As value-based care continues to solidify its position in the healthcare industry, more providers and patients are recognizing the crucial role independent pharmacies play in this new approach.
While independent pharmacies are praised for their well-established patient relationships, it takes more than a friendly smile and small talk at the pick-up counter to be an effective health coach.
Rhonda Failey, PioneerRx’s Director of Education, believes there are three key elements necessary to guiding patients to more positive patterns. During her 18 years as a psychology professor, she gained extensive knowledge of human behavior and decision-making. Whether a patient is struggling with nonadherence or needs guidance during a smoking cessation program, pharmacists can rely on three actions to yield improved results in the patients’ well-being.
According to Rhonda, autonomy begins in childhood, and we continually seek it out as we mature. “We cherish our autonomy,” she asserts. “We don’t want it taken from us.” This idea is echoed in Motivational Interviewing in Health Care where the authors state, “Clinicians may inform, advise, even warn, but ultimately it is the patient who decides what to do. To recognize and honor this autonomy is also a key element in facilitating health behavior change.” While practicing high-touch care, pharmacists won’t see long-lasting results unless patients can prove to providers and themselves that no external control is needed to change negative habits and maintain healthy ones.
When coaching for change in health behavior, practitioners can be a major influence in motivation. “The way in which you talk with patients about their health can substantially influence their personal motivation for behavior change,” affirms the authors in Motivational Interviewing in Health Care. Psychologists recognize two types of motivation: extrinsic and intrinsic. Extrinsic motivation is based on the expectation of external rewards such as money or praise, or avoiding punishment. Extrinsic motivators may start out strong, but “the shine wears off and they can lose their power,” says Rhonda. On the other hand, intrinsic motivation involves performing an action for its personal reward and the fulfillment it brings. “It can be quite difficult to figure out what is intrinsically motivating for someone,” Rhonda says, “but when you do, you have the keys to the kingdom.” This begs the question — how can pharmacists and their staff pinpoint a patient’s intrinsic motivator?
Empathetic clinicians may determine patient motivators more quickly than others. To practice empathy is to connect with someone and be able to effectively communicate with them, or to “walk a mile in their shoes,” to quote the popular adage. Motivational Interviewing offers three core skills for efficient communication and empathy:
- Ask questions to better understand the patient’s needs. Asking questions such as “What are three important benefits you see in making this change?” or “If you decide to do _____, how would you do it?” encourage the patient to consider making a change and generating their own ideas and desires for it. On the other hand, questions like “Why can’t you ___?” and “Why don’t you want to ____?” elicit a defensive response from the patient. When interviewing the patient, aim for questions that reveal their motivations that can be used to shape a practical approach to improved outcomes.
- Active listening signals to patients that their practitioner values their thoughts and encourages patients to reveal more. When performed correctly, the provider should have a deeper understanding of the patient’s problem and needs. The patient should feel understood and that their perspective is valued by their provider.
- Informing the patient of facts and insight in an understandable way bridges the knowledge gap. Patients should leave the pharmacy feeling empowered and knowledgeable; poor adherence or “glazed looks” from the patient are signs that the pharmacist may need to convey the information differently.
Pharmacists must be mindful of the fact that each patient has unique obstacles and needs; they may not respond to a “one-size fits all” approach to building a rapport that results in more empathetic interactions. “The good news is you can learn to be more empathetic,” Rhonda reassures. “It’s like playing the piano — the more you practice, the better you get.”
With autonomy, motivation, and empathy, pharmacists reaffirm their status as the “most accessible healthcare provider” by demonstrating to their patients what it truly means to care.
Rollnick, S., Miller, W. R., & Butler, C. C. (2008). Motivational interviewing in health care: Helping patients change behavior. New York: The Guilford Press.