What is the outline for patient interviews for diabetes or warfarin management?

Comprehensive Patient Interview Outline for Diabetes and Warfarin Management

A structured, comprehensive patient interview is essential for effective documentation and management of patients with diabetes or on warfarin therapy to optimize mortality, morbidity, and quality of life outcomes. 1

Diabetes Management Interview Structure

Disease Characteristics and Glycemic Control

• Current glycemic control
  • Recent A1C values and trends
  • Blood glucose monitoring patterns (frequency, timing, results)
  • Patient's understanding and use of glucose data
  • History of hyperglycemic crises (DKA episodes, frequency, severity, causes)
  • Hypoglycemia awareness, frequency, causes, and timing of episodes 2

Treatment Regimen

• Current medications
  • Insulin type, dosage, timing (if applicable)
  • Oral agents and adherence
  • Medication-taking behavior including rationing of medications/supplies
  • Medication intolerance or side effects
  • Review of previous treatment regimens and response 2, 1
• Technology use
  • Insulin pump settings and use (if applicable)
  • CGM data and utilization
  • Use of health apps, online education, patient portals 2

Complications Assessment

• Microvascular complications
  • Retinopathy: vision changes, last eye exam
  • Nephropathy: kidney function, urinary symptoms
  • Neuropathy: sensory symptoms, foot lesions, autonomic symptoms 2
• Macrovascular complications
  • Coronary heart disease: chest pain, shortness of breath
  • Cerebrovascular disease: stroke symptoms
  • Peripheral arterial disease: claudication, decreased walking speed 2, 1
• Foot health
  • History of foot ulcers or amputations
  • Current foot symptoms
  • Foot care practices 2

Lifestyle Factors

• Eating patterns and dietary adherence
• Physical activity habits and exercise tolerance
• Weight history and changes
• Sleep patterns and possible sleep apnea symptoms
• Tobacco, alcohol, and substance use 2

Psychosocial Assessment

• Diabetes-related distress
• Symptoms of depression or anxiety
• Social support system
• Financial concerns affecting diabetes management
• Impact of diabetes on quality of life 1

Preventive Care

• Vaccination history
• Last dental visit
• Last dilated eye examination
• Recent specialist visits 2

Warfarin Management Interview Structure

Anticoagulation Status

• Current INR values and trends
• Target INR range based on indication
• Frequency of INR monitoring
• History of values outside therapeutic range 3
• Method of INR monitoring (lab, clinic, home testing) 4

Medication Management

• Current warfarin dose and regimen
• Adherence to prescribed regimen
• Understanding of dose adjustments
• Medication storage practices
• Use of pill organizers or other adherence aids 3

Bleeding Risk Assessment

• History of bleeding events (location, severity, management)
• Signs of current bleeding (bruising, gums, nose, urine, stool)
• Recent falls or trauma
• Upcoming procedures requiring anticoagulation management 3

Medication Interactions

• New medications (prescription, OTC, supplements)
• Changes to existing medications
• Understanding of potential interactions
• Use of NSAIDs or other high-risk medications 3
• Changes in glucose-lowering medications (may affect warfarin efficacy) 5

Diet and Lifestyle

• Vitamin K intake consistency
• Major dietary changes
• Alcohol consumption
• Physical activity changes
• Travel plans affecting monitoring 3

Comorbidity Management

• For patients with both diabetes and on warfarin:
  • Glycemic control status (may not directly affect INR but requires monitoring) 6
  • Changes in diabetes medications 5
  • Complications that might increase bleeding risk
  • Comprehensive medication review for interactions 7

Documentation Framework

Initial Visit Documentation

1. Chief complaint/reason for visit
2. Disease history
   • Diagnosis details and duration
   • Previous treatment approaches and responses
   • Complications history
3. Current management
   • Medication regimen with doses and timing
   • Monitoring practices and results
   • Self-management skills and knowledge
4. Physical examination findings
   • Vital signs including orthostatic measurements if indicated
   • Focused exam based on condition (foot exam for diabetes, signs of bleeding for warfarin)
5. Laboratory and diagnostic results
   • Recent A1C, lipids, renal function for diabetes
   • Recent INR values and trends for warfarin
6. Assessment
   • Current disease control status
   • Risk assessment
   • Identified barriers to optimal management
7. Plan
   • Medication adjustments
   • Monitoring recommendations
   • Education needs
   • Follow-up timing 2

Follow-up Visit Documentation

1. Interval history
   • Changes since last visit
   • Response to treatment modifications
   • New symptoms or concerns
2. Monitoring results
   • Blood glucose patterns or INR values
   • Patient's interpretation of data
3. Medication review
   • Adherence assessment
   • Side effects or concerns
   • Need for adjustments
4. Focused assessment
   • Disease control status
   • Progress toward goals
5. Plan updates
   • Medication or monitoring changes
   • Education reinforcement
   • Next follow-up 2

Communication Best Practices

• Use empowering, non-judgmental language
• Employ person-centered terminology (e.g., "person with diabetes" rather than "diabetic")
• Establish collaborative partnership in care planning
• Use teach-back method to confirm understanding
• Document specific, measurable, achievable goals based on patient priorities 1, 8

Special Considerations

• Assess social determinants of health (food security, housing stability, transportation access, financial security)
• Evaluate cultural factors influencing management
• Document patient's confidence in self-management abilities
• Identify areas where patient feels less confident 2, 1

This comprehensive interview structure ensures thorough documentation while focusing on factors most likely to impact morbidity, mortality, and quality of life for patients with diabetes or on warfarin therapy.