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Patient-Centered Care through Motivational Interviewing VHQC - QualitySync II Corey A Lester, PharmD April 10, 2013. Patient-Centered Care.
Patient-Centered Care through Motivational Interviewing VHQC - QualitySync II Corey A Lester, PharmD April 10, 2013
Patient-Centered Care 'Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.' IOM (Institute of Medicine). 2001. Crossing the Quality Chasm: A New Health System for the 21st Century.
Today's Objectives Develop your communication skill set Identify stages of patient behavior change Describe motivational interviewing strategy Apply communication techniques to healthcare
Types of Communication Verbal Nonverbal Written
Patient-Centered Care • Present points one-by one • Explain things simply • Think before you speak
Nonverbal Communication • Message conveyed • without using words • Facial expressions are universal across all cultures • Oculesics may help discern our interpretation
Word Choice Clear Concise Coherent Emphasis
Improving Word Choice • Read a variety of nonfiction genres • Avoid the use of pronouns • Practice using engaging and effective language • Use of a Thesaurus
Deficiencies in Communication • We often obtain little information about patients' perceptions • Ignore what is important to patients • Displaying 'blocking behaviors' • Patients withhold important information
Barriers to Communication • External Factors • Telephones • Computers • Outside conversation • Internal Factors • Cognitive ability • Family problems • New diagnosis
Ineffective Communication University of Florida - Dept. of Psychiatry. 2009
Motivational Interviewing • Developed by William Miller and Stephen Rollnick in 1980s • Instill intrinsic motivation within people to change behaviors • Pharmacists adopting technique to improve medication adherence and improve health
Major Assumptions Motivation is a state, not a trait Resistance is a cue to change strategy Ambivalence is good We are allies Change / Growth are part of human experience
Patient Behavior Change Precontemplation Re l apse Progres s Contemplation Preparation Action Maintenance
Stage 1: Precontemplation Precontemplation Re l apse Progres s Contemplation Preparation Action Maintenance
Stage 2 : Contemplation Pro's Con's Aware of personal consequences Unsure about long term benefits Lasts a few weeks to entire lifetime Gallon et al.
Stage 3: Preparation "I've got to do something about this - this is serious." "Something has to change. What can I do?" • You have committed to making change • Actively seeking out advice and materials • Do not skip this step!
Stage 4 : Action • Up to patient and only the patient • Greatest risk for relapse • Use short-term reward system to sustain motivation • Open to receiving help and looking for support
Stage 5 : Maintenance New Status Quo • Successfully avoid temptations • Identify risky situations • Normal and natural to regress
Stage 6 : Relapse Precontemplation Rel apse Progres s Contemplation Preparation Action Maintenance
Roll with Resistance Resistance • Do not argue for change • Practice 'psychological judo'
Express Early Empathy The capacity for participation in another's feelings or ideas in a neutral way • Feel understood - becomes better listener • Decreases anxieties • Builds up rapport
Develop Discrepancy On a scale from 1 to 10... 1 2 3 4 5 6 7 8 9 10 • Reflects 'can do' vs. 'can't do' attitude • Do you believe you can change? • We believe in what you are trying to do
Open-Ended Questions 'How did your physician tell you to take this medication?' 'What did your physician tell you this medication was for?' 'What concerns you most about taking this medication?' 'What have you tried before?' Encourages patients to take control over direction of conversation
Affirmations • Genuine, direct statements of support • Demonstrates understanding 'I can see that caring for your family is important to you' 'I appreciate your honesty' 'It shows commitment seeking advice' Goal : Notice and acknowledge patient effort and strength
Reflective Listening Words patient uses Words patient uses Words patient uses Words patient uses
Summaries Let me see if I understand so far... Here is what I've heard. Tell me if I've missed anything. • Communicate back the big picture • Ensures we stay on topic • Emphasize positive 'change talk' statements
'Take advantage of every opportunity to practice your communication skills so that when important occasions arise, you will have the gift, the style, the sharpness, the clarity, and the emotions to affect other people.' -Jim Rohn
Thank you Questions or Comments