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Patient-Centered Care through Motivational Interviewing VHQC - QualitySync II Corey A Lester, PharmD April 10, 2013. Patient-Centered Care.

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Patient-Centered Care through Motivational Interviewing VHQC - QualitySync II


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    1. Patient-Centered Care through Motivational Interviewing VHQC - QualitySync II Corey A Lester, PharmD April 10, 2013

    2. 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.

    3. Today's Objectives Develop your communication skill set Identify stages of patient behavior change Describe motivational interviewing strategy Apply communication techniques to healthcare

    4. Types of Communication Verbal Nonverbal Written

    5. Patient-Centered Care • Present points one-by one • Explain things simply • Think before you speak

    6. Nonverbal Communication • Message conveyed • without using words • Facial expressions are universal across all cultures • Oculesics may help discern our interpretation

    7. Written Communication Types

    8. Word Choice Clear Concise Coherent Emphasis

    9. Improving Word Choice • Read a variety of nonfiction genres • Avoid the use of pronouns • Practice using engaging and effective language • Use of a Thesaurus

    10. Deficiencies in Communication • We often obtain little information about patients' perceptions • Ignore what is important to patients • Displaying 'blocking behaviors' • Patients withhold important information

    11. Barriers to Communication • External Factors • Telephones • Computers • Outside conversation • Internal Factors • Cognitive ability • Family problems • New diagnosis

    12. Am J Health-Syst Pharm. 2005. 62: 1311-1314

    13. Ineffective Communication University of Florida - Dept. of Psychiatry. 2009

    14. 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

    15. 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

    16. Patient Behavior Change Precontemplation Re l apse Progres s Contemplation Preparation Action Maintenance

    17. Stage 1: Precontemplation Precontemplation Re l apse Progres s Contemplation Preparation Action Maintenance

    18. 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.

    19. 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!

    20. 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

    21. Stage 5 : Maintenance New Status Quo • Successfully avoid temptations • Identify risky situations • Normal and natural to regress

    22. Stage 6 : Relapse Precontemplation Rel apse Progres s Contemplation Preparation Action Maintenance

    23. Roll with Resistance Resistance • Do not argue for change • Practice 'psychological judo'

    24. 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

    25. 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

    26. 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

    27. 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

    28. Reflective Listening Words patient uses Words patient uses Words patient uses Words patient uses

    29. 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

    30. Ineffective Communication

    31. Am J Health-Syst Pharm. 2005. 62: 1311-1314

    32. '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

    33. Thank you Questions or Comments