Moving from "let's fix them" to "actually listen": the development of a primary care intervention for mental-physical multimorbidity.

BACKGROUND: Effective person-centred interventions are needed to support people living with mental-physical multimorbidity to achieve better health and wellbeing outcomes. Depression is identified as the most common mental health condition co-occurring with a physical health condition and is the focus of this intervention development study. The aim of this study is to identify the key components needed for an effective intervention based on a clear theoretical foundation, consideration of how motivational interviewing can inform the intervention, clinical guidelines to date, and the insights of primary care nurses. METHODS: A multimethod approach to intervention development involving review and integration of the theoretical principles of Theory of Planned Behavior and the patient-centred clinical skills of motivational interviewing, review of the expert consensus clinical guidelines for multimorbidity, and incorporation of a thematic analysis of group interviews with Australian nurses about their perspectives of what is needed in intervention to support people living with mental-physical multimorbidity. RESULTS: Three mechanisms emerged from the review of theory, guidelines and practitioner perspective; the intervention needs to actively 'engage' patients through the development of a collaborative and empathic relationship, 'focus' on the patient's priorities, and 'empower' people to make behaviour change. CONCLUSION: The outcome of the present study is a fully described primary care intervention for people living with mental-physical multimorbidity, with a particular focus on people living with depression and a physical health condition. It builds on theory, expert consensus guidelines and clinician perspective, and is to be tested in a clinical trial.

Do GPs use motivational interviewing skills in routine consultations with patients living with mental-physical multimorbidity? An observational study of primary care in Scotland.

OBJECTIVES: To examine whether motivational interviewing is used by GPs in consultations with patients living with mental-physical multimorbidity. METHODS: Secondary analysis of selected videos from an existing database of routine general practice consultations with adult patients in Glasgow, Scotland. Consultations involving patients with mental-physical multimorbidity were selected and coded using the Motivational Interviewing Treatment Integrity (MITI) coding system. RESULTS: Sixty consultations were coded involving 32 GPs across 16 practices. Mean consultation length was 9.9 min. On average GPs asked 1.7 questions per minute and offered 1.2 pieces of information per minute. Using the MITI, five GPs met beginner proficiency for the relational global qualities of partnership and empathy; however, none of the GPs met beginner proficiency for the technical global rating of efforts made to encourage patients to discuss behaviour change. Simple reflections were observed in 67% of consultations and complex reflections in 28% of consultations. Confrontation, a technique inconsistent with motivational interviewing, was observed in 18% of consultations. DISCUSSION: MI was not evident in these consultations with patients living with mental-physical multimorbidity. This study provides information about the baseline motivational interviewing-consistent skills of GPs working with multimorbid patients and may be helpful in informing motivational interviewing training efforts and future research.

Guiding patients through complexity: Motivational interviewing for patients with multimorbidity

BACKGROUND: Multimorbidity is an increasing and complex issue in Australian general practice. General practitioners (GPs) face the challenge of navigating multiple potential intervention pathways. Emerging guidelines for multimorbidity recommend patient-centred care and addressing the lifestyle factors of the patient. Motivational interviewing is a patient-centred approach that is focused on behavioural change and effective across a range of lifestyle factors. OBJECTIVE: The aim of this article is to provide a practical introduction to motivational interviewing skills that may be helpful in working with patients who have multimorbidity. Key skills discussed in this article include agenda setting, giving advice, responding to resistance, and asking questions to evoke a patient’s own motivation for change. DISCUSSION: GPs are ideally placed to assist patients with multimorbidity to navigate recommendations and identify which recommendations will work. Navigating complexity is at the heart of general practice, and multimorbidity demands more than an ‘assess-and-advise’ model of care. Motivational interviewing provides a promising and readily applicable framework to empower patients living with multimorbidity.

A systematic review of motivational interviewing in healthcare: the potential of motivational interviewing to address the lifestyle factors relevant to multimorbidity.

Internationally, health systems face an increasing demand for services from people living with multimorbidity. Multimorbidity is often associated with high levels of treatment burden. Targeting lifestyle factors that impact across multiple conditions may promote quality of life and better health outcomes for people with multimorbidity. Motivational interviewing (MI) has been studied as one approach to supporting lifestyle behaviour change. A systematic review was conducted to assess the effectiveness of MI in healthcare settings and to consider its relevance for multimorbidity. Twelve meta-analyses pertinent to multimorbidity lifestyle factors were identified. As an intervention, MI has been found to have a small-to-medium statistically significant effect across a wide variety of single diseases and for a range of behavioural outcomes. This review highlights the need for specific research into the application of MI to determine if the benefits of MI seen with single diseases are also present in the context of multimorbidity.

Effect of a low-resource-intensive lifestyle modification program incorporating gymnasium-based and home-based resistance training on type 2 diabetes risk in Australian adults.

OBJECTIVE: The purpose of this study was to assess the effectiveness of a low-resource-intensive lifestyle modification program incorporating resistance training and to compare a gymnasium-based with a home-based resistance training program on diabetes diagnosis status and risk. RESEARCH DESIGN AND METHODS: A quasi-experimental two-group study was undertaken with 122 participants with diabetes risk factors; 36.9% had impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) at baseline. The intervention included a 6-week group self-management education program, a gymnasium-based or home-based 12-week resistance training program, and a 34-week maintenance program. Fasting plasma glucose (FPG) and 2-h plasma glucose, blood lipids, blood pressure, body composition, physical activity, and diet were assessed at baseline and week 52. RESULTS: Mean 2-h plasma glucose and FPG fell by 0.34 mmol/l (95% CI -0.60 to -0.08) and 0.15 mmol/l (-0.23 to -0.07), respectively. The proportion of participants with IFG or IGT decreased from 36.9 to 23.0% (P = 0.006). Mean weight loss was 4.07 kg (-4.99 to -3.15). The only significant difference between resistance training groups was a greater reduction in systolic blood pressure for the gymnasium-based group (P = 0.008). CONCLUSIONS: This intervention significantly improved diabetes diagnostic status and reduced diabetes risk to a degree comparable to that of other low-resource-intensive lifestyle modification programs and more intensive interventions applied to individuals with IGT. The effects of home-based and gymnasium-based resistance training did not differ significantly.