Darnell Doyanne, Parker Lea, Engstrom Allison, Fisher Dylan, Diteman Kaylie, Dunn Christopher
Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.
Trauma Surg Acute Care Open. 2019 Dec 29;4(1):e000370. doi: 10.1136/tsaco-2019-000370. eCollection 2019.
Traumatic injury requiring hospitalization is common in the USA and frequently related to alcohol consumption. The American College of Surgeons requires that Level I and II verified trauma centers implement universal alcohol screening and brief intervention for injured patients. We examined whether Level I trauma center provider skill in patient-centered alcohol brief interventions improved after training and whether professional role (eg, nursing, social work) and education were associated with these skills.
We present evaluation data collected as part of training in alcohol brief interventions embedded within a larger clinical trial of a collaborative care intervention targeting posttraumatic stress disorder and related comorbidities. Sixty-five providers from 25 US Level I trauma centers engaged in a 1-day workshop, with 2 hours dedicated to training in patient-centered alcohol brief interventions followed by 6 months of weekly coaching in a collaborative care model. Providers completed standardized patient role-plays prior to and 6 months after the workshop training. The standardized patient actors rated provider quality of alcohol brief interventions immediately after each role-play using the Behavior Change Counseling Index (BECCI), a pragmatic measure designed to assess the quality of behavior change counseling, an adaptation of motivational interviewing suitable for brief healthcare consultations about behavior change.
Seventy-two percent of providers completed both standardized patient role-play assessments. A statistically significant improvement in overall BECCI scores ((41)=-2.53, p=0.02, Cohen's =-0.39) was observed among those providers with available pre-post data. Provider professional role was associated with BECCI scores at pre-training ((3, 58)=11.25, p<0.01) and post-training ((3, 41)=8.10, p<0.01).
Findings underscore the need for training in patient-centered alcohol brief interventions and suggest that even a modest training helps providers engage in a more patient-centered way during a role-play assessment.
Level V, therapeutic/care management.
在美国，需要住院治疗的创伤性损伤很常见，且常常与饮酒有关。美国外科医师学会要求一级和二级认证创伤中心对受伤患者实施普遍的酒精筛查和简短干预。我们研究了一级创伤中心医护人员以患者为中心的酒精简短干预技能在培训后是否有所提高，以及专业角色（如护理、社会工作）和教育程度是否与这些技能相关。
我们展示了在一项针对创伤后应激障碍及相关共病的协作护理干预的大型临床试验中，作为酒精简短干预培训一部分收集的评估数据。来自美国25个一级创伤中心的65名医护人员参加了为期1天的研讨会，其中2小时专门用于以患者为中心的酒精简短干预培训，随后在协作护理模式下进行为期6个月的每周指导。医护人员在研讨会培训前和培训后6个月完成标准化患者角色扮演。标准化患者演员在每次角色扮演后立即使用行为改变咨询指数（BECCI）对医护人员酒精简短干预的质量进行评分，BECCI是一种实用的测量方法，旨在评估行为改变咨询的质量，是适用于关于行为改变的简短医疗咨询的动机性访谈的一种改编形式。
72%的医护人员完成了两次标准化患者角色扮演评估。在有前后数据的医护人员中，观察到BECCI总分有统计学显著改善（(41)= -2.53，p = 0.02，科恩氏d = -0.39）。医护人员的专业角色在培训前（(3, 58)= 11.25，p < 0.01）和培训后（(3, 41)= 8.10，p < 0.01）均与BECCI评分相关。
研究结果强调了以患者为中心的酒精简短干预培训的必要性，并表明即使是适度的培训也有助于医护人员在角色扮演评估中以更以患者为中心的方式进行。
五级，治疗/护理管理。
