Motivational Interviewing Techniques for Chronic Disease Management: Focus on Cardiovascular Disease

By Matta, Thomas M.; Miller, Danielle M. | Drug Topics, October 2014 | Go to article overview

Motivational Interviewing Techniques for Chronic Disease Management: Focus on Cardiovascular Disease


Matta, Thomas M., Miller, Danielle M., Drug Topics


Abstract

Pharmacists are uniquely positioned healthcare professionals with direct patient contact who not only play an integral role in making pharmacological recommendations and providing disease state management, but can also assist with changing patients' health-related behaviors such as diet, exercise, and smoking cessation. With the shift in health care to a more patient-centered approach, patients need to be and feel empowered to become active participants in their health care. Although there are various ways for healthcare providers to assist patients in changing their health-related behaviors, motivational interviewing is one approach that has been well studied and has led to positive health outcomes.

Introduction

Pharmacists are healthcare professionals with direct patient contact who are in a unique position that allows them to address patient health conditions as well as medication and lifestyle management. In particular, the role of pharmacists in outpatient ambulatory care clinics and community settings is becoming increasingly focused on preventive care and keeping patients out of the hospital. To achieve these ends, pharmacists are being encouraged to assist with managing various chronic disease states, such as diabetes, hypertension, hyperlipidemia, asthma, and chronic obstructive pulmonary disease. Pharmacists not only play an integral role in making pharmacological recommendations and providing disease state management, but they can also assist with changing their patients' health-related behaviors such as diet, exercise, and smoking cessation.

With the shift in health care to a more patient-centered approach, patients must and should feel empowered to become active participants in their health care. Although there are various ways to assist in changing health-related behaviors, motivational interviewing is one approach that has been well studied and has led to positive health outcomes.1,2 Motivational interviewing is a patient-centered style of collaboratively engaging with patients to empower them to make changes by creating a certain mindset. Because motivation is considered a mental state that is subject to change, motivational interviewing can be used to help patients feel ready to improve their health outcomes.3 Pharmacists can use this method to help patients realize the necessity of change and to help facilitate that change process through collaboration and conversation.4,5 Therefore, motivational interviewing is a means of constructive, unbiased communication between patients and healthcare professionals. The use of this approach in chronic disease state management is not a novel concept. Although first introduced to address substance abuse, this technique has been rapidly expanded to the management of chronic diseases such as diabetes, hypertension, and dyslipidemia. Motivational interviewing has also been shown to be beneficial in helping patients make lifestyle changes such as smoking cessation and improved medication adherence.6 Because pharmacists holistically treat a patient's overall health, health behaviors factor into the aforementioned chronic diseases, especially in terms of cardiovascular health.

Cardiovascular disease is an umbrella term for multiple conditions such as heart failure, coronary artery disease, stroke, and myocardial infarction. Such conditions, which are largely preventable, can occur when chronic disease states such as hypertension, dyslipidemia, and diabetes mellitus go untreated or uncontrolled. Cardiovascular disease remains the number one leading cause of death in the United States.7 The enormity of this problem has not gone unnoticed. In September 2011, the Department of Health and Human Services launched the Million Hearts campaign with the goal of preventing one million myocardial infarctions and strokes by 2017.8The role of pharmacists in this initiative is vital, particularly in the outpatient and community settings where preventive care is fundamental. …

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