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Wang K, Fenton BT, Skanderson M, Black AC, Becker WC, Seng EK, Anthony SE, Guirguis AB, Altalib HH, Kimber A, Lorenze N, Scholten JD, Graham GD, Sandbrink F, Sico JJ. Changes in opioid prescribing in veterans with headache during the COVID-19 pandemic: A regression discontinuity in time analysis. Headache 2023; 63:1295-1303. [PMID: 37596904 DOI: 10.1111/head.14605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE To determine changes in opioid prescribing among veterans with headaches during the coronavirus disease of 2019 (COVID-19) pandemic by comparing the stay-at-home phase (March 15 to May 30, 2020) and the reopening phase (May 31 to December 31, 2020). BACKGROUND Opioid prescribing for chronic pain has declined substantially since 2016; however, changes in opioid prescribing during the COVID-19 pandemic among veterans with headaches remain unknown. METHODS This retrospective cohort study utilized regression discontinuity in time and difference-in-differences design to analyze veterans aged ≥18 years with a previous diagnosis of headache disorders and an outpatient visit to the Veterans Health Administration (VHA) during the study period. We measured the weekly number of opioid prescriptions, the number of days supplied, the daily dose in morphine milligram equivalents (MMEs), and the number of prescriptions with ≥50 morphine equivalent daily doses (MEDD). RESULTS A total of 81,376 veterans were analyzed with 589,950 opioid prescriptions. The mean (SD) age was 51.6 (13.5) years, 57,242 (70.3%) were male, and 53,464 (65.7%) were White. During the pre-pandemic period, 323.6 opioid prescriptions (interquartile range 292.1-325.8) were dispensed weekly, with an median (IQR) of 24.1 (24.0-24.4) days supplied and 31.8 (31.2-32.5) MMEs. Transition to stay-at-home was associated with a 7.7% decrease in the number of prescriptions (incidence rate ratio [IRR] 1.077, 95% confidence interval [CI] 0.866-0.984) and a 9.8% increase in days supplied (IRR 1.098, 95% CI 1.078-1.119). Similar trends were observed during the reopening period. Subgroup analysis among veterans on long-term opioid therapy also revealed 1.7% and 1.4% increases in days supplied during the stay-at-home (IRR 1.017, 95% CI 1.009-1.025) and reopening phase (IRR 1.014, 95% CI 1.007-1.021); however, changes in the total number of prescriptions, MME/day, or the number of prescriptions >50 MEDD were insignificant. CONCLUSION Prescription opioid access was maintained for veterans within VHA during the pandemic. The de-escalation of opioid prescribing observed prior to the pandemic was not seen in our study.
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Affiliation(s)
- Kaicheng Wang
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut, USA
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Brenda T Fenton
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut, USA
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Melissa Skanderson
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut, USA
| | - Anne C Black
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - William C Becker
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Elizabeth K Seng
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sarah E Anthony
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Hamada H Altalib
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Addison Kimber
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nancy Lorenze
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joel D Scholten
- Physical Medicine and Rehabilitation Service, Washington DC VA Medical Center, Washington, District of Columbia, USA
| | - Glenn D Graham
- Department of Neurology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Friedhelm Sandbrink
- Pain Management Specialty Services, Washington DC VA Medical Center, Washington, District of Columbia, USA
| | - Jason J Sico
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
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Wang K, Fenton BT, Dao VX, Guirguis AB, Anthony SE, Skanderson M, Sico JJ. Trajectory of blood pressure after initiating anti-calcitonin gene-related peptide treatment of migraine: a target trial emulation from the veterans health administration. J Headache Pain 2023; 24:108. [PMID: 37582724 PMCID: PMC10426172 DOI: 10.1186/s10194-023-01640-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Calcitonin gene-related peptide (CGRP) is involved in migraine pathophysiology and blood pressure regulation. Although clinical trials have established the cardio-cerebrovascular safety profile of anti-CGRP treatment, limited high-quality real-world evidence exists on its long-term effects on blood pressure (BP). To address this gap, we examined the safety of anti-CGRP treatment on BP in patients with migraine headache in the Veterans Health Administration (VHA). METHODS We emulated a target trial of patients who initiated anti-CGRP treatment or topiramate for migraine prevention between May 17th, 2018 and February 28th, 2023. We calculated stabilized inverse probability weights to balance between groups and then used weighted linear mixed-effect models to estimate the systolic and diastolic BP changes over the study period. For patients without hypertension at baseline, we estimated the cumulative incidence of hypertension using Kaplan-Meier curve. We also used weight mixed-effect Poisson model to estimate the number of antihypertension medications for patients with hypertension at baseline. RESULTS This analysis included 69,589 patients and 554,437 blood pressure readings. of these, 18,880 patients received anti-CGRP treatment, and they were more likely to be women, have a chronic migraine diagnosis and higher healthcare utilization than those received topiramate. Among patients without hypertension at baseline, we found no significant differences in systolic BP changes over the four-year follow-up between anti-CGRP (slope [standard error, SE] = 0.48[0.06]) and topiramate treated patients (slope[SE] = 0.39[0.04]). The incidence of hypertension was similar for anti-CGRP and topiramate group (4.4 vs 4.3 per 100 person-years). Among patients with hypertension at baseline who initiated anti-CGRP treatment, we found a small but persistent effect on exacerbating hypertension during the first four years of treatment, as evidenced by a significant annual 3.7% increase in the number of antihypertensive medications prescribed (RR = 1.037, 95%CI 1.025-1.048). CONCLUSIONS Our findings suggest that anti-CGRP treatment is safe regarding blood pressure in patients without hypertension. However, for those with baseline hypertension, anti-CGRP treatment resulted in a small but persistent increase in the number of antihypertensives, indicating an exacerbation of hypertension. Future studies are needed to evaluate the cardio-cerebrovascular safety of anti-CGRP treatment beyond the first four years.
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Affiliation(s)
- Kaicheng Wang
- Department of Veterans Affairs, Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, Orange, CT, USA.
- Yale Center for Analytical Sciences, Yale School of Public Health, 300 George St STE 511, New Haven, CT, 06511, USA.
| | - Brenda T Fenton
- Department of Veterans Affairs, Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, Orange, CT, USA
- Pain Research, Informatics, Multi-Morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Vinh X Dao
- Pharmacy Benefits Management Services, VA Minneapolis Health Care System, Minneapolis, MN, USA
- Headache Center of Excellence, VA Minneapolis Health Care System, Minneapolis, MN, USA
| | - Alexander B Guirguis
- Pharmacy Benefits Management Services, VA Connecticut Healthcare System, West Haven, CT, USA
- Headache Center of Excellence, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Sarah E Anthony
- Department of Veterans Affairs, Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, Orange, CT, USA
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Melissa Skanderson
- Department of Veterans Affairs, Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, Orange, CT, USA
| | - Jason J Sico
- Department of Veterans Affairs, Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, Orange, CT, USA
- Headache Center of Excellence, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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3
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Wang K, Fenton BT, Deng Y, Anthony SE, Dao VX, Schindler E, Lipton RB, Guirguis A, Skanderson M, Seng EK, Sico JJ. Calcitonin Gene-Related Peptide Monoclonal Antibodies and Risk of SARS-CoV-2 Infection and Severe COVID-19 Outcomes Among Veterans With Migraine Disorder. JAMA Netw Open 2023; 6:e2326371. [PMID: 37523183 PMCID: PMC10391301 DOI: 10.1001/jamanetworkopen.2023.26371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/15/2023] [Indexed: 08/01/2023] Open
Abstract
Importance Calcitonin gene-related peptide (CGRP), a neuropeptide involved in migraine pathophysiology, is also a key neuroimmune modulator. CGRP antagonists may help mitigate the hyperinflammatory response observed in patients with COVID-19; however, findings from the literature are contradictory, and to date, no study has investigated the safety and effectiveness of CGRP antagonists against COVID-19. Objective To evaluate the association between CGRP monoclonal antibody (mAb) treatment and risk of SARS-CoV-2 infection and sequela hospitalization, requiring supplemental oxygen, use of mechanical ventilation, or death. Design, Setting, and Participants This retrospective cohort study analyzed the electronic health records of US veterans aged 18 to 65 years who were diagnosed with migraine disorder and were at risk of COVID-19 between January 20, 2020, and May 19, 2022. Exposure Initiation of CGRP mAbs. Main Outcomes and Measures The main outcome was cumulative incidence of SARS-CoV-2 infection. Odds of 30-day hospitalization, requiring supplemental oxygen, use of mechanical ventilation, or death were secondary outcomes. Results Among 8 178 652 eligible person-trials (354 294 veterans), 9992 (mean [SD] age, 46.0 [9.5] years; 53.9% male) initiated CGRP mAbs and 8 168 660 (mean [SD] age, 46.6 [10.2] years; 65.7% male) did not initiate CGRP mAbs. Over a 28-month follow-up period, 1247 initiators (12.5%) and 780 575 noninitiators (9.6%) tested positive for SARS-CoV-2. After censoring persons who deviated from treatment, the incidence was 7.4 cases per 1000 person-months among initiators and 6.9 per 1000 person-months among noninitiators. The inverse probability-weighted observational analogs of intention-to-treat and per-protocol hazard ratios were 0.95 (95% CI, 0.89-1.01) and 0.93 (95% CI, 0.86-1.02), respectively. No significant differences in the likelihood of hospitalization (odds ratio [OR], 0.93; 95% CI, 0.62-1.41), requiring supplemental oxygen (OR, 0.77; 95% CI, 0.45-1.30), use of mechanical ventilation (OR, 0.85; 95% CI, 0.26-2.84), or death (OR, 0.67; 95% CI, 0.09-5.23) were observed between CGRP mAb initiators and noninitiators who tested positive for SARS-CoV-2. Conclusions and Relevance In this cohort study, CGRP mAb treatment was not associated with positive SARS-CoV-2 test results or risk of severe COVID-19 outcomes, suggesting that CGRP mAbs may be used for migraine prevention during the COVID-19 pandemic. Given the few events of requiring supplemental oxygen, use of mechanical ventilation, and death, replication analysis in a larger sample of patients later in the course of disease is warranted.
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Affiliation(s)
- Kaicheng Wang
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Brenda T. Fenton
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Sarah E. Anthony
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Vinh X. Dao
- Headache Center of Excellence, VA Minneapolis Health Care System, Minneapolis, Minnesota
| | - Emmanuelle Schindler
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
- Headache Center of Excellence, VA Connecticut Healthcare System, West Haven
| | - Richard B. Lipton
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Alexander Guirguis
- Headache Center of Excellence, VA Connecticut Healthcare System, West Haven
| | - Melissa Skanderson
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut
| | - Elizabeth K. Seng
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - Jason J. Sico
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
- Headache Center of Excellence, VA Connecticut Healthcare System, West Haven
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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4
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Merlin JS, Black AC, Midboe AM, Troszak L, Asch SM, Bohnert A, Fenton BT, Giannitrapani KF, Glassman P, Kerns RD, Silveira M, Lorenz KA, Abel EA, Becker WC. Long-term opioid therapy trajectories and overdose in patients with and without cancer. BMJ Oncol 2023; 2:e000023. [PMID: 38259328 PMCID: PMC10802123 DOI: 10.1136/bmjonc-2022-000023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Objective Pain is experienced by most patients with cancer and opioids are a cornerstone of management. Our objectives were (1) to identify patterns or trajectories of long-term opioid therapy (LTOT) and their correlates among patients with and without cancer and (2) to assess the association between trajectories and risk for opioid overdose, considering the potential moderating role of cancer. Methods and Analysis We conducted a retrospective cohort study among individuals in the US Veterans Health Administration (VHA) database with incident LTOT with and without cancer (N=44,351; N=285,772, respectively) between 2010-2017. We investigated the relationship between LTOT trajectory and all International Classification of Diseases-9 and 10-defined accidental and intentional opioid-related overdoses. Results Trajectories of opioid receipt observed in patients without cancer and replicated in patients with cancer were: low-dose/stable trend, low-dose/de-escalating trend, moderate-dose/stable trend, moderate-dose/escalating with quadratic downturn trend, and high-dose/escalating with quadratic downturn trend. Time to first overdose was significantly predicted by higher-dose and escalating trajectories; the two low-dose trajectories conferred similar, lower risk. Conditional hazard ratios (99% CI) for the moderate-dose, moderate-dose/escalating with quadratic downturn and high-dose/escalating with quadratic downturn trends were 1·84 (1·18, 2·85), 2·56 (1·54, 4·25), and 2·41 (1·37, 4·26), respectively. Effects of trajectories on time to overdose did not differ by presence of cancer; inferences were replicated when restricting to patients with stage 3/4 cancer. Conclusion Patients with cancer face opioid overdose risks like patients without cancer. Future studies should seek to expand and address our knowledge about opioid risk in cancer patients. Trial registration None.
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Affiliation(s)
- Jessica S Merlin
- CHAllenges on Managing and Preventing Pain (CHAMPP) Clinical Research Center, University of Pittsburgh, Pittsburgh, PA, USA
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anne C Black
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Health Services Research & Development, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Amanda M Midboe
- VA Palo Alto Healthcare System, Center for Innovation to Implementation, Palo Alto, CA
- Department of Medicine/Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Lara Troszak
- VA Palo Alto Healthcare System, Center for Innovation to Implementation, Palo Alto, CA
| | - Steven M Asch
- VA Palo Alto Healthcare System, Center for Innovation to Implementation, Palo Alto, CA
- Department of Medicine/Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Amy Bohnert
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Brenda T Fenton
- Health Services Research & Development, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Karleen F Giannitrapani
- VA Palo Alto Healthcare System, Center for Innovation to Implementation, Palo Alto, CA
- Department of Medicine/Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Peter Glassman
- VA Center for Medication Safety, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Pharmacy Benefits Management Services, Department of Veterans Affairs, Washington, DC, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Robert D Kerns
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Health Services Research & Development, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Maria Silveira
- Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Palliative Care, Lieutenant Colonel Charles S. Kettles VA Medical Center, Ann Arbor MI, USA
| | - Karl A Lorenz
- VA Palo Alto Healthcare System, Center for Innovation to Implementation, Palo Alto, CA
- Department of Medicine/Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Erica A Abel
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Health Services Research & Development, VA Connecticut Healthcare System, West Haven, CT, USA
| | - William C Becker
- Health Services Research & Development, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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5
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Lindsey HM, Goldman RE, Riley SD, Baird S, Burrone L, Grinberg AS, Fenton BT, Sico JJ, Damush TM. Complex Patient Navigation by Veteran Patients in the Veterans Health Administration (VHA) for Chronic Headache Disease: A Qualitative Study. J Patient Exp 2023; 10:23743735231151547. [PMID: 36710997 PMCID: PMC9880564 DOI: 10.1177/23743735231151547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Patients living with headache diseases often have difficulty accessing evidence-based care. Authors conducted a qualitative research study with 20 patients receiving headache care at seven Headache Centers of Excellence within the Veterans Health Administration to examine their experiences navigating headache care. This study employed thematic qualitative analysis and conducted cross-case comparisons. Several key findings emerged. 1) Most patients saw multiple healthcare providers over numerous years before reaching a headache specialist to manage chronic headaches. 2) Receipt of high-quality and comprehensive headache specialty care was associated with high satisfaction. 3) Patients with headache diseases reported oftentimes they experienced an arduous journey across multiple healthcare systems and between several healthcare providers before receiving evidence-based headache treatment that they found acceptable. Results demonstrate that most patients were satisfied with their current specialty headache care in the Veterans Health Administration. Authors discuss implications for future studies and highlight ways to improve patient satisfaction and timely access to appropriate headache care.
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Affiliation(s)
- Hayley M Lindsey
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
- University of Rhode Island, Kingston, RI, USA
- Hayley M Lindsey, VHA Headache Centers of
Excellence Research and Evaluation Center, VA Connecticut Healthcare System 200
Edison Road Orange, CT, 06477, USA; Pain, Research, Informatics, Medical
Comorbidities and Education (PRIME) Center, VA Connecticut Healthcare System,
200 Edison Road Orange, CT, 06477, USA; University of Rhode Island, Kingston,
RI, 02881, USA.
| | - Roberta E Goldman
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
- Warren Alpert Medical School of Brown
University, Providence, RI, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Samantha D Riley
- Veterans Health Administration Health Services Research and
Development (HSR&D) Center for Health Information and Communication and Quality
Enhancement Research Initiative Expanding expertise Through E-health Network
Development (EXTEND) QUERI Centers, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Sean Baird
- Veterans Health Administration Health Services Research and
Development (HSR&D) Center for Health Information and Communication and Quality
Enhancement Research Initiative Expanding expertise Through E-health Network
Development (EXTEND) QUERI Centers, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Laura Burrone
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
| | - Amy S Grinberg
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
| | - Brenda T Fenton
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
| | - Jason J Sico
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Teresa M Damush
- Veterans Health Administration Health Services Research and
Development (HSR&D) Center for Health Information and Communication and Quality
Enhancement Research Initiative Expanding expertise Through E-health Network
Development (EXTEND) QUERI Centers, Roudebush VA Medical Center, Indianapolis, IN, USA
- Indiana University School of
Medicine, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
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6
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Fodeh SJ, Fenton BT, Wang R, Skanderson M, Altalib H, Kuruvilla D, Schindler E, Haskell S, Brandt C, Sico JJ. Understanding headache classification coding within the veterans health administration using ICD-9-CM and ICD-10-CM in fiscal years 2014-2017. PLoS One 2023; 18:e0279163. [PMID: 36598881 PMCID: PMC9812322 DOI: 10.1371/journal.pone.0279163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/17/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Understand the continuity and changes in headache not-otherwise-specified (NOS), migraine, and post-traumatic headache (PTH) diagnoses after the transition from ICD-9-CM to ICD-10-CM in the Veterans Health Administration (VHA). BACKGROUND Headache is one of the most commonly diagnosed chronic conditions managed within primary and specialty care clinics. The VHA transitioned from ICD-9-CM to ICD-10-CM on October-1-2015. The effect transitioning on coding of specific headache diagnoses is unknown. Accuracy of headache diagnosis is important since different headache types respond to different treatments. METHODS We mapped headache diagnoses from ICD-9-CM (FY 2014/2015) onto ICD-10-CM (FY 2016/2017) and computed coding proportions two years before/after the transition in VHA. We used queries to determine the change in transition pathways. We report the odds of ICD-10-CM coding associated with ICD-9-CM controlling for provider type, and patient age, sex, and race/ethnicity. RESULTS Only 37%, 58% and 34% of patients with ICD-9-CM coding of NOS, migraine, and PTH respectively had an ICD-10-CM headache diagnosis. Of those with an ICD-10-CM diagnosis, 73-79% had a single headache diagnosis. The odds ratios for receiving the same code in both ICD-9-CM and ICD-10-CM after adjustment for ICD-9-CM and ICD-10-CM headache comorbidities and sociodemographic factors were high (range 6-26) and statistically significant. Specifically, 75% of patients with headache NOS had received one headache diagnoses (Adjusted headache NOS-ICD-9-CM OR for headache NOS-ICD-10-CM = 6.1, 95% CI 5.89-6.32. 79% of migraineurs had one headache diagnoses, mostly migraine (Adjusted migraine-ICD-9-CM OR for migraine-ICD-10-CM = 26.43, 95% CI 25.51-27.38). The same held true for PTH (Adjusted PTH-ICD-9-CM OR for PTH-ICD-10-CM = 22.92, 95% CI: 18.97-27.68). These strong associations remained after adjustment for specialist care in ICD-10-CM follow-up period. DISCUSSION The majority of people with ICD-9-CM headache diagnoses did not have an ICD-10-CM headache diagnosis. However, a given diagnosis in ICD-9-CM by a primary care provider (PCP) was significantly predictive of its assignment in ICD-10-CM as was seeing either a neurologist or physiatrist (compared to a generalist) for an ICD-10-CM headache diagnosis. CONCLUSION When a veteran had a specific diagnosis in ICD-9-CM, the odds of being coded with the same diagnosis in ICD-10-CM were significantly higher. Specialist visit during the ICD-10-CM period was independently associated with all three ICD-10-CM headaches.
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Affiliation(s)
- Samah Jamal Fodeh
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Yale School of Public Health, New Haven, CT, United States of America
- Yale Center for Medical Informatics, New Haven, CT, United States of America
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
- * E-mail:
| | - Brenda T. Fenton
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Rixin Wang
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Yale School of Public Health, New Haven, CT, United States of America
- Yale Center for Medical Informatics, New Haven, CT, United States of America
| | - Melissa Skanderson
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Hamada Altalib
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Yale School of Public Health, New Haven, CT, United States of America
- Yale Center for Medical Informatics, New Haven, CT, United States of America
- Neurology Service, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, United States of America
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States of America
- Center for NeuroEpidemiological and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, United States of America
| | - Deena Kuruvilla
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Emmanuelle Schindler
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, United States of America
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States of America
- Center for NeuroEpidemiological and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, United States of America
| | - Sally Haskell
- Primary Care Service, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Comprehensive Women’s Health, VA Central Office, Chester, VA, United States of America
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Cynthia Brandt
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Yale School of Public Health, New Haven, CT, United States of America
- Yale Center for Medical Informatics, New Haven, CT, United States of America
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
- Primary Care Service, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Jason J. Sico
- Veterans Health Administration Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Yale Center for Medical Informatics, New Haven, CT, United States of America
- Neurology Service, VA Connecticut Healthcare System, West Haven, CT, United States of America
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, United States of America
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States of America
- Center for NeuroEpidemiological and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, United States of America
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
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Sico JJ, Seng EK, Wang K, Skanderson M, Schindler EAD, Ney JP, Lorenze N, Kimber A, Lindsey H, Grinberg AS, Kuruvilla D, Higgins DS, Graham G, Sandbrink F, Scholten J, Shapiro RE, Lipton RB, Fenton BT. Characteristics and Gender Differences of Headache in the Veterans Health Administration: A National Cohort Study, Fiscal Year 2008-2019. Neurology 2022; 99:e1993-e2005. [PMID: 36100437 PMCID: PMC9651459 DOI: 10.1212/wnl.0000000000200905] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/16/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To determine gender differences in headache types diagnosed, sociodemographic characteristics, military campaign and exposures, and health care utilization among US veterans in the Veterans Health Administration (VHA). METHODS This study used a retrospective cohort design to examine VHA electronic health record (EHR) data. This cohort includes veterans who had at least 1 visit for any headache between fiscal years 2008 and 2019. Headache diagnoses were classified into 8 categories using International Classification of Disease, Clinical Modification codes. Demographics, military-related exposures, comorbidities, and type of provider(s) consulted were extracted from the EHR and compared by gender. Age-adjusted incidence and prevalence rates of medically diagnosed headache disorders were calculated separately for each type of headache. RESULTS Of the 1,524,960 veterans with headache diagnoses included in the cohort, 82.8% were men. Compared with women, men were more often White (70.4% vs 56.7%), older (52.0 ± 16.8 vs 41.9 ± 13.0 years), with higher rates of traumatic brain injury (2.9% vs 1.1%) and post-traumatic stress disorder (23.7% vs 21.7%), and lower rates of military sexual trauma (3.2% vs 33.7%; p < 0.001 for all). Age-adjusted incidence rate of headache of any type was higher among women. Migraine and trigeminal autonomic cephalalgia rates were most stable over time. Men were more likely than women to be diagnosed with headache not otherwise specified (77.4% vs 67.7%) and have higher incidence rates of headaches related to trauma (3.4% vs 1.9% [post-traumatic]; 5.5% vs 5.1% [postwhiplash]; p < 0.001 for all). Men also had fewer headache types diagnosed (mean ± SD; 1.3 ± 0.6 vs 1.5 ± 0.7), had fewer encounters for headache/year (0.8 ± 1.2 vs 1.2 ± 1.6), and fewer visits to headache specialists (20.8% vs 27.4% p < 0.001 for all), compared with women. Emergency department utilization for headache care was high for both genders and higher for women compared with men (20.3% vs 22.9%; p < 0.001). DISCUSSION Among veterans with headache diagnoses, important gender differences exist for men and women veterans receiving headache care within VHA regarding sociodemographic characteristics, headache diagnoses, military exposure, and headache health care utilization. The findings have potential implications for providers and the health care system caring for veterans living with headache.
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Affiliation(s)
- Jason Jonathon Sico
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY.
| | - Elizabeth K Seng
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
| | - Kaicheng Wang
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
| | - Melissa Skanderson
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
| | - Emmanuelle A D Schindler
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
| | - John P Ney
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
| | - Nancy Lorenze
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
| | - Addison Kimber
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
| | - Hayley Lindsey
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
| | - Amy S Grinberg
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
| | - Deena Kuruvilla
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
| | - Donald S Higgins
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
| | - Glenn Graham
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
| | - Friedhelm Sandbrink
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
| | - Joel Scholten
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
| | - Robert E Shapiro
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
| | - Richard B Lipton
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
| | - Brenda T Fenton
- From the Neurology Service (J.J.S., E.A.D.S.), Clinical Epidemiology Research Center (CERC) (J.J.S.), Pain Research (J.J.S., M.S., N.L., A.K., H.L., B.T.F.), Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven; Departments of Neurology (J.J.S., N.L., A.K., H.L., E.A.D.S.), Internal Medicine (J.J.S.), Center for Neuroepidemiological and Clinical Neurological Research (J.J.S., E.A.D.S.), Yale Center for Analytic Sciences (K.W.), Yale School of Medicine, New Haven, CT; Veterans Health Administration Headache Centers of Excellence (HCoE) Research and Evaluation Center (J.J.S., E.K.S., K.W., M.S., E.A.D.S., J.P.N., N.L., A.K., H.L., A.S.G., D.K., B.T.F.), Department of Veterans Affairs, Orange, CT; Yeshiva University (E.K.S.), New York City, NY; Neurology Service (J.P.N.), Edith Nourse Rogers Memorial Veterans Hospital Bedford, MA; Department of Neurology (J.P.N.), Boston University School of Medicine, MA; Westport Headache Institute (D.K.), Westport, CT; Albany Stratton VA Medical Center (D.S.H.), NY; Department of Neurology (G.G.), George Washington University, Washington, DC; Department of Neurology (G.G.), University of California San Francisco School of Medicine, Specialty Care Services (G.G.), Veterans Health Administration Pain Management (F.S.), Opioid Safety and PDMP Program, Department of Veterans Affairs, Washington, DC; Departments of Neurology (F.S.), Physical Medicine and Rehabilitation (J.S.), Veterans Affairs Medical Center, Washington, DC; Department of Neurology (R.E.S.), University of Vermont Medical Center, Burlington, VT; Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; and Department of Neurology (R.B.L.), Montefiore Medical Center, Bronx, NY
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Seng EK, Fenton BT, Wang K, Lipton RB, Ney J, Damush T, Grinberg AS, Skanderson M, Sico JJ. Frequency, Demographics, Comorbidities, and Health Care Utilization by Veterans With Migraine: A VA Nationwide Cohort Study. Neurology 2022; 99:e1979-e1992. [PMID: 36100439 PMCID: PMC9651466 DOI: 10.1212/wnl.0000000000200888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/11/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVE To describe the relative frequency, demographics, comorbidities, and health care utilization of veterans who receive migraine care at the Veteran's Health Administration (VHA) and to evaluate differences by gender. METHODS This study extracted data from VHA administrative sources. Veterans diagnosed with migraine by a health care provider between fiscal year 2008 and 2019 were included. Demographics and military exposures were extracted at cohort entry. Comorbidities were extracted within 18 months of the first migraine diagnosis. Health care utilization and headache comorbidities were extracted across the study period. Differences between men and women were evaluated using χ2 tests and Student t tests. RESULTS More than half a million (n = 567,121) veterans were diagnosed with migraine during the 12-year study period, accounting for 5.3% of the 10.8 million veterans served in the VHA; in the most recent year of the study period (2019), the annual incidence and 1-year period prevalence of medically diagnosed migraine was 2.7% and 13.0% for women and 0.7% and 2.5% for men. In the total cohort diagnosed with migraine, 27.8% were women and 72.2% men. Among those with diagnosed migraine, a higher proportion of men vs women also had a TBI diagnosis (3.9% vs 1.1%; p < 0.001). A higher proportion of women vs men reported military sexual trauma (35.5% vs 3.5%; p < 0.001). Participants with diagnosed migraine had an average of 1.44 (SD 1.73) annual encounters for headache. Primary care was the most common headache care setting (88.1%); almost one-fifth of veterans with diagnosed migraine sought care in the ED at least once during the study period. Common comorbidities were overweight/obesity (80.3%), nonheadache pain disorders (61.7%), and mental health disorders (48.8%). DISCUSSION Migraine is commonly treated in the VHA setting, but likely underascertained. Most people treated for migraine in the VHA are men. Pain comorbidities and psychiatric disorders are common. Future research should identify methods to improve diagnosis and treatment and to reduce use of the emergency department.
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Affiliation(s)
- Elizabeth K Seng
- From the VA Connecticut Healthcare System (B.T.F., K.W., A.S.G., M.S., J.J.S.), West Haven; Yeshiva University (A.S.G.), Bronx; Albert Einstein College of Medicine (R.B.L.), Bronx; Montefiore Medical Center (R.B.L.), Bronx, NY; Yale School of Medicine (B.T.F., K.W., M.S., J.J.S.), New Haven; Yale School of Public Health (K.W.), New Haven, CT; Bedford VA Medical Center (J.N.); Boston University School of Medicine (J.N.), MA; Richard L. Roudebush VA Medical Center (T.D.), Indianapolis; and Indiana University School of Medicine (T.D.), Indianapolis.
| | - Brenda T Fenton
- From the VA Connecticut Healthcare System (B.T.F., K.W., A.S.G., M.S., J.J.S.), West Haven; Yeshiva University (A.S.G.), Bronx; Albert Einstein College of Medicine (R.B.L.), Bronx; Montefiore Medical Center (R.B.L.), Bronx, NY; Yale School of Medicine (B.T.F., K.W., M.S., J.J.S.), New Haven; Yale School of Public Health (K.W.), New Haven, CT; Bedford VA Medical Center (J.N.); Boston University School of Medicine (J.N.), MA; Richard L. Roudebush VA Medical Center (T.D.), Indianapolis; and Indiana University School of Medicine (T.D.), Indianapolis
| | - Kaicheng Wang
- From the VA Connecticut Healthcare System (B.T.F., K.W., A.S.G., M.S., J.J.S.), West Haven; Yeshiva University (A.S.G.), Bronx; Albert Einstein College of Medicine (R.B.L.), Bronx; Montefiore Medical Center (R.B.L.), Bronx, NY; Yale School of Medicine (B.T.F., K.W., M.S., J.J.S.), New Haven; Yale School of Public Health (K.W.), New Haven, CT; Bedford VA Medical Center (J.N.); Boston University School of Medicine (J.N.), MA; Richard L. Roudebush VA Medical Center (T.D.), Indianapolis; and Indiana University School of Medicine (T.D.), Indianapolis
| | - Richard B Lipton
- From the VA Connecticut Healthcare System (B.T.F., K.W., A.S.G., M.S., J.J.S.), West Haven; Yeshiva University (A.S.G.), Bronx; Albert Einstein College of Medicine (R.B.L.), Bronx; Montefiore Medical Center (R.B.L.), Bronx, NY; Yale School of Medicine (B.T.F., K.W., M.S., J.J.S.), New Haven; Yale School of Public Health (K.W.), New Haven, CT; Bedford VA Medical Center (J.N.); Boston University School of Medicine (J.N.), MA; Richard L. Roudebush VA Medical Center (T.D.), Indianapolis; and Indiana University School of Medicine (T.D.), Indianapolis
| | - John Ney
- From the VA Connecticut Healthcare System (B.T.F., K.W., A.S.G., M.S., J.J.S.), West Haven; Yeshiva University (A.S.G.), Bronx; Albert Einstein College of Medicine (R.B.L.), Bronx; Montefiore Medical Center (R.B.L.), Bronx, NY; Yale School of Medicine (B.T.F., K.W., M.S., J.J.S.), New Haven; Yale School of Public Health (K.W.), New Haven, CT; Bedford VA Medical Center (J.N.); Boston University School of Medicine (J.N.), MA; Richard L. Roudebush VA Medical Center (T.D.), Indianapolis; and Indiana University School of Medicine (T.D.), Indianapolis
| | - Teresa Damush
- From the VA Connecticut Healthcare System (B.T.F., K.W., A.S.G., M.S., J.J.S.), West Haven; Yeshiva University (A.S.G.), Bronx; Albert Einstein College of Medicine (R.B.L.), Bronx; Montefiore Medical Center (R.B.L.), Bronx, NY; Yale School of Medicine (B.T.F., K.W., M.S., J.J.S.), New Haven; Yale School of Public Health (K.W.), New Haven, CT; Bedford VA Medical Center (J.N.); Boston University School of Medicine (J.N.), MA; Richard L. Roudebush VA Medical Center (T.D.), Indianapolis; and Indiana University School of Medicine (T.D.), Indianapolis
| | - Amy S Grinberg
- From the VA Connecticut Healthcare System (B.T.F., K.W., A.S.G., M.S., J.J.S.), West Haven; Yeshiva University (A.S.G.), Bronx; Albert Einstein College of Medicine (R.B.L.), Bronx; Montefiore Medical Center (R.B.L.), Bronx, NY; Yale School of Medicine (B.T.F., K.W., M.S., J.J.S.), New Haven; Yale School of Public Health (K.W.), New Haven, CT; Bedford VA Medical Center (J.N.); Boston University School of Medicine (J.N.), MA; Richard L. Roudebush VA Medical Center (T.D.), Indianapolis; and Indiana University School of Medicine (T.D.), Indianapolis
| | - Melissa Skanderson
- From the VA Connecticut Healthcare System (B.T.F., K.W., A.S.G., M.S., J.J.S.), West Haven; Yeshiva University (A.S.G.), Bronx; Albert Einstein College of Medicine (R.B.L.), Bronx; Montefiore Medical Center (R.B.L.), Bronx, NY; Yale School of Medicine (B.T.F., K.W., M.S., J.J.S.), New Haven; Yale School of Public Health (K.W.), New Haven, CT; Bedford VA Medical Center (J.N.); Boston University School of Medicine (J.N.), MA; Richard L. Roudebush VA Medical Center (T.D.), Indianapolis; and Indiana University School of Medicine (T.D.), Indianapolis
| | - Jason J Sico
- From the VA Connecticut Healthcare System (B.T.F., K.W., A.S.G., M.S., J.J.S.), West Haven; Yeshiva University (A.S.G.), Bronx; Albert Einstein College of Medicine (R.B.L.), Bronx; Montefiore Medical Center (R.B.L.), Bronx, NY; Yale School of Medicine (B.T.F., K.W., M.S., J.J.S.), New Haven; Yale School of Public Health (K.W.), New Haven, CT; Bedford VA Medical Center (J.N.); Boston University School of Medicine (J.N.), MA; Richard L. Roudebush VA Medical Center (T.D.), Indianapolis; and Indiana University School of Medicine (T.D.), Indianapolis
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Merlin JS, Black AC, Midboe AM, Troszak L, Asch SM, Bohnert A, Fenton BT, Giannitrapani KF, Glassman P, Kerns RD, Silveira M, Lorenz KA, Becker WC. Long-term Opioid Therapy and Overdose in Patients with and without Cancer. The Journal of Pain 2022. [DOI: 10.1016/j.jpain.2022.03.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Grinberg AS, Fenton BT, Wang K, Lindsey H, Goldman RE, Baird S, Riley S, Burrone L, Seng EK, Damush TM, Sico JJ. Telehealth perceptions and utilization for the delivery of headache care before and during the COVID-19 pandemic: A mixed-methods study. Headache 2022; 62:613-623. [PMID: 35545754 PMCID: PMC9348149 DOI: 10.1111/head.14310] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the utilization of telehealth for headache services within the Veterans Health Administration's facilities housing a Headache Centers of Excellence and multiple stakeholder's perspectives to inform future telehealth delivery. BACKGROUND Telehealth delivery of headache treatment may enhance patient access to headache care, yet little is known about the utilization or patient and provider perceptions of telehealth for veterans with headache. METHODS This mixed-methods study analyzed multiple data sources: (1) administrative data, which included 58,798 patients with medically diagnosed headache disorders, documented in at least one outpatient visit, from August 2019 through September 2020 from the 12 Veterans Health Administration's facilities with a Headache Center of Excellence and (2) qualitative semistructured interviews with 20 patients and 43 providers 6 months before the coronavirus disease 2019 (COVID-19) pandemic, and 10 patients and 20 providers 6 months during the beginning of the pandemic. RESULTS During the pandemic, in-person visits declined from 12,794 to 6099 (52.0%), whereas video (incidence rate ratio [IRR] = 2.05, 95% confidence interval [CI] = 1.66, 2.52), and telephone visits (IRR = 15.2, 95% CI = 10.7, 21.6) significantly increased. Utilization differed based on patient age, race/ethnicity, and rurality. Patients and providers perceived value in using telehealth, yet had limited experience with this modality pre-pandemic. Providers preferred in-person appointments for initial encounters and telehealth for follow-up visits. Providers and patients identified benefits and challenges of telehealth delivery, often relying on multiple delivery methods for telehealth to enhance patient engagement. CONCLUSIONS The uptake of telehealth delivery of headache-related care rapidly expanded in response to the pandemic. Patients and providers were amenable to utilizing telehealth, yet also experienced technological barriers. To encourage equitable access to telehealth and direct resources to those in need, it is crucial to understand patient preferences regarding in-person versus telehealth visits and identify patient groups who face barriers to access.
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Affiliation(s)
- Amy S Grinberg
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Brenda T Fenton
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Kaicheng Wang
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Hayley Lindsey
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Roberta E Goldman
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sean Baird
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Samantha Riley
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Laura Burrone
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Elizabeth K Seng
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.,The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Teresa M Damush
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, Indiana, USA.,Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Jason J Sico
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
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Goldman RE, Damush TM, Kuruvilla DE, Lindsey H, Baird S, Riley S, Burrone Bs L, Grinberg AS, Seng EK, Fenton BT, Sico JJ. Essential components of care in a multidisciplinary headache center: Perspectives from headache neurology specialists. Headache 2022; 62:306-318. [PMID: 35293614 DOI: 10.1111/head.14277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVE Comprehensive headache care involves numerous specialties and components that have not been well documented or standardized. This study aimed to elicit best practices and characterize important elements of care to be provided in multidisciplinary headache centers. METHODS Qualitative, semi-structured telephone interviews with a purposive sample of headache neurology specialists from across the US, using open-ended questions. Interviews were recorded, transcribed, and coded. Coded data were further analyzed using immersion/crystallization techniques for final interpretation. RESULTS Mean years providing headache care was 17.7 (SD = 10.6). Twelve of the 13 participants held United Council for Neurologic Subspecialties headache certification. Six described their practice site as providing multidisciplinary headache care. Participants explained most of their patients had seen multiple doctors over many years, and had tried numerous unsuccessful treatments. They noted patients with chronic headache frequently present with comorbidities and become stigmatized. All participants asserted successful care depends on taking time to talk with and listen to patients, gain understanding, and earn trust. All participants believed multidisciplinary care is essential within a comprehensive headache center, along with staffing enough headache specialists, implementing detailed headache intake and follow-up protocols, and providing the newest medications, neuromodulation devices, botulinum toxin injections, monoclonal antibodies, nerve blocks and infusions, and treatment from a health psychologist. Other essential services for a headache center are other behavioral health practitioners providing cognitive behavioral therapy, mindfulness, biofeedback and pain management; and autonomic neurology, neuropsychology, vestibular audiology, sleep medicine, physical therapy, occupational therapy, exercise physiology, speech therapy, nutrition, complementary integrative health modalities, and highly trained support staff. CONCLUSION While headache neurology specialists form the backbone of headache care, experts interviewed for this study maintained their specialty is just one of many types of care needed to adequately treat patients with chronic headache, and this is best provided in a comprehensive, multidisciplinary center.
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Affiliation(s)
- Roberta E Goldman
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA
| | - Teresa M Damush
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, Indiana, USA.,Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Deena E Kuruvilla
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Westport Headache Institute, Westport, Connecticut, USA
| | - Hayley Lindsey
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Sean Baird
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Samantha Riley
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Laura Burrone Bs
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA
| | - Amy S Grinberg
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA
| | - Elizabeth K Seng
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.,The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Brenda T Fenton
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Jason J Sico
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
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12
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Kuruvilla DE, Lindsey H, Grinberg AS, Goldman RE, Riley S, Baird S, Fenton BT, Sico JJ, Damush TM. Complementary and integrative medicine perspectives among veteran patients and VHA healthcare providers for the treatment of headache disorders: a qualitative study. BMC Complement Med Ther 2022; 22:22. [PMID: 35078450 PMCID: PMC8790919 DOI: 10.1186/s12906-022-03511-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate veteran patient and provider perceptions and preferences on complementary and integrative medicine (CIM) for headache management. Background The Veterans Health Administration (VHA) has spearheaded a Whole Health system of care focusing on CIM-based care for veteran patients. Less is known about patients’ and providers’ CIM perceptions and preferences for chronic headache management. Methods We conducted semi-structured interviews with 20 veteran patients diagnosed with headache and 43 clinical providers, across 12 VHA Headache Centers of Excellence (HCoE), from January 2019 to March 2020. We conducted thematic and case comparative analyses. Results Veteran patients and VHA clinical providers viewed CIM favorably for the treatment of chronic headache. Specific barriers to CIM approaches included: (1) A lack of personnel specialized in specific CIM approaches for timely access, and (2) variation in patient perceptions and responses to CIM treatment efficacy for headache management. Conclusion Veteran patients and VHA clinical providers in this study viewed CIM favorably as a safe addition to mainstream headache treatments. Advantages to CIM include favorable adverse effect profiles and patient autonomy over the treatment. By adding more CIM providers and resources throughout the VHA, CIM modalities may be recommended more routinely in the management of veterans with headache. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-022-03511-6.
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13
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Spinola S, Fenton BT, Meshberg-Cohen S, Black AC, Rosen MI. Comparison of attitudes towards the service connection claims process among veterans filing for PTSD and veterans filing for musculoskeletal disorders. Medicine (Baltimore) 2021; 100:e27068. [PMID: 34477140 PMCID: PMC8415949 DOI: 10.1097/md.0000000000027068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/15/2021] [Accepted: 08/05/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Many veterans have negative views about the service connection claims process for posttraumatic stress disorder (PTSD), which likely impacts willingness to file service connection claims, re-file claims, and use Veterans Healthcare Administration care. Nevertheless, veterans have reported that PTSD claims are important to them for the financial benefits, validation of prior experience and harm, and self-other issues such as pleasing a significant other. It is unknown if reported attitudes are specific to PTSD claimants or if they would be similar to those submitting claims for other disorders, such as musculoskeletal disorders. Therefore, the purpose of this study was to compare attitudes and beliefs about service connection processes between veterans submitting service connection claims for PTSD and musculoskeletal disorders.Participants were Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans filing service connection claims for PTSD (n = 218) or musculoskeletal disorder (n = 257) who completed a modified Disability Application Appraisal Inventory. This secondary data analysis using multiple regression models tested the effect of demographics, clinical characteristics, and claim type on 5 Disability Application Appraisal Inventory subscales: Knowledge about service connection claims, Negative Expectations about the process, and importance of Financial Benefits, importance of Validation of veteran's experience/condition, and importance of Self-Other attitudes.The PTSD group assigned significantly less importance to financial benefits than the musculoskeletal disorder group. In addition, the subset of the PTSD group without depression had significantly more Negative Expectations than musculoskeletal disorder claimants without depression. Negative Expectations did not differ between the PTSD and musculoskeletal disorder groups with depression. Depression was significantly positively associated with Negative Expectations, importance of Financial Benefits, and importance of Validation.Most perceptions around seeking service connection are not specific to PTSD claimants. Depression is associated with having negative expectations about service connection claims and motivations to file claims. Addressing depression and negative expectations during the compensation and pension process might help veterans at this important point of contact with Veterans Healthcare Administration services.
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Affiliation(s)
- Suzanne Spinola
- VA Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, Department of Psychiatry, CT
| | - Brenda T. Fenton
- VA Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, Department of Neurology, CT
| | - Sarah Meshberg-Cohen
- VA Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, Department of Psychiatry, CT
| | - Anne C. Black
- VA Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, Department of Internal Medicine, CT
| | - Marc I. Rosen
- VA Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, Department of Psychiatry, CT
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14
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Schindler EAD, Cooper V, Quine DB, Fenton BT, Wright DA, Weil MJ, Sico JJ. "You will eat shoe polish if you think it would help"-Familiar and lesser-known themes identified from mixed-methods analysis of a cluster headache survey. Headache 2021; 61:318-328. [PMID: 33502769 DOI: 10.1111/head.14063] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/12/2020] [Accepted: 12/21/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To characterize patient-reported ideas and concerns about cluster headache, treatment options, and management strategies. BACKGROUND Cluster headache patients experience severe pain and often suffer additional consequences from their disease. Patients have identified methods to cope with and combat cluster headache that are not widely known. METHODS Secondary analysis was performed using deidentified data from the online Clusterbusters Medication Use survey, wherein 10 questions allowed for freely written comments. Using mixed-methods techniques, neurologists with expertise in headache medicine identified themes from these comments. Subgroup analysis sought to identify variables associated with specific themes. RESULTS Among 2274 free-text responses from 493 adult participants, 23 themes were identified. Themes commonly discussed in the literature included such topics as "nothing worked" (24.7%, 122/493), "side effects" (12.8%, 63/493), and difficulties with "access/cost" (2.4%, 12/493). Less widely recognized themes included the use of "illicit substances" (35.5%, 175/493) and "vitamins/supplements" (12.2%, 60/493) in disease management. Lesser-known themes included "coffee" (5.3%, 26/493) and "exercise/physical activity" (4.7%, 23/493). Using strict significance criteria, no subgroup was associated with any theme. Several poignant quotes highlighted patient thoughts and experiences. CONCLUSIONS This mixed-methods analysis identified challenges endured by cluster headache patients, as well as a variety of patient-directed disease management approaches. The volunteered information spotlights pharmacological, physiological, and psychological aspects of cluster headache that warrant further exploratory and interventional investigation.
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Affiliation(s)
- Emmanuelle A D Schindler
- Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Neurology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Vanessa Cooper
- Neurology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Douglas B Quine
- Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Pain, Research, Informatics, Medical comorbidities, and Education (PRIME) Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Brenda T Fenton
- Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Pain, Research, Informatics, Medical comorbidities, and Education (PRIME) Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | | | | | - Jason J Sico
- Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Neurology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology, Yale School of Medicine, New Haven, CT, USA.,Pain, Research, Informatics, Medical comorbidities, and Education (PRIME) Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
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15
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Wandner LD, Fenton BT, Goulet JL, Carroll CM, Heapy A, Higgins DM, Bair MJ, Sandbrink F, Kerns RD. Treatment of a Large Cohort of Veterans Experiencing Musculoskeletal Disorders with Spinal Cord Stimulation in the Veterans Health Administration: Veteran Characteristics and Outcomes. J Pain Res 2020; 13:1687-1697. [PMID: 32753944 PMCID: PMC7354010 DOI: 10.2147/jpr.s241567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/07/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Spinal cord stimulator (SCS) implantation is used to treat chronic pain, including painful musculoskeletal disorders (MSDs). This study examined the characteristics and outcomes of veterans receiving SCSs in Veterans Health Administration (VHA) facilities. METHODS The sample was drawn from the MSD Cohort and limited to three MSDs with the highest number of implants (N=815,475). There were 1490 veterans with these conditions who received SCS implants from 2000 to 2012, of which 95% (n=1414) had pain intensity numeric rating scale (NRS) data both pre- and post-implant. RESULTS Veterans who were 35-44 years old, White, and married reported higher pain NRS ratings, had comorbid inclusion diagnoses, had no medical comorbidities, had a BMI 25-29.9, or had a depressive disorder diagnosis were more likely to receive an SCS. Veterans 55+ years old or with an alcohol or substance use disorder were less likely to receive an SCS. Over 90% of those receiving an SCS were prescribed opioids in the year prior to implant. Veterans who had a presurgical pain score ≥4 had a clinically meaningful decrease in their pain score in the year following their 90-day recovery period (Day 91-456) greater than expected by chance alone. Similarly, there was a significant decrease in the percent of veterans receiving opioid therapy (92.4% vs 86.6%, p<0.0001) and a significant overall decrease in opioid dose [morphine equivalent dose per day (MEDD) =26.48 vs MEDD=22.59, p<0.0003]. CONCLUSION Results offer evidence of benefit for some veterans with the examined conditions. Given known risks of opioid therapy, the reduction is an important potential benefit of SCS implants.
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Affiliation(s)
- Laura D Wandner
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Brenda T Fenton
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Joseph L Goulet
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Alicia Heapy
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Diana M Higgins
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
| | - Friedhelm Sandbrink
- Department of Neurology, VA Medical Center, Washington, DC, USA
- Department of Neurology, Georgetown University, Washington, DC, USA
| | - Robert D Kerns
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
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16
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Rosen MI, Martino S, Sellinger J, Lazar CM, Fenton BT, Mattocks K. Access to Pain Care From Compensation Clinics: A Relational Coordination Perspective. Fed Pract 2020; 37:336-342. [PMID: 32908339 PMCID: PMC7473717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The Compensation and Pension (C&P) determination process is a potential gateway to accessing pain treatment in the Veterans Health Administration (VHA). However, attitudes about C&P as a gateway and about collaboration with C&P clinics among VHA staff are unknown. METHODS In preparation for an initiative to link veterans seeking compensation for musculoskeletal disorders to treatment, clinical and administrative staff from the 8 VHA medical centers in New England were invited to complete a relational coordination survey that examined how different workgroups collaborate (communication and relationships) to provide pain care to veterans. A subset of those staff also participated in a semistructured interview about pain treatment referral practices within their medical centers. VHA staff were from primary care, administration, pain management, and C&P teams. RESULTS Eighty-three VHA staff were invited to complete the relational coordination survey; 66 completed the survey and 39 participated in the semistructured interview. Most C&P staff interviewed thought of the compensation examination as a forensic process and that C&P-based efforts to engage veterans might interfere with the examination or were not their responsibility. However, some examiners described their efforts to determine new veterans' eligibility for VHA care and to connect them to specific treatments. VHA staff reported that there was little communication between the C&P team and other teams. The survey results supported this finding. The C&P group's relational coordination composite scores were lower than any other workgroup. CONCLUSION Outreach to veterans at New England C&P clinics was inconsistent, and C&P teams rated low on a measure of coordination with workgroups involved in pain treatment. Compensation examinations appear to be underused opportunities to help veterans access treatment. C&P-based treatment engagement is feasible; it is being done by some Compensation teams.
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Affiliation(s)
- Marc I Rosen
- is the Director of Addictions Firm, is the Chief of Psychology, is the Director of Clinical Health Psychology, is the Associate Director, Methods and Biostatistics Core, PRIME Center; all at VA Connecticut Healthcare System in West Haven. is the Associate Chief of Staff for Research at the VA Central Western Massachusetts Healthcare System in Leeds. Marc Rosen and Steve Martino are Professors of Psychiatry, John Sellinger is an Assistant Professor of Psychiatry, and is a Research Associate, all at Yale University in New Haven, Connecticut. Kristin Mattocks is an Associate Professor of Population and Quantitative Health Sciences at the University of Massachusetts Medical School in Worcester
| | - Steve Martino
- is the Director of Addictions Firm, is the Chief of Psychology, is the Director of Clinical Health Psychology, is the Associate Director, Methods and Biostatistics Core, PRIME Center; all at VA Connecticut Healthcare System in West Haven. is the Associate Chief of Staff for Research at the VA Central Western Massachusetts Healthcare System in Leeds. Marc Rosen and Steve Martino are Professors of Psychiatry, John Sellinger is an Assistant Professor of Psychiatry, and is a Research Associate, all at Yale University in New Haven, Connecticut. Kristin Mattocks is an Associate Professor of Population and Quantitative Health Sciences at the University of Massachusetts Medical School in Worcester
| | - John Sellinger
- is the Director of Addictions Firm, is the Chief of Psychology, is the Director of Clinical Health Psychology, is the Associate Director, Methods and Biostatistics Core, PRIME Center; all at VA Connecticut Healthcare System in West Haven. is the Associate Chief of Staff for Research at the VA Central Western Massachusetts Healthcare System in Leeds. Marc Rosen and Steve Martino are Professors of Psychiatry, John Sellinger is an Assistant Professor of Psychiatry, and is a Research Associate, all at Yale University in New Haven, Connecticut. Kristin Mattocks is an Associate Professor of Population and Quantitative Health Sciences at the University of Massachusetts Medical School in Worcester
| | - Christina M Lazar
- is the Director of Addictions Firm, is the Chief of Psychology, is the Director of Clinical Health Psychology, is the Associate Director, Methods and Biostatistics Core, PRIME Center; all at VA Connecticut Healthcare System in West Haven. is the Associate Chief of Staff for Research at the VA Central Western Massachusetts Healthcare System in Leeds. Marc Rosen and Steve Martino are Professors of Psychiatry, John Sellinger is an Assistant Professor of Psychiatry, and is a Research Associate, all at Yale University in New Haven, Connecticut. Kristin Mattocks is an Associate Professor of Population and Quantitative Health Sciences at the University of Massachusetts Medical School in Worcester
| | - Brenda T Fenton
- is the Director of Addictions Firm, is the Chief of Psychology, is the Director of Clinical Health Psychology, is the Associate Director, Methods and Biostatistics Core, PRIME Center; all at VA Connecticut Healthcare System in West Haven. is the Associate Chief of Staff for Research at the VA Central Western Massachusetts Healthcare System in Leeds. Marc Rosen and Steve Martino are Professors of Psychiatry, John Sellinger is an Assistant Professor of Psychiatry, and is a Research Associate, all at Yale University in New Haven, Connecticut. Kristin Mattocks is an Associate Professor of Population and Quantitative Health Sciences at the University of Massachusetts Medical School in Worcester
| | - Kristin Mattocks
- is the Director of Addictions Firm, is the Chief of Psychology, is the Director of Clinical Health Psychology, is the Associate Director, Methods and Biostatistics Core, PRIME Center; all at VA Connecticut Healthcare System in West Haven. is the Associate Chief of Staff for Research at the VA Central Western Massachusetts Healthcare System in Leeds. Marc Rosen and Steve Martino are Professors of Psychiatry, John Sellinger is an Assistant Professor of Psychiatry, and is a Research Associate, all at Yale University in New Haven, Connecticut. Kristin Mattocks is an Associate Professor of Population and Quantitative Health Sciences at the University of Massachusetts Medical School in Worcester
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17
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Diaz MM, Hu X, Fenton BT, Kimuli I, Lee A, Lindsey H, Bigelow JK, Maiser S, Altalib HH, Sico JJ. Prevalence of and characteristics associated with in-hospital mortality in a Ugandan neurology ward. BMC Neurol 2020; 20:42. [PMID: 32005185 PMCID: PMC6995141 DOI: 10.1186/s12883-020-1627-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 01/23/2020] [Indexed: 12/04/2022] Open
Abstract
Background While the burden of neurologic illness in developing countries is increasing, less is known about mortality among patients admitted to sub-Saharan African hospitals with neurologic disease. We sought to characterize the rate and patient-level predictors of in-hospital mortality in a Ugandan Neurology ward.cc. Methods Data was prospectively collected on 335 patients admitted to the Neurology ward of Mulago Hospital, Kampala, Uganda. Kaplan-Meier survival curves and multivariate COX proportional hazard modeling were used to assess survival. Results Within our sample (n = 307), 35.8% received no diagnosis at time of hospital admission. Stroke (27.3%), head trauma (19.6%), and malaria (16.0%) were the most common diagnoses. Among the 56 (18.5%) patients who died during the index hospitalization, the most common diagnosis at admission and at death was stroke. Adjusted regression analysis showed that patients without a diagnosis at time of death (HR = 7.01 [2.42–20.35], p < .001) and those with diagnoses of infections (HR = 5.21 [2.16–12.58], p = <.001), stroke (HR = 2.69 [1.20–6.04], p = .017), or head trauma (HR = 3.39, [1.27–9.07], p = 0.15) had worse survival. Conclusions In-hospital mortality affected nearly 20% of the cohort, with worse survival among those without a diagnosis and with infections, stroke, head trauma. Future work should identify reasons for increased mortality among these high-risk groups and implement targeted interventions.
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Affiliation(s)
- Monica M Diaz
- Department of Neurosciences, University of California San Diego, 220 Dickinson Street, Mail Code 8231, San Diego, CA, 92103, USA. .,University of California San Diego Health, 220 Dickinson Street, Mail Code 8231, San Diego, CA, 92103, USA. .,Johnson and Johnson Global Scholars Program, Yale School of Medicine, 20 York Street, New Haven, CT, 06510, USA.
| | - Xin Hu
- Yale Center for Analytical Science, Yale School of Public Health, New Haven, CT, USA
| | - Brenda T Fenton
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.,Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ivan Kimuli
- Mulago Hospital and Makerere University, Kampala, Uganda
| | - Allison Lee
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Hayley Lindsey
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | | | - Samuel Maiser
- Departments of Neurology and Internal Medicine, University of Minnesota, Minneapolis, MN, USA.,Hennepin Healthcare, Minneapolis, MN, USA
| | - Hamada H Altalib
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,Center for NeuroEpidemiological and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, USA.,Neurology Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Jason J Sico
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.,Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.,Center for NeuroEpidemiological and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, USA.,Neurology Service, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, USA
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18
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Altalib HH, Galluzzo D, Argraves S, Goulet J, Bornovski Y, Cheung KH, Jackson-Shaheed E, Tolchin B, Fenton BT, Pugh MJ. Managing Functional Neurological Disorders: Protocol of a Cohort Study on Psychogenic Non-Epileptic Seizures Study. Neuropsychiatr Dis Treat 2019; 15:3557-3568. [PMID: 31920316 PMCID: PMC6939176 DOI: 10.2147/ndt.s234852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/20/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Functional neurological disorders (FNDs) are neurological symptoms that cannot be explained by an underlying neurological lesion or other medical illness and that do not have clear neuropathological correlates. Psychogenic non-epileptic seizures (PNES) are a common and highly disabling form of FND, characterized by paroxysmal episodes of involuntary movements and altered consciousness that can appear clinically similar to epileptic seizures. PNES are unique among FNDs in that they are diagnosed by video electroencephalographic (VEEG), a well-established biomarker for the disorder. The course of illness and response to treatment of PNES remain controversial. This study aims to describe the epidemiology of PNES in the Department of Veterans Affairs Healthcare System (VA), evaluate outcomes of veterans offered different treatments, and compare models of care for PNES. METHODS This electronic health record (EHR) cohort study utilizes an informatics search tool and a natural language processing algorithm to identify cases of PNES nationally. We will use VA inpatient, outpatient, pharmacy, and chart abstraction data across all 170 medical centers to identify cases in fiscal years 2002-2018. Outcome measurements such as seizure frequency, emergency room visits, hospital admissions, suicide-related behavior, and the utilization of psychotherapy prior to and after PNES diagnosis will be used to assess the effectiveness of models of care. DISCUSSION This study will describe the risk factors and course of treatment of a large cohort of people with PNES. Since PNES are cared for by a variety of different modalities, treatment orientations, and models of care, effectiveness outcomes such as seizure outcomes and utilization of emergency visits for seizures will be assessed. Outcome measurements such as seizure frequency, emergency room visits, hospital admissions, suicide-related behavior, and psychotherapy prior to and after PNES diagnosis will be used to assess the effectiveness of models of care.
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Affiliation(s)
- Hamada Hamid Altalib
- VA Connecticut Healthcare System, West Haven, CT, USA
- Comprehensive Epilepsy Center, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | | | - Stephanie Argraves
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Joseph Goulet
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Yarden Bornovski
- VA Connecticut Healthcare System, West Haven, CT, USA
- Comprehensive Epilepsy Center, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Kei-Hoi Cheung
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ebony Jackson-Shaheed
- VA Connecticut Healthcare System, West Haven, CT, USA
- Comprehensive Epilepsy Center, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Benjamin Tolchin
- VA Connecticut Healthcare System, West Haven, CT, USA
- Comprehensive Epilepsy Center, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | | | - Mary Jo Pugh
- University of Utah, Salt Lake City, UT, USA
- Salt Lake City Veterans Healthcare System, Salt Lake City, UT, USA
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19
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Wadia R, Akgun K, Brandt C, Fenton BT, Levin W, Marple AH, Garla V, Rose MG, Taddei T, Taylor C. Comparison of Natural Language Processing and Manual Coding for the Identification of Cross-Sectional Imaging Reports Suspicious for Lung Cancer. JCO Clin Cancer Inform 2019; 2:1-7. [PMID: 30652545 PMCID: PMC6873962 DOI: 10.1200/cci.17.00069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose To compare the accuracy and reliability of a natural language processing (NLP) algorithm with manual coding by radiologists, and the combination of the two methods, for the identification of patients whose computed tomography (CT) reports raised the concern for lung cancer. Methods An NLP algorithm was developed using Clinical Text Analysis and Knowledge Extraction System (cTAKES) with the Yale cTAKES Extensions and trained to differentiate between language indicating benign lesions and lesions concerning for lung cancer. A random sample of 450 chest CT reports performed at Veterans Affairs Connecticut Healthcare System between January 2014 and July 2015 was selected. A reference standard was created by the manual review of reports to determine if the text stated that follow-up was needed for concern for cancer. The NLP algorithm was applied to all reports and compared with case identification using the manual coding by the radiologists. Results A total of 450 reports representing 428 patients were analyzed. NLP had higher sensitivity and lower specificity than manual coding (77.3% v 51.5% and 72.5% v 82.5%, respectively). NLP and manual coding had similar positive predictive values (88.4% v 88.9%), and NLP had a higher negative predictive value than manual coding (54% v 38.5%). When NLP and manual coding were combined, sensitivity increased to 92.3%, with a decrease in specificity to 62.85%. Combined NLP and manual coding had a positive predictive value of 87.0% and a negative predictive value of 75.2%. Conclusion Our NLP algorithm was more sensitive than manual coding of CT chest reports for the identification of patients who required follow-up for suspicion of lung cancer. The combination of NLP and manual coding is a sensitive way to identify patients who need further workup for lung cancer.
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Affiliation(s)
- Roxanne Wadia
- Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Andrew H. Marple, Vijay Garla, Michal G. Rose, and Tamar Taddei, Yale University School of Medicine, New Haven; and Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Woody Levin, Michal G. Rose, Tamar Taddei, and Caroline Taylor, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Kathleen Akgun
- Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Andrew H. Marple, Vijay Garla, Michal G. Rose, and Tamar Taddei, Yale University School of Medicine, New Haven; and Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Woody Levin, Michal G. Rose, Tamar Taddei, and Caroline Taylor, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Cynthia Brandt
- Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Andrew H. Marple, Vijay Garla, Michal G. Rose, and Tamar Taddei, Yale University School of Medicine, New Haven; and Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Woody Levin, Michal G. Rose, Tamar Taddei, and Caroline Taylor, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Brenda T Fenton
- Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Andrew H. Marple, Vijay Garla, Michal G. Rose, and Tamar Taddei, Yale University School of Medicine, New Haven; and Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Woody Levin, Michal G. Rose, Tamar Taddei, and Caroline Taylor, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Woody Levin
- Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Andrew H. Marple, Vijay Garla, Michal G. Rose, and Tamar Taddei, Yale University School of Medicine, New Haven; and Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Woody Levin, Michal G. Rose, Tamar Taddei, and Caroline Taylor, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Andrew H Marple
- Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Andrew H. Marple, Vijay Garla, Michal G. Rose, and Tamar Taddei, Yale University School of Medicine, New Haven; and Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Woody Levin, Michal G. Rose, Tamar Taddei, and Caroline Taylor, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Vijay Garla
- Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Andrew H. Marple, Vijay Garla, Michal G. Rose, and Tamar Taddei, Yale University School of Medicine, New Haven; and Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Woody Levin, Michal G. Rose, Tamar Taddei, and Caroline Taylor, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Michal G Rose
- Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Andrew H. Marple, Vijay Garla, Michal G. Rose, and Tamar Taddei, Yale University School of Medicine, New Haven; and Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Woody Levin, Michal G. Rose, Tamar Taddei, and Caroline Taylor, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Tamar Taddei
- Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Andrew H. Marple, Vijay Garla, Michal G. Rose, and Tamar Taddei, Yale University School of Medicine, New Haven; and Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Woody Levin, Michal G. Rose, Tamar Taddei, and Caroline Taylor, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Caroline Taylor
- Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Andrew H. Marple, Vijay Garla, Michal G. Rose, and Tamar Taddei, Yale University School of Medicine, New Haven; and Roxanne Wadia, Kathleen Akgun, Cynthia Brandt, Brenda T. Fenton, Woody Levin, Michal G. Rose, Tamar Taddei, and Caroline Taylor, Veterans Affairs Connecticut Healthcare System, West Haven, CT
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20
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Sico J, Burrone L, Bottomley S, Keefner L, Ellimuttil S, Ragunton JM, Damush T, Hurd P, Fenton BT. Abstract TP376: Barriers and Facilitators to Obtaining the “New” Goal Blood Pressure for Patients With Ischemic Stroke - A Mixed Methods Analysis from the Veterans Health Administration. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tp376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The 2017 ACC/AHA updated hypertension guideline recommends a “new” goal blood pressure (BP) of <130/80 mmHg for stroke survivors. Little is known regarding the perceived barriers and facilitators to implementing this recommendation and whether Veterans Health Administration medical centers (VAMCs) routinely achieving this degree of post-stroke BP control.
Methods:
Chart review was conducted to determine the numbers of patients with hypertension who obtained ACC/AHA (i.e., <140/90 mmHg) and Joint National Committee (JNC)-8 recommended BP goals (i.e., 130/80 mmHg). Thematic analysis was performed on 27 semi-structured qualitative interviews with providers, hospital and clinic administrators, and quality improvement staff conducted February-April 2018 at two diverse VAMCs. Interviews were conducted prior to the start of a CAre Transition and Hypertension (CATcH) improvement intervention. Code descriptions of “opinions regarding ‘new’ BP guidelines,” “barriers to BP management,” and, “facilitators to BP management” were compared across sites and among providers. A multidisciplinary team conducted consensus-based coding of transcripts.
Results:
In the sixteen-months prior to the implementation of CATcH, facility-level pass rates for BP control were: 50% (18/36) patients at Site 1 and 64% (16/25) at Site 2 had obtained old goal BP, whereas 28% (10/36) at Site 1 and 20% (5/20) at Site 2 obtained new goal BP. Barriers and facilitators of bp management were identified at the patient-, provider-, and facility-levels (Table). Similar themes were seen across sites.
Conclusions:
Pre-intervention pass rates for bp need to improve. Multiple barriers and facilitators at the patient-, provider-, and systems-levels have been considered in designing the CATcH intervention, which seeks to incorporate the 2017 ACC/AHA hypertension guidelines into routine clinical care and improve on current facility-level performance.
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Affiliation(s)
- Jason Sico
- Yale Sch of Medicine/Veterans Health Administration, Guilford, CT
| | | | | | | | | | | | - Teresa Damush
- Veterans Health Administration/Indiana Univ Sch of Medicine, Indianapolis, IN
| | - Paul Hurd
- Veterans Health Administration, Dallas, TX
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21
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Midboe AM, Martino S, Krein SL, Frank JW, Painter JT, Chandler M, Schroeder A, Fenton BT, Troszak L, Erhardt T, Kerns RD, Becker WC. Testing implementation facilitation of a primary care-based collaborative care clinical program using a hybrid type III interrupted time series design: a study protocol. Implement Sci 2018; 13:145. [PMID: 30486877 PMCID: PMC6262952 DOI: 10.1186/s13012-018-0838-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022] Open
Abstract
Background Dissemination of evidence-based practices that can reduce morbidity and mortality is important to combat the growing opioid overdose crisis in the USA. Research and expert consensus support reducing high-dose opioid therapy, avoiding risky opioid-benzodiazepine combination therapy, and promoting multi-modal, collaborative models of pain care. Collaborative care interventions that support primary care providers have been effective in medication tapering. We developed a patient-centered Primary Care-Integrated Pain Support (PIPS) collaborative care clinical program based on effective components of previous collaborative care interventions. Implementation facilitation, a multi-faceted and dynamic strategy involving the provision of interactive problem-solving and support during implementation of a new program, is used to support key organizational staff throughout PIPS implementation. The primary aim of this study is to evaluate the effectiveness of the implementation facilitation strategy for implementing and sustaining PIPS in the Veterans Health Administration (VHA). The secondary aim is to examine the effect of the program on key patient-level clinical outcomes—transitioning to safer regimens and enhancing access to complementary and integrative health treatments. The tertiary aim is to determine the categorical costs and ultimate budget impact of PIPS implementation. Methods This multi-site study employs an interrupted time series, hybrid type III design to evaluate the effectiveness of implementation facilitation for a collaborative care clinical program—PIPS—in primary care clinics in three geographically diverse VHA health care systems (sites). Participants include pharmacists and allied staff involved in the delivery of clinical pain management services as well as patients. Eligible patients are prescribed either an outpatient opioid prescription greater than or equal to 90 mg morphine equivalent daily dose or a combination opioid-benzodiazepine regimen. They must also have an upcoming appointment in primary care. The Consolidated Framework for Implementation Research will guide the mixed methods work across the formative evaluation phases and informs the selection of activities included in implementation facilitation. The RE-AIM framework will be used to assess Reach, Effectiveness, Adoption, Implementation, and Maintenance of PIPS. Discussion This implementation study will provide important insight into the effectiveness of implementation facilitation to enhance uptake of a collaborative care program in primary care, which targets unsafe opioid prescribing practices. Electronic supplementary material The online version of this article (10.1186/s13012-018-0838-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amanda M Midboe
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Stanford University, 795 Willow Rd (152-MPD), Menlo Park, CA, 94025, USA.
| | - Steve Martino
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.,Yale School of Medicine, New Haven, CT, USA
| | - Sarah L Krein
- Center for Clinical Management Research (CCMR), VA Ann Arbor, Ann Arbor, MI, USA.,University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Joseph W Frank
- VA Eastern Colorado Healthcare System, HSR&D Center for Veteran-Centered and Value-Driven Care, Denver, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | - Jacob T Painter
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.,Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael Chandler
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.,Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Allison Schroeder
- VA Eastern Colorado Healthcare System, HSR&D Center for Veteran-Centered and Value-Driven Care, Denver, CO, USA
| | - Brenda T Fenton
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.,Yale School of Medicine, New Haven, CT, USA
| | - Lara Troszak
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Stanford University, 795 Willow Rd (152-MPD), Menlo Park, CA, 94025, USA
| | - Taryn Erhardt
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Stanford University, 795 Willow Rd (152-MPD), Menlo Park, CA, 94025, USA
| | - Robert D Kerns
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.,Yale School of Medicine, New Haven, CT, USA
| | - William C Becker
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.,Yale School of Medicine, New Haven, CT, USA
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22
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Becker WC, Mattocks KM, Frank JW, Bair MJ, Jankowski RL, Kerns RD, Painter JT, Fenton BT, Midboe AM, Martino S. Mixed methods formative evaluation of a collaborative care program to decrease risky opioid prescribing and increase non-pharmacologic approaches to pain management. Addict Behav 2018; 86:138-145. [PMID: 29576479 DOI: 10.1016/j.addbeh.2018.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 01/30/2018] [Accepted: 03/06/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Opioid prescribing and subsequent rates of serious harms have dramatically increased in the past two decades, yet there are still significant barriers to reduction of risky opioid regimens. This formative evaluation utilized a mixed-methods approach to identify barriers and factors that may facilitate the successful implementation of Primary Care-Integrated Pain Support (PIPS), a clinical program designed to support the reduction of risky opioid regimens while increasing the uptake of non-pharmacologic treatment modalities. METHODS Eighteen Department of Veterans Affairs (VA) employees across three sites completed a survey consisting of the Organizational Readiness for Implementing Change (ORIC) scale; a subset of these individuals (n = 9) then completed a semi-structured qualitative phone interview regarding implementing PIPS within the VA. ORIC results were analyzed using descriptive statistics while interview transcripts were coded and sorted according to qualitative themes. RESULTS Quantitative analysis based on ORIC indicated high levels of organizational readiness to implement PIPS. Interview analysis revealed several salient themes: system-level barriers such as tension among various pain management providers; patient-level barriers such as perception of support and tension between patient and provider; and facilitating factors of PIPS, such as the importance of the clinical pharmacist role. CONCLUSIONS While organizational readiness for implementing PIPS appears high, modifications to our implementation facilitation strategy (e.g., establishing clinical pharmacists as champions; marketing PIPS to leadership as a way to improve VA opioid safety metrics) may improve capacity of the sites to implement PIPS successfully.
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23
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Fenton BT, Goulet JL, Bair MJ, Cowley T, Kerns RD. Relationships Between Temporomandibular Disorders, MSD Conditions, and Mental Health Comorbidities: Findings from the Veterans Musculoskeletal Disorders Cohort. Pain Med 2018; 19:S61-S68. [PMID: 30203016 DOI: 10.1093/pm/pny145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective Temporomandibular disorders (TMDs) have been associated with other chronic painful conditions (e.g., fibromyalgia, headache) and suicide and mood disorders. Here we examined musculoskeletal, painful, and mental health comorbidities in men vs women veterans with TMD (compared with non-TMD musculoskeletal disorders [MSDs] cases), as well as comorbidity patterns within TMD cases. Design Observational cohort. Setting National Veterans Health Administration. Subjects A cohort of 4.1 million veterans having 1+ MSDs, entering the cohort between 2001 and 2011. Methods Chi-square tests, t tests, and logistic regression were utilized for cross-sectional analysis. Results Among veterans with any MSD, those with TMD were younger and more likely to be women. The association of TMD with race/ethnicity differed by sex. Odds of TMD were higher in men of Hispanic ethnicity (OR = 1.38, 95% CI = 1.27-1.48) and nonwhite race/ethnicity other than black or Hispanic (OR = 1.29, 95% CI = 1.16-1.45) compared with white men. Odds of TMD were significantly lower for black (OR = 0.54, 95% CI = 0.49-0.60) and Hispanic women (OR = 0.84, 95% CI = 0.73-0.995) relative to white women. Non-MSD comorbidities (e.g., irritable bowel syndrome, mental health, headaches) were significantly associated with TMD in male veterans; their pattern was similar in women. Veterans with back pain, nontraumatic joint disorder, or osteoarthritis had more MSD multimorbidity than those with TMD. Conclusions Complex patterns of comorbidity in TMD cases may indicate different underlying mechanisms of association in subgroups or phenotypes, thereby suggesting multiple targets to improve TMD. Longitudinal comprehensive studies powered to look at sex and racial/ethnic groupings are needed to identify targets to personalize care.
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Affiliation(s)
- Brenda T Fenton
- PRIME Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Joseph L Goulet
- PRIME Center, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Indianapolis, Indiana.,Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana.,Regenstrief Institute, Center for Health Services Research, Indianapolis, Indiana
| | | | - Robert D Kerns
- PRIME Center, VA Connecticut Healthcare System, West Haven, Connecticut.,Departments of Psychiatry and Neurology, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Psychology, Yale University, New Haven, Connecticut, USA
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24
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Fried TR, Niehoff KM, Street RL, Charpentier PA, Rajeevan N, Miller PL, Goldstein MK, O’Leary JR, Fenton BT. Effect of the Tool to Reduce Inappropriate Medications on Medication Communication and Deprescribing. J Am Geriatr Soc 2017; 65:2265-2271. [PMID: 28804870 PMCID: PMC5641237 DOI: 10.1111/jgs.15042] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To examine the effect of the Tool to Reduce Inappropriate Medications (TRIM), a web tool linking an electronic health record (EHR) to a clinical decision support system, on medication communication and prescribing. DESIGN Randomized clinical trial. SETTING Primary care clinics at a Veterans Affairs Medical Center. PARTICIPANTS Veterans aged 65 and older prescribed seven or more medications randomized to receipt of TRIM or usual care (N = 128). INTERVENTION TRIM extracts information on medications and chronic conditions from the EHR and contains data entry screens for information obtained from brief chart review and telephonic patient assessment. These data serve as input for automated algorithms identifying medication reconciliation discrepancies, potentially inappropriate medications (PIMs), and potentially inappropriate regimens. Clinician feedback reports summarize discrepancies and provide recommendations for deprescribing. Patient feedback reports summarize discrepancies and self-reported medication problems. MEASUREMENTS Primary: subscales of the Patient Assessment of Care for Chronic Conditions (PACIC) related to shared decision-making; clinician and patient communication. Secondary: changes in medications. RESULTS 29.7% of TRIM participants and 15.6% of control participants provided the highest PACIC ratings; this difference was not significant. Adjusting for covariates and clustering of patients within clinicians, TRIM was associated with significantly more-active patient communication and facilitative clinician communication and with more medication-related communication among patients and clinicians. TRIM was significantly associated with correction of medication discrepancies but had no effect on number of medications or reduction in PIMs. CONCLUSION TRIM improved communication about medications and accuracy of documentation. Although there was no association with prescribing, the small sample size provided limited power to examine medication-related outcomes.
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Affiliation(s)
- Terri R. Fried
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
- Department of Medicine (Program on Aging), Yale School of Medicine, New Haven, CT
| | - Kristina M. Niehoff
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
| | - Richard L. Street
- Department of Communication, Texas A&M University, College Station, TX
- Houston Center for Quality of Care and Utilization Studies, Baylor College of Medicine, Houston, TX
| | | | - Nallakkandi Rajeevan
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
- Center for Medical Informatics, Yale University School of Medicine, New Haven, CT
| | - Perry L. Miller
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
- Center for Medical Informatics, Yale University School of Medicine, New Haven, CT
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT
| | - Mary K. Goldstein
- Palo Alto Geriatrics Research Education and Clinical Center (GRECC) and Medical Service, VA Palo Alto Health Care System, Palo Alto, CA
- Department of Medicine (Center for Primary Care and Outcomes Research), Stanford University, Stanford, CA
| | - John R. O’Leary
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
- Program on Aging, Yale School of Medicine, New Haven, CT
| | - Brenda T. Fenton
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT
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Heapy AA, Wandner L, Driscoll MA, LaChappelle K, Czlapinski R, Fenton BT, Piette JD, Aikens JE, Janevic MR, Kerns RD. Developing a typology of patient-generated behavioral goals for cognitive behavioral therapy for chronic pain (CBT-CP): classification and predicting outcomes. J Behav Med 2017; 41:174-185. [PMID: 28936717 DOI: 10.1007/s10865-017-9885-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 09/08/2017] [Indexed: 01/25/2023]
Abstract
Patient-generated treatment goals describe what patients value, yet the content of these goals, and the relationship among goal types, goal accomplishment, and treatment outcomes has received little examination. We used inductive sorting to categorize patient-generated goals made by 147 adults receiving cognitive-behavioral therapy for chronic pain. The resulting goal categories were: Physical Activity (29.0%), Functional Status (24.6%), Wellness (16.3%), Recreational Activities (11.3%), House/Yard Work (9.7%), Socializing (7.1%), and Work/School (2.0%). Next, we examined associations between number of goals by category, goal accomplishment, and clinically meaningful improvements in pain-related interference, pain intensity and depressive symptoms. Improvement in all outcome domains was related to goal accomplishment. Additionally, depressive symptoms were related to number of Physical Activity, House/Yard Work, Recreational Activities, and Wellness goals, whereas improved pain-intensity was significantly related to House/Yard Work. Classifying patient-generated goals facilitates investigation of the relationships among goal type, goal accomplishment and treatment outcomes.
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Affiliation(s)
- Alicia A Heapy
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, 950 Campbell Avenue (11 ACSLG), West Haven, CT, 06516, USA. .,Yale School of Medicine, New Haven, CT, USA.
| | - Laura Wandner
- Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, 20889, USA
| | - Mary A Driscoll
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, 950 Campbell Avenue (11 ACSLG), West Haven, CT, 06516, USA.,Yale School of Medicine, New Haven, CT, USA
| | - Kathryn LaChappelle
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, 950 Campbell Avenue (11 ACSLG), West Haven, CT, 06516, USA
| | - Rebecca Czlapinski
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, 950 Campbell Avenue (11 ACSLG), West Haven, CT, 06516, USA
| | - Brenda T Fenton
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, 950 Campbell Avenue (11 ACSLG), West Haven, CT, 06516, USA.,Yale School of Medicine, New Haven, CT, USA
| | - John D Piette
- VA Ann Arbor Center for Clinical Management Research Health Services Research and Development Center of Innovation, Ann Arbor, MI, USA.,Center for Managing Chronic Disease, University of Michigan School of Public Health, 2802 SPH I, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - James E Aikens
- Department of Family Medicine, University of Michigan Medical School, 1018 Fuller St., Ann Arbor, MI, 48104-1213, USA
| | - Mary R Janevic
- Center for Managing Chronic Disease, University of Michigan School of Public Health, 2802 SPH I, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Robert D Kerns
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, 950 Campbell Avenue (11 ACSLG), West Haven, CT, 06516, USA.,Yale School of Medicine, New Haven, CT, USA
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26
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Hausmann LRM, Brandt CA, Carroll CM, Fenton BT, Ibrahim SA, Becker WC, Burgess DJ, Wandner LD, Bair MJ, Goulet JL. Racial and Ethnic Differences in Total Knee Arthroplasty in the Veterans Affairs Health Care System, 2001-2013. Arthritis Care Res (Hoboken) 2017; 69:1171-1178. [PMID: 27788302 DOI: 10.1002/acr.23137] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 10/03/2016] [Accepted: 10/25/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine black-white and Hispanic-white differences in total knee arthroplasty from 2001 to 2013 in a large cohort of patients diagnosed with osteoarthritis (OA) in the Veterans Affairs (VA) health care system. METHODS Data were from the VA Musculoskeletal Disorders cohort, which includes data from electronic health records of more than 5.4 million veterans with musculoskeletal disorders diagnoses. We included white (non-Hispanic), black (non-Hispanic), and Hispanic (any race) veterans, age ≥50 years, with an OA diagnosis from 2001-2011 (n = 539,841). Veterans were followed from their first OA diagnosis until September 30, 2013. As a proxy for increased clinical severity, analyses were also conducted for a subsample restricted to those who saw an orthopedic or rheumatology specialist (n = 148,844). We used Cox proportional hazards regression to examine racial and ethnic differences in total knee arthroplasty by year of OA diagnosis, adjusting for age, sex, body mass index, physical and mental diagnoses, and pain intensity scores. RESULTS We identified 12,087 total knee arthroplasty procedures in a sample of 473,170 white, 50,172 black, and 16,499 Hispanic veterans. In adjusted models examining black-white and Hispanic-white differences by year of OA diagnosis, total knee arthroplasty rates were lower for black than for white veterans diagnosed in all but 2 years. There were no Hispanic-white differences regardless of when diagnosis occurred. These patterns held in the specialty clinic subsample. CONCLUSION Black-white differences in total knee arthroplasty appear to be persistent in the VA, even after controlling for potential clinical confounders.
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Affiliation(s)
- Leslie R M Hausmann
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education Center, West Haven, and Yale School of Medicine, New Haven, Connecticut
| | | | - Brenda T Fenton
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education Center, West Haven, and Yale School of Public Health, New Haven, Connecticut
| | - Said A Ibrahim
- Corporal Michael J. Crescenz VA Medical Center, Center for Health Equity Research and Promotion, and University of Pennsylvania, Philadelphia
| | - William C Becker
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education Center, West Haven, and Yale School of Medicine, New Haven, Connecticut
| | - Diana J Burgess
- Minneapolis VA Healthcare System, Center for Chronic Disease Outcomes Research and University of Minnesota, Minneapolis
| | - Laura D Wandner
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Matthew J Bair
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indiana University School of Medicine, and Regenstrief Institute, Indianapolis
| | - Joseph L Goulet
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education Center, West Haven, and Yale School of Medicine, New Haven, Connecticut
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Fried TR, Zenoni M, Iannone L, O'Leary J, Fenton BT. Engagement in Advance Care Planning and Surrogates' Knowledge of Patients' Treatment Goals. J Am Geriatr Soc 2017; 65:1712-1718. [PMID: 28317097 DOI: 10.1111/jgs.14858] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A key objective of advance care planning (ACP) is improving surrogates' knowledge of patients' treatment goals. Little is known about whether ACP outside of a trial accomplishes this. The objective was to examine patient and surrogate reports of ACP engagement and associations with surrogate knowledge of goals. DESIGN Cohort study SETTING: Primary care in a Veterans Affairs Medical Center. PARTICIPANTS 350 community-dwelling veterans age ≥55 years and the individual they would choose to make medical decisions on their behalf, interviewed separately. MEASUREMENTS Treatment goals were assessed by veterans' ratings of 3 health states: severe physical disability, cognitive disability, and pain, as an acceptable or unacceptable result of treatment for severe illness. Surrogates had knowledge if they correctly predicted all 3 responses. Veterans and surrogates were asked about living will and health care proxy completion and communication about life-sustaining treatment and quality versus quantity of life (QOL). RESULTS Over 40% of dyads agreed that the veteran had not completed a living will or health care proxy and that there was no QOL communication. For each activity, sizeable proportions (18-34%) disagreed about participation. In dyads who agreed QOL communication had occurred, 30% of surrogates had knowledge, compared to 21% in dyads who agreed communication had not occurred and 15% in dyads who disagreed (P = .01). This relationship persisted in multivariable analysis. Agreement about other ACP activities was not associated with knowledge. CONCLUSION Disagreement about ACP participation was common. Agreement about communication regarding QOL was modestly associated with surrogate knowledge of treatment goals. Eliciting surrogates' perspectives is critical to ACP. Even dyads who agree about participation may need additional support for successful engagement.
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Affiliation(s)
- Terri R Fried
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Maria Zenoni
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Lynne Iannone
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut.,Program on Aging, Yale School of Medicine, New Haven, Connecticut
| | - John O'Leary
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut.,Program on Aging, Yale School of Medicine, New Haven, Connecticut
| | - Brenda T Fenton
- Pain Research, Informatics, Multi-Morbidities and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
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Altalib HH, Elzamzamy K, Pugh MJ, Gonzalez JB, Cheung KH, Fenton BT, Kerns RD, Brandt CA, LaFrance WC. Communicating diagnostic certainty of psychogenic nonepileptic seizures - a national study of provider documentation. Epilepsy Behav 2016; 64:4-8. [PMID: 27723497 DOI: 10.1016/j.yebeh.2016.08.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/25/2016] [Accepted: 08/31/2016] [Indexed: 11/29/2022]
Abstract
Management of psychogenic nonepileptic seizures (PNES) requires collaboration among and between health care professionals. Although criteria are established for diagnosis of PNES, miscommunication between neurologists, primary care providers, and mental health professionals may occur if the clinical impression is not clearly articulated. We extracted progress notes from the Department of Veterans Affairs (VA) electronic health record (EHR) nationally to study veterans who were evaluated for PNES. Of the 750 patients being worked up for PNES, the majority of patients did not meet criteria for PNES (64.6%). Of those who were thought to suffer from PNES, 147 (19.6%) met International League Against Epilepsy (ILAE) criteria for documented PNES, 14 (1.9%) for clinically established PNES, and 104 (13.9%) for probable or possible PNES. Neurologists tended to use ambiguous language, such as "thought to be" or "suggestive of" to describe their impressions of patients overall, even those with definitive PNES. Ambiguous language may lead to miscommunication across providers and inappropriate health care.
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Affiliation(s)
- Hamada H Altalib
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA; Yale University, Department of Neurology, USA; Yale University, Department of Psychiatry, USA.
| | - Khalid Elzamzamy
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA
| | - Mary Jo Pugh
- South Texas VA Healthcare System, USA; University of Texas Health Science Center, Department of Biostatistics and Epidemiology, USA
| | | | - Kei-Hoi Cheung
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA; Yale University, Department of Emergency Medicine, USA
| | - Brenda T Fenton
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA
| | - Robert D Kerns
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA; Yale University, Department of Neurology, USA; Yale University, Department of Psychiatry, USA
| | - Cynthia A Brandt
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA; Yale University, Department of Emergency Medicine, USA
| | - W Curt LaFrance
- Brown University, Departments of Psychiatry and Neurology, USA; Providence VA Medical Center, Department of Psychiatry, USA
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29
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Altalib HH, Fenton BT, Sico J, Goulet JL, Bathulapalli H, Mohammad A, Kulas J, Driscoll M, Dziura J, Mattocks K, Kerns R, Brandt C, Haskell S. Increase in migraine diagnoses and guideline-concordant treatment in veterans, 2004-2012. Cephalalgia 2016; 37:3-10. [PMID: 26950804 DOI: 10.1177/0333102416631959] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and aim Health administrators, policy makers, and educators have attempted to increase guideline adherence of migraine medications while reducing inappropriate use of opioid- and barbiturate-containing medications. We evaluated the burden of migraine and proportion of guideline-concordant care in a large, national health care system over time. Methods We conducted a time-series study using data from the Veterans Health Administration (VHA) electronic health record. Veterans with migraines were identified by ICD-9 code (346.X). Prescriptions and comorbid conditions were evaluated before and after migraine diagnosis. Chi-square tests and logistic regression were performed. Results A total of 57,064 veterans were diagnosed with migraine headache (5.3%), with women significantly more likely diagnosed (11.6% vs. 4.4%, p < 0.0001). The number of veterans diagnosed with migraine has significantly increased over the years. By 2012, triptans were prescribed to 43% of people with migraine, with no difference by gender. However, triptan prescriptions increased from 2004 to 2012 in men, but not women, veterans. Preventive medicines showed a significant increase with the year of migraine diagnosis, after controlling for age, sex, race, and for comorbidities treated with medications used for migraine prevention. Conclusions The burden of migraines is increasing within the VHA, with a corresponding increase in the delivery of guideline-concordant acute and prophylactic migraine-specific medication.
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Affiliation(s)
- H H Altalib
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,2 Yale University, Department of Neurology, USA.,3 Yale University, Department of Psychiatry, USA
| | - B T Fenton
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA
| | - J Sico
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,2 Yale University, Department of Neurology, USA
| | - J L Goulet
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,3 Yale University, Department of Psychiatry, USA
| | - H Bathulapalli
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA
| | - A Mohammad
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,4 Yale University, Department of Internal Medicine, USA
| | - J Kulas
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,3 Yale University, Department of Psychiatry, USA
| | - M Driscoll
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,3 Yale University, Department of Psychiatry, USA
| | - J Dziura
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,5 Yale University, Department of Emergency Medicine, USA
| | - K Mattocks
- 6 VA Central Western Massachusetts Healthcare System, USA.,7 University of Massachusetts Medical School, Department of Quantitative Health Science, USA
| | - R Kerns
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,2 Yale University, Department of Neurology, USA.,3 Yale University, Department of Psychiatry, USA
| | - C Brandt
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,5 Yale University, Department of Emergency Medicine, USA
| | - S Haskell
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,4 Yale University, Department of Internal Medicine, USA
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Sico JJ, Fenton BT, Carroll C, Goulet J, Brandt C, Kerns R. Abstract WP199: Hemorrhagic and Ischemic Stroke Risk Among Persons With Pain. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wp199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Pain frequently occurs after ischemic and hemorrhagic stroke. Though conditions such as hypertension are associated with both pain and stroke, little is known about the relationship between pain and stroke risk.
Hypothesis:
Pain will be associated with increased hemorrhagic rather than ischemic stroke.
Methods:
We examined stroke among Veterans in the Musculoskeletal Disorder (MSD) Cohort, which contains 4.1 million Veterans diagnosed with at least one musculoskeletal disorder between 2001 and 2011. All conditions were identified via ICD-9 codes and all comorbidity defined as occurring one year prior to and six months after the date of first MSD diagnosis. Pain was measured by the pain intensity numeric rating scale score on the date of first MSD diagnosis. Logistic regression was used to examine the association between pain and stroke subtype.
Results:
Comorbid hemorrhagic (n=9,141; 0.22%) and ischemic (n=19,301; 0.47%) strokes were uncommon in the MSD cohort. The majority of hemorrhagic stroke patients (88%) had their stroke following their first MSD diagnosis, compared with 58% of ischemic stroke patients (p<.0001). After controlling for sociodemographic characteristics, medical comorbidities (including hypertension), and BMI, persons with pain had a higher odds of having a hemorrhagic, rather than an ischemic stroke (odds ratio ∼ 1.35, confidence interval = 1.2, 1.6). When examining odds including persons without stroke (multinomial model), severe pain (versus ‘no pain’) was significantly associated with increased odds of hemorrhagic stroke (versus ‘no stroke’). When comparing ischemic stroke to no stroke, odds ratios at all pain levels revealed significantly higher pain in those patients without comorbid ischemic stroke.
Conclusion:
Pain was associated with increased odds of having a hemorrhagic stroke (compared to ischemic). Only severe pain increased the odds of hemorrhagic stroke (compared to ‘no stroke’). Pain was significantly decreased in the ischemic stroke group compared to the group without comorbid stroke. Further work is necessary to understand mediators and moderators between pain, increased hemorrhagic (e.g., NSAID use) and decreased ischemic (e.g., aphasia) stroke risk.
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Affiliation(s)
- Jason J Sico
- Yale Univ Sch of Medicine/VA Connecticut Healthcare System, West Haven, CT
| | - Brenda T Fenton
- Yale Univ Sch of Medicine/VA Connecticut Healthcare System, West Haven, CT
| | - Constance Carroll
- Yale Univ Sch of Medicine/VA Connecticut Healthcare System, West Haven, CT
| | - Joseph Goulet
- Yale Univ Sch of Medicine/VA Connecticut Healthcare System, West Haven, CT
| | - Cynthia Brandt
- Yale Univ Sch of Medicine/VA Connecticut Healthcare System, West Haven, CT
| | - Robert Kerns
- Yale Univ Sch of Medicine/VA Connecticut Healthcare System, West Haven, CT
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31
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Lustenberger Y, Fenton BT, Rothen S, Vandeleur CL, Matthey ML, Chouchena O, Ferrero F, Preisig M. Spouse Similarity in Recollections of Parenting Received: A Study in a Nonclinical Sample. Swiss Journal of Psychology 2008. [DOI: 10.1024/1421-0185.67.3.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despite a large body of research on both children’s relationships to their parents and adult dyadic relationships, associations between these types of relationships have rarely been studied. In this paper, spouse similarity in recollections of parenting received in childhood was assessed in a nonclinical sample. Parenting by the same- and opposite-sex parent was measured using the Parental Bonding Instrument (PBI). Spouse similarity was found with respect to the recalled level of care received from the same-sex parent. This correlation was independent of similarity in sociodemographic variables or current psychiatric symptomatology. The fact that spouse similarity did not increase with increasing age suggests that similarity is a result of assortative mating rather than convergence during marriage. These results suggest a significant association between parent-child relationships and the mating process.
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Affiliation(s)
- Yodok Lustenberger
- Department of Psychiatry, University Hospital Center and University of Lausanne,
| | - Brenda T. Fenton
- Department of Psychiatry, University Hospital Center and University of Lausanne,
| | - Stephane Rothen
- Department of Psychiatry, University Hospital Center and University of Lausanne,
| | | | - Marie-Louise Matthey
- Department of Psychiatry, University Hospital Center and University of Lausanne,
| | - Olivier Chouchena
- Department of Psychiatry, University Hospital Center and University of Lausanne,
| | - François Ferrero
- Department of Psychiatry, University Hospital Center and University of Lausanne,
| | - Martin Preisig
- Department of Psychiatry, University Hospital Center and University of Lausanne,
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Affiliation(s)
- Rakesh K Jain
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, 100 Blossom Street, Cox-7, Boston, MA 02114, USA.
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33
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Berney A, Preisig M, Matthey ML, Ferrero F, Fenton BT. Diagnostic interview for genetic studies (DIGS): inter-rater and test-retest reliability of alcohol and drug diagnoses. Drug Alcohol Depend 2002; 65:149-58. [PMID: 11772476 DOI: 10.1016/s0376-8716(01)00156-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The semi-structured diagnostic interview for genetic studies (DIGS) was developed to assess major mood and psychotic disorders and their spectrum manifestations in genetic studies. Our research group developed a French version of the DIGS and tested its inter-rater and test-retest reliability in psychiatric patients. In this article, we present estimates of the reliability of substance use and antisocial personality disorders. High kappa coefficients for inter-rater reliability were found for drug and alcohol as well as antisocial personality diagnoses and slightly lower kappas for test-retest reliability. Combined with evidence of the reliability of major mood and psychotic disorders, these findings support the suitability of the DIGS for studies of familial aggregation and comorbidity of psychiatric disorders including substance use and antisocial personality disorders.
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Affiliation(s)
- Alexandre Berney
- University Department of Adult Psychiatry, Hôpital de Cery, CH-1008 Prilly-Lausanne, Switzerland
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Dubuis-Stadelmann E, Fenton BT, Ferrero F, Preisig M. Spouse similarity for temperament, personality and psychiatric symptomatology. Personality and Individual Differences 2001. [DOI: 10.1016/s0191-8869(00)00092-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Clinical and epidemiological studies have consistently revealed an association between alcohol use disorders and both bipolar and nonbipolar mood disorders. However, the evidence regarding the nature of these associations is unclear. The familial patterns of alcohol and affective disorders were examined using data from a controlled family study of probands with alcohol and anxiety disorders who were sampled from treatment settings and the community. The substantial degree of comorbidity between mood and anxiety disorders among probands allowed for the examination of comorbidity and familial aggregation of alcohol and mood disorders. The major findings are that (1) alcoholism was associated with bipolar and nonbipolar mood disorders in the relatives; (2) there was a strong degree of familial aggregation of alcohol dependence and both types of mood disorders were observed; and (3) there was no evidence of cross-aggregation (i.e., increase in mood disorders among probands with alcohol dependence, and vice versa) between alcoholism and mood disorders. The independent familial aggregation of bipolar disorder and alcoholism and the finding that the onset of bipolar disorder tended to precede that of alcoholism are compatible with a self-medication hypothesis as the explanation for the frequent co-occurrence of these disorders. In contrast, the independent familial aggregation and the tendency of an earlier onset of alcoholism than that of nonbipolar depression suggest that unipolar mood disorders are frequently secondary to alcoholism.
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Affiliation(s)
- M Preisig
- University Department of Adult Psychiatry, Site de Cery, CH-1008 Prilly-Lausanne, Switzerland
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Preisig M, Bellivier F, Fenton BT, Baud P, Berney A, Courtet P, Hardy P, Golaz J, Leboyer M, Mallet J, Matthey ML, Mouthon D, Neidhart E, Nosten-Bertrand M, Stadelmann-Dubuis E, Guimon J, Ferrero F, Buresi C, Malafosse A. Association between bipolar disorder and monoamine oxidase A gene polymorphisms: results of a multicenter study. Am J Psychiatry 2000; 157:948-55. [PMID: 10831475 DOI: 10.1176/appi.ajp.157.6.948] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although genetic factors have been implicated in the etiology of bipolar disorder, no specific gene has been conclusively identified. Given the link between abnormalities in serotonergic neurotransmission and bipolar disorder, a candidate gene association approach was applied to study the involvement of the monoamine oxidase A (MAOA) gene, which codes for a catabolic enzyme of serotonin, in the susceptibility to bipolar disorder. METHOD In France and Switzerland, 272 patients with bipolar disorder and 122 healthy subjects were typed for three polymorphic markers of the MAOA gene: the MAOA-CA repeat, the MAOA restriction fragment length polymorphism (RFLP), and a repeat directly adjacent to the variable number of tandem repeats (VNTR) locus. RESULTS A significant difference in the distribution of the alleles for the MAOA-CA repeat was observed between the female bipolar patients and comparison group. CONCLUSIONS The results obtained in the French and Swiss population confirm findings from two studies conducted in the United Kingdom.
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Affiliation(s)
- M Preisig
- Departement Universitaire de Psychiatrie Adulte, Lausanne, Switzerland.
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Vandeleur CL, Preisig M, Fenton BT, Ferrero F. Construct validity and internal reliability of a French version of FACES III in adolescents and adults 1This work was supported by the Swiss National Science Foundation (Grant number 32-40677.94). We would like to thank the administrations of the participating schools as well as the parents and children who completed the questionnaires. Swiss Journal of Psychology 1999. [DOI: 10.1024//1421-0185.58.3.161] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Family cohesion and adaptability, as operationalised in the Family Adaptability and Cohesion Scales III (FACES III), are two hypothesised dimensions of family functioning. We tested the properties of a French version of FACES III in school-children (mean age: 13 years; S.D:0.85) recruited from the general population and their parents. Separate confirmatory factor analyses were performed for adolescents and adults. The results of both analyses were compatible with a two-factor structure similar to that proposed by the authors of the original instrument. However, orthogonality between the two factors was only supported in the adult data. Internal reliability estimates were 0.78 and 0.68 in adolescents and 0.82 and 0.65 in adults, for cohesion and adaptability respectively.
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Affiliation(s)
- Caroline L. Vandeleur
- University Department of Adult Psychiatry, Lausanne, Switzerland
- Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Martin Preisig
- University Department of Adult Psychiatry, Lausanne, Switzerland
| | - Brenda T. Fenton
- Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - François Ferrero
- Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
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Preisig M, Fenton BT, Matthey ML, Berney A, Ferrero F. Diagnostic interview for genetic studies (DIGS): inter-rater and test-retest reliability of the French version. Eur Arch Psychiatry Clin Neurosci 1999; 249:174-9. [PMID: 10449592 DOI: 10.1007/s004060050084] [Citation(s) in RCA: 240] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The National Institute of Mental Health developed the semi-structured Diagnostic Interview for Genetic Studies (DIGS) for the assessment of major mood and psychotic disorders and their spectrum conditions. The DIGS was translated into French in a collaborative effort of investigators from sites in France and Switzerland. Inter-rater and test-retest reliability of the French version have been established in a clinical sample in Lausanne. Excellent inter-rater reliability was found for schizophrenia, bipolar disorder, major depression, and unipolar schizoaffective disorder while fair inter-rater reliability was demonstrated for bipolar schizoaffective disorder. Using a six-week test-retest interval, reliability for all diagnoses was found to be fair to good with the exception of bipolar schizoaffective disorder. The lower test-retest reliability was the result of a relatively long test-retest interval that favored incomplete symptom recall. In order to increase reliability for lifetime diagnoses in persons not currently affected, best-estimate procedures using additional sources of diagnostic information such as medical records and reports from relatives should supplement DIGS information in family-genetic studies. Within such a procedure, the DIGS appears to be a useful part of data collection for genetic studies on major mood disorders and schizophrenia in French-speaking populations.
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Affiliation(s)
- M Preisig
- University Department of Adult Psychiatry, Hôpital de Cery, CH-1008 Prilly-Lausanne, Switzerland
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Merikangas KR, Fenton BT, Cheng SH, Stolar MJ, Risch N. Association between migraine and stroke in a large-scale epidemiological study of the United States. Arch Neurol 1997; 54:362-8. [PMID: 9109736 DOI: 10.1001/archneur.1997.00550160012009] [Citation(s) in RCA: 214] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the association between stroke and migraine in an epidemiological study. DATA SOURCES AND DESIGN: The National Health and Nutrition Examination Survey baseline and first follow-up data were used to investigate cross-sectional and longitudinal associations between headache/migraine and stroke. SETTING Study participants from a national probability sample of the civilian noninstitutionalized population of the United States. MAIN OUTCOME MEASURE Self-reported physician diagnosis of stroke. RESULTS After controlling for established risk factors for stroke (hypertension, diabetes, heart disease, and gender), both migraine and severe nonspecific headache were associated with a significantly increased risk for stroke reported at follow-up. The risk for stroke associated with migraine decreased as the age at stroke increased. CONCLUSIONS Our results strengthen previous evidence regarding a nonrandom association of both headache and migraine with stroke, particularly among young women. To our knowledge, this is the first systematic examination in a large-scale prospective epidemiological study of men and women with sufficient statistical power to test the association between migraine and stroke in women. Severe headache and migraine should be considered as risk factors for the development of stroke, particularly in the absence of other well-established stroke risk factors. Further investigation is required to identify the putative mechanisms underlying comorbidity of migraine and stroke.
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Affiliation(s)
- K R Merikangas
- Genetic Epidemiology Research Unit, Yale University School of Medicine, New Haven, Conn, USA.
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Abstract
OBJECTIVE Studies of the learned helplessness paradigm in laboratory animals show increased central noradrenergic activity following exposure to uncontrollable stressors. In clinical studies, depressed patients as a group report higher perceptions of helplessness and powerlessness. The authors examined the relationship between perceptions of powerlessness and noradrenergic activity in depressed patients. METHOD Twenty drug-free patients (12 women and 8 men) meeting DSM-III criteria for major depressive disorder were given the Kobasa Hardiness Questionnaire, which contains subscales measuring feelings of powerlessness, security, and alientation. Concurrently, 24-hour urine samples were collected for measurement of urinary MHPG. RESULTS Significant correlations were found between MHPG levels and total hardiness scores as well as between MHPG levels and total powerlessness scores but not between MHPG levels and total security or total alientation scores. CONCLUSIONS These results suggest that depressed patients with high urinary output of MHPG are more likely to show the cognitive features of learned helplessness.
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Affiliation(s)
- J A Samson
- Department of Psychiatry, Harvard Medical School, Boston, MA
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Vasile RG, Samson JA, Bemporad J, Bloomingdale KL, Creasey D, Fenton BT, Gudeman JE, Schildkraut JJ. A biopsychosocial approach to treating patients with affective disorders. Am J Psychiatry 1987; 144:341-4. [PMID: 2881492 DOI: 10.1176/ajp.144.3.341] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The authors describe the development of an affective disorders consultation service that implemented a biopsychosocial model of subspecialty consultation within a university-affiliated community mental health center. They retrospectively analyzed the first 2 years of consultations, assessing the process of consultation and examining patterns of consultee inquiries and consultation recommendations. Consultants recommended combined psychopharmacologic and psychodynamic therapies for most patients and found psychodynamic psychotherapy strikingly overlooked by consultees, all of whom were psychiatrists or other mental health professionals. This evaluation documents the psychiatric consultees' deemphasis of the biopsychosocial perspective in clinical practice.
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