Integrating MI into 30-Minute Medication Visits
Medication compliance improves when patients voice their own motivations
5 focused minutes of MI > 20 minutes of lecturing
Respects patient self-determination
Better engagement, retention, and clinical results
The SPIRIT matters more than perfect technique in time-constrained settings
| Time | Process | Focus | Key Question |
|---|---|---|---|
| 0-5 min | Engaging | Build rapport | "What brings you in?" |
| 5-10 min | Focusing | Target behavior | "What would you like to work on?" |
| 10-20 min | Evoking | Find motivation | "What makes you want to change?" |
| 20-30 min | Planning | Commit to action | "What steps will you take?" |
| Skill | Example |
|---|---|
| Open Questions | "What concerns you about this medication?" |
| Affirmations | "It took courage to come in today." |
| Reflections | "You're frustrated because side effects affect work." |
| Summaries | "Let me see if I have this right..." |
| Type | Keywords | Example |
|---|---|---|
| Desire | want, wish | "I want to feel better" |
| Ability | can, could | "I could take it with breakfast" |
| Reason | would help | "It would help me keep my job" |
| Need | have to | "I need to do something" |
| Commitment | will, promise | "I will start today" |
| Activation | ready, willing | "I'm ready to try" |
| Taking Steps | already doing | "I called the pharmacy" |
CAT = Ready for Planning!
Sustain Talk — Arguments against change
Discord — Relationship tension
Partnership, acceptance, compassion, evocation
Open questions, affirmations, reflections, summaries
Commitment, activation, taking steps = ready to plan
Don't confront; reflect and explore