COMPUTER ASSISTED PATIENT INTERVIEWING IN CLINICAL PHARMACY

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Clinical pharmacists are responding to the drug information explosion by participating more directly in patient care. Specifically, clinical pharmacists have become increasingly active in dispensing pharmaceutical information to patients, checking for patient compliance with their medication regimen, screening for adverse effects caused by single drugs and drug combinations, and sorting out possible complications between medications and food, allergies and chronic medical conditions. A collaborative project was initiated between the Computer Systems Laboratory and the Clinical Center Pharmacy Department to design and develop a computer system that could directly interview patients in order to collect medication histories and flag possible untoward effects related to medication regiments. It is believed that this "patient friendly" system, if successful, could truly "clone" the skills of clinical pharmacists. A computer interviewing system can accommodate many patients, making more pharmacist time available for patients who are not suitable candidates for direct computer interviewing. The system developed by CSL interviews patients to solicit medication regimen, medical conditions and symptoms, medication compliance, dietary history, occupational and environmental toxic exposure and other information needed to assess adverse drug reactions (ADRs) or interactions. At the end of the automated interview, the system produces a concise report for the attending physician. This year, the United States Pharmacopeial Convention Drug Information database was chosen for use with the interviewing system. Because the database contains adverse clinical effects in lay terminology, it enabled us to develop a lay terminology thesaurus to access the drug information. USP expects to use the thesaurus to standardize adverse effects terminology and eliminate redundant terms for describing the same effect. CSL also developed a machine-learned ADR detection and evaluation scheme using Delphi polling results obtained from 10 clinical pharmacists that is being integrated into the interviewing system.