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Original Article

Healthcare provider–patient communication and migraine assessment: results of the American Migraine Communication Study, phase II

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Pages 1711-1718 | Accepted 11 Apr 2008, Published online: 06 May 2008
 

ABSTRACT

Objective: The American Migraine Communication Study I (AMCS I) revealed communication deficits illustrated by differing healthcare professional (HCP) and patient reports about issues such as impairment and frequency. AMCS II was designed to assess an intervention using open-ended questions about impairment and ’ask-tell-ask‚ sequences to confirm headache frequency in days versus attacks.

Research design and methods: HCPs who participated in AMCS I completed an internet-based intervention. Researchers were sent to HCPs' offices, and patients likely to discuss migraine were recruited immediately prior to normally-scheduled appointments. Post-consent, visits were recorded without a researcher present. Separate post-visit interviews were conducted with all parties. All interactions were transcribed.

Main outcome measures: Transcripts were analyzed using validated sociolinguistic techniques, and study results were compared to AMCS I.

Results: HCPs assessed impairment in 90 % of interactions compared to 10 % in AMCS I (p < 0.0001) and used open-ended questions to assess impairment in 55 % of visits (95 % CI: 0.4261–0.6598). Impairment between attacks was discussed in 37 % of visits vs. 0 % in AMCS I (p < 0.0001). HCPs completed full ask-tell-ask sequences in 29 % of visits (95 % CI: 0.1921–0.4070). AMCS II contained more discussions of migraine preventive therapy with appropriate candidates compared to AMCS I (74 vs. 50 % ; p = 0.069) without statistically increasing median visit length (9:36 vs. 11:00; p = 0.668). Post-visit, HCPs and patients were often aligned about impairment and frequency and reported high levels of satisfaction.

Conclusions: Although further research with a larger sample is needed, a brief, internet-based intervention appears to promote positive communication changes not associated with increased visit length.

Acknowledgments

Declaration of interest: This study was sponsored by Ortho-McNeil Neurologics, Inc.

No medical writers or additional assistance were used in writing this manuscript or preparing its submission. SRH has received honoraria from GlaxoSmithKline, Eli Lilly and Company, Ortho-McNeil, and Pfizer. He has consulted with GlaxoSmithKline, Eli Lilly and Company, Ortho-McNeil, and Pfizer. RBL has received grants from Allergan, Advanced Bionics Corporation, GlaxoSmithKline, Merck & Co., Inc., Neuralieve, Ortho-McNeil, Pfizer, Proethics Ltd., and St. Jude Children's Research Hospital. He has consulted for Allergan, Ortho-McNeil and Pfizer. FDS has received grants from Allergan, Endo Pharmaceuticals, GlaxoSmithKline, Medtronic, Merck Sharp & Dohme, Neurochem Inc., Ortho-McNeil Pharmaceutical, and Pfizer. He has received honoraria from Endo Pharmaceuticals, GlaxoSmithKline, Merck Sharp & Dohme, and Ortho-McNeil Pharmaceutical. He has consulted for Endo Pharmaceuticals, GlaxoSmithKline, Merck Sharp & Dohme, and Ortho-McNeil Pharmaceutical. RKC is the owner of Banyan Group, Inc., a medical clinic, clinical research facility, and meeting planning division that conducts medical education. Banyan Group has received grants from Abbott Laboratories, Advanced Bionics Corporation, Alizyme, Allergan, Alexza Pharmaceuticals, Aradgim Corporation, CAPNIA, Incorporated, Cipher Pharmaceuticals, Inc., Eisai, Inc., Endo Pharmaceuticals, GelStat Corp., GlaxoSmithKline, Jazz Pharmaceuticals, Johnson & Johnson, MAP Pharmaceuticals, Matrixx Initiatives, Inc., Merck & Co., Neuralieve, Novartis, Ortho-McNeil, Pfizer, Pozen Pharmaceutical Development Company, SCHWARZ Pharma AG, Torrey Pines, and Vernalis. He has received honoraria from ABT Associates, Allergan, Aradgim Corp., Atrix, Capnia, Endo, GlaxoSmithKline, Jazz Pharmaceuticals, Johnson & Johnson, MedPointe Pharmaceuticals, Merck & Co., Inc., and Winston Laboratories, Inc. He has consulted for ABT Associates, Allergan, Aradgim Corp., Atrix, CAPNIA Incorporated, Endo Pharmaceuticals, GlaxoSmithKline, Jazz Pharmaceuticals, Johnson & Johnson, MedPointe Pharmaceuticals, Merck & Co., Inc., and Winston Laboratories, Inc. CAE, SES and MRN have no conflicts to declare.

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