Effectiveness of a training program for the management of risky alcohol use in primary care professionals based on motivational interviewing / Eficacia de un programa de formación para el manejo del consumo de riesgo de alcohol en profesionales de atención primaria basado en la entrevista motivacional

Objective: To assess the effectiveness of a training program for Primary Care (PC) professionals developed to increase knowledge, attitudes, and skills for managing patients with risky alcohol use and in the motivational interview. Design: Multicenter, two-arm parallel, randomized, open-label controlled clinical trial. Setting: PC of the Andalusian Health Service. Participants: The study was completed by 80 healthcare professionals from 31 PC centers. Interventions: In both experimental and control groups, a workshop on managing patients with risky alcohol consumption and the resolution of two videotaped clinical cases with standardized patients were conducted. The experimental group attended a workshop on motivational interviewing. Main measurements: Knowledge about managing risky alcohol use, clinical performance in patients with this health problem, and assessment of the motivational interview. Results: Mean age was 39.50±13.06 – SD – (95% CI: 36.59–42.41); 71.3% (95% CI: 61.1–80.9%) were women. The average score of both groups in the knowledge questionnaire before the training program was 15.10±4.66, becoming 21.99±3.93 points after the training (95% CI: 5.70–7.92; p<0.001). The experimental group showed an average score of 18.53±13.23 before the intervention with the motivational interview and 28.33±11.86 after this intervention (p=0.002). In contrast, no significant variation was found in the score of the control group. Conclusions: A training program aimed at PC professionals designed to increase knowledge on how to manage risky alcohol use and acquire communication skills in motivational interviewing is effective.(AU)

Objetivo: Evaluar la efectividad de un programa de formación para profesionales de Atención Primaria (AP) para incrementar conocimientos, actitudes y habilidades en el manejo de pacientes con consumo de riesgo de alcohol y en la entrevista motivacional. Diseño: Ensayo clínico controlado, abierto, aleatorizado, multicéntrico, paralelo de dos brazos. Emplazamiento: Centros de AP del Servicio Andaluz de Salud. Participantes: Fue completado por 80 profesionales sanitarios de 31 centros. Intervenciones: En el grupo experimental y en el control se realizó un taller de manejo de pacientes con consumo de riesgo de alcohol y la resolución de dos casos clínicos videograbados con pacientes estandarizados. El grupo experimental asistió a un taller sobre entrevista motivacional. Mediciones principales: Conocimiento sobre el manejo del consumo de riesgo de alcohol, desempeño clínico en pacientes con este problema de salud y valoración de la entrevista motivacional. Resultados: La edad media fue 39.50±13,06 -DE- (IC 95%: 36,59-42,41); El 71,3% (IC 95%: 61,1%-80,9%) eran mujeres. La puntuación media en el cuestionario de conocimientos antes del programa de formación fue de 15,10±4,66, siendo 21,99±3,93 puntos después del entrenamiento (IC 95%:5,70-7,92; p<0,001). La puntuación promedio del grupo experimental antes de la intervención con la entrevista motivacional era de 18,53±13,23 y después de 28,33±11,86 (p=0,002). No se encontró variación significativa en la puntuación del grupo control. Conclusiones: Un programa de formación para profesionales de AP, para incrementar el conocimiento sobre cómo gestionar el consumo de riesgo de alcohol y adquirir habilidades comunicativas en la entrevista motivacional es efectivo.(AU)

Primary Care Professionals' Empathy and Its Relationship to Approaching Patients with Risky Alcohol Consumption.

The aim of this study was to estimate the level of empathy among primary care (PC) health professionals and its relationship with their approach to patients at risk due to alcohol consumption. This is an observational, descriptive, and multicenter study that included 80 PHC professionals. The professionals completed a questionnaire comprising socio-occupational questions and inquiries regarding their actions when dealing with patients suspected of risky alcohol consumption. The Jefferson Scale of Empathy was used to measure their level of empathy and was completed by 80 professionals, of whom 57.5% were family physicians, 10% were nurses, and 32.5% were family- and community-medicine residents. The mean age was 39.5 ± 13.1 (SD) (range of 24-65 years) and 71.3% were females. The mean empathy level score was 112.9 ± 11.1 (95% CI: 110.4-115.4; range: 81-132 points). Actions that stood out for their frequency were providing health advice in the general population, offering advice to pregnant women, and recommending abstinence to users of hazardous machinery or motor vehicles. The level of empathy was associated with age (p = 0.029), the health center's scope (p = 0.044), systematic alcohol exploration (p = 0.034), and follow-ups for patients diagnosed with risky consumption (p = 0.037). The mean score obtained indicated a high level of empathy among professionals. Professionals with greater empathy more frequently conducted systematic screening for risky alcohol consumption.

Effectiveness of a training program for the management of risky alcohol use in primary care professionals based on motivational interviewing.

OBJECTIVE: To assess the effectiveness of a training program for Primary Care (PC) professionals developed to increase knowledge, attitudes, and skills for managing patients with risky alcohol use and in the motivational interview. DESIGN: Multicenter, two-arm parallel, randomized, open-label controlled clinical trial. SETTING: PC of the Andalusian Health Service. PARTICIPANTS: The study was completed by 80 healthcare professionals from 31 PC centers. INTERVENTIONS: In both experimental and control groups, a workshop on managing patients with risky alcohol consumption and the resolution of two videotaped clinical cases with standardized patients were conducted. The experimental group attended a workshop on motivational interviewing. MAIN MEASUREMENTS: Knowledge about managing risky alcohol use, clinical performance in patients with this health problem, and assessment of the motivational interview. RESULTS: Mean age was 39.50±13.06 - SD - (95% CI: 36.59-42.41); 71.3% (95% CI: 61.1-80.9%) were women. The average score of both groups in the knowledge questionnaire before the training program was 15.10±4.66, becoming 21.99±3.93 points after the training (95% CI: 5.70-7.92; p<0.001). The experimental group showed an average score of 18.53±13.23 before the intervention with the motivational interview and 28.33±11.86 after this intervention (p=0.002). In contrast, no significant variation was found in the score of the control group. CONCLUSIONS: A training program aimed at PC professionals designed to increase knowledge on how to manage risky alcohol use and acquire communication skills in motivational interviewing is effective.

Effectiveness of a brief motivational intervention in the management of risky alcohol use in primary care: ALCO-AP20 study protocol.

Background: Motivational interviewing (MI) could be a method for minimizing alcohol-related harm. The study aims to assess the effectiveness of a brief intervention, based on a MI, in patients with risky alcohol use attended in Primary Care (PC). Materials and methods: A cluster-randomized, two-arm parallel, multicenter, open-label, controlled clinical trial. Fifty PC healthcare professionals from the province of Córdoba (Spain) will be randomized to one of the two study groups: (1) Experimental Group (EG): MI-based approach; (2) Control Group (CG): Usual care based on health advice. EG intervention: Professionals will receive a training program focused on MI, consisting of a training workshop and the use of pre- and post-workshop questionnaires to measure knowledge and skills acquired, as well as the degree of empathy, with a videotape of the health professionals with standardized patients, before and after the workshop, and subsequent training feedback. CG intervention: Workshop on the management of risky alcohol use based on health advice; participants will also complete the pre-and post-workshop questionnaires and be videotaped. Study population: Patients ≥ 14 years old with risky alcohol consumption (28 Standard Drink Units-SDU-/week in men and 17 SDU/week in women) or excessive alcohol use (≥ 6 SDU in men or ≥ 4 SDU in women, in less than 2 h). It would be necessary to include 110 subjects/group to find a difference of 20% between the percentage of patients in abstinence between EG (37%) and CG (20%), alpha error of 5%, and statistical power of 80%. Assuming a loss rate of 5% and the cluster design effect, the number of subjects to be recruited is estimated at 197/group. The follow-up period will be 12 months. The primary outcome variables will be the self-reported alcohol use level and the Alcohol Use Disorders Identification Test (AUDIT) questionnaire score. Discussion: The study aims to demonstrate the effectiveness of the motivational approach in the comprehensive treatment of the patient with risky alcohol use, improving the empathy of the healthcare professionals and strengthening the healthcare professional-patient relationship to achieve the behavioral change of the patients with this problem in primary care consultations. Clinical trial registration: ClinicalTrials.gov.

Mindfulness in primary care healthcare and teaching professionals and its relationship with stress at work: a multicentric cross-sectional study.

BACKGROUND: Work stress is a common problem among the health personnel of the Spanish National Health System. The objective of this paper is to assess the state of mindfulness among Spanish primary care providers and to evaluate its potential relationship with work stress and basic labor and sociodemographic characteristics. METHODS: Cross-sectional, multi-centric study. Primary care nurses, teachers, teaching collaborators and residents assigned to six Spanish Family Medicine/Family and Community Care Departments were invited to participate (n = 475). A template was designed in Google Forms, including sociodemographic and work-related variables. The state of mindfulness was measured with the Five Facet Mindfulness Questionnaire (FFMQ), while work-related stress was measured using an ordinal scale ranging from 0 to 10 points. Descriptive and inferential statistical analyses were carried out, as well as bivariate and multivariate statistics. RESULTS: The mean age of participants was 40,14 ± 13.12 (range:23-65 years); 66.9% were women, 42.5% internal medicine residents, 29.3% family physicians, and 20.2% nurses. More than half (54.5%) knew about mindfulness, with 24.0% have received training on it, and 22.5% were usual practitioners. The average level of mindfulness was 127.18 ± 15.45 (range: 89-177). The average score of stress at work was 6.00 ± 2.44; 49.9% (range: 0-10). 49.9% of participants scored 7 or more on the stress at work scale. There was an inverse correlation between the levels of mindfulness (FFMQ total score) and work-related stress (Spearman's r = - 0.155, p = 0.003). Significant relationships between the mindfulness practice and the level of mindfulness (F = 29.80, p < 0.001), as well as between the mindfulness practice and the level of work-related stress (F = 9.68, p = 0.042), were also found. CONCLUSIONS: Levels of mindfulness in primary care health providers were in line with those levels observed in other groups of health professionals. Half of all of the primary care providers suffered from a high degree of stress. Although weak, inverse relationships were observed between levels of mindfulness and stress at work, with lower values of stress at work among those who practiced mindfulness. TRIAL REGISTRATION: NCT03629457 .