For Noncompliant Patients, a Fix That Works

Neil Chesanow

Disclosures

June 26, 2014

In This Article

An Approach to Improving Compliance That Works

A growing number of doctors have been using a special technique that gets superior compliance from patients. Here are some of the enviable results:

In a study on medication compliance in 50 people with severe asthma, those who received this technique refilled their prescriptions for inhaled corticosteroids 21% more often in a year, compared with those who received usual care.[1]

In a study of 217 obese women with type 2 diabetes, those who received this technique lost significantly more weight than those who didn't.[2] They also showed significant reductions in their A1c levels at 6 months.

In a study of more than 2500 teenagers who smoked, those who received it showed significantly higher abstinence rates than those who didn't after 2 years.[3]

What is this special something?

It's a way of talking with patients that's designed to elicit their barriers to compliance and assist them in overcoming those barriers. Studies show that doctors using this method of interaction can often work wonders. They can get people with chronic conditions who consistently don't take their medications as their doctors prescribe -- or follow their doctors' advice on losing weight, reducing alcohol consumption, stopping smoking, or quitting other unhealthy habits -- to begin to take constructive action on their own behalf.

Called "motivational interviewing," the method was first introduced in 1983 by a psychologist whose goal was to change behavior in people who were alcoholics and drug addicts.[4] The idea was to get them -- by showing empathy, being nonjudgmental, and posing simple but strategic questions -- to reveal why they resisted behavior change and what would motivate them to change so that they could begin to address their barriers.

This method of talking produced such positive outcomes that over the years, it has been adapted to treating patients with a variety of chronic conditions, from cardiovascular disease to respiratory illness, diabetes, and cancer. The method is currently taught by hospitals, such as Massachusetts General; medical schools, including Johns Hopkins and Duke; nursing schools, such as the University of Colorado's; and even insurers, such as Blue Cross Blue Shield of Michigan.

Until recently, motivational interviewing required more frequent and longer patient visits than primary care physicians could usually offer, and the original method, designed for addiction specialists, is complex and challenging to learn, with lengthy training that's impractical for many busy primary doctors.

Over the past few years, however, experts in teaching the method have designed a version that's realistic for primary doctors to use with noncompliant patients.

Behavioral psychologist Kim Lavoie, PhD, Associate Professor at the University of Quebec at Montreal and Codirector of the Montreal Behavioral Medicine Centre in Montreal, Canada, has trained more than 7000 physicians and other providers in a pared-down version of motivational interviewing that she and other trainers, both here and abroad, have renamed "motivational communication."

This simplified version, for doctors who are short on time for both formal training and interaction with patients, sticks to basics that are easy to grasp. It can get positive results in as little as 5 minutes, Lavoie maintains. Even in an African nation such as Namibia, where 40% of the population is HIV positive and 30%-40% abuses alcohol, a single session can show positive results.[5] Here's how it works.

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