Migreni olan okul çalışanlarında migren tedavisinin özürlülük ve ekonomik kayıp üzerine etkisi: Prospektif çalışma
Date
2010
Authors
Şen, Çiğdem Çavdar
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Migren ve diğer primer baş ağrıları sadece bir ağrı sorunu olarak görülmemeli, tüm sonuçları ile birlikte değerlendirilmelidir. Migren ekonomik ve sosyal açıdan hem topluma hem de bireye önemli yükler getirmektedir.Çalışmamızda, migreni olan okul çalışanlarının, uygun tedavi aldıklarında tedavi almadıkları döneme kıyasla kazanımlarının neler olacağının saptanması amaçlandı.Ayda bir ve birden fazla atağı olan, mevcut tedavisinden fayda görmeyen, çalışan (öğretmen ve memur) 42 migren hastası onam formu imzalatılarak 8 aylık prospektif takip çalışmasına alındı. İlk 3 ay mevcut tedavilerinde değişiklik yapılmayan olguların bazal ağrılı gün sayısı (takip dönemi) saptandı. Sonraki 2 aylık dönemde tedavi düzenlemesi (ilaç-doz ayarlama dönemi) yapıların olguların takip eden 3 ay boyunca etkin tedavi altında (tedavi dönemi) takipleri yapıldı. Hastaların başağrısı sıklığı, şiddeti, süresi, işe gidip gitmedikleri, izin alıp almadıkları, ağrı sırasında aldıkları analjezik sayısı, ağrı nedeniyle medikal bir tedavi alıp almadıkları, acile gidip gitmedikleri her vizite verilmiş olan günlüklerle sorgulandı.Tedavi döneminde takip dönemine göre ağrı şiddeti, ağrı süresi, ağrılı gün sayısı, analjezik sayısı, işten izin alınan gün sayısı, iş verimliliğinde % 50'nin altına düşen gün sayısının 3 aylık toplam ortalama değerleri anlamlı olarak düşük bulundu (p<0.05). Ağrılı dönemde acil servise başvurulan gün sayısında anlamlı bir değişikliğe rastlanmadı. Tedavinin 3.ayı ile tedavisiz dönemin ortalama değerlerine bakıldığında işten izin alma gün sayısı (p>0.05) ve acil servise başvurulan gün sayısı (p>0.05) dışında tüm veriler anlamlı olarak düşük bulundu ( p<0.05). Takip dönemindeki doğrudan maliyet, tedavi dönemindeki doğrudan maliyetten anlamlı olarak düşük bulunmuştur.Çalışmamız; çalışan migrenli hastalarda, tedavi altında olmanın dolaylı maliyetlerde önemli miktarda azalmaya, doğrudan maliyette ise artışa neden olduğunu göstermiştir. Ağrının gerek kişiye, gerekse topluma getirdiği yükler göz önüne alındığında tedavi altındaki çalışan migrenlilerin, ekonomide büyük bir kazanç oluşturduğunu düşünmekteyiz.
Migraine and other primary headaches should not be perceived as a pain-related condition but should be evaluated in the light of their results on health sector and the society as whole. Migraine imposes an important economical and social burden on society and the individual.In this study, we aimed to evaluate the effect of appropriate treatment of migraine on headache-related economic burden among migraineurs employed in primary schools.Forty-two patients (teachers or employees in the schools) fulfilling the diagnostic criteria for migraine with one or more attacks per month, failure of their present medications were included in the 8-month prospective study after signing informed consent.During the first three month period, "screening period", they were allowed to continue their previous medications. The forth and the fifth months were "medication dosage period" while the last three months were the "effective treatment period". All the patients were asked to fill in diaries the frequency, intensity, duration of headaches, number of days missed from work or decreased in effectiveness at work, presence of any medication or referral to the emergency department during an attack, number of analgesics.Intensity, duration of headache, number of days with headache, number of analgesics, number of days with headache and missed from work, number of days with decreased effectiveness at work, (<50% of normal efficiency) during treatment period were statistically significantly lower than the ones in the screening period (p<0.05). There was no statistical change in the number of days with referral to the emergency department during these two periods. The mean number of data excluding days missed from work and with referral to the emergency department during the third month of treatment period were statistically lower when compared to the values during the screening period (p<0.05). Direct cost in the screening period was significantly lower than the one in the treatment period (p<0.05).Our study results showed that treatment of migraine among migraineurs working in schools lead to increase in indirect costs but decrease in direct costs. Taking into account the burden of pain on the individuals and the society as a whole, we think that treatment of working migraineurs is a financial gain.
Migraine and other primary headaches should not be perceived as a pain-related condition but should be evaluated in the light of their results on health sector and the society as whole. Migraine imposes an important economical and social burden on society and the individual.In this study, we aimed to evaluate the effect of appropriate treatment of migraine on headache-related economic burden among migraineurs employed in primary schools.Forty-two patients (teachers or employees in the schools) fulfilling the diagnostic criteria for migraine with one or more attacks per month, failure of their present medications were included in the 8-month prospective study after signing informed consent.During the first three month period, "screening period", they were allowed to continue their previous medications. The forth and the fifth months were "medication dosage period" while the last three months were the "effective treatment period". All the patients were asked to fill in diaries the frequency, intensity, duration of headaches, number of days missed from work or decreased in effectiveness at work, presence of any medication or referral to the emergency department during an attack, number of analgesics.Intensity, duration of headache, number of days with headache, number of analgesics, number of days with headache and missed from work, number of days with decreased effectiveness at work, (<50% of normal efficiency) during treatment period were statistically significantly lower than the ones in the screening period (p<0.05). There was no statistical change in the number of days with referral to the emergency department during these two periods. The mean number of data excluding days missed from work and with referral to the emergency department during the third month of treatment period were statistically lower when compared to the values during the screening period (p<0.05). Direct cost in the screening period was significantly lower than the one in the treatment period (p<0.05).Our study results showed that treatment of migraine among migraineurs working in schools lead to increase in indirect costs but decrease in direct costs. Taking into account the burden of pain on the individuals and the society as a whole, we think that treatment of working migraineurs is a financial gain.
Description
Keywords
Migren, Doğrudan ve dolaylı maliyet, Tedavi sonrası dolaylı maliyet, Migraine, Direct and indirect costs, Treatment
Citation
Şen, Ç. Ç. (2010). Migreni olan okul çalışanlarında migren tedavisinin özürlülük ve ekonomik kayıp üzerine etkisi: Prospektif çalışma. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.