Georgina* is a 35 year old mother of three young children. She has had asthma since childhood and frequent admissions to hospital for this, throughout her life. One of the struggles Georgina has is in continuing to take her medication when she is feeling well and not experiencing symptoms of asthma.
I work as a practice nurse in a busy urban practice and see Georgina and her family regularly for routine health care needs. Recently Georgina was admitted to hospital via ambulance when she became unwell at home with a severe asthma attack. Georgina’s GP has asked me to follow up with her regarding her medication adherence.
In previous conversations with Georgina around taking her preventive medications, I have emphasised the importance of taking her medications even when she is feeling well and Georgina has agreed to do this. However the usual pattern is that Georgina will take her meds for the first few weeks after our discussion but then begin to miss doses and finally stop taking them altogether. Then she will become unwell and the cycle begins over again.
I am determined that in this consultation I will attempt to try and understand better what forces are in play for Georgina regarding her using her preventive asthma medications . My understanding from interventions such as Motivational Interviewing (Miller & Rollnick, 2013), is that I need to listen more to the person and do less talking, education and advising, than perhaps I normally do.
The following table, illustrates in an abridged form both the approach I may have previously adopted and the more facilitative and alliance based motivational interviewing approach that I have learnt (Borrelli, Riekert, Weinstein, & Rathier, 2007; Lavoie et al., 2014).[table id=1 /]
This session took around 30 minutes and I arranged to see Georgina again in a month. At this appointment Georgina reported she was feeling well and taking her medication more regularly with only two days when she missed it. The following is again an example of my possible pre and post motivational interviewing approach to this information.[table id=2 /]
* Georgina is a fictional character but the example is based on real life characters and experiences.
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Borrelli, B., Riekert, K. A., Weinstein, A., & Rathier, L. (2007). Brief motivational interviewing as a clinical strategy to promote asthma medication adherence. The Journal of Allergy and Clinical Immunology, 120(5), 1023-1030.
Lavoie, K. L., Moullec, G., Lemiere, C., Blais, L., Labrecque, M., Beauchesne, M. F., et al. (2014). Efficacy of brief motivational interviewing to improve adherence to inhaled corticosteroids among adult asthmatics: results from a randomized controlled pilot feasibility trial. Patient Preference And Adherence, 8, 1555-1569.
Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping people change (3rd ed.). New York: Guilford Press.