Implementing Motivational Interviewing for Substance Misuse on Medical Inpatient Units: a Randomized Controlled Trial

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