Please cite this article as: Moral RR, Torres LAP, Ortega LP, Larumbe MC, Villalobos AR, García JAF, Rejano JMP, Effectiveness of motivational interviewing to improve therapeutic adherence in patients over 65 years old with chronic diseases: A cluster randomized clinical trial in primary care, Patient Education and Counseling (2015), http://dx.doi.org/10. 1016/j.pec.2015.03.008 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Page 1 of 28A c c e p t e d M a n u s c r i p t 1 1  The most common intervention used by doctors is to prescribe drugs.  Related to this is the problem of poor medication adherence.  Motivational Interviewing, is an interview style designed to promote behavioural changes.  Motivational Interviewing is a patient-centered methods that can be used to improve medication adherence en primary care.Page 2 proportion of subjects changing to adherence was 7.6% higher in the EG (p<0.001).Therapeutic adherence was higher for patients in the EG (OR=2.84), women (OR=0.24) and those with high educational levels (OR=3.93). Conclusion:A face-to-face motivational approach in primary care helps elderly patients with chronic diseases who are being treated by polypharmacy to achieve an improved level of treatment adherence than traditional strategies of providing information and advice.Practice Implications: MI is a patient-centered approach that can be used to improve medication adherence in primary care. Trial RegistrationThis trial is registered at ClinicalTrials.gov (NCT01291966).

The CICAA scale is a generic patient centered clinical communication evaluation tool that may be used in different clinical contexts and situations, since it has shown to be reliable, valid and efficient.

BackgroundClinical Practice Guidelines recommend using peripheral blood pulse measuring as a screening test for Atrial Fibrillation. However, there is no adequate evidence supporting the efficacy of such procedure in primary care clinical practice. This paper describes a study protocol designed to verify whether early opportunistic screening for Atrial Fibrillation by measuring blood pulse is more effective than regular practice in subjects aged 65 years attending primary care centers.Methods/designAn cluster-randomized controlled trial conducted in Primary Care Centers of the Spanish National Health Service. A total of 269 physicians and nurses will be allocated to one of the two arms of the trial by stratified randomization with a 3:2 ratio (three practitioners will be assigned to the Control Group for every two practitioners assigned to the Experimental Group). As many as 12 870 patients aged 65 years or older and meeting eligibility criteria will be recruited (8 580 will be allocated to the Experimental Group and 4 290 to the Control Group). Randomization and allocation to trial groups will be carried out by a central computer system. The Experimental Group practitioners will conduct an opportunistic case finding for patients with Atrial Fibrillation, while the Control Group practitioners will follow the regular guidelines. The first step will be finding new Atrial Fibrillation cases. A descriptive inferential analysis will be performed (bivariate and multivariate by multilevel logistic regression analysis).DiscussionIf our hypothesis is confirmed, we expect Primary Care professionals to take a more proactive approach and adopt a new protocol when a patient meeting the established screening criteria is identified. Finally, we expect this measure to be incorporated into Clinical Practice Guidelines.Trial registrationThe study is registered as NCT01291953 (ClinicalTrials.gob)

ResumenObjetivoEvaluar la efectividad de actividades formativas dirigidas a sanitarios de atención primaria sobre el manejo de pacientes con problemas de consumo de alcohol.DiseñoRevisión sistemática cualitativa de ensayos clínicos controlados aleatorizados.Fuentes de datosTrip Database, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, EMBASE, CINAHL, Web of Science, Scopus, Alcohol and Alcohol Problems Science Database–ETOH y FAMILY RESOURCES DATABASE. La búsqueda se realizó en junio de 2017.Selección de estudiosMuestra final n = 3. Se incluyeron: ensayos clínicos controlados aleatorizados, indexados hasta el 30 de mayo de 2017, con objetivo evaluar la efectividad de actividades formativas orientadas a profesionales de atención primaria en el abordaje de pacientes con problemas de consumo de alcohol.Extracción de datosLas medidas fueron expresadas en términos de efectividad de la aplicación de la actividad formativa: nivel de implementación global, cribado de consumo de alcohol, intervención de pacientes con consumo de riesgo y nivel de apoyo requerido.ResultadosTres ensayos clínicos controlados aleatorizados, publicados desde 1999 a 2004, fueron incluidos. Tanto el cribado, como las técnicas de intervención breve, experimentaron un incremento de su aplicación en los tres estudios, tras el desarrollo de los programas formativos. Se consiguieron resultados significativos en términos de efectividad en 2 de los 3 ensayos seleccionados, tanto en la detección de consumidores de riesgo, como en la intervención breve.ConclusiónEl desarrollo de programas formativos en el abordaje de pacientes con problemas de consumo de alcohol constituye una estrategia efectiva para los profesionales de atención primaria, permitiendo la implementación del cribado poblacional y de técnicas de intervención breve.