title: Training to use motivational interviewing techniques for depression: a cluster randomized trial.
abstract: OBJECTIVE
  The goal of this study was to assess the effects of training primary care providers (PCPs) to use Motivational Interviewing (MI) when treating depressed patients on providers' MI performance and patients' expressions of interest in depression treatment ("change talk") and short-term treatment adherence.
  
  
  METHODS
  This was a cluster randomized trial in urban primary care clinics (3 intervention, 4 control). We recruited 21 PCPs (10 intervention, 11 control) and 171 English-speaking patients with newly diagnosed depression (85 intervention, 86 control). MI training included a baseline and up to 2 refresher classroom trainings, along with feedback on audiotaped patient encounters. We report summary measures of technical (rate of MI-consistent statements per 10 minutes during encounters) and relational (global rating of "MI Spirit") MI performance, the association between MI performance and number of MI trainings attended (0, 1, 2, or 3), and rates of patient change talk regarding depression treatments (physical activity, antidepressant medication). We report PCP use of physical activity recommendations and antidepressant prescriptions and patients' short-term physical activity level and prescription fill rates.
  
  
  RESULTS
  Use of MI-consistent statements was 26% higher for MI-trained versus control PCPs (P = .005). PCPs attending all 3 MI trainings (n = 6) had 38% higher use of MI-consistent statements (P < .001) and were over 5 times more likely to show beginning proficiency in MI Spirit (P = .036) relative to control PCPs. Although PCPs' use of physical activity recommendations and antidepressant prescriptions was not significantly different by randomization arm, patients seen by MI-trained PCPs had more frequent change talk (P = .001). Patients of MI-trained PCPs also expressed change talk about physical activity 3 times more frequently (P = .01) and reported more physical activity (3.05 vs 1.84 days in the week after the visit; P = .007) than their counterparts visiting untrained PCPs. Change talk about antidepressant medication and fill rates were similar by randomization arm (P > .05 for both).
  
  
  CONCLUSIONS
  MI training resulted in improved MI performance, more depression-related patient change talk, and better short-term adherence.
authors.affiliation: From the Department of Family Medicine (RDK, CE, FdG), the Department of Internal Medicine (DB), the Department of Psychiatry (MT), and the Department of Health and Behavioral Sciences (SK), University of Colorado, Denver; Denver Health, Denver, CO (RDK, DB, ME); the Department of Psychology, Fort Lewis College, Durango, CO (BLB); the Department of Psychology and Neuroscience, University of Colorado, Boulder (SD); and Emory University School of Medicine (JK). robert.keeley@ucdenver.edu.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Keeley
authors.affiliation: From the Department of Family Medicine (RDK, CE, FdG), the Department of Internal Medicine (DB), the Department of Psychiatry (MT), and the Department of Health and Behavioral Sciences (SK), University of Colorado, Denver; Denver Health, Denver, CO (RDK, DB, ME); the Department of Psychology, Fort Lewis College, Durango, CO (BLB); the Department of Psychology and Neuroscience, University of Colorado, Boulder (SD); and Emory University School of Medicine (JK).
authors.forename: Brian L
authors.initials: BL
authors.lastname: Burke
authors.affiliation: From the Department of Family Medicine (RDK, CE, FdG), the Department of Internal Medicine (DB), the Department of Psychiatry (MT), and the Department of Health and Behavioral Sciences (SK), University of Colorado, Denver; Denver Health, Denver, CO (RDK, DB, ME); the Department of Psychology, Fort Lewis College, Durango, CO (BLB); the Department of Psychology and Neuroscience, University of Colorado, Boulder (SD); and Emory University School of Medicine (JK).
authors.forename: David
authors.initials: D
authors.lastname: Brody
authors.affiliation: From the Department of Family Medicine (RDK, CE, FdG), the Department of Internal Medicine (DB), the Department of Psychiatry (MT), and the Department of Health and Behavioral Sciences (SK), University of Colorado, Denver; Denver Health, Denver, CO (RDK, DB, ME); the Department of Psychology, Fort Lewis College, Durango, CO (BLB); the Department of Psychology and Neuroscience, University of Colorado, Boulder (SD); and Emory University School of Medicine (JK).
authors.forename: Sona
authors.initials: S
authors.lastname: Dimidjian
authors.affiliation: From the Department of Family Medicine (RDK, CE, FdG), the Department of Internal Medicine (DB), the Department of Psychiatry (MT), and the Department of Health and Behavioral Sciences (SK), University of Colorado, Denver; Denver Health, Denver, CO (RDK, DB, ME); the Department of Psychology, Fort Lewis College, Durango, CO (BLB); the Department of Psychology and Neuroscience, University of Colorado, Boulder (SD); and Emory University School of Medicine (JK).
authors.forename: Matthew
authors.initials: M
authors.lastname: Engel
authors.affiliation: From the Department of Family Medicine (RDK, CE, FdG), the Department of Internal Medicine (DB), the Department of Psychiatry (MT), and the Department of Health and Behavioral Sciences (SK), University of Colorado, Denver; Denver Health, Denver, CO (RDK, DB, ME); the Department of Psychology, Fort Lewis College, Durango, CO (BLB); the Department of Psychology and Neuroscience, University of Colorado, Boulder (SD); and Emory University School of Medicine (JK).
authors.forename: Caroline
authors.initials: C
authors.lastname: Emsermann
authors.affiliation: From the Department of Family Medicine (RDK, CE, FdG), the Department of Internal Medicine (DB), the Department of Psychiatry (MT), and the Department of Health and Behavioral Sciences (SK), University of Colorado, Denver; Denver Health, Denver, CO (RDK, DB, ME); the Department of Psychology, Fort Lewis College, Durango, CO (BLB); the Department of Psychology and Neuroscience, University of Colorado, Boulder (SD); and Emory University School of Medicine (JK).
authors.forename: Frank
authors.initials: F
authors.lastname: deGruy
authors.affiliation: From the Department of Family Medicine (RDK, CE, FdG), the Department of Internal Medicine (DB), the Department of Psychiatry (MT), and the Department of Health and Behavioral Sciences (SK), University of Colorado, Denver; Denver Health, Denver, CO (RDK, DB, ME); the Department of Psychology, Fort Lewis College, Durango, CO (BLB); the Department of Psychology and Neuroscience, University of Colorado, Boulder (SD); and Emory University School of Medicine (JK).
authors.forename: Marshall
authors.initials: M
authors.lastname: Thomas
authors.affiliation: From the Department of Family Medicine (RDK, CE, FdG), the Department of Internal Medicine (DB), the Department of Psychiatry (MT), and the Department of Health and Behavioral Sciences (SK), University of Colorado, Denver; Denver Health, Denver, CO (RDK, DB, ME); the Department of Psychology, Fort Lewis College, Durango, CO (BLB); the Department of Psychology and Neuroscience, University of Colorado, Boulder (SD); and Emory University School of Medicine (JK).
authors.forename: Ernesto
authors.initials: E
authors.lastname: Moralez
authors.affiliation: From the Department of Family Medicine (RDK, CE, FdG), the Department of Internal Medicine (DB), the Department of Psychiatry (MT), and the Department of Health and Behavioral Sciences (SK), University of Colorado, Denver; Denver Health, Denver, CO (RDK, DB, ME); the Department of Psychology, Fort Lewis College, Durango, CO (BLB); the Department of Psychology and Neuroscience, University of Colorado, Boulder (SD); and Emory University School of Medicine (JK).
authors.forename: Steve
authors.initials: S
authors.lastname: Koester
authors.affiliation: From the Department of Family Medicine (RDK, CE, FdG), the Department of Internal Medicine (DB), the Department of Psychiatry (MT), and the Department of Health and Behavioral Sciences (SK), University of Colorado, Denver; Denver Health, Denver, CO (RDK, DB, ME); the Department of Psychology, Fort Lewis College, Durango, CO (BLB); the Department of Psychology and Neuroscience, University of Colorado, Boulder (SD); and Emory University School of Medicine (JK).
authors.forename: Jessica
authors.initials: J
authors.lastname: Kaplan
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D016000:Cluster Analysis; D003865:Major Depressive Disorder / Q000628:therapy*; D004502:Education, Medical, Continuing / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D009043:Motor Activity; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance / Q000706:statistics & numerical data*; D058007:Physicians, Primary Care / Q000193:education*; D011320:Primary Health Care / Q000379:methods*; D013637:Tape Recording; D019037:Urban Health Services
chemical_list: D000928:Antidepressive Agents
keywords: Depressive Disorder; Medical Education; Motivational Interviewing; Patient Adherence; Randomized Controlled Trial