Clinical Decision Support for Patient Migraine Management

患者偏头痛管理的临床决策支持

• 批准号: 9890012
• 负责人: Elizabeth K Seng-Tamaccio
• 金额: $ 19.31万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-15 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9890012
• 关键词: Acute; Adherence; Adrenergic beta-Antagonists; Affect; Age; American; Anti-Inflammatory Agents; Antiepileptic Agents; Applications Grants; Award; Behavioral; Belief; Clinic Visits; Clinical Investigator; Clinical Psychology; Clinical Treatment; Complex; Data; Decision Making; Diet; Disease; Doctor of Philosophy; Ecological momentary assessment; Economics; Education; Electronic Health Record; Electronics; Equipment; Faculty; Feedback; Foundations; Frequencies; Gender; Goals; Headache; Health; Healthcare Systems; Individual Differences; Internships; Intervention; K-Series Research Career Programs; Knowledge; Lead; Life; Literature; Medicine; Mentorship; Migraine; Mobile Health Application; Monitor; Nausea and Vomiting; Neurology; Ohio; Pain; Participant; Patients; Pattern; Pharmaceutical Preparations; Pharmacy facility; Physicians; Positioning Attribute; Preventive; Provider; Psychological Factors; Psychology; Randomized; Randomized Clinical Trials; Recommendation; Recording of previous events; Reporting; Research; Role; Schools; Sleep; Stress; Symptoms; System; Testing; Time; Training; Translating; Universities; Variant; Vulnerable Populations; base; behavioral study; career; career development; chronic painful condition; clinical decision support; clinical decision-making; clinical efficacy; clinical investigation; college; comorbidity; compliance behavior; cost; design; diaries; effective intervention; improved; individual variation; mHealth; medical schools; medication compliance; mobile application; nervous system disorder; post-doctoral training; programs; prototype; public health relevance; satisfaction; statistics; support tools; systematic review; tenure track; tool; triptans; virtual

 DESCRIPTION (provided by applicant): I earned a Ph.D. in clinical psychology in the health track from Ohio University in 2012. My early research examined psychological factors in the treatment of migraine and translating an established behavioral migraine treatment to a mobile health application. My dissertation carved out an independent line of research examining acute migraine medication adherence. The proposed project extends this research by examining adherence to acute and preventive migraine management strategies using a mobile health application, and developing a mobile health intervention to improve adherence to migraine management strategies. In 2013, after an internship and post-doctoral training at the West Haven VA and Yale School of Medicine, I attained a tenure-track faculty position at Yeshiva University's Ferkauf Graduate School of Psychology (Clinical Psychology, Health Emphasis Ph.D. Program) and Albert Einstein College of Medicine (Department of Neurology). My burgeoning program of research examines psychological factors in headache and adherence. These two departments support my career development with excellent mentorship, space, equipment, administrative support; they have a history of supporting successful K-awards with dually appointed faculty. My career goal is to become an independent clinical investigator and leader in the study of behavioral factors in migraine. My short-term objectives (over the K-award period) are to 1) evaluate factors associated with adherence to migraine management strategies and 2) develop a clinical decision support tool to improve adherence to migraine management. My long-term objectives are to improve our understanding of factors associated with patient adherence in migraine, and develop and disseminate interventions to improve patient adherence in migraine. These advances could significantly reduce the impact and burden of migraine. This award will help me achieve that goal through providing increased dedicated research time and training in migraine management, clinical investigation, clinical decision support, and advanced statistics. Migraine is a prevalent, disabling disorder characterized by episodic attacks of head pain. Patient adherence to recommended migraine management strategies can reduce the cost and burden of migraine. Patient adherence to migraine management strategies is consistently poor, in part because people with migraine must engage in both preventive migraine management to reduce migraine frequency and acute migraine management to reduce the impact of a migraine attack. Few studies have investigated who adheres to preventive and acute migraine management strategies (individual differences) and when patients adhere to these strategies (conditions). This knowledge will provide individualized targets to improve adherence. Few interventions have been developed to improve patient adherence to migraine management. Adherence to acute migraine management requires complex in-the- moment decision-making; therefore, a system designed to enhance decision-making (a Clinical Decision Support Tool; CDST) embedded in a commonly used headache diary mobile application may be an effective intervention to improve patient adherence. The proposed research aims to 1) Describe and analyze how individual differences and circumstances influence adherence to preventive and acute migraine management strategies, and 2) Develop a tailored CDST to improve preventive and acute migraine management strategies. Aim 1: One hundred people with frequent, episodic migraine (6-14 days/month) will take a mobile electronic headache diary for three months, adapted to employ fixed interval assessments (same time daily) and ecological momentary assessments (random intervals during the day) to fully capture adherence to preventive and acute migraine management strategies. This study will identify patterns of individual differences and circumstances associated with migraine management adherence. Aim 2: I will pilot a prototype CDST for one week in 24 people with frequent, episodic migraine to obtain feedback about acceptability and satisfaction, and will refine the CDST based on this feedback. Sixty people with frequent, episodic migraine who record suboptimal migraine management adherence for at least one preventive and one acute strategy during three months of monitoring (see Aim 1) will be randomized to receive 1) a CDST (tailored to the most problematic preventive and acute migraine management strategy for each participant) or 2) a Headache Education embedded in the headache diary for an additional three months. This trial will allow us to test feasibility andto obtain initial effect size estimates for the CDST intervention. This trial will provide the preliminary data necessary for a successful federal grant application to support a fully- powered randomized clinical trial examining the efficacy of the CDST to improve preventive and acute migraine management strategies.

 描述（由申请人提供）：我获得了博士学位。2012年从俄亥俄州大学获得临床心理学的博士学位。我早期的研究考察了偏头痛治疗中的心理因素，并将既定的偏头痛行为治疗转化为移动的健康应用。我的论文开辟了一条独立的研究路线，研究急性偏头痛药物依从性。拟议的项目通过使用移动的健康应用程序检查急性和预防性偏头痛管理策略的依从性，并开发移动的健康干预措施来改善偏头痛管理策略的依从性，从而扩展了这项研究。2013年，在West Haven VA和耶鲁医学院实习和博士后培训后，我在Yeshiva University的Ferkauf心理学研究生院获得了终身教职（临床心理学，健康重点博士）。计划）和阿尔伯特爱因斯坦医学院（神经病学系）。我正在进行的研究项目是调查头痛和坚持治疗的心理因素。这两个部门支持我的职业发展与优秀的导师，空间，设备，行政支持;他们有支持成功的K奖与双重任命的教师的历史。我的职业目标是成为一名独立的临床研究者和偏头痛行为因素研究的领导者。我的短期目标（在K奖期间）是1）评估与偏头痛管理策略依从性相关的因素，2）开发临床决策支持工具以提高偏头痛管理的依从性。我的长期目标是提高我们对偏头痛患者依从性相关因素的理解，并开发和传播干预措施以提高偏头痛患者的依从性。这些进展可以显着减少偏头痛的影响和负担。这个奖项将帮助我实现这一目标，通过提供更多的专门研究时间和偏头痛管理，临床研究，临床决策支持和先进的统计培训。偏头痛是一种流行的致残性疾病，其特征是头痛的发作。患者坚持推荐的偏头痛管理策略可以降低偏头痛的成本和负担。患者对偏头痛管理策略的依从性一直很差，部分原因是偏头痛患者必须进行预防性偏头痛管理以减少偏头痛频率和急性偏头痛管理以减少偏头痛发作的影响。很少有研究调查谁坚持预防性和急性偏头痛管理策略（个体差异）以及患者何时坚持这些策略（条件）。这些知识将提供个性化的目标，以提高依从性。很少有干预措施被开发出来，以提高患者对偏头痛管理的依从性。坚持急性偏头痛治疗需要复杂的即时决策;因此，嵌入常用头痛日记移动的应用程序中的旨在增强决策的系统（临床决策支持工具; CDST）可能是改善患者依从性的有效干预措施。拟议的研究旨在1）描述和分析个体差异和环境如何影响预防和急性偏头痛管理策略的依从性，以及2）开发定制的CDST以改善预防和急性偏头痛管理策略。目标1：100名频繁发作的偏头痛患者（6-14天/月）将使用移动的电子头痛日记三个月，适用于采用固定间隔评估（每天同一时间）和生态瞬时评估（白天随机间隔），以充分捕获对预防性和急性偏头痛管理策略的依从性。这项研究将确定与偏头痛管理依从性相关的个体差异和环境模式。目标二：我将在24名频繁发作的偏头痛患者中试用CDST原型一周，以获得关于可接受性和满意度的反馈，并将根据此反馈改进CDST。在三个月的监测期间记录了至少一种预防性和一种急性策略的次优偏头痛管理依从性的60名频繁发作性偏头痛患者（参见目标1）将随机接受1）CDST（针对每位参与者最有问题的预防性和急性偏头痛管理策略）或2）额外三个月的头痛日记中嵌入的头痛教育。这项试验将使我们能够测试CDST干预的可行性并获得初步的效应量估计。这项试验将提供成功的联邦拨款申请所必需的初步数据，以支持一项充分的随机临床试验，检查CDST改善预防和急性偏头痛管理策略的疗效。

项目成果

Acute migraine medication adherence, migraine disability and patient satisfaction: A naturalistic daily diary study.

急性偏头痛药物依从性、偏头痛残疾和患者满意度：一项自然主义每日日记研究。

• DOI: 10.1177/0333102416663459
• 发表时间: 2017-09
• 期刊: Cephalalgia : an international journal of headache
• 作者: Seng EK;Robbins MS;Nicholson RA
• 通讯作者: Nicholson RA

Acceptance, Psychiatric Symptoms, and Migraine Disability: An Observational Study in a Headache Center.

接受度、精神症状和偏头痛障碍：头痛中心的观察性研究。

• DOI: 10.1111/head.13325
• 发表时间: 2018
• 期刊: Headache
• 影响因子: 5
• 作者: Seng,ElizabethK;Kuka,AlexanderJ;Mayson,SarahJo;Smitherman,ToddA;Buse,DawnC
• 通讯作者: Buse,DawnC

Using Cognitive Behavioral Therapy Techniques to Treat Migraine.

• DOI: 10.1007/bf03544665
• 发表时间: 2018
• 期刊: Journal of health service psychology
• 作者: Seng EK

Lifetime history of an anxiety or depression disorder and adherence to medications used for the acute treatment of migraine.

一生有焦虑症或抑郁症病史，并且坚持服用用于急性偏头痛治疗的药物。

• DOI: 10.1111/head.14477
• 发表时间: 2023
• 期刊: Headache
• 影响因子: 5
• 作者: Butler,Nicole;Snyder,IvyC;Korn,TaliaG;Nicholson,RobertA;Robbins,MatthewS;Seng,ElizabethK
• 通讯作者: Seng,ElizabethK

The Relationship of Tobacco Use and Migraine: A Narrative Review.

• DOI: 10.1007/s11916-023-01103-8
• 发表时间: 2023-04
• 期刊: Current pain and headache reports
• 影响因子: 3.7