Three Strategies for Implementing Motivational Interviewing on Medical Inpatient

对住院患者实施动机访谈的三种策略

• 批准号: 8492052
• 负责人: Steve Martino
• 金额: $ 74.3万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8492052
• 关键词: Address; Adherence; Admission activity; Alcohol or Other Drugs use; Behavioral; Caring; Competence; Consultations; Counseling; Educational process of instructing; Educational workshop; Effectiveness; Frequencies; General Hospitals; Health; Healthcare; Hospitalists; Hospitalization; Hospitals; Inpatients; Intervention; Interview; Lead; Learning; Life; Medical; Medical Education; Methods; Modeling; Modus; Motivation; Outcome; Patients; Performance; Physician Assistants; Primary Health Care; Problem behavior; Process; Proxy; Qualitative Methods; Randomized; Randomized Controlled Trials; Recruitment Activity; Relative (related person); Research; Role; Secure; Services; Specialist; Supervision; Testing; Time; Training; Work; addiction; base; brief intervention; continuing medical education; cost; cost effective; cost effectiveness; drug abuse prevention; evidence base; flexibility; medical specialties; motivational enhancement therapy; primary care setting; primary outcome; response; secondary outcome; substance abuse treatment; uptake

DESCRIPTION (provided by applicant): General medical hospitals provide care for a disproportionate share of patients who abuse or are dependent upon substances. This group is among the most costly to treat and has the poorest medical and substance use outcomes. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance use problems in that patients are: 1) accessible; 2) have time for an intervention; and 3) are often admitted for complications related to substance use that renders hospitalization a "teachable moment". Brief interventions that increase motivation for substance abuse treatment are well suited for an inpatient medical setting but optimal methods for the implementation of such interventions are not well researched. We propose to use quantitative and qualitative methods to examine the effectiveness of three different implementation strategies for integrating motivational interviewing (MI) into the practice of physician assistants (PAs) working within Yale-New Haven Hospital's general medical hospitalist service. Specifically, we will randomize 30 PAs to one of three conditions: (1) a continuing medical education workshop that provides background and "shows" PAs how to conduct MI (the control condition, called SEE ONE); (2) a "see one, do one" apprenticeship model involving workshop training plus live supervision of bedside practice (DO ONE); and (3) ordering MI from CL after learning about it in a workshop (ORDER ONE). Following the respective MI trainings, each PA will be assessed for the provision of MI to 40 study-eligible inpatients, recruited by the research team after admission to our general medical units. Implementation issues will be explored qualitatively. Our primary aims are to assess: 1) the uptake of MI by PAs; 2) the integrity of MI when PAs use it on the medical units; and 3) the relative costs and cost-effectiveness of the three different implementation strategies.

描述（由申请人提供）：一般医疗医院为滥用或依赖物质的患者提供不成比例的患者提供护理。该小组是治疗最昂贵的人之一，并且具有最差的医疗和药物使用结果。住院提供了一个独特的机会，可以识别和激励患者解决其物质使用问题，因为患者是：1）可访问； 2）有时间进行干预； 3）经常因与药物使用有关的并发症而被接受，这使住院成为“可教的时刻”。简短的干预措施增加了药物滥用治疗的动力非常适合住院医疗环境，但是对这种干预措施的实施的最佳方法并未得到很好的研究。我们建议使用定量和定性方法来研究将动机访谈（MI）整合到Yale-New Haven医院一般医疗医院一般医院服务中工作的三种不同实施策略（MI）的有效性。具体来说，我们将将30个PA随机为三个条件之一：（1）持续提供的医学教育研讨会，提供背景和“显示” PAS如何进行MI（控制条件，称为一个）； （2）a“见一个，做一个”学徒模型，涉及研讨会培训以及床边实践的现场监督（做一个）； （3）在研讨会（Onder One）中了解到CL后从CL订购MI。在各自的MI培训之后，将对每个PA的MI进行评估至40个符合学习资格的住院患者，该人员在入院后由研究小组招募。实施问题将进行定性探索。我们的主要目的是评估：1）PAS对MI的吸收； 2）MI在PAS在医疗单位上使用时的完整性； 3）三种不同实施策略的相对成本和成本效益。