Recorded mpro hbc session 2 1 11-12 final

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Prevention Learning and Action Network Webinar Slides with Recording

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  • We will build on these ideas in Sessions 2 and 3 and, hopefully, offer some suggestions for making small improvements in how you work with patients to set goals and change health behaviors
  • We will build on these ideas in Sessions 2 and 3 and, hopefully, offer some suggestions for making small improvements in how you work with patients to set goals and change health behaviors
  • Recorded mpro hbc session 2 1 11-12 final

    1. 1. Improving Patient Adherence Through Health Behavior Change Kevin Townsend, PharmD, MSc, BCPS April 18, 2012 MMM00028A © 2007 Pfizer Inc. All rights reserved. May 2007NPC05009A/281792-01 © 2011 Pfizer Inc. All rights reserved. June 2011 1
    2. 2. Health Behavior Welcome to the Web Ex Change• If you are seeing this slide, you have successfully entered the Web Ex. Congratulations!• To join the audio portion of the conference please use this: – Call in: 1-866-462-0164 – Passcode/Meeting Number: *9747004*• You should see, at least, the “Participant” and “Chat” panels on the right side of your screen. If not, go to “View” menu at top. – “View” > “Panels” > “Manage Panels” – Click on chat or participant and click on arrow to move them to the right• ***In the CHAT window: Please enter your practice name, your name, and number of participants from your office. Thanks!***• To ask for help during the workshop enter a request in the chat window.
    3. 3. Health Behavior Welcome to the Web Ex Change Session 2Improving Patient Adherence Through Health Behavior Change• MPRO Comments• LAN Updates• HBC Workshop• Speaker information Kevin Townsend, PharmD, MSc, BCPS Medical Outcomes Specialist; Pfizer Inc• Slide content developed by Pfizer Inc. MMM00028A © 2007 Pfizer Inc. Printed in USA/May 2007 3
    4. 4. Health Behavior Welcome to the Web Ex Change• Chat “monitors” will be used to capture your questions and other feedback• Notes will be taken during the call and made available after the workshop.• Information entered into the “Chat” panel can be seen by everyone (Unless you are only chatting with some participants.)• Note pad type computers may not have full functionality (e.g., polling features) 4
    5. 5. Health Behavior Welcome to the Web Ex Change• Prepare for an active workshop!• Key concepts will be presented on the slides• Live polls will be used to gather your answers and opinions• Questions that can’t be addressed during the workshop will be answered afterwards or at a future workshop• Suggestions, best practices, and tips that are captured in the chat room will be summarized and made available to all attendees as a reference. 5
    6. 6. Feedback From Last Workshop (2/9/12) Chat NOW!• Which “Behavioral” model communication styles did offices pick to work on? HERE IS WHAT YOU TOLD US: – Acting in “Servant Role” to patient. – “Negotiating” not “Dictating” (4 offices). – “Assessing Motivation” instead of trying to motivate the patient. – “Understanding and accepting” the patients current stage (2 offices). – “Labeling” the patient. – “Information exchange”.• What disease or patient type did this refer to? HERE IS WHAT YOU TOLD US: – Weight loss. – Adherence (3 offices).• TELL US MORE (Use CHAT window) – From your “homework ”, what were some specific things you did or modified that were useful? – In what types of patients? – EVERYONE: please share your successes, challenges, and ideas 6
    7. 7. Health Behavior Change Stages of change model Stages of Change 5 stages of change By identifying patients position in the change process, health care providers can tailor intervention, usually with skills they already possess Focus is not to convince patient to change behavior but to help patient move along stages of changeProchaska JO et al. Am Psychol 1992; 47:1102-1114. 7Rollnick S, et al. Health Behavior Change: A Guide For Practitioners. 2003:17-39.Zimmerman GL, et al. Am Fam Physician. 2000;61:1409-1416.
    8. 8. Adherence Poll Question Research Use Web Ex Poll Window to Answer Poll Question!• When helping someone start a new goal or treatment, does your practice start by thinking about the patients stage of change (or readiness to change)? – YES – NO8
    9. 9. Health Behavior Change Precontemplation stage Stages of Change • Characteristics – Patient not even considering changing – May be in denial or not consider problem serious – May have tried to change and failed so many times they have given up • Strategies – Educate on risks benefits – Highlight the positive outcomes related to the change • Example – Smoker is in denial of health risks: “heart attack won’t happen to me, my father smoked for 92 years” 9Zimmerman GL, et al. Am Fam Physician. 2000;61:1409-1416.
    10. 10. Health Behavior Change Contemplation stage Stages of Change • Characteristics – Person is ambivalent about changing – During this stage the person weighs benefits costs or barriers of the change including time, expense, fear • Strategies – Identify barriers and misconceptions the patient has – Address their concerns and identify appropriate support systems • Example – A patient with high cholesterol recognizing need to change: “I know I need to change my diet, but I don’t want to give up the foods I like” 10Zimmerman GL, et al. Am Fam Physician. 2000;61:1409-1416.
    11. 11. Your Thoughts Please! Chat NOW! Use Chat Panel to Tell Us• What’s a common example of a patient you see in your practice who is……….. – PRECONTEMPLATIVE – CONTEMPLATIVE – For Example: • Precontemplative: Smoker who refuses to talk about quitting • Contemplative: Patient with high cholesterol (who’s friend just had an MI) asks if there are any “easy” diets he can try.11
    12. 12. Health Behavior Change Preparation stage Stages of Change • Characteristics – The person is prepared to experiment with small changes • Strategies – Develop realistic goals and timelines for the change – Don’t try too many changes or too much change all at once – Provide positive reinforcement about patient’s willingness to change • Example – Overweight patient preparing to exercise by identifying exercise facilities in their area and planning on how to fit this into their schedule 12Zimmerman GL, et al. Am Fam Physician. 2000;61:1409-1416.
    13. 13. Health Behavior Change Action stage Stages of Change • Characteristics – The person takes definitive action to change their behavior • Strategies – Provide positive reinforcement – Remind them of the positive benefits of the change – Verify their support system • Example – Patient with high blood pressure fills medication, self- monitors BP daily, and continuously takes medication. They use reminder system to help them not forget to take medication 13Zimmerman GL, et al. Am Fam Physician. 2000;61:1409-1416.
    14. 14. Health BehaviorMaintenance and relapse prevention Change Stages of stage Change • Characteristics – The person strives to maintain the new behavior over the long term • Strategies – Provide encouragement and support – Identify any potential barriers that may sideline them from their goals • Example – Patient refills their medication regularly, continues to follow their diet, and incorporates daily visits to the gym 14Zimmerman GL, et al. Am Fam Physician. 2000;61:1409-1416.
    15. 15. Your Thoughts Please! Chat NOW! Use Chat Panel to Tell Us• What’s a common example of a patient you see in your practice who is……….. – PREPARATION – ACTION – MAINTENANCE – For Example: • Preparation: HTN patient who agrees to try a pill box as a reminder • Action: DM patient who has started dieting and using insulin • Maintenance: Patient who quit smoking 8 months ago15
    16. 16. Health BehaviorThe 4 general principles of ChangeHealth Behavior Change REDS • REDS 1. Roll with resistance 2. Express empathy 3. Develop discrepancy 4. Support self-efficacy 16 Miller WR, et al. Motivational Interviewing. 2002:33-42.
    17. 17. Health Behavior ChangeThe principles of Health Behavior Change REDS1. Roll with resistance • Use understanding, empathy • Get clarification • New perspectives are invited, not imposed • Resistance is not directly opposed • Resistance is a signal to respond differently • Repeat your understanding • The patient is primary resource in finding answers and solutions Miller WR, et al. Motivational Interviewing. 2002:33-42 17
    18. 18. Poll Question Health Behavior Change Use Web Ex Poll Window to Answer Poll Question 1. Roll with resistance If a 50-year old patient with hypertension says: “I just don’t like the idea of taking a medicine every day,” what is an appropriate response? – “Well, if you want to get your blood pressure under control, you need to take the medicine every day” – “High blood pressure is a chronic illness and you have to take your medication every day” – “What in particular don’t you like about taking your medication every day?” – “Having to take medicine every day concerns you?”18
    19. 19. Poll Answer Health Behavior Change Use Web Ex Poll Window to Answer Poll Question 1. Roll with resistance If a 50-year old patient with hypertension says: “I just don’t like the idea of taking a medicine every day,” what is an appropriate response? – “Well, if you want to get your blood pressure under control, you need to take the medicine every day” – “High blood pressure is a chronic illness and you have to take your medication every day” – “What in particular don’t you like about taking your medication every day?” – “Having to take medicine every day concerns you?”19
    20. 20. Health BehaviorThe principles of Health Behavior Change Change2. Express empathy REDS • Acceptance facilitates change • Skillful reflective listening is fundamental • Identify and understand resistance and reasons for unhealthy behaviors without judgment • Empathy creates a climate for change through trust and must be shown throughout the process Miller WR, et al. Motivational Interviewing. 2002:33-42 Berger BA. Case Manager. 2004:15:58-62. 20
    21. 21. Poll Question Health Behavior Change Use Web Ex Poll Window to Answer Poll Question2. Express empathy If a patient with hypertension says “I can’t believe I have high blood pressure, I have always been so healthy,” what is an appropriate response? – “This has come as a shock to you, especially since you have been so healthy” – “Well, even healthy people get high blood pressure” – “Millions of people have high blood pressure and it is perfectly treatable” – “You are having a hard time accepting you have high blood pressure because you have always been so healthy” 21
    22. 22. Poll Answer Health Behavior Change Use Web Ex Poll Window to Answer Poll Question2. Express empathy If a patient with hypertension says “I can’t believe I have high blood pressure, I have always been so healthy,” what is an appropriate response? – “This has come as a shock to you, especially since you have been so healthy” – “Well, even healthy people get high blood pressure” – “Millions of people have high blood pressure and it is perfectly treatable” – “You are having a hard time accepting you have high blood pressure because you have always been so healthy” 22
    23. 23. Health BehaviorThe principles of Health Behavior Change Change3. Develop discrepancy REDS • Discrepancy = dissonance • Point out the good things and bad things about change, the pros and cons • Discrepancy throws the patient’s system out of kilter • Restate the discrepancies heard • The patient should identify the arguments for change • Change is motivated by a perceived discrepancy between present behavior and important personal goals or values Miller WR, et al. Motivational Interviewing. 2002:33-42. 23 Berger BA. Case Manager. 2004:15:58-62.
    24. 24. Poll Question Health Behavior Change Use Web Ex Poll Window to Answer Poll Question3. Develop discrepancy1 • A patient who has a child with severe asthma continues to smoke. Select the best motivational interviewing responses from the following: – “What you are doing is harmful to your child and you need to stop” – “We’ve talked in the past about the effect your smoking could have on your child’s asthma. Tell me what your thoughts are about that” – “Cigarette smoke on your clothes can make your child’s asthma worse even if you smoke outside. You must stop smoking” – “What are your thoughts about smoking around your family? On a scale of 1 to 10, how important is quitting to you? How confident are you that you could quit if you tried?” 1. Miller et al. Motivational Interviewing: Preparing People for Change. 2002:33-42. 2
    25. 25. Poll Answer Health Behavior Change Use Web Ex Poll Window to Answer Poll Question3. Develop discrepancy1 • A patient who has a child with severe asthma continues to smoke. Select the best motivational interviewing responses from the following: – “What you are doing is harmful to your child and you need to stop” – “We’ve talked in the past about the effect your smoking could have on your child’s asthma. Tell me what your thoughts are about that” – “Cigarette smoke on your clothes can make your child’s asthma worse even if you smoke outside. You must stop smoking” – “What are your thoughts about smoking around your family? On a scale of 1 to 10, how important is quitting to you? How confident are you that you could quit if you tried?” 1. Miller et al. Motivational Interviewing: Preparing People for Change. 2002:33-42. 2
    26. 26. Health Behavior ChangeThe principles of Health Behavior Change REDS4. Support self-efficacy • A person’s belief in the possibility of change is an important motivator • The person, not the counselor, is responsible for choosing and carrying out change • Notice the positive, including statements, not just behaviors • Let the person know you’ve noticed • Let them know how you feel • Praise the behavior, not the person • Continue to support self-efficacy throughout the process Miller WR, et al. Motivational Interviewing. 2002:33-42. 26 Berger BA. Case Manager. 2004:15:58-62.
    27. 27. Poll Question Health Behavior Change Use Web Ex Poll Window to Answer Poll QuestionThe principles of Health Behavior Change4. Support self-efficacy During his last visit a patient with diabetes is told he needs to start exercising as part of his treatment. You have earlier rolled with resistance and empathized with him. To support his self-efficacy, what is an appropriate response? – “What are your thoughts about your exercise program?” – “You really need to do it, not just think about it” – “Getting into a regular exercise routine will help you” – “Good. What kind of exercise have you thought about?” 27
    28. 28. Poll Answer Health Behavior Change Use Web Ex Poll Window to Answer Poll QuestionThe principles of Health Behavior Change4. Support self-efficacy During his last visit a patient with diabetes is told he needs to start exercising as part of his treatment. You have earlier rolled with resistance and empathized with him. To support his self-efficacy, what is an appropriate response? – “What are your thoughts about your exercise program?” – “You really need to do it, not just think about it” – “Getting into a regular exercise routine will help you” – “Good. What kind of exercise have you thought about?” 28
    29. 29. Your Thoughts Please! Chat NOW! Use Chat Panel to Tell Us• Based on what we’ve covered so far, in what types of patients will you apply motivational interviewing techniques? – Example: “We will begin using motivational interviewing with our non-adherent CHF patients.”29
    30. 30. Thank You!Next workshop date: JulyAction item for next time: One-One-OnePick one HBC technique and use it at least one time with onepatient.We’ll collect feedback during our next workshop.Example:•Move a precontemplative patient to contemplation.•Try reflective listening with a patient•Use R., E., D., or S. with a patient being asked to set a goal 30
    31. 31. Thank You!Next workshop date: July 12, 2012You will be receiving an email from MPRO with thefollowing link that will take you to a programevaluation survey.http://www.surveymonkey.com/s/PBPLKRGIf you would please take a few minutes to respondand give us your feedback we would greatlyappreciate it!Thank you. 31

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