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Journal of General Internal Medicine

, Volume 34, Issue 11, pp 2520–2529 | Cite as

Implementing Motivational Interviewing for Substance Misuse on Medical Inpatient Units: a Randomized Controlled Trial

  • Steve MartinoEmail author
  • Paula Zimbrean
  • Ariadna Forray
  • Joy S. Kaufman
  • Paul H. Desan
  • Todd A. Olmstead
  • Kathryn Gilstad-Hayden
  • Ralitza Gueorguieva
  • Kimberly A. Yonkers
Original Research

Abstract

Background

General medical hospitals provide care for a disproportionate share of patients who misuse substances. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance misuse.

Objective

To determine the effectiveness of three strategies for implementing motivational interviewing for substance misuse with general medical inpatients.

Design

Type 3 hybrid effectiveness-implementation randomized controlled trial (Clinical Trials.gov: NCT01825057).

Participants

Thirty-eight providers (physicians, physician assistants, nurses) from 13 general medical inpatient services, and 1173 of their patients admitted to an academically affiliated acute care hospital.

Interventions

Implementation strategies included (1) a continuing medical education workshop on detection of substance misuse and provision of a motivational interview; (2) workshop plus bedside supervision (apprenticeship condition); and (3) a workshop plus ability to place a medical order for an interview from a consultation-liaison service (consult condition).

Main Measures

Primary outcomes were the percentage of study-eligible patients who received an interview for substance misuse and the integrity (adherence, competence) of the interviews. The secondary outcome was the percent of patient statements within the interviews that indicated motivation for reducing substance misuse.

Key Results

20.5% of patients in the consult condition received an interview, compared to 0.8% (Hedge’s g = 1.49) and 3.0% (Hedge’s g = 1.26) in the respective workshop only and apprenticeship conditions (p < 0.001). Motivational interviews in the consult condition were performed with more fundamental motivational interviewing adherence and competence than the other conditions. Most statements made by patients during the interviews favored reducing substance misuse, with no differences between conditions.

Conclusions

Providers’ ability to place an order to have experts from the consultation-liaison service deliver a motivational interview was a more effective implementation strategy than a workshop or apprenticeship method for ensuring motivational interviewing is available to medical inpatients who misuse substances.

Trial Registry

NCT01825057

KEY WORDS

behavioral science consultation implementation research substance abuse 

Notes

Acknowledgments

The authors wish to thank the medical providers at the medical hospital where the study was conducted. We also would like to thank Victor Morris, Will Cushing, Jose Salvana, and Scott Sussman for the work they have done in support of the project. Finally, we want to acknowledge our research staff (Rebecca Aldi, Monica Canning-Ball, Heather Howell, Jessica Katon, Ashley McCaherty, and Jonathan Ryan) for their efforts to implement this trial with integrity.

Funding Information

The National Institute on Drug Abuse funded the study (R01 DA034243). The content of this manuscript solely reflects the authors’ views and not those of the funding agency or the authors’ institutional affiliates.

Compliance with Ethical Standards

The Yale University Human Investigation Committee approved the study (ClinicalTrials.gov (NCT01825057). We screened interested providers and obtained written informed consent alongside baseline assessments. Research assistants (RAs) screened and obtained written informed consent from eligible and interested patients.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Copyright information

© Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2019

Authors and Affiliations

  • Steve Martino
    • 1
    • 2
    Email author
  • Paula Zimbrean
    • 1
  • Ariadna Forray
    • 1
  • Joy S. Kaufman
    • 1
  • Paul H. Desan
    • 1
  • Todd A. Olmstead
    • 3
  • Kathryn Gilstad-Hayden
    • 1
  • Ralitza Gueorguieva
    • 4
  • Kimberly A. Yonkers
    • 1
  1. 1.Department of PsychiatryYale University School of MedicineNew HavenUSA
  2. 2.Psychology Service VA Connecticut Healthcare SystemWest HavenUSA
  3. 3.Lyndon B. Johnson School of Public AffairsThe University of Texas at AustinAustinUSA
  4. 4.Department of BiostatisticsYale University School of Public HealthNew HavenUSA

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