised a structured treatment approach with an individual treatment plan, treatment goals and an interprofessional team approach. Our outcome comprehensive measures included quality of life (QOL: EQ-5D-5L), pre-defined indicators for diabetes guideline adherence, number of used services and direct medical costs. We applied a difference-in-difference (DID) approach to compare DMP with usual care (follow-up 1 year). Costs were calculated with non-parametric bootstrapping (2017 Swiss Francs, CHF; conversion rate to Euros: 0.85) from a third-party payer perspective (Swiss health care insurance). Results QOL in a sub-sample of 80 patients did not change during follow-up (mean utility 0.89 at baseline and follow-up; p=0.94). Guideline adherence showed slight improvements for DMP. For example, non-adherence (baseline DMP: 19%) decreased in the DMP group by -3 %-points (DID; 95%-CI: -0.07 to 0.01) but not in the control group. A general trend emerged, though mostly not statistically significant, with less used services in the DMP group compared to the control group. Costs increased in both groups during follow-up, but the increase was higher in the control group (DID, mean total costs per patient per year: CHF -950.00 [95%-CI: -1959.53 to 59.56]). Such a negative difference-in-difference estimate in favor of DMP also emerged for cost sub-categories (e.g. costs for inpatient and outpatient care). Conclusions The structured treatment program under evaluation is a promising approach to improve diabetes care in a Swiss primary care setting but more follow-up data are needed.

Sign in / Sign up

Export Citation Format

Share Document