Motivational Interviewing: Assessing Readiness for Change in a Primary Care Setting

Tobacco use is the single most preventable cause of disease, disability, and death in the United States. In this role it places a profound burden on both the medical care system (estimated costs are over 193 billion annually) and U.S. economy. It is because of this that Tobacco was one of the twelve chosen Leading Health Indicators under the Healthy People 2020 Objectives.

Healthcare providers who have patients that actively smoke can be in a difficult position.  Often times, it can feel as if there are time constraints that will not allow for an adequate conversation regarding the impact of smoking and the steps toward cessation. In addition, it is vital that the conversation not appear to the patient as confrontational or patronizing. Likely, the patient is aware that their smoking is detrimental to their health: They are not looking for a reminder, but a solution.

To help work with a patient toward smoking cessation will take time, patience and positive, supportive communication. However, providers now have an opportunity to bill for the time spent with a patient counseling him/her on tobacco cessation utilizing the CMS Prevention Codes, and by utilizing Motivational Interviewing, providers can effectively converse and interact with patients to assist them to make positive changes.

Motivational Interviewing (MI) is a person-centered communication method of fostering change by helping a person explore and resolve ambivalence. Rather than using external pressure, MI looks for ways to access internal motivation for change. MI consists of four main principles: expressing empathy and avoiding arguing, developing discrepancy, rolling with resistance, and supporting self-efficacy (client’s belief that they can make the change).

By utilizing open-ended questions the provider can initially assess the patients beliefs about their smoking. Examples of open-ended questions include: “What do you think it would be like to quit smoking?”, and “What do you think would be helpful to you in quitting smoking?”. The provider can then effectively work with the patient toward achieving their goal by each of them understanding what role they play in making the change, and how the provider can support the patient’s efforts. Follow-up assessments and counseling of tobacco cessation can also be billed under CMS Codes which allow the provider to stay active in the intervention plan that the patient and provider developed.

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