Kiosk-based program helps reduce headaches
Study underscores impact on employee health
A disease management program targeting chronic headaches among a working population has at once demonstrated just how widespread the impact of headaches is on employees, and shown that educational programs can be highly effective interventions.
This pilot program, conducted at four New York and two Delaware locations of the financial firm J.P. Morgan & Co., employed a multimedia kiosk to question employees about their headaches. The employees subsequently received personalized reports about their headaches (see the sample on p. 92), and participants in New York were given access to an on-site neurologist and additional educational information. Three months after the baseline screening a follow-up assessment was conducted.
Here are some of the highlights and findings of the study, which appeared in the March 1999 Journal of Occupational and Environmental Medicine:
• Of the 177 evaluable participants who completed both the baseline and follow-up sessions, 56% reported overall improvement in headache symptoms.
• Of the 177, 19% saw a physician for headache after the initial kiosk session.
• For participants who reported lost workdays because of headache (32%), the number of days missed had decreased by follow-up.
• Participants reported higher satisfaction with headache management after using the program, and fewer urgent care/emergency room visits for headache.
• Migraine and chronic daily headache sufferers appeared to benefit the most from the program.
A defined need
The lead author of the JOEM article was William J. Schneider, MD, MPH, director of health services at J.P. Morgan’s headquarters in New York. He was interested in having his employees participate in the program because of the known impact of headache on the population.
"Before we did this headache study, we had run a number of noontime seminars and lectures on an enormous variety of topics," says Schneider. "The three topics that consistently got the largest outpouring were stress, allergy, and headache." While stress got the most attention, Schneider felt it was important to address headache.
In fact, in the JOEM study, Schneider and his co-authors assert: "Headache is a common disorder in the workplace and has a significant impact on work attendance, with up to seven million working days lost per year because of headache-related problems."1 The authors also outline significant direct (physician care, diagnostic tests, medication) and indirect (lost productivity) costs of headache.
"Wellness professionals should be very concerned with headache simply because it is so prevalent," says Schneider. "It occupies the health care consciousness of a good percentage of any population."
What Schneider and his colleagues were concerned with were chronic, recurrent headaches that are part of a headache syndrome, such as migraine. For that reason, participants were asked to classify their headaches according to the four main headache types: migraine, cluster, tension, and chronic daily headache. These are classified based on pain type (pulsating, throbbing, sharp, pressure, diffuse); intensity, rated on a 10-point scale; and presence of other symptoms, such as nausea.
The take-away messages
Schneider says the study carries a number of important messages for wellness professionals. "No. 1, this program was not a lunch & learn’; employees had to come up during the day — these are very dedicated employees — and spend some 40 minutes, which they knew they would need to make up. Despite that, a large number of people came and participated; a lot of employees obviously had a sufficient interest in getting some attention paid to their headache to take time out of their busy day. To me, this was one of the most important messages," he says.
The study also addressed a morale issue, Schneider asserts. "Typically, when you deal with any health promotion issue you like to think it’s for substantive issues to make people feel better," he observes. "But the fact that we felt enough of our employees to put this program on had significant morale value."
Of course, Schneider adds, even though the study was very short there were improvements in a number of parameters as a result of the intervention. "And there was another finding — one so superficial it might be overlooked," he adds. "A substantial number of participants who had either not consulted a physician recently or had not consulted one at all were induced to do so. In other studies, people with headaches had tended to trivialize them."
Naturally, Schneider credits the program itself — the kiosk, the questionnaire, and so forth — with producing many of these results. But just when you’ve found a good thing, wouldn’t you know they’d change it?
The kiosk, in essence, doesn’t exist anymore. "There is a newer, better format," Schneider explains. "The people who produced this program — Glaxo Wellcome — have now put it in the form of a disk that can go in a company’s Intranet, so employees can do it at their desks."
Schneider has no problem with progress. "Everything needs to be revisited," he notes. "For example, I and my staff do CPR training each year. Beyond that, these programs should be re-publicized if they are part of your Intranet, to re-educate the population, or to let them know it’s there. After all, your work force is continually turning over."
[For more information, contact: William J. Schneider, MD, MPH, Medical Department, J.P. Morgan & Co. Inc., 60 Wall St., New York, NY 10260-0060. Telephone: (212) 648-7996.]
Reference
1. Schneider WJ, Furth PA, Blalock TH, et al. A pilot study of a headache program in the workplace: The effect of education. J Occup Envir Med 1999; 41:202-209.
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