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Chumbler N.R.,University of Georgia | Li X.,Deputy Undersecretary for Health & Operations and Management | Morey M.C.,Geriatric Research | Morey M.C.,Duke University | And 7 more authors.
Journal of Telemedicine and Telecare | Year: 2015

We determined the effect of a multifaceted stroke telerehabilitation (STeleR) intervention on falls-related self-efficacy and satisfaction with care. We conducted a prospective, randomized, multisite, single-blinded trial in 52 veterans from three Veterans Affairs Medical Centers. Participants who experienced a stroke in the past 24 months were randomized to the STeleR intervention or usual care. Participants in the intervention arm were administered an exit interview to gather specific patient satisfaction data three months after their final outcome measure. The STeleR intervention consisted of three home visits, five telephone calls, and an in-home messaging device provided over three months to instruct patients in functionally based exercises and adaptive strategies. The outcome measures included Falls Efficacy Scale to measure fall-related self-efficacy and a Stroke-Specific Patient Satisfaction with Care (SSPSC) scale, a measure separated into two subscales (satisfaction with home care and satisfaction with hospital care) was employed to measure the participants’ satisfaction. At six months, compared with the usual care group, the STeleR group showed statistically significant improvements in one of the two SSPSC scales (satisfaction with hospital care, p =.029) and approached significance in the second SSPSC scale (satisfaction with home care, p =.077). There were no improvements in fall-related self-efficacy. Core concepts identified were: (a) beneficial impact of the trained assistant; (b) exercises helpful; (c) home use of technology. The STeleR intervention improved satisfaction with care, especially as it relates to care following their experience from the hospital. With the limited resources available for in-home rehabilitation for stroke survivors, STeleR (and especially its exercise components) can be a useful complement to traditional post-stroke rehabilitation. © 2015, © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.


Pollak K.I.,Duke Cancer Institute | Pollak K.I.,Duke University | Coffman C.J.,Durham Medical Center Durham | Coffman C.J.,Duke University | And 12 more authors.
Patient Education and Counseling | Year: 2014

Objective: Physicians' use of Motivational Interviewing (MI) techniques when discussing weight with adolescent patients is unknown. Methods: We coded audio-recorded encounters between 49 primary care physicians and 180 overweight adolescent patients. During weight discussions, we used the MITI 3.0 to assess: Empathy, MI Spirit, open-ended questions, reflections, MI consistent behaviors (e.g., praising) and MI inconsistent behaviors (e.g., confronting). We examined associations of patient and physician characteristics with (1) MI techniques, (2) time discussing weight, and (3) encounter time. Results: Physicians used more MI consistent techniques with female patients (p= 0.06) and with heavier patients (p= 0.02). Physicians with prior MI training also used more MI consistent techniques (p= 0.04) and asked more open-ended questions (p= 0.05). Pediatricians had a higher MI Spirit score than family physicians (p= 0.03). Older patient age was associated with physicians spending less time discussing weight-related topics (p= 0.04) and higher BMI percentile was associated with physicians spending more time discussing weight-related topics (p= 0.01). Increased use of MI inconsistent techniques was associated with longer encounters (p= 0.02). Conclusion: Physicians' weight discussions vary based on adolescent and physician characteristics. Importantly, not using MI lengthened encounter time. Practice implications: Physicians might consider using MI techniques more and attempt to use these equally with all adolescents. © 2014 Elsevier Ireland Ltd.


Pollak K.I.,Duke University | Coffman C.J.,Durham Medical Center Durham | Coffman C.J.,Duke University | Alexander S.C.,Durham Medical Center Durham | And 11 more authors.
Patient Education and Counseling | Year: 2011

Objective: Evidence suggests that physicians' use of motivational interviewing (MI) techniques helps patients lose weight. We assessed patient, physician, relationship, and systems predictors of length of weight-loss discussions and whether physicians' used MI techniques. Methods: Forty primary care physicians and 461 of their overweight or obese patients were audio recorded and surveyed. Results: Weight-related topics were commonly discussed (nutrition 78%, physical activity 82%, and BMI/weight 72%). Use of MI techniques was low. A multivariable linear mixed model was fit to time spent discussing weight, adjusting for patient clustering within physician. More time was spent with obese patients (p= .0002), by African American physicians (p= .03), family physicians (p= .02), and physicians who believed patients were embarrassed to discuss weight (p= .05). Female physicians were more likely to use MI techniques (p= .02); African American physicians were more likely to use MI-inconsistent techniques (p< .001). Conclusion: Primary care physicians routinely counsel about weight and are likely to spend more time with obese than with overweight patients. Internists spend less time on weight. Patient and systems factors do not seem to influence physicians' use MI techniques. Practice implications: All physicians, particularly, male and African American physicians, could increase their use of MI techniques to promote more weight loss among patients. © 2011 Elsevier Ireland Ltd.

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