RT Journal Article
SR Electronic
T1 Training to Use Motivational Interviewing Techniques for Depression: A Cluster Randomized Trial
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 621
OP 636
DO 10.3122/jabfm.2014.05.130324
VO 27
IS 5
A1 Keeley, Robert D.
A1 Burke, Brian L.
A1 Brody, David
A1 Dimidjian, Sona
A1 Engel, Matthew
A1 Emsermann, Caroline
A1 deGruy, Frank
A1 Thomas, Marshall
A1 Moralez, Ernesto
A1 Koester, Steve
A1 Kaplan, Jessica
YR 2014
UL http://www.jabfm.org/content/27/5/621.abstract
AB Objective: The goal of this study was to assess the effects of training primary care providers (PCPs) to use Motivational Interviewing (MI) when treating depressed patients on providers' MI performance and patients' expressions of interest in depression treatment (“change talk”) and short-term treatment adherence. Methods: This was a cluster randomized trial in urban primary care clinics (3 intervention, 4 control). We recruited 21 PCPs (10 intervention, 11 control) and 171 English-speaking patients with newly diagnosed depression (85 intervention, 86 control). MI training included a baseline and up to 2 refresher classroom trainings, along with feedback on audiotaped patient encounters. We report summary measures of technical (rate of MI-consistent statements per 10 minutes during encounters) and relational (global rating of “MI Spirit”) MI performance, the association between MI performance and number of MI trainings attended (0, 1, 2, or 3), and rates of patient change talk regarding depression treatments (physical activity, antidepressant medication). We report PCP use of physical activity recommendations and antidepressant prescriptions and patients' short-term physical activity level and prescription fill rates. Results: Use of MI-consistent statements was 26% higher for MI-trained versus control PCPs (P = .005). PCPs attending all 3 MI trainings (n = 6) had 38% higher use of MI-consistent statements (P < .001) and were over 5 times more likely to show beginning proficiency in MI Spirit (P = .036) relative to control PCPs. Although PCPs' use of physical activity recommendations and antidepressant prescriptions was not significantly different by randomization arm, patients seen by MI-trained PCPs had more frequent change talk (P = .001). Patients of MI-trained PCPs also expressed change talk about physical activity 3 times more frequently (P = .01) and reported more physical activity (3.05 vs 1.84 days in the week after the visit; P = .007) than their counterparts visiting untrained PCPs. Change talk about antidepressant medication and fill rates were similar by randomization arm (P > .05 for both). Conclusions: MI training resulted in improved MI performance, more depression-related patient change talk, and better short-term adherence.