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What does “Harm Reduction” mean in medical practice?. Miriam Komaromy, MD Medical Director, Albuquerque Health Care for the Homeless. Miriam Komaromy, MD Internal Medicine and Addiction miriamkomaromy@gmail.com 505-715-0394. Essential underlying philosophy for medical practice.
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What does “Harm Reduction” mean in medical practice? Miriam Komaromy, MD Medical Director, Albuquerque Health Care for the Homeless
Miriam Komaromy, MD • Internal Medicine and Addiction • miriamkomaromy@gmail.com • 505-715-0394
Essential underlying philosophy for medical practice • Only the patient can choose change • Respectful communication is key • My goal ≠ patient’s goal • Can we “mandate” change? • Goal: help patient move toward more healthy behaviors • This is harm reduction!
Examples: Patient chooses to… • Decrease the amount of alcohol she drinks on a binge so she can make better decisions about not driving • Decrease his daily cigarette smoking from 2 packs to 1 • Start to address her diabetes by walking to her daughter’s house rather than driving 2 days out of the week
Essential for addiction treatment • A disease characterized by relapse • Would you refuse to treat an asthmatic patient whose peak flow is low? • Treatment goal: decrease frequency and severity of relapse, acquire sobriety skills • MAT • “classic” HR techniques are also important (syringe exchange, naloxone) • “chronic disease management” model
Disease Management Model When is disease-management approach indicated? Moderate-to-heavy dependence “pre-contemplative” Unwilling to aim for abstinence Medical co-morbidities drive need for change
How to implement disease management Identify patient’s concerns and goals Set mutually agreed-upon goals, e.g.: Decrease drinking days/month Decrease drinks/drinking day Increase social contacts/week Improve housing, finances, social svcs Engage family/social support members (e.g., Al-Anon, decrease co-dependent behaviors)
Study of Disease Management in Alcoholism Clinical Indicators after 2 Years in Disease Management & Control Groups Willenbring ML, Arch Int Med 1999
HR essential for negotiating all behavior change • Even if the “best” treatment from a medical standpoint is a drug that must be taken 2-3 times per day, if a patient can’t/won’t take it that often, best to change to a once-a-day drug • A homeless client may not take a diuretic because of limited access to bathrooms; explore this from the beginning and you will see less “non-compliance”
Motivational Interviewing techniques = tools for harm reduction • How are you feeling about your smoking? How is that working for you? • Ask permission to discuss • Change readiness scale • Confidence scale • Help your patient move toward “10” • Choose a mutually-agreed upon goal