Changing health behaviors — whether it be quitting smoking, starting an exercise routine, or taking medications as prescribed — is difficult and commonly loaded with ambivalence. That may explain why only 50% of patients take their medications as directed. This statistic becomes even more dire when you consider that 39% of people over 65 take five or more medications each day. Medication adherence is a complex issue. While some commonalities exist, there are various reasons why people stop taking medication and no one-size-fits-all solution to the problem.
One area that is often overlooked is the influence of communication between patients and healthcare professionals. Building rapport with every patient population is essential for healthcare providers whose roles are transforming due to rising costs and increased demands on our healthcare system. The ubiquity of community pharmacies puts pharmacists in a great position to leverage their personal relationship with patients.
Dr. Bruce Berger, a pharmacist and professor emeritus at Auburn University, has taught motivational interviewing (MI) to healthcare professionals for over 25 years. He also has a PhD focused on health behavior change and health psychology, and warns healthcare professionals not to lecture their patients on the need for adherence. In a blog post on the topic, he advises providers to “listen for how the patient is making sense — our approach is predicated on clearly identifying how a patient is making sense about an illness or behavior (taking a med, etc.). A sense leads to a conclusion which leads to a decision about behavior.”
Psychology Today defines MI as “a counseling method that helps people resolve ambivalent feelings and insecurities to find the internal motivation they need to change their behavior. It’s a practical, empathetic, and short-term process that takes into consideration how difficult it is to make life changes.” MI is not about telling someone what to do and certainly not about instilling fear. Most people already know that certain behavior is bad for them. Instead, the goal is to get people to talk about how they want to change, thereby increasing their motivation for changing.
Dr. Berger’s approach is a perfect fit for pharmacists, who are the most accessible healthcare providers in the U.S. and who talk to patients about their health and well-being all day long. One quarter of patients have either made or changed a healthcare decision based on a conversation with a pharmacist. With this level of approachability, pharmacists are in a prime position to have meaningful and honest dialogue with patients by asking open-ended questions, such as:
- What does having ______ mean to you?
- How important is it to you to manage your ______ (or take the medicine, lose weight, quit smoking, etc.)?
- What would make taking the medicine (quitting smoking, losing weight) more important to you?
- What’s your understanding of the purpose of this medicine?
- What gets in the way of you taking the medicine, losing weight, quitting smoking (etc.)?
- What would have to change for you to decide to take the medicine, lose weight (etc.)?
Everything starts with listening in order to get a better grasp on how patients process information and make decisions. By doing this, pharmacists become partners willing to understand what patients are thinking.
To learn more about how motivational interviewing (MI) can address patient ambivalence and improve adherence, watch our recorded webinar with Dr. Berger. Dr Berger has completed substantial research in the areas of interpersonal and organizational communication and psychology, and application of these disciplines to the pharmacist's role in treatment adherence and treatment outcomes.
