Martino Steve, Zimbrean Paula, Forray Ariadna, Kaufman Joy, Desan Paul, Olmstead Todd A, Gueorguieva Ralitza, Howell Heather, McCaherty Ashley, Yonkers Kimberly A
Psychology Service, VA Connecticut Healthcare System, 950 Campbell Avenue (116B), West Haven, CT, 06516, USA.
Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
Implement Sci. 2015 Sep 29;10:138. doi: 10.1186/s13012-015-0327-9.
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 addiction recovery outcomes. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance use problems in that patients are accessible, have time for an intervention, and are often admitted for complications related to substance use that renders hospitalization a "teachable moment."
METHODS/DESIGN: This randomized controlled trial will examine the effectiveness of three different strategies for integrating motivational interviewing (MI) into the practice of providers working within a general medical inpatient hospitalist service: (1) a continuing medical education workshop that provides background and "shows" providers how to conduct MI (See One); (2) an apprenticeship model involving workshop training plus live supervision of bedside practice (Do One); and (3) ordering MI from the psychiatry consultation-liaison (CL) service after learning about it in a workshop (Order One). Thirty providers (physicians, physician assistants, nurses) will be randomized to conditions and then assessed for their provision of MI to 40 study-eligible inpatients. The primary aims of the study are to assess (1) the utilization of MI in each condition; (2) the integrity of MI when providers use it on the medical units; and (3) the relative costs and cost-effectiveness of the three different implementation strategies.
If implementation of Do One and Order One is successful, the field will have two alternative strategies for supporting medical providers' proficient use of brief behavioral interventions, such as MI, for medical inpatients who use substances problematically.
Clinical Trials.gov ( NCT01825057 ).
综合医院为滥用或依赖药物的患者提供了不成比例的医疗服务。这一群体是治疗费用最高的群体之一，医疗和成瘾康复效果最差。住院治疗提供了一个独特的机会来识别并激励患者解决其药物使用问题，因为患者容易接触到，有时间进行干预，而且常常因与药物使用相关的并发症而住院，这使得住院治疗成为一个“可教育的时机”。
方法/设计：这项随机对照试验将研究三种不同策略将动机性访谈（MI）整合到综合医院内科住院医师服务提供者实践中的有效性：（1）一个继续医学教育研讨会，提供背景知识并“向”提供者展示如何进行MI（观摩组）；（2）一种学徒模式，包括研讨会培训以及对床边实践的现场监督（实操组）；（3）在研讨会上了解MI后，从精神科会诊-联络（CL）服务处订购MI（订购组）。30名提供者（医生、医师助理、护士）将被随机分配到不同组，然后评估他们对40名符合研究条件的住院患者提供MI的情况。该研究的主要目的是评估：（1）每种情况下MI的使用情况；（P）提供者在医疗科室使用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。
如果实操组和订购组的实施成功，该领域将有两种替代策略来支持医疗提供者熟练地对有药物使用问题的住院患者使用简短行为干预措施，如MI。
ClinicalTrials.gov（NCT01825057）。
