In Part One, we explained why motivational interviewing is important and what it is (and isn’t). In Part Two, we covered how to strategically Ask questions and Listen to your patients’ responses. In Part Three, we will explore Informing, the third required skill for successful motivational interviewing, and practical uses of your pharmacy’s management system.
Informing is a common duty among healthcare providers, yet it becomes a repeated action when patients do not properly receive the information. In MI, it’s important to receive the patient’s permission first before attempting to inform them. Gaining permission honors their autonomy, encourages the pharmacist-patient collaboration, and lowers the patient’s resistance to change (Motivational Interviewing, 91-92). Questions that request patient permission include:
Patients may already feel overwhelmed when they arrive at the pharmacy, and overloading them with information will only lead to more distress about changing their health behaviors. One strategy to avoid overloading while increasing comprehension is the Chunk-Check-Chunk method where the provider explains a chunk of information, checks that the patient understands, then explains another chunk of information (Motivational Interviewing, 94).
One negative habit to avoid when informing is to give unsolicited advice and share facts that are supposed to motivate the patient. This is the righting reflex, and it yields little success. What pharmacists may view as a patient being “stubborn” or “dismissive” might actually be a patient feeling powerless or unheard during the conversation.
Who says technology can’t play a meaningful role in conversation? Your pharmacy’s management system should be able to help you with the following:
Pharmacies are well-known for the relationships they foster with their patients. These connections can be nurtured by partnering patients with Health Coaches, or specific pharmacy team members who consistently follow up and interact with their designated patients.
Within PioneerRx, Health Coaches can filter their view to only display their targeted patients. Pharmacy team members may use this view to determine which patients may benefit from motivational interviewing during their next pharmacy visit.
All pharmacies can benefit from implementing care plans for their patients. Care Goals are the actionable steps within the care plan that are geared towards improving the patient’s outcomes. For example, a care goal may be created to implement a smoking cessation program for a patient. One of the initial steps of this care goal would be to have a conversation about smoking habits using MI strategies. PioneerRx’s care plan functionality enables community pharmacies to enact and document purposeful interactions that encourage healthier behaviors.
Tracking your patients’ progress by recording their lab results may present opportunities to have more meaningful conversations. PioneerRx offers dozens of labs and even creates MTM actions for overdue labs, which encourages pharmacy team members to continuously check in with patients.
One of the main concerns of all pharmacists is time. Perfecting another skill while trying to maintain an efficient workflow may seem daunting, but in the long run, MI may actually save pharmacists time. The repeated conversations about negative health behaviors will decrease, and pharmacies may use this time to practice more proactive patient care measures.
Another concern healthcare providers express about motivational interviewing is the need for extensive practice in order to properly perform MI. According to the psychologists credited for pioneering this method, “Training research indicates that proficiency in MI is not readily developed through self-study or by attending a workshop, but typically requires practice with feedback and coaching over time…” (“Ten Things” p.135). Make MI training a team effort amongst pharmacy staff. Together, everyone can observe each other and offer suggestions along the way.
Motivational interviewing is not guaranteed to work every time. Some patients may not respond to this method, which gives the pharmacy staff a chance to improve and tailor their approach for the next interaction. One system to consider is Gretchen Rubin’s Four Tendencies. Adjusting the conversation to suit a patient who displays ambivalence and one of the Tendencies may lead to greater success at the next attempt. (Note: PioneerRx users have the ability to notate patient Tendencies in the “Demographics” area of the patient profile.)
Like any new practice implemented in the pharmacy, MI requires research, practice, and more practice. The results of incorporating motivational interviewing into the daily operations are invaluable. Patients will be more empowered and willing to take charge of their health outcomes, and in a system where many patients feel misunderstood, independent pharmacies will be addressing ambivalence and practicing empathetic care.
Miller, W. R., & Rollnick, S. (2009). Ten Things that Motivational Interviewing Is Not. Behavioural and Cognitive Psychotherapy,37(2), 129-140. doi:10.1017/s1352465809005128
Rollnick, S., Miller, W. R., & Butler, C. (2008). Motivational interviewing in health care: Helping patients change behavior. New York: Guilford Press.