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23 T M C ยป P U L S E | J U LY 2 0 1 8 Motivational interviewing Building new behavior can take a few months to a few years, which can be problematic for patients with complicated or ever-changing medication regimens. Susan Abughosh, Ph.D., is hoping to improve medication compliance by changing patient behavior. The University of Houston (UH) pharmaceutical health outcomes and policy researcher recently received $459,000 from the National Institutes of Health to help patients with diabetes and high blood pressure follow their medication schedules. Poor medication adherence kills 125,000 Americans annually and costs the health care system nearly $300 billion a year in additional doctor visits, emergency department visits and hospitalizations, according to the American Heart Association (AHA). The AHA also identifies four reasons why people don't take their medication: they forget, they don't think it's working, they fear side effects and the cost is too high. Abughosh, an associate professor in the UH College of Pharmacy, plans on taking a personal- ized approach to the problem via customized con- versations between patients and UH pharmacy students. This process, known as motivational interviewing, includes asking open-ended questions, providing positive reinforcement and expressing empathy and understanding. "Instead of talking as an expert, we train stu- dents in motivational interviewing of patients to move them down to behavior change," Abughosh said. "Patients are the experts of themselves, and they have their own reasons why they are not [taking their medications]." Abughosh is working with Marcia Holstad, a project consultant with Emory University School of Nursing, to teach the students motivational interviewing techniques. The students will then interview patients by phone during their six-week rotation at Cigna Healthspring, a north Houston health care provider. For the first year of the three-year grant, the team will identify medication refill patterns among a group of about 15,000 patients who have been prescribed an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB), commonly used to regu- late high blood pressure and diabetes. Students will make monthly follow-up calls for six months, Abughosh said, and post-intervention data will be examined to see if there has been any improvement for high-risk patients. "We know that knowledge doesn't always translate into behavior change, but empathy and reflecting back on the problem actually helps," she said. "Motivational interviewing intervention is a powerful tool and could be used in other set- tings. And providing the pharmacy students with this kind of resource is a skill they can carry into their own lives." The University of Houston's Susan Abughosh, Ph.D., received a grant to help patients with diabetes and high blood pressure follow their medication schedules. Credit: Courtesy of UH