Medication History Interview

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Medication History Interview

Objective

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

• Describe the importance of medication history interview

• Explain the steps involved in MHI

Medication history interview (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