Clinical Decision Support for Patient Migraine Management

患者偏头痛管理的临床决策支持

• 批准号: 9087375
• 负责人: Elizabeth K Seng-Tamaccio
• 金额: $ 19.31万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE, INC
• 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 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9087375
• 关键词: Acute; Adherence; Adrenergic beta-Antagonists; Affect; Age; American; Anti-Inflammatory Agents; Anti-inflammatory; Antiepileptic Agents; Applications Grants; Award; Behavioral; Belief; Clinic Visits; Clinical; Clinical Investigator; Clinical Psychology; Clinical Treatment; Comorbidity; Complex; Data; Decision Making; Diet; Disease; Doctor of Philosophy; Ecological momentary assessment; Economic Burden; Education; Electronic Health Record; Electronics; Equipment; Faculty; Feedback; Foundations; Frequencies; Gender; Goals; Headache; Health; Healthcare Systems; Individual; Individual Differences; Internships; Intervention; K-Series Research Career Programs; Knowledge; Lead; Life; Light; Literature; Medicine; Mentorship; Migraine; Monitor; Nausea and Vomiting; Neurology; Non-Steroidal Anti-Inflammatory Agents; 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 pain; clinical decision-making; clinical efficacy; clinical investigation; college; compliance behavior; cost; design; diaries; effective intervention; health application; improved; 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

 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（由应用程序提供）：我获得了博士学位。我的早期研究在俄亥俄州大学的健康状况中获得临床心理学研究。我的早期研究检查了偏头痛治疗的心理因素，并将既定的行为偏头痛治疗转化为移动健康应用。我的论文刻出了一系列独立的研究线，研究了急性偏头痛药物的依从性。拟议的项目通过使用移动健康应用来检查对急性和预防性偏头痛管理策略的依从性，并开发移动健康干预措施以提高对偏头痛管理策略的依从性，从而扩展了这项研究。 2013年，在西黑文弗吉尼亚州和耶鲁大学医学院实习和博士后培训之后，我在Yeshiva University的Ferkauf大学心理学研究生学院（临床心理学，健康强调）博士学位担任了终身教师职位。计划）和阿尔伯特·爱因斯坦医学院（神经病学系）。我的研究考试中的水伤计划心理因素和依从性的心理因素。这两个部门通过出色的心态，空间，设备，行政支持来支持我的职业发展；他们有一个由双重任命的教职员工支持成功的K-award的历史。我的职业目标是成为一名独立的临床研究者和领导者，我的短期目标（在K-宣告时期）是1）评估与遵守偏头痛管理策略相关的因素； 2）开发一种临床决策支持工具，以提高对偏头痛管理的依从性。我的长期目标是提高我们对与偏头痛患者依从性相关的因素的理解，并制定和传播干预措施以改善偏头痛的患者依从性。这些进步可能会大大减少偏头痛的影响和燃烧。该奖项将通过提供增加专门的研究时间和偏头痛管理，临床投资，临床决策支持和高级统计的培训来帮助我实现这一目标。偏头痛是一种普遍的残疾疾病，其特征是头部疼痛发作。患者遵守推荐的偏头痛管理策略可以降低偏头痛的成本和燃烧。患者对偏头痛管理策略的遵守始终很差，部分原因是偏头痛的人必须既有预防性偏头痛管理，以减少偏头痛频率和急性偏头痛管理，以减少偏头痛攻击的影响。很少有研究调查谁遵守预防和急性偏头痛管理策略（个体差异）以及患者遵守这些策略（条件）。这些知识将提供个性化的目标以提高依从性。几乎没有采取干预措施来改善患者对偏头痛管理的依从性。遵守急性偏头痛管理需要复杂的决策；因此，旨在增强决策（一种临床决策支持工具； CDST）的系统可能是提高患者依从性的有效干预措施。拟议的研究目的是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）开发量身定制的CDST来改善预防和急性偏头痛管理策略。 AIM 1：一百人经常具有情节性偏头痛（6-14天/月）将进行三个月的移动电子头日记，适合员工固定间隔评估（每天同一时间）和生态瞬时评估（在白天进行随机间隔），以完全捕获依从性，以预防和敏锐的偏头痛管理策略。这项研究将确定与偏头痛管理依从性相关的个体差异和情况的模式。 AIM 2：我将在24人中驾驶原型CDST一周，频繁，情节性偏头痛，以获取有关可接受性和满意度的反馈，并根据此反馈来完善CDST。 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 header diary for an additional three months.该试验将使我们能够测试可行性并获得CDST干预措施的初始效应大小估计。该试验将为成功的联邦赠款应用程序提供必要的初步数据，以支持一项全功耗的随机临床试验，以研究CDST提高预防和急性偏头痛管理策略的效率。