Department of Neurology, Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
J Gen Intern Med. 2008 Aug;23(8):1145-51. doi: 10.1007/s11606-008-0591-3. Epub 2008 May 6.
Research indicates that successful migraine assessment and treatment depends on information obtained during patient and healthcare professional (HCP) discussions. However, no studies outline how migraine is actually discussed during clinical encounters.
Record naturally occurring HCP-migraineur interactions, analyzing frequency and impairment assessment, and preventive treatment discussions.
HCPs seeing high volumes of migraineurs were recruited for a communication study. Patients likely to discuss migraine were recruited immediately before their normally scheduled appointment and, once consented, were audio- and video-recorded without a researcher present. Separate post-visit interviews were conducted with patients and HCPs. All interactions were transcribed.
Sixty patients (83% female; mean age 41.7) were analyzed. Patients were diagnosed with migraine 14 years and experienced 5 per month, on average.
Transcripts were analyzed using sociolinguistic techniques such as number and type of questions asked and post-visit alignment on migraine frequency and impairment. American Migraine Prevalence and Prevention Study guidelines were utilized.
Ninety-one percent of HCP-initiated, migraine-specific questions were closed-ended/short answer; assessments focused on frequency and did not focus on attention on impairment. Open-ended questions in patient post-visit interviews yielded robust impairment-related information. Post-visit, 55% of HCP-patient pairs were misaligned regarding frequency; 51% on impairment. Of the 20 (33%) patients who were preventive medication candidates, 80% did not receive it and 50% of their visits lacked discussion of prevention.
Sociolinguistic analysis revealed that HCPs often used narrowly focused, closed-ended questions and were often unaware of how migraine affected patients' lives as a result. It is recommended that HCPs assess impairment using open-ended questions in combination with the ask-tell-ask technique.
研究表明，成功评估和治疗偏头痛取决于患者和医疗保健专业人员（HCP）讨论中获得的信息。然而，没有研究概述偏头痛在临床就诊中是如何实际讨论的。
记录自然发生的 HCP-偏头痛患者互动，分析频率和损伤评估以及预防治疗讨论。
招募了大量偏头痛患者的 HCP 参与沟通研究。在患者通常预约前立即招募可能讨论偏头痛的患者，并在同意后在没有研究人员在场的情况下进行音频和视频记录。随后对患者和 HCP 进行了单独的就诊后访谈。所有互动均进行了转录。
分析了 60 名患者（83%为女性；平均年龄 41.7 岁）。患者偏头痛诊断 14 年，每月平均发作 5 次。
使用社会语言学技术分析转录本，例如提出的问题数量和类型，以及就诊后偏头痛频率和损伤的一致性。使用美国偏头痛患病率和预防研究指南。
91%的 HCP 发起的偏头痛特异性问题是封闭式/简短回答；评估侧重于频率，而不关注对损伤的关注。患者就诊后访谈中的开放式问题产生了大量与损伤相关的信息。就诊后，55%的 HCP-患者对频率不一致；51%在损伤方面不一致。在 20 名（33%）有预防药物治疗候选资格的患者中，80%未接受预防药物治疗，50%的就诊未讨论预防措施。
社会语言学分析表明，HCP 通常使用重点狭窄、封闭式问题，并且常常不知道偏头痛如何影响患者的生活。建议 HCP 使用开放式问题结合询问-告知-询问技术评估损伤。
