Supporting treatment adherence with motivational interviewing

Pharmacists are in a unique position to influence public health, one patient at a time. With more than 90% of Americans living within five miles of a community pharmacy, retail pharmacists often have multiple opportunities to engage patients, with touchpoints ranging from vaccinations and point-of-care tests to prescription filling and medication consultations.

Medication therapy management (MTM) is an area where pharmacists can use their trusted role to support better outcomes. Research tells us that pharmacist consultations can improve patient adherence, but low adherence rates have plagued healthcare for decades. Of the 3.8 billion prescriptions written in the United States annually, approximately 1 in 5 are never filled, and nonadherence costs the health care system between $100 billion and $300 billion annually.

Pharmacists need more tools under their belt to be as effective as possible in their interactions with patients when it comes to medication adherence. At Biologics by McKesson Specialty Pharmacy, our clinicians draw on multiple approaches to engage with patients, from conversation starters to risk assessment questionnaires. One key tool we use now is motivational interviewing, a style of collaborative conversation designed to increase a person’s own motivation and commitment to change.

What is Motivational Interviewing (MI)?

MI is an evidence-based practice developed by psychologists in the 1980s, originally developed for people with alcohol dependence and substance abuse. Based on the idea that behavior change is only possible when a person feels accepted and valued, MI has been shown to be successful in many different areas, from smoking cessation and eating disorders to diabetes management.

Research supports the efficacy of MI to promote medication adherence, including a randomized controlled trial of 366 patients with multiple sclerosis in which the intervention group received telephone counseling based on motivational interviewing. In this study, only 1.2% of patients in the intervention group discontinued therapy, compared with 8.7% of patients in the standard care group who discontinued.

Any adherence intervention must begin with the understanding that each patient is unique and has different reasons for non-adherence. Factors influencing adherence may include patient attitudes and beliefs, therapy-related reasons such as adverse effects, and socioeconomic or financial barriers. The beauty of MI is that it recognizes and leaves room for each patient’s personal and specific circumstances.

MI guiding principles and essential skills

MI training is an extensive process for professional counselors, but pharmacists and clinicians can learn from its guiding principles and core skills. It starts with understanding what MI is no— confrontation, command, preaching, warning or persuasion — and what MI is— non-judgmental, compassionate, affirming, open and accepting.

MI’s guiding principles include:

1. Resistance to the righting impulse—i.e. avoiding highlighting the risks or problems of the patient’s current (non-attachment) behavior that may cause him to become defensive.

2. Understanding the patient’s motivation.

3. Listening with empathy.

4. Empowering the patient to find their own motivation to engage in positive behaviors.

Putting these principles into practice, pharmacists can use open-ended questions—“Why are you concerned about your new medication?”—that elicit a response from the patient, rather than questions that feel like a directive or mandate. Then they can commit in reflective listening, which involves listening carefully to the patient and repeating what is said with understanding.

Using affirmations—”I’m so glad you were able to get all the doses on time, it wasn’t easy”—helps build rapport, demonstrate empathy, and build the patient’s confidence and self-efficacy.

Finally, pharmacists can seek (and challenge) “change the conversation” in the patient – ​​“I need to start taking my medication every day” or “I know it’s possible to do this” – and reflect these ideas back to the patient in an affirming and empowering way.

Motivational interviewing is a skill that takes practice and there are resources available to help pharmacists improve their abilities. The National Pharmacists Association offers a 6-module course with 8 hours of continuing education based on the book Motivational interviewing for health professionals: a sound approach by Drs. Bruce A. Berger and William A. Willom.

After all, the basis of attachment is trust, communication and empathy. Motivational interviewing embraces these concepts to ensure that patients ultimately remain adherent to their therapy and get the most benefit from their medications.