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与兽医动机访谈培训相关的奶牛群健康管理活动。

Dairy herd health management activities in relation to training of veterinarians in motivational interviewing.

机构信息

Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, SE-750 07 Uppsala, Sweden.

MeetMe Psykologkonsult AB, Åvägen 16, SE-443 31 Lerum, Sweden.

出版信息

Prev Vet Med. 2022 Jul;204:105679. doi: 10.1016/j.prevetmed.2022.105679. Epub 2022 May 18.

DOI:10.1016/j.prevetmed.2022.105679
PMID:35636232
Abstract

Communication has been identified as one constraint for cattle veterinarians to act as proactive health consultants. Motivational Interviewing (MI), an evidence-based client-centered communication methodology, may therefore be a useful tool in veterinary herd health management (VHHM). The aim of this exploratory study was to investigate associations between training in MI and different measures of performance in VHHM. MI skills of 36 Swedish cattle veterinarians randomly assigned to two groups - MI veterinarians (n = 18) who had received six-months training in MI and control veterinarians (n = 18) who were not trained - were assessed using the MI Treatment Integrity coding system. Skills were categorized as untrained, trained_poor, trained_near moderate and trained_moderate. Veterinarians each visited two to six cattle farms for VHHM consultations and revisited the same farms three to six months later to document implementation of recommendations. A gamma model and logistic or ordered logistic regression models were used to evaluate associations between MI training and performance measured as: a) proportion of consultations resulting in written herd health plans, b) proportion of recommended measures fully or partially implemented, c) Likert scores of different estimates of client satisfaction and d) total time during 6 months allocated to VHHM visits on cattle farms. We found no evidence of any significant effects of MI training on the eight performance variables analyzed. However, a pattern of numerically higher values (better performance) in trained veterinarians with poor or moderate MI skills than in untrained veterinarians was observed in most variables. Clients were highly satisfied with veterinarians' attitude, competence and time efficiency. Farms implemented a median of 66.7% (interquartile range: 50-100) of the measures partially or fully. Veterinarians allocated little time to VHHM visits (median: 2.2; interquartile range: 0.65-4.1 h per week of full-time work within cattle). Veterinarians with moderate skills spent 2.14 times more time on VHHM visits than untrained veterinarians, but the confidence interval was wide (0.88-5.21). The pattern of numerically higher values in trained veterinarians supported findings from other studies in the same project indicating a positive effect of MI training on VHHM. Our observations suggest a considerable potential to increase veterinarians' engagement in VHHM.

摘要

沟通被认为是牛兽医主动充当健康顾问的一个制约因素。因此,动机性访谈(MI),一种基于证据的以客户为中心的沟通方法,可能是兽医群体健康管理(VHHM)的有用工具。本探索性研究的目的是调查 MI 培训与 VHHM 不同绩效衡量标准之间的关联。使用 MI 治疗完整性编码系统评估 36 名随机分配到两组的瑞典牛兽医的 MI 技能:接受了六个月 MI 培训的 MI 兽医(n=18)和未接受培训的对照组兽医(n=18)。技能分为未培训、培训差、培训接近中等和培训中等。兽医每次为 VHHM 咨询访问 2 到 6 个奶牛场,并在 3 到 6 个月后重新访问相同的农场,以记录建议的实施情况。使用伽马模型和逻辑或有序逻辑回归模型评估 MI 培训与以下绩效衡量标准之间的关联:a)导致书面牛群健康计划的咨询比例,b)完全或部分实施建议措施的比例,c)不同客户满意度估计的李克特评分,d)兽医在牛场的 VHHM 访问期间 6 个月内分配的总时间。我们没有发现 MI 培训对分析的八个绩效变量有任何显著影响的证据。然而,在大多数变量中,观察到具有较差或中等 MI 技能的受过培训的兽医的数值较高(较好的绩效)的模式。客户对兽医的态度、能力和时间效率非常满意。农场部分或全部实施了 66.7%(中位数;四分位距:50-100)的措施。兽医每周分配给 VHHM 访问的时间很少(中位数:2.2;四分位距:0.65-4.1 小时,全职工作内的牛)。具有中等技能的兽医在 VHHM 访问上花费的时间比未受过培训的兽医多 2.14 倍,但置信区间较宽(0.88-5.21)。在受过培训的兽医中数值较高的模式支持同一项目中其他研究的发现,表明 MI 培训对 VHHM 有积极影响。我们的观察结果表明,兽医在 VHHM 中的参与度有很大的提高潜力。

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