When pharmacists promote behavioral changes, it encourages positive patterns that last a lifetime.
How many of us know what we are supposed to do but just do not do it?
We know that it is beneficial to go for a walk instead of binge watching shows on Netflix, and we know that opting for an apple over a slice of cherry pie is preferable, but we make bad choices anyway. Behavioral change can be challenging, especially when long-term habits are ingrained. One of our biggest challenges as pharmacists is finding ways to help patients adhere to their medication and health regimens.
We can have all the best information, technology, and data, but if patients are not buying it, they will not follow what their providers recommend. As noted in a recent study on adherence,1 an overall 40% of patients did not adhere to their doctors’ prescription recommendations. Another 35% neglected to fully follow through on suggested physical therapy directives. Nonadherence to physician-recommended changes in lifestyle habits was a whopping 70%.
So, the question then becomes, how do we effectively engage patients to be engaged in their own health?
As a pharmacist and health coach, I encounter many patients who are newly diagnosed with diabetes or another lifestyle-related condition. Initially, they may feel hopeless, scared, and like there is not much they can do. They want to feel better and reach their health goals without giving up all the things that they love. Guiding them to realize how much they have to gain, instead of what they need to give up, is helpful in shifting their mindset to be excited about their goals.
My top priority is to help them realize that they can improve their health through mindfulness, exercise, proper nutrition, and a positive mindset. I gradually help them shift from feeling disempowered to feeling empowered by educating them about their illnesses and sharing lifestyle changes that they can make to improve their conditions. I tailor my recommendations to what works for each patient and focus on 1 goal at a time. We provide tools and share problem-solving skills, such as how to refocus when a setback happens, and draw out their strengths so that patients learn self-reliance. This is patient-focused and not provider-directed. It is a relationship that fosters trust and patient autonomy.
It reminds me of the Chinese proverb, "Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime."
Empowered patients are more likely to stick to recommendations, because they feel like active participants in their health decisions. Empowering patients through motivational interviewing (MI) techniques results in better compliance to medication, an increase in involvement, and thus better health outcomes, such as a decrease in A1C and improvement in blood sugar control. With the new
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
legislation in effect and an increased focus on quality, health care providers will be rewarded for these improved outcomes related to adherence and outcomes for those with diabetes and other chronic conditions. It is a win-win for everyone.
So, how do pharmacists implement these empowerment techniques?
MI has been shown,2 across various health conditions, to improve outcomes when counseling patients on adherence and modifying behaviors, such as smoking cessation, proper nutrition, and exercise. However, knowledge does not always equal results. Human behavior is driven by emotion, and we need to uncover what truly matters to patients to encourage them to make healthier choices. For example, if they continue smoking, they may not be there to see their grandchildren grow up. If someone with diabetes does not control their blood sugar, they increase the likelihood of amputation, kidney disease, etc. Our goal is to partner with patients and teach them self-reliance and to be resilient. The spirit of MI is collaborative rather than authoritarian, evokes the client’s own motivation rather than trying to force it, and honors the client’s autonomy. We are much more likely to stick to a goal that we have created, as opposed to one someone else made for us.
Getting trained in MI is important and can help pharmacists effectively communicate with patients. Formalizing private counseling sessions or incorporating these techniques into medication therapy management could be a way to implement MI and help patients.
To take it a step further, here are 3 helpful ways to empower patients:
1. Ask open-ended questions to explore what patients' possible barriers are, and allowing them to discover solutions that work best for their lifestyles and schedules. For the most part, human beings do not like being told what to do. We may not know that the patient works overnight and hates greens, so our recommendation to eat every 3 hours and choose kale for lunch will not likely be well received. Providing a menu of possible solutions and inquiring about what plan might work best always leads to better results.
2. Ask the patient, “What is 1 thing you could do this week to reach your health goal?” Breaking down big goals into small ones makes them more manageable and realistic. Sometimes less is more.
3. Follow up with the patient to solidify the relationship and to offer support in accountability. Do not judge or accuse them if they do not meet their goals. Remember, habits take time to establish and several attempts to change. Support them and encourage them to succeed.
When pharmacists support patients through behavioral changes, it encourages positive patterns that can last a lifetime.
1. Martin LR, Williams SL, Haskard KB, Dimatteo MR. The challenge of patient adherence. Ther Clin Risk Manag. 2005;1(3): 189—99.
Burke B L, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult and Clin Psychol 2003;71(5):843-61.