Patient Interview In Pharmaceutical Care (PC)

Patient interview is crucial for proper diagnosis and pharmaceutical care (PC). Pharmacists must gather patient-specific medical and drug histories competently, evaluate the data collected, identify and prioritize a patient's drug therapy problem(s), develop and implement a care plan, and monitor the outcomes achieved to practice patient-centered pharmacy.

Integral to patient-centered pharmacy practice is the process of collecting a patient's history to find and resolve the 7 types of drug therapy problems: no indication for drug therapy; dosage too high; dosage too low; wrong drug (also referred to as ineffective drug); adverse drug reaction; inappropriate compliance; and needs additional drug therapy.

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Medication therapy management services should include a systematic process of collecting patient-specific information, assessing drug therapy to identify medication-related problems, prioritizing such problems, and creating a care plan to resolve them. Pharmacy care plans that are patient-specific; address health literacy, cultural diversity, and behavioral psychosocial issues; and are evidence-based.

Types Of Patient Data

Patients coming to the pharmacy are mostly conscious. Patient interview is rather straightforward here. In other cases, it can be children that are not old enough to talk or cannot express themselves. However, since pharmaceutical care is extended to emergencies and inpatients, pharmacists can encounter unconscious patients. In such a situation, the patient's interview is turned towards the caregiver or bystander.

Type Of Patient Interview Data

There are two types of patient data that is necessary for pharmaceutical care. They are subjective and objective.

Subjective Interview Data

Subjective data is information from the client's point of view (“symptoms”), including feelings, perceptions, and concerns obtained through interviews. A good subjective interview will streamline diagnosis and reduce the need for extensive physical and laboratory examination. The hallmark of an effective patient subjective interview is effective and good communication. Knowing what to ask and how to ask it is crucial.

Patient interview: subjective interview

Objective Interview Data

Objective data are observable and measurable data (“signs”) obtained through observation, physical examination, and laboratory and diagnostic testing. The choice of objective procedure is determined partly by results of subjective interview. Good subjective data gives clearer diagnosis and leads the path for pharmaceutical care.

Patient Interview

Preparation

A good patient interview must begin with preparation. Get patient details including case notes, laboratory report, treatment chart, etc. Study the details and get first hand information before meeting the patient. This is not actually applicable in all cases, especially in community pharmacy where you meet new clients often. 

Patient Privacy And Confidentiality

Patients are free to explain themselves when they are sure their health details will be safe with the pharmacist. The interview environment should encourage patients to talk. Patient interview in a crowded place may hinder the patient from explaining everything.

Communication/Interview

Communication is the effective passing of information and the other understanding it the way it is supposed to be. And in communication, there are verbal (linguistic) and nonverbal (nonlinguistic) forms of communication.

Verbal (Linguistic)

1. Establish rapport: to start a patient interview, greet and introduce yourself. State your name, designation and purpose of the interview. Also, let the patient know how long the whole process will take. Splitting the interview into sessions for convenience instead of a long rowdy session may be inconvenient for the patient. Do this professionally with respect.

2. Questions: the better part of the interview will be questions from the pharmacist to the patient to answer. The right use of questions will yield positive results. The beginning of a patient interview should be the use of open ended questions. A question at a time. Allow the patient to think and complete a reply before asking another. Then narrow down the interview by introducing close ended, leading and probing questions not in any other.

3. Medical Jargons: patients are from various fields. So the use of medical jargon will lead to wrong information that may lead to wrong data. Use the simplest form of the language.

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4. Culture Matter: this is very important in a country like Nigeria with diverse cultures and religion. A question or statement that may seem normal in one culture may be a taboo in another. Make small research and use simple communication language.

Patient Interview Screening Questions

1. Location: “Where is the symptom/problem?”

2. Quality: “What is it like?”

3. Quantity: “How severe is it?”

4. Timing: “How long or how often has it been present?”

5. Setting: “How did it happen?”

6. Modifying Factors: “What makes it better or worse?”

7. Associated symptoms: “What other symptoms do you have”

8. What did your physician tell you this medication was for?

9. How did your physician tell you to use this medication?

10. What did your physician tell you to expect from this medication?

Nonverbal (Nonlinguistic)

They say 'action speaks louder than words.' This is so true when it comes to patient interviews. When there is a contradiction between verbal form of communication and nonverbal, nonverbal stands. This is because humans cannot hide their nonverbal communication but can skew verbal communication.

There is this acronym for remembering the best nonverbal cues in a patient's interview. It is SOLER (Sit squarely, have an Open posture, Lean forward, make Eye contact and Relax). Let us explain further.

1. Eye Contact: good communication between pharmacist and patient should involve about 60-70 % eye contact. And it is more effective when the pharmacist is at the same eye level with the patient. So, if the patient is sitting and the pharmacist is standing, eye contact will be lost in most cases. Also, nothing like a veil should block both pharmacist and patient.

2. Sitting Posture: crossing of arms and tapping the foot in a haste to leave are bad signs that send signals to the patient the pharmacist is not ready to listen or solve the problem. Use hand gestures effectively.

3. Confident And Bold: patient wants the best when it comes to health. They want to be in safe hands. They can tell this with the confidence the pharmacist carries out the interview. When they are confident of that, they tend to comply.

4. Dress And Grooming: they say you address the way you dress. This is not far from the truth. Professional dressing separates the pharmacist from other persons and sends a lot of messages to the patient who will likely comply during the interview.

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5. Listening Skill: one of the most important parts of a patient interview. A pharmacist must be patient and listen to patient answers empathetically. Patients can sense this skill miles away. Patients are more eager to cooperate when they feel the pharmacist is not just there because of his job but because they have feelings for their well-being.

6. Relax

Documentation Using Data Collection Forms

There are two types of pharmaceutical care intervention documentation forms. The first form called from 1 comes with four pages labelled A-D. Page A is for patient demographics, medical records, medication record, social and compliance history which are part of subjective interview. Page B is for objective data from laboratory examination and physical assessment relevant to pharmacotherapy. Page C provides space for the drug therapy problem. Page D is blank for taking notes. Form 2 is one page called page E for documentation of pharmaceutical care for outpatient pharmacy.

The pharmacist should fill part of these forms during the interview and complete details immediately after the interview. A well-designed form will include space for a pharmacist to collect information related to:

1· Basic patient demographics,

2· Prescription and nonprescription drug use,

3· Social and family history,

4· Medical history,

5· Complaints or symptoms that indicate how well drug therapy is working,

6· Possible adverse effects or potential untreated conditions that will require the pharmacists' intervention or referral to a physician.

Skills Needed

1. Open ended questions

2. Empathy

3. Facilitation

4. Confrontation

5. Reflection

6. Interpretation

7. Clarification

8. Feeling