One of the many ways independent pharmacies increase the value of the healthcare scene is their patient relationships and interactions. More providers and patients are acknowledging the power of the rapport that develops between pharmacy team members and their patients.
Pharmacists can elevate their conversations with Motivational Interviewing (MI). This method originates from clinical psychologists William R. Miller and Stephen Rollnick, who developed the concept of MI through their experiences in counseling problem drinkers. MI is defined as a “client-centered, directive method for enhancing internal motivation in patients to change their behavior as they explore and resolve their own ambivalence to change” (Fundamental Skills, 198). When applied to pharmacy, this can help patients realize their own motivations that affect their health behaviors, such as adherence or habits.
Motivational interviewing may seem like a practice that is already well-established in independent pharmacies, but it goes beyond a personal rapport. Instead, the pharmacy guides the conversation so the patient can acknowledge their own intrinsic motivators. While extrinsic motivators offer tangible rewards such as prizes or praise or repercussions such as a medical diagnosis, the intrinsic motivators are more powerful because they are personal; they bring fulfillment or enjoyment, and they are usually associated with positive emotions and long-term motivation and success.
All patients benefit from productive conversations with their healthcare providers, but one characteristic defines someone who truly needs MI: ambivalence, or to be in a state of wavering back and forth about something. Specifically, patients who are ambivalent about making health behavior changes are excellent candidates for motivational interviewing. Ambivalence often leads to anxiety about making a decision, according to Bill Matulich, and it’s common to avoid uncomfortable feelings like anxiety, which leads to procrastination.
“When people get stuck [in ambivalence] and change doesn’t happen as quickly as the counselor thinks it should, then it may look like the client is being resistant,” says Matulich. “Motivational interviewing helps by resolving this ambivalence and helping the client move towards healthy behavior change” (Introduction to Motivational Interviewing). The purpose of motivational interviewing is not to persuade patients to change, but to help them discover their own intrinsic motivations for making healthy changes in their lives.
Fundamental Skills for Patient Care in Pharmacy Practice suggests referring to the Transtheoretical Model of Change when considering a patient for MI. Although Miller and Rollnick have clarified that motivational interviewing is not based off the model developed by James O. Prochaska and Carlo Di Clemente, it can be used as a supplemental guide in the beginning stages of MI. The five stages of the Model of Change are Precontemplation, Contemplation, Preparation, Action, and Maintenance. Patients classified in the Precontemplation and Contemplation stages are ideal candidates for health behavioral change. In the Precontemplation stage, the patient does not recognize any problem with their current state and does not see any reason to change. Patients in the Contemplation stage can acknowledge their behavior is problematic, but they have not taken action. When employing MI, the provider’s goal is to guide the patients to the latter three stages where their intrinsic motivation has a higher guarantee of change and to increase the patient’s self-efficacy of maintaining the changes that are made.
Independent pharmacists experience more face time with patients than most healthcare providers. Pharmacists can use their knowledge of their patients’ habits and behaviors to determine their intrinsic motivators, which may lead to powerful changes in patient outcomes.