Motivational Interviewing Helps Patients to Say ‘Yes’ to Behavior Change

Monday, February 20th, 2012
This post was written by Patricia Donovan

Nurse case managers, health coaches and even pharmacists are employing motivational interviewing to engage patients and health plan members in disease management programs.

Once the domain of psychiatrists, motivational interviewing (MI) is “a directive, client-centered counseling style — it’s not necessarily a technique,” explains Dr. Ruth Wolever, a clinical health psychologist and director of research at Duke Integrative Medicine.

“It’s a style that is designed to invite or elicit behavior change specifically through the process of helping clients to explore and to resolve ambivalence that they may have toward that specific behavior change.”

Clinical data backs up the benefits of MI in decreasing resistance and enhancing individuals’ motivation to change. And now, pioneering efforts in MI use at Aetna, Highmark and elsewhere are helping to build the business case for training staff in motivational interviewing.

Aetna introduced motivational interviewing (MI) to disease management nurses in its Care Management Disease Management programs on a limited basis in 2009 and fully implemented it in 2010. Today, more than 50 Aetna “MI champions,” have been trained, in consultation with MI pioneer Kenneth Resnicow, Ph. D., professor, Health Behavior & Health Education, University of Michigan School of Public Health, to deliver and support MI practices within Aetna.

In total, more than 1,800 Aetna clinicians and clinical support staff in Aetna sites around the globe are using MI to help members reach better health.

Since the introduction of MI, Aetna reports significant improvements in member engagement, health outcomes and member satisfaction. The payor notes that member engagement in its Disease Management programs has increased 43 percent — from 53.1 percent before the program to 76 percent at the end of the September 2011.

Equally important, says Aetna, members are remaining in the programs. Dropouts decreased 55 percent during the third quarter of 2011 compared to pre-MI days.

“We are creating a highly personalized member experience with real conversations, not scripted interactions. Members take greater responsibility for their actions and health, and we are seeing improved results in treatment adherence, condition maintenance and overall health,” says Michael Golinkoff, Ph. D., head of Aetna’s Behavioral Health Clinical and Service Delivery.

Elsewhere, community pharmacists are being trained in the principles of “motivational interviewing light” to boost levels of medication adherence. A collaboration between the University of Pittsburgh School of Medicine, Highmark Blue Cross Blue Shield and Rite-Aid pharmacies deployed motivational interviewing training to 120 participating pharmacies. Pharmacists were taught overall interviewing techniques and strategies for dealing with patients’ resistance to taking medication.

Preliminary results showed that standardized screening and brief (2 to 5 minutes long) therapeutic conversations between patient and pharmacist helped to reduce patient risk.

“We are evaluating some interim results and looking at changes,” notes Janice Pringle, Ph.D., director of the Program Evaluation Research Unit (PERU) and an associate professor at the University of Pittsburgh School of Pharmacy.

“There is an indication that there are statistically significant changes in adherence for the participating sites. However, this will be borne out by more thorough evaluations, which will occur in mid-2012. We will not only be comparing changes over time amongst the intervention pharmacies, but also comparing to a group of what we consider control pharmacies for the same time period and the same metrics.”

Medication non-adherence accounts for nearly $290 billion in avoidable medical spending each year, according to a recent New England Healthcare Institute estimate.

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