Non-communicable disease 3
Track 26
| Saturday, October 28, 2023 |
| 10:35 AM - 12:30 PM |
| Meeting Room E3.8 |
Speaker
Dr Sairat Noknoy
Vice President
Royal College of Family Physicians of Thailand
Motivational Interviewing: assisting behavioral change for people with Non-Communicable Diseases
10:35 AM - 11:30 AMSummary
Motivational interviewing(MI) is a client-centred, empathic and directive counselling style that helps elicit behavioural change by helping the patient to explore and resolve ambivalence. MI possesses essential skills and techniques beneficial for family practitioners in providing care for patients with non-communicable diseases. Systematic reviews and meta-analyses showed significant effects of MI for the control of body mass index, total cholesterol, systolic blood pressure, and alcohol concentration, and increased participation in physical activities.
The Spirit of MI is based on Carl Rogers's client-centred counselling principle, in which a practitioner works collaboratively with a patient, with compassion and respect for the patient's autonomy. MI is also linked to self-determination theory and the transtheoretical model of behavioural change. In the process of MI, a practitioner, therefore, applies four core skills: open-ended questions, affirmation, reflection, and summarization(abbreviated as OARS), to evoke the patient’s ambivalence and enhance his/her motivation.
During the conversation, a practitioner applied OARS skills to help the patient recognize his/her motivation, the discrepancy between his/her present thoughts and the goal where he/she would like to be. Meanwhile, recognizing that resistance to change is normal, a practitioner avoids argumentation by using reflective listening to roll with resistance, to express empathy in the patient’s experience, to support the patient’s self-efficacy and to guide the conversation to enhance the motivation for behavioural change. MI helps the practitioner understand the patient’s thoughts where he or she is in the process of change and the level of the patient’s motivation from the patient’s talk.
In this workshop, attendees will learn about the skills and techniques that are the foundation of MI through a demonstration of case scenarios that are commonly found in clinical practice. This interactive workshop will provide a chance for attendees to discuss and practice through small group activities and role-plays.
The Spirit of MI is based on Carl Rogers's client-centred counselling principle, in which a practitioner works collaboratively with a patient, with compassion and respect for the patient's autonomy. MI is also linked to self-determination theory and the transtheoretical model of behavioural change. In the process of MI, a practitioner, therefore, applies four core skills: open-ended questions, affirmation, reflection, and summarization(abbreviated as OARS), to evoke the patient’s ambivalence and enhance his/her motivation.
During the conversation, a practitioner applied OARS skills to help the patient recognize his/her motivation, the discrepancy between his/her present thoughts and the goal where he/she would like to be. Meanwhile, recognizing that resistance to change is normal, a practitioner avoids argumentation by using reflective listening to roll with resistance, to express empathy in the patient’s experience, to support the patient’s self-efficacy and to guide the conversation to enhance the motivation for behavioural change. MI helps the practitioner understand the patient’s thoughts where he or she is in the process of change and the level of the patient’s motivation from the patient’s talk.
In this workshop, attendees will learn about the skills and techniques that are the foundation of MI through a demonstration of case scenarios that are commonly found in clinical practice. This interactive workshop will provide a chance for attendees to discuss and practice through small group activities and role-plays.
Takeaways
At the conclusion of my presentation attendees will be able to
1. determine patient's level of motivation for behavioural change
2. identify patient's change talk to be able to use it for reflection
3. apply four basic skills, OARS, to help enhance patient's motivation for change
1. determine patient's level of motivation for behavioural change
2. identify patient's change talk to be able to use it for reflection
3. apply four basic skills, OARS, to help enhance patient's motivation for change
Biography
As current vice president of the Royal College of Family Physicians of Thailand, I fully advocate that family medicine practice is the cornerstone for the improvement of the health system and primary health care needs to be driven through the engagement of all sectors.
I have been practicing for more than 20 years as a family physician, working in various settings from a community hospital, a teaching medical Center and a primary care unit in a multicultural environment. Apart from clinical practice, I also do research and published articles related to the field of family medicine and healthcare development. As primary health care development is a combination between primary care practice and public health work, I have experience as a Public Health Professional, in which my current job involves integrating HIV, STIs, Hepatitis and TB programs to enable patient-oriented services at the primary care level.
Dr Anneliese Willems
Lecturer, Medical Educator And Gp
University of Melbourne
Recurrent boils and abscesses: Could it be HS?
11:35 AM - 12:30 PMSummary
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that is characterised by recurrent and painful nodules, abscesses, and sinus tracts that affects approximately 1% of the population. These lesions particularly form in the intertriginous regions, such as the axillary, inguinal and gluteal skin folds, but can develop anywhere on the body.
The exact pathogenesis of HS is still not completely understood, but several factors have been implicated in its development, including genetics, bacterial colonisation, hormonal changes and abnormal immune response. HS nodules form by an abnormal keratinisation process in the hair follicle, resulting in the formation of occluded hair follicles. The resulting inflammatory response results in rupture of the hair follicle which spreads inflammatory cytokines into the local tissues which, in turn, worsens the local inflammation. These can ultimately create exquisitely tender abscesses and discharging sinus tracts, with significant scarring.
HS has been described as one of the most painful skin conditions, yet unfortunately, historically there have been often significant delays to diagnosis. Treatment of hidradenitis suppurativa is multifactorial, combining lifestyle modifications (particularly smoking cessation, avoidance of friction in intertriginous regions, weight optimisation and management of comorbidities), topical medications (such as compounded resorcinol and antibiotics), intralesional corticosteroid injections, systemic medications, and surgical interventions (including reroofing surgery).
The general practitioner plays an important role in the diagnosis and multidisciplinary management of HS. This workshop will provide an overview of the diagnosis, staging and primary care management of this complex condition, including approaches to topical therapies, delivery of intralesional steroids and an overview of systemic and surgical therapies.
The exact pathogenesis of HS is still not completely understood, but several factors have been implicated in its development, including genetics, bacterial colonisation, hormonal changes and abnormal immune response. HS nodules form by an abnormal keratinisation process in the hair follicle, resulting in the formation of occluded hair follicles. The resulting inflammatory response results in rupture of the hair follicle which spreads inflammatory cytokines into the local tissues which, in turn, worsens the local inflammation. These can ultimately create exquisitely tender abscesses and discharging sinus tracts, with significant scarring.
HS has been described as one of the most painful skin conditions, yet unfortunately, historically there have been often significant delays to diagnosis. Treatment of hidradenitis suppurativa is multifactorial, combining lifestyle modifications (particularly smoking cessation, avoidance of friction in intertriginous regions, weight optimisation and management of comorbidities), topical medications (such as compounded resorcinol and antibiotics), intralesional corticosteroid injections, systemic medications, and surgical interventions (including reroofing surgery).
The general practitioner plays an important role in the diagnosis and multidisciplinary management of HS. This workshop will provide an overview of the diagnosis, staging and primary care management of this complex condition, including approaches to topical therapies, delivery of intralesional steroids and an overview of systemic and surgical therapies.
Takeaways
• Outline the clinical presentation, staging and diagnosis of hidradenitis suppurativa (HS)
• Describe the role of the GP within the multidisciplinary management of HS, including patient education, conservative management options, topical therapies, intralesional corticosteroid injections and judicious use of systemic antibiotics.
• Outline referral processes and multidisciplinary management options for severe disease, including systemic and surgical therapies (including de-roofing surgeries).
• Describe the role of the GP within the multidisciplinary management of HS, including patient education, conservative management options, topical therapies, intralesional corticosteroid injections and judicious use of systemic antibiotics.
• Outline referral processes and multidisciplinary management options for severe disease, including systemic and surgical therapies (including de-roofing surgeries).
Biography
Dr Anneliese Willems is a lecturer at the University of Melbourne and a Melbourne-based general practitioner with a special interest in dermatology. Having worked in undergraduate and postgraduate medical education for approaching 10 years, she is particularly passionate about enhancing education in skin disease and promoting interprofessional collaboration between treating practitioners. She has written or co-written over 20 peer-reviewed publications and is a co-host on the dermatology education podcast, Spot Diagnosis.
