Assessing evidence-based medicine and opioid/barbiturate as first-line acute treatment of pediatric migraine and primary headache: A retrospective observational study of health systems data
To evaluate providers' use and predictors of evidence-based medicine or opioid/barbiturate as first-line acute treatment for children's initial presentation of acute migraine or primary headache. This retrospective, observational study utilized patient (children ages 6-17) and provider/enc...
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| Published in: | Cephalalgia Vol. 39; no. 8; p. 1000 |
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| Main Authors: | , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
England
01.07.2019
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| Subjects: | |
| ISSN: | 1468-2982, 1468-2982 |
| Online Access: | Get more information |
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| Summary: | To evaluate providers' use and predictors of evidence-based medicine or opioid/barbiturate as first-line acute treatment for children's initial presentation of acute migraine or primary headache.
This retrospective, observational study utilized patient (children ages 6-17) and provider/encounter characteristics extracted from the patient's Electronic Health Record from 2008-2014 during an initial encounter for migraine or primary headache. The primary outcome was provider evidence-based medicine utilization; overall prescriptions and opioid/barbiturate prescriptions were also evaluated. Hierarchical linear modeling examined whether Level 1 (patient: Demographic, insurance type) and Level 2 (provider/encounter: Treatment setting/location, encounter diagnoses) characteristics influenced outcomes.
In all, 38,926 patients (56.7% female, mean age = 12.1) and 1617 providers were evaluated. Only 17.7% of patients were diagnosed with migraine; 16.1% received evidence-based medicine. Older children (OR = 1.07,
< 0.001), females (OR = 1.14,
< 0.001), and those diagnosed with migraine (OR = 4.71,
< 0.001) were more likely to receive evidence-based medicine. Among prescriptions, 15.8% were for opioids/barbiturates. Older children (OR = 1.14,
< 0.001) and those cared for in the emergency department/urgent care (OR = 2.02,
< 0.001) were at increased risk.
Demographics and migraine diagnosis are associated with evidence-based medicine and opioid/barbiturates. Primary care provides an opportunity to target provider interventions to enhance effective pediatric headache treatment. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 |
| ISSN: | 1468-2982 1468-2982 |
| DOI: | 10.1177/0333102419833080 |