Slide 1: Educational purposes disclaimer
This presentation is offered for educational purposes only, intended to serve as continuing medical education for health care professionals. The content of the presentation represents the views and opinions of the original creators of such content and does not necessarily represent the views or opin
Slide 2: Improving Medication Adherence with Motivational Interviewing – Example of a Heart Failure Patient
A:CARE CONGRESS Improving Medication Adherence with Motivational Interviewing – Example of a Heart Failure Patient Prof. Atul Pathak Professor of Medicine and Head of the Department of Cardiovascular Medicine at the Princess Grace Hospital, Monaco GLO2208853 | Nov-21 | 2
Slide 3: Problems?
Problems? Heart Failure is Hear Failure is Too many Drugs do not Drugs reducing a silent and non a fluctuating comorbidities always provide morbidity and silent disease disease i.e. diabetes, relief of mortaliy have CKD (pill symptoms also adverse burden) drug reactions so Benefit / Risk Ratio not p
Slide 4: Why is a patient not ready to change?
Why is a patient not ready to change? It is NOT that… They don’t want to see (denial) They don’t care (no motivation) They are just early in the stages of change GLO2208853 | Nov-21 | 4
Slide 5: Traditional approach
Traditional approach People have to “hit Change is motivated bottom” to be ready by discomfort for change If you can make people Corollary: People don’t feel bad enough, they change if they haven’t will change. suffered enough Sources: Slide adapted by Jeanne Obert, 2006, from Miller, W.R., & Rollni
Slide 6: Another approach: motivating!
Another approach: motivating! Patient and practitioner Motivation for change can are equal partners in be fostered by an accepting, relationship empowering, and safe (collaborative effort atmosphere between two experts) Sources: Slide adapted by Jeanne Obert, 2006, from Miller, W.R., & Rollnick, S.
Slide 7: What are motivational strategies?
What are motivational strategies? 1 2 3 Communication tools A style of talking with Enhance the patient’s and Skills patient constructively own motivation to about reducing their change using strategies Based on Health health risks and that are empathic and Behaviors changing their non-confrontation
Slide 8: What are motivational strategies?
What are motivational strategies? A patient-centered directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. Sources: Slide adapted by Jeanne Obert, 2006, from Miller, W.R., & Rollnick, S. (2002). Motivational Interviewing: Preparing people for change. N
Slide 9: Motivation requires knowledge about stages of change
Motivation requires knowledge about stages of change Recognizing the need to change and understanding how to change doesn’t happen all at once. It usually takes time and patience. People often go through a series of “stages” as they begin to recognize that they have a problem. Prochaska, J. O., & Di
Slide 10: Helping people change
Helping people change Motivational interviewing is the process of helping people moving through the stages of change. GLO2208853 | Nov-21 | 10
Slide 11: Stages of Change
Stages of Change Precontemplation Contemplation Relapse Preparation Maintenance Action Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice, 19(3), 276–288. Sources: Slide adapted by Jeanne Obert
Slide 12: Population distribution across stages of behavioral change
For any behavioral problem at a given time, there are (in the population at large) 40% 40% 20% in in in precontemplation contemplation preparation or action Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997 Sep-Oct;12(1):38-48. GLO2208853 | Nov-
Slide 13: The stages of motivation
The stages of motivation Contemplation Precontemplation To stimulate an analysis of 01 To inform, to create doubt 02 the problem (the pros and cons) Preparation 03 To fix the objective together Relapse To analyze the causes, to How to elicit patient 06 remember the successes, and to motivation? rein
Slide 14: Building motivation using OARS (the microskills)
Building motivation using OARS (the microskills) HOW CAN I HELP PATIENTS Use the microskills Open-ended Affirmations Reflections Summaries questions To elicit and reinforce self-motivational statements (Change Talk) GLO2208853 | Nov-21 | 14
Slide 15: OARS: Open-ended questions
OARS: Open-ended questions CLOSE VERSUS OPEN-ENDED QUESTIONS “Are there good things about not taking the pills?” vs. “What are the good things about not taking the pills?” “Are there bad things about using drugs?” vs. “Tell me about the not-so-good things about using drugs” “Do you have concerns abo
Slide 16: OARS: Affirmation
OARS: Affirmation Thanks for coming today I appreciate that you are willing to talk to me about your heart failure You are obviously a resourceful person to have coped with those difficulties That’s a good idea It’s hard to talk about....I really appreciate your keeping on with this GLO2208853 | Nov
Slide 17: OARS: Reflective listening
OARS: Reflective listening Reflective listening is used to Check out whether you really understood the patient Highlight the patient‘s ambivalence about their substance use Steer the patient towards a greater recognition of her or his problems and concerns, and Reinforce statements indicating that t
Slide 18: OARS: Summarize
OARS: Summarize Summarizing is an important way of discussing together what has already been said, making sure you understood the patient correctly, and preparing them to move on. Summarising is putting together a group of reflections. GLO2208853 | Nov-21 | 18
Slide 19: Four principles of motivational interviewing
Four principles of motivational interviewing Expressing Developing Avoiding Supporting empathy discrepancy argumentation self-efficacy GLO2208853 | Nov-21 | 19
Slide 20: Support Self-Efficacy
Support Self-Efficacy Patient is There is Belief that responsible hope in the change is for choosing range of possible is and carrying alternative important out actions approaches motivator to change available GLO2208853 | Nov-21 | 20
Slide 21: Signs of readiness to change
Signs of readiness to change Fewer questions Self- about the motivational Looking problems statements ahead Less More Resolve Experimenting resistance questions with change about change GLO2208853 | Nov-21 | 21
Slide 22: The tool
The tool MOTIVATIONAL STAGE Question I: Is my patient taking his pills? (or for any task predefined by the physician) Yes, he is No, he is not Question lla: Question IIb: How long has he been doing this? Does he feel concemed about the proposed task? For less than 6 months More than 6 months Yes Not
Slide 23: Evidences
Evidences Systematic reviews and meta-analyses Some reviews have even shown have shown some beneficial effect of statistically significant change in direct motivational strategies compared to measures such as blood pressure, traditional advice giving in various cholesterol, and body contexts such as
Slide 24: Impact of motivational interviewing on clinical parameters
Impact of motivational interviewing on clinical parameters Estimate of Effect measure n P-value (95% CI) Effect (variation) Body mass index 1140 0.72 0.0001 (0.33 to 1.11) HbA1c (%GHb) 243 0.43 0.155 (-0.16 to 1.01) Total blood cholesterol (mmol/l) 1358 0.27 0.0001 (0.20 to 0.34) Systolic blood pres
Slide 25: Conclusion
Conclusion Heart failure is a perfect example of a chronic disease where motivational tools can improve adherence Change yourself Change your patient Just do it ! GLO2208853 | Nov-21 | 25