MI MI and Shared MI MI and Shared and Shared Decision Making and - - PowerPoint PPT Presentation

MI MI and Shared and Shared Decision Making Decision Making

The project PRECIOUS has received funding from the European Union s Seventh Framework Programme under Grant Agreement nº 611366"

MI MI and Shared and Shared Decision Making Decision Making in chronically ill patients: in chronically ill patients: is is mhealth mhealth key for adherence? key for adherence?

PILAR LUSILLA PILAR LUSILLA

6th 6th PAMI Conference PAMI Conference Hotel Hotel Mercure Mercure Poznań Poznań Centrum Centrum 18 October 2015 18 October 2015

Index Index

INTRODUCTION: INTRODUCTION: P Patient atient adherence adherence in in chronic chronic medical medical conditions conditions Principles Principles of

• f patient

patient centered centered care care Principles Principles of

• f patient

patient centered centered care care The The link link between between SDM and MI SDM and MI MI, SDM & MI, SDM & Mhealth Mhealth Take Take to to home home message message

Adherence to treatment Adherence to treatment & chronically ill patients & chronically ill patients

Doctors are highly qualified experts. But Doctors are highly qualified experts. But a a very high very high percentage of patients do not follow their experts’ percentage of patients do not follow their experts’ percentage of patients do not follow their experts’ percentage of patients do not follow their experts’ recommendations. recommendations.

The challenge of poor The challenge of poor adherence adherence

WHO WHO: : 30 30-

• 70

70% % of

• f chronically

chronically ill ill patients patients are are non non-

• adherent

adherent to to medical medical treatments treatments and and medical medical recommendations recommendations recommendations recommendations F Few ew of

• f them

them inform inform their their doctors, doctors, and and not not all all doctors doctors identify identify correctly correctly the the lack lack of

• f adherence

adherence

WHO: Adherence to long-term therapies: evidence for action. 2003.

70% VOLUNTARY

30%

non-voluntary (forgetfulness)

Understanding poor compliance Understanding poor compliance

VOLUNTARY (drop-out)

Doubts about

NEEDS

WORRIES

About side effects

Patient Patient C Centered entered Care Care (PCC) (PCC)

ASSOCIATED WITH ASSOCIATED WITH: : IMPROVED PATIENT IMPROVED PATIENT OUTCOMES OUTCOMES IMPROVED SELF IMPROVED SELF-

• IMPROVED SELF

IMPROVED SELF-

• MANAGEMENT

MANAGEMENT PATIENT SATISFACTION PATIENT SATISFACTION MEDICATION ADHERENCE MEDICATION ADHERENCE

Ethical Ethical principles principles of

• f s

sharing haring decision decision making making

Self Self-

• Determination

Determination Theory Theory (SDT): (SDT): our

• ur intrinsic

intrinsic tendencies (motivation) is to tendencies (motivation) is to protect and preserve protect and preserve

• ur well
• ur well-
• being

being. .

• ur well
• ur well-
• being

being. . Relational autonomy Relational autonomy: : we are we are not entirely not entirely free free, our , our decisions will decisions will always relate to interpersonal always relate to interpersonal relationships and relationships and mutual dependencies mutual dependencies

SDM: Concept SDM: Concept

”An ”An approach where approach where clinicians and clinicians and patients share the patients share the best available evidence when best available evidence when faced with faced with the task of the task of making decisions, and where patients making decisions, and where patients are supported are supported to consider to consider options

• ptions to achieve

to achieve informed informed to consider to consider options

• ptions to achieve

to achieve informed informed preferences preferences” ”

Elwyn G, Coulter A, Laitner S, Walker E, Watson P, Thomson R. Implementing shared decision making in the NHS. BMJ. 2010

A 3 A 3-

• step model for

step model for clinical practice clinical practice

Make sure that patients know that reasonable options are available Support the work

• f considering

preferences and deciding what is best provide more detailed information about options

SDM and SDM and MI: similarities MI: similarities

P Patient atient-

• centered

centered orientation

• rientation

Focus on engaging patients to explore their: Focus on engaging patients to explore their:

Views and opinions, Views and opinions, Options for treatment Options for treatment Options for treatment Options for treatment Management approaches from the patients’ perspective Management approaches from the patients’ perspective

Similar communication Similar communication skills: exchanging information, skills: exchanging information, reflective listening reflective listening, , developing developing trust. trust.

Two complementary Two complementary processes processes

MI MI Addresses ambivalence Addresses ambivalence to change to change The The interviewer seeks interviewer seeks SDM SDM Strives to clarify Strives to clarify treatment options treatment options Help Help a patient to a patient to The The interviewer seeks interviewer seeks to explore and to explore and understand the understand the patient’s reasons to patient’s reasons to change before setting change before setting

• ut a plan of action.
• ut a plan of action.

Help Help a patient to a patient to actively consider those actively consider those

• ptions before
• ptions before

supporting a supporting a journey journey toward informed, well toward informed, well-

• considered preferences

considered preferences and confident decision and confident decision

Key issues about Key issues about mHealth mHealth

mHealth mHealth solutions can solutions can empower citizens with empower citizens with information and motivation information and motivation to improve lifestyles and to improve lifestyles and reduce reduce chronic chronic diseases diseases reduce reduce chronic chronic diseases diseases Patients Patients can stay can stay healthier, healthier, resources resources can be better can be better utilised, utilised, lowering lowering the costs of the costs of care. care.

Source: PWC, socioeconomic impact of mHealth 2013

Socioeconomic impact Socioeconomic impact

Future perspectives Future perspectives

By 2017, 3,4 billion people worldwide will own a By 2017, 3,4 billion people worldwide will own a smartphone and 50% will use health apps smartphone and 50% will use health apps

Source: PWC. Health’Research Institute. Top health Industry issues of 2015

Mobile health app Mobile health app

mHealth mHealth app are becoming app are becoming a a regular regular part of care part of care

86% 86% of clinicians believe

that mobile apps will become important to physicians for patient care management

• ver the next 5 years

So… An opportunity An opportunity to MI and SDM?

Conclusions

• nclusions

MI and SDM are two patient centered approach that can be MI and SDM are two patient centered approach that can be useful for increasing treatment adherence useful for increasing treatment adherence mhealth mhealth apps can play a relevant role to improve the health apps can play a relevant role to improve the health in the population as mobile devices are worldwide in the population as mobile devices are worldwide available. available. An attractive format and a patient An attractive format and a patient centered centered approach approach An attractive format and a patient An attractive format and a patient centered centered approach approach seems to be appropriate when a health app is designed seems to be appropriate when a health app is designed Although with limitation, MI principles and some MI Although with limitation, MI principles and some MI strategies as well as SDM model can be adapted to an strategies as well as SDM model can be adapted to an mhealth mhealth format format. . More research is needed in order to find evidence More research is needed in order to find evidence-

• based

based feasibility and efficacy. feasibility and efficacy.