motivational interviewing, behavior modifications, and adherence Flashcards
- Evidence-based model
- Can be used as a technique (framework) to address patient problems
5 A’s Model of Intervention
5 A’s Model of Intervention is most extensively documented use in __ counseling
tobacco cessation
The 5 A’s of Model of Intervention
- ask
- advise
- assess
- assist
- arrange
5 A’s: Identify and document the current behavior that you want to change
ask
Give info about health risks if this behavior is not changed
Give info about health benefits associated with changing this behavior
advise
Determine if patient is willing to change their behavior
assess
If patient is willing, use interventions to help make the change
Education, counseling, medication, social services, etc.
assist
Schedule short-interval follow-up with patient
arrange
5 A’s model of intervention can also be modified into a _____ patient education model for new and follow-up visits on behavior changes
self-management
Shows that for most people, a change in behavior occurs gradually and in several phases
stages of change AKA Transtheoretical Model of Change
5 stages of change
- precontemplation
- contemplation
- preparation
- action
- maintenance (relapse prevention)
Not even considering change
Denial or disbelief that their behavior is harmful
Have failed so many times they’ve given up on changing
precontemplation stage
Ambivalent about changing
Giving up negative behavior causes them to feel a sense of loss despite the gain we educate them about
contemplation stage
Prepare to make a specific change
Experiment with small changes as their determination to change increases
preparation stage
Actively pursuing a change
Often the patient’s action is not enough
Provide encouragement, support and praise
action stage
Incorporating the new behavior for the long term
Slips or relapses can discourage the patient and result in the patient giving up
Many patients “recycle” several times before the change becomes fully established
maintenance stage
The extent to which a patient’s behavior corresponds with the agreed-upon recommendations from a health care provider
adherence
problems with adherence can result in
poor health outcomes and increased healthcare costs
Disproportionately affects the poor
5 causes of nonadherence
- Patient didn’t agree to care plan
- Unable to afford care
- Unable to access treatment
- Patient does not like side effects of treatment plan
- Patient thinks they are “better” and no longer need treatment
Changes that can help nonadherence
- Shared Decision Making
- Change the treatment to a more affordable one; look for patient assistance to help cover cost
- Alternative treatment; look for for ways to improve patient access
- Explain risks vs. benefits; look for alternative treatment
- Educate patients on the course of their disease
4 major causes of nonadherence
- healthcare team and system-related factors
- Provider’s relationship with patients
- Capacity to educate patients
- Accessibility of treatment resources
- Follow-up with patient
- Knowledge and skill of provider - Condition-related factors
- Illness-related demands faced by the patient
- Cultural meaning and stigma of the illness
- Symptoms and severity of disease
- Rate of progress of disease
- Impact on physical, psychological, social, vocational functioning
- Comorbidities of disease - Characteristics of therapies
- Access to treatment or medication
- Complexity of medication
- immediacy of benefits
- Side effects of benefits
- Availability of medical support
- Cost of therapy
- Visibility of therapy - Patient-related factors
- Patient beliefs about illness
- Motivation to manage disease
- Confidence and self-efficacy to manage their illness
- Expectancies of treatment
- Priorities to care for self vs. others
how to combat non-adherence by: (3)
- providing care
- Respectful of patient preferences
- Coordinated across multiple conditions and providers
- Evidence-based treatment
- Monitored for quality of services and outcomes - educating patients
- To self-manage their conditions
- About available community and online resources - reorganizing health systems
- To enhance sharing of knowledge and information
- To improve access to providers and therapies
how to combat non-adherence by: (3)
- providing care
- Respectful of patient preferences
- Coordinated across multiple conditions and providers
- Evidence-based treatment
- Monitored for quality of services and outcomes - educating patients
- To self-manage their conditions
- About available community and online resources - reorganizing health systems
- To enhance sharing of knowledge and information
- To improve access to providers and therapies
