Mission PossibleEmpowering The Patient Thru 

Motivational Interviewing

What is Motivational Interviewing

The use of Motivational interviewing encourages patients to take an active role in their therapy

Motivational Interviewing focuses on exploring and resolving the uncertainty and centers on motivational processes within the individual that facilitates change. It does not “impose” change but rather supports change in a manner that is conducive with the patient’s values and concerns

From provider making all patient care decisions

To a care team working with patient and making health care decisions together

Helping patients change behavior is an important role of the Care Team. Change interventions are very useful in addressing lifestyle modifications for disease prevention and long term disease management.

TAKING CARE TO THE NEXT LEVEL

EMPOWERING THE PATIENT

Patient empowerment interventions have demonstrated significant success in the treatment of several chronic conditions

The use of Motivational interviewing encourages patients to take an active role in their therapy

UNDERSTANDING CHANGE

•Not a single event

•Behavior change is a “process”

•Occurs gradually

•Relapses inevitable in most cases

•Some patients may “recycle” through change stages

STAGES OF CHANGE

•Pre-contemplation

•Contemplation

•Preparation

•Action

•Maintenance

PRE-CONTEMPLATION

•Not thinking about change

•Feeling of no control

•Does not feel it applies to them

•Believes consequences are not serious

CONTEMPLATION

Weighing benefits

Concerned about barriers

• Time

• Expense

• Fear

Sense of loss

• Giving up an enjoyed behavior

• Is this loss worth the gain?

PREPARATION

Prepares to make small changes

Determination to change increases

ACTION

Taking definitive action to change

• Demonstrates desire for lifestyle change

• Should be praised

MAINTENANCE/RELAPSE

Maintaining new behavior over time

Relapses may occur

• Patients may want to give up

• Encouragement

• Remind of successes

Recycling

• Patients may go through the stages of change several times before change becomes established

• Be patient

• Continue encouragement

The Pre-Contemplator

• Ask open ended questions such as:

• Have you tried to change in the past?

• How will you know when it’s time to think about changing?

• What signals will tell you to start thinking about changing?

• What qualities in yourself are important to you?

• Is there a connection between those qualities and “not considering” a change?

MOTIVATIONAL INTERVIEWING TECHNIQUES

Contemplation Stage

• Why do you want to change now?

• What barriers keep you from changing now?

• How can we help you overcome those barriers?

• What things have helped in the past?

• What would help you now?

• What do you think you need to learn about changing?

• How would you like to be different?

• What do you want to do next?

Action Stage

If prior stages have been glossed over, action itself is often not enough i.e. New Year’s resolutions

•Any action taken by the patient should be praised

•The action stage shows the desire for lifestyle modification on behalf of the patient

•Encourage patient by saying empowering phrases like

•I think what you are doing is very difficult and I’m proud to be working with you on reaching your goal!

•Many people avoid change, it says a lot about you that you are willing to take this step!

Maintenance Stage

•Incorporating new behavior over the “long-haul”

•Congratulations, what is making this work for you?

•What could help this work better?

Relapse

•Discouragement over the occasional slips

•Ask…What worked for a while?

•Don’t be mad at yourself, this is a normal step in the change process

•What did you learn from this?

•Are you willing to give it another try?

HOW TO EFFECTIVELY MANAGE…..

Patient Populations•Follow Evidence-Based guidelines

•i.e. MQIC guidelines for Diabetes, Asthma, Obesity, etc..•Patient Reminders

•Letters•Follow-up phone calls

•Pre-Visit Preparations•Morning huddles with Care Team•Needed lab work before appt•Gathering lab/imaging results•Using patient visit summaries for needed health maint.

•Use of Patient Registry•Patients meeting a certain criteria

Patient Visit Summaries

Used at beginning of each day to alert Care Team of needed medical services such as lab work for diabetes, etc…Also helps Care Team prepare for day before patient arrives.

Vulnerable Patients

•Low Income/Uninsured

•Transportation issues

•Ability to purchase medications

•Ability to pay co-pay

•English Not Primary Language

•Barrier to communicate

•Verbal and written communication

•Migrant Population

•No continuity of care

•The Elderly

General Communication

• Demonstrate genuine interest and respect

• Establish rapport

• Listen to what the patient believes to be important

• Do not assume patients understand what we are talking about

TIPS FOR EFFECTIVE COMMUNICATION

Elderly Patient

• Respect person’s background and knowledge

• Avoid distractions

• Sit face to face – maintain eye contact

• Provide written information or handouts

• Speak slowly and clearly

• Stick to one topic at a time

• Give patient opportunity to ask questions

• Take into consideration known vision/hearing issues

COMMUNICATING WITH VULNERABLE POPULATIONS

Non English Speaking or Broken English

• Speak clearly and pronounce words correctly

• Use qualified translator if necessary

• Avoid using children as translator

• Speaking louder does not create instant understanding

• Avoid baby-talk or running words together

• Avoid contractions or shortened words (cannot, not can’t)

• Be explicit, i.e. “yes” not “uh-huh”

COMMUNICATING WITH VULNERABLE POPULATIONS

The Cross-Cultural Patient

• Does not refer only to different ethnic backgrounds, also includes:

• Age

• Gender

• Education

• Use plain non medical language

• Provide written information if necessary

• Use teach back technique

COMMUNICATING WITH VULNERABLE POPULATIONS

Resist the “Righting Reflex”

• Guide vs. correct the patient

• Patient comes up with their own goals/not us choosing them for them

Understand and Explore Patient’s Motivation

• Ask open ended questions

Listen with Empathy

Empower the Patient

• Patient feels in control of their health management

RECAP OF MOTIVATIONAL INTERVIEWING

Questions? Comments?

FAMILY

HEALTH CAREBALDWIN*GRANT*WHITE CLOUD*CADILLAC*MCBAIN

Stages of Change, American Family Physician, March 1, 2000 1:61(5):1409-1416

Motivational Interviewing Skill and Techniques, Taken from internet on October 28, 2012 from www.samhsa.gov

Overcoming Health Care Disparities via Cross-Cultural Communication, Cleveland Clinic Journal of Medicine, volume 79, Number 2, February 2012

REFERENCES