The Burden of Chronic Disease, Adherence to Treatment and Motivational Interviewing

The burden of chronic disease in Australia currently stands at 80%. More than 50% of GP consultations now address some form of chronic illness or disease. Lifestyle choices mean 54% of the adult population is overweight. In terms of future expectations, 10% of children aged 0-14 years will experience 3 or more long term chronic health conditions. In the year 2007-8, 32% of 731,000 hypothetically avoidable hospital admissions were a result of complications of chronic disease.

The literature indicates the rate of adherence to treatments for acute illness is between 20 and 40%. This suggests that only 20-40% of the population complete a prescribed course of antibiotics. Adherence to treatment for chronic illness is between 30 to 60%. In relation to the prevention of illness i.e. proposed dietary intake, daily exercise requirement, alcohol intake etc., adherence lies around 80%, indicating that 20% of the population at any one time choose to ignore these guidelines.

Health System Deficits and the Benefits of Motivational Interviewing

The World Health Organization has noted the inability of health care systems to address the burden of chronic disease. System deficits include a lack of clinician education and preparation, a lack of clinical and behavioural tools to support clinician’s work, poor communication between clinicians and clients, and gaps in the provision of care. The communication model that many clinicians have been taught does not always support having difficult conversations with clients about poor lifestyle choices or their apparent inability to follow treatment advice. Motivational Interviewing has been shown to enhance the clinician’s effectiveness in initiating and supporting change by using non-threatening and non-confrontational dialogue with clients. Motivational Interviewing treats the client as the expert in the management of their health, rather than the more traditional approach of the clinician being the expert and telling the client what they should and should not do.

Research and Motivational Interviewing

Motivational Interviewing was initially used in the management of addiction. It has now been adapted and is used across the health care continuum in the management and prevention of chronic disease. Randomized controlled trails have found that Motivational Interviewing has a greater impact on lifestyle choices e.g. smoking cessation, diet and exercise, hazardous drinking and chronic disease management than ‘standard’ approaches such as client education and risk reduction interventions – the traditional methods employed by many clinicians.

Contact us to find out more about Motivational Interviewing and how we can assist your organisation to support and empower your staff.

References

Jordan, J. E., & Osborne, R. H. (2007). Chronic Disease Self Management Programs: challenges ahead. MJA. 186(2), 84-86.
Levensky, E. R., Forcehimes, A. A., O’Donohue, W. T., & Beitz, K. (2007). Motivational interviewing: An evidence-based approach to counselling helps patients follow treatment. AJN, 107, (10),50-8.
Linden, A., Butterworth, S. W., & Prochaska, J. O. (2010). Motivational interviewing-based health coaching as a chronic care intervention. Journal of Evaluation in Clinical Practice, 16, 166-174.

Lundahl, B., & Burke, B. L. (2009). The effectiveness and applicability of motivational interviewing: A practice-friendly review of four meta-analyses. Journal of Clinical Psychology in Session, 65(11), 1232-1245. doi: 10.1002/jclp.20638

Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. L. (2010). A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Research on Social Work Practice, 20, 137-160. doi: 10.1177/1049731509347850

Österlund, E., Fossum, B., Ehrenberg, A., Larsson, K., & Klang, B. (2011). Use of motivational interviewing in smoking cessation at nurse-led chronic obstructive pulmonary disease clinics. Journal of Advanced Nursing, 68(4), 767-782. doi: 10.1111/j.1365-2648.2011.05766.x
Queensland Government (2010). Chronic Disease Guidelines [3rd ed.]. Brisbane, Queensland.
Young, M. (2010). Behaviour change and motivational interviewing in the patient with diabetes. Journal of Endocrinology, Metabolism and Diabetes of South Africa, 15(1), 45-47.

World Health Organization. (2003). Adherence to long-term therapies: evidence for action. WHO, Geneva.