The Ida Motivation Tools can be used in other audiological areas outside of hearing aids. Nicola Topass, a team leader at the Royal Surrey County Hospital in Guildford, England, has begun using them with her vestibular patients as a way to reduce “did not attend” rates in her clinic.
“We had done an audit of our ‘did not attend’ rates for the patients in our clinic and noticed that the rate was much higher than that for general hearing aid clinics,” says Topass. “We had already offered a customized approach which the current research had suggested was the best treatment approach. I had then attended the BAA conference and heard about the Motivation Tools that the research group in Nottingham was using, and saw potential for these tools in our clinic. I thus with the help of our in-house clinic psychologist modified the tools for the use in our clinics.”
The clinic measures patient motivation in a two-step process. Level 1 of this process is a group pre-session of six people, where the nature of the rehabilitation is explained. Patients then opt into treatment, and are sent home with the Line and the Box to prepare for their first session. Because the pre-session is held for groups, progress isn’t affected if patients cancel at the last minute.
Level 2 involves discussing the Line and the Box with the patient at their first proper session. “Patients seem already geared to the tasks and find it easier to engage in the process if they have completed the tools at home,” she says. The clinician and patient might return to the Box after the three month mark if the patient isn’t making progress.
As a result of these early interventions, Topass has found that fewer people opt out of rehabilitation, and those that exit the program because of lack of motivation do so earlier. A sample of 175 appointments taken between September 2012 and February 2013 found that the DNA rate was 12.6% and the late cancellation rate was 15.4%. After implementing the new system, a sample of 170 appointments taken between September 2013 and February 2014 had a DNA rate of 4.7% and a late cancellation rate of 4.7%.
Dr. Topass is currently working on the next phase of the research, which will give more insight into whether Level 1 or Level 2 has the greatest impact on patient motivation. This will be done by using an in-house satisfaction questionnaire in combination with a standardized “quality of life” questionnaire.
“We would not have a control group as such but patients will be in either one of the two pathways,” she explains. “Pathway 1 would only have Level 1 intervention and Pathway 2 would have Level 1 and 2 intervention. We are not going to have a control group without any motivational interviewing (MI) as it is difficult to differentiate MI from patient centered management in our clinical team as they have been conducting MI techniques for some time. It would thus be difficult to control for this as an element at present for the pilot study.”
She hopes to have the next round of results available in June or July of 2015.
Image courtesy of Nicola Topass/Surrey Dizziness Service