Headache Disorders in VHA Primary Care: Prevalence, Psychiatric Comorbidity, and Health Care Utilization.

IF 2 4区 医学 Q3 BEHAVIORAL SCIENCES Behavioral Medicine Pub Date : 2024-10-01 Epub Date: 2023-09-15 DOI:10.1080/08964289.2023.2249169
Abigail E Ramon, Kyle Possemato, Gregory P Beehler
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Abstract

Military veterans are at increased risk for headache disorders compared to the general population, yet the prevalence and burden associated with headache disorders among veterans is not yet well understood. In this electronic medical record study, we examined the prevalence of headache disorders among veterans seen in a northeastern network of Veterans Health Administration (VHA) primary care during 2017-2018. We also examined rates of psychiatric comorbidity and health care utilization of veterans with headache disorders for the year following the date of the first headache code in the medical record. Of the total population of veterans in the network, 1.3% had a headache disorder and another 3.5% had a possible headache disorder. Migraine and chronic migraine represented the majority of cases. Posttraumatic stress disorder was the most frequent psychiatric comorbidity. Having a headache disorder was associated with higher rates of primary care, neurology, pain clinic, and mental health service use but not higher rates of emergency department or Whole Health (e.g., patient-centered, holistic health services) use. Prevalence findings are comparable to those previously found among veterans, but a substantial proportion of veterans may have been misdiagnosed. Veterans with headache disorders have high rates of psychiatric comorbidity and use several types of health services at higher rates. Findings highlight the need for interdisciplinary care and further education and support for primary care providers. Primary care settings that integrate evidence-based behavioral and Whole Health services may be an optimal way of providing more holistic care for headache disorders.

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退伍军人事务部初级保健中的头痛疾病:流行率、精神病合并症和医疗保健使用情况。
与普通人群相比,退伍军人罹患头痛疾病的风险更高,但人们对退伍军人头痛疾病的患病率和相关负担还不甚了解。在这项电子病历研究中,我们调查了 2017-2018 年期间在东北部退伍军人健康管理局(VHA)初级保健网络就诊的退伍军人中头痛疾病的患病率。我们还研究了在病历中首次出现头痛代码的次年,患有头痛疾病的退伍军人的精神疾病合并率和医疗保健利用率。在网络中的退伍军人总数中,1.3%患有头痛疾病,另有3.5%可能患有头痛疾病。偏头痛和慢性偏头痛占大多数。创伤后应激障碍是最常见的精神并发症。头痛症与初级保健、神经科、疼痛诊所和心理健康服务的使用率较高有关,但与急诊科或整体健康(如以患者为中心的整体健康服务)的使用率较高无关。患病率调查结果与之前在退伍军人中发现的结果相当,但有相当一部分退伍军人可能被误诊。患有头痛症的退伍军人合并精神疾病的比例很高,使用多种类型医疗服务的比例也较高。研究结果凸显了跨学科护理以及对初级医疗服务提供者提供进一步教育和支持的必要性。整合循证行为和整体健康服务的初级保健机构可能是为头痛疾病提供更全面护理的最佳方式。
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来源期刊
Behavioral Medicine
Behavioral Medicine 医学-行为科学
CiteScore
5.30
自引率
4.30%
发文量
44
审稿时长
>12 weeks
期刊介绍: Behavioral Medicine is a multidisciplinary peer-reviewed journal, which fosters and promotes the exchange of knowledge and the advancement of theory in the field of behavioral medicine, including but not limited to understandings of disease prevention, health promotion, health disparities, identification of health risk factors, and interventions designed to reduce health risks, ameliorate health disparities, enhancing all aspects of health. The journal seeks to advance knowledge and theory in these domains in all segments of the population and across the lifespan, in local, national, and global contexts, and with an emphasis on the synergies that exist between biological, psychological, psychosocial, and structural factors as they related to these areas of study and across health states. Behavioral Medicine publishes original empirical studies (experimental and observational research studies, quantitative and qualitative studies, evaluation studies) as well as clinical/case studies. The journal also publishes review articles, which provide systematic evaluations of the literature and propose alternative and innovative theoretical paradigms, as well as brief reports and responses to articles previously published in Behavioral Medicine.
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