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Effects of a Website Designed to Improve the Management of Migraines

Authors

  • Christopher N. Sciamanna MD,

  • Robert A. Nicholson PhD,

  • Jennifer H. Lofland PhD,

  • Michael Manocchia PhD,

  • Sarah Mui BS,

  • Christine W. Hartman PhD


  • From the Jefferson Medical College, Philadelphia, PA (Drs. Sciamanna, Lofland, and Hartman); Saint Louis University School of Medicine, St Louis, MO (Dr. Nicholson); Health Dialog Analytic Solutions, Boston, MA (Dr. Manocchia); and University of Massachusetts, Amherst, MA (Dr. Mui).

Address all correspondence to Dr. Christopher N. Sci amanna, Jefferson Medical College, 1015 Walnut Street, Suite 115, Philadelphia, PA 19107.

Abstract

Objective.—The aim was to examine the effect of using a Web-based computer program that provides personalized feedback to migraine patients, on the interactions of patients and providers.

Background.—Despite the widespread availability of evidence-based migraine treatment guidelines, patients often do not receive optimal treatment to reduce migraine pain and disability.

Methods.—To address these quality gaps in migraine care, we developed a Web-based computer program, to be used by migraine patients before doctor visits. The feedback is designed to prompt patients to ask questions that lead to higher quality of care. This study was conducted to examine the effect of using the program on migraine-specific doctor-patient communications. Patients were randomized to use the Website before (intervention) or after (control) a visit with their provider. The outcome measures were the migraine-specific topics discussed during the visit, measured by an exit survey after the visit.

Results.—Fifty of 53 subjects randomized completed the postvisit measures (94%). Overall, the mean age was 42.0 years, most patients were female (86.5%), all were white, and 58.5% saw a headache specialist during their visit. Most (75.0%) reported having headaches at least once per week and 48.1% rated their headaches as “severe.” Intervention patients were significantly more likely to “discuss whether you had migraine headaches or some other type of headache?” (89.3% vs 54.5%; P < .01) and to “discuss whether or not there may be a more serious cause of your headaches?” (50.0% vs 13.6%; P < .01). Intervention patients were more likely to report discussing 8 of 12 migraine-related topics more frequently and a greater overall number of topics (5.5 vs 4.3) than control patients. This difference was not statistically significant.

Conclusions.—These results suggest that the Website may have a positive impact on migraine-specific doctor-patient communications. A larger study, including important quality of life and utilization outcomes, is warranted.

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