Behavior Change in Chronic Disease Management Kevin Jackson, OD MPH FAAO Diana Dolan, Psy.D.

Transcription

1 Behavior Change in Chronic Disease Management Kevin Jackson, OD MPH FAAO Diana Dolan, Psy.D. Please silence all mobile devices and remove items from chairs so others can sit. Unauthorized recording of this session is prohibited.

2 Disclosure Statement: Dr. Jackson: Nothing to disclose Dr. Dolan: Nothing to disclose

3 ID the Problem Importance of chronic disease relative to disease burden Patient behavior and its impact on health Brief window that doctors have to change behavior Environmental, societal, familial and economic influences on patient behavior

4 Chronic Issues in Optometry Diabetes Hypertension Glaucoma Contact lens care and disposal Dry eye and blepharitis Vision therapy

5 Common Methods Used to Influence Behavior Patient education Cajoling patients Scare tactics For a number of our patients, nothing seems to move them.

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7 Fear of change Lack of skills/self-efficacy Hopelessness History of prior failures Secondary gain Barriers to Change

8 Transtheoretical Model of Change WHY don t patients do what we tell them to? Compliance is limited by patient readiness Ambivalence is normal Practitioners must recognize what stage of change patient is in

9 Transtheoretical Model of Change Precontemplation Contemplation Relapse Maintenance Preparation Prochaska & DiClemente (1983) Action

10 Stages of Change: Patient Examples Precontemplation Everything is fine Contemplation I m willing to think about it Preparation I have a plan in place, just waiting for the right time

11 Stages of Change: Patient Examples Action Maintenance Relapse Doc, I took your advice If things stay like this, I ll be happy Oops!

12 Using a Motivational Interviewing Style and Motivational Strategies 12

13 What is Motivational Interviewing? Communication skills that are motivational rather than judgmental in nature A patient-centered, directive method for enhancing intrinsic motivation to change Focused on exploring and resolving ambivalence Focused on eliciting change talk

14 Motivational Interviewing is Evidence-Based Currently more than 1200 publications 200 of which are Randomized Control Trials Primary focus has been on addictive behaviors Research base is broadening into the areas of healthcare, corrections, and working with youth

15 How is Motivational Interviewing Different? Collaboration vs Confrontation Evocation vs Education Autonomy vs Authority

16 Benefits of Using a Motivational Interviewing Approach Significantly reduced health care costs Increased compliance with medication and treatment recommendations Improved outcomes Greater patient satisfaction

17 Empathy: Key Feature in Motivational Interviewing WHY? High levels of empathy associated with positive outcomes Key to expressing empathy throughreflective Listening Listening in a reflective manner demonstrates an understanding of patients and validates their concerns Moyers et al (2013) 17

18 Core Motivational Interviewing Techniques Be empathic Elicit change talk by using OARS in your communication Assess and increase readiness to change Assess and increase confidence to make change

19 What is Change Talk? Talking about disadvantages of the status quo (the present) Talking about advantages of change Expressing optimism for change Expressing intention to change

20 Using OARS to Elicit Change Talk Open-ended questions Affirmations Reflective Statements Summarizing

21 Readiness Ruler Readiness for change varies over time Definitely NOT ready Definitely ready On a scale of 1 to 10, where 1 is definitely not ready and 10 is definitely ready, what number best describes how ready you feel at the present time to make this change?

22 Confidence Ruler Patients must also feel confident in their ability to make changes Not at all confident Very confident On a scale from 1 to 10 where 1 is not at all confident and 10 is very confident, how confident are you right now that you could make this change?

23 Increasing Confidence Ask patients about changes they ve made Ask patients how they feel about those changes You have been able to make other difficult changes. How have you been able to do that? Even though you haven t quit, you have managed to cut down on your smoking. How were you able to do that? How do you feel about the changes you made? How have those changes impacted your life? How do you feel about those effects?

24 Utility in Primary Care Who has time? Months and years have been spent on ineffective techniques. If I did this with all my patients I would see half the patients I do now. What if my patient does not want to change? Why would I spend all that time on diabetes, hypertension and smoking? Isn t that what the internist gets paid a lot more to do? I have an excellent rapport with my patients now why change?

25 Applications to Primary Care Optometry Treatment Adherence (Glaucoma, Hypertension, Diabetes, Vision Therapy, Blepharitis) Diet (Diabetes, Hypertension, Blepharitis, Macular Degeneration) Exercise (Diabetes, Hypertension) Smoking (Hypertension, Macular Degeneration)

26 VIDEO DEMONSTRATION

27 VIDEO DEMONSTRATION

28 VIDEO DEMONSTRATION

29 Reinforcement and the Team Approach Consistent health messaging Get the patient thinking the seed you plant may come to fruition in the dentist/pcm office

30 Technology Aids Text Alerts Mobile Applications Gamification Mobile Text Messaging for Health: A Systematic Review of Reviews Amanda KH, H, Cole-Lewis2,3, and Jay M. Bernhardt4 Annu Rev Public Health March 18; 36:

31 Resources for Practitioners EBP Center for Deployment Psychology

32 Resources for Practitioners Dr. Lisa Merlo

33 Please remember to complete your session evaluations on the Academy.18 meeting app Tweet about this session using the official meeting hashtag #Academy18

34 Questions?