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Mom always said, "You kill more flies with honey." She may have had something there.
To really put patients at ease and increase adherence to medication regimens, pharmacists should implement “motivational interviewing” principles and skills, said Bruce A. Berger, PhD, president of Berger Consulting LLC and emeritus professor at Auburn University, speaking at the recent NACDS Total Store Expo conference, during a talk titled “Medication adherence and the role of motivational interviewing.”
Bruce Berger“The patient has always had veto power, but healthcare providers operate under an illusion of control. We believe that if we tell them to take a medication, they will or should do it. That’s part of the reason that the average national medication adherence rate is less than 50% for chronic asymptomatic illnesses,” Berger told Drug Topics. “Motivational interviewing takes less time than what is being done now, because healthcare providers won’t have to deal with the same issues with patients over and over.”
To help pharmacists and other healthcare providers boost adherence rates and improve their relationships with patients, Berger and NACDS Foundation have teamed up to provide an 8-hour e-learning course, “Comprehensive motivational interviewing training for healthcare providers” (comMIt).
Developed several years ago, the concept of motivational interviewing enabled clinical psychologists to better work with people who are ambivalent or resistant to changing behaviors connected with substance abuse. Berger expanded the concept to teach healthcare providers how to improve their relationships with and encourage adherence in patients who are ambivalent or resistant to change.
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When patients are ambivalent or resistant to change - e.g., patients who do not understand why they were prescribed a new blood pressure medication - they are basing their comments and decisions on faulty or incomplete information, or both.
“If that information is challenged - if that is the first thing I do as a healthcare provider - they are going to become defensive, because I caused them to lose face. They are also going to become resistant to me, in addition to the health behavior,” Berger said.
The typical healthcare provider’s response to a patient resistant to a new medication is something like, “You need to take the medication because your blood pressure is elevated and you need to bring it down,” Berger said.
“That is a threatening statement to them. Their way of thinking is being threatened. Even factual information, if told in a direct way, puts them on guard if their way of thinking is not first honored and understood.”
Other healthcare provider responses that typically backfire include “Just because you are feeling okay, doesn’t mean you are okay,” “You need to quit smoking,” and “You need to lose weight. How many times have we talked about this?”
Instead, pharmacists can honor patients’ point of view and reflect statements back to them. For example, when a patient states, “Why do I need this medication? I feel fine,” pharmacists can respond, “You know, you ask a really good question. You’re wondering why, given that you feel okay, you need to take that medication.”
Such a statement “does not challenge their thinking and there is no possibility of relational resistance. The issue still exists, but at least they know I’m on the side,” Berger said.
Next, ask for permission to share information with the patient. A statement such as “You raise a good question. Would you mind if I share some thoughts with you and you tell me what you think? Ultimately, this is your decision,” empowers the patient and offers a choice.
The next step is to address - with permission - the patient’s issue. For example, said Berger, what if patients are resistant to taking a new blood pressure medication because they “feel fine”?
In that case, he said, pharmacists can respond, “Unfortunately, high blood pressure doesn’t have any symptoms, but can result in a stroke or heart attack even when you feel okay. Your blood pressure 150/100. We know that when blood pressure drops below 140/90, your risks of stroke or heart attack go down dramatically. A blood pressure of 150/100 puts you at much greater risk of heart attack or stroke if your blood pressure doesn’t come down. This medication can bring your blood pressure down and greatly reduce the risk of stroke or heart attack. What are your thoughts now about taking the medication?”