Improving Patient Interviewing Techniques · The Improving Patient Interviewing Techniques presentation is fully endorsed by Stephen Rollnick, PhD. Dr. Rollnick, who lent his vast

Improving Patient Interviewing TechniquesHow Motivational Interviewing Can Help You and Your Patients

Jon Vlasnik, PharmD, BCPSHealth Economics & Outcomes ResearchBoehringer-Ingelheim

Copyright © 2012, Boehringer Ingelheim Pharmaceuticals, Inc. All rights reserved. (09/12) MI427800MHC

Endorsed by Stephen Rollnick, PhD

The Improving Patient Interviewing Techniques presentation is fully endorsed by Stephen Rollnick, PhD. Dr. Rollnick, who lent his vast expertise and experience to its development, is

• A specialist on communication and behavior change and a co-founder of motivational interviewing (MI)

• A clinical psychologist and Professor of Health Care Communication in the Department of Primary Care & Public Health, School of Medicine, Cardiff University, Wales, United Kingdom

• The author and co-author of numerous books and scientific journal articles on MI and health-behavior change

• The co-founder of the Motivational Interviewing Network of Trainers (MINT) and its system for training trainers

2Disclosure: Stephen Rollnick was compensated for the preparation of this material.

Objectives

The purpose of this presentation is to help you

• Understand how MI can help– Facilitate better patient-provider communication– Address medication adherence and its effect on health outcomes– Improve patient satisfaction and autonomy

• Learn how you might apply MI in everyday practice– With medication adherence– When lifestyle changes are necessary

3

The Benefits of Motivational Interviewing

• Increased medication adherence– Reduced risk of hospitalizations

• Improved patient satisfaction and autonomy– Higher Hospital Consumer Assessment of Healthcare Providers

and Systems (HCAHPS) scores– Alignment with accountable care organization (ACO)

quality-of-care goals

• Better engagement in disease-management programs

• Helps to meet the self-management support criteria for patient-centered medical home (PCMH) certification

4

Golin CE et al. J Acquir Immune Defic Syndr. 2006;42(1):42-51; Sokol MC et al. Med Care. 2005;43(6):521-530; Pollak KI et al. J Am Board Fam Med. 2011;24(6):665-672; CMS Web site. https://www.cms.gov/HospitalQualityInits/30_HospitalHCAHPS.asp. Accessed March 1, 2012; AHA Committee on Research. Accountable Care Organizations: AHA Research Synthesis Report. Chicago, Illinois: American Hospital Association; 2010; MarketWatch Web site. http://www.marketwatch.com/story/aetna-members-more-motivated-to-make-healthy-changes-2012-02-15. Accessed February 24, 2012; Cole S et al. In: Patient-Centered Primary Care Collaborative. Transforming Patient Engagement: Health IT in the Patient Centered Medical Home. Washington, DC: PCPCC; 2010:20-25; Kuzel AJ, Skoch EM. Ann Fam Med 2009;7(1):85-86.

Improving Quality Goals With InStep

5

Rollnick S et al. Motivational Interviewing in Health Care. New York, NY: The Guilford Press; 2008.NCQA website. http://www.ncqa.org/Portals/0/Marketing/HPA%20Brochure%20Web.pdf. Accessed July 18, 2012.HEDIS website. http://www.ncqa.org/LinkClick.aspx?fileticket=O-31v4G27sU%3D&tabid=1415. Accessed July 18, 2012.NCQA website. http://www.ncqa.org/LinkClick.aspx?fileticket=Mv2IW8SCCvI%3d&tabid=1312. Accessed July 17, 2012.NCQA website. http://www.ncqa.org/LinkClick.aspx?fileticket=ycS4coFOGnw%3d&tabid=631. Accessed July 18, 2012.NQCA website. http://www.ncqa.org/Portals/0/Programs/Recognition/DRP_web.pdf. Accessed July 15, 2012.NCQA website. http://www.ncqa.org/Portals/0/Programs/Recognition/Heart_stroke_web.pdf. Accessed July 15, 2012.The Joint Commission website. http://www.jointcommission.org/assets/1/6/Transcript_promoting_health_equity.pdf. Accessed July 30, 2012.The Joint Commission website. http://www.jointcommission.org/certification/chronic_obstructive_pulmonary_disease.aspx. Accessed August 15, 2012.

InStep Action Supporting Quality Goal

Improve patient experience of care CAHPS® and HEDIS® scores; NQCA ACO

Support the implementation of continuous quality improvement program Standard 6C: NCQA PCMH Recognition

Activate a patient’s own motivation for adopting healthy behaviors and remaining adherent to treatment

NCQA Diabetes and Heart/Stroke Recognition

Help meet the requirements for patient-centered communication and patient education on self-management of a chronic disease

The Joint Commission Advanced Certification in COPD

CAHPS, Consumer Assessment of Healthcare Providers and Systems; HEDIS, Healthcare Effectiveness Data and Information Set ; NQCA, National Committee for Quality Assurance. CAHPS and HEDIS are registered trademarks of the Agency for Healthcare Research and Quality.

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Improvement in Mean Adherence

4.5%

-3.8%-5%-4%-3%-2%-1%0%1%2%3%4%5%

MI Group Control GroupP=.10.

Impr

ovem

ent

HIV, human immunodeficiency virus.Golin CE et al. J Acquir Immune Defic Syndr. 2006;42(1):42-51.

Primary ResultsWhile the primary outcome was not statistically significant, there was a

trend toward improvement in adherence.

7

Achieved >95% Adherence*

29%

17%

0%

5%

10%

15%

20%

25%

30%

35%

MI Group Control GroupP=.13.

Adh

eren

ce

Secondary ResultsControlling for ethnicity, the MI

group had 2.75 times higher odds of achieving >95% adherence than the

control group (P=.045).

Golin CE et al. J Acquir Immune Defic Syndr. 2006;42(1):42-51.

8

27%

11%

0%

5%

10%

15%

20%

25%

30%

HCP MoreEmpathic

HCP LessEmpathicP=.004.

46%

30%

0%5%

10%15%20%25%30%35%40%45%50%

HCP UsedReflective

Statements

HCP Did Not UseReflective

StatementsP=.006.

Rate of High Patient Satisfaction Rate of High Autonomy Support

Satis

fact

ion

Rat

e

Aut

onom

y Su

ppor

t Rat

e

HCP, healthcare professional.Pollak KI et al. J Am Board Fam Med. 2011;24(6):665-672.

Levels of Member Participation Program Dropouts Decreased

9MarketWatch Web site. http://www.marketwatch.com/story/aetna-members-more-motivated-to-make-healthy-changes-2012-02-15, Accessed February 24, 2012.

53%

76%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Before MI With MI

0%

20%

40%

60%

80%

100%

55%

% P

artic

ipat

ion

% D

ecre

ase

2010 2011

Understanding the DifferencesComparing Patient Interview Techniques

10

Understand Learn

Sample Patient Interview A

11

How effective was this interview?

Understand Learn

COPD, chronic obstructive pulmonary disease; HCP, healthcare professional.

• HCP: How are you doing?• PATIENT: OK, thanks. But my chest is still not getting better. You know, it’s getting

worse sometimes.• HCP: Are you taking your COPD medicines every day?• PATIENT: Most of the time.• HCP: Is there a reason why you haven’t been taking it as I prescribed?• PATIENT: Sometimes I just forget.• HCP: It’s very important to remember your medicine every day to help manage your COPD.• PATIENT: Uh-huh.• HCP: What about Product X? Have you been taking that regularly?• PATIENT: Quite often. I forget sometimes.• HCP: Even if you are having a good day, it’s important to take that one every day because it

will help you in the long term and prevent your chest from getting worse.• PATIENT: Uh-huh• HCP: What about Product Y?• PATIENT: I try to take that one.

Sample Patient Interview B

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• HCP: How has your breathing been lately?• PATIENT: I think it’s getting worse.• HCP: I imagine that it’s not easy on top of everything else, and you're concerned about not

getting worse.• PATIENT: Yes, that’s exactly right. You know, I have my good days, and I want to get better with this,

but I think it’s getting worse. Should I take some other medicine?• HCP: Well, can we talk about the ones you are taking now, just to see how it’s going? • PATIENT: Sure, OK. I take 3 of them: Product X, Product Y, and Product Z.• HCP: And how is it going with them?• PATIENT: I take Product X and Product Y every day…and Product Z I'm supposed to take every day,

but I forget sometimes.• HCP: What’s up with Product Z for you? How do you feel about taking it? • PATIENT: It doesn’t seem to do any good, and I forget sometimes, and it’s a new drug you gave me.• HCP: You are not sure whether its helping you.• PATIENT: Yes, that’s right. Why should I be taking it?• HCP: What do you remember about why this medicine is useful?• PATIENT: Good question. Not a lot, to be honest.


Understand Learn

Sample Patient Interview – Video A

13


Sample Patient Interview – Video B

14


Review: Comparing Interview Techniques

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Biomedical Approach MI ApproachHCP-centered Patient-centered

Information is provided Information is exchanged

HPC solves problem Patient searches for solution

HCP directs HCP negotiates

Focuses on compliance Focuses on adherence

Argumentative/judgmental Inviting/nonjudgmental

Persuade/manipulate Understand/accept

Ambivalence seen as a problem Ambivalence seen as normal

Confrontational style Negotiating style

HCP expects respect/trust HCP earns respect/trust

Uses• Direct questions• Declarative statements• Directive advice

Uses• Open-ended questions• Positive affirmations• Reflective listening

Understand Learn

Berger BA. Case Manager. 2004;15(5):46-50; Resnicow K et al. Health Psychol. 2002;21(5):444-451; Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. 2nd ed. New York, NY: The Guilford Press; 2002.; Stephen Rollnick, PhD, e-mail communication, August 10, 2012.

The Impact of Nonadherenceand Behavioral Barriers

The Need for Motivational Interviewing

16

Understand Learn

Stages of Medication Nonadherence

• Medication nonadherence can occur at 4 different stages along the treatment continuum, based on patient behavior

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Rx Not Filled Rx Not Taken Rx Not Continued After Initial Therapy

Another

29%do not continue

to take it

Another

12%do not take

their medication

12%of patients do

not fill their prescriptions

88%Adherence

76%Adherence

47%Adherence

Rx Sometimes Missed or Skipped

25%Adherence

Another

22%take less medication

than prescribed

Understand Learn

Case Management Society of America. Case Management Adherence Guidelines Version 2.0. 2006.

Nonadherence Rates in Chronic Conditions

• Poor medication adherence can lead to a worsening of disease and avoidable health risks, especially in chronic illnesses

• 53.8% of nonadherence is associated with behavioral barriers, such as forgetting to take medications or health illiteracy

• <50% of patients on chronic therapies are adherent within the first year of treatment

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Understand Learn

Osterberg L, Blaschke T. N Engl J Med. 2005;353(5):487-497; Case Management Society of America. Case Management Adherence Guidelines Version 2.0. 2006; The Healthcare Intelligence Network. Guide to Improving Medication Adherence. HIN; 2012; Rand CS, Wise RA. Am J Respir Crit Care Med. 1994;149:S69-S76; Restrepo RD et al. Int J Chron Obstruct Pulmon Dis. 2008;3(3):371-384; Baroletti S, Dell'Orfano H. Circulation 2010;121(12):1455-1458; Rubin RR. Am J Med. 2005;118(5A):27S-34S; Alhalaiqa F et al. J Hum Hypertens. 2012;26(2):117-126.

0%

20%

40%

60%

80%

100%

Asthma COPD CoronaryHeart Disease

Diabetes Hypertension

<40%

30%-70%40%-60%

60%-85%(orals and insulin)

53%-70%

Adh

eren

ce R

ate

Reasons for Nonadherence

• Nonadherence is more than just patient forgetfulness or an unwillingness to take one’s medicine

• There are many reasons for poor adherence, including– Apathy, depression, or stress– Confusion– Lack of social or family support– Past noncompliance with prescribed treatments– Low confidence in the medication or the provider– Concerns about taking drugs, such as substance abuse or fear

of addiction– Limited education about the medication or illness– Problems understanding prescribing instructions (health literacy)

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Adherence can be improved by clarifying a patient’s challenges and helping to improve his/her motivation and understanding

Understand Learn

The Healthcare Intelligence Network. Guide to Improving Medication Adherence. Sea Girt, NJ: HIN; 2012; Case Management Society of America. Case Management Adherence Guidelines Version 2.0. 2006; Vlasnik JJ et al. Case Manager. 2005;16(2):47-51.; Stephen Rollnick, PhD, e-mail communication, August 10, 2012.

What Is Motivational Interviewing?

Improving Your Patient-HCP Dialogue

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Understand Learn

Motivational Interviewing Exercise

• Divide into teams of 2 or 3

• Time: 15 to 20 minutes

• Instructions– Imagine this: you have just been diagnosed with a lifelong condition

(eg, diabetes, COPD). You are with your HCP, who tells you about the diagnosis and medication (if appropriate), and also about why you need to adjust your lifestyle (diet, exercise, alcohol use, etc). You are a little shocked

– By yourself, consider these 2 questions for 2 minutes, then write down your answers: How could the HCP be helpful to you at this point? What would NOT be helpful for you?

– Meet with 2 or 3 colleagues and swap notes– Convene a large group discussion to obtain a consensus about the

2 questions

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Understand Learn

What Is Motivational Interviewing?

22

MI is a directive, person-centered, counseling method for increasing intrinsic motivation to change by helping

clients explore and resolve ambivalence

Understand Learn

Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. 2nd ed. New York, NY: The Guilford Press; 2002.

Goals of Motivational Interviewing Techniques

23

Understand Learn

Resnicow K et al. Health Psychol. 2002;21(5):444-451.; Stephen Rollnick, PhD, e-mail communication, August 10, 2012.

Create a supportive and nonjudgmental atmosphere

Help patients feel comfortable openly discussing their medicine use and/or a change in lifestyle

Guide patients so they—not you, the HCP—say why and how they might change

• This is called “change talk”

Increase the amount of change talk to facilitate better outcomes

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Understand Learn

Exchanging Information Is a Key Strategy

Information exchange occurs throughout the MI process

It is useful for dealing with many consultation challenges

It is implemented through the Elicit-Provide-Elicit technique

Vlasnik JJ et al. Case Man. 2005;16(2):55-59. ; Rollnick S et al. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, NY: The Guilford Press; 2008. ; Stephen Rollnick, PhD, e-mail communication, August 10, 2012.

Exchanging Information With Motivational Interviewing

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Understand Learn

Vlasnik JJ et al. Case Man. 2005;16(2):55-59. ; Rollnick S et al. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, NY: The Guilford Press; 2008.; Stephen Rollnick, PhD, e-mail communication, August 10, 2012.

Objective• Exchange information with your patients in 2-sided conversations that

encourage them to drive the discussions throughout the MI process

Method• Ask permission • Reinforce autonomy• Apply the “Elicit-Provide-Elicit” technique

– Elicit what the patient already knows or would like to know– Provide information – Elicit the patient’s conclusions

Exchanging Information Using the Elicit-Provide-Elicit Technique

Illustrative Dialogue

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Understand Learn

• HCP: You sound unhappy about your AFib medicine. It’s up to you, but we could spend a few minutes talking about it. (ASK PERMISSION/ REINFORCE AUTONOMY)

• Patient: OK.• HCP: Tell me, how do you understand the way it works? (ELICIT)• Patient: Who, me? I can’t remember much. Does it stop the… (continues)• HCP: See what you think of this. This medicine, if it’s taken regularly,

whether you are feeling well or not, does this… (explains briefly) (PROVIDE)

• What do you think of this? What does it mean for you and your condition? (ELICIT)

• Patient: Well, are you saying that… (patient is working out what it means with a supportive practitioner who has avoiding any scolding or lecturing)

AFib, atrial fibrillation.

Getting Started:Steps for Motivational Interviewing

Exch

ange

Info

rmat

ion

STEP 1

STEP 2

STEP 3

STEP 4

Establish Rapport: Engage the patient in an honest, empathetic discussion

Set Agenda: Agree about the direction of your discussion

Assess Importance & Confidence: Let the patient tell you why and how they might change

Plan the Next Step: Help with decision-making, even if it means not changing

Understand Learn

Rollnick S et al. Health Behavior Change: A Guide for Practitioners. New York, NY: Churchill Livingstone; 1999.; Stephen Rollnick, PhD, e-mail communication, August 10, 2012. 27

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Step 1: Establish RapportUnderstand Learn

OARS, Open-ended questions, Affirmation, Reflection, and Summary.Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. 2nd ed. New York, NY: The Guilford Press; 2002.; Stephen Rollnick, PhD, e-mail communication, August 10, 2012.

Objective• Ensure engagement in the helping process and show patients that you

understand their perspective

Method• Express empathy

– Let your patients know that you understand how they feel• Roll with resistance

– Avoid arguments. Try not to argue for change—this is the patient’s job• Apply OARS skills

– O – Open-ended questions: Allow patients to say how they feel– A – Affirmation: HCP highlights their strengths– R – Reflection: HCP makes short, empathic listening statements– S – Summary: HCP captures what’s been said and moves on

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Background Beliefs Abilities Medical Knowledge

Domestic situation Cultural and religious influences

Language barriers Understanding of his/her health condition(s) and medication(s)

Physical-wellness practices

Opinion of him-/herself Literacy level Understanding of the importance of medication adherence

Understanding of medical and pharmacy benefit coverage

Opinions of traditional Western medicine vsholistic medicine, herbal remedies, and self-help

Physical and/or mental disabilities

Comprehension of potential adverse events associated with prescribed medications and home remedies

Tallman K et al. Permanente J. 2007;11(1):19-29.


Method (cont)• As you work to build a rapport with your patients, strive to understand what

you can about their backgrounds, beliefs, abilities, and medical knowledge

30

Illustrative DialogueStep 1: Establish Rapport

Understand Learn

Express Empathy – Example #1• HCP: How are you doing with your diabetes medicines?• Patient: Ah, fine. Thank you.• HCP: You’re trying to keep going with them.• Patient: Yes, but it’s not so easy. I find that I miss doses and I don’t feel well a

lot of the time. I get so tired.• HCP: You’re not feeling all that well, and remembering to take your medicine is

not easy.• Patient: Exactly, right.

Express Empathy – Example #2• HCP: How are things going?• Patient: Ah, my back’s started hurting and I don’t know whether I’ll have to stop

working. I worry about my chest because it gets bad in the winter. And… (patient continues to list problems)

• HCP: You’ve got quite a lot on your plate.• Patient: Yes, that’s right.

31



Roll With Resistance – Example #1• Patient: I don’t like that diabetes medicine. It doesn’t make me feel good.• HCP: You're not sure it’s helping you.

Roll With Resistance – Example #2• Patient: My job’s so busy, I don’t have the time to think about my diabetes.• HCP: It’s hard to keep on top of everything.

32


O – Open-ended questions“How do you feel about your progress?”

Illustrative Questions/Statements

A – Affirmation“Despite all the pressure, you came down today to get a check-up.”

R – Reflection“You are worried about the side effects.”

S – Summary“You don’t like the side effects, yet you want to get on top of this condition. And you are wondering whether there is another AFibmedicine that might be better.”

33

Step 2: Set AgendaUnderstand Learn

Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. 2nd ed. New York, NY: The Guilford Press; 2002.; Stephen Rollnick, PhD, e-mail communication, August 10, 2012.

Objective• Think about the direction of the conversations and agree with your patients

about what the focus of your brief discussions will be

Method• The direction is clear – Sometimes the direction is clear. Just ask permission

and emphasize autonomy (eg, “It’s up to you whether you would like to talk about this”)or

• There are choices about direction – This is often the case. There are choices about different lifestyle changes or different medicines

– Ask permission to step back and consider the focus together – Lay out possible topics from your side– Invite the patient to suggest any others– Agree about the agenda

• Apply OARS skills

34

Step 2: Set AgendaUnderstand Learn

When there are choices about direction• HCP: Let’s decide what is best to talk about.• Patient: Okay, that’s fine. (Patient agrees to pause and discuss)• HCP: We could focus on your COPD medicine, your latest FEV1 levels,

or your progress with quitting smoking. What about you? Is there anything you think might be better for us to talk about?

• Patient: I was thinking about my COPD medicine and… (Patient and HCP take a minute to review the options)

• HCP: So, let’s start with your COPD medicine, and then perhaps we can talk about your FEV1 levels in a moment, okay? (Patient agrees)


FEV1, forced expiratory volume in 1 second.

35

Step 3: Assess Importance & ConfidenceUnderstand Learn

Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. 2nd ed. New York, NY: The Guilford Press; 2002.; Rollnick S et al. Health Behavior Change: A Guide for Practitioners. New York, NY: Churchill Livingstone; 1999.; Stephen Rollnick, PhD, e-mail communication, August 10, 2012.

Objective• To ask key questions about motivation that allow patients (rather than the HCP)

to say why and how they might change

Method• Ask how important is it for the patient to change the discussed behavior

– Draw out the why of change from the patient • Ask how confident the patient is that he or she will succeed at changing

the behavior– Draw out the how of change from the patient

• Summarize, ask open-ended questions, and use other OARS skills– Ask the patient what he or she would like to do

36

Step 3: Assess Importance & ConfidenceUnderstand Learn

Ask how important the change is• How important is it for you to change this behavior?• Why do you want to make this change?• What are the best reasons for doing it?

Illustrative Questions

Ask how confident they are that they will succeed• How confident do you feel about changing this behavior?• How might you go about it in order to succeed?• What have you noticed that might help you?

Ask an open-ended question after summarizing• Where does this leave you now?• How would you like to proceed?• What would you like to do next?

Readiness Ruler: Completing an Assessment

• The Readiness Ruler is a simple tool that allows you to– Measure a patient’s willingness or readiness to change a health behavior– Determine where a patient is on the continuum between “not ready to

change,” “unsure,” and “already changing”– Ask simple, open-ended questions to help build motivation

• To complete an assessment– Raise the subject of health-behavior change with your patient and listen

carefully to understand his or her perspective– Avoid giving any advice at this stage– Ask him or her to list one health-behavior change and to mark on the ruler

where he or she feels he or she is in the change process

37Rollnick S et al. Health Behavior Change: A Guide for Practitioners. New York, NY: Churchill Livingstone; 1999.; Vlasnik JJ et al. Case Manager. 2005;16(2):55-59.; Stephen Rollnick, PhD, e-mail communication, August 10, 2012.

Readiness Ruler: Follow-up Questions

• After your patient has completed the ruler, ask some follow-up questions to begin an open dialogue about his or her health behavior, such as

– Why are you at a ___ and not a zero?– Why do you want to make this change?– How might you go about it in order to succeed?– What are the best reasons for doing it?

38Rollnick S et al. Health Behavior Change: A Guide for Practitioners. New York, NY: Churchill Livingstone; 1999.; Vlasnik JJ et al. Case Manager. 2005;16(2):55-59.; Stephen Rollnick, PhD, e-mail communication, August 10, 2012.

39

Step 4: Plan the Next StepUnderstand Learn

Stephen Rollnick, PhD, e-mail communication, August 10, 2012.

Objective• Help your patients make decisions for themselves

Method• Emphasize autonomy

– Say “It’s up to you” or ask “What do you think will work best?”• Use open-ended questions and other OARS skills

– Summarizing allows you to capture progress and move on, or close the consultation

• Facilitate a 3-step strategy– Step back and brainstorm possible solutions– Help patients clarify workable plans– Summarize

40


Rollnick S et al. J Mental Health. 1992;1:25-37.; Stephen Rollnick, PhD, e-mail communication, August 10, 2012.

Method (cont)• Even when conversations go well, change is not easy and does not always come quickly

• It is important to convey the following points to your patients:

– It’s okay to not make a decision sometimes. No decision does not mean it’s a failed consultation

– Decisions break down. It’s a common and normal occurrence

– Commitment often fluctuates. Don’t give up. Regroup and try again

41


HCP: So, you have decided to try to take your COPD medicine more regularly. Does it make sense to you if we just stop for a moment and think about how you might do this? How might you succeed with this?


Patient: Well, I could put a rubber band on my toothbrush I suppose, to remind me.

HCP: Yes, that’s one thing. Sounds like it might work. Let’s see what else we can come up with, and then you can choose what plan makes sense to you. (They gather a few ideas.)

HCP: We’ve talked about X, Y, and Z. What makes the most sense to you?

Patient: (Identifies what might work)

HCP: (Summarizes the plan and says something like) This might work or it might not. But don’t worry about failing, because you can always think of another solution, and we can certainly do this together again.

What We Learned Today

42

Steps for Motivational Interviewing

43

Step 1: Establish Rapport Step 2: Set Agenda

Engage the patient in an honest, empathetic discussion

Agree about the direction of your discussion

Step 3: Assess Importance/Confidence Step 4: Plan the Next Step

Let the patient tell you why and how they might change

Help with decision-making, even if itmeans not changing

Rollnick S et al. Health Behavior Change: A Guide for Practitioners. New York, NY: Churchill Livingstone; 1999. ; Stephen Rollnick, PhD, e-mail communication, August 10, 2012. Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. 2nd ed. New York, NY: The Guilford Press; 2002.; Rollnick S et al. J Mental Health. 1992;1:25-37.; Vlasnik JJ et al. Case Manager. 2005;16(2):55-59. ; Rollnick S et al. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, NY: The Guilford Press; 2008.

Information exchange occurs throughout the MI process –Elicit-Provide-Elicit is a more collaborative strategy

The Benefits of Motivational Interviewing

MI can help• Empower patients to recognize and address their health-behavior barriers

and drive their own changes

• Address medication-adherence issues to improve health outcomes, such as reducing hospitalizations

• Increase patient engagement in disease management programs

• Improve patient satisfaction, which can lead to higher HCAHPS scores and align with ACO quality-of-care goals

• Meet the self-management support criteria that can help lead to PCMH certification

• Facilitate more productive communication between you and your patients

44

Golin CE et al. J Acquir Immune Defic Syndr. 2006;42(1):42-51.; Sokol MC et al. Med Care. 2005;43(6):521-530.; MarketWatch Web site. http://www.marketwatch.com/story/aetna-members-more-motivated-to-make-healthy-changes-2012-02-15. Accessed February 24, 2012.; Pollak KI et al. J Am Board Fam Med. 2011;24(6):665-672.; CMS Web site. https://www.cms.gov/HospitalQualityInits/30_HospitalHCAHPS.asp. Accessed March 1, 2012.; AHA Committee on Research. Accountable Care Organizations: AHA Research Synthesis Report. Chicago, Illinois: American Hospital Association; 2010.; Cole S et al. In: Patient-Centered Primary Care Collaborative. Transforming Patient Engagement: Health IT in the Patient Centered Medical Home. Washington, DC: PCPCC; 2010:20-25.; Kuzel AJ, Skoch EM. Ann Fam Med 2009;7(1):86-87.; Kavookjian J. In: Science and Practice of Pharmacotherapy I and II–PSAP-VII, Book 8. ACCP; 2011:1-15.; Resnicow K et al. Health Psychol. 2002;21(5):444-451.

Documents

Improving Patient Interviewing Techniques · The Improving Patient Interviewing Techniques presentation is fully endorsed by Stephen Rollnick, PhD. Dr. Rollnick, who lent his vast