Medication History Interview

• It is defined as the process of interviewing the patient about their medications, current or past, for the purpose of developing and planning ongoing pharmaceutical care.
• The most fundamental responsibility of a clinical pharmacist is to ensure each patient receives effective, safe and cost-effective drug therapy. Drug therapy review refers to the process by which a pharmacist reviews a patient’s medication regimen to ensure that the drug therapy meets these objectives. 
• This is a complex process that involves the assessment and interpretation of clinical information from a diverse range of sources. The review process draws upon the clinical pharmacists’ skills in pharmacotherapeutics, clinical pharmacokinetics, adverse drug reactions, drug interactions, interpretation of laboratory data and communication skills. For drug therapy review to be effective, these skills must be combined with sound clinical reasoning and judgment.
• Drug therapy reviews can take place in both hospital and community settings. In hospitals, drug therapy review can be undertaken at any time during the patient's admission, but is most commonly performed when the patient is admitted to the hospital, during the pre-ward round preparation and during ward rounds. 
• In an acute care setting, the daily review is desirable to keep up with changes in the patient's condition and drug therapy. Ideally, the pharmacist should follow the patient's progress from the day of admission until the day of discharge.
• As the first step in drug therapy review, pharmacists need to collect information that will assist them in determining the appropriateness of drug therapy. This includes the patient's age, sex, body weight, social history, current and recent medication, allergy and sensitivity status, presenting complaints, past medical history and results of relevant laboratory tests and other investigations. This enables the pharmacist to understand the patient's disease condition, the reason why certain drugs are being administered and the patient's daily clinical progress. 
• This understanding is the foundation for drug therapy review. Relevant information can be obtained from a variety of sources including case notes, medication charts, nursing notes, observational charts, and laboratory results and through discussions with medical and nursing staff and patient interviews.

• When patients are admitted to a hospital, medical staff document relevant information regarding the admission in the patient's case notes. This usually includes a list of medications that the patient is currently taking. This list may be inaccurate or incomplete, particularly in situations where medical staffs are overburdened with patients. 
• By speaking personally to patients about their medications, pharmacists are able to obtain further information which may be of importance to the ongoing medical management of the patients. Interviewing a patient about their medications also enables the pharmacist to establish a rapport with the patient, explain their role in patients’ overall care and commence preliminary counseling on medication use. The information obtained from the review can be used as a basis for planning ongoing pharmaceutical care.
• Ideally, a medication history should be taken for all patients. If this is not possible, priority should be given to those patients where maximum benefit is likely to occur. For example, patients with polypharmacy and those with multiple and chronic diseases may benefit more than patients treated with a single drug or for a self-limiting illness. 
• In some situations, medication history interviews may not be possible due to the patient's illness, some patients with psychiatric disorders or with dementia. In these situations, it is helpful to speak to the patient’s family member or caregiver.

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Aspects of Medication Use Which May Be Obtained From Medication History Interview

• History of previous allergies/ADRs.
• Purpose of drug use.
• Dosing regimen
• Perceived side effects
• Potential Drug-Drug/food interactions
• Treatment with other medicine systems
• Adherence to a drug regimen
• Social drug use
• The general attitude toward drug use and illness

The nature of the patient's medication history interview will depend upon the individual patient. Pharmacists should tailor their questions and discussion according to the information that is needed and the patient's ability to provide the information. 

Whenever possible, discussions regarding medications should be taken up with both the pharmacist and the patient handling the medication in question. This helps the patient to avoid the possibility of confusion about which medication is under discussion.

Steps Involved in Medication History Interview

1. Patient selection- Get the identity of the patient likely to benefit from the interview.
2. Self-preparation- Understand patients’ condition and therapy before starting the interview.
3. Introduction- Introduce yourself and explain the purpose of an interview.
4. Conduct interview- Obtain all relevant information by open- and close-ended questions.
5. Conclusion- Summarize important points and clarify if necessary.
6. Documentation-Document all data for future reference.

When interviewing patients for their medication history, pharmacists should follow the procedure outlined above. Long exhaustive interviews may be counterproductive, as some patients may become tired or distressed. Pharmacists should communicate with patients in a language that the patient can understand. 

It is important to pay close attention to what the patient is saying and tailor responses to his or her comments. Using open-ended questions rather than asking closed-ended questions encourages patients to give more details about their disease conditions and medications. Asking questions and receiving information in a nonjudgmental way is also useful.

At the end of the interview, the completeness of the information that has been completed should be assessed and any areas of uncertainty should be clarified. Patients should be asked if they have any questions related to their medications, which may encourage patients to provide more information that may not have been recalled during the interview. 

Following the interview, the list of medications should be compared with the medication chart for any discrepancies, and to help identify any drug-related problems.

Details of medication history are also required for some other purposes:

1. If a patient is on treatment with some other drugs, before declaring that the drug is not effective, one should be sure that the drug has been taken in adequate doses and for an adequate duration.
2. If the drug has been taken adequately (dose and duration) and the patient has not shown a satisfactory response, there is no meaning in continuing the same drug. He might require a change of drug or the addition of some other drugs. So the continuation of certain drugs without knowing how long he is taking them may lead to toxic effects particularly, the drugs that have low therapeutic windows like digoxin and anticoagulants.
3. There are some drugs that are to be continued for a long time like drugs for bronchial asthma, anti-epileptic drugs etc. Abrupt withdrawal of these drugs may lead to exacerbation of underlying diseases. Hence unless contraindicated, such types of drugs have to be discontinued irrespective of the type of present illness.
4. While taking the treatment history do not rely on the name of the drugs told by the patient, because often they do not tell them correctly. So always analyzing the prescription is better.
5. In the case of infants, it may be required to know the medications, the mother received during pregnancy and lactation.

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