Ch..ch..ch..Changes! Motivation Interviewing in Primary Care Alex J. Reed, PsyD, MPH Director of Behavioral Health Education

Learning Objectives 1. Describe the benefits of motivation interviewing for primary care patients and providers. 2. Explore techniques for using motivation interviewing in patient care. 3. Be able to discuss strategies for implementing motivational interviewing strategies in primary care settings. 

What is Motivational Interviewing? Motivational interviewing involves helping patient to say why and who they might change. It is based on the use of a guiding style.

MI Studies MI outperformed traditional advice giving in 80% of studies1 “Promising intervention components for hypertensive pts include linking adherence behavior with daily habits, providing adherence feedback to patients, self-monitoring blood pressure, special packaging of medications and motivational interviewing”2

MI Studies In a systematic review3 for pts at risk or diagnosed with CV disease, MI Could more effective on altering smoking habits Positively improved clients systolic and diastolic BP Might have favorable effects on improving client’s depression

Core RULES of MI R: Resist the Righting Reflex U: Understand your patient’s motivations. L: Listen to you patient. E: Empower you patient. Resist the Righting Reflex: People tend to resist persuasion. Alcoholic who knows they drink to much but enjoy drinking and don’t think of themselves as having a problem. Understand your patient’s motivations. It is the patient’s own reasons for change, and not yours, that are most likely to trigger behavior change. Listen to you patient. The answers for behavior change most likely lie within the patient and finding them requires some learning. Empower you patient. Help to explore how a patient can make a difference in their own health.

Additional MI SKILLS - OARS Open-ended questions Affirmations Reflective listening/reflections Summaries Open ended – What brings you in today? Affirmations – Your lab numbers look good. You are doing a great job in lowering your cholesterol. Reflections: You have been under a lot of stress lately Summary: Let me take a moment to recap what you have talked about…

Let’s practice some skills Yes and, yes but, no, reflection, it’s important to me that you said that…

Agenda Setting

Pros and Cons What do you like about your smoking? What bothers you about your smoking? Summarize pros and cons Helps to assist in identi

Change Talk Look for small change talk from your patient Usually includes the desire, ability, reason Small change talk can include what they want to talk about, e.g. What would be most helpful for us to talk? Is it condoms, medication or something else? Small commitment: Not “So when are you going to cut back on your smoking? Instead, It’s up to you when and and how you want to quit smoking, but I am wondering how do you see yourself succeeding with this?

Assessing Interest and Confidence On a scale of 1-10, how interested are you in working on _________? On a scale of 1-10, how confident are you that you can change _________?

Interest and Confidence 2 x 2 Not Confident Confident Let pt know you will bring up in the future Assess knowledge Pros and Cons Give hope and tools Assess Knowledge Go get’em, tiger! Not Interested Interested

Ask-Elicit-Ask Check understanding of the situation Provide information Ask about patients interpretation of your information

Making decisions It will be up to you to decide how and when you want to quit smoking. How do you see yourself succeeding? So you want to get through the withdrawal from nicotine. There are lots of ways to help with this, but what makes sense to you?

In Summary

References 1. Rubak, S., Sandbaek, A., Lauritzen, T. & Christensen, B. (2005). Motivational Interviewing: A systematic review and meta-analysis. British Journal of General Practice, 55, 305-312. 2. Conn, V.S., Ruppar, T.M., Chase, J.D., Enriquez, M., Cooper, P.S. (2015). Interventions to improve medication adherence in hypertensive patients: Systematic review and meta-analysis. Current Hypertension Rep, 17. 3. Lee, W.W., Choi, K.C., Yum, R.W., Yu, D.S., Chair, S.Y. (2016). Effectiveness of motivational interviewing on lifestyle modification and health outcomes of clients at risk or diagnoses with cardiovascular disease: A systematic review. International Journal of Nursing Studies, 53: 331-341. 4. Rollnick, S., Butler, C., Kinnersley, P., Gregory, J., Mash, B. (2010). Motivational Interviewing. BMJ, 320, 1242-1245 5. Salvo, M.C., Cannon-Breland, M.L. (2015). Motivational interviewing for medication adherence. Journal of the American Pharmacists Association, 55 (4), e354-363.