The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview...

28
The Patient-Centered Interview Joanna Katzman, MD, MSPH Created by George D. Comerci, Jr. MD, FACP, DAAPM

Transcript of The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview...

Page 1: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

The Patient-Centered Interview

Joanna Katzman, MD, MSPH

Created by George D. Comerci, Jr. MD, FACP, DAAPM

Page 2: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Financial Disclosures

NONE

Page 3: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Learning Objectives

At the end of this presentation the participant will:

• Describe the difference between a patient-centered and clinician-

centered interview.

• Describe the 5 Step Interview Model of Smith

• Explain several important interviewer activities that occur during each

step of the “Model”

• Describe important elements of the physician portion of the interview

of the patient with pain

Page 4: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

5

“The interview is the most powerful, encompassing and versatile instrument available to the physician”

George L. Engel

Page 5: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

The Interview (Smith.2002)

A vehicle for the exchange of information between patient and clinician

The greatest amount of information comes from the interview

The interview generates data essential to diagnosis, treatment and prevention

The interview determines how the patient-clinician relationship evolves

Page 6: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Clinician Centered Interview

The clinician is in control

Elicits only 6% of problems that ultimately are determined to be psychosocial in nature

Data elicited is dependent upon the clinician not the patient (thus data is skewed)

Page 7: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

8

Clinician interrupts the patient before they complete their opening statement 69% of the time

This occurs after a mean time of 18 seconds

(Beckman.1984)

Page 8: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

The Biopsychosocial Model is the basis for the Patient Centered Interview

The integration of psychological and social aspects of a person with the biologic aspects

Encourages the patient the patient to express what is most important to them

Relationship-Centered

Page 9: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Advantages of the Patient Centered Interview

Higher patient satisfaction

Higher patient compliance and recall

Decreased doctor shopping

Decreased malpractice

Improved health outcomes

Page 10: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Five Step Model of Smith Smith, RC. Patient Centered Interviewing.2002. Williams and Wilkins. Phila., Pa.

1. Set the stage for the interview

2. Obtaining the Agenda (Chief complaint and other concerns)

3. Opening the HP[pain]I

4. Continuing the Patient-Centered HPI

5. Transition to the Doctor Centered Process

Page 11: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Step 1: Set the stage for the interview

Welcome the patient

Use the patient’s name

Introduce yourself and your role

Ensure patient readiness and privacy

Remove barriers to communication

Ensure comfort and put the patient at ease

Page 12: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Step 2: Obtaining the Agenda The chief complaint and other concerns

(Indicate time available)

(Indicate own needs)

Obtain a list of the patients concerns

“what else, what else”

Summarize and finalize the agenda

Negotiate items, prn

Page 13: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Step 3: Open the History of Present Illness

Liberally use open ended questions

Liberally use facilitation skills

Obtain additional information from non-verbal sources

Page 14: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Patient Centered Interview: Facilitating Skills and the Five Step Model

Facilitating Skills

Questioning Skills

open ended vs. closed questions

use of non-verbals: (silence, nodding, “uh’huh”)

Relationship Building Skills

Emotion-seeking

Emotion handling

Page 15: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Pain History

7 Dimensions of a Pain Symptom

• Location

• Radiation

• Modifying factors (what makes pain worse/better)

• Temporal factors (when does pain occur)

• Severity of pain

• Quality of Pain

• Associated symptoms

Page 16: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Pain History (cont.)

Functional Aspects

How is pain affecting the patient’s life?

What is the patient unable to do that he/she could previously

do?

What does the patient think is causing the pain ?

What fears does the patient have regarding the pain?

What impact is pain having on relationships:

With family/partner/spouse/employer?

Page 17: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Pain History (cont)

Prior Treatments

Injections/Interventions

PT

CAM

Surgeries

Chiropractic, massage, myofascial therapy

Etc.

Page 18: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Psychological History

Adverse Childhood Events

Current and past psychological problems

PTSD

Depression

Bipolar Illness

Suicide attempts

Treatments

Page 19: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Step 4: Patient Centered HPI

Physical Symptom History

Personal Story

Emotional Story

Expand the Story to new chapters

Page 20: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Step 5: Transition to the Clinician Centered Portion of the Interview

Summarize

Check for Accuracy

Note your transition to a new phase of the interview process

Page 21: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Physician-Centered Portion of the Interview

PMH

Meds/Allergies

Social History

Family History: addictions

Review of Systems

Establish Goals of Therapy

Page 22: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

PMH

Past Medical Problems

Current Active Medical Problems

Past Surgeries

OBGYN History

Medications

Allergies and Medication Intolerances

Page 23: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Social History

Drugs

Alcohol

Tobacco

Criminal history

Living situation

Support system

Occupation

Workman's Comp, Disability, Litigation

Page 24: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Family History

• Usually first degree relatives

• Must inquire about addiction and alcoholism

Page 25: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

ROS

• General/Constitutional

• Neurologic

• Psychological

• Musculoskeletal

• Digestive

• Urologic

• Endocrinologic

• Vascular

• Hematologic

• Rheumatologic

• Cardiovascular

• Upper Respiratory and Pulmonary

Page 26: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Establish Goals of Therapy

What can you, the clinician, reasonably be expected to do?

What barriers does the patient perceive?

What is patient’s confidence level?

What would the patient like to accomplish if pain could be

better controlled?

Short term?

Long term?

Page 27: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Summary

The difference between the clinician-centered interview and the patient centered interview

The Five Step Process

Facilitation skills

The clinician centered process

Page 28: The Patient-Centered Interview - ihs.gov€¦ · Advantages of the Patient Centered Interview Higher patient satisfaction Higher patient compliance and recall Decreased doctor shopping

Patient-Centered Care:

Patient-Centered Care:

NCI patient centered care in cancer patient

NCI patient centered care in cancer patient

Patient-Centered EMR Communication

Patient-Centered EMR Communication

Patient-Centered Narrative Interviewing

Patient-Centered Narrative Interviewing

The Patient-Centered Medical Home Centered Medical Home · The Patient-Centered Medical Home Centered Medical Home ... past to the Patient-Centered Medical Home ... Family Med, Gen’l

The Patient-Centered Medical Home Centered Medical Home · The Patient-Centered Medical Home Centered Medical Home ... past to the Patient-Centered Medical Home ... Family Med, Gen’l

PATIENT-CENTERED CARE Annotated Bibliographyqsen.org/docs/Patient-Centered-Care-CONSOLIDATED...PATIENT-CENTERED CARE Annotated Bibliography Aled, J. (2007). Putting practice into teaching:

PATIENT-CENTERED CARE Annotated Bibliographyqsen.org/docs/Patient-Centered-Care-CONSOLIDATED...PATIENT-CENTERED CARE Annotated Bibliography Aled, J. (2007). Putting practice into teaching:

Patient Centered Primary Care Collaborative · erogers@pcpcc.net Patient Centered Primary Care Collaborative and the National Patient Centered Medical Home Movement Table of Contents

Patient Centered Primary Care Collaborative · [email protected] Patient Centered Primary Care Collaborative and the National Patient Centered Medical Home Movement Table of Contents

Patient Centered Medical Home: Patient Provider Agreement

Patient Centered Medical Home: Patient Provider Agreement

Imlementing patient centered Quality management Patient-Centered Quality... · 2021. 6. 21. · Implementing Patient-Centered Quality Management 3. primary PSAP, which needs to correctly

Imlementing patient centered Quality management Patient-Centered Quality... · 2021. 6. 21. · Implementing Patient-Centered Quality Management 3. primary PSAP, which needs to correctly

Progress from the Patient-Centered Outcomes Research ...€¦ · Progress from the Patient-Centered Outcomes Research Institute ... PATIENT-CENTERED OUTCOMES RESEARCH INSTITUTE ...

Progress from the Patient-Centered Outcomes Research ...€¦ · Progress from the Patient-Centered Outcomes Research Institute ... PATIENT-CENTERED OUTCOMES RESEARCH INSTITUTE ...

Person-Centered Design, Patient-Centered Healthcare

Person-Centered Design, Patient-Centered Healthcare

The Beginning of the 3 Interview: Patient- Centered Interviewing...5-Step Patient-Centered Interviewing Step 1: Set the stage for the interview (30–60 s) 1. Welcome/greet the patient

The Beginning of the 3 Interview: Patient- Centered Interviewing...5-Step Patient-Centered Interviewing Step 1: Set the stage for the interview (30–60 s) 1. Welcome/greet the patient

Getting started with Patient-Centered Medical Home … started with Patient-Centered Medical Home ... Getting started with Patient-Centered Medical Home ... Flow diagram of referral

Getting started with Patient-Centered Medical Home … started with Patient-Centered Medical Home ... Getting started with Patient-Centered Medical Home ... Flow diagram of referral

Advisory Panel on Patient Engagement - Patient Centered

Advisory Panel on Patient Engagement - Patient Centered

Patient-Centered Consent

Patient-Centered Consent

Patient-Centered Benefit-Risk Assessment (PCBR) - …mdic.org/wp-content/uploads/2014/06/Patient-Centered-Benefit-Risk... · Patient-Centered Benefit-Risk Assessment (PCBR) ... •

Patient-Centered Benefit-Risk Assessment (PCBR) - …mdic.org/wp-content/uploads/2014/06/Patient-Centered-Benefit-Risk... · Patient-Centered Benefit-Risk Assessment (PCBR) ... •

A Framework for Patient-Centered Communication in Cancer … · Patient-Centered Communication in Cancer Care O ... management These functions ... A Framework for Patient-Centered

A Framework for Patient-Centered Communication in Cancer … · Patient-Centered Communication in Cancer Care O ... management These functions ... A Framework for Patient-Centered

Patient centered care rvsd

Patient centered care rvsd

PATIENT-CENTERED CARE RESOURCE COMPENDIUM...PATIENT-CENTERED CARE RESOURCE COMPENDIUM (A Companion to the Patient-Centered Care Improvement Guide) November 2008 This Resource Compendium,

PATIENT-CENTERED CARE RESOURCE COMPENDIUM...PATIENT-CENTERED CARE RESOURCE COMPENDIUM (A Companion to the Patient-Centered Care Improvement Guide) November 2008 This Resource Compendium,

PATIENT-CENTERED INTERACTIONS

PATIENT-CENTERED INTERACTIONS