Support medication adherence through motivational interviewing
Motivational interviewing is a style of collaborative conversation that can help patients stay on track and achieve better outcomes.
Pharmacists are in a unique position to impact public health, one patient at a time. With over 90% of Americans living within five miles of a community pharmacyretail pharmacists often have multiple opportunities for patient engagement, with touchpoints ranging from vaccinations and point-of-care testing to prescription pick-ups and medication advice.
Medication therapy management (MTM) is an area where pharmacists can leverage their role of trust to drive better outcomes. Research tells us that pharmacist advice can improve patient compliance, but low adherence rates have hampered health care for decades. Of the 3.8 billion prescriptions written in the United States each year, approximately 1 in 5 are never filled and non-compliance costs the healthcare system between 100 and 300 billion dollars per year.
Pharmacists need more tools on their belts to be as effective as possible in their interactions with patients regarding medication adherence. At Biologics by McKesson Specialty Pharmacy, our clinicians rely on multiple approaches to engage with patients, from conversation starters to risk assessment questionnaires. One of the main tools we currently use is motivational interviewing, a style of collaborative conversation designed to build a person’s motivation and commitment to change.
What is Motivational Interviewing (MI)?
MI is an evidence-based practice developed by psychologists in the 1980s, originally developed for people with alcoholism and drug addiction. Based on the idea that behavior change is only possible when a person feels accepted and valued, MI has been shown to be effective in many different areas, from smoking cessation and mood disorders diet to diabetes management.
Research supports the effectiveness of MI in promoting medication adherence, including a randomized controlled trial study of 366 patients with multiple sclerosis, in which the intervention group received telephone counseling based on motivational interviewing. In this study, only 1.2% of patients in the intervention group discontinued treatment, compared to 8.7% of patients in the standard care group who discontinued treatment.
Any medication adherence intervention must begin with understanding that each patient is unique and has different reasons for potentially becoming non-adherent. Factors affecting adherence can include patient attitudes and beliefs, treatment-related reasons such as adverse effects, and socioeconomic or financial barriers. The beauty of MI is that it recognizes and accommodates each patient’s unique and personal circumstances.
MI Guiding Principles and Core Competencies
MI training is a thorough process for professional counselors, but pharmacists and clinicians can learn from its guiding principles and core competencies. It starts with understanding what MI is not—confrontation, command, preaching, warning, or persuasion—and what MI is– non-judgmental, compassionate, assertive, open and accepting.
MI’s guiding principles include:
1. Resist the righting impulse, that is, avoid pointing out the risks or problems of a patient’s current (non-adherent) behavior, which may put them on the defensive.
2. Understand the motivations of the patient.
3. Listen with empathy.
4. Empower the patient to find their own motivation to adopt positive behaviors.
Putting these principles into practice, pharmacists can use open-ended questions – “Why are you concerned about your new medicine? – that elicit a response from the patient, rather than questions that sound like a directive or mandate. They can then engage in reflective listening, which consists of listening attentively to the patient and repeating what he says with understanding.
Using affirmations – “I’m so glad you were able to take all the doses on time, it’s not easy” – helps build rapport, show empathy, and build trust and confidence. patient’s self-efficacy.
Finally, pharmacists can watch (and evoke)”change of speechin the patient – “I need to start taking my medication every day” or “I know it’s possible to do this” – and reflect these ideas back to the patient in an affirmative and empowering way.
Motivational interviewing is a skill that takes practice, and resources are available to help pharmacists improve their abilities. The National Association of Community Pharmacists offers a module in 6 coaching with 8 hours of continuing education, based on the book Motivational Interviewing for Health Professionals: A Sensible Approach by Drs. Bruce A. Berger and William A. Villaume.
Ultimately, the foundation of membership is trust, communication and empathy. Motivational interviewing encompasses these concepts to ensure that ultimately patients stay true to their therapy and get the most out of their medication.