2/9/2017 DISCLOSURES MOTIVATIONAL INTERVIEWING TO PROMOTE BEHAVIOR CHANGE LEARNING OBJECTIVES WHY PHARMACISTS AND TECHNICIANS
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1 MOTIVATIONAL INTERVIEWING TO PROMOTE BEHAVIOR CHANGE DISCLOSURES The presenter has no actual or potential conflicts of interest in relation to this presentation. Sarah E. Kelling, PharmD, MPH, BCACP Clinical Assistant Professor of Pharmacy University of Michigan College of Pharmacy LEARNING OBJECTIVES Summarize the directing, guiding, and following communication styles. Describe the four processes of motivational interviewing. Practice using OARS, agenda mapping, asking evocative questions, and goal attainment scaling. WRITE A health related goal that you would like to achieve but feels out of reach MOTIVATIONAL INTERVIEWING WHY PHARMACISTS AND TECHNICIANS 50% of patients do not take medications as prescribed A person centered counseling style for addressing the common problem of ambivalence about change 125,000 preventable deaths per year $290 billion in avoidable costs National Council on Patient Information and Education. (2013). New England Healthcare Institute. (2009) 1
2 CAUSES OF NON ADHERENCE PATIENT FACTORS Health care system Condition Therapy Knowledge Motivation Social & economic Nonadherence Patient Self efficacy Adult Meducation. (2012). Adult Meducation. (2012). COMMUNICATION STYLES PROCESSES OF MOTIVATIONAL INTERVIEWING Directing Command Order Tell Guiding Collaborate Encourage Motivate Following Allow Comprehend Shadow Engaging Focusing Evoking Planning ENGAGING ENGAGING Needed to develop relationship between patient and health care professional Tips Make sure everyone is introduced Create a private environment Ask the patient about goals Clarify any misunderstandings 2
3 OARS ASKING OPEN QUESTIONS Asking open questions Affirming Reflecting Summarizing Provides an opportunity for patient to think about and share information Examples How do you think your medicines are working for you? What concerns do you have about your medicines? How do you think I may be able to help you? AFFIRMING REFLECTING Recognize and acknowledge the good Strategies Focus on the patient Notice, recognize, and acknowledge the positive Reframe actions or situations in a positive light Comment on positive traits or skills Makes a guess about what the person means Focuses on the patient s narrative Complex reflection adds some meaning and emphasis to what the patient says Can be used to reframe the conversation SUMMARIZING Collecting summary recalls a series of interrelated items Linking summary involves reflecting on what the patient said and connecting that with something you remember from prior conversation Transitional summary involves wrapping up a task or shifting to something new Write three open ended questions that may be helpful in your practice. 3
4 FOCUSING FOCUSING Determine patient goals and direction for conversation Sources of focus Patient Setting Clinical expertise AGENDA MAPPING Taking medications Checking blood sugar Physical activity Quitting smoking Think about a patient you might encounter. Create an agenda map. Foot care Food choices EVOKING EVOKING Eliciting patient s motivation for change Helps patient move from ambivalence to action Change is more likely when patients talk about it I want I can It would help me I need I am ready 4
5 ASKING EVOCATIVE QUESTIONS IMPORTANCE RULER Topic Desire Ability Reasons Need Example How would you like your life to be different a year from now compared to today? What ideas do you have for how you could? What would make it worth your while to? How important is it for you to? How important is it for you to? 0: not at all important 10: the most important thing for me right now Why are you at X and not at Y (lower number)? What would it take to go from X to Z (higher number)? If you were to decide to change, what might be your options? Share your health goal. Role play asking evocative questions and using the importance ruler. PLANNING PLANNING Develop a commitment to change and formulate a plan of action Uses the patient s expertise as well as your own Think about troubleshooting Example questions What are you thinking about [issue] at this point? What might you do next? What you do you if [issue] occurs? PLANNING Elicit Provide Elicit 5
6 GOAL SETTING SMART GOALS S specific M measurable A attainable R relevant T timely Current performance GOAL ATTAINMENT SCALE Example related to exercise minutes or more minutes minutes minutes minutes minutes 3 <30 minutes Write a goal attainment scale for your health goal. ADDITIONAL RESOURCES Online MINT: Books Motivational interviewing for health care professional: A sensible approach Motivational interviewing: Helping people change CONCLUSION Motivational interviewing is a patient centered counseling approach designed to encourage behavior change. Pharmacists can use motivational interviewing to promote adherence to medications and other health related recommendations. REFERENCES Berger BA and Villaume WA. (2013). Motivational interviewing for health care professionals: A sensible approach. Washington, DC: American Pharmacists Association. Miller WR and Rollnick S. (2013). Motivational interviewing: Helping people change. (3 rd edition). New York: The Guilford Press. National Council on Patient Information and Education. (2013). Accelerating progress in prescription medicine adherence: The adherence action agenda. A National Action Plan to Address America s Other Drug Problem. New England Healthcare Institute. (2009). Thinking outside the pillbox: A systemwide approach to improving patient medication adherence for chronic disease. A NEHI Research Brief. Overview of medication adherence. (2012). Adult Meducation. Accessed February 4, MOTIVATIONAL INTERVIEWING TO PROMOTE BEHAVIOR CHANGE Sarah E. Kelling, PharmD, MPH, BCACP Clinical Assistant Professor of Pharmacy University of Michigan College of Pharmacy skelling@med.umich.edu 6
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