July 26, 2007 Taking medications, engaging in healthy lifestyles and quitting harmful habits are vital for good health, but patients often resist the advice of health care providers and thus neglect what is in their best interests.
It’s not a case of being stubborn or a lack of will, says an Auburn University pharmacy professor, but rather it stems from attempts to persuade patients when they are not ready. Bruce Berger, head of the AU Department of Pharmacy Care Systems, has conducted research which found instead that exploring a patient’s motivation for resistance, through a process called motivational interviewing, can greatly increase compliance.
“A person might say that smoking relaxes him, so the typical responses are ‘Can’t you think of something else that relaxes you?’ or ‘You know smoking will destroy your lungs,’ which puts the person on the defensive,” Berger said. “A better response using motivational interviewing would be, ‘It would be hard to give up something that is relaxing. What would have to happen for you to consider quitting smoking?’
“Someone also might quit taking medication because he doesn’t feel any improvement yet. We can’t make patients comply, but we can find out their motivation and increase the probability that they will make good decisions,” said Berger, who recently received the 2007 Wiederholt Prize from the American Pharmacists Association for the best published paper in economic, social and administrative sciences in its professional journal.
His paper, “Evaluation of software-based telephone counseling to enhance medication persistency among patients with multiple sclerosis,” appeared in the July-August 2005 issue of the Journal of the American Pharmacists Association. It documented Berger’s evaluation of computer software he developed to help telephone call center personnel assist multiple sclerosis patients who had questions or concerns about their medication.
The software incorporates motivational interviewing to help guide counselors through the process of asking questions and providing appropriate responses. His study had 367 participants, with 196 receiving standard care and 172 receiving counselor intervention with the software. For patients receiving advice from counselors without the software, he found that 8.7 percent quit taking their medications. However, when the software program was used, the rate was only 1.2 percent.
“The results show a very significant improvement when motivational interviewing was used to explore their reasons for not wanting to continue the drug,” Berger said.
For patients who had doubts about whether their medicine was working, the software would prompt the call center personnel to say, “What would make you feel more confident that your medicine is still working?”
“Each person has an internal set of pros and cons that influence behavior,” he said. “We need to find out those factors and keep the goal in mind, which is getting patients to take their medications to make changes such as losing weight. The goal is not to win an argument or prove we are right and the patient is wrong. The goal is to help patients accomplish what they want to accomplish in regard to their health.”
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