Feasibility and Preliminary Efficacy of an Occupational Therapy Intervention for Older Adults With Chronic Conditions in a Primary Care Clinic.

IMPORTANCE: Occupational therapy can play a role in primary care management of chronic diseases among older adults. OBJECTIVE: To assess the feasibility of delivering a primary care occupation-focused intervention (Integrated PRimary care and Occupational therapy for Aging and Chronic disease Treatment to preserve Independence and Functioning, or i-PROACTIF) for older adults with chronic disease. DESIGN: Feasibility study comparing i-PROACTIF with complex care management using a two-group randomized controlled trial design with data gathered at baseline and during and after the 8-wk intervention. SETTING: Family medicine clinic serving an urban, low-income, working-class community. OUTCOMES AND MEASURES: Feasibility indicators were recruitment, retention, utility of clinical assessments, and acceptability of interventions assessed through feedback surveys completed by patients and primary care providers (PCPs). Patient outcomes, including perspectives on chronic illness care, occupational performance, and overall well-being, were collected using standardized, validated measures and analyzed descriptively. PARTICIPANTS: Eighteen adult volunteers, ages ≥50 yr, with heart disease, arthritis, and uncontrolled diabetes completed the study. Ten PCPs completed feedback surveys. INTERVENTION: i-PROACTIF focuses on preserving functional independence, is based on the Person-Environment-Occupation framework, and consists of two assessment sessions and six weekly treatment sessions. RESULTS: Recruitment goals were achieved, with an 86% retention rate. Clinical measures unearthed deficits in areas that were unreported or underreported by patients. Participants reported being extremely satisfied with the intervention. Physicians and nurses also supported the intervention. Both groups showed improved scores on most outcomes. CONCLUSION AND RELEVANCE: Delivering and evaluating i-PROACTIF was feasible and acceptable. Future efficacy trials are needed before it can be used in clinical settings. WHAT THIS ARTICLE ADDS: The results of this study can inform future occupational therapy interventions and clinical trials in primary care for older adults with chronic conditions.

Evaluation of a Motivational Interviewing Training for Third-Year Medical Students.

BACKGROUND AND OBJECTIVES: Prevalence of chronic disease is rising at unprecedented rates with associated costs that account for 84% of US health care spending. Physicians have the opportunity to guide patients to make lifestyle changes for preventing and self-managing chronic diseases. However, current medical education offers limited training opportunities in behavioral change counseling approaches. Motivational interviewing (MI) is an increasingly well-recognized intervention in the medical community that addresses both behavior change and self-management support. While evidence to support training in motivational interviewing for medical students is growing, more studies are needed. The purpose of this study is to evaluate changes in third-year medical students' knowledge, skills, and attitudes as a result of a 4-hour MI training. METHODS: The study utilized a quasi-experimental design with a pretest and posttest to evaluate the impact of a MI workshop. Fifty-three third-year medical students completed the 4-hour workshop. Each student completed an identical pretest and posttest assessing changes in knowledge, skills, and attitudes. Data were analyzed using t test analysis and qualitative thematic analysis. RESULTS: Medical students demonstrated statistically significant improvements in confidence, knowledge, and skills. Students' qualitative comments demonstrated increased understanding of MI and desire and confidence to use new skills. CONCLUSIONS: The study provides promising evidence that a short 4-hour training can render positive changes among medical students, which supports integration in medical student education programs. Future studies may include evaluation of curriculum enhancements with a more rigorous research design and development of additional training opportunities.