Addressing Disparities in Health with Motivational Interviewing


Deborah Baker, PhD; Hyewon Jun, MD, MPH; Dee Keyser; Peggy Latare, MD

Abstracts from the Kaiser Permanente 2019 National Quality Conference

From Hawaii

Background: Behavioral change is a key intervention in treating chronic disease, such as diabetes or obesity. Our patient population is diverse as evidenced by our health care disparities, and this requires many approaches. Motivational interviewing (MI) is fundamental in personalizing care and discovering a patient’s motivation in changing behavior toward wellness. With the rate of physician burn out, this technique helps clinicians connect to patients, build resiliency, and find joy in practice.
Methods: Codesign started with a patient advisor who had expertise and passion for this work. We chose to adapt the curriculum on the basis of the MI work of Steven Malcolm Berg-Smith, MD, as well as The Permanente Medical Group Regional Health Education. We cotaught this work with a patient advisor rather than using actors for skills practice in the 3 medical office buildings where we piloted the program. We started with two 2.5-hour sessions offered with continuing medical education credits and meals on 2 islands: Oahu and Maui. Clinicians volunteered to attend. We invited primary care physicians, psychiatrists, therapists, health coaches, dieticians, and pharmacists. Each session was limited to 10 participants.
Results: We have 600 practitioners in our Medical Group and approximately 75 primary care physicians in the 3 medical office buildings in which we piloted the program. Thirty-three practitioners participated and gave positive feedback. We had mixed disciplines in each of the groups. We collected information from participants before and after the workshop. On the basis of their feedback, we adapted our curriculum over the 3 pilot sites, which resulted in two 2-hour sessions. After-hours sessions were challenging for clinicians and our last pilot was performed during an extended lunch. On the basis of this pilot, this program will now be offered regularly to all staff in addition to Art of Medicine, Shared Decision Making, Communicating Unanticipated Adverse Outcomes, and Communication Skills Intensive.
Discussion: A patient advisor codesigning and teaching an evidence-based model with clinicians resulted in an effective and efficient program. MI helps clinicians cultivate a stronger relationship with patients, thus finding a deeper joy in their practice. Witnessing the resilience in their patients through their stories results in practitioners rediscovering this resilience in themselves. With the diversity of patients in Hawaii, MI is the patient- and family-centered way to engage with patients in their health care. As a Region, we already rank high in quality (National Committee for Quality Assurance rankings and Medicare 5-Star status). MI will reduce disparities hidden within these measures.

Abstracts from the Kaiser Permanente 2019 National Quality Conference


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