A New Model for OT Consideration
In my house I'm the boss. My wife is just the decision maker - Woody Allen
In her article in OT Practice (7/28/08, pgs 15-18), "Working With the 'Difficult' Client", Costa states (pg 16),
"Clients who arouse negative feelings are often those who do not respond to treatment, fail to comply with treatment recommendations, or challenge clinicians' authority. "
I'm surprised to see the concepts of "compliance" and "clinicians' authority" still being presented to health and human service professionals. "Adherence" has become the preferred term, despite Steiner & Earnest's1 suggestion in 2000 that "[t]he terms compliance and adherence should be abandoned because they subtly exaggerate the importance of the clinician, describe behavior inaccurately, and shed little light on motivations." This quote opens a two-part article2 about the "medication interest model" (MIM)3 of interviewing people to determine the best treatment approaches for each one.
Although OT was not mentioned as one of the disciplines contributing to the development of the MIM*, the model is infused with occupational themes. For example, "[M]any patients search, not only for relief from their symptoms...but also seek to regain the chance to play [sports], return to work, recover their sense of self-esteem, and believe in their dreams again." 4 The "interviewing tip" for determining a "personalized motivator" and guiding the client "to arrive at the conclusion that the [treatment] is a good idea" is called "The Inquiry into Lost Dreams." If that title doesn't scream potential for OT, I don't know what does!
As the model's title indicates, the MIM is focused on medication use, and relies on the concepts of the Choice Triad:
- The patient believes something is wrong
- The patient is motivated to use a medication to do something about it
- The patient is convinced that the "pros" of the medication outweigh the "cons"
Shea explains that within the Choice Triad, "Patients weigh the pros and cons by looking at three belief sets, generated from three corresponding questions. These belief sets and their corresponding questions are as follows:
- Efficacy (Does this drug make me feel better?)
- Cost (Is it worth it to me to take this drug?)
- Meaning (What does it say about me that I have to take this drug?) 5
Does your OT "Spidey Sense" tingle at this like mine does? Meaning tied to self-concept as an underpinning of motivation and decision-making....enough said.
The MIM discusses techniques to find out about people's occupational preferences and desires. You know we OTs are uniquely qualified to enhance outcomes with that information. I think OTs should become familiar with the MIM; explore its applicability beyond just medications use; and use the MIM as a frame of reference when discussing intervention plans with multi-disciplinary teams.
My introduction to the MIM has helped me reflect anew on the successes, as well as the challenges, I have had with my clients, and will help me keep my eyes, ears and mind even more open from now on.
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References:
1 Steiner, J. F., & Earnest, M. A. (2000). Lingua medica: The language of medication-taking. Annals of Internal Medicine, 132(11), 928.
2 Shea, S.C. (2008) The "Medication Interest Model" An Integrative Clinical Interviewing Approach for Improving Medication Adherence-Part 1: Clinical Applications. Professional Case Management Vol. 13, No. 6, 305 Lippincott Williams & Wilkins
* "...the MIM grew directly from the fields of case management, psychiatry, primary care medicine and nursing...." - Shea, 2008 p. 305
3 Shea, S. C. (2006). Improving medication adherence: How to talk with patients about their medications. Philadelphia: Lippincott Williams & Wilkins.
4 Shea (2008), p. 310
5 Shea, S.C. (2009) The "Medication Interest Model" An Integrative Clinical Interviewing Approach for Improving Medication Adherence-Part 2: Implications for Teaching and Research. Professional Case Management Vol. 14, No. 1, 6 Lippincott Williams & Wilkins