Effect of a migraine management model dominated by headache specialists and centered on community doctors
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摘要:
目的 探讨以头痛专科医生为主导、社区医生为中心的慢病管理模式在偏头痛患者中的应用效果，以期改善患者头痛症状、提高生活质量。 方法 选取2023年1月—2024年6月于蚌埠医科大学第一附属医院神经内科就诊的160例偏头痛患者，采用随机数字表法分为主动管理组与对照组，各80例。对照组给予常规诊疗模式，主动管理组给予主动管理模式，分别于管理前及管理后12个月对患者的头痛症状及生活质量开展评价，采用logistic多因素回归分析影响患者生活质量的因素。 结果 管理12个月时，主动管理组患者每月发作频次及时长较管理前减少（P < 0.001），VAS评分较管理前下降[4.0(3.0, 5.0)分vs.8.0(7.0, 9.0)分, Z=120.498, P < 0.001]；偏头痛失能程度问卷（MIDAS）评分、7项广泛性焦虑障碍量表（GAD-7）评分、患者健康问卷抑郁筛查量表（PHQ-9）评分、匹兹堡睡眠指数量表（PSQI）评分等均较管理前下降（P < 0.01）；头痛影响测评量表-6（HIT-6）评分较前下降，健康状况调查问卷（SF-36）评分较前升高（P < 0.01）。多因素logistic回归分析显示，管理模式、基线发作频次、VAS评分、GAD-7评分、PSQI评分均是影响患者生活质量提升的独立因素（P < 0.05）。调整混杂因素后，主动干预组患者SF-36评分升高的比值是对照组的5.580倍（B=1.720，SE=0.340，Waldχ2=25.800，P < 0.001）。 结论 以专科医生为主导、社区医生为中心的慢病管理模式能提高偏头痛患者的生活质量。 Abstract:Objective To investigate the application effect of a chronic disease management model led by headache specialists and centered on community doctors in patients with migraine, so as to improve headache symptoms and quality of life. Methods A total of 160 migraine patients treated in the Department of Neurology, the First Affiliated Hospital of Bengbu Medical University from January 2023 to June 2024 were selected and divided into the active management group and the control groups by random number table method, with 80 cases in each group. The control group received routine diagnosis and treatment model, while the active management group received an active management model. Headache symptoms and quality of life were evaluated before management and 12 months after management, respectively. Logistic multivariate regression analysis was used to analyze the factors affecting patients' quality of life. Results At 12 months of management, the monthly attack frequency and duration in the active management group were lower than those before management (P < 0.001), and the VAS score was decreased compared with before management [4.0 (3.0, 5.0) vs. 8.0 (7.0, 9.0), Z=120.498, P < 0.001]. migraine disability assessment scale (MIDAS) score, generalized anxiety disorder-7 (GAD-7) score, patient health questionnaire-9 (PHQ-9) score, and Pittsburgh sleep quality index (PSQI) score were all lower than before (P < 0.01). Headache impact test-6 (HIT-6) score was decreased, and short form 36 health survey (SF-36) score was increased compared with before (both P < 0.01). Multivariate logistic regression analysis showed that management model, baseline attack frequency, VAS score, GAD-7 score, and PSQI score were independent factors affecting the improvement of patients' quality of life (P < 0.05). After adjusting for confounders, patients in the active intervention group had a 5.58-fold higher odds of an increased SF-36 score compared with the control group (B=1.720, SE=0.340, Waldχ2=25.800, P < 0.01). Conclusion The chronic disease management model led by specialists and centered on community doctors can improve the quality of life of migraine patients. -
Key words:
- Migraine /
- Community management model /
- Headache specialist doctor /
- Community doctor
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表 1 2组偏头痛患者基线资料比较
Table 1. Comparison of baseline data between the two groups of migraine patients
组别 例数 性别(例) 年龄(x±s，岁) 受教育年限[M(P25, P75)，年] 有固定照护者[例(%)] 男性 女性 对照组 80 15 65 32.30±8.17 12.00(9.00, 15.75) 57(71.25) 主动管理组 80 18 62 33.34±8.81 12.00(9.00, 12.75) 60(75.00) 统计量 0.153a 0.772b -0.968c 0.127a P值 0.696 0.549 0.333 0.722 注：a为χ2值，b为t值，c为Z值。 
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表 2 2组偏头痛患者管理前后症状管理指标比较[M(P25, P75)]
Table 2. Comparison of symptom management indicators before and after management for 2 groups of migraine patients[M(P25, P75)]
组别 例数 发作频次(次/月) 发作时长(h/月) VAS评分(分) 管理前 管理后 管理前 管理后 管理前 管理后 对照组 80 5.0(3.3, 6.8) 5.5(4.0, 8.0) 120.0(84.0, 160.0) 144.0(97.0, 189.3) 8.0(7.0, 9.0) 8.0(8.0, 9.0) 主动管理组 80 5.0(3.3, 7.0) 2.0(2.0, 3.0)a 120.0(80.0, 163.0) 55.0(40.0, 80.0)a 8.0(7.0, 9.0) 4.0(3.0, 5.0)a Z值 0.004 77.474 0.001 78.044 0.233 120.498 P值 0.951 < 0.001 0.973 < 0.001 0.629 < 0.001 组别 例数 MIDAS评分(分) GAD-7评分(分) PHQ-9评分(分) PSQI评分(分) 管理前 管理后 管理前 管理后 管理前 管理后 管理前 管理后 对照组 100.0(90.0, 120.0) 120.0(100.0，127.0) 9.0(7.3，10.0) 12.0(10.0, 13.8) 8.5(6.0，12.0) 11.0(8.0，15.0) 8.5(5.3，10.0) 9.0(5.0, 12.0) 主动管理组 95.0(85.0, 115.0) 32.0(28.0, 40.0)a 8.5(7.0, 10.0) 3.0(2.0，4.8)a 8.0(6.0，11.8) 5.0(2.0，6.8)a 7.5(5.0，10.0) 3.5(2.0, 5.0)a Z值 3.401 119.450 0.354 120.171 -0.075 81.072 -0.604 59.065 P值 0.065 < 0.001 0.552 < 0.001 0.784 < 0.001 0.437 < 0.001 注：与同组管理前比较，aP＜0.05。
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表 3 2组偏头痛患者管理前后生活质量比较[M(P25, P75)，分]
Table 3. Comparison of quality of life before and after management in two groups of migraine patientsts[M(P25, P75), points]
组别 例数 HIT-6评分 SF-36评分 管理前 管理后 管理前 管理后 对照组 80 60.0(55.3, 65.0) 61.0(59.0, 65.0) 50.0(44.0, 60.0) 50.0(42.0, 57.5) 主动管理组 80 62.0(58.0, 65.0) 46.0(40.0, 50.8)a 50.0(41.0, 58.8) 67.5(61.5, 74.0)a Z值 0.543 91.936 -1.094 69.669 P值 0.461 < 0.001 0.296 < 0.001 注：与同组管理前比较，aP＜0.05。
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表 4 偏头痛患者生活质量的影响因素分析
Table 4. Analysis of factors affecting the quality of life of migraine patients
变量 B SE Waldχ2 P值 OR值 95% CI VIF 管理模式(主动管理=1) 1.720 0.340 25.800 < 0.001 5.580 2.650~11.760 1.230 基线发作频次 -0.100 0.040 6.250 0.012 0.900 0.830~0.980 1.850 基线VAS评分 -0.120 0.050 5.760 0.016 0.890 0.800~0.980 2.120 基线GAD-7评分 -0.110 0.040 7.560 0.006 0.900 0.830~0.970 1.560 基线PSQI评分 -0.070 0.030 5.440 0.020 0.930 0.880~0.990 1.340
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