Page 38 - Delaware Medical Journal - March/April 2019
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TRENDS IN PATIENT ENGAGEMENT:
How to Keep Patients Compliant and Involved With Their Care
transformation, how can you ensure your patients are taking medications, showing
up for visits, and generally following
your recommendations? Here are some approaches recommended by three different experts.
ENGAGEMENT THROUGH MOTIVATIONAL INTERVIEWING
In researching one of her books, Bernard came across “motivational interviewing,” a psychology technique used to establish a relationship of trust and empathy.
“You listen to the patient, and then you try to
can hear their own words,” she explains. “It doesn’t take a whole lot of time.”
Bernard decided to try motivational interviewing with one of her own patients, who was struggling with elevated liver enzymes and had admitted to excessive alcohol consumption. The patient had been resistant to lectures about the importance of cutting back.
Instead, Bernard tried a new approach: asking the patient what about her life would get better if she drank less. The patient admitted that her husband would be happier and less inclined to complain. sounded as though cutting back would make things more pleasant at home
and asked the patient what she thought
admitted she could try having tea at breakfast instead of vodka — an answer that shed new light on the severity of her drinking problem. On her next visit, the patient’s lab values were much improved and she had started on a new exercise plan. (For a more complete account of this case, see www.medicaleconomics.com/med- motivational-psychology/page/0/1.)
Want to try motivational interviewing? Here are the key things to keep in mind, according to Bernard:
Don’t lecture. Lectures can cause patients to shut you out.
Tina Irgang Leaderman
You probably became a physician because you wanted to help patients get and stay healthy. If only it were that easy. Medication non-compliance, missed visits, and undisclosed behavioral issues are just a few of the obstacles physicians face in trying to keep patients engaged with their care.
“There are so many layers to getting patients on the same page as the doctor about why they need to be healthy,” says practice management consultant, author, and speaker Rebekah Bernard, MD. “You have to make sure you and the patient are seeing eye-to-eye about what the patient feels they need.”
And the stakes are getting higher, especially for primary care physicians. “We look to primary care as the main gatekeeper now that will focus on prevention and wellness,”
says Rita Landgraf, chair of the Patient and Consumer Education Committee of the Delaware Center for Health Innovation, and former Delaware Secretary of Health and Social Services. “How do we engage patients to keep them well?”
Both at the national and state level, experts are striving to answer that question,
she notes. In Delaware, funding from
the Center for Medicare and Medicaid Innovation has supported efforts to integrate care better across disciplines and improve outcomes. One of the key goals is to create a better bridge between primary and behavioral care, says Landgraf. “You can’t separate the head from the body. Research has shown, for example, that cardiovascular disease many times can lead to depression. Yet we’ve created two distinct systems of care.”
However, as the system undergoes this
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Del Med J | March/April 2019 | Vol. 91 | No. 2
