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

Objective: The American Migraine Communication Study I (AMCS 1) 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.