1. Can Primary Care Physicians Learn and Adopt Brief Motivational Interviewing Techniques in their Practice?
Alan Adelman, MD, MS
David Richard, MD
Robert Gabbay, MD, PhD
Deborah Van Horn, PhD
Marie Graybill, RN
Allen Kunselman, MA

2. Supported through a grant from NIDDK
Penn State Hershey
NIDDK

3. Context
Brief motivational interviewing (BMI) is a patient-centered approach to behavior change counseling
Adapted from MI because of time constraints of medical encounter
Proposed as a behavioral change counseling method that utilizes specific techniques germane to a primary care practice
Mixed results in the literature

4. Research Aims Can practicing primary care clinicians learn BMI?
Will practicing primary care clinicians adopt this counseling technique into their practice?
Can a practicing primary care clinician who uses this counseling technique have an impact on diabetes outcomes?

5. Methods
Recruited 24 clinicians from the Penn State Ambulatory Research Network
Randomized by office to intervention/control
12 Month training program

6. Methods Pre-evaluation Post-evaluation
Audio-taped baseline encounters with participant-selected established patient with DM2
Post-evaluation
Control – audiotaped encounters with participant-selected established patient with DM2
Intervention – 2 unannounced visits by standardized patients – scenario new patient with DM2
Tapes rated using BECCI and MITI scales

7. Measures of MI Fidelity
Motivational Interviewing Treatment Integrity (MITI)
Behaviour Change Counselling Index (BECCI)

8. Training 3 hour workshops at baseline and 3 months
1 hour sessions at 1, 2, 4, 5, 6, 9 and 12 months
Submission of 2 audiotaped encounters with particpant-selected patients before each training session – rated using BECCI and MITI with personalized feedback
Motivational Interviewing in Health Care – Helping Patients Change Behavior by Rollnick, Miller & Butler

9. Skills
Open-ended questions, affirmative/reflective/summary statements (OARS)
Assessing Importance/Confidence
Decision Balance
Elicit-Provide-Elicit
Action Planning

10. Results

11. Population 21 physicians completed – 11 intervention, 10 control
Specialty – 2 internists, 19 family physicians
Experience - several years to > 20 years post residency

12. BECCI Change in Measure Intervention Control P-value BECCI 0.82 0.10
0.019
BECCI-Speak
0.38
-0.04
0.306

13. MITI Change in Measure Intervention Control P-value Global Spirit 1.17
0.31
0.037
% Complex Reflections
14.18
-1.74
0.086
% Open Questions
-5.22
0.82
0.180
Reflection to Question Ratio
0.09
0.00
0.502

14. MITI Change in Measure Intervention Control P-value % MI Adherent
19.20
9.41
0.425
MITI Direction
0.61
-0.20
0.014
MITI Empathy
1.28
0.14
MITI Information Giving
9.39
6.86
0.600

15. Conclusions Can primary care physicians learn BMI – yes, but….
The skill of Reflection may take longer to master
Will primary care physicians adopt into their practice – yes in the short term
Can a practicing primary care clinician who uses BMI have an impact on diabetes outcomes? – Remains an unanswered question

16. Limitations Small numbers – this was a pilot study
Measuring MI fidelity
Not well suited for a clinical encounter
No clear standards for primary care
No clear threshold

17. Questions?