OBJECTIVE: Motivational Interviewing(MI) is an approach to helping patients discover their own resources for making positive, healthy and desired changes in their lives. It is a client-centered approach. MI involves a number of techniques that can be effectively learned and put into practice by primary healthcare practitioners. There are several studies of the effectiveness of MI in the addictions field out of which it grew, however, more and more clinicians are beginning to see the value of MI in medicine. Studies of MI used in healthcare are becoming more frequent. There is information about the techniques being used in HlV patients with extensive treatment regimens that are difficult to adhere to. It has also been used with tobacco dependent patients and those with chronic diseases that require regular treatment. There are fewer studies that have examined the effect of using MI in socioeconomically disadvantaged patient populations in primary care. These populations often face many obstacles to making healthy behavior changes, even simple ones. This study will investigate the use of MI in a community health center that serves the underinsured and uninsured.
STUDY DESIGN: Clinicians in the clinic were trained in MI through workshops and refresher courses. After an MI intervention during the medical interview, patients were . given a short oral survey to assess their perception of the MI approach used, their understanding of the visit,and how likely they were to make a behavior change. The data from the survey was analyzed to determine if the MI approach is one that primary care, patients would be receptive to and iiit aids understanding of the medical visit. Finally,. it was assessed whether a brief motivational interviewing approach had any positive effect on the willingness of patients to further consider a healthy behavior change.
RESULTS: Oral surveys were completed by 53 men and women over a month-long period. 69.8% of patients did not perceive much difference between the Motivational Interviewing visit and past medical visits. However, 39.6% of patients felt that talking with thehealthcare provider was easier during this visit than in past medical visits at this or other clinics. 56.6% of patients stated that they had felt at some time that a healthcare provider did not listen to them. However, with the MI visit, 54.7% felt that there was equal talking and listening between the provider and themselves, while only 28.3% felt that the provider talked more than they did. When asked about understanding, 50.9% of patients reported feeling that they don't always understand everything said by providers during medical visits, yet 98.1 % of patients stated they understood most, if not all of what was said during the.MI visit. Of 53 patients, 66% discussed healthy changes that they wanted to make with their provider and 100% of these came up with tools together with the provider for making the change. Behavior change was related to a wide variety of topics.
CONCLUSION: Motivational Interviewing is possible to work into a primary care visit and does seem to lead to improved patient understanding of medical visits. It is also associated with discussions about change and leads to talk about tools and ideas to make changes in the majority of cases. It can be successfully used in a variety of situations in primary care in a socioeconomically disadvantaged population.
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