Nightingale Barbara, Gopalan Priya, Azzam Pierre, Douaihy Antoine, Conti Tracey
Department of Psychiatry, University of Pittsburgh and Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center.
Fam Med. 2016 Mar;48(3):187-93.
As time and resource constraints grow in primary care, so does the value of efficient strategies to promote patient self-management, particularly for chronic diseases such as diabetes mellitus (DM). To that end, incorporating motivational interviewing (MI) into clinical practice has been shown to improve outcomes for patients with DM. Brief motivational interventions (BMI) draw from MI and may be integrated into more concise office visits. Little research has investigated strategies for BMI training for family medicine residents, particularly in the care of patients with DM. This study evaluates the impact of BMI training on improving DM self-management.
Family medicine residents were trained in BMI for DM over four sessions, then implemented BMI during routine office visits for 1 year. Pre- and post-implementation surveys were compared between residents who received BMI training and those who did not.
After BMI training, residents' self-reported use of MI-adherent approaches to managing unhealthy behaviors in patients with DM doubled, and knowledge of MI increased by nearly 50%. BMI-trained residents showed 19% improvement in the application of MI skills, using an objective measure of open-response questions to behavioral change statements.
After fewer than four training sessions in BMI, residents not only improved in their ability to apply motivational skills but also altered their clinical approaches to counseling patients with DM. BMI can also be used to evoke health behavior changes, thereby improving self-management. Training family medicine residents in BMI is effective and can be easily incorporated into a residency curriculum.
随着基层医疗中时间和资源限制的增加，促进患者自我管理的有效策略的价值也日益凸显，尤其是对于糖尿病（DM）等慢性病。为此，将动机性访谈（MI）纳入临床实践已被证明可改善糖尿病患者的治疗效果。简短动机性干预（BMI）借鉴了MI的方法，可整合到更简短的门诊就诊中。很少有研究调查针对家庭医学住院医师的BMI培训策略，尤其是在糖尿病患者护理方面。本研究评估BMI培训对改善糖尿病自我管理的影响。
家庭医学住院医师接受了为期四次的糖尿病BMI培训，然后在常规门诊就诊中实施BMI长达1年。对接受BMI培训的住院医师和未接受培训的住院医师在实施前后的调查进行比较。
经过BMI培训后，住院医师自我报告的在管理糖尿病患者不健康行为时采用符合MI的方法增加了一倍，对MI的了解增加了近50%。通过对行为改变陈述的开放式回答问题的客观测量，接受BMI培训的住院医师在MI技能应用方面提高了19%。
在接受少于四次的BMI培训后，住院医师不仅在应用动机性技能的能力上有所提高，而且改变了他们为糖尿病患者提供咨询的临床方法。BMI还可用于引发健康行为改变，从而改善自我管理。对家庭医学住院医师进行BMI培训是有效的，并且可以轻松纳入住院医师课程。
