A disease that persists for a long time. A chronic disease could last for 3 months or more. Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor do they just disappear. Health damaging behaviours - particularly tobacco use, lack of physical activity, and poor eating habits - are major contributors to the leading chronic diseases.
One of the big challenges is simply finding ways to help the many patients with chronic diseases understand why treatment is important and how to follow it. Many factors of patient’s nonadherence, such as feelings, thoughts, practical barriers, behavior change is difficult and is in the hands of the patient and not the practitioner.
Self-management is a necessary aim in the treatment of chronic illnesses, such as diabetes, heart disease, arthritis, lupus, and chronic obstructive pulmonary disease. Although effective treatments are available for these serious conditions, the rate of adherence to medication, dietary changes, physical activity, blood monitoring, or attendance to regular medical screenings is reported to be approximately only 50%.
The key is sense of the IMPORTANCE of change + sense of CONFIDENCE in one’s ability to change = READINESS TO CHANGE. There is a need for a system wide change in how we think about and manage chronic diseases.
Many pharmacists give patients advice about the importance of medication adherence by simply telling them to take their medication as directed. Patients may passively agree to take their medication regimens but not follow through. This approach to counseling patients is not effective because it fails to explore the patient’s barriers and motivations toward being adherent to the regimen and does not address the patient’s readiness to commit to following through with the prescribed plan.
Motivational interviewing is an alternative form of communication that combines a patient-centered yet directive approach to discussing medication adherence and health behavior change. Motivational interviewing focuses on the patient’s own motivation for change and adherence to treatment and identifies reasons why a patient may be ambivalent or resistant to making a change.
1. Identify patient's behavioural stage:
2. Give intervention based on the patient’s stage:
3. Always use the READS principle: