Impact of a Migraine Management Program on Improving Health Outcomes

Abstract

The goals of this program were to evaluate the effectiveness of migraine disease management techniques in improving patient satisfaction with migraine care, decreasing the frequency and severity of headaches and migraine-associated disability, increasing the effectiveness of migraine treatment and work productivity, improving physician diagnosis and treatment of migraine, and ultimately determining the program's impact on healthcare resource utilization. A prospective observational study was undertaken. This prospective Migraine Management Program (MMP) used active patient and healthcare physician-based disease management resources, tools, and techniques. Members were identified using administrative and medical claims databases indicating an ICD-9 diagnosis code (346.XX) for migraine during the previous twelve months. All identified patients received the Migraine Therapy Assessment Questionnaire (MTAQ) to assess their level of migraine control for pre/post measurement. Of the 2,134 patients responding to the initial MTAQ, 789 completed both a baseline and follow-up and 1,345 completed only a baseline questionnaire. For those patients completing both, there was a statistically significant reduction in all identified management issues: poor symptom control, high attack frequency, knowledge/behavior barriers, economic burden, and dissatisfaction with treatment. Comparing the former group to those completing only the baseline MTAQ, the latter were significantly more likely to report problems with three migraine management issues; poorer symptom control, greater economic burden, and dissatisfaction with their treatment. The use of appropriate patient and physician educational interventions, such as Aetna's MMP incorporating disease management principles and the MTAQ questionnaire, can have a significant impact on patient-centered outcomes and satisfaction with their migraine treatment.

Impact of Topiramate Migraine Prophylaxis on Workplace Productivity: Results from Two US Randomized, Double-Blind, Placebo-Controlled, Multicenter Trials

“…5,6,49 Health plans have recognized the importance of migraine headache and have begun to include it among the offerings of disease management programs. 50,51 As purchasers and payers search for effective tools to manage migraine headache and control associated costs and detriments in TLP, interventions with proven outcomes should be part of the armamentarium.…”

Assessing the Impact of Migraine Onset on Work Productivity

“…2,3,8-10 From the employer perspective, lost worker productivity is reflected through absenteeism (missing work) and presenteeism (being at work, but not being as productive as is typical). [3][4][5][8][9][10][11][12][13][14][15][16] Nevertheless, there is debate as to the proportional contribution of absenteeism compared to presenteeism, with the latter gaining more attention over the years. 3,8,[16][17][18][19][20][21][22][23][24] The American Migraine Study revealed that 51% of women and 38% of men experienced six or more lost workday equivalents each year as a result of migraine attacks, two-thirds of which were attributed to reduced effectiveness at work rather than to actual absenteeism.…”

Quality in the provision of headache care. 1: systematic review of the literature and commentary

“…All these studies were conducted in highly resourced locations, but evaluated strategies and aspects of care delivered in a range of settings by different practitioners. Four studies [18, 23, 28, 30] were conducted in primary care, three [14, 36, 37] in intermediate care, where treatment was provided by general practitioners with a special interest in headache, and one [20] in a setting where specialist nurses provided care. Six studies [21, 22, 31, 38–40] were conducted in specialty headache clinics, one [35] in an inpatient treatment setting, and five [13, 15, 17, 32, 33] evaluated headache care in emergency departments.…”

“…Six studies [21, 22, 31, 38–40] were conducted in specialty headache clinics, one [35] in an inpatient treatment setting, and five [13, 15, 17, 32, 33] evaluated headache care in emergency departments. Four studies [17, 19, 28, 39] assessed diagnostic accuracy, while eight [16, 18, 23, 26, 27, 31, 34, 35] evaluated the effects of specific strategies of headache management. Only two of the studies [31, 34] included a control group; one of these [34] was a randomized clinical trial.…”