Usability and Improvement Opportunities of a Mobile App-Based Interactive Care Plan for Migraine: A Survey Study of Users (Preprint)
Authors: Young Nathan P , Stern Jennifer A , Steel Stephanie J , Ebbert Jon O 
Published: October 2024

BACKGROUND

We implemented a novel mobile app-based Migraine Interactive Care Plan (MICP) integrated with our EHR. The MICP facilitates remote assessment of adult migraine patients, delivery of educational content, and care team communication. Feasibility of the MICP was demonstrated in a pilot implementation study.

OBJECTIVE

We aimed to assess the preferences and satisfaction of migraine patient users of a mobile app-based care plan integrated with the electronic health record (EHR).

METHODS

An electronic survey was administered to a single cohort of MICP users between 12/6/21 and 12/30/21. The survey assessed patient preferences for which data to track, frequency of tracking, and satisfaction with the MICP. Survey responses were compared between subsets determined by patient-reported headache frequency, treatment with and without botulinum toxin and CGRP antagonist therapy. The Wilcoxon rank-sum test was utilized for continuous variables and Chi-square test or Fisher’s exact test for categorical variables.

RESULTS

The response rate was 30.4% (n=56/184). No significant differences in age (P = 0.2579) or sex (P = 0.1944) between respondents and non-respondents were observed. Respondent median age was 42 (range, 20-72) years and 94.6% (n=53/56) were female. Headache frequency was: 1) 0 to 8 days (n=26/56, 46.4%); 2) 9 to 14 days (n=12/56, 21.4%); and 3) 15 or more days (n=18/56, 32.1%). No difference was observed in survey responses based on headache frequency or treatment.
Majority of respondents preferred to track headache days weekly (n=30/56, 53.6%) or daily (n=15/56, 26.8%) and preferred to change the frequency of headache tracking reminders (n=42/56, 75%). Respondents were somewhat or very interested in daily tracking personal observations in free text (n=41/52, 78.8%), medication treatment (n=43/52, 82.7%) and treatment response (n=39/56, 69.6%), class of medication treatment (n=36/52, 69.2%), severity of functional impairment (n=39/56, 69.6%), type of functional impairment (n=35/53, 66%), headache day (n=40/54, 74.1%), and headache pain level on a scale of 1 to 10 (n=38/53, 71.7%). Respondents agreed or strongly agreed that the education content was useful (n=31/51, 60.8%) but lacked personalization (n=25/51, 49%). Most respondents agreed or strongly agreed that they were satisfied with the MICP (n=38/50, 76%) and that it helped them communicate with their care team (n=38/53, 71.7%).

CONCLUSIONS

Most MICP users were motivated to track headache frequency, medication treatment with response, functional impairment, and pain intensity. Opportunities to improve the MICP include: 1) allowing patients to change the frequency of assessments and notifications; 2) record personal observations/comments via free text which may include headache triggers; 3) assessment of headache severity using a 1 to 10 pain scale; and 4) tailoring headache education based on frequency and severity (episodic vs chronic migraine). These observations may be useful to improve usability of the MICP and similar EHR-integrated migraine care platforms that others may develop.