Employee and Employer Benefits From a Migraine Management Program: Disease Outcomes and Cost Analysis.

OBJECTIVE: To assess the impact of a migraine management program offered as a complimentary service by a company within its corporate well-being program. BACKGROUND: Migraine imposes a substantial burden on patients, families, employers, and societies. As migraine primarily affects working-age adults, this has important implications for both employees and employers. Workplace educational and well-being programs positively contribute to employees' productivity, reduce costs related to absenteeism, and improve the quality of life of the employees living with migraine. METHODS: This was a non-interventional cohort study, which followed employees and their family members over time. Participants received 1 telemedicine consultation to determine migraine diagnosis or a high probability of having migraine and 6 sessions of individualized telecoaching from a specialized nurse via a specially developed smartphone application to optimize their migraine management leveraging all appropriate medical and lifestyle options. Participants were evaluated during the program and at 3 months after completion through a series of validated questionnaires including Migraine Disability Assessment (MIDAS), Patient Activation Measure (PAM), and satisfaction with the services offered. A cost analysis was also performed to determine the economic benefit of the program considering the number of completers, dropouts, their associated program costs, MIDAS data, average salary of a Swiss employee in the pharma sector, and working days per year. RESULTS: Of the 141 participants enrolled in the program, 79 completed 6-month and 42 completed 9-month assessments. The total MIDAS scores (mean, standard deviation [SD]) significantly improved from baseline by 54% at Month 6 (15.0 [13.6] vs 6.9 [8.2]; mean [SD] reduction: 8.1 [12.9], 95% confidence interval [CI]: 5.6-10.6; P < .0001) and by 64% at Month 9 (15.4 [14.7] vs 5.6 [6.0]; mean [SD] reduction: 9.8 [14.0], 95% CI: 6.6-13.0; P < .0001). The PAM scores also significantly improved from baseline by 8% at Month 6 (63.8 [10.9] vs 69.6 [12.8]; mean [SD] increase: 5.8 [12.8], 95% CI: 3.2-8.4; P = .003) and 11% at Month 9 (63.5 [10.7] vs 71.3 [12.2]; mean [SD] increase: 7.8 [11.0], 95% CI: 4.3-11.2; P = .003). At Month 6, common coaching lessons and respective action plans focused on progressive muscle relaxation, sleep, hydration, nutrition, general disease education, and stress management. The exit survey showed that the majority of the participants who completed the program had a meaningful and sustained improvement in their overall health and reported a high level of satisfaction with the program. The cost analysis revealed that on average participants gained 10.8 (95% CI: 9.3-12.3) working days/year that were previously lost due to migraine, resulting in a positive return on investment (ROI) of 490% (95% CI: 410%-570%), indicating a higher magnitude of savings that could be achieved by the implementation of such program. In addition to ROI and work productivity gained, participants also gained on average 13.6 (95% CI: 9.9-17.3) migraine-free days/year for their private and social life. CONCLUSION: The employer-sponsored disease management program provided a better understanding of migraine, promoted methods and approaches to improve management by combining medical and lifestyle options leading to significant improvements in migraine symptoms that sustained beyond the intervention, supporting prolonged effectiveness of such programs. The program also provided a high ROI to the employer, supporting that the systematic inclusion of such programs into corporate well-being initiatives can be of significant benefit not only to the impacted individuals but to the employers as well.

Digital skin images submitted by patients: an evaluation of feasibility in store-and-forward teledermatology.

This evaluation investigates the quality of digital skin images submitted by patients, and evaluates the feasibility of making a diagnosis and suggesting therapeutic intervention without direct physical examination. A broad sample of patients who called the Swiss Centre for Telemedicine for a skin problem, were invited to receive an oral and an electronic tutorial and to submit digital images of the lesion. All patients (N = 46) who submitted digital images of their skin problems during a two week period were included in the evaluation. Images were electronically transferred to a dermatologist from an independent office. Seventy-four percent of image sets contained focused images, and 72% contained adequate detail. Making a specific diagnosis was feasible in 67% of cases, and the dermatologist was able to narrow down the differential diagnosis in an additional 17%. Recommending therapeutic interventions was possible for the skin problems of 70% of patients. In conclusion, most digital skin images submitted by patients are of sufficient quality, and establishing a dermatological diagnosis is feasible in most cases. These results contribute to the validation of teledermatological processes based on patient-supplied skin images.

Patient adherence to recommendations after teleconsultation: survey of patients from a telemedicine centre in Switzerland.

We investigated patients' adherence to recommendations after telephone triage at the Swiss Centre for Telemedicine. We studied cases where the medical problem was assessed as not requiring an immediate face-to-face consultation. Two weeks after teleconsultation, follow-up telephone interviews were conducted with 1129 self-care patients. The patients were asked if they had adhered to the telephone recommendations and whether they had had a subsequent face-to-face consultation. A total of 1003 patients (88%) were available for the follow-up telephone interview. Of those, 85% reported that they had adhered to all self-care recommendations and 86% had followed the advice about further use of the health-care system. Overall, 28% of patients had attended a face-to-face consultation. Half of them were referred by the teleconsultation centre, and half of them had decided themselves not to follow the centre's recommendation. Since acceptance of self-care recommendations after teleconsultation was high, teleconsultation may be an efficient alternative to face-to-face consultations for some conditions.