The Case for Motivational Interviewing

Motivational interviewing is a direct, patient-centered conversational method that elicits positive change by helping patients explore and resolve ambivalence. The goal is to increase a person’s intrinsic motivation so that change arises from within rather than being imposed. Motivational interviewing can impact quality and value measures, create healthcare value for patients, and contribute to reducing costs.

During a presentation at AMCP Annual Meeting 2018, Maureen Hennessey, PhD, CPCC, andElizabeth Oyekan, PharmD, FCSHP, CPHQ, both of Precision for Value, discussed real-world evidence and best practices for using this tool.

A study found that motivational interviewing improved adherence by 17% using 15- to 20-minute interventions at three- and six-month follow-up. Another study found that motivational interventions do not need to exceed 15 minutes, and just one intervention per patient can increase the likelihood of a positive outcome. In a randomized, controlled clinical trial, patients in a group receiving motivational interviewing had a statistically and clinically significantly lower proportion of interferon beta-1a treatment discontinuation (1.2%) compared with a standard care group (8.7%). This reduction in treatment discontinuation represented a potential cost savings of more than $93 million per year.

The philosophy of motivational interviewing includes the following ideas and implications:

• Patient resistance is a product of the environment, not an intrinsic behavior
• The patient and provider relationship should be cooperative and congenial
• Motivational interviewing centers around overcoming ambivalence
• The practitioner keeps options open
• Responsibility rests on the patient
• Self-efficacy is paramount

Motivational interviewing includes four steps: engage, focus, evoke and plan. The four principles of motivational interviewing are roll with resistance, express empathy, develop discrepancy, and support self-efficacy. The four core skills of motivational interviewing are open-ended questions, affirmations, reflections, and summarizations.

The speakers gave an example of the use of motivational interviewing for a patient recently diagnosed with diabetes. The key points to convey include:

• Express an understanding of the patient’s worries or concerns about the diagnosis or disease-related event
• Assess the patient’s understanding of the diagnosis and factors that may have contributed to it
• Assess the patient’s understanding of the necessary lifestyle changes and their impact on overall health (i.e., diet and exercise)
• Encourage any positive changes that have occurred
• Emphasize the importance of lifestyle changes and medication adherence for better health

Challenges of effective motivational interviewing—despite strong evidence supporting its clinical efficacy—include training costs, sustaining the practice of motivational interviewing skills, and maintaining an evidence-based approach.

Some best practices to improve the operations of motivational interviewing are:

• Gain executive support and team buy-in
• Develop and support champions
• Identify goals and collect baseline data on processes and outcomes
• Develop a plan and start with a pilot program
• Study the results and adjust the program based on the findings
• Celebrate any success and build for sustainability

Presentation M7: Motivational Interviewing: Improving Outcomes Through Enhanced Motivation. AMCP Annual Meeting 2018.