Changing physician knowledge, attitudes, and beliefs about migraine: evaluation of a new educational intervention

From the May 2006 issue of Headache: [full text by subscription]

Patwardhan MB, Samsa GP, Lipton RB, Matchar DB. Changing physician knowledge, attitudes, and beliefs about migraine: evaluation of a new educational intervention. Headache 2006; 46(5):732-741.

Objective: Use a presurvey of primary care providers (PCPs) enrolled in a continuing medical education (CME) program on headache management to ascertain their existing knowledge, attitudes, and beliefs regarding migraine and use a postsurvey to determine the extent to which the CME program has brought participant knowledge, attitudes, and skills closer to conformance with best evidence.
Background: Migraine is a common and debilitating condition, which PCPs may not always manage satisfactorily. In an effort to improve management, the American Headache Society has developed a CME program called BRAINSTORM that encourages PCPs to adopt the US Headache Consortium Guidelines for headache care.
Methods: A 20-item questionnaire was developed that covered the essential elements of migraine care. The questionnaire was administered before and after a BRAINSTORM* presentation to 254 consenting primary care clinicians attending a medical meeting at 1 of 6 sites. A control group of 112 comparable physicians who did not attend the presentation completed the same questionnaire. Prepresentation scores of attendees were compared to scores of nonattendees to assess the generalizability of results. Prepresentation scores on selected questions were used to assess participant baseline knowledge, attitudes, and beliefs. Pre- and postpresentation scores for attendees at all sites were compared using the Mantel-Haenszel statistic to assess the effectiveness of the BRAINSTORM CME. Pre- and postpresentation scores were compared by site using the Breslow-Day test to evaluate any differential impact based on CME location.
Results: Prepresentation scores of attendees and nonattendees were found to be similar. No significant difference in performance was noted across sites. A chi-square analysis revealed a statistically significant difference between pre- and postpresentation scores for 16 of the test’s 20 questions. In the pretest, all participants scored <66% on 2 questions related to prevalence, impact, and pathophysiology of migraine, 2 questions pertaining to history taking/physical examination, and 3 migraine management questions. Attendee scores improved to >66% posttest on all except 2 questions related to prevalence, impact, and pathophysiology of migraine.
Conclusion: Our results indicate that PCPs need to acquire greater understanding about the epidemiology and pathophysiology of migraine and may require guidance in history taking and physical examination of migraine patients. Improvement in scores posttest confirms that the BRAINSTORM program has a significant immediate impact on the knowledge, beliefs, and attitudes of participants. The program could be strengthened to improve emphasis in some areas where posttest scores showed no improvement.
*BRAINSTORM is a 2½-hour interactive program that uses video case vignettes, animation, and illustrations to examine the impact of headache on patients’ lives and teach the diagnosis and treatment of patients with migraine disorders. Four distinct modules, each 20 minutes in length, convey specific educational messages on
(1) understanding the prevalence and impact of migraine,
(2) understanding migraine mechanisms,
(3) history taking/physical examination and diagnosis of migraine, and
(4) migraine management.
Physician experts act as facilitators for the program. To ensure that a consistent message is conveyed in every presentation, facilitators are trained by AHS and provided with a guidebook and a CD-ROM. They guide participant discussion of the materials presented and ensure time for questions and answers. All participants are provided with a workbook, a CD-ROM with program material, and directions to other educational resources for physicians and patients.     
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