Motivational Interviewing: Effective Communication is Important for Technicians

Pharmacy technicians are frequently the first point of contact when patients and customers arrive to pick up their prescriptions and/or purchase any OTC medications. Pharmacy technicians also interact with personnel from prescribers’ offices, health plans, informal caregivers, and other stakeholders in the medication use process. Thus, effective communication is among the most important skills for technicians, yet one that is often overlooked.¹

Patients may visit the pharmacy with many uncertainties and questions about their medication and other issues related to their health condition. At the same time, these patients might be tired and/or frustrated by having to navigate our complex health care system.

Pharmacy technicians have to assuage concerns and frustrations of patients and also determine which questions and issues should be triaged to the pharmacist. Use of effective communication strategies, such as motivational interviewing (MI), can help mitigate patients’ anxiety and elicit the information needed for proper referral and triage, as well as to help further connote the pharmacists’ message of caring.

Motivational interviewing is a patient-centric, collaborative communication style that helps patients self-reflect and explore ambivalence about the choices they make so as to promote changes in those choices and behaviors. It allows the person to find it in themselves to want to make those changes or take a difference stance on an issue, as opposed to someone else attempting to dictate or force these changes upon them.

Traditional conversations between a patient and health care provider are more authoritative, emphasizing transfer of information and expectation of outcome, rather than exploring ambivalence. For example, rather than tell a patient they must quit smoking or face the consequences and then rattle off a list of deleterious outcomes associated with smoking, motivational interviewing would employ empathy and ask the patient to reflect on why quitting smoking might be helpful for them and their loved ones.

MI encourages patients to take an active role in making healthy lifestyle choices on their own. MI is composed of 4 key elements, known as the spirit of MI: collaboration, acceptance, compassion, and evocation.

The collaboration between the patient and pharmacy technician is the first element of motivational interviewing. MI can be applied in the initial interaction between the pharmacy technician and patient, in which the technician can ask open-ended questions during their brief conversation to understand what the patient needs.

Allowing patients to feel in control during their conversations is empowering to them. They are much more likely to share information and allow you to get to the real root of the problem or identify real barriers through their openness, honesty, and self-reflection. Obviously, this is accompanied by a non-judgmental tone and is devoid of any attempts to scold or chide the patient.

Acceptance, the second element of motivational interviewing, has pharmacy technicians recognizing and acknowledging the positive efforts of the patient’s actions. It connotes respect of the patient's values and preferences.

For example, if a previously nonadherent patient confides in you that they have changed their evening routine to better incorporate their bedtime medications and achieved some level of success, you would acknowledge that improvement rather than demand that they do even better. It does not mean you accept suboptimal adherence, but that you at least recognize the positive changes that have been made and explore options to improve adherence even further, on the patient’s terms.

Compassion is the third element. Active listening and being present in the conversation demonstrate to the patient that you are fully committed to helping them. The fourth element of the spirit of MI is evocation. Evoking patients to change a behavior helps them move from ambivalence to action.

Patients will become more willing to change a behavior and sustain it when evoked. This can be done through reflecting and summarizing for the them the plan or behavior change that they derived for themselves.

In addition to the 4 key elements of motivational interviewing, 5 principles help to guide our actions while conducting MI. These can be summarized by the READS acronym.

R—Roll with resistance: reframe and reflect, but do not actively confront the patient with their resistance to behavior change. Explore positive and negative consequences of their staying with the current behavior.

E—Express empathy: in this case, real empathy. For example, if a friend tells you that they were in a car accident yesterday but didn’t sustain major injuries, you would not first ask them if they were speeding, whose fault it was, or tell them that everything will be fine or that you got into an accident, yourself, a few months prior. None of these would actually make them feel better.

A—Avoid argumentation: this is easier when you ask questions rather than make declarative statements; however, you should also avoid questions that are leading or condescending.

D—Develop discrepancy: helping the patient come to their own realization of the discrepancy existing between their goal and their behaviors.

S—Support self-efficacy: inspiring confidence that the patient can make changes.

Motivational interviewing is one of many techniques a pharmacy technician can apply in dealing with patients, even if the crux of the behavior change counseling is undertaken by the pharmacist. By exploring ambivalence, demonstrating empathy, and asking open-ended questions, technicians can get better results from various communication encounters, including medication histories.

MI can also be applied elsewhere. In dealing with peers, technicians can create a better sense of teamwork, facilitate citizenship behaviors among one another, and help each other realize the value in each person’s contribution to the organization.

In speaking with persons from physician offices or health plans, use of MI concepts will help focus the discussion on the most important issues, avoid turf battles, and help create greater awareness by the other conversant that their views or behaviors might not be in the best interest of the patient. Technicians can look for continuing education and other resources on MI that can help them employ this selfless and effective communication practice.

References

• Desselle SP, Hoh R, Holmes ER, Gill A, Zamora L. Pharmacy technician self-efficacies: Insight to aid future education, staff development, and workforce planning. Res Social Adm Pharm. 2018;14(6):581-588.
• Salvo MC, Cannon-Breland ML. Motivational interviewing for medication adherence. Pharmacy Today. 2015(6):81-89.
• Voth S. Motivational Interviewing is Changing the Conversation. Available at: https://info.nhanow.com/mediacenter/motivational_interviewing_is_changing_the_conversation. Accessed on May 18, 2020.
• Berger BA, Villaume WA. Motivational interviewing for health care professionals: A sensible approach. J Am Pharm Assoc. 2013;53:11-17.

About the Authors

Ashley Saclolo, MS, is a PharmD candidate at Touro University California College of Pharmacy.

Shane P. Desselle, RPh, PhD, FAPhA, is professor of Social and Behavioral Pharmacy at Touro University California College of Pharmacy.