Lecture 9 - Patient Interviewing

patient interview

foundation for optimal mediation regimes that’s focused on subjective info gathered from patient involving complete conversation with patient

why are patient interviews important?

• aids in patient assessment

• identify medication therapy issues and health promotion opportunities

• support personalized treatment plans

• opportunity to educate patients

approaches to patient interviews depend on…

setting, patient characteristics, other sources

settings of patient interviews

hospitals, medical clinics, community pharmacies; usually will have background info available except in retail settings

patient characteristics (approaches in interviewing)

age, caregiver involvement, health literacy, knowledge of medications and medical history

other sources of patient info

• Medical Chart

• Pharmacy Profile

• Patient medication list

• Patient medication bottles

steps to conducting patient interviews

1. Preparation

2. Introduction

3. Interview

4. Conclusion

preparation phase of patient interview

• REVIEW chart/pharmacy patient profile if available

• DEVELOP communication strategy

• ENSURE private environment available

introduction phase of patient interview

• find out who patient is

• tell patient who you are

• inform patient of purpose of visit and how long it’s going to take

• ask patient if it’s ok to consult with them

interview phase of patient interview

gather:

 Chief Complaint (CC)

 History of Present Illness (HPI)

 Past Medical History (PMH)

 Past Surgical History (PSH)

 Family History (FH)

 Social History (SH)

 Allergies (ALL)

 Medications

 Immunizations

 Health Care Sources (providers, pharmacies)

chief complaint (CC)

Brief statement of why they are seeking medical care, in patients own terms

History of Present Illness (HPI)

Recent history that pertains to the symptoms/complaints/comments noted in the chief complaint, such as duration/timing/what makes it worse

Past Medical History (PMH)

problems identified prior to current visit (usually chronic); inquire about duration/date of onset (may need to estimate)

Past Surgical History (PSH)

be specific on procedure and date

Family History (FH)

Purpose of collection to assess current/future health risk and may assist in choosing therapy; Focus on 1st degree relatives (parents, siblings, children) and ask about status of life, age, and identification of hereditary diseases

Social History (SH)

include alcohol/tobacco/illicit drug use, diet and exercise regimes, occupation, personal limitations (visual impairment, literacy issues, etc)

alcohol

ask type, quantity per day, frequency, duration of alcohol consumption, previous history if pertinent

tobacco (tob)

type, quantity, frequency, duration, attempts to quit, interest in quitting, previous history of use; ask vaping separately

illicit drugs

type (drug and street name), quantity per day/sitting, frequency and duration, route of administration, attempts to quit, interest in quitting; ask marijuana separately

diet

restrictions or excess (like salt, fat, cholesterol, etc.), timing of meals if restrictive or pertinent to drug therapy

exercise

type, duration per session, frequency of sessions

allergies (ALL)

assess drug, food, and seasonal with reaction if consumed; distinguish from intolerance

intolerance vs allergy

food allergy involves the immune system and can be severe, even life-threatening, while food intolerance is a digestive issue not involving the immune system and is generally less severe

medication review (MEDS)

drug name, dosage form, dose, route, frequency (ask patient and compare to records), indication, prescriber, adherence, length of use, any discontinuation

sources of medication information

• patient interview

• patient medication list

• family members and caregivers

• medication bottles

• pharmacy

• provider’s office

• medical records

medication questions

• ask “what medication do you take?”

• then ask “are you taking any medication not in a tablet or capsule, like inhaler or injection?”

• “what about supplements? any herbals"?”

immunizations in patient review

focus on appropriate for age and/or risk factors (like shingles or flu), be familiar with multiple names of vaccine

health care sources

for other physicians/specialists and pharmacies; get name, contact info