Impacto de la formación en entrevista motivacional para médicos: diseño y evaluación de un programa formativo (MOTIVA)

Objetivo principal: Desarrollar un programa formativo en entrevista motivacional para médicos de familia, y evaluar el impacto. Objetivos secundarios: 1. Diseñar un programa formativo (PF) en entrevista motivacional multifacético 2. Evaluar la eficacia del programa con pacientes estandarizados 3. Evaluar la eficacia del programa con pacientes reales 4. Analizar la factibilidad del programa. Diseño del estudio: Ensayo clínico multicéntrico, a doble ciego, y aleatorizado con dos grupos, Experimental (GE) y Control (GC) de médicos de familia con seguimiento de 12 meses. Descripción de la muestra: 54 médicos (GC=28, GE=26), 32 centros. Finalizaron: GC=26, GE =25. Material: Pacientes estandarizados, videograbaciones, taller Entrevista Motivacional, actividades de formación. Evaluación: Escala EVEM, Indicador sintético, Encuesta final. Metodología: 4 fases: 1. Pacientes estandarizados (PE) en GC y GE, Videograbaciones (VG) previas al PF. 2. VG con PE en GE, Taller Entrevista Motivacional de 16 horas y actividades formativas. 3. VG pacientes reales (PR) en GC y GE. 4. VG con PE final del estudio (GC y GE). Evaluación del Programa Formativo: Escala EVEM, Índice sintético y encuesta final. Resultados: 1. Al inicio del proyecto, la media en escala EVEM es de 21,27 puntos en el GE (38% del valor máximo), frente a 20,23 puntos en el GC (36%) (p=0,79). Los dos grupos son comparables. 2. Las VG post-taller (GE) muestran media de 35,16 puntos (63%_IC95% 53,2-72,5). El taller formativo mejora las habilidades en EM (p<0,001) respecto fase 1. 3. Las VG de los pacientes reales en el GE se constata un mantenimiento en las habilidades adquiridas durante el taller, con una media en la escala EVEM de 36,9 puntos (64%_IC95% 54,5-73,4), frente a 15,9 puntos (28,2%_IC95%16,9_39,5) en el GC (p<0,001). 4. Una vez concluido PF, en fase 4, se realizan VG con PE. La media EVEM final del grupo GE es de 37,6 puntos (68%_IC95% 59,3-75,1) con p<0,001. 5. La adherencia al programa formativo MOTIVA calculada con el indicador sintético durante los 12 meses de desarrollo, se asocia a una mejora en habilidades adquiridas en entrevista motivacional (P=0,017). Conclusiones: 1. El Programa Formativo MOTIVA, que es un programa multifacético y de seguimiento anual, mejora las habilidades en entrevista motivacional de los médicos cuando se evalúa con PE y con PR. 2. El taller en entrevista motivacional mejora significativamente el perfil de los médicos de familia y la competencia se mantiene a lo largo de 12 meses con otras actividades formativas. 3. El Indicador Sintético (IS) es una herramienta que permite medir la adherencia al Programa Formativo MOTIVA, ponderando cada actividad según su influencia en el aprendizaje.Main objective: To develop a training program in Motivational Interviewing for Family Physicians and assess the impact. Secondary objectives: 1. To design a multifaceted training program (TP) in Motivational Interviewing. 2. To assess the efficacy of the program with standardized patients. 3. To assess the efficacy of the program with real patients. 4. To analyse the feasibility of this program. Study design: Multicenter, double blind and randomized clinical essay, with two arms, Experimental (EG) and Control (CG) of Family Physicians with a follow up of 12 months. Sample description: 54 physicians (CG=28, EG=26), 32 centers. Ended by CG=26, EG=25 Material: Standardized Patients, Video recordings (VR), Motivational Interviewing Workshop, training activities. Assessment: EVEM scale, Synthetic indicator, final poll Methodology: 4 phases: 1. Standardized patients (SP) in CG and EG, Videorecodings (VR) before TP; 2. VR with SP in EG, 16 h Motivational Interviewing workshop, other training activities; 3. VR with real patients (RP) in CG and EG; 4. VR with SP at end of study (CG and EG). Training Program Assessment: EVEM scale, Synthetic indicator and final poll. Results: 1. Before starting the training program, the mean in the EVEM scale is 21,27 points for EG (38% of maximum score), and 20,23 points in CG (36%) (p=0,79). Both groups are comparable. 2. After-workshop VR data (EG) show a mean of 35,16 points (63%_IC95% 53,2-72,5). The MI training workshop improves MI skills (p<0,001) compared with phase 1. 3. Real patients VR in EG show that the skills acquired during the workshop are maintained, with a mean score in the EVEM scale of 36,9 points (64%_IC95% 54,5-73,4), compared to 15,9 points (28,2%_IC95%16,9_39,5) in CG (p<0,001). 4. Once finalized the TP, in phase 4, VR with SP are recorded. The mean score for EG in the EVEM scale is 37,6 points (68%_IC95% 59,3-75,1) with p<0,001. 5. The adherence to the training program MOTIVA, as calculated using the synthetic indicator, during its 12 month period duration is associated to an improvement in the acquired motivational interviewing skills (P=0,017) Conclusions: 1. The multifaceted annual training program MOTIVA improves physicians’ Motivational Interviewing skills when assessed both with SP and RP. 2. The Motivational Interviewing workshop significantly improves the profile of family physicians, and the competence is maintained along the 12 months thanks to other training activities. 3. The Synthetic Indicator (SI) is a tool that enables the measure of the adherence to the training program MOTIVA, pondering each activity according to its influence in the learning process

Impacto de la formación en entrevista motivacional para médicos: diseño y evaluación de un programa formativo (MOTIVA)

Objetivo principal: Desarrollar un programa formativo en entrevista motivacional para médicos de familia, y evaluar el impacto. Objetivos secundarios: 1.Diseñar un programa formativo (PF) en entrevista motivacional multifacético 2.Evaluar la eficacia del programa con pacientes estandarizados 3.Evaluar la eficacia del programa con pacientes reales 4.Analizar la factibilidad del programa. Diseño del estudio: Ensayo clínico multicéntrico, a doble ciego, y aleatorizado con dos grupos, Experimental (GE) y Control (GC) de médicos de familia con seguimiento de 12 meses. Descripción de la muestra: 54 médicos (GC=28, GE=26), 32 centros. Finalizaron: GC=26, GE =25. Material: Pacientes estandarizados, videograbaciones, taller Entrevista Motivacional, actividades de formación. Evaluación: Escala EVEM, Indicador sintético, Encuesta final. Metodología: 4 fases: 1.Pacientes estandarizados (PE) en GC y GE, Videograbaciones (VG) previas al PF. 2.VG con PE en GE, Taller Entrevista Motivacional de 16 horas y actividades formativas. 3.VG pacientes reales (PR) en GC y GE. 4.VG con PE final del estudio (GC y GE). Evaluación del Programa Formativo: Escala EVEM, Índice sintético y encuesta final. Resultados: 1.Al inicio del proyecto, la media en escala EVEM es de 21,27 puntos en el GE (38% del valor máximo), frente a 20,23 puntos en el GC (36%) (p=0,79). Los dos grupos son comparables. 2.Las VG post-taller (GE) muestran media de 35,16 puntos (63%_IC95% 53,2-72,5). El taller formativo mejora las habilidades en EM (p 0,001) respecto fase 1. 3.Las VG de los pacientes reales en el GE se constata un mantenimiento en las habilidades adquiridas durante el taller, con una media en la escala EVEM de 36,9 puntos (64%_IC95% 54,5-73,4), frente a 15,9 puntos (28,2%_IC95%16,9_39,5) en el GC (p 0,001). 4.Una vez concluido PF, en fase 4, se realizan VG con PE. La media EVEM final del grupo GE es de 37,6 puntos (68%_IC95% 59,3-75,1) con p 0,001. 5.La adherencia al programa formativo MOTIVA calculada con el indicador sintético durante los 12 meses de desarrollo, se asocia a una mejora en habilidades adquiridas en entrevista motivacional (P=0,017). Conclusiones: 1.El Programa Formativo MOTIVA, que es un programa multifacético y de seguimiento anual, mejora las habilidades en entrevista motivacional de los médicos cuando se evalúa con PE y con PR. 2.El taller en entrevista motivacional mejora significativamente el perfil de los médicos de familia y la competencia se mantiene a lo largo de 12 meses con otras actividades formativas. 3.El Indicador Sintético (IS) es una herramienta que permite medir la adherencia al Programa Formativo MOTIVA, ponderando cada actividad según su influencia en el aprendizaje.Main objective: To develop a training program in Motivational Interviewing for Family Physicians and assess the impact. Secondary objectives: 1. To design a multifaceted training program (TP) in Motivational Interviewing. 2. To assess the efficacy of the program with standardized patients. 3. To assess the efficacy of the program with real patients. 4. To analyse the feasibility of this program. Study design: Multicenter, double blind and randomized clinical essay, with two arms, Experimental (EG) and Control (CG) of Family Physicians with a follow up of 12 months. Sample description: 54 physicians (CG=28, EG=26), 32 centers. Ended by CG=26, EG=25 Material: Standardized Patients, Video recordings (VR), Motivational Interviewing Workshop, training activities. Assessment: EVEM scale, Synthetic indicator, final poll Methodology: 4 phases: 1. Standardized patients (SP) in CG and EG, Videorecodings (VR) before TP; 2. VR with SP in EG, 16 h Motivational Interviewing workshop, other training activities; 3. VR with real patients (RP) in CG and EG; 4. VR with SP at end of study (CG and EG). Training Program Assessment: EVEM scale, Synthetic indicator and final poll. Results: 1. Before starting the training program, the mean in the EVEM scale is 21,27 points for EG (38% of maximum score), and 20,23 points in CG (36%) (p=0,79). Both groups are comparable. 2. After-workshop VR data (EG) show a mean of 35,16 points (63%_IC95% 53,2-72,5). The MI training workshop improves MI skills (p 0,001) compared with phase 1. 3. Real patients VR in EG show that the skills acquired during the workshop are maintained, with a mean score in the EVEM scale of 36,9 points (64%_IC95% 54,5-73,4), compared to 15,9 points (28,2%_IC95%16,9_39,5) in CG (p 0,001). 4. Once finalized the TP, in phase 4, VR with SP are recorded. The mean score for EG in the EVEM scale is 37,6 points (68%_IC95% 59,3-75,1) with p 0,001. 5. The adherence to the training program MOTIVA, as calculated using the synthetic indicator, during its 12 month period duration is associated to an improvement in the acquired motivational interviewing skills (P=0,017) Conclusions: 1. The multifaceted annual training program MOTIVA improves physicians' Motivational Interviewing skills when assessed both with SP and RP. 2. The Motivational Interviewing workshop significantly improves the profile of family physicians, and the competence is maintained along the 12 months thanks to other training activities. 3. The Synthetic Indicator (SI) is a tool that enables the measure of the adherence to the training program MOTIVA, pondering each activity according to its influence in the learning process

Impact of training on Motivational Interviewing (MI) for Family Physicians: Design and assessment of a Training Program (MOTIVA)

Aim To develop a training program in Motivational Interviewing for Family Physicians and assess the impact. Study design Multicenter, double blind and randomized clinical essay, with 2 arms, Experimental (EG) and Control (CG) of Family Physicians with a follow up of 12 months. Location 32 Primary Healthcare Centers. Sample description 54 physicians (CG = 28, EG = 26). Interventions Training Program MOTIVA in ME with an initial presential course (16 h), followed by online activities during 12months, and presential meetings (Problem BasedInterviewing with expert feedback). Main measurements Communicative skills in MI were assessed based on video-recordings (VR) with the EVEM 2.0 scale by peer reviewers. 236 VR with standardized patients and 96 VR with real patients. Results Average results in EVEM scale (up to 56 points) at the beginning of the study were EG = 21.27 (CI 95% 15.8-26.7) and CG = 20.23 (CI95% 16.4-23.9) with no differences between both groups (P=.79). After the training, EG punctuation increased by 13.89 points (P<.001), average 35.16 (CI 95% 29.8-40.6). Real patients’ VR in EG over a 12 month period keep their MI skills with an average of 36.9 points (CI 95% 30.3-43.6) versus CG 15.9 points (CI 95% 9.8-22.0). Once ended the MOTIVA Training Program, the EG maintains the acquired skills: final average EG = 37.6 (CI 95% 33.2-41.1) versus CG = 24.3 (CI95% 19.0-29.2) (P<.001). Conclusions The MOTIVA Training Program improves Motivational Interviewing skills, significatively improving after a presential course and sequential keep-alive activities. The effectiveness of the Program has been proven in the Third and Fourth steps of Miller's PyramidEste trabajo recibió una Beca Isabel Fernández 2012 de la semFYC.YesObjetivo Desarrollar un programa de formación en Entrevista Motivacional (EM) para Médicos de Familia y evaluar el impacto. Diseño Ensayo clínico multicéntrico a doble ciego y aleatorizado, con 2 ramas (experimental (GE) y control (GC)) de Médicos de Familia, con un seguimiento de 12 meses. Emplazamiento 32 Centros de Atención Primaria. Descripción de la muestra 54 médicos (GC = 28, GE = 26). Intervenciones Programa de formación MOTIVA en EM con un curso presencial inicial (16 h), seguido de actividades en línea durante 12 meses y reuniones presenciales (entrevistas basadas en problemas con feedback de expertos). Medidas principales las habilidades comunicativas en EM se evaluaron en base a videograbaciones (VG) con la escala EVEM 2.0, por parejas de revisores. Se analizaron 236 VG con pacientes estandarizados y 96 VG con pacientes reales. Resultados Los resultados promedio en la escala EVEM (hasta 56 puntos) al inicio del estudio fueron GE = 21,27 (IC 95% 15,8-26,7) y GC = 20,23 (IC95% 16,4-23,9) sin diferencias entre ambos grupos (p = 0,79). Después del curso, la puntuación GE aumentó en 13,89 puntos (P <0,001), promedio 35,16 (IC 95% 29,8-40,6). Las VG de pacientes reales en GE durante el periodo de 12 meses mantiene sus habilidades en EM con un promedio de 36,9 puntos (IC 95% 30,3-43,6) versus GC 15,9 puntos (IC 95% 9,8-22,0). Una vez finalizado el Programa de Formación MOTIVA, el GE mantiene las habilidades adquiridas: GE promedio final = 37.6 (IC 95% 33.2-41.1) versus GC = 24,3 (IC95% 19,0-29,2) (p <0,001). Conclusiones El Programa de Formación MOTIVA mejora significativamente las habilidades de entrevista motivacional, mejorando después de un curso presencial y actividades secuenciales de mantenimiento. La eficacia del programa ha sido probada en el tercer y cuarto escalón de la Pirámide de Miller

A Co-Design Process to Elaborate Educational Materials to Promote Appropriate Use of Antibiotics for Acute Lower Respiratory Tract Infections in Primary Healthcare in Catalonia (Spain)

Co-design processes with patients allow developing health education materials, that are adapted to the population's knowledge and use of language, to reduce inappropriate antibiotic use. This study presents a co-design process of educational material with patients (over 18 years old) with a previous diagnosis of acute lower respiratory tract infection. The co-design was framed within a qualitative study (Phase I, interviews; Phase II, focus group) conducted in Barcelona between April and September 2019. Twenty-nine semi-structured interviews were conducted. Six people participated in the focus group. Based on participants' narratives, educational materials can be useful to support healthcare consultations. Materials should be designed to be accessible in terms of the content and language used. The co-design of educational materials is essential for health promotion. This study presents an example of how materials can be co-developed with patients. The material elaborated in this study is being used for the ISAAC-CAT project and may be useful for future research, practice in health services and health policy

Measuring the quality of motivational interviewing in primary health care encounters: The development and validation of the motivational interviewing assessment scale (MIAS).

Motivational interviewing (MI) is a collaborative, goal-oriented method to help patients change behaviour. Tools that are often used to measure MI are the motivational interviewing skills code' (MISC), the 'motivational interviewing treatment integrity' (MITI) and the 'behaviour change counselling index' (BECCI). The first two instruments have not been designed to be used in primary healthcare (PHC) settings. The BECCI actually is time-consuming. The motivational interviewing assessment scale (MIAS, 'EVEM' in Spanish) was developed to measure MI in PHC encounters as an alternative to the previous instruments. To validate MIAS as an instrument to assess the quality of MI in PHC settings. (a) Sixteen experts in MI participated in the design, face and consensus validity, using a Delphi-type methodology. (b) 27 PHC centres located in Spain. four experts in MI tested its psychometric properties with 332 video recordings coming from the Dislip-EM study (consultations provided by 37 practitioners). dimensionality, internal consistency, reliability (intra-class correlation coefficient-ICC), sensitivity to change and convergent validity with the BECCI scale. A 14-item scale was obtained after the validation process. Factor analysis: two factors explained 76.6% of the total variance. Internal consistency, α = 0.99. Reliability: intra-rater ICC = 0.96; inter-rater ICC = 0.97. Sensitivity to change: means before and after training were 23.63 versus 38.57 (P  The MIAS is a consistent and reliable instrument to assess the use of MI in PHC settings. [Box: see text]

Additional file 1: of Effectiveness of motivational interviewing in patients with dyslipidemia: a randomized cluster trial

CONSORT 2010 checklist of information to include when reporting a cluster randomised trial. (DOC 131 kb