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    Can motivational interviewing improve patients' drug compliance rates?


    Bruce Berger urges pharmacists to involve patients in improving their drug adherence rates. (Photo: Sandra Levy)
    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.

    Emphasizing that motivational interviewing can help bring patients to a realistic assessment of the benefits and risks of being compliant, Berger stressed that motivation is internal. It is not enhanced by persuasion or convincing, and patients have to understand and believe the diagnoses.

    Berger offered the following tips for motivational interviewing:

    • Identify the motivational issues that make the patient take or not take their medication.
    • Assess the patient's understanding of their illness and treatment.
    • Ask permission to give advice/information.
    • Explore the decisional balance. "Ask the patient about what he or she sees as the benefits and downsides of engaging in a behavior (taking medicine, losing weight, etc.) Find out how they might overcome any barriers they may perceive and suggest solutions if they don't have any, recommended Berger.
    • Look for opportunities to reflect back your understanding to the patient.

    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:

    • What don't you understand about your illness?
    • Do you think this drug will work? What does "work" mean?
    • Do you believe in your doctor's diagnosis? "If patients don't understand their condition or how their medication works, it is important to know how to talk to them," said Berger.
    • What is your understanding of what the medication is going to do? "For example, how does your medication affect your diabetes? What is your understanding if you don't treat your diabetes?"
    • How long is the medicine going to take to work?

    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."

    Sandra Levy
    Sandra Levy is Managing Editor-Projects. She covers self care, chains and business, home care, over-the-counter medicines and Rx-to-OTC ...

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