Medication History Interview

Medication History Interview

Content

       Importance of medication history interview

       Steps involved in MHI

Objective

After completion of this lecture, student will be able to:

       Describe the importance of medication history interview

       Explain the steps involved in MHI

Definition

Medication history interview (MHI) is defined as obtaining accurate information on patient’s medication use that may assist in the overall healthcare of the patient

Purpose

To gather all relevant information that could influence drug selection

      Presenting complaints

      Past medical history

Goals

The ultimate goal of medication history interview is to individualize the medication order to ensure the rational drug use. This can be achieved by:

       Gathering the accurate and relevant information on medication use

       Comparing the obtained information with the information collected by the other healthcare professionals

       Assessing the information for its appropriateness in relation to every aspect of drug use

       Assessing the patient’s attitude towards the drug therapy

       Assessing the need for medication counseling and medication aids

Significance 

It enables the pharmacists to:

       Establish the rapport with the patient

       Explain their role in the patient management

       Conduct preliminary medication counseling

       Plan the ongoing patient management/ pharmaceutical care

 

Source

Patient’s medication history can be obtained from 

        Patients

        Care takers

        Records compiled by the other HCP

Aspects to be assessed

       History of previous allergies and/or ADRs

       Indication / purpose of drug use

       Dosing regimen

       Perceived efficacy of each drug

       Perceived side-effects

       Adherence to drug regimen

       Potential drug – drug or drug food interactions

       Drug administration techniques

       Use of medication aids

       Treatment with other system of medicines (e.g., Ayurveda, Siddha and Unani)

       Use of prescription and /or non-prescription medications

       Specific problems relating to medication use.

       Immunization status (if relevant)

       Possibility of pregnancy in women of childbearing age

       Social drug use (alcohol, tobacco, pan masala etc)

       Evidence of drug abuse

       General attitudes towards illness and medication use

Case 1

       Mr. X

       Age 42

       Known case of DM, HTN

       Taking Metformin, insulin and prop

       Expr: gidd, sweating, palpitation

       Nonveg, over weight

 

Procedure (general)

       The nature of the patient’s medication history interview will depend upon the individual patient

       To the extent possible, ask open ended questions rather than asking closed ended questions

       Initial patient interaction should occur by appointment in a private, professional environment

       Assess the patient’s understanding and attitude towards their medications and health condition

       Patient must be treated with respect during pharmacist-patient interaction

       Pay special attention to what the patient is saying and tailor the responses to their comments

       Encourage the patient to speak more, and  carefully listens and observe

       The data collected should be compared with the medication administration record for any discrepancies, and also to identify any drug related problems

Steps involved in MHI

Steps to be followed while interviewing

       Patient selection              

       Self-preparation      

       Self-introduction                            

       Conduct interview

       Conclusion

       Documentation

Patient selection

       Ideally patient medication history should be taken for all patients

       If this is not possible, prioritize patient selection

       But may not be possible in certain cases e.g., patients with psychiatric disorders, impaired cognition

Self-preparation

Before commencing an interview:

       Collect all relevant data from the various sources available

       Have a thorough understanding about the patients’ disease and medications

Privacy & confidentiality

       Consider the factors related to privacy and confidentiality of interviews

       Make sure that none other than the pharmacist and patient present in the room so as to make the patient to feel comfortable

       Try to instill confidence in the patient to facilitate an effective exchange of information

Purpose of interview

       Explain the patients about the purpose of conducting interview

       Likely benefits that the patients might obtain from interview

       However the pharmacist should respect the patient’s rights to decline an interview

Conduct of interview

       Use of communication principles such as listening, body language, voice intonation, and history taking skills is crucial to a successful patient interaction

       Adopt suitable position to enable the conversation to take place comfortably and effectively 

       Communicate to patients with the language which the patients can understand

       Ask open-ended questions

       Ask questions and receive information in a nonjudgmental way (E.g. ‘Please tell me how you take your medications’ rather than asking ‘Do you take your medication as prescribed by your doctor?’)

       Ask questions which are appropriate and relevant to the patient medical condition

       Exhaustive interview and unimportant questions need to be avoided as these may be counter productive

Information to be obtained

       History of previous allergies and ADRs

       Indication/purpose of drug use

       Dosing regimen including dose, route, frequency and duration of therapy

       Perceived efficacy of each drug

       Perceived side effects

       Adherence to drug regimen

       Prescription and /or nonprescription medication use

       Immunization status

       Possibility of pregnancy in woman of childbearing age

       Social drug use (alcohol, tobacco)

Documentation

Document all the information obtained during MHI to:

       Utilize the gathered data in the ongoing pharmaceutical care

       Provide readily available information that is needed for HCP

       Compare the documented reference with  information obtained from the other HCP for any discrepancies

       Identify and assess medical problems

Summary

       At the end of interview ascertain whether all the important and relevant information are obtained or not

       Summarize the important information for the patient

       Ask patients if they have any questions related to their medications

       Encourage the patients to provide more information, which may be recalled after the interview

       Finally inform the patient regarding when the next opportunity will arise for the further review and discussion

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