MEDICATION

HISTORY INTERVIEW
Introduction
• At the outset Clinical pharmacist must keep it in mind that this is not
an interview of a candidate for some job/or place in an institution. He
must remember that he is going to interview a patient, who is sick, in
anxiety and not in a position to oblige him, even if he wishes. Hence
the interview must be planned in such a way, to get maximum
information, with minimum trouble and time to the patient.
Moreover the clinical pharmacist must remember that his approach
must be in a manner that the patient should not feel that he is being
questioned by a superior officer. At no point of time the patient
should feel that he is under pressure to disclose personal information
and other details.
  Difference between Interview and Counselling
Clinical pharmacist has to interact with the patient, from the very beginning of
patient's stay in the hospital to his discharge from the ward. He has to interact
with the patient on many occasions, from the date of admission in the ward to
end of treatment and beyond.During these interactions, on initial days he gathers
information about the patient and at the end gave information about his post
hospital routines. . However, there is no hard and fast rule that it should be like
this, because it may be interchanged in many situations, so that, information may
be given during interview and gathered in counselling session.
 Pre-requirements for an Interview
• The patient who is to be interviewed by the pharmacist might have had
the same or some other disease earlier and that illness experience and the
present mood bring in lot of stress on the patient.
• All routine works of all family members gets disturbed, if it is the bread
winner of the family got sick. These patients are more worried about
expenses and loss of income than the disease itself.
• Hence a Clinical pharmacist must be sympathetic and helpful to the
patient, so that he can cope with the situation. This is the most important
pre-requisite for a medication history interview .
• The success or otherwise of an interview depends on pharmacist’s
approach.
• At least he must know the patients name, age and present complaint from
hospital records.
 Structure of Patient’s Case History

 Patient's name, age, sex and address

 Date of admission and patient hospital registration number
 Present complaint
 Already existing diseases like, T.B, Asthma, Diabetes etc
 Medicines currently using [Prescription and OTC drugs with dose used]
 Use of drugs of alternative systems medicine like, Siddha, Ayurveda etc
 Allergy to drug, food and others
Problems encountered, if any, during drug use [ADR, Drug Interaction]
Immunization [if relevant]
Pregnancy and any problem faced [if applicable]
Any surgery undergone and its current status
Social drug use habits [alcohol, tobacco etc]
Any evidence of drug abuse or misuse
General attitude towards medicine use [compliance/ non compliance]
• Patient’s opinion for present illness.
 Role of Body Language
• In order to communicate with other body language plays important role.
Not only the words but also the body communicates lot of messages to
others. Communication with others body language plays an through sign
language by deaf and dumb persons is the example for this.
• When a message is delivered with facial expressions, hand gestures and
other body movements and postures as in cinema and drama, it reaches the
receiver quickly.
• Pharmacist also uses it instead of sitting idle with blank looks in front of the
patient. 
Looking at the eyes of the patients while he speaks, head nod and
inclining towards the patient are some of the signs of the body which
indicate, the pharmacist is actively listening to the patient.
Similarly even the voice of the pharmacist while speaking to the patient
has a significant role. The tone and tempo of voice conveys the message
that one is sympathetic towards other or not A voice filled with concern
for the patient will definitely influence him.
• Thus a sweet empathetic voice is of great help to the pharmacist to
achieve what he wants.
Role of Prompts
• Irrespective of pharmacist’s sympathetic behavior and good body
language, all the needed information from the patient cannot be
obtained due to various reasons. Few among them are patient’s
forgetfulness or lack of concentration, or ignorance about what t is
more acute in the case of illiterate and semi literate patients.
• They may not be able to answer pharmacist’s questions accurately, as
medicine they are taking and what for. Such, the medication history
interview may not be useful.
• In such situations, interviewing pharmacist has to adopt few
techniques like prompting or getting help from the family members of
the patient. Prompting is nothing but stimulating or leading a person to
start and sustain something.)
• Pharmacist can as prompting questions, so that the patient starts
recollecting the answer for the questions. Prompting help trigger the
patient’s memory. For example pharmacist can ask do you take
medicines for your hypertension. Or do you apply anything externally
for any skin infection? Such questions make the patient to recollect
even treatments given to him long time back.
• Thus prompting questions asked by pharmacist results in fruitful
interview. If correct answer is not forthcoming even after prompting,
pharmacist has to rely on patients family members or care givers.
 Interview Questions
1. Do you carry medicines to your work place?

2. Do you forget some doses?

3. What will you do if you forget to refill the prescription?

4. If the medicine is inconvenient to you in any way what will you do?

5. Do you use costly medicines as and when needed or as per doctor's

instruction?

6. Have you ever increased or decreased the dose of a drug?

Essential Skills for Medication History
Interview
Candace W Burnett, et al, has listed in American Journal of Pharmaceutical
Education [vol. 66, 2002 some 14 skills which are needed for conducting a
good medication history interview. They are given below:
1. Formal form of addressing the patient. [Good Morning Mr. X!]
2. Rapport with patient. [self introduction, purpose, time required]
3. Active listening, empathetic responding.
4. Open ended questions ,Closed ended questions
5. Transition from one subject to another. [mention it for mental preparation]
6. Verbal involvement/repeating patient's own words.
7. Verbal involvement/repeating patient's own words.
8. Avoidance of leading questiword.
9. Avoidance of 'why questions.
10. Timing [giving time to adopt to series of questions]
11. Clarifying conflicting information
12. Silence [allowing patient to show emotion, digest information etc]
13. Answering questions by the patient and
14. Mentioning previous answer and question [to link current question]
Closing of interview

• To close the interview pharmacist must highlight a part or entire interview to

the patient. which permits the patient on the interviewer to correct any error,
clear any confusion confirm information already given or add new information.
• At the end of the interview, pharmacist can ask for additional information which
the patient think might be useful. Also he can ask patient's opinion or reasons
for the presen problem.
• All these points should be noted in a short form, then and there, during the
interview itself and elaborately written immediately after the interview as a
report for the referenc of treating physician and health care team.
 Use of Patient’s Case History in Evaluation
of Drug Therapy
 
As all this information is to be evaluated and compared during DUE,
importance must be given to present a correct and reliable data to the DUE
committee. These data help the DUE committee to identify
1. Medication error either during present or earlier therapy
2. Untreated indications or undetected illness
3. Correctness of present therapy and
4. Improvement anything required in present drug's use etc.
Conclusion
If an interview is conducted properly and all the relevant information is
obtained from the patient, it helps the medical fraternity enormously.
The advantages are numerous and beneficial to all the persons involved
in the health care of the patient, including the patient himself. It helps in
speedy and correct diagnosis. It avoids unnecessary repetitions of earlier
ineffective treatment; it saves the patient from unpleasant exposure to
drugs allergic to him; it prevent patient from ADR, drug interaction etc.