Motivational interviewing, appreciative inquiry, and setting attainable goals can increase the self-efficacy and adherence of patients in the management of chronic disease.
By Tessa Heitkamp, PharmD Candidate 2020
Pharmacists are known to be one of the most accessible healthcare professionals. There are no appointments needed to speak with a pharmacist, no receptionist stopping a patient from addressing a pharmacist, and most importantly no charge to receive a pharmacist’s recommendation. With the rise of medication management services, pharmacists are taking a more active role in educating patients on their medications and disease states. Pharmacists can utilize health-coaching strategies to improve medication adherence and management of chronic diseases.
With the increasing demand for pharmacists to provide more services, often without extra help or time, why should you add health coaching to the list? Health coaching has the potential to improve patient care, patient satisfaction, pharmacist-physician relationships, and reimbursement. Major insurance companies are starting to offer reimbursement for health coaching services and some patients may be willing to pay out-of-pocket. Health coaching can also be implemented during counseling sessions or MTM services. Implementing health coaching techniques as a pharmacist can have a large impact on patient lives.
The primary role of a health coach is to understand individual preferences, barriers, and support systems and use that information to empower the patient to achieve health goals. This is accomplished through reflective listening, using open-ended questions, appreciative inquiry, motivational interviewing, and setting SMART goals. Pharmacists can help patients make sustainable behavioral changes and improve health outcomes this way. The primary aspects of health coaching and how to implement these activities into your practice are summarized below.
Reflective listening is crucial in developing patient trust and building rapport. It involves listening more than talking, asking more than telling, and reflecting more than commenting. Each patient has individual concerns and beliefs about their condition, and it is important to acknowledge what they have voiced with empathy and avoid judgement. Rephrase what the patient has told you and reflect it back to ensure understanding. Then it is appropriate to ask the patient more questions about their concerns and beliefs. For example, if a patient states, “I was just given a huge to-do list for my new diagnosis of diabetes. I don’t know how I’m expected to remember all of this on top of changing my diet and exercise routine.” Reflect back by saying, “It sounds like you’ve become over-whelmed with all of these changes. If I’m understanding correctly, it seems like you’re unsure of where to start.”
Open-ended questions allow patients to elaborate on their own knowledge and feelings towards a subject. Pharmacists often ask open-ended questions, but it’s important to ask the right open-ended questions. They should both empower the patient and get their perspective on current therapies. Here are some examples:
Appreciative inquiry is asking questions in a way that focuses on the positive responses to amplify strength. This approach to asking questions allows the patient to focus on what is going right in their situation instead of what is going wrong. For example, instead of asking, “How many times did you miss a dose of your medication?” try asking, “How successful are on a scale of 1 to 10 are you in taking your medications?” This questions focuses on patient successes instead of patient failures. Here are some more examples
Motivational interviewing helps resolve resistance by strengthening the patient’s motivation and commitment to change. In 2013, Bruce Berger Ph.D. and William Vilaume Ph.D. outlined six steps in motivational interviewing (Berger and Villaume 2013).
These 5 steps in goal setting are vital to helping patients achieve their health and wellness goals.
To fully understand the nuances of health coaching, pharmacists can become certified health and wellness coaches. There are several educational programs that offer online and in-person certifications for health care professionals. To find a certification program that’s right for you and approved by the International Consortium for Health & Wellness (ICHWC) visit https://ichwc.org/approved-programs/.
Berger B, Vallaume W. Motivational Interviewing for Health Care Professionals: A Sensible Approach. Washington, DC: American Pharmacists Association; 2013.