Toward an Emerging Role for Motivational Interviewing in Primary Care.

Purpose Of Review: Implementing Motivational Interviewing (MI) in primary care settings has been problematic due in part to persistent gaps in knowledge. Examples include poor understanding of how to effectively train persons to conduct MI, or of which aspects of MI-related communication are associated with better outcomes for patients. This review describes how recent research findings addressing the knowledge gaps support a growing role for MI in primary care.

Motivational interviewing improves depression outcome in primary care: A cluster randomized trial.

Objective: To examine the effects of Motivational Interviewing (MI) conducted by primary care providers on rates of improvement over time for depressive symptoms and remission among low-income patients with newly diagnosed Major Depressive Disorder.

Method: Ten care teams were randomized to MI with standard management of depression (MI-SMD; 4 teams, 10 providers, 88 patients) or SMD alone (6 teams, 16 providers, 80 patients). Patients were assessed at 6, 12 and 36 weeks with the Patient Health Questionnaire-9 (PHQ-9).

Training to use motivational interviewing techniques for depression: a cluster randomized trial.

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).

A qualitative comparison of primary care clinicians' and their patients' perspectives on achieving depression care: implications for improving outcomes.

Background: Improving the patient experience of primary care is a stated focus of efforts to transform primary care practices into "Patient-centered Medical Homes" (PCMH) in the United States, yet understanding and promoting what defines a positive experience from the patient's perspective has been de-emphasized relative to the development of technological and communication infrastructure at the PCMH. The objective of this qualitative study was to compare primary care clinicians' and their patients' perceptions of the patients' experiences, expectations and preferences as they try to achieve care for depression.

Methods: We interviewed 6 primary care clinicians along with 30 of their patients with a history of depressive disorder attending 4 small to medium-sized primary care practices from rural and urban settings.

Aspects of patient and clinician language predict adherence to antidepressant medication.

Objective: High-quality patient-clinician communication is associated with better medication adherence, but the specific language components associated with adherence are poorly understood. We examined how patient and clinician language may influence adherence.

Methods: We audio-recorded primary care encounters from 63 patients newly diagnosed with depression and prescribed an antidepressant medication.

Effects of emotional response on adherence to antihypertensive medication and blood pressure improvement.

Background. Developing interventions to improve medication adherence may depend upon discovery of novel behavioral risk factors for nonadherence. Objective.

An Association between Emotional Responsiveness and Smoking Behavior.

Introduction. Emotional responsiveness (ER) has been theorized to play a protective role in pathways to tobacco initiation, regular use, and dependence, yet a possible association between ER and smoking behavior has not been studied. Our aim was to test whether measuring ER to a neutral stimulus was associated with decreased odds of current smoking.

A moderator-mediator analysis of coronary heart disease mortality.

Objective: The purpose of this study is to better understand how risk factors for coronary heart disease (CHD) mortality may interact.

Methods: We conducted a moderator-mediator analysis of a representative national sample of 5027 and 2902 community-dwelling women and men in the first National Health and Nutrition Examination Survey free of CHD in 1982. The outcome was 10-year CHD mortality.

An association between negatively biased response to neutral stimuli and antidepressant nonadherence.

Objective: Our primary objective was to test whether negatively biased response to neutral physical or visual stimuli was associated with antidepressant nonadherence.

Methods: We surveyed 22 primary care adults receiving pharmacological treatment for depression. Somatoform complaints, in addition to interpretation of and response to neutral facial expressions (NFEs), were assessed with surveys.

RCT of a care manager intervention for major depression in primary care: 2-year costs for patients with physical vs psychological complaints.

Purpose: Depression care management for primary care patients results in sustained improvement in clinical outcomes with diminishing costs over time. Clinical benefits, however, are concentrated primarily in patients who report to their primary care clinicians psychological rather than exclusively physical symptoms. This study proposes to determine whether the intervention affects outpatient costs differentially when comparing patients who have psychological with patients who have physical complaints.

Does a depression intervention result in improved outcomes for patients presenting with physical symptoms?

Objective: To investigate the effects of exclusively physical presentation of depression on 1). depression management and outcomes under usual care conditions, and 2). the impact of an intervention to improve management and outcomes.

Parental attitudes about a pregnancy predict birth weight in a low-income population.

Background: Low birth weight remains the primary cause of neonatal morbidity and mortality in the United States. We examined whether maternal happiness about a pregnancy, in addition to her report of the father's happiness, predicts birth weight and risk for low birth weight (<2,500 g).

Methods: In this prospective cohort study, the mother's report of her and her partner's happiness about the pregnancy was measured before 21 weeks' gestation on a scale from 1 to 10 (1 to 3 unhappy, 4 to 7 ambivalent, or 8 to 10 happy).