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Motivational Interviewing: A Proven Patient Engagement Technique

September 19, 2018
Motivational interviewing helps care teams guide patients through behavior change.
Patricia Ingerick

Chances are if you’re focused on patient engagement then you’re familiar with motivational interviewing (MI). With roots in addiction treatment, MI is a proven technique to help medical assistants, care managers, health coaches, nurses and physicians guide patients through behavior change.

As the member of the care team who often spends the most time with patients, there is increasing emphasis on the role of the medical assistant. The transition to value-based care and population health means the trend to elevate the contributions of medical assistants will continue.

Typically, medical assistants perform administrative and basic clinical duties. Their responsibilities range from greeting patients, scheduling appointments and completing insurance forms to taking medical histories and assisting physicians during exams. Medical assistants also serve as a patient liaison, often helping patients feel at ease in the physician’s office, explaining instructions and next steps, and more recently, working one-on-one with patients on behavior change.

The Geneia Institute Study of Medical Assistants

The Geneia Institute recently completed a study to explore the personal barriers to providing patient-centered care (PCC) from the perspective of medical assistants. Our goal was to identify the knowledge and skills needed to overcome those barriers.

We conducted semi-structured, in-depth interviews with six medical assistants at the Hamilton Health Center in Harrisburg, PA, a federally qualified health center and a designated patient-centered medical home. Hamilton Health providers care for a complex patient population, which makes providing optimized PCC challenging. They care for a diverse population of all ages, many of whom are structurally vulnerable. More than 6,000 of their patients are best served in a language other than English, 78 percent of patients are covered through Medicaid, and 12 percent of their patient population is uninsured. The median number of years of work experience of those interviewed was six years. The median number of years working for the study site was four years.

Exploring the personal barriers medical assistants experience that hinder providing patient-centered care reveals a need for better preparation to deliver whole person care. Current education and training fails to prepare medical assistants for the non-clinical aspects of the job.

Our Findings

Personal barriers to providing PCC fell into three main themes:

  1. Lack of training regarding strategies for effective patient interactions. This lack of training manifests in a number of ways ranging from difficulty obtaining needed patient information to repeated use of ineffective educational and engagement strategies. 
  2. Beliefs and attitudes about patient engagement. Medical assistants need knowledge and skills related to the social determinants of health to improve beliefs and attitudes about patient engagement. When medical assistants are unaware of social determinants it is nearly impossible to achieve the impactful care they strongly desire to provide. 
  3. Limited effectiveness of efforts to decrease barriers. To decrease the barriers to following a care plan, MAs need to understand how factors like employer benefits influence patients’ ability to follow medical advice.

Our Recommendations

The medical assistants interviewed strive to provide exceptional patient-centered care; however, they experience several personal barriers to providing this type of care primarily resulting from a lack of preparation to meet the non-clinical demands of their job. To overcome these barriers, we recommended additional relevant education in building patient relationships, implementing effective patient education and engagement strategies, and identifying and addressing social determinants of health to overcome. As the result of our study, medical assistants at Hamilton Health have embarked on precisely this kind of education, including training on motivational interviewing techniques.