Dr. Blake Anderson, President and CEO HealthSciences Institute
Preventing and managing chronic diseases requires patients who are engaged and who follow-through with provider lifestyle and treatment recommendations. While providers can do their part by delivering evidence-based care, only about 50% of patients adhere with medication regimes— leading to over $100 Billion a year in avoidable hospitalizations. Adherence with lifestyle recommendations can be even lower. Clearly patients aren’t listening or maybe we’re not listening to them.
At a time when 75% of US health care spending is attributed to the care of chronic diseases—when patients with chronic diseases are the most frequent consumers of primary care and hospital services—it is essential that we do all that we can do to better engage patients as partners in their health care. In fact, most chronic diseases and disease-related problems are the result of behavior.
Telling patients what to do is not enough
Preventing and better caring for chronic diseases requires a new model of care. In the old acute care model, health care problems could be fixed or cured. Advice and patient education were used to encourage patients to “comply.” Today, most chronic diseases cannot be cured, but must be managed. And it is estimated that up to 95% of care for chronic diseases such as diabetes is self-care. So while it’s our duty to educate and advise patients, poorly timed or overused information-based approaches can actually invite patient resistance. Patients who are at highest risk of chronic diseases and chronic disease-related complications have often been told many times. Think about how you feel when someone close to you provides “helpful” advice about how you should live your life—over and over again.
Patients are not usually concerned about their disease
The patient education approach assumes that patients are primarily motivated to change their behavior or manage their health. However, at any given time, most people are not ready to change their behavior. They’re ambivalent about change—which is commonly mistaken for “resistance.” Moreover, most patients are less concerned with the “disease” than the problems that the disease causes in their daily lives. Most patients are primarily concerned about how the disease could prevent them from doing the things that are important to them—whether that is going to coffee with friends, visiting their grandchildren, or taking care of housework.
Building readiness and motivation to change
Motivational interviewing is a formal, systematic approach that clinicians can use to help evoke the person’s reason for changing. What’s important to them, their goals, their ambivalence, the pros and cons of change. It is person-centered and designed to prevent resistance.
Motivational interviewing can be deceptively simple, but it is not an easy approach to teach. When we work with organizations to train providers on the best practices of chronic condition coaching we spend a solid day on motivational interviewing. It cuts to the heart of patient engagement. But it also cuts against the patient education approach. It is completely different from the advice-giving approach most healthcare providers are accustomed to and have been schooled in. It is not about telling patients to do something. It is about getting patients to tell us why and how they can improve their health.
Motivational interviewing is just one part of an array of evidence-based health coaching techniques. Unfortunately, these methods are not widely used in healthcare organizations across the country.
It’s time for change
It’s true that there are exceptional, talented, well-meaning health professionals out there who are great at treating patients with chronic conditions. But it is time to drop our assumption that healthcare professionals, even the best, intuitively know the best way to engage and motivate patients. It’s time to put decades of behavioral science research into our everyday practices. It’s time to finally pair evidence-based medicine with evidence-based health coaching.
Learn more at healthsciences.org
About Dr. Blake Anderson
Health coaching has recently emerged as a promising alternative to patient education oriented approaches. By putting the focus on the patient and their goals—not the disease or the information—patient engagement can be improved. It is no wonder that health coaching has emerged as a promising approach for engaging patients in lifestyle management and treatment adherence. However just as we advocate for evidence-based medical care, health coaching should be evidence-based. While most health coaching approaches are based on pop psychology, there are evidence-based approaches such as brief motivational interviewing that are well-suited for health care encounters, and have been proven effective for improving engagement, activation and self-care. HealthSciences Institute is a strong advocate of these evidence-based approaches.
Dr. Blake Andersen, a health psychologist and national authority on health-related behavior change, is the President & CEO of HealthSciences Institute. The Institute offers the only nationally accredited health coaching, disease management, and chronic care improvement professional learning and certification and staff accreditation program (Chronic Care Professional Certification) in partnership with DMAA: The Care Continuum Alliance and health plan, health system and state partners. HealthSciences also hosts the national Population Health Improvement Learning Collaborative—the largest community of clinicians in wellness, disease management and chronic care.
