motivational interviewing, behavior modifications, and adherence

Question 1

• Evidence-based model
• Can be used as a technique (framework) to address patient problems

Answer 1

5 A’s Model of Intervention

Question 2

5 A’s Model of Intervention is most extensively documented use in __ counseling

Answer 2

tobacco cessation

Question 3

The 5 A’s of Model of Intervention

Answer 3

1. ask
2. advise
3. assess
4. assist
5. arrange

Question 4

5 A’s: Identify and document the current behavior that you want to change

Answer 4

ask

Question 5

Give info about health risks if this behavior is not changed
Give info about health benefits associated with changing this behavior

Answer 5

advise

Question 6

Determine if patient is willing to change their behavior

Answer 6

assess

Question 7

If patient is willing, use interventions to help make the change
Education, counseling, medication, social services, etc.

Answer 7

assist

Question 8

Schedule short-interval follow-up with patient

Answer 8

arrange

Question 9

5 A’s model of intervention can also be modified into a _____ patient education model for new and follow-up visits on behavior changes

Answer 9

self-management

Question 10

Shows that for most people, a change in behavior occurs gradually and in several phases

Answer 10

stages of change AKA Transtheoretical Model of Change

Question 11

5 stages of change

Answer 11

1. precontemplation
2. contemplation
3. preparation
4. action
5. maintenance (relapse prevention)

Question 12

Not even considering change
Denial or disbelief that their behavior is harmful
Have failed so many times they’ve given up on changing

Answer 12

precontemplation stage

Question 13

Ambivalent about changing
Giving up negative behavior causes them to feel a sense of loss despite the gain we educate them about

Answer 13

contemplation stage

Question 14

Prepare to make a specific change
Experiment with small changes as their determination to change increases

Answer 14

preparation stage

Question 15

Actively pursuing a change
Often the patient’s action is not enough
Provide encouragement, support and praise

Answer 15

action stage

Question 16

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

Answer 16

maintenance stage

Question 17

The extent to which a patient’s behavior corresponds with the agreed-upon recommendations from a health care provider

Answer 17

adherence

Question 18

problems with adherence can result in

Answer 18

poor health outcomes and increased healthcare costs
Disproportionately affects the poor

Question 19

5 causes of nonadherence

Answer 19

1. Patient didn’t agree to care plan
2. Unable to afford care
3. Unable to access treatment
4. Patient does not like side effects of treatment plan
5. Patient thinks they are “better” and no longer need treatment

Question 20

Changes that can help nonadherence

Answer 20

1. Shared Decision Making
2. Change the treatment to a more affordable one; look for patient assistance to help cover cost
3. Alternative treatment; look for for ways to improve patient access
4. Explain risks vs. benefits; look for alternative treatment
5. Educate patients on the course of their disease

Question 21

4 major causes of nonadherence

Answer 21

1. 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
2. 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
3. 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
4. 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

Question 22

how to combat non-adherence by: (3)

Answer 22

1. providing care
   - Respectful of patient preferences
   - Coordinated across multiple conditions and providers
   - Evidence-based treatment
   - Monitored for quality of services and outcomes
2. educating patients
   - To self-manage their conditions
   - About available community and online resources
3. reorganizing health systems
   - To enhance sharing of knowledge and information
   - To improve access to providers and therapies

Question 23

how to combat non-adherence by: (3)

Answer 23

1. providing care
   - Respectful of patient preferences
   - Coordinated across multiple conditions and providers
   - Evidence-based treatment
   - Monitored for quality of services and outcomes
2. educating patients
   - To self-manage their conditions
   - About available community and online resources
3. reorganizing health systems
   - To enhance sharing of knowledge and information
   - To improve access to providers and therapies