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Objective: To evaluate the effectiveness of motivational interviewing (MI) in improving medication adherence in older patients being treated by polypharmacy. Methods: Cluster randomized clinical trial in 16 primary care centers with 27 health care providers and 154 patients. Thirty-two health care providers were assigned to an experimental (EG) or control group (CG). Interventions: MI training program and review of patient treatments. Providers in the EG carried out MI, whereas those in the CG used an “advice approach”. Three follow-up visits were completed, at 15 days and at 3 and 6[0] months. Medication adherence in both groups was compared (p

OBJECTIVES: To increase medical students’ ability to detect contextual and emotional cues and to respond empathetically to patients. METHODS: a training course in communication skills and patient-centered care with different teaching activities (didactic, reflective and interactive: workshops and encounters with simulated patients) was delivered to third-year medical students just before their clerckships. The program was evaluated by an external observer (OE) and simulated patients (SP) in 2 or 3 videotaped encounters. RESULTS: Students improved significantly from baseline to 3rd interview in all communicative skills and domains explored both in OE (32.4%) and SP (38.3%) measurement. At the end of the course students detected significantly more clues and made more empathetic expressions. CONCLUSIONS: The course seems to improve the ability of students to explore the illness experience, showing more empathy in a more genuine way. This was carried out in consultations lasting 10 minutes. PRACTICAL IMPLICATIONS: The program is effective and feasible to be applied as a regular formative activity. Further research is needed to assess whether this training program is applicable to students in more advanced educational levels and if it has any additional outcomes. pre-print 432 KB

Objective To explore the communicative behaviours as used by specialty physicians, and their patients’ perception of the communicative act as well as their satisfaction with the encounter. Methods Cross-sectional study involving 27 specialty physicians and 257 outpatients. Encounters were video-recorded and analysed through the GATHA-ESP scale. Patients rated the quality of the interaction and their satisfaction with it in a questionnaire. Results Most specialist doctors use a “managerial” style where there is no exploration of their patients’ emotions (22%), expectations (28%) or psychosocial aspects (10–20%). Less than one doctor out of every four ever gave the patient an opportunity to participate in any type of decision making at the surgery. Patients were more satisfied with those encounters they felt more patient-centred ( F : 11.37; p Conclusions Specialty physicians show a limited range of communicative skills as they use a doctor-centred style that allows for little patient participation. Patients’ perceptions of patient-centeredness are linked to satisfaction more than the analysis of doctors’ behaviour at the consultation does. Practice implications It seems important to foster training in communication skills in the different specialist vocational training programs. Studies on physician–patient communication should deal with the perceived and observed perspectives on this domain.