ippe 4 - patient data collection - pharmacist.com – patient data ppt.pdfwho to interview? if there...

ChapChapter 3 ter 3 -- Patient Data Patient Data CollectionCollection

From last classFrom last class

A patient presents with a new Rx for A patient presents with a new Rx for NorvascNorvasc 10 mg 10 mg qdqd for BP of 164/102. for BP of 164/102. He has never had it before. You He has never had it before. You think this is too high a dose (usual think this is too high a dose (usual initial dose is 2.5 initial dose is 2.5 --5 mg 5 mg qdqd. How . How you you rephrase the you you rephrase the ““dose too highdose too high””problem in words that will not offend problem in words that will not offend the Doctor?the Doctor?

Some possible solutions Some possible solutions -- 11

Doctor, I rarely see initial doses of Doctor, I rarely see initial doses of NorvascNorvasc this high. Usually, I see 2.5this high. Usually, I see 2.5--5 mg 5 mg popo qdqd initially. Can you please initially. Can you please help me understand what you know help me understand what you know about this patient that sufficiently about this patient that sufficiently concerned you to choose the higher concerned you to choose the higher dose? It will help me to educate the dose? It will help me to educate the patient better about his drug therapy patient better about his drug therapy and disease if I know.and disease if I know.


Doctor, I am concerned that the Doctor, I am concerned that the patient may be at risk for a patient may be at risk for a hypotensivehypotensive episode if we start with episode if we start with 10 mg. Would you consider 5 mg 10 mg. Would you consider 5 mg initially? For this week, Iinitially? For this week, I’’ll have the ll have the patient come into the pharmacy and patient come into the pharmacy and monitor his BP daily. He has agreed monitor his BP daily. He has agreed to this. If his diastolic isnto this. If his diastolic isn’’t less than t less than 90 within 3 days or if he has any 90 within 3 days or if he has any adverse effects, I will call you.adverse effects, I will call you.


Doctor, the literature suggests Doctor, the literature suggests starting starting NorvascNorvasc for hypertension at for hypertension at 2.5 mg 2.5 mg popo qdqd and tapering up over and tapering up over 77--14 days. Can we do that in this 14 days. Can we do that in this patient, or is there some particular patient, or is there some particular concern you had that indicates he concern you had that indicates he needs a fully therapeutic dose needs a fully therapeutic dose immediately? I donimmediately? I don’’t want to see the t want to see the patient have a fall if he cannot patient have a fall if he cannot initially tolerate 10 mg.initially tolerate 10 mg.

Who to interview?Who to interview?

If there are 57 problems per 100 patients, If there are 57 problems per 100 patients, who do I interview or ignore?who do I interview or ignore?When refilling a Rx, When refilling a Rx, alwaysalways ask the ask the patient, patient, ““How is your (drug name) How is your (drug name) working for you?working for you?””They will answer, They will answer, ““OK I guessOK I guess””This allows This allows RPhRPh to followto follow--up and inquire up and inquire more deeply more deeply -- ““So how is your BP/blood So how is your BP/blood sugar/asthma lately?sugar/asthma lately?””

Subjective data Subjective data

Cannot be directly measuredCannot be directly measuredMay not always be accurateMay not always be accurateMay not be reproducibleMay not be reproducibleOften supplied directly by the patientOften supplied directly by the patientGenerally includes PMH, CC, HPI, Generally includes PMH, CC, HPI, SH/FH, ADLSH/FH, ADL

Objective dataObjective data

Can be measuredCan be measuredIs observableIs observableNot influenced by prejudice or Not influenced by prejudice or emotionemotionTypically numericalTypically numericalOften includes vital signs, lab Often includes vital signs, lab measuresmeasuresOften created in the pharmacy Often created in the pharmacy --PEFR, Lipids, BS, vitals etcPEFR, Lipids, BS, vitals etc

Subjective or objective? Subjective or objective? -- 11

Lab data can be Lab data can be eithereither depending on depending on the sourcethe sourceIf the patient tells you, itIf the patient tells you, it’’s s subjectivesubjectiveIf the source is verifiable itIf the source is verifiable it’’s s objectiveobjectiveVerifiable sources Verifiable sources -- lab slips, doctorlab slips, doctor’’ssoffice, patient chart, diagnostic test office, patient chart, diagnostic test performed by the pharmacistperformed by the pharmacist


Patient home monitoring logs can be Patient home monitoring logs can be eithereitherIf If RPhRPh is certain patient is testing is certain patient is testing and recording results correctly, itand recording results correctly, it’’s s objectiveobjectiveIf If RPhRPh cannot be certain patient is cannot be certain patient is testing or recording consistently and testing or recording consistently and accurately, itaccurately, it’’s subjective.s subjective.

Subjective or objective? Subjective or objective? -- 33Medication histories can be Medication histories can be eithereitherA well performed drug history by a trained A well performed drug history by a trained pharmacist is objective. Includes Rxpharmacist is objective. Includes Rx’’s, s, RxRx’’s filled elsewhere, samples, pills s filled elsewhere, samples, pills borrowed from familborrowed from family/friendsy/friends, OTC, OTC’’s and s and herbals and the outcome of therapyherbals and the outcome of therapyHospital profiles/ MARS are objectiveHospital profiles/ MARS are objectiveHistory jHistory just taken off computer is ust taken off computer is objective buobjective but incompletet incomplete..


Compliance histories can be Compliance histories can be eithereitherA true assessment of compliance (pill A true assessment of compliance (pill count, calculation of days of therapy, count, calculation of days of therapy, thorough/openthorough/open--ended interview) is ended interview) is objectiveobjectivePartial or closePartial or close--ended interview is ended interview is subjective (e.g., Do you forget to subjective (e.g., Do you forget to take your medications very often?)take your medications very often?)

FinallyFinally……..

Gender, age/DOB, race are generally Gender, age/DOB, race are generally put in the subjective, even if they put in the subjective, even if they are sometimes objective. SOAP are sometimes objective. SOAP notes simply read better this way, notes simply read better this way, e.g., e.g., LiangLiang Yee is a 75Yee is a 75--yryr--old Asian old Asian femalefemale……..Include the Include the sourcesource of the information of the information in your SOAP notesin your SOAP notes

Getting started Getting started -- 11

Interview by appointment or on the fly?Interview by appointment or on the fly?By phone or in person?By phone or in person?Is semiIs semi--private space available to conduct private space available to conduct the interview?the interview?Does the pharmacy have sufficient Does the pharmacy have sufficient support systems to permit you to leave support systems to permit you to leave the pharmacy and spend 15the pharmacy and spend 15--30 minutes 30 minutes with the patient and not come back to with the patient and not come back to utter chaos?utter chaos?


How are your communication skills?How are your communication skills?OpenOpen-- vsvs closedclosed--ended questions?ended questions?Focused Focused vsvs comprehensive comprehensive interviews?interviews?Logical flow to the questions you Logical flow to the questions you ask?ask?Do you present a calm, professional Do you present a calm, professional appearance or look flustered and appearance or look flustered and nervous?nervous?WhatWhat’’s your body language saying?s your body language saying?


You do not need to ask every question of You do not need to ask every question of every patient every timeevery patient every timeYou will need to learn how to judge what You will need to learn how to judge what is absolutely necessary and what is notis absolutely necessary and what is notConsider gathering all the patientConsider gathering all the patient’’s data in s data in pieces over a series of interviews rather pieces over a series of interviews rather than all at one sittingthan all at one sitting

Basic data to collect Basic data to collect -- 11Demographic data Demographic data -- name, address, phone name, address, phone (home and office), best times to call, (home and office), best times to call, permission to leave messages, financial permission to leave messages, financial and insurance informationand insurance informationGeneral data General data -- diet, exercise, diet, exercise, employment, height, weightemployment, height, weightSH/FH SH/FH -- smoking, smoking, EtOHEtOH, illicit drug use, , illicit drug use, caffeine, family disease historycaffeine, family disease history

Basic data to collect Basic data to collect -- 22

Medical history Medical history -- ““What are all the things What are all the things you currently see a doctor for? What you currently see a doctor for? What complaints do you have that you doncomplaints do you have that you don’’t see t see a doctor for?a doctor for?””PMH PMH -- ““What have you previously seen a What have you previously seen a doctor for? Did the problem get better?doctor for? Did the problem get better?””CCCC-- ““What is your main healthWhat is your main health--related related problem today?problem today?””

Basic data to collect Basic data to collect -- 33

HPI HPI -- ““What is currently happening with What is currently happening with the major healththe major health--related complaint you related complaint you have today?have today?””PatientPatient’’s expectations of you and the rest s expectations of you and the rest of the system of the system -- ““If I could fix one healthIf I could fix one health--related problem for you, what would you related problem for you, what would you like it to be? What is the one healthlike it to be? What is the one health--related issue that concerns you the most?related issue that concerns you the most?””

Useful questions to ask Useful questions to ask -- 11

The Basic 7The Basic 7•• Where is the problem/symptom?Where is the problem/symptom?•• What is it like?What is it like?•• How severe is it?How severe is it?•• How long have you had it?How long have you had it?•• How did it happen?How did it happen?•• What makes it better or worse?What makes it better or worse?•• What other symptoms are present?What other symptoms are present?


Many of the problems that arise when Many of the problems that arise when pharmacists contact physicians occur pharmacists contact physicians occur because the pharmacist cannot answer because the pharmacist cannot answer the Bathe Basic sic 7 questions above. If the 7 questions above. If the pharmacist does not have this pharmacist does not have this information, the physician will nearly information, the physician will nearly always ask the pharmacist to send the always ask the pharmacist to send the patient in to see the doctor.patient in to see the doctor.


Three US PuThree US Public blic HealtHealth h SServiceervice questions:questions:•• What did the doctor tell you this medication is What did the doctor tell you this medication is

for?for?•• How did the doctor tell you to take it?How did the doctor tell you to take it?•• What did the doctor tell you to expect?What did the doctor tell you to expect?

Answers to these questions often suggest Answers to these questions often suggest patients at risk for a drug therapy patients at risk for a drug therapy problem.problem.

If time is a problemIf time is a problem

Conduct a focused interview:Conduct a focused interview:•• What are all the things you see a doctor What are all the things you see a doctor

for?for?•• What are all the medications you take? What are all the medications you take?

(Rx, Rx(Rx, Rx’’s filled elsewhere, samples, s filled elsewhere, samples, OTCs, borrowed from family/friends, OTCs, borrowed from family/friends, herbals/herbals/nutritionalsnutritionals))

•• What happens when you take them?What happens when you take them?

Data collection forms Data collection forms -- 11

Provide space to collect the relevant Provide space to collect the relevant data in a logical and coherent fashiondata in a logical and coherent fashionCan be used to start a pharmacistCan be used to start a pharmacist’’s s patient recordpatient recordCan be filled out by the patient while Can be filled out by the patient while waiting to speak to the pharmacistwaiting to speak to the pharmacist

Data collection forms Data collection forms -- 22

Can provide a false sense of security. Can provide a false sense of security. What if itWhat if it’’s not on the form?s not on the form?Can result in a tendency to write or think Can result in a tendency to write or think ahead to the next question and not listenahead to the next question and not listenAre popular with pharmacists just learning Are popular with pharmacists just learning how to interview patients, but are how to interview patients, but are generally dropped after some practice.generally dropped after some practice.

Sources of dataSources of data

The patient, the patient, the patientThe patient, the patient, the patientFamily members, caregivers, Family members, caregivers, providersprovidersPhysician offices, clinical labs, Physician offices, clinical labs, hospitals etchospitals etcHospital charts, nursing home Hospital charts, nursing home records, MARSrecords, MARSOther pharmaciesOther pharmaciesThe patientThe patient

Possible problemsPossible problems

Providers may not release information Providers may not release information without a without a ““Patient Information Release Patient Information Release FormForm””Be prepared to pay for copying costs. Be prepared to pay for copying costs. DonDon’’t ask the hospital for the entire chart. t ask the hospital for the entire chart. It might be 400 pages long and cost you It might be 400 pages long and cost you $150$150Be mindful of patient confidentiality issues Be mindful of patient confidentiality issues –– e.g., asking a 17e.g., asking a 17--yryr--oldold’’s mom re: os mom re: oral ral contraceptivescontraceptives

ippe 4 - patient data collection - pharmacist.com – patient data ppt.pdfwho to interview? if there...

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