This pilot project proposes to train practitioners in community health clinics to a unique level of excellence in their care for patients with chronic illness. Practitioners need skills not included in their usual training but highly warranted for working with patients, particularly those who are minority and indigent. These patients suffer from complex problems of living as well as from complex problems of health — typically several chronic illnesses at once. There are several factors that may inhibit providers’ use of behavioral interventions in their practices, including lack of knowledge, lack of confidence in detecting and managing risk behaviors, and fear of alienating patients.

In this collaboration between UTMB and UT-Austin investigators, we will develop and evaluate a systematic approach for teaching social workers, nurses and resident physicians to use evidence-based brief motivational interventions in community settings. The interventions will focus on alcohol and other drug misuse, diet, exercise, and medication adherence. In addition to teaching practitioners to use these interventions, we will also monitor their adherence to the training protocols and assess changes in their readiness, self-efficacy, and decisional balance considerations for using this approach. We will also evaluate practitioners’ use of brief motivational interventions by assessing outcomes in a small subset of patients through exit interviews, electronic chart reviews and three-month follow-up telephone interviews.

A total of six practitioners will be selected from each of three disciplines: social work, nursing, and medicine (two from each discipline). These practitioners will receive: 1) comprehensive training in MI and brief interventions; 2) practice sessions with standardized patients following completion of initial training; and 3) assessment of specialists’ MI and brief intervention through on-site observation, feedback, and coaching sessions throughout the project. Once trained, the practitioners will pilot the brief intervention with a total of 12 patients. We will use pre and post training questionnaires based on constructs from the Transtheoretical Model of Change to measure practitioner motivation, perceived importance and self-efficacy in performing the intervention. We will also conduct focus groups to assess key barriers to implementation and continuation of interventions in their usual practices. Patient acceptance of the intervention will be assessed through exit interviews, and behavior change outcomes will be assessed via telephone at three month follow-up.

The University of Texas Medical Branch, Galveston