Terri Lavery (Janssen Inc); Loys Ligate (Early Psychosis Intervention Program of Waterloo, Wellington, Dufferin and Grand Valley)

Objective

To evaluate the use of interactive workshops with Canadian psychiatrists to impart knowledge and skills around motivational interviewing, with the goal of improving patients’ acceptance of treatment for schizophrenia, in particular long-acting injectables (LAIs), early in the course of illness

Background

Despite recent evidence that demonstrates the potential benefits of LAIs for early episode patients,1 clinicians often reserve the use of LAIs as a last resort for patients with schizophrenia.2 Physicians often assume that patients will not accept LAIs and neglect to offer them as an option.3 If patients feel that they are part of the treatment choice, they are more likely to adhere to treatment.4 Motivational interviewing has been applied to improve treatment adherence, including psychotropics,but not to the initiation of LAIs in particular.5With this in mind, a motivational interviewing teaching program was developed for physicians wishing to enhance their interviewing skills when discussing the initiation of LAIs with their patients.

Method

A faculty of 5 psychiatrists designed a workshop whereby the principles of MI were reviewed and practiced. MI techniques are summarized by the acronym OARS: 1) Open ended questions; 2) Affirmation of patient’s self-efficacy; 3) Reflection of patient’s thoughts and needs; 4) Summaries of the discussion to promote consideration of change. Workshops begin with a training video that illustrates the pitfalls associated with a punitive or coercive approach to the initiation of LAIs. During the workshop, segments of a second training video are shown in conjunction with interactive exercises to reinforce internalization of the techniques. Polling-the-audience and role-playing are just two of the exercises usedto improve retention.

Pre and post assessments were conducted to measure changes in three domains of learning: knowledge, attitude and skills (KAS). The purpose of this KAS analysis was to determine if the workshop participants had an improvement in their knowledge and skill level as well as to determine if the attendees had a change in attitude related to the use and applicability of MI to patient acceptance of LAIs

Results

A total of 277 clinicians attended workshops from June to December, 2011. The results were statistically significant (p < 0.0001) for all 4 KAS items assessed by paired t-tests. (Figure 1)

Conclusion

MI Interactive workshops provide clinicians with the knowledge, attitude and skills to help facilitate a dialogue between physicians and patients around the acceptance of LAIs. The use of MI techniques