Implementing Motivational Interviewing for Substance Misuse on Medical Inpatient Units: a Randomized Controlled Trial.
behavioral science
consultation
implementation research
substance abuse
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
14
12
2018
accepted:
11
07
2019
revised:
28
05
2019
pubmed:
31
8
2019
medline:
18
11
2020
entrez:
31
8
2019
Statut:
ppublish
Résumé
General medical hospitals provide care for a disproportionate share of patients who misuse substances. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance misuse. To determine the effectiveness of three strategies for implementing motivational interviewing for substance misuse with general medical inpatients. Type 3 hybrid effectiveness-implementation randomized controlled trial (Clinical Trials.gov: NCT01825057). Thirty-eight providers (physicians, physician assistants, nurses) from 13 general medical inpatient services, and 1173 of their patients admitted to an academically affiliated acute care hospital. Implementation strategies included (1) a continuing medical education workshop on detection of substance misuse and provision of a motivational interview; (2) workshop plus bedside supervision (apprenticeship condition); and (3) a workshop plus ability to place a medical order for an interview from a consultation-liaison service (consult condition). Primary outcomes were the percentage of study-eligible patients who received an interview for substance misuse and the integrity (adherence, competence) of the interviews. The secondary outcome was the percent of patient statements within the interviews that indicated motivation for reducing substance misuse. 20.5% of patients in the consult condition received an interview, compared to 0.8% (Hedge's g = 1.49) and 3.0% (Hedge's g = 1.26) in the respective workshop only and apprenticeship conditions (p < 0.001). Motivational interviews in the consult condition were performed with more fundamental motivational interviewing adherence and competence than the other conditions. Most statements made by patients during the interviews favored reducing substance misuse, with no differences between conditions. Providers' ability to place an order to have experts from the consultation-liaison service deliver a motivational interview was a more effective implementation strategy than a workshop or apprenticeship method for ensuring motivational interviewing is available to medical inpatients who misuse substances. NCT01825057.
Sections du résumé
BACKGROUND
General medical hospitals provide care for a disproportionate share of patients who misuse substances. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance misuse.
OBJECTIVE
To determine the effectiveness of three strategies for implementing motivational interviewing for substance misuse with general medical inpatients.
DESIGN
Type 3 hybrid effectiveness-implementation randomized controlled trial (Clinical Trials.gov: NCT01825057).
PARTICIPANTS
Thirty-eight providers (physicians, physician assistants, nurses) from 13 general medical inpatient services, and 1173 of their patients admitted to an academically affiliated acute care hospital.
INTERVENTIONS
Implementation strategies included (1) a continuing medical education workshop on detection of substance misuse and provision of a motivational interview; (2) workshop plus bedside supervision (apprenticeship condition); and (3) a workshop plus ability to place a medical order for an interview from a consultation-liaison service (consult condition).
MAIN MEASURES
Primary outcomes were the percentage of study-eligible patients who received an interview for substance misuse and the integrity (adherence, competence) of the interviews. The secondary outcome was the percent of patient statements within the interviews that indicated motivation for reducing substance misuse.
KEY RESULTS
20.5% of patients in the consult condition received an interview, compared to 0.8% (Hedge's g = 1.49) and 3.0% (Hedge's g = 1.26) in the respective workshop only and apprenticeship conditions (p < 0.001). Motivational interviews in the consult condition were performed with more fundamental motivational interviewing adherence and competence than the other conditions. Most statements made by patients during the interviews favored reducing substance misuse, with no differences between conditions.
CONCLUSIONS
Providers' ability to place an order to have experts from the consultation-liaison service deliver a motivational interview was a more effective implementation strategy than a workshop or apprenticeship method for ensuring motivational interviewing is available to medical inpatients who misuse substances.
TRIAL REGISTRY
NCT01825057.
Identifiants
pubmed: 31468342
doi: 10.1007/s11606-019-05257-3
pii: 10.1007/s11606-019-05257-3
pmc: PMC6848470
doi:
Banques de données
ClinicalTrials.gov
['NCT01825057']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2520-2529Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA034243
Pays : United States
Références
Psychosomatics. 2005 Jan-Feb;46(1):47-57
pubmed: 15765821
Med Care. 1996 Mar;34(3):220-33
pubmed: 8628042
Arch Intern Med. 2003 Mar 24;163(6):713-9
pubmed: 12639205
Aust N Z J Psychiatry. 1995 Sep;29(3):424-32
pubmed: 8573045
Drug Alcohol Depend. 2008 Jul 1;96(1-2):37-48
pubmed: 18328638
Gen Hosp Psychiatry. 2001 May-Jun;23(3):124-32
pubmed: 11427244
J Hosp Med. 2008 Sep;3(5):369-75
pubmed: 18951399
J Subst Abuse. 1993;5(2):187-93
pubmed: 8104569
Subst Abus. 2005 Mar;26(1):23-31
pubmed: 16492660
Am J Addict. 2005 May-Jun;14(3):256-67
pubmed: 16019976
Gen Hosp Psychiatry. 1983 Jul;5(2):115-21
pubmed: 6618169
Patient Educ Couns. 2011 Jul;84(1):16-26
pubmed: 20667432
Psychosomatics. 1997 Jan-Feb;38(1):38-44
pubmed: 8997115
J Consult Clin Psychol. 2018 Feb;86(2):140-157
pubmed: 29265832
Drug Alcohol Depend. 2013 Oct 1;132(3):681-7
pubmed: 23684633
Resuscitation. 2010 Dec;81(12):1692-7
pubmed: 21067856
J Consult Clin Psychol. 2010 Dec;78(6):868-84
pubmed: 21114344
Addiction. 2014 Aug;109(8):1287-94
pubmed: 24661345
Addict Behav. 2008 Sep;33(9):1177-82
pubmed: 18558466
Arch Intern Med. 2004 Apr 12;164(7):749-56
pubmed: 15078644
Annu Rev Public Health. 2014;35:255-74
pubmed: 24641560
Implement Sci. 2013 Aug 10;8:89
pubmed: 23937766
Milbank Q. 2007;85(1):93-138
pubmed: 17319808
Am J Prev Med. 2016 Oct;51(4):551-65
pubmed: 27647056
Acad Med. 2002 Jul;77(7):748
pubmed: 12114170
Addiction. 2011 Feb;106(2):428-41
pubmed: 20925684
Health Aff (Millwood). 2016 May 1;35(5):832-7
pubmed: 27140989
Implement Sci. 2009 Aug 07;4:50
pubmed: 19664226
Drug Alcohol Depend. 2007 Mar 16;87(2-3):107-18
pubmed: 17023123
Drug Alcohol Depend. 2018 May 1;186:23-28
pubmed: 29529456
Med Care. 2012 Mar;50(3):217-26
pubmed: 22310560
Wis Med J. 1995;94(3):135-40
pubmed: 7778330
Int J Psychiatry Med. 1998;28(1):21-39
pubmed: 9617647
Psychiatr Serv. 2012 Jul;63(7):660-5
pubmed: 22549401
J Gen Intern Med. 2006 Apr;21(4):381-5
pubmed: 16686818
J Subst Abuse Treat. 2008 Jul;35(1):1-12
pubmed: 17935930
Drug Alcohol Depend. 2005 Oct 1;80(1):105-16
pubmed: 16157233
Fam Syst Health. 2010 Jun;28(2):130-45
pubmed: 20695671
Adm Policy Ment Health. 2017 Nov;44(6):838-852
pubmed: 28315076
Clin Psychol Rev. 2010 Jun;30(4):448-66
pubmed: 20304542
J Subst Abuse Treat. 2002 Dec;23(4):309-18
pubmed: 12495792
Open Forum Infect Dis. 2016 Jul 26;3(3):ofw157
pubmed: 27800528
J Consult Clin Psychol. 2014 Dec;82(6):973-83
pubmed: 24841862
J Subst Abuse Treat. 2005 Dec;29(4):283-93
pubmed: 16311181
Qual Saf Health Care. 2009 Feb;18(1):63-8
pubmed: 19204135
Milbank Q. 2004;82(4):581-629
pubmed: 15595944
Br J Addict. 1992 Dec;87(12):1691-702
pubmed: 1490083
Curr HIV/AIDS Rep. 2011 Dec;8(4):223-34
pubmed: 21858414
J Subst Abuse Treat. 1992;9(3):199-213
pubmed: 1334156
Gen Hosp Psychiatry. 1983 Jul;5(2):83-7
pubmed: 6618174
Br J Addict. 1989 Jul;84(7):791-9
pubmed: 2758152
JAMA. 1992 Sep 2;268(9):1111-7
pubmed: 1501333
J Gen Intern Med. 2017 Aug;32(8):909-916
pubmed: 28526932
Psychiatr Serv. 2015 Feb 1;66(2):134-40
pubmed: 25642610
J Cardiovasc Risk. 1996 Apr;3(2):199-203
pubmed: 8836863
Addiction. 2017 Sep;112(9):1558-1564
pubmed: 28191702
J Gen Intern Med. 2001 Sep;16(9):606-13
pubmed: 11556941
JAMA Pediatr. 2015 Apr;169(4):374-82
pubmed: 25686473
JAMA. 1998 Jun 10;279(22):1767-8
pubmed: 9628694
J Subst Abuse Treat. 2013 Aug;45(2):155-62
pubmed: 23537923
Ann Intern Med. 2007 Feb 6;146(3):167-76
pubmed: 17283347
Drug Alcohol Depend. 2011 Jun 1;115(3):229-36
pubmed: 21227601
J Subst Abuse Treat. 2017 Aug;79:1-5
pubmed: 28673521