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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

基本信息

批准号：
8368582
负责人：
Steve Martino
金额：
$ 78.5万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
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/8368582
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

项目摘要

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. PUBLIC HEALTH RELEVANCE: Brief interventions that increase motivation for substance abuse treatment are well suited for an inpatient medical setting. 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).

描述（由申请人提供）：综合医院为大部分滥用或依赖药物的患者提供护理。该群体的治疗费用最高，医疗和药物使用结果最差。住院治疗提供了一个独特的机会来识别和激励患者解决他们的药物使用问题，因为患者： 1) 容易接近； 2）有时间进行干预； 3) 经常因与药物滥用相关的并发症而入院，这使得住院成为“受教育的时刻”。增加药物滥用治疗动机的简短干预措施非常适合住院医疗环境，但实施此类干预措施的最佳方法尚未得到充分研究。我们建议使用定量和定性方法来检查三种不同实施策略的有效性，将动机访谈（MI）整合到耶鲁-纽黑文医院普通医疗住院医师服务中的医师助理（PA）实践中。具体来说，我们将 30 位 PA 随机分配到以下三个条件之一：(1) 继续医学教育研讨会，提供背景并“展示”PA 如何进行 MI（控制条件，称为 SEE ONE）； (2)“看一做一”学徒模式，包括车间培训加上床边实践的现场监督（DO ONE）； (3) 在研讨会上了解到 MI 后，向 CL 订购 MI (ORDER ONE)。在各自的 MI 培训之后，将评估每个 PA 是否向 40 名符合研究资格的住院患者提供 MI，这些患者是由研究团队在进入我们的综合医疗单位后招募的。将定性地探讨实施问题。我们的主要目标是评估： 1) PA 对 MI 的吸收； 2）PA在医疗单位使用MI时的完整性； 3) 三种不同实施策略的相对成本和成本效益。公共卫生相关性：增加药物滥用治疗动机的简短干预措施非常适合住院医疗环境。我们建议使用定量和定性方法来检验将动机访谈（MI）整合到医师助理实践中的三种不同实施策略的有效性（PA）。