Estonian experience in teaching Motivational Interviewing for medical providers

Transcription

1 Estonian experience in teaching Motivational Interviewing for medical providers Anneli Rätsep PhD GP senior researcher Department of Family Medicine University of Tartu

2 Doctor s expectations that patient... Knows carbohydrate content of their food Monitors the fat content of their diet (cholesterol) Takes properly medication for lowering blood sugar, cholesterol and blood pressure Is able to inject insulin Measures blood glucose level and blood pressure at home and keeps the diary Is physically active more than 150 minutes at least five days a week Visits regularly to the doctor and nurse

3 Rightning reflex I have to show to my patient the problem of his/her behavior I have to give information, so my patient will understand the problem I have to teach to my patient some skills, so that he can change his behavior I have to scare my patient enough, so he will change his behavior. Rollnick S, Miller WR, Butler C. Motivational interviewing in health care : helping patients change behavior. New York: Guilford Press, 2008.

4 Patients perceptions P1: I have diabetes and I am like on a leash, let s say I am on a leash of doctor. There are moments when I think that I do not want to be on a leash all the time P5: One should take medication as much as needed but as little as possible. P5: I haven t accepted the idea of talking about it, I am not interested in it (insulin therapy). If I was interested then may-be I would talk about it, then I would ask. Yes I d rather ask myself, but I am not interested.

5 If you are arguing for change and your patient is arguing against it, you ve got it exactly backward (Miller & Rollnick, 2013)

6 What has changed? The most common criticism made at present by older practitioners is that young graduates have been taught a great deal about the mechanism of disease, but very little about the practice of medicine or, to put it more bluntly, they are too scientific and do not know how to take care of patients. Peabody, F. Journal of the American Medical Association (JAMA 1927; 88: )

7 What can be done differently? Time Caring Emphaty Compassion Peabody, F. Journal of the American Medical Association (JAMA 1927; 88: )

8 Goal oriented Communication style Eliciting and exploring person s own reasons for change Patient centred MI Dealing with ambivalence Rollnick S, Miller WR, Butler C. Motivational interviewing in health care : helping patients change behavior. Third edition New York: Guilford Press, 2013.

9 Teaching MI Behavioural component Technical skills OARS Open ended questions Affirmations Reflective listening Summarising

10 Spirit of Motivational interviewing Partnership Acceptance Absolute worth Empathy Autonomy Affirmation Compassion Evocation Rollnick S, Miller WR, Butler C. Motivational interviewing in health care : helping patients change behavior. Third edition New York: Guilford Press, 2013.

11 Is there an evidence? More than 200 RCT-s Armstrong et al. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev Brodie et al. Motivational interviewing to change quality of life for people with chronic heart failure: a randomised controlled trial. Int J Nurs Stud Vasilaki et al. The efficacy of motivational interviewing as a brief intervention for excessive drinking: a meta-analytic review. Alcohol Alcohol Rubak S, et al. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005

12 Estonia health care personnel (1884 to inhabitants) 4323 doctors, among them ~1000 family doctors ) 8805 nurses 12

13 Retrospect on teaching of MI in Estonia ( ) The first course Instructions to the Theory and Practice of Motivational Interviewing (20 psychiatrists and psychologists) basic training and Train-thetrainers of Motivational Interviewing for prison specialists 400 prison specialists have passed 3-day basic courses during the years

14 Retrospect on teaching of MI in Estonia ( ) Special research group of assessment and evaluation system of Motivational Interviewing Treatment Integrity Code was organised The Association of the Trainers of the Motivational Interviewing in Estonia (EMITA) was organised - 21 members from different specialities 5 trainers are members of Motivational Interviewing Network of Trainers

15 Breakthrough in health care 2009 survey among the primary health care specialists (nurses, GPs, occupational therapist) Project of Health Development Institute and ESF (European Social Fund) MI international trainers: Michael Beltenburg, Sven Wåhlin, Tim Anstiss, Judit Carpenter, Erik Knifström, Jeff Breckon 3 MI trainers - MINT members from Estonia 6 GPs (5 of them members of Department of the Family Medicine at the University of Tartu)

16 Motivational Interviewing in Health Care in Estonian

17 Courses for medical personnel MI introduction (8h) 33 courses - ~700 participants Counselling on alcohol consumption (8 h) 27 courses Councelling for healthy life style (16 h) 19 courses Skills development 16 h+ 8h with MITI coding and feedback 6 courses

18 Narrative feedback Good decriptive, memorable exercises, help better understand the theory I like the form of learning, adequate tempo, good involvement of the participants Group work was suprisingly successful for my I am usually shy in a new environment Very good, emphatic and supporting trainers

19 Narrative feedback It was liked that the trainers practice themselves and used good examples from real life Reflection was new for me interesting! MI is self-preserving I had the chance to do practical excercises and realised how difficult it is to find the right words

20 Conclusions The learning process was highly appreciated by the trainees MI is included to the training of residency trainees in family medicine in Estonia 6th year undergraduates - 4 hours seminar Positive feedback motivates trainers to learn more and continue with teaching Training of trainers continues In the future we hope to start with continuous training for already trained medical personnel

21 Thank you for your attention!