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 implem...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2019-11, Vol.34 (11), p.2520-2529 |
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| creator | Martino, Steve Zimbrean, Paula Forray, Ariadna Kaufman, Joy S. Desan, Paul H. Olmstead, Todd A. Gilstad-Hayden, Kathryn Gueorguieva, Ralitza Yonkers, Kimberly A. |
| description | 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
|
| doi_str_mv | 10.1007/s11606-019-05257-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6848470</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2283107201</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-48e82e557879946db3920f21fb7bcebd6731afda9442f904eb1ff6d90309e74d3</originalsourceid><addsrcrecordid>eNp9kU1vEzEQhi0EoiHwBzggS1y4LPgra5sDUhWVNlIjJGjPlnc9G1zt2sHeDWp_fZ2klI8DJ480z7yeeV-EXlPynhIiP2RKa1JXhOqKLNhCVvwJmtFSVVRo-RTNiFKiUpKLE_Qi5xtCKGdMPUcnnIpaccFmaFoN2x4GCKMPG7yOo9_Z0cdge7wKI6Sdh5_7ThcT_jY1ebShBbz2ecqAY8BrcL49wNsyV2TwdfBj_ogt_mqDi4O_A4eXMYwp9n0pr5K3_Uv0rLN9hlcP7xxdfz67Wl5Ul1_OV8vTy6oVUoyVUKAYLBZSSa1F7RquGekY7RrZtNC4WnJqO2e1EKzTREBDu652mnCiQQrH5-jTUXc7NQO4tuyXbG-2yQ823Zpovfm7E_x3s4k7UyuhhCRF4N2DQIo_JsijGXxuoe9tgDhlU-zklEhWnJ2jt_-gN3FKxcgDxTjlst5T7Ei1KeacoHtchhKzT9UcUzUlVXNI1fAy9ObPMx5HfsVYAH4EcmmFDaTff_9H9h50Na-f</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2282313761</pqid></control><display><type>article</type><title>Implementing Motivational Interviewing for Substance Misuse on Medical Inpatient Units: a Randomized Controlled Trial</title><source>SpringerLink Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Martino, Steve ; Zimbrean, Paula ; Forray, Ariadna ; Kaufman, Joy S. ; Desan, Paul H. ; Olmstead, Todd A. ; Gilstad-Hayden, Kathryn ; Gueorguieva, Ralitza ; Yonkers, Kimberly A.</creator><creatorcontrib>Martino, Steve ; Zimbrean, Paula ; Forray, Ariadna ; Kaufman, Joy S. ; Desan, Paul H. ; Olmstead, Todd A. ; Gilstad-Hayden, Kathryn ; Gueorguieva, Ralitza ; Yonkers, Kimberly A.</creatorcontrib><description>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
< 0.001). Motivational interviews in the consult condition were performed with more fundamental motivational interviewing adherence and competence than the other conditions. Most statements made by patients during the interviews favored reducing substance misuse, with no differences between conditions.
Conclusions
Providers’ ability to place an order to have experts from the consultation-liaison service deliver a motivational interview was a more effective implementation strategy than a workshop or apprenticeship method for ensuring motivational interviewing is available to medical inpatients who misuse substances.
Trial Registry
NCT01825057</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-019-05257-3</identifier><identifier>PMID: 31468342</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Apprenticeship ; Clinical trials ; Consultation ; Internal Medicine ; Interviews ; Medical personnel ; Medicine ; Medicine & Public Health ; Motivation ; Original Research ; Patients ; Physicians ; Randomization ; Substance use disorder</subject><ispartof>Journal of general internal medicine : JGIM, 2019-11, Vol.34 (11), p.2520-2529</ispartof><rights>Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2019</rights><rights>Journal of General Internal Medicine is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-48e82e557879946db3920f21fb7bcebd6731afda9442f904eb1ff6d90309e74d3</citedby><cites>FETCH-LOGICAL-c474t-48e82e557879946db3920f21fb7bcebd6731afda9442f904eb1ff6d90309e74d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6848470/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6848470/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,41464,42533,51294,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31468342$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Martino, Steve</creatorcontrib><creatorcontrib>Zimbrean, Paula</creatorcontrib><creatorcontrib>Forray, Ariadna</creatorcontrib><creatorcontrib>Kaufman, Joy S.</creatorcontrib><creatorcontrib>Desan, Paul H.</creatorcontrib><creatorcontrib>Olmstead, Todd A.</creatorcontrib><creatorcontrib>Gilstad-Hayden, Kathryn</creatorcontrib><creatorcontrib>Gueorguieva, Ralitza</creatorcontrib><creatorcontrib>Yonkers, Kimberly A.</creatorcontrib><title>Implementing Motivational Interviewing for Substance Misuse on Medical Inpatient Units: a Randomized Controlled Trial</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>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
< 0.001). Motivational interviews in the consult condition were performed with more fundamental motivational interviewing adherence and competence than the other conditions. Most statements made by patients during the interviews favored reducing substance misuse, with no differences between conditions.
Conclusions
Providers’ ability to place an order to have experts from the consultation-liaison service deliver a motivational interview was a more effective implementation strategy than a workshop or apprenticeship method for ensuring motivational interviewing is available to medical inpatients who misuse substances.
Trial Registry
NCT01825057</description><subject>Apprenticeship</subject><subject>Clinical trials</subject><subject>Consultation</subject><subject>Internal Medicine</subject><subject>Interviews</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Motivation</subject><subject>Original Research</subject><subject>Patients</subject><subject>Physicians</subject><subject>Randomization</subject><subject>Substance use disorder</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kU1vEzEQhi0EoiHwBzggS1y4LPgra5sDUhWVNlIjJGjPlnc9G1zt2sHeDWp_fZ2klI8DJ480z7yeeV-EXlPynhIiP2RKa1JXhOqKLNhCVvwJmtFSVVRo-RTNiFKiUpKLE_Qi5xtCKGdMPUcnnIpaccFmaFoN2x4GCKMPG7yOo9_Z0cdge7wKI6Sdh5_7ThcT_jY1ebShBbz2ecqAY8BrcL49wNsyV2TwdfBj_ogt_mqDi4O_A4eXMYwp9n0pr5K3_Uv0rLN9hlcP7xxdfz67Wl5Ul1_OV8vTy6oVUoyVUKAYLBZSSa1F7RquGekY7RrZtNC4WnJqO2e1EKzTREBDu652mnCiQQrH5-jTUXc7NQO4tuyXbG-2yQ823Zpovfm7E_x3s4k7UyuhhCRF4N2DQIo_JsijGXxuoe9tgDhlU-zklEhWnJ2jt_-gN3FKxcgDxTjlst5T7Ei1KeacoHtchhKzT9UcUzUlVXNI1fAy9ObPMx5HfsVYAH4EcmmFDaTff_9H9h50Na-f</recordid><startdate>20191101</startdate><enddate>20191101</enddate><creator>Martino, Steve</creator><creator>Zimbrean, Paula</creator><creator>Forray, Ariadna</creator><creator>Kaufman, Joy S.</creator><creator>Desan, Paul H.</creator><creator>Olmstead, Todd A.</creator><creator>Gilstad-Hayden, Kathryn</creator><creator>Gueorguieva, Ralitza</creator><creator>Yonkers, Kimberly A.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20191101</creationdate><title>Implementing Motivational Interviewing for Substance Misuse on Medical Inpatient Units: a Randomized Controlled Trial</title><author>Martino, Steve ; Zimbrean, Paula ; Forray, Ariadna ; Kaufman, Joy S. ; Desan, Paul H. ; Olmstead, Todd A. ; Gilstad-Hayden, Kathryn ; Gueorguieva, Ralitza ; Yonkers, Kimberly A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-48e82e557879946db3920f21fb7bcebd6731afda9442f904eb1ff6d90309e74d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Apprenticeship</topic><topic>Clinical trials</topic><topic>Consultation</topic><topic>Internal Medicine</topic><topic>Interviews</topic><topic>Medical personnel</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Motivation</topic><topic>Original Research</topic><topic>Patients</topic><topic>Physicians</topic><topic>Randomization</topic><topic>Substance use disorder</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Martino, Steve</creatorcontrib><creatorcontrib>Zimbrean, Paula</creatorcontrib><creatorcontrib>Forray, Ariadna</creatorcontrib><creatorcontrib>Kaufman, Joy S.</creatorcontrib><creatorcontrib>Desan, Paul H.</creatorcontrib><creatorcontrib>Olmstead, Todd A.</creatorcontrib><creatorcontrib>Gilstad-Hayden, Kathryn</creatorcontrib><creatorcontrib>Gueorguieva, Ralitza</creatorcontrib><creatorcontrib>Yonkers, Kimberly A.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Martino, Steve</au><au>Zimbrean, Paula</au><au>Forray, Ariadna</au><au>Kaufman, Joy S.</au><au>Desan, Paul H.</au><au>Olmstead, Todd A.</au><au>Gilstad-Hayden, Kathryn</au><au>Gueorguieva, Ralitza</au><au>Yonkers, Kimberly A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Implementing Motivational Interviewing for Substance Misuse on Medical Inpatient Units: a Randomized Controlled Trial</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2019-11-01</date><risdate>2019</risdate><volume>34</volume><issue>11</issue><spage>2520</spage><epage>2529</epage><pages>2520-2529</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>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
< 0.001). Motivational interviews in the consult condition were performed with more fundamental motivational interviewing adherence and competence than the other conditions. Most statements made by patients during the interviews favored reducing substance misuse, with no differences between conditions.
Conclusions
Providers’ ability to place an order to have experts from the consultation-liaison service deliver a motivational interview was a more effective implementation strategy than a workshop or apprenticeship method for ensuring motivational interviewing is available to medical inpatients who misuse substances.
Trial Registry
NCT01825057</abstract><cop>New York</cop><pub>Springer US</pub><pmid>31468342</pmid><doi>10.1007/s11606-019-05257-3</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0884-8734 |
| ispartof | Journal of general internal medicine : JGIM, 2019-11, Vol.34 (11), p.2520-2529 |
| issn | 0884-8734 1525-1497 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6848470 |
| source | SpringerLink Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Apprenticeship Clinical trials Consultation Internal Medicine Interviews Medical personnel Medicine Medicine & Public Health Motivation Original Research Patients Physicians Randomization Substance use disorder |
| title | Implementing Motivational Interviewing for Substance Misuse on Medical Inpatient Units: a Randomized Controlled Trial |
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