Terri Lavery (Janssen Inc); Loys Ligate (Early Psychosis Intervention Program of Waterloo, Wellington, Dufferin and Grand Valley)
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
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.
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
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)
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
will likely improve patient acceptance of LAI therapy early in the course of illness. However, further research is needed to access whether the use of MI is reflected in such outcome and will be evaluated in Phase II of the program.
- Janssen Inc.
- EPI Program Waterloo, Wellington, Dufferin, Grand Valley Institute for Women; Associate Clinical Professor, McMaster University
The authors wish to acknowledge Drs Marc-André Roy, Steve Kisely, Bill MacEwan and Dijana Oliver for their assistance in developing the workshop.
- Emsley R, et al. Remission in patients with first episode schizophrenia receiving assured antipsychotic medication: study with risperidone long-acting injection. Journal of Clinical Psychopharmacology: Volume 28, Number 2, April 2008
- Agid O, Foussias G, Remington G. Long-acting injectable antipsychotics in the treatment of schizophrenia: their role in relapse prevention. Expert Opin. Pharmacother. (2010) 11(14)
- Heres S, Hamann J, Kissling W, Leucht S. Attitudes of psychiatrists toward antipsychotic depot medication. J Clin Psychiatry 2006;67:1948-53
- Campbell L, Kisely S. Prescribing preferred medications improves adherence in people with severe mental illness. Evidence Based Mental Health 2010;13:108.
- Julius R, Novitsky M, Dubin W. Medication adherence: a review of the literature and implications for clinical practice. Journal of Psychiatric Practice 2009;15:34-44.
Workshop was developed through an educational grant from Janssen Inc. Terri Lavery is an employee of Janssen Inc. The other authors received financial compensation for developing the workshop.