Motivational Interviewing to Improve Patient Adherence

and Outcomes

Russell E. Spieth, PhD, CRC

Senior Consultant/Trainer, Motivational Interviewing May 31, 2017

MOTIVATIONAL INTERVIEWING (MI): LEARNING

OBJECTIVES

• Provide an understanding of how MI can improve

patient adherence and health outcomes

• Offer and overview of the dimensions of the MI Spirit

(i.e., partnership, acceptance, compassion, and

evocation)

• Detail and practice the skills of MI

MI: DEFINITIONS

“A collaborative conversation style for strengthening a person’s own motivation and commitment to change.”

(pg.12)

“Arranging conversations so people talk themselves into change based on their own values and interests” (pg. 4)

Miller and Rollnick, (2013)

MI: CHANGE TALK

Desire

Ability

Reasons

Need

Commitment

Activation

Taking Steps

= CHANGE

MI: EFFECTIVENESS

A multi-clinic primary care agency trained all staff in MI at half of their clinics. The clinicians in the MI clinics reported

significant decreases in burnout scores, increases in self-rated MI skills, and greater staff cohesion as compared to the control group. In addition, their clients reported significantly

higher satisfaction as compared to the control group.

Pollak et al. (2016)

MI: EFFECTIVENESS

MI produced better outcomes than educational/directive approaches in 75% of RCTs that evaluate BMI, BAC,

hemoglobin A1C, total cholesterol, systolic blood pressure, and smoking.

Douaihy, Kelly, & Gold (2014)

MI: EFFECTIVENESS

A meta analysis of MI in 72 clinical trials for smoking cessation, diabetes, asthma, weight loss and exercise,

and AOD found a significant effect in 74% of studies, 81% when MI used for one hour or more.

Rubak et al., (2005)

MI: SPIRIT

Partnership

Acceptance

Compassion

Evocation

MI: SPIRIT

Partnership/Collaboration: Actively Foster and Encourage Power Sharing so that Patient’s Ideas Substantially Influence the Direction and Outcome of the Session.

Acceptance: (4 Aspects) Accurate Empathy to understand another’s internal perspective; Absolute Worth to see the potential of all people; Autonomy Support to appreciate another’s right and capacity to self-direction, and Affirmation to seek and acknowledge person’s strengths and efforts.

Compassion: A Deliberate Commitment to Pursue the Welfare and Best Interests of Another Person. Do no harm

Evocation: Proactively Evoke Patient’s Own Reasons for Change and Ideas About How to Change.

MI: SPIRIT 3 Communication Styles in Healthcare:

Directing

Provider determines the agenda/focus. Implies the practitioner is the expert and will fix the patient.

Following

Extreme focus on patient’s priorities without any push/pull in specific direction. Listen and follow patients conversation wherever it takes you. Implies a trust in patient wisdom.

Guiding MI typically uses the guiding style

Collaborative search for direction, focus of treatment is negotiated. Exchanging Information: Elicit-Provide-Elicit

Ask where the person wants to go; Inform the person about options; Listen/Respect what person wants to do and help accordingly

MI: PRINCIPLES AND STRATEGIES

Develop Discrepancy

Roll with Resistance

Boost Self Efficacy

Express Empathy

MI: 5 SKILLS

Open-ended questions

Affirmations

Reflective Listening

Summaries

Informing

Reflective listening is listening to language

accurately, forming a reasonable guess as to what

is being communicated and giving voice to that

hunch in the form of a statement (Miller &

Rollnick, 2013).

MI: COMPLEX REFLECTIONS

Complex Reflection: a major restatement to add meaning or

emphasis, and/or to infer feelings

Pt) Person has anger in their voice as they state, “I can’t believe that

you are going to stop prescribing me oxycodone.”

MI: COMPLEX REFLECTIONS

1) Pt) I know I should be exercising to help my

diabetes but I am way too busy?

2) Int) How is it going with the medication?

Pt) I don’t think as good, I think slower.

ACKNOWLEDGEMENTS

This program is partially funded by the MEDTAPP Healthcare

Access (HCA) Initiative and utilizes federal financial

participation funds through the Ohio Department of

Medicaid. Views stated in this presentation are those of the

researchers only and are not attributed to the study

sponsors, the Ohio Department of Medicaid or to the

Federal Medicaid Program. MEDTAPP HCA Initiative funding

supports teaching and training to improve the delivery of

Medicaid services and does not support the delivery of

Medicaid eligible services.

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Pollak et al. (2016). Effect of teaching motivational interviewing via communication coaching on clinician and patient satisfaction in primary care and pediatric obesity-focused offices. Patient Education and Counseling, 99, 300-303.

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