Migraine program cuts lost work days
Physician says desktop application next step
Headache contributes to absenteeism and productivity loss in the workplace, according to national studies. A pilot computer-based workplace migraine program not only reduced lost workdays but showed improvement in overall function and health in just three months.
J.P. Morgan & Co., with offices in New York and Delaware, came forward to pilot the Migraine Matrix program developed by the care management division of Glaxo Wellcome in Research Triangle Park, NC, because headache and allergy are second only to stress in attracting employee attendance at the corporate health seminars. "Headache results in people not working as efficiently. They come in but they don’t work well," says William J. Schneider, MD, MPH, director of health services at J.P. Morgan & Co. in New York.
"We really didn’t know how many employees would come forward for the program. We anticipated about 16% of our population would turn out to be chronic headache sufferers based on population studies. We found we had nearly twice that." (For suggested reading on the impact of head aches on the workplace, see end of article.)
J.P. Morgan used several methods to recruit employees to participate in the program, Schneider says, including the following:
• corporate electronic mail describing the program;
• notices in company newsletters;
• ads on the corporate televised announcement system;
• posters in medical departments and lobbies;
• tabletop ads in the cafeteria.
In addition, the company provided incentives such as a corporate-monogrammed leather card-holder for completing the baseline screening session and entrance in a drawing to win free airline miles for participants who completed the follow-up assessment, says Schneider.
There were 475 total program participants, with 428 completing either a baseline or follow-up session for a completion rate of 92%. Of the 185 participants who completed both the baseline screening and the three-month follow-up assessment, 177 were evaluable for study outcomes. The other eight met criteria for urgent assessment and were referred to a physician.
Inside the matrix
Kiosks were set up in the workplace for participant use. The kiosks contained a multimedia computer equipped with a touch screen monitor and memory sufficient to hold visual presentations. They also contained printed educational materials. To avoid waiting lines, employees interested in participating were required to schedule an appointment through the medical department to use the kiosks, notes Schneider. "This was one drawback of the program. Our population, like all work populations, is very busy. It’s not easy to commit them to pull away from their desks for 20 to 30 minutes in the middle of the day to go to a kiosk and answer questions. The kiosks were set up at fixed locations. It took time for employees to access [them]."
Participants answered questions about the clinical, social, and economic impact of their headaches at both baseline and follow-up. Two educational reports were generated for participants who completed the headache screen, with one sent to the employee and the other to the employee’s health care provider.
The employee report includes the following information based on each individual’s responses to the questions:
• description of migraine symptoms;
• potential causes of the migraines;
• individuals’ opinions of the causes;
• suggested actions to decrease frequency and severity of migraines;
• encouragement for patients to take the report to their next physician’s office visit.
The health care provider report includes:
• identification of the type of headache or migraine the patient suffers from;
• description of the frequency and severity of the headaches reported by patients;
• headache-related disability factors, such as lost work days;
• headache risk factors reported by the patient;
• other headache-related information, such as health care utilization related to headache;
• patient satisfaction with current headache treatment.
The Migraine Matrix assessment tool assigns a headache magnitude score for each participants based on responses to questions about symptoms, effect of headache on productivity, health care utilization, comorbidities, and lifestyle. To protect the confidentiality of employees, data analysis was performed by an independent firm.
Participants were encouraged to complete the three-month follow-up assessment by electronic mail and telephone. During the follow-up assessment, participants responded to different questions designed to indicate any changes in their headaches and the impact of their headaches on their function at both work and home.
Study outcomes include the following:
• 29% of participants previously were under a doctor’s care for headache, and 35% were actively receiving a doctors care for headache at the time of participation in the program.
• 19% of participants visited a physician for headache following the baseline screening.
• The mean number of days with headache in the past four weeks decreased from 5.5 at baseline assessment to 4 at follow-up. The results were similar for participants treated by physicians and those not treated by physicians.
• 56% of participants reported improvement in their headache symptoms at follow-up.
• For those participants who reported urgent care or emergency room treatment for headache at baseline, the mean number of visits decreased from 1.74 for six months before baseline to 0.42 visits at follow-up.
• 32% reported lost workdays due to headache at baseline. The mean number of workdays lost was 0.35 a month at baseline and 0.25 a month at follow-up, for an improvement of 29%.
The big chill
Schneider says that although the program had a positive effect, the pilot did indicate there was room for improvement. "The program works, but it’s disruptive on people’s routines to require them to leave their workstations to access a fixed location," he notes. "Some employees may even have chosen not to access the kiosks because they didn’t want to be seen by co-workers. There’s that feeling that people are watching."
Although staff were given the opportunity to revisit the kiosks for more information, none did, except to complete their follow-up assessment, he says. "Glaxo is working to refine the database so it is more compact and organizations can introduce the Migraine Matrix program through their company’s intranet. This way, employees can receive much of the same information without even leaving their desks. Even though screens were placed around the kiosks for privacy, sitting at your own desk provides much greater privacy.
"We found that use of a fixed site just doesn’t work in this electronic age," says Schneider. "Im sure that we would have had even greater participation if we had been able to provide the same information available at the kiosks at our employ ees’ work stations."
Suggested reading
• Schneider WJ, Furth PA, Blalock TH, Sherrill TA. A pilot study of a headache program in the workplace. J Occup Environ Med 1999; 41:202-209.
• Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemi ology of headache in a general population: A prevalence study. J Clin Epidemiol 1991; 44:1,147-1,157.
• Schwarz BS, Stewart WF, Lipton RB. Lost workdays and decreased work effectiveness associated with headache in the workplace. J Occup Environ Med 1997; 39:320-327.
• Spinal H. Managing headaches in the workplace. Nurs Stand 1993; 7:25, 28-29.
• Stewart WF, Lipton RB, Simon D. Work-related disability: Results from the American migraine study. Cephaligia 1996; 16:231-238.
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