The purpose of the patient interview and history is to learn about the well and the sick as they seek care (Ball, et al., 2019). The first meeting with the patient sets the tone for the interview and history process. Effective communication is paramount to build a positive patient relationship, and it is important to not become a barrier to effective communication. In this scenario, the patient is a forty-year-old, black, recent immigrant from Africa presenting without health insurance. The interview and history process will be tailored to the patientâ€™s background and lifestyle and differ with each patient to establish rapport. Establishing a pattern of open communication is key to eliciting courtesy towards the patient and their cultural norms, maintaining a sense of comfort, building connection, and establishing confirmation and attentiveness.
Social norms are large determinants of health to patients, and it is important to take this into consideration. A recent immigrant from Africa may be accustomed to a different precedent of â€œhealthâ€ than a patient whose nationality originated in the United States. Risk assessment instruments are important to include in the health history gathering process. A health risk assessment (HRA) is a questionnaire that evaluates lifestyle factors and health risks of an individual. There are many types of HRAs, and they can be used for different purposes. Data collected by an HRA is a critical component of understanding population health and provides health and wellness professionals the insights needed to make targeted and informed population health decisions. By gathering data right at the sourceâ€”from the individualâ€”wellness and population health professionals shape impactful programs based on information thatâ€™s often harder to gather than biometric data. When individuals complete an HRA it paves the way for them to make healthier lifestyle choices, because it gets them thinking about the risks they face and what they can do to change their lifestyle. Over time this shift in thinking translates to a shift in behavior.
A risk assessment tool that would benefit this patient is based on cardiovascular risk. Cardiovascular disease is the leading cause of death in the United States and is largely influenced by lifestyle decisions (Roth, Johnson, & Abate, 2018). Therefore, delving into the patientâ€™s lifestyle choices would prove beneficial in determining the state of their cardiovascular health. However, research is needed to identify how to convert modified risk perceptions and emotional responses into lifestyle behavior change (Soureti, 2010). Risk assessment tools allow early interventions by providers to recommend lifestyle modification or drugs to control modifiable CV risk factors, including hypertension, diabetes, smoking, dyslipidemia and obesity. The Systematic cOronary Risk Evaluation (SCORE) risk estimation is based on the following risk factors: gender, age, smoking, systolic blood pressure, total cholesterol, and estimates fatal cardiovascular disease events over a ten-year period (Hong, & Mainous, 2020). Highlighted features include patient history and progress management, patient list management, a graphical display featuring absolute CVD risk and risk factors contribution to total risk, intervention area, and printable patient advice.
Five targeted questions I would ask my patient to assess health risks and begin a building a health history:
- Are you troubled by financial questions about your medical care including insurance coverage? Are there any resources you believe would be of importance to you?
- Are there any cultural beliefs that I should know about to make your care more effective, or do your religious beliefs affect your healthcare decisions?
- What preventative measures do you participate in regarding health maintenance?
- What have you found to be your biggest health challenge?
- Do you have any hereditary conditions/diseases?
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Hong, Y.-R., & Mainous, A. G., III. (2020). Development and Validation of a County-Level Social Determinants of Health Risk Assessment Tool for Cardiovascular Disease. Annals of Family Medicine, 18(4), 318. https://doi.org/10.1370/afm.2534.
Soureti, A., Hurling, R., Murray, P., Mechelen, W., Cobain, M. (2010). Evaluation of a cardiovascular disease risk assessment tool for the promotion of healthier lifestyles, European journal of cardiovascular prevention and rehabilitation (17) 5, 519â€“523, https://doi.org/10.1097/HJR.0b013e328337ccd3
Roth, G. A., Johnson, C. O., Abate, K. H. (2018) Burden of cardiovascular diseases among US states. Global Burden of Cardiovascular Diseases Collaboration. 3(5), 375-389.