Motivational Interviewing: Effective Communication Is Vital

Pharmacy technicians (techs) are frequently the first point of contact when patients pick up their prescriptions or purchase OTC medications.

Techs also interact with caregivers, health plans, employees from prescribers’ offices, and other stake holders in the medication-use process. Thus, effective communication is among the most important skills for techs, yet one that is often overlooked.¹

Patients may visit the pharmacy with many questions about their medications and other issues related to their health conditions. At the same time, they may be frustrated at having to navigate the complex health care system.

Techs must assuage patients’ concerns and frustrations and determine which issues should be attended to by the pharmacist. Using effective communication strategies, such as motivational interviewing (MI), can help mitigate patients’ anxiety and elicit the information needed for proper referral. It may also help to convey the message that pharmacists care.

MI is a collaborative, patient-centric communication style that helps patients explore their ambivalence and reflect on their choices to promote changes in behavior.² The goal is for patients to be motivated to make changes or take a difference stance on an issue, as opposed to simply accepting something or having it forced upon them.³

Traditional conversations between a health care provider and patient are more authoritative, emphasizing the 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, then rattle off a list of deleterious outcomes associated with the habit, a tech using MI principles would employ empathy and ask the patient to reflect on why quitting 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. The technique is composed of 4 key elements, known as the spirit of MI: collaboration, acceptance, compassion, and evocation.

Collaboration between patient and tech is the first element. The tech can initiate this during the first interaction, asking open-ended questions to ascertainwhat the patient needs.

Enabling patients to feel in control during their conversations empowers them. They are much more likely to share information and allow the tech to get to the root of the problem or identify barriers through honesty, openness, and self-reflection. Collaboration is accompanied by a nonjudgmental tone, with no attempts to chide or scold the patient.

During the second element of MI, acceptance, the tech recognizes and acknowledges the positive efforts of the patient’s actions. This indicates respect for the patient’s preferences and values.

For example, if a patient who was previously nonadherent confides that they have changed their evening routine to better incorporate bedtime medi- cations and achieved some level of success, the tech would acknowledge that improvement rather than demand the patient do even better. This does not mean the tech accepts suboptimal adherence, but that they recognize the positive changes the patient has made. The tech can then explore options to further improve adherence, on the patient’s terms.

Compassion is the third element. Actively listening and being present in the conversation demonstrates to the patient that the tech is fully committed to helping. The fourth element of the MI spirit is evocation. By evoking the patient’s motivation to change a behavior, for example, the tech can help them move from ambivalence to action and help them to sustain that change. Techs can do this through reflecting and summarizing for the patient the planned behavior change.

In addition to the 4 key elements, the following 5 principles help guide one’s actions while conducting MI. These can be summarized by the READS acronym⁴:

R—ROLL WITH RESISTANCE

Reframe and reflect but do not actively confront patients with their resistance to behavior change. Explore with them the negative and positive consequences of not changing their behavior.

E—EXPRESS EMPATHY

Real empathy is required in this case. For example, if you told a friend you were in a car accident yesterday but did not sustain major injuries, they would not first ask whether you had been speeding or whose fault it was. Neither would they say that everything will be fine or talk about their own accident a few months earlier. None of these comments would make you feel better.

A—AVOID ARGUMENTATION

This is easier when asking questions rather than making declarative statements. Techs should also avoid questions that are condescending or leading.

D—DEVELOP DISCREPANCY

Help patients come to their own realization of the discrepancy that exists between their behaviors and goals.

S—SUPPORT SELF-EFFICACY

Inspire patients with confidence that they can make changes.

MI is one of many techniques that techs can apply when interacting with patients, even if it is the pharmacist who ultimately undertakes the main behavior-change counseling. By asking open-ended questions, demonstrating empathy, and exploring ambivalence, techs can get better results from various communication encounters, including medication histories.

Additionally, techs can create a better sense of teamwork among their peers by employing MI, helping them to realize the value of each person’s contribution to the organization.

In other situations, such as when speaking with individuals from health insurance companies or physician offices, using MI concepts can enable techs to avoid turf battles, make the other person aware that their behaviors or views might not be in the patient’s best interests, and focus the discussion on the most important issues. Continuing education and other resources on MI can help techs to employ this effective and selfless 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. doi:10.1016/j.sapharm.2017.07.00
• Salvo MC, Cannon-Breland ML. Motivational interviewing for medication adherence. J Am Pharm Assoc(2003). 2015;55(4):e354-e361; quiz e362-e363. doi:10.1331/JAPhA.2015.15532
• Voth S. Motivational interviewing is changing the conversation. National Healthcareer Association. July 2018. Accessed July 7, 2020. https://info.nhanow.com/mediacenter/motivational_interviewing_is_changing_the_conversation
• Donegan TE. Review of Berger BA, Villaume WA. Motivational Interviewing for Health Care Professionals: A Sensible Approach. American Pharmacists Association; 2013. Am J Pharm Educ. 2014;78(4):88. doi:10.5688/ajpe78488