Communication Skills Interviewing and assessment By Dr. Vian Ahmed BSc. Pharmacy, MSc. Clinical Pharmacy, PhD. Student

Patient Assessment Is an important aspect of patient care in; Determining what patients understand about their medications, How they are taking their medications, How well their medications are working, Problems they perceive with their therapy.

Patient Assessment So it is a key elements to ensure positive health outcomes. Assists pharmacists in planning an appropriate strategy for increasing understanding & appropriate use of medications.

Patient Interviewing Is an important component of disease management process as pharmacists obtain information for therapeutic decision making. Allows pharmacists to evaluate patient adherence to medication regimens by asking appropriate questions.

Patient Interviewing It appears to be a simple process. Research & experience have shown that interviewing is a complex process in need of more attention, because the quality of the information received is not always optimal.

Components of an effective interview Listening Probing Asking sensitive questions Use of silence Establishing rapport

Listening In general, people are better senders of information than receivers of information. Nothing will end an interview faster than having patients realize that you are not listening to them.

Listening Techniques

Listening Techniques Stop talking Get rid of distractions. Use good eye contact React to ideas, not to the person. Read nonverbal messages. Listen to how something is said. Provide feedback to clarify any messages.

Probing Is the use of questions to elicit needed information from patients or to help clarify their problems or concerns.

Probing The phrasing & timing of the question is important “why” type questions can make people feel that they have to justify their reason for doing a certain thing. It is better to use “what” or “how” type of questions.

Probing For example; × Why do you miss doses of medication? What causes you to miss doses of medication?

Probing The patient should be allowed to finish answering the current question before proceeding to the next one. Leading questions should be avoided because they strongly imply an expected answer. Example 1; You don’t usually forget to take the medication, do you?

Probing Example 2; You take this three times a day with meals, right? These questions lead patients into saying what they think you want to hear rather than what the truth may be.

Probing (types of question) Closed-ended questions Open-ended questions Answered with yes or no Answers are more detail May induce defensiveness Not induce defensiveness Easier to formulate Harder to formulate Not obtain complete information Crucial in obtaining complete information Allow patient to be passive during the interviewing process because you are doing most of the talking Allow patients to present information in their own words Avoid specific subjects and emotional expression Allow specific subjects and emotional expression Referred to as “pharmacist-centered questions Referred to as “patient-centered questions e.g. Has your doctor told you how to take this medication? e.g. How has your doctor told you to take this medication?

Probing (types of question) A combination of open-ended & closed-ended questions is most efficient in practice. Start with an open-ended question, followed by more directed, closed-ended questions.

Probing (types of question) For example; Mr. R taking antihypertensive & you look for SEs; How have you been feeling since starting this medicine? Or “What things have you noticed since beginning this medication? How bothersome are these SEs? Do you have trouble sleeping? Do you feel weak?

Probing (types of question) Open-ended questions allows you to assess the patient understanding of the key elements of drug therapy; Purpose of medication How the medication works Dose/interval Duration of therapy Goals of therapy How effectiveness will be monitored? AE & strategies to deal with these events Drug-specific issues

Asking Sensitive Questions Sensitive questions like; Questions assessing adherence, alcohol use, or use of recreational drugs. Assessment of effects (including SEs) of medications that relate to sexual functioning.

Asking Sensitive Questions Solutions; Let the patient know that the behaviors or problems you are asking about are common. Ask whether the situation has ever, at any time, occurred & then ask about the current situation.

Asking Sensitive Questions Example1; Asking about adherence It is very difficult to take a medication consistently, day after day. Nearly everyone will miss a dose of medication once in a while” before asking specific questions. “This is a very common concern . . .,” “Frequently my patients have difficulty . . “Everybody has trouble with . . . .”

Asking Sensitive Questions Example 2; Asking about drug abuse “Other types of drugs, such as marijuana, are sometimes used by People to relax or with friends at a party. Have you at any time in your life smoked marijuana?”

Asking Sensitive Questions Example 2; Continued….. If the answer is “yes,” the follow-up question might be ; “To put things in a more recent time frame, have you smoked marijuana during the past year?” Then questions about frequency of use & use of other drugs could follow.

Use of Silence During the interview, there should be times when neither you nor the patient speak. Many times, the patient needs time to think about or react to the information you have provided or the question you have asked. too much silence when a patient is expressing feelings (fear or depression) may be interpreted by the patient as rejection.

Establishing a rapport Rapport is defined as a close & harmonious relationship in which the people or groups concerned understand each other's feelings or ideas & communicate well.

Establishing a rapport Rapport is built mainly on mutual consideration & respect. Rapport is aided by; Using good eye contact, Using a sincere, friendly greeting, Being courteous during the discussion, Not stereotyping or prejudging the patient.

Notes to remember; Privacy allows both you and the patient to express personal concerns, to ask difficult questions, to listen more effectively & to share honest opinions. Start the interview by greeting patients by name & by introducing yourself to patients. To conclude the interview, you need to briefly summarize the key information.