Browsing by Subject "Motivational interviewing"

Now showing 1 - 4 of 4
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    A Patient-Centered Nurse-Supported Primary care-based Collaborative Care Program to Treat Opioid Use Disorder and Depression: Design and Protocol for the MI-CARE Randomized Controlled Trial
    (Elsevier, 2023) DeBar, Lynn L.; Bushey, Michael A.; Kroenke, Kurt; Bobb, Jennifer F.; Schoenbaum, Michael; Thompson, Ella E.; Justice, Morgan; Zatzick, Douglas; Hamilton, Leah K.; McMullen, Carmit K.; Hallgren, Kevin A.; Benes, Lindsay L.; Forman, David P.; Caldeiro, Ryan M.; Brown, Ryan P.; Campbell, Noll L.; Anderson, Melissa L.; Son, Sungtaek; Haggstrom, David A.; Whiteside, Lauren; Schleyer, Titus K. L.; Bradley, Katharine A.; Psychiatry, School of Medicine
    Background: Opioid use disorder (OUD) contributes to rising morbidity and mortality. Life-saving OUD treatments can be provided in primary care but most patients with OUD don't receive treatment. Comorbid depression and other conditions complicate OUD management, especially in primary care. The MI-CARE trial is a pragmatic randomized encouragement (Zelen) trial testing whether offering collaborative care (CC) to patients with OUD and clinically-significant depressive symptoms increases OUD medication treatment with buprenorphine and improves depression outcomes compared to usual care. Methods: Adult primary care patients with OUD and depressive symptoms (n ≥ 800) from two statewide health systems: Kaiser Permanente Washington and Indiana University Health are identified with computer algorithms from electronic Health record (EHR) data and automatically enrolled. A random sub-sample (50%) of eligible patients is offered the MI-CARE intervention: a 12-month nurse-driven CC intervention that includes motivational interviewing and behavioral activation. The remaining 50% of the study cohort comprise the usual care comparison group and is never contacted. The primary outcome is days of buprenorphine treatment provided during the intervention period. The powered secondary outcome is change in Patient Health Questionnaire (PHQ)-9 depression scores. Both outcomes are obtained from secondary electronic healthcare sources and compared in "intent-to-treat" analyses. Conclusion: MI-CARE addresses the need for rigorous encouragement trials to evaluate benefits of offering CC to generalizable samples of patients with OUD and mental health conditions identified from EHRs, as they would be in practice, and comparing outcomes to usual primary care. We describe the design and implementation of the trial, currently underway.
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    Designing Motivational Interviewing Instruction Employing the First Principles of Instruction
    (2019-03) Cook, Mary Jane; Reising, Deanna L.; Boling, Elizabeth; Gates, Sharon; Wonder, Amy
    Health care reform emphasizes prevention of chronic disease through the reduction of modifiable risk factors as a way to reduce health care costs, morbidity, and mortality. Motivational interviewing (MI) is an effective method of health behavior counseling. It has been used successfully applied in health related behavior change and self- management of chronic disease. The knowledge, skills, and attitude of MI are acquired through learning as other techniques used in the health professions. Nurse practitioner faculty need guidance on how to design instruction in MI that incorporates competencies and utilizes innovative strategies. Prescriptive instructional design theory utilizes knowledge from educational research to establish the steps in the design process. The purpose of this research was to apply prescriptive instructional theory to the design of effective, efficient, and engaging instruction in MI resulting in beginning proficiency in the NP students. A formative design was used for this study. The First Principles of Instruction served as the prescriptive design theory used in the design of instruction in MI. Data sources included the researcher’s design journal, observation during interaction with the instance, demographics of authentic users, authentic user reaction, and knowledge testing. Four cycles of design-redesign were completed. Results of the study point to improvements in the First Principles of Instruction. The instruction was effective, based on the improved scores from pretest to posttest on the Helpful Response Questionnaire. The improved scores also indicated an increase in knowledge of MI. Efficiency was not improved from pretest to posttest. The definition of efficiency as less time to completion of the task did not apply to MI communication skills. The First Principles of Instruction were useful in the design of the techniques of MI. However, there is little guidance for the affective component of MI such as empathy. The prescriptions of the First Principles of Instruction were useful in designing the instruction in MI. NP students indicated in post instruction interviews that engagement in the instruction was related to the relevance of the subject matter to practice and interactive exercises.
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    Research to Encourage Exercise for Fibromyalgia (REEF): Use of motivational interviewing design and method
    (Contemporary Clinical Trials, 2011) Ang, Dennis C.; Kaleth, Anthony S.; Bigatti, Silvia; Mazzuxa, Steve; Saha, Chandan; Hilligoss, Janna; Lengerich, Mimi; Bandy, Robert
    Fibromyalgia (FM), defined as the presence of both chronic widespread pain and the finding of 11/18 tender points on examination, is an illness associated with major personal and societal burden. Supervised aerobic exercise is an important treatment modality to improve patient symptoms. Unfortunately, adherence to an exercise regimen after a structured supervised program is disappointingly low. Since FM is a chronic illness, studies are needed to test strategies that would enhance exercise adherence in these individuals. Individuals who are able to adhere to exercise almost always maintain the symptomatic benefits of exercise. The objective of this paper was to describe the protocol of the Research to Encourage Exercise for Fibromyalgia (REEF). REEF is a randomized attention-controlled trial that seeks to test the efficacy of 6 sessions of telephone delivered motivational interviewing (MI) that targets exercise adherence to improve FM-relevant clinical outcomes (i.e., physical function and pain severity). The trial has recently completed enrolling 216 subjects, and randomization has resulted in well-balanced groups. Details on the study design, MI program, and treatment fidelity are provided in the paper. Outcome assessments at week 12, week 24 and week 36 will test the immediate, intermediate and long-term effects of exercise-based MI on adherence (as measured by the Community Health Activities Model Program for Seniors/CHAMPS and accelerometer) and clinical outcomes. When completed, REEF will determine whether exercise-based MI could be utilized as a management strategy to sustain the clinical benefits of exercise for FM.
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    Research to Encourage Exercise for Fibromyalgia (REEF): Use of Motivational Interviewing, Outcomes From a Randomized-controlled Trial
    (The Clinical Journal of Pain, 2013) Ang, Dennis C.; Kaleth, Anthony S.; Bigatti, Silvia; Mazzuca, Steven A.; Jensen, Mark P.; Hilligoss, Janna; Slaven, James; Saha, Chandan
    Objectives Regular exercise is associated with important benefits in patients with fibromyalgia (FM). Unfortunately, long-term maintenance of exercise after a structured program is rare. The present study tested the efficacy of Motivational Interviewing (MI) to promote exercise and improve symptoms in patients with FM. Methods 216 patients with FM were randomized to 6 MI sessions (n=107) or an equal number of FM self-management lessons (education control/EC, n=109). Co-primary endpoints were an increase of 30 minutes in moderate-vigorous physical activity and improvement in the Fibromyalgia Impact Questionnaire-Physical Impairment (FIQ-PI) score, assessed at pre-treatment, post-treatment, and 3- and 6-month follow-up. Secondary outcomes included clinically meaningful improvements in FIQ score, pain severity ratings, and a 6-minute walk test. Results There were no significant treatment group differences in either co-primary endpoint at 6-month follow-up. However, more MI participants than controls exhibited meaningful improvements in FIQ score at 6-month follow-up (62.9% vs. 49.5%, p=0.06). Compared to EC subjects, MI subjects also displayed a larger increment in their 6-minute walk test (43.9 vs. 24.8 meters, p=0.03). Additionally, MI was superior to EC in increasing the number of hours of physical activity immediately post-intervention and in reducing pain severity both immediately after the intervention and at 3-month follow-up. Conclusions Despite a lack of benefits on long term outcome, MI appears to have short-term benefits with respect to self-report physical activity and clinical outcomes. This is the first study in FM that explicitly addresses exercise maintenance as a primary aim.