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Physicians: .25 AMA PRA Category I CreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours

Release Date: August 20, 2014
Expiration Date: August 20, 2015

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon above.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:

1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD
Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP
Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company


Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This enduring material activity, DynaMed EBM Focus Volume 9, has been reviewed and is acceptable for up to 15.25 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 5, 2014. Term of approval is for one year from this date. Each EBM Focus is approved for .25 Prescribed credits. Credit may be claimed for one year from the date of each update. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour(s) of continuing education by the American Association of Nurse Practitioners. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.

Program ID: 1405237N

Last week 415 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 210 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article was selected by the DynaMed Editorial Team.

Brief Motivational Interviewing Interventions in Primary Care Do Not Reduce Drug Use in Adults
Reference: JAMA 2014 Aug 6;312(5):492 JAMA 2014 Aug 6;312(5):502 (level 1 [likely reliable] evidence)

Substance abuse is an important issue in primary care. In patients with alcohol use disorder, a high-quality trial of 774 adults previously showed that a brief primary care physician intervention (2 physician visits and 2 nurse follow-up phone calls) can decrease alcohol use, problem drinking, and hospitalization rates vs. usual care (Alcohol Clin Exp Res 2002 Jan;26(1):36). However, data supporting similar brief interventions in primary care for reducing drug use are limited. Two recent randomized trials evaluated the efficacy of brief motivational interviewing interventions for reducing drug use in adults attending primary care.

In the first trial, 868 adults with illegal drug or nonprescribed medication use were randomized to a brief intervention (motivational interview plus handout and list of substance abuse resources) vs. enhanced usual care (handout and list of substance abuse resources) and were followed for up to 1 year. At baseline, the mean use of the most common problem drug in the previous month was 13.8 days. At 3 months post-intervention, the mean use of the most common problem drug in the previous month was 11.9 days with the brief intervention vs. 9.8 days with enhanced usual care (not significant).

In the second trial, 528 adults with drug use were randomized to brief negotiated interview (10-15 minute structured interview conducted by health educators) vs. adapted motivational interview (30-45 minute session followed by 20-30 minute booster session conducted by counselors) vs. no intervention (control) and followed for 6 months. At baseline, the mean use of the main drug in the previous month was 14.4 days. At 6 months post-intervention, the mean use of the main drug in the previous month was 11.2 days with the brief negotiated interview, 12.1 days with the adapted motivational interview, and 11.5 days with control. There were no significant differences between either intervention vs. control in an unadjusted analysis, or after adjusting for baseline differences.

Based on the findings from these 2 new trials, brief interventions for adults with drug abuse problems do not appear effective in the primary care setting. An important limitation of both trials is the wide variation in the specific substance being used, and it is possible that these interventions had some benefit for specific substances of abuse but did not demonstrate benefit since trials were not adequately powered for subgroup analyses. However, this is not supported by current evidence. Given that substance abuse is a chronic disease, it seems likely that interventions that include ongoing treatment and monitoring are warranted.

For more information see the Substance use disorders topic in DynaMed.

Special thanks to Greg Haman and Hoi See Tsao of Harvard Medical School and Dr. Soo Choi of Seoul National University for their contributions to this week's article.

Earn CME Credit for reading this e-Newsletter. For more information on this educational activity, see the CME sidebar.

EBSCO Health Launches Pediatric Clinical Information Mobile App

PEMSoft Now Available For iPhone, iPad, and Android Devices

A mobile app designed specifically for pediatricians, emergency department physicians, physicians-in-training and other medical providers caring for children with acute illnesses and injury, is now available from EBSCO Health, the leading provider of clinical decision support solutions for the healthcare industry.

Designed by pediatricians, emergency physicians and other medical specialists, PEMSoft is a pediatric evidence-based point-of-care medical reference tool for hospitals, emergency departments, clinics, pediatric group practices, transport services, and medical schools. The vast content in PEMSoft addresses the entire spectrum of neonatal, infant, child, adolescent and young adult health. PEMSoft authors adhere to a strict evidence-based editorial policy focused on systematic identification, evaluation and consolidation of practice-changing clinical literature.

The PEMSoft Mobile app includes explicit step-by-step emergency critical care procedures, information about common pediatric signs and symptoms and content covering pediatric injuries and management approaches. More than 3,000 evidence-based pediatric topics and a similar number of medical illustrations, clinical images and videos are also available via the mobile app.

The PEMSoft Mobile App is accessible from both Apple and Android devices.

Visit the PEMSoft page for more information.

Call for Peer Reviews

We are currently seeking subspecialty reviewers for our Patient Education Resource Center (PERC). PERC provides fact sheets and discharge instructions for patients leaving the hospital or emergency room. These hand-outs fulfill the meaningful use requirements for the Medicare & Medicare Services Incentive Programs.

Click here to speak with us about becoming a peer reviewer.

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Section Editor of Specialty Content