Clinical Decision Support for Patient Migraine Management

 描述(申请人提供)：我于2012年在俄亥俄大学获得健康跟踪临床心理学博士学位。我的早期研究考察了偏头痛治疗中的心理因素，并将既定的行为偏头痛治疗转化为移动健康应用程序。我的论文开辟了一条独立的研究路线，研究急性偏头痛的用药依从性。拟议的项目通过使用移动健康应用程序检查对急性和预防性偏头痛管理策略的遵守情况，并开发移动健康干预以提高对偏头痛管理策略的遵守情况，从而扩展了这项研究。2013年，在弗吉尼亚州西黑文大学和耶鲁大学医学院实习和博士后培训后，我在耶希瓦大学费尔考夫心理研究生院(临床心理学、健康重点博士项目)和阿尔伯特·爱因斯坦医学院(神经学系)获得了终身教职。我的研究项目正在蓬勃发展，研究头痛和坚持的心理因素。这两个系以出色的导师、空间、设备和行政支持支持我的职业发展；它们有支持成功的K奖的历史，教职员工由两人任命。我的职业目标是成为一名独立的临床研究员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)评估与坚持偏头痛治疗策略相关的因素，2)开发一种临床决策支持工具，以提高对偏头痛治疗的坚持。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。这些进展可以显著减轻偏头痛的影响和负担。这个奖项将通过在偏头痛管理、临床研究、临床决策支持和高级统计方面提供更多的专门研究时间和培训来帮助我实现这一目标。偏头痛是一种常见的致残性疾病，以阵发性头痛为特征。患者坚持推荐的偏头痛治疗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，并进行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治疗策略(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，以提高遵从性。很少有干预措施被开发来提高患者对偏头痛治疗的依从性。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应用程序的旨在增强决策的系统(临床决策支持工具；CDST)可能是提高患者依从性的有效干预措施。这项拟议的研究旨在1)描述和分析个体差异和环境如何影响对预防和急性偏头痛管理策略的坚持，以及2)开发定制的CDST以改进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)将接受为期三个月的移动电子头痛日记，以适应采用固定间隔评估(每天同一时间)和生态瞬时评估(白天随机间隔)，以全面记录对预防和急性偏头痛管理策略的遵守情况。这项研究将确定与偏头痛治疗依从性相关的个体差异和情况的模式。目标2：我将在24名频繁发作的偏头痛患者中试用CDST原型，为期一周，以获得有关可接受性和满意度的反馈，并将根据该反馈改进CDST。60名频繁发作偏头痛患者在三个月的监测期间(见目标1)记录了至少一种预防和一种急性策略的不佳偏头痛治疗依从性，他们将被随机接受1)CDST(为每个参与者量身定做的最有问题的预防和急性偏头痛管理策略)或2)在头痛日记中嵌入额外三个月的头痛教育。这项试验将使我们能够测试可行性，并获得CDST干预的初步效应大小估计。这项试验将提供成功的联邦拨款申请所需的初步数据，以支持一项全功率随机临床试验，检查CDST改善预防和急性偏头痛治疗策略的有效性。

 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.