Interviewing and Assessment of Patients
Introduction
• Interview - process of obtaining information
from patients to assess potential medication
related problems
• Interviewing is a complex process
• The interviewing process determines the accuracy,
depth and breadth of info obtained
• In the interviewing process the info that the
patient already knows must first be determined
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Components of an Effective Interview
• Listening
• Stop talking and get rid of distraction
• Use good eye contact
• React to ideas, not to the person
• Read nonverbal messages and listen to how something is said
• Provide feedback to clarify any messages
• Probing
• The use of questions to elicit needed information from patients or to help
clarify their problems or concerns
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Probing cont…
In Probing patients:
• Avoid “why” type questions (instead use “what” and “how”)
• Avoid leading questions
• Give the patient time to finish answering the question
• Use a combination of open and closed ended questions
• Open ended questions:
• Elicit more complete and unabridged info
• Do not squeeze the patient to your perspective
• Convey willingness to listen
• Almost always better than closed ended questions in yielding
more info
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Probing cont…
• Closed ended questions
• Reduce openness
• Can encourage passivity
• Can lead to patient avoidance of emotional expressions
• Help you to collect specific clinical data efficiently
• Asking Sensitive Questions
• Questions assessing: adherence, alcohol use, use of
recreational drugs, medication effects related to sexual
functioning, STI
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Asking Sensitive Questions cont…
Techniques of asking sensitive questions
• Use “universal statements”
• “this is a very common concern…”; “frequently my patients have
difficulty…”; “everybody has trouble with…”
• Ask whether the situation has ever, at any time, occurred and then ask
about the current situation
• The way you phrase the question and your tone of voice must be
consistent
• Embed more threatening topics among less threatening ones
• Ask more personal questions later in the interview
• Tell patients why you ask and do not ask irrelevant questions
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Components of an Effective Interview cont…
• Use of Silence
• Avoid the temptation to fill empty spaces in the interview
with unnecessary talk
• Establishing Rapport
• Using good eye contact
• Using a sincere, friendly greeting
• By being courteous during the discussion
• By not stereotyping or prejudging the patient
• Patient’s perception of you will influence their relationship
with you
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Important considerations to make during the interviewing process
• Type of Information
• Determine the amount and type of information desired before the
interview begins
• Type of environment
• Privacy: associated with level of pt understanding and adherence
• Starting the interview
• Greet patients by name and introduce yourself
• State the purpose of the interview in terms of the benefit to the pt
• The amount of time needed, subjects to be covered, outcome
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Considerations in the interviewing process cont…
During the Interview:
• Avoid making recommendation during the information
gathering phase
• Do not jump to conclusions
• Do not shift from one subject to another until each has been
followed through
• Guide the interview using both open and closed ended
questions
• Keep your goals clearly in mind
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During the interview cont…
• Determine the patient’s ability to learn specific
information (reading ability, vision or hearing
impairments, language)
• Use good probing, listening and feedback
• Be aware of the patient’s nonverbal messages
• Move from general to specific (less personal to
personal)
• Note taking should be as brief as possible
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Considerations in the interviewing process cont…
• Ending the Interview
• People seem to remember what is said last
• Ask the patient to summarize the information you told them
• Summarize key info provided by the patient
• Summary may tactfully hint to the pt that the session is ending
• Use nonverbal messages to show that the interview is ending
• Simple closed ended questions may help
• Reassure the patient about a particular problem
• Document key information
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Documenting Interview Information
Use the SOAP note
• Subjective: info reported by the patient or care giver
• Objective: information provided by lab test or physical
exam
• Assessment: description of any medication related problem
• Document findings that indicate appropriate use, adequate response,
and no problem with the regimen
• Plan: detail the actions to be taken to resolve the problem
• Include both intervention plan and monitoring plan
• Specify action to be taken by you, date, time to follow up
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Summary
• What are the critical components of an effective interview?
• What are the differences between open ended and closed ended questions
and when should each be used?
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Patient Counseling
Introduction
• Effective counseling is not simply providing
information
• Patient understanding of the information provided
depends on:
• Timing and organization of the message
• Involvement of the patient
• Counseling session is a meeting of experts
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Patient Counseling Checklist
1. Pharmacist introduces self
• Greet the patient, extend a hand
• State your name: Hello I am ________, your pharmacist
2. Identify patient or patient’s agent
• You may need to call patients if the information truly
needs to be communicated directly to the patient
• Written information becomes more important in third
party communication
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Patient Counseling Checklist cont…
3. Ask if patient has time to discuss medicine
• If the patient does not have time:
• Written information needs to be used
• Patient needs to be contacted at more convenient time or Both
4. Explain purpose and importance of counseling session
• What is in it for the patient
5. Ask patient what physician told him about the
medication and what it is treating
• Ask what patient knows and understands about the disease
• Use available patient profile information
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Patient Counseling Checklist cont…
6. Ask patient if s/he has any concerns prior to information
provision
• Patient concerns should be given the attention they disserve
7. Responds with appropriate empathy, listening and attention
to concerns
• These skills are effective for communicating caring
8. Tell patient the name, indication, and route of administration
of the medication
• Done after pharmacist determined medication is appropriate
• Name of medication-impo in case of an emergency
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Patient Counseling Checklist cont…
• Stating indication
• reinforces the Dx and promotes confidence in
appropriateness of Rx
• Do not assume the route of administration is
obvious
• Don’t assume printing on the label will cover these
points
9. Tell patient the dosage regimen
• How many times a day
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Patient Counseling Checklist cont…
10. Ask patient if s/he will have problem taking the medication
as prescribed
• Pharmacist should make every attempt to resolve problems related to the
dosage regimen
11. Tailors medication regimen to patient’s daily routine
• Ask patient about daily routines rather than suggesting them
12. Tell patient how long it will take for the medication to show
effect
• This might reduce non-adherence
13. Tell patient how long s/he might be on the medication
• Helps eliminate unrealistic expectations
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Patient Counseling Checklist cont…
14. Tell patient when s/he is due back for a refill
• Assists in planning and goal setting for the patient
15. Emphasize benefits of the medication and support its use
• Discuss barriers and concerns after telling them benefits
• This helps build patient confidence in the chosen therapy
• In solving the problem ask for the patients thoughts
16. Discuss major SE and whether they will go away
• Discuss how to manage SE and what to do if they don’t go away
• Develop a flexible approach in dissemination of information
• The more specific the better
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Patient Counseling Checklist cont…
17. Point out additional rare SEs are listed in the info sheet
• Encourage patient to call in case of concerns about these
18. Use written info to support counseling where appropriate
• Promotes more effective counseling
19. Discuss precautions (e.g. activities to avoid)
20. Discuss beneficial activities
21. Discuss drug-dug, drug-food, & drug-disease interactions
• Patient should be told why these precautions are necessary
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Patient Counseling Checklist cont…
22. Discuss storage recommendations and ancillary instructions
(e.g. shake well, refrigerate)
23. Explain to patient in precise terms what to do if s/he misses a
dose
• Be specific
24. Check for understanding by asking patient to repeat back key
information
• E.g. drug name, SE, missed doses, storage
25. Recheck for any additional concerns or questions
26. Advise patients to always check their medicine before living
the pharmacy
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Patient Counseling Checklist cont…
27. Use appropriate language throughout counseling session
• Be watchful of nonverbal communication
28. Maintain control of the counseling session
• Keep superfluous conversation to a minimum
29. Organize information in an appropriate manner
• Most important info should be presented at the beginning and
repeated at the end
• Support of the drug should precede SE
30. Follow up to determine how patient is doing
• Patient should be given reminder options
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Educating Patients
Introduction
• Counseling is giving advice, but it also implies mutual discussion and an
exchange of opinions.
• Counseling is related to psychotherapy
• involve listening, questioning, evaluating, interpreting, supporting, explaining,
informing, advising, and ordering
• Education - “instruction and development to impart skills and knowledge”
• involves processes through which people develop their abilities, and enrich their
knowledge, and
• which help bring about changes in their attitudes or behavior
• “Counseling” = counseling + Education
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Educational Methods
1. Lectures
• should really be limited to larger groups
• Advantage: promote the profession of pharmacy,
• Disadvantage :
• knowledge retention is generally fairly low
• little opportunity for the pharmacist to address individual concerns
• not recommended for counseling individual patients
• Strategies for effective lecture:
• use audiovisual aids and group discussion
• Incorporate descriptions of personal experiences and discussion of
particular cases
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Educational Methods cont…
2. Dialogue and Discussion:
• should use techniques that allow the patient to be involved
• Advantage: it is more effective in improving the patient’s understanding
altering his or her attitudes
• Disadvantage: may be more time consuming than simply lecturing
3. Demonstrations and Practice of techniques:
• by pharmacist or video
Advantage:
• effective when a medication requires a particular technique
• Clarifies procedures, since it is easier to follow than verbal instruction
alone.
• Easier for the pharmacist to detect possible errors
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Educational Methods cont…
4. Print information: may be provided in the forms of prescription label,
auxiliary labels, information sheets, pamphlets, or booklets.
• Print information is valuable as an adjunct to dialogue and discussion
• should be scrutinized by the pharmacist
• should be customized as much as possible to the patient’s situation
5. Audiovisual methods: May be used with one patient or with small
groups of patients
• More effective when used together with discussion
• Advantage: improve the patient’s understanding of the method of drug
administration and help alter attitudes about medication use and illness
• Disadvantages: materials may be expensive to produce initially
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Educational Methods cont…
6. Computer assisted learning: Topics which may be addressed
include:
• Good health habits, poison and specific disease information
• DI on common drugs, and deciding when to seek medical care
• Advantages:
• Most helpful for patients with chronic diseases
• Health assessments and history taking can be done with more privacy
• Disadvantage:
• Availability of misleading or inaccurate information on the internet
• Requires internet connection and availability of computers
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Educational Methods cont…
7. Miscellaneous Methods:
• Patients can be provided with a diary to monitor their
progress
• Referral to patient support groups
• These types of groups may improve the patient’s
understanding and attitude toward his or her
condition and medication use.
• Telephone consultations via medical help line
• Text messaging using mobile phones
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Selection of the Educational Method
1. The Setting
• In a more private setting -Counseling may be more effective:
• more discussion is possible.
• it is easier to provide demonstrations,
• The lack of complete privacy
• Lecture, print information, audiovisual materials, internet or phone
• However: you should also consider:
• Finding a quite area
• Scheduling an appointment with the patient at a quieter time in the
pharmacy, or at the patient’s home.
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Selection of the Educational Method cont…
2. The patient’s health literacy level
• warning signs that patients are experiencing difficulty with written
information:
• avoiding filling out forms or questionnaires,
• relying on others to read material for them,
• never referring to written information received in the past,
• asking a lot of questions or none at all,
• Nonverbal signs - frustration or anxiety while reading.
• In case of low health literacy :
• print materials should be selected for easy reading.
• using audiovisual aids and demonstrations
• Oral communication - use simpler language and slower presentation
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Selection of the Educational Method cont…
3. The patient’s physical and mental state
• Pain, discomfort, disabilities and stress
• In such cases:
• vision impaired patient - verbal information
• hearing-impaired patient - print materials.
• delay education and counseling until a patient is in an appropriate
state of physical or mental being.
• Having materials that can be taken home
• follow up by telephone or home visit
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Developing Patient Education Program
• Individual patient education programs Steps:
• Identify the educational needs of the patient and family
• Establish educational goals- knowledge, skills, and attitudes
• Select appropriate educational methods
• Implement the educational plan
• Evaluate
• Educational programs for patient groups
• Same steps except for the first step here is identifying common
problems
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Educational Presentations
• Select topics to meet the audience’s wants and needs
• Gear the info and style of presentation to the audience’s level
• Be knowledgeable on the topics presented
• Use a variety of resources
• Organize the speech carefully
• Include humor judiciously
• Use handout materials, props, audiovisual aids
• Involve the audience as much as possible
• Ask for feedback
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Conflict
• Conflict is a dynamic force; it is the consequence of real
or perceived differences in mutually exclusive goals,
values, ideas, attitudes, beliefs, feelings, or actions.
Or it is:
• The process in which one party perceives that its interests are being
opposed or negatively affected by another party
• Perception of mutual interference
• A process that begins when goals of one party are frustrated
by another
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Is Conflict Good or Bad?
Two types of conflict
1. Constructive (task) conflict
• Conflict is aimed at issue, not parties
• Produces benefits of conflict
• Upper limit to any conflict, including constructive
2. Relationship (socio-emotional) conflict
• Aims conflict at the person (e.g. their competence), not
the task or issue
• Introduces perceptual biases
• Distorts information processing
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Is Conflict Good or Bad?
• Relationship conflict is
dysfunctional (not
performing as expected)
• Problem: difficult to
separate constructive
from relationship
conflict
Good
Conflict outcomes
• Lack of constructive
conflict is bad, but
some produces positive
outcomes, up to a point
Constructive
conflict
0
Bad
Low
Relationship
conflict
Level of conflict
High
Minimizing Relationship Conflict
• Three conditions that minimize relationship conflict
while engaging in constructive conflict
• Emotional intelligence
• Cohesive team (working together as a united whole)
• Supportive team norms
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Sources of Conflict
Incompatible
Goals
• One party’s goals perceived to
interfere with other’s goals
Differentiation
• Different values/beliefs
• Explains cross-cultural and
generational conflict
Task
Interdependence
• Conflict increases with
interdependence
• Higher risk that parties interfere
with each other
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Sources of Conflict (… continued)
Scarce
Resources
• Motivates competition for the
resource
Ambiguous
Rules
• Creates uncertainty, threatens
goals
• Without rules, people rely on
politics
Communicat
ion Problems
• Increases stereotyping
• Reduces motivation to
communicate
• Escalates conflict when arrogant
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Strategies
Conflict Resolution
Strategies for
ConflictforResolution
1. Withdrawal—little or no significance to
either party (lose-lose)
2. Forcing—force outcome regardless of
the desire of one party (win-lose)
3. Conciliation —giving in to preserve
relationship with other party (lose-win)
4. Compromise—concerned with both
outcome and relationship (?-?)
5. Confrontation—meet the problem head
on (win-win)
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LEEN--A Model for Conflict
Resolution
L- Listen
E- Empathize
E- Explain
N- Negotiate
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Interpersonal Conflict Handling
Styles
High
Assertiveness
Forcing
Problem-solving
Compromising
Avoiding
Low
Yielding
Cooperativeness
High
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Other Conflict Handling Styles
1. Avoiding: is best when…
• Relationship conflict is high
• Conflict resolution cost is higher than its benefits
2. Forcing: is best when…
• You have a deep confidence about your position
• Quick resolution required
• Other party would take advantage of cooperation
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Other Conflict Handling Styles (…continued)
3. Yielding: is best when…
• Other party has much more power
• Issue is much less important to you than other party
• Value/logic of your position is changeable
4. Compromising: (something accepted
rather than wanted) is best when…
• Parties have equal power
• Quick solution is required
• Parties lack trust/openness
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Structural Solutions for Managing Conflict
1. Reducing Differentiation
• Remove sources of different values and beliefs
• Move employees around to different jobs,
departments, and regions
• Other ways to reduce differentiation:
• Common dress code/status
• Common work experiences
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2. Reduce Task Interdependence (unable to
exist or survive without each other)
3. Increase Resources
• Duplicate resources
4. Clarify Rules and Procedures
• Clarify resource distribution
• Change interdependence
5. Communication
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