Motivational Interviewing Improves Patient Outcomes

A diabetes patient’s ambivalence about changing their diet or taking their insulin can stand between successful management of their disease and a further escalation that could lead to blindness, limb removal, or even death.

That’s where motivational interviewing makes a difference, says Maureen Hennessey, PhD, senior vice president and director of quality and population health solutions, and Elizabeth Oyekan, PharmD, senior director of quality and population health solutions, at New York-based Precision for Value. The company consults with pharmaceutical and life science clients in demonstrating the value and outcomes of their medical products.

Hennessey and Oyekan discussed how motivational interviewing can improve patient outcomes at the Academy of Managed Care Pharmacy Managed Care and Specialty Pharmacy Annual Meeting, which took place in Boston April 23 to 26.

Hennessey describes motivational interviewing as a patient-centric style of communication that helps to elicit and motivate change. Motivational interviewing strategies are more collaborative than coercive or combative and more supportive than directive, she adds.

If, for example, a patient with diabetes typically eats potatoes for dinner every night, that can interfere with their diabetes treatment plan. Rather than arguing with a patient and telling them they shouldn’t eat potatoes, motivational interviewing techniques can help determine their willingness to eat a smaller portion size or eat potatoes less often, says Hennessey.

She says there are four steps of motivational interviewing, which include:

• Engaging the patient. If the patient isn’t engaged, you’re really not going to be able to create that collaborative alliance, says Hennessey. Engaging with a patient, for example, might involve acknowledging that they enjoy eating a particular type of food, such as potatoes, and communicating about particular foods you like, says Hennessey.
• Encouraging the patient to focus on something they’re willing to address. For example, suggest that the patient reduce their portion size or eat potatoes every other night. Oyekan says many patients are anxious about being told they need to dramatically change their diets, without regard for their culture and daily lives. That’s why she recommends that healthcare professionals coach patients to cut back, noting that these dietary changes should be a gradual process.
• Evoking the patient’s motivation. This is where you start to identify ways that the patient is starting to think about change and encourage that discussion, she says.
• Planning for the first step they can take along their change journey. “Once the patient realizes that they don’t have to totally give everything up, they breathe a little better,” she adds. And that willingness to listen to dietary guidance can prevent patients from resisting their treatment plan.

Oyekan says compassion and empathy are key to the practice of motivational interviewing.

Exercising both is helpful when determining why a patient isn’t adhering to treatment recommendations, such as failing to take their medications, says Hennessey.

Asking a patient to tell you more about why they’re not taking their medications is helpful, says Hennessey.
She shared the example of a male patient with diabetes who didn’t take his medications. With this patient, his father had a negative outcome as a result of his diabetes medications. The patient then learned that there were new, more effective medications available.

Healthcare professionals first need to understand where the patient is coming from, and then they need to ask for permission to educate them about new treatments, says Hennessey, noting that asking for permission to provide that information is key. It also gives the patient a collaborative stance from which to get more engaged in their own treatment plan.