Three Strategies for Implementing Motivational Interviewing on Medical Inpatient

描述（由申请人提供）：普通医院为滥用药物或依赖药物的患者提供护理的比例过高。这一群体的治疗费用最高，医疗和药物使用结果也最差。住院治疗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，因为患者是：1)可接近的；2)有时间进行干预；3)经常因与药物使用有关的并发症入院，这使得住院成为一个“教育时刻”。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验将动机访谈（MI）整合到耶鲁-纽黑文医院综合医疗医院服务的医师助理（PAs）实践中的三种不同实施策略的有效性。具体来说，我们将随机分配30名pa到三个条件之一：(1)继续医学教育研讨会，提供背景知识并“展示”pa如何进行MI（对照条件，称为SEE one）；(2)“看一做一”的学徒模式，包括车间培训加临床实践现场监督（do one）；(3)在车间了解MI后，向CL订购MI （ORDER ONE）。在各自的MI培训后，每个PA将被评估是否为40名符合研究条件的住院患者提供MI，这些患者是在我们的普通医疗单位入院后由研究团队招募的。将从质量上探讨实施问题。我们的主要目的是评估：1)PAs对MI的吸收；2)医务人员在医疗单位使用MI时MI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.