PowerPoint PresentationChanging Patient Behavior is Easier Said Than Done Betty Rabinowitz, MD FACP CMO NextGen Healthcare Rochester, NY Presenterreportsnoconflictsofinterestattimeofpresentation. • Describetheprinciplesofself-determinationtheory • IdentifyhowtoapplySelf-DeterminationTheoryto healthcareencountersandcomplexpatient situations LearningObjectives 2020 Causes of Death Hypertension Smoking HighCholesterol Yusufetal.,INTERHEARTLancet2004;364:953-962 • OveralllifetimeriskforCVDwas60.3%formenand55.6% forwomen.Thisisthebiggestsingleriskweallfaceinour lives. • Tobaccouse,highcholesterolandbloodpressureaccountfor themajorityofthisrisk. The Impact of Healthy Lifestyle Factors on Life Expectancies Circulation 2018 Jul 24;138(4):345-355. YanpingLietal.,Circulation2018:137 Factor Impact BMI–18.5to25 Gain2-4years ModerateAlcoholIntake Gain2years HighQualityDiet Gain4years 150minutesPhysicalActivityperweek Gain4-6years AllCauseMortalityfor0riskvs.5riskfactors -0.26(CI0.22-0.31) CancerMortality -0.35(CI0.27-0.45) CardiovascularMortality -0.18(CI0.12-0.26) Adopting5atage50 Lifeexpectancy>14yearslongerforwomen LifeExpectancy>12yearslongerformen The Impact of Low-Risk Factors • Theprojectedlifeexpectancyatage50yearswason average14.0yearslongeramongfemaleAmericans with5low-riskfactorscomparedwiththosewith zerolow-riskfactors • Formen,thedifferencewas12.2yearslonger Adopting a healthy lifestyle could substantially reduce premature mortality and prolong life expectancy in US adults. -10-©2021MGMA.Allrightsreserved. Not Many Patients Adhere to Our Recommendations• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5338986/ changefor>1year smokingwithbest oftreatments 20-30%ofmedication prescriptionsare neverfilled Approximately50%of medicationsfor chronicdiseaseare nottakenas prescribed Athirdofkidney transplantpatientsdon’t taketheiranti-rejection medications cardiovasculardiseaseand itsmajorriskfactorshave pooradherenceto prescribedmedications Statin Persistence for 1 Year After Initiation Patients High Adherence (80% days covered) Number analyzed NoDM&NoMI 37% 2,200,000 • Fear • Cost • Misunderstanding • Toocomplicateddrugregimens • Lackofsymptoms • Mistrust Extrinsic Versus Intrinsic Motivation • Extrinsicmotivation:completingataskorexhibitinga behaviortoavoidpunishmentorreceiveareward • Intrinsicmotivation:doinganactivityforitsinherent satisfactionratherthanforaseparableconsequence Human Psychological Needs integrityandwellbeing Whensatisfied, evidenceofthriving Basicpsychological needs:essentialfor psychologicalgrowth, integrityandwellness Naturalratherthan acquired Psychological Needs: Supporting Optimal Motivation Deci&Ryan,1991,2000 • Theneedtofeelchoicefulandvolitionalin one’sbehavior • Theneedtofeeloptimallychallengedand capableofachievingoutcomes Autonomy • Theneedtofeelconnectedtoand understoodbyimportantothers Competence Relatedness Self-Determination Theory Versus Behavioral Theories • Behavioralapproachestypicallyinvolverewardsor penaltiesortrytolowerbarriers • Applyingselfdeterminationtheoryprinciplesincreases humanenergytoovercomebarriersbyworkingto supportandsatisfyourpsychologicalneeds. The Undermining Effect: Deactivation of Bilateral Striatum as a Function of Rewards in Subsequent Performance Intrinsic Motivation Can Be Facilitated The Clinician’s Role in Autonomy Support Elicitand acknowledge thepatient’s perspectives andfeelings 01 Explorethe patient’svalues andhowthey relatetothe behaviorbeing addressed 02 03 Provide alternate optionsfor changeand acknowledge theoptionof NOTchanging 04 05 The Clinician’s Role in Competence Support BePositivethe patientcan succeed 01 02 04 Developaplan thatis appropriatefor thepatient’s abilities 05 06 The Clinician’s Role in Relatedness Support 01 02 Remainnon- judgmentaland provide unconditional positiveregard 01 02 03 06 US Preventive Services Task Force 5A’s https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/tools-and-resources-for-better-preventive-care Arrangefollow-up