Interviewing and Assessment - Community Pharmacy
Learning Objectives
After studying this chapter, the graduate pharmacy student should be able to:
- Design and conduct effective patient interviews for medication therapy assessment
- Differentiate between open-ended and closed-ended questioning techniques
- Apply appropriate strategies for asking sensitive questions in clinical contexts
- Structure interviews based on purpose, environment, and patient needs
- Document patient-reported outcomes using standardized formats like SOAP notes
- Adapt interviewing techniques for telephone and digital communication platforms
Introduction: The Art and Science of Clinical Interviewing
Interviewing represents a fundamental yet complex component of patient assessment in pharmacy practice. While seemingly simple—pharmacists ask questions daily—the quality of information obtained varies significantly based on interviewing skill. Effective interviews bridge the gap between clinical knowledge and individual patient experiences.
The Assessment-Intervention Connection
Patient interviews serve as the foundation for all subsequent interventions. Accurate assessment of patient understanding, medication use patterns, therapeutic response, and perceived problems determines the appropriateness and effectiveness of any educational or clinical intervention.
Interviewing Defined
A structured conversation designed to obtain specific information for therapeutic decision-making. In pharmacy, this ranges from simple allergy inquiries to complex medication history interviews assessing adherence, effectiveness, and problems across multiple therapies.
Components of Effective Interviewing
Mastering clinical interviewing requires developing specific skills analogous to learning complex procedures like driving—individual skills become automatic through practice but require analysis when problems occur.
The Interviewing Process Flow
Active Listening
Full attention to both verbal and nonverbal messages, with techniques including stopping talking, eliminating distractions, using eye contact, and providing feedback.
Strategic Probing
Using carefully phrased questions to elicit needed information, with attention to question type (open vs. closed), timing, and avoidance of leading questions.
Appropriate Silence
Allowing thinking time without filling gaps unnecessarily, recognizing that patient talk time correlates with interview success.
Rapport Building
Establishing mutual consideration and respect through professional greetings, eye contact, courtesy, and avoidance of stereotyping.
Questioning Techniques: Open vs. Closed
| Aspect | Open-Ended Questions | Closed-Ended Questions |
|---|---|---|
| Definition | Questions that don't limit response; encourage elaboration | Questions answered with yes/no or few words |
| Example | "How has your doctor told you to take this medication?" | "Has your doctor told you how to take this medication?" |
| Advantages | Elicit more complete information; reduce defensiveness; assess understanding | Efficient for specific facts; good for screening; time-saving |
| Disadvantages | Can be time-consuming; may elicit irrelevant information | Limit information; can seem interrogative; encourage passivity |
| Best Use | Assessment of understanding; exploring experiences/feelings; beginning interviews | Confirming specific facts; screening; time-limited situations |
| Alternative Names | Patient-centered questions | Pharmacist-centered questions |
Asking Sensitive Questions
Certain clinical topics require special approaches to maintain patient comfort while obtaining necessary information.
Techniques for Sensitive Topics
- Normalization/Universal Statements: "Many people have difficulty taking medications consistently" (Gardner et al, 1995)
- Stepwise Approach: Ask about "ever" occurrence first, then current situation
- Embedding Technique: Place sensitive questions among less threatening topics
- Clear Rationale: Explain why sensitive information is needed for care
- Matter-of-Fact Manner: Use same tone as for non-sensitive questions
- Timing Consideration: Ask more personal questions later in interviews
Sensitive Questioning Example
Topic: Assessing adherence to antiretroviral therapy
Approach: "Taking medication exactly as prescribed can be challenging for anyone. Have you ever missed a dose of this medication? [If yes] Thinking about the past week, about how many doses would you estimate you might have missed?"
Rationale: Stepwise approach normalizes difficulty while obtaining specific adherence information.
The Indian Health Service Model
An effective patient education program using three key open-ended questions for new prescriptions (Gardner et al, 1991):
- "What did your doctor tell you the medication is for?"
- "How did your doctor tell you to take the medication?"
- "What did your doctor tell you to expect?"
These questions assess key therapeutic elements while identifying knowledge gaps.
Interviewing as a Structured Process
Effective interviews follow intentional structures adapted to specific purposes and contexts.
Interview Planning Considerations
| Planning Element | Directed Interview | Non-Directed Interview |
|---|---|---|
| Purpose | Obtain specific predetermined information | Explore unknown or ambiguous issues |
| Control Level | Pharmacist maintains control | Patient determines direction |
| Question Type | More closed-ended questions | Primarily open-ended questions |
| Best For | Medication histories; specific screening | Exploring concerns; building rapport |
| Time Required | Generally shorter | Potentially longer |
Research Evidence: Privacy Matters
Studies (Beardsley et al, 1977) demonstrate that increased privacy correlates with improved patient information retention and adherence. Privacy facilitates honest expression, difficult question asking, and effective listening for both parties.
The Interview Structure
- Opening: Greeting, introduction, purpose statement, time frame
- Body: Question sequence moving from general to specific
- Closing: Summary, verification of understanding, follow-up plan
Case Study: Hypertension Medication Interview
The following example demonstrates effective interviewing techniques in community pharmacy practice.
Case Study 7.1: Robert Evans Interview
Pharmacist (Ed): "Hello. Are you Robert Evans? I'm Ed Robinson, the pharmacist. I'd like to talk about your medications while yours is being filled. This helps identify potential problems. Do you have about 10 minutes?"
Key Elements Demonstrated:
- Personal greeting and introduction
- Clear purpose statement with patient benefit focus
- Time frame specification
- Open-ended initial question: "What has your doctor told you about this medicine?"
- Progressive questioning about effectiveness, monitoring, adherence, lifestyle factors
- Comprehensive assessment including OTC products, herbs, allergies
- Closing with availability statement
Assessment Domains in Medication Interviews
- Patient Understanding: Purpose, instructions, expectations
- Actual Use Patterns: Dosing schedule, adherence, modifications
- Therapeutic Effectiveness: Patient perception, monitoring results
- Problem Identification: Side effects, costs, concerns, barriers
- Comprehensive Medication Review: Prescriptions, OTCs, herbals, supplements
- Health Status: Other conditions, untreated problems
Patient-Reported Outcomes (PROs)
Increasingly, therapeutic monitoring relies on patient self-report, making PRO assessment a critical interviewing skill.
Patient-Reported Outcomes Defined
Any outcome reported subjectively by patients or caregivers, including symptom experience, functional status, quality of life, treatment satisfaction, and adherence reports. PROs serve as primary efficacy endpoints for 30% of newly approved drugs (Willke et al, 2004).
Common PRO Assessment Tools
- Depression: PRIME-MD 2-item screen, CES-D, Hamilton Scale
- Pain: Visual Analogue Scale (0-10), pain diaries
- Quality of Life: Disease-specific and generic instruments
- Symptom Logs: Patient-maintained records of experiences
- Adherence Measures: Self-report, pill counts, refill records
Depression Screening Example
PRIME-MD Two Questions:
- "During the past month, have you often been bothered by feeling down, depressed, or hopeless?"
- "During the past month, have you often been bothered by having little interest or pleasure in doing things?"
Action: "Yes" to either question indicates need for further assessment and potential referral.
Documentation: SOAP Notes
Systematic documentation ensures continuity of care and effective communication among healthcare providers.
SOAP Note Components
| Component | Content | Example |
|---|---|---|
| S (Subjective) | Patient-reported information | "Reports missing 2-3 doses of metformin weekly due to forgetting" |
| O (Objective) | Measurable data | "BP 150/95; last HbA1c 8.2%" |
| A (Assessment) | Problem identification and analysis | "Poor glycemic control secondary to nonadherence" |
| P (Plan) | Intervention and monitoring plan | "Educate on use of pill organizer; schedule follow-up call in 1 week" |
Documentation Principles
- Specificity: Vague documentation leads to ambiguous communication
- Completeness: Document both problems and appropriate therapy
- Action-Oriented: Plans should specify who does what by when
- Continuity: Notes create "institutional memory" for ongoing care
- Legal Protection: Proper documentation supports quality of care
Telephone Interviewing
Telephone communication presents unique challenges requiring specific adaptations of interviewing skills.
Effective Telephone Techniques
- Preparation: Have all relevant information available before calling
- Professional Identification: "Professional Pharmacy, Jane Jones speaking"
- Name Usage: Ask for and use caller's name throughout conversation
- Full Attention: Avoid multitasking during telephone interactions
- Hold Protocol: Ask permission, give reason, thank for waiting
- Assertive Opening: State purpose clearly without apology
- Time Consideration: Ask if now is a good time for longer conversations
- Professional Closing: Thank caller, allow them to hang up first
The Smile Principle
Smiling before answering the telephone transmits through vocal tone, creating a more positive interaction. This simple technique significantly impacts telephone communication effectiveness.
Advanced Practice Applications
For graduate pharmacy students, interviewing skills have specific advanced applications in evolving practice roles.
Graduate-Level Interviewing Competencies
- Comprehensive Medication Reviews: Conducting in-depth assessments for complex patients
- Transition of Care Interviews: Assessing medication-related problems during care transitions
- Motivational Interviewing: Using specialized techniques to facilitate behavior change
- Cultural Adaptation: Modifying approaches for diverse patient populations
- Digital Interviewing: Conducting assessments via telehealth platforms
- Research Interviews: Collecting data for clinical studies and quality improvement
- Supervisory Assessment: Interviewing students and staff for performance evaluation
Pharmacist's Work-up of Drug Therapy
A comprehensive assessment framework (Cipolle et al, 1998) including: demographics, family history, past medical history, current problems, allergies, lifestyle factors, immunization history, medication record, and review of systems. This represents the gold standard for thorough medication therapy assessment.
Critical Thinking Questions for Graduate Discussion
- How might interviewing techniques need to be adapted for patients with cognitive impairments, limited health literacy, or language barriers?
- What ethical considerations arise when documenting sensitive information in shared electronic health records accessible to multiple providers?
- How can pharmacists balance thorough assessment with time constraints in various practice settings (community, hospital, clinic)?
- In what ways might emerging technologies (AI, natural language processing) transform patient interviewing and assessment in pharmacy practice?
- How does cultural competence specifically impact questioning techniques and interpretation of patient responses in clinical interviews?
