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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