MI… Not Just a

Heart Attack:

Utilizing motivational
interviewing to optimize
patient care Indiana Pharmacists Association

Jason Isch, PharmD, BCACP

Assistant Professor,
Manchester University
Molly Corder, PharmD
PGY-1 Ambulatory Care
Resident, Saint Joseph
Health System 2021 ANNUAL MEETING
 Conflict of Interest
We have no actual of potential conflict of interest in relation to this presentation.

All images used freely via Pixabay.com under a Creative Common CC-BY license.
2021 ANNUAL MEETING
 Learning Objectives
1. Summarize the “Four Fundamental Processes”
of motivational interviewing (MI)

2. Develop reflective listening statements

based on patient responses

3. Assist patients in developing their own plan

while utilizing the “Spirit of MI”

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 Current HealthCare Model

Are we really the expert?

How are we trained?

• Avoid the “righting reflex”

We believe what we say

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 Motivation
 Motivation is defined
as the process that
initiates, guides, and
maintains goal-oriented
behaviors

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 True or False?

! ! !
 As a pharmacist (or healthcare professional),

to change their behavior.

L S E
I believe part of my job is to motivate people

FA
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 Motivational Interviewing is…
 More simply, MI is…
a conversation about change
 Purpose:
To strengthen personal motivation
for and commitment to a specific
goal or targeted change

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 Communication is hard…
 What are some common communication “traps”
you have encountered when working with patients
or others within the healthcare network?
 Motivational interviewing is NOT:
 Based on the trans-theoretical model
 A way of tricking people into doing what
they don’t want to do
 A technique
 Easy
 A panacea

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 … so we developed MI!!!
 Purpose:
 to explore ambivalence and resistance
with our patients

 “Ambivalence” – the state of having mixed feelings

or contradictory ideas about something

 “Resistance” – the refusal to accept

or comply with something
 Because it helps our patients to a
path of better health!
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 Behavior Change
 Healthcare Decisions PharmD  Personal Decisions PharmD
 Diabetes  IE: divorce/breakup,
 Heart Failure quitting job, end-of-life
 Hypertension  Do not lead towards change
 Hyperlipidemia  Stay equipoise
 Asthma  Equal voice/neutral
 COPD
 Smoking cessation SUSTAIN
 Alcoholism
CHANGE CHANGE SUSTAIN
 Weight loss
 Non-compliance
Many many more!
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 The “Spirit of MI”
 Collaboration
 Acceptance
 Autonomy
 Absolute Worth
 Affirmation
 Accurate Empathy

 Evocation
 Compassion/Empathy
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing:
Helping people change (3rd ed.). New York, NY: Guilford Press.

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 4 Fundamental Processes
 Engaging – relational foundation
 Focusing – strategic centering
 Evoking – the transition to MI
 Planning – when the time is right

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 What is engaging?
Relational
Empathy Respect
Foundation

Rapport Trust Support

Safe
Comfort Building
environment

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 Why engage?

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 How to engage
• Simple reflection
• Avoid questions and filler

• Reflections > questions

• Training wheels

• Mirror the patient

• Let the patient talk!

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 Imply Feeling & Reflect Vulnerability

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 Change Talk

“You are concerned

about your diabetes”

“You can’t imagine giving

yourself a shot everyday
for the rest of your life”

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 Reflecting Personal Motivators

Think of 3 things
What motivates
that influence
you?
your decisions.

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 Reflective Listening Activity
 Partner up with someone!
 One person play the “patient” and  Helpful Hints
one person play the “pharmacist”
 Don’t be afraid of silence!
1. Patient will determine an
activity where change may be  Patient help out your pharmacist!
required
2. Pharmacists’ Job is to reflect
back what they are hearing
3. Patient’s job is to explore why
they might consider a change

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 4 Fundamental Processes
 Engaging – relational foundation
 Focusing – strategic centering
 Evoking – the transition to MI
 Planning – when the time is right

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 Why do we need “focus”?

Provider Patient
Goals Goals

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 Focusing
 Summary statements
 End the summary with hope and movement
 Don’t need to reflect ALL points discussed
 Examples:
 “Let me see if I understand”
 “Here’s what I’ve heard. Let me know
if I’ve missed anything…”
 Would someone be willing to share a summary
statement from their reflective listening activity?

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 Focusing
 Agenda Mapping
 Effective to compartmentalize
change talk Smoking Diabetes
Blood
Pressure
Sleeping
Exercise
Habits
Snacks

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 4 Fundamental Processes
 Engaging – relational foundation
 Focusing – strategic centering
 Evoking – the transition to MI
 Planning – when the time is right

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 Evoking- The Transition to MI

Allow the patient to draw out

thoughts

Empower your patient

Provides the backbone for the plan

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 Elaboration
 “Collecting data” from our patient while intentionally
showing them we are on their team
 Examples:
 “Tell me more”
 “In what ways?”
 “How so?”

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 Think Extreme
 What is the WORST thing that may happen
if you do NOT make this change?
 What is the BEST thing that may happen
if you do NOT make this change?
 What is the WORST thing that may happen
if you DO make this change?
 What is the BEST thing that may happen
if you DO make this change?

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 Looking forward & backwards
 What would your life look like if you were
SUCCESSFUL making this change?
 What did your life look like BEFORE this happened?

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 Chair Activity
1. Patient will determine an activity
where change may be required
(and then sit in the middle chair)
2. Pharmacists’ Job is to reflect
and ask key evoking questions SUSTAIN NEUTRAL CHANGE
about the activity
3. Patient’s job is to respond and move
to the corresponding chair relative
to how they feel about change
4. Continue the process until patient is
ready to move to “planning” phase
or when an impasse has been reached

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 4 Fundamental Processes
 Engaging – relational foundation
 Focusing – strategic centering
 Evoking – the transition to MI
 Planning – when the time is right

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 Planning
 Elicit-Provide-Elicit Model
 Elicit: “What do you know about…?”
 Provide: “Do you mind if I tell
you more about …?”
 Elicit: “What thoughts do you
have about this now?”
 Timing is KEY!
 Examples:
 “Given what you’ve told me, what do
you think you will do next?”
 “Where do you think you would
like to go from here?”
 “What’s your next step?”

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 Remember… Autonomy!
 You may completely disagree with the
patient’s decision or lack thereof… BUT:
 You have to be ready to accept where they
are in the decision making process
 You don’t know how this interaction
will impact them in the future
 You need to be patient!

“For here the saying holds true,

‘One sows and another reaps.’”
~ John 4:37

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 Putting it all Together!
 Practice in whatever
setting you are in!
 Set goals and
write reflections
 Practice early and often
 Have others assess
your skills
 Find resources and
learn more about MI! Miller WR, & Rollnick S. Motivational interviewing:
Berger BA, Villaume WA. Motivational Interviewing
Helping people change (3rd ed.). for Health Care Professionals: A Sensible Approach
New York, NY: Guilford Press; 2013 (2nd ed.). Washington, DC: American Pharmacists
Association; 2019
The 4 Processes of MI. State of Colorado Division of Criminal Justice. Available at :
https://cdpsdocs.state.co.us/epic/epicwebsite/resources/mi_communities_of_practice/4_processes/4_processes.pdf Accessed on 3 January, 2021.
 Practice the Skills!
Scenario 1:
A patient comes in to the pharmacy
unwilling to use their inhaler.
“I hate this stupid thing… Why am
I even filling this prescriptions?”

Scenario 2:
A patient comes in to the clinic for a
follow-up to an ER visit.
“The doctors at the hospital are just
shoveling pills at me. I have no idea
what this stuff even does.”

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 Questions?

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