Borrelli Belinda, Riekert Kristin A, Weinstein Andrew, Rathier Lucille
Centers for Behavioral and Preventive Medicine, Brown Medical School and The Miriam Hospital, Providence, RI, USA.
J Allergy Clin Immunol. 2007 Nov;120(5):1023-30. doi: 10.1016/j.jaci.2007.08.017. Epub 2007 Sep 29.
Patient-centered approaches are associated with better patient retention and treatment outcomes, without increased time and cost. Motivational interviewing (MI) is a patient-centered counseling approach that can be briefly integrated into patient encounters and is specifically designed to enhance motivation to change among patients not ready to change. Existing asthma management approaches (eg, education and self-management) increase resistance among patients not ready or willing to follow medical recommendations. MI helps patients resolve their ambivalence about behavior change and builds their intrinsic motivation before providing education. Although MI overlaps with patient-centered communication, it additionally includes some concrete motivational strategies that can be briefly and easily implemented in medical settings (eg, setting an agenda, assessing motivation and confidence for change, helping the patient weigh the costs and benefits of change, and providing medical advice and health feedback). Reflective listening is used to help patients clarify their ambivalence and diffuse resistance. MI has been shown to be efficacious across a wide variety of health behavior change areas. This article will describe the method and spirit of MI as applied to asthma management by reviewing the principles of MI, brief MI strategies to motivate medication adherence, the evidence base for MI, and the costs and benefits of building MI into clinical practice.
以患者为中心的方法与更好的患者留存率和治疗效果相关，且不会增加时间和成本。动机性访谈（MI）是一种以患者为中心的咨询方法，可以简要地融入与患者的接触中，专门设计用于增强尚未准备好改变的患者的改变动机。现有的哮喘管理方法（如教育和自我管理）会增加那些未准备好或不愿意遵循医疗建议的患者的抵触情绪。动机性访谈有助于患者解决其对行为改变的矛盾心理，并在提供教育之前建立其内在动机。虽然动机性访谈与以患者为中心的沟通有重叠之处，但它还包括一些具体的激励策略，这些策略可以在医疗环境中简要且轻松地实施（例如，设定议程、评估改变的动机和信心、帮助患者权衡改变的成本和收益，以及提供医疗建议和健康反馈）。反思性倾听用于帮助患者澄清其矛盾心理并化解抵触情绪。动机性访谈已被证明在广泛的健康行为改变领域中是有效的。本文将通过回顾动机性访谈的原则、激励药物依从性的简短动机性访谈策略、动机性访谈的证据基础以及将动机性访谈纳入临床实践的成本和收益，来描述动机性访谈应用于哮喘管理的方法和精神。
