Three Strategies for Implementing Motivational Interviewing on Medical Inpatient

描述(申请人提供)：普通医疗医院为滥用或依赖药物的患者提供不成比例的护理。这一群体是治疗费用最高的群体之一，医疗和药物使用结果最差。住院提供了一个独特的机会来确定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)经常因与药物使用有关的并发症而入院，使住院成为一个“可教的时刻”。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很好的研究。我们建议使用定量和定性的方法来检验三种不同的实施策略的有效性，这些实施策略将动机访谈(MI)整合到耶鲁-纽黑文医院普通内科住院医生服务中的医生助理(PA)的实践中。具体地说，我们会将30名临床助理随机分为三种情况：(1)提供背景并向临床助理“展示”如何进行MI(控制条件，称为See One)的持续医学教育工作坊；(2)包括工作坊培训和现场监督床边实习的“See One，Do One”学徒模式(Do One)；以及(3)在研讨会上了解MI后向CL订购MI(订单一)。在各自的MI培训之后，将评估每个PA向40名符合研究条件的住院患者提供MI的情况，这些患者是研究团队在进入我们的普通医疗单位后招募的。将定性地探讨执行问题。我们的主要目标是评估：1)PAS对MI的吸收；2)PAS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。

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.