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Healthcare providers who know how to effectively deal with patients' ambivalence and resistance have adherence rates that are five times higher than healthcare providers who are in an information-giving mode. This message was delivered by Bruce Berger, Ph.D., R.Ph., head and professor of pharmacy care systems, Auburn University, to attendees of the Food Marketing Institute's supermarket pharmacy conference, held recently in Las Vegas.
"We have to get away from this idea that if we simply tell people what to do, they are going to do it. We know that information and knowledge are prerequisite, but they do not predict adherence," said Berger.
Berger went on to explain that 70% of people who come into a pharmacy to get a smoking cessation patch have no intention of quitting. "They will slap the patch on and will continue to smoke and end up in an emergency room with nicotine overdose. Seventy percent of patients who come to a pharmacy with a chronic illness that they need to treat with a prescription have no intention of treating that illness appropriately. The No. 1 predictor of treatment adherence and outcomes is getting a healthcare provider who cares about them. It's the relationship between the healthcare provider and the patient. Motivational interviewing is about creating that relationship," Berger explained.
Berger offered the following tips for motivational interviewing:
Pharmacists should be particularly concerned about adherence problems when a patient has a chronic asymptomatic illness, the illness is progressive, regimens are complex, there are injections involved, and cost is a barrier, cautioned Berger.
Berger advised pharmacists to also ask patients the following questions:
Emphasizing that reminders work well only if patients are motivated to do what you are reminding them about, Berger said, "Discharge interventions in a hospital only work well if the patient is involved in the decision making and if the patient expects the discharge to happen and is prepared for it. If you do discharge (counseling) on a patient who wants to get out of the hospital right now, they are not listening to what you have to say. Continuity of care has far superior rates of adherence outcomes than one-shot interventions."
Finally, Berger advised that when you try to persuade or convince people to do something they are not ready to do, you are going to force them to defend the very behavior they are trying to change. "Don't tell them the benefits. Ask, What benefits do you see? What I'm trying to do is to get that decisional balance tilted in favor of the benefits of doing the behavior. Any attempts to improve adherence must involve the patient in the decision-making process. The patient must be involved in setting goals of treatment that are relevant to the patient improving (his) adherence. If you can't match up something in their life that is important to them, they won't do it."