No abstract

BackgroundIt is known that making people change their habits is challenging. It is crucial to identify the most effective approach that general practitioners (GPs) should use to help their patients change unhealthy habits. The objective this study was to assess the efficacy of a multifactorial intervention based on Motivational Interviewing performed by general practitioners to enhance lipid levels in patients with dyslipidemia, as compared to standard care.MethodsA multicenter, controlled, randomized, cluster, two-parallel arm trial with a 12-month follow-up conducted in 25 community health centers of the Spanish. 38 GPs and 227 primary care patients with uncontrolled dyslipidemia were included in the trial. GPs performed an intervention based either on Motivational Interviewing (MI) or standard practice. Lipid levels were measured, and the control degree was analyzed based on the criteria of clinical guidelines.Results107 were assigned to the Experimental Group (EG) and 120 to the Control Group (CG). An overall improvement was achieved in total cholesterol levels (Mean Difference –MD- = −19.60; 95 % CI: −15.33 at −23.87 mg/dl; p < 0.001), LDL-cholesterol levels (MD = −13.78; 95 % CI: −9.77 at −17.79 mg/dl; p < 0.001) and triglycerides (MD = −19.14; CI 95 %: −11.29 at −26.99 mg/dl; p < 0.001). No differences were found between the two groups. However, when we assessed the degree of lipid control by combining cholesterol <200 mg/dl and LDL-cholesterol < 130 mg/dl parameters, it was observed that a higher percentage of patients achieved target figures in the EG versus CG (13.1 % vs. 5.0 %; adjusted OR = 5.77, 95 % CI: 1.67-19.91).ConclusionA Motivational Interviewing-based approach conducted by Primary Care physicians aimed at patients with dyslipidemia, achieved a significant reduction in all lipid parameters, cardiovascular risk, weight reduction and the adherence to the Mediterranean diet, similar to that obtained with the usual intervention and superior in the proportion of patients achieving combined lipid control goals and the level of physical exercise.Trial registrationthe trial is registered in ClinicalTrials.gov (NCT01282190; January 21, 2011).Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0370-2) contains supplementary material, which is available to authorized users.

OBJECTIVES:To know the patients' expectations and the fulfillment of these at family medicine consultations by resident doctors and to assess their effect on some consultation outcomes. DESIGN:A prospective cohort study. PARTICIPANTS:Patients attending family medicine consultations held by 38 resident doctors: 1,301 eligible patients, 702 filled in all questionnaires.MEASUREMENTS: Before each visit, the patients' expectations about that particular consultation were registered. Right after the visit was over, their perception of several aspects of the communicative interaction with the doctor was measured. Later, patients were interviewed on the phone to know how their expectations had been fulfilled, how satisfied they were about the consultation, how they had followed the doctor's suggestions, if they were going to seek further care for the same cause later, and the evolution of their clinical problem. Logistic regression was the main analysis used. RESULTS:The most common expectations were the doctor showing interest and listening (30.5%), getting some information about the diagnosis (16.3%), and sharing problems and doubts (11.1%). The rate of main expectations that were met was 76.5%. Satisfaction with the encounter was associated with the clinical evolution [odds ratio (OR) 2.23; confidence interval (CI): 1.32-3.75], and the fulfilling of the patients' main or two main expectations was significantly related to all the measured outcomes (satisfaction OR 3.51, CI: 1.73-7.8; adherence OR 1.80, CI: 1.11-2.92; clinical evolution OR 1.54, CI: 1.01-2.35; and seeking further care later OR 0.54, CI:0.36-0.81) CONCLUSIONS: Patients prioritize expectations of a more general sort when they attend primary care consultations and residents fulfill these acceptably. The fulfillment of expectations seems to affect the studied outcomes more than other factors.

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).