Hundreds attend Urgo Medical supported debate on motivational interviewing in diabetes

Motivational interviewing was a hot topic at the most recent Diabetes Professional Care (DPC) conference.

In a debate, led by GP and broadcaster Dr Sarah Jarvis, and in front of a 600-strong audience, expert witnesses Professor Paul Chadwick, Professor Karen Ousey, Sue Marshall and Donna Welch explored whether motivational interviewing could achieve better diabetes outcomes than scare tactics.

Behaviour change and diabetes care is always a difficult subject, but the courtroom style debate, supported by Urgo Medical, the company behind UrgoStart, the NICE recommended treatment range for diabetes-related foot ulcers and venous leg ulcers, considered both sides of the argument.

The case was made that patient-centred care is associated with better outcomes, including medication adherence and self-management, and improved satisfaction.

Introducing the topic, Dr Jarvis said: “Individuals are the experts on their lives, and when it comes to changing behaviours for long term health effects, are the only ones who can do so. But to make the necessary changes, they have to be motivated and energised.”

Diabetes prevalence

Motivational interviewing is a proven counselling strategy designed to improve outcomes by engaging patients in the self-management of their condition, important where behaviour change is needed.

We know that the prevalence of diabetes is expected to increase worldwide,¹ and this means a subsequent increased time and financial burden.² Diabetes costs the NHS £10 billion each year but most of this is because of complications.³

However, 80 per cent of diabetes-related amputations are potentially avoidable, and individuals are at greater risk of complications if they neglect their feet.⁴

Donna Welch, Principal Podiatrist – Diabetes, City Health Care Partnership CIC, said this means that healthcare professionals (HCPs) need to adopt more effective and efficient approaches to managing care.

She said: “NICE recognises that the greatest influence on health improvement is in fact, the patient themselves. We want people to be more proactive in managing their own foot health needs, and various consultation models recognise the benefits of transferring some responsibility of care to the patient. Motivational interviewing is a great way to do that.”

Dr Jarvis told the room how following the simple ‘RULE’ formula helps HCPs explore any resistance and come up with engaging strategies that the patient can follow for their own care.⁵

The panel agreed people need to be more proactive in managing their own foot health needs. They reasoned that even when the patient with diabetes attends every appointment, the vast majority of their life is spent managing their own condition. Empowering them to take their condition into their own hands is crucial.

Dealing with diabetes is difficult. But there are strategies to help improve management of symptoms. This DPC event showed how motivational interviewing could help unlock the answers and improve outcomes for patients.

Dr Jarvis shared the principles of motivational interviewing that centre on the RULE formula:⁵

• Resisting the righting reflex
• Understanding the patient’s motivation
• Listening to the patient
• Empowering the patient

References:

1. Shaw JE, Sicree RA, Zimmet PZ (2010). Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Research and Clinical Practice. 2010;87(1):4-14
2. Kerr M, Rayman G, Jeffcoate WJ (2014). Cost of diabetic foot disease to the National Health Service in England. Diabetic Medicine. 2014;31(12):1498-1504
3. Diabetes UK (2017). The Cost of Diabetes Report [Internet]. Available at: https://www.diabetes.org.uk/resources-s3/2017-11/diabetes%20uk%20cost%20of%20diabetes%20report.pdf [Last accessed January 2020]
4. Diabetes UK, NHS Diabetes (2011). Putting feet first: national minimum skills framework [Internet]. Available at: https://diabetes-resources-production.s3-eu-west-1.amazonaws.com/diabetes-storage/migration/pdf/NMSF_16Feb2011.pdf [Last accessed January 2020]
5. Hall K, Gibbie T, Lubman DI (2012). Motivational interviewing techniques, facilitating behaviour change in the general practice setting. Psychological Strategies. 2012;41(9):660-667