Author Affiliations: Divisions of Rheumatology, Immunology, and Allergy (Drs Solomon, Iversen, and Katz) and Pharmacoepidemiology (Dr Solomon), Department of Orthopedic Surgery (Dr Katz), Brigham and Women's Hospital, and Department of Physical Therapy, Northeastern University (Dr Iversen), Boston, Massachusetts.
We appreciate the interest of Lavoie and colleagues in our recent article1 and agree that the results of the trial are not straightforward to interpret. The intervention's effects did not reach statistical significance, but there was some modest improvement in medication adherence. Lavoie and colleagues requested more details about the fidelity of the motivational interviewing (MI). The trial's health educators all received a half-day training in MI, followed by role playing exercises; most also had prior knowledge of this method. Ongoing MI supervision was provided through 2 formats. First, every 2 to 4 weeks, a behavioral scientist trained in MI conducted teleconferences with the health educators focused on reviewing telephone calls, discussing MI strategies, and providing guidance on patient issues raised during calls. In addition, 3 times during the 2-year study, an MI trainer reviewed actual patient telephone calls with each health educator individually. The calls were rated using the Motivational Interviewing Treatment Integrity rating scale2; the health educators were debriefed about their performance and provided written feedback.
Daniel H. Solomon, Maura Daly Iversen, Jeffrey N. Katz. Does Motivational Interviewing Improve Medication Adherence?—Reply. Arch Intern Med. 2012;172(17):1351–1352. doi:10.1001/archinternmed.2012.3409