ATTITUDE, INTERPERSONAL SKILLS, & COMMUNICATION



Clinical Assessment of Primary Care Providers

Your name: _________________________________________________

Provider you are assessing: ____________________________________

His/her profession and title: _____________________________________

Institution: __________________________________________________

Observation dates(s): _______________ Today’s date: _______________

| |

|Preceptors and clinical observers: Please rate the provider you have just observed regarding the following abilities, knowledge, and |

|skills. Circle the appropriate number on a scale of 1–5 to the right of each assessment area. 1= needs significant improvement, training, |

|etc, 2= needs improvement, 3= average, 4= good, 5= excellent. If a particular area of this assessment does not apply to the provider you |

|are observing, leave the rating of that area blank. Include any comments or recommendations beneath the number scale for that item. Thank|

|you. |

|Attitude, Interpersonal Skills, & Communication |

|Showed respectful compassion and |1 2 3 4 5 |Comfort with patient despite |1 2 3 4 5 |

|good listening skills with |Comments |his/her HIV status or lifestyle | |

|patient, patient’s family and | | | |

|friends | | | |

|Provided care consistent with |1 2 3 4 5 |Demonstrated knowledge of how |1 2 3 4 5 |

|patient’s cultural beliefs | |mental and spiritual health | |

| | |impacts a patient’s attitude, | |

| | |quality of life, and capacity to | |

| | |adhere to treatment | |

|Willing to work with a team of |1 2 3 4 5 |Explained/educated patient about |1 2 3 4 5 |

|western, complementary, and | |how HIV/AIDS impacts immune system| |

|traditional healers | | | |

|Protected patient’s |1 2 3 4 5 |Provided information about HIV |1 2 3 4 5 |

|confidentiality | |testing in explicit, | |

| | |understandable language, | |

| | |including: benefits and | |

| | |consequences of testing, | |

| | |interpretation of test results, | |

| | |risk reduction for HIV | |

| | |transmission | |

|Obtained informed consent before |1 2 3 4 5 | Negogiating rather than coercive|1 2 3 4 5 |

|HIV testing | |with patients when making | |

| | |decisions | |

|Comfortable in discussing HIV risk|1 2 3 4 5 | |

|behaviors, i.e., explicit sexual | | |

|and drug-use behaviors | | |

|Diagnosis and Treatment Protocols and Guidelines |

|Understands and uses best |1 2 3 4 5 |Performed a comprehensive HIV/STI |1 2 3 4 5 |

|practices and protocols for HIV+ | |risk assessment using best | |

|patients | |risk-screening strategies for | |

| | |patient, clinic, and community | |

|Recognized and appropriately |1 2 3 4 5 |Assessed for worsening disease |1 2 3 4 5 |

|treated HIV-related opportunistic | |progression, e.g., assessing CD4 | |

|infections | |counts, viral loads, and symptoms | |

|Screened for HIV infection in |1 2 3 4 5 |Discussed importance of risk |1 2 3 4 5 |

|patients who have not been tested,| |reduction (e.g., condoms/safe | |

|including for signs and symptoms | |sexual practices, clean needles, | |

|and for history of exposure | |protection from occupational | |

| | |exposure | |

|Appropriately considered impact of|1 2 3 4 5 | |

|co-morbid conditions (e.g. | | |

|hepatitis, mental health, | | |

|substance abuse) on management of | | |

|patient’s HIV | | |

|Psycho-Social History |

|Screened for history of physical, |1 2 3 4 5 |Screened for substance use/abuse |1 2 3 4 5 |

|emotional, or sexual abuse | |(tobacco, alcohol, or other drugs)| |

| | |in a non-judgmental manner | |

|Properly reviewed past social and |1 2 3 4 5 | |

|medical history | | |

|Medication |

|Counseled ART treatment candidates|1 2 3 4 5 |Explored possible drug |1 2 3 4 5 |

|on initiation of ART including | |interactions and overlapping | |

|adherence and side effects | |toxicities among medications, | |

| | |supplements, and traditional | |

| | |remedies | |

|Made an appropriate recommendation|1 2 3 4 5 |Made sure patient was able to |1 2 3 4 5 |

|about beginning, continuing, | |understand medication labels and | |

|adjusting, or ending ART | |referrals | |

|Referrals and Follow-Up |

|Demonstrated understanding of when |1 2 3 4 5 |Made appropriate referrals, |1 2 3 4 5 |

|and where to refer patients to - or | |e.g., specialists, medication | |

|consult with - an HIV specialist | |counseling, special OB-GYN needs| |

|Encouraged patients to follow up |1 2 3 4 5 |Found resources for medication |1 2 3 4 5 |

|with referrals, appointments, | |support, day activities, etc. | |

|therapies, and medication | | | |

|Homeless Patient Evaluation and Treatment |

|(if applicable) |

|Determined if homelessness is |1 2 3 4 5 |Assessed patient’s social |1 2 3 4 5 |

|episodic or chronic, screened for | |support - family, friends, | |

|current living situation and contact| |counselors, shelter | |

|information | | | |

|Identified barriers to care, e.g., |1 2 3 4 5 |Took complete medical history, |1 2 3 4 5 |

|self-care skills, language, and | |including past visits with other| |

|dependable location to support | |healthcare providers and STI | |

|medication compliance, | |exposure | |

|transportation, and embarrassment | | | |

|with peers, medical staff, and | | | |

|community | | | |

|Performed or referred for |1 2 3 4 5 |Performed or referred for a | |

|nutritional and hydration assessment| |dermatological assessment, re: | |

| | |oral candidiasis, tinea pedis | |

| | |(athlete’s foot), corns, | |

| | |blisters, and ulcers | |

|Pregnant Mother Evaluation and Treatment |

|(if applicable) |

|Discussed risk of mother to child |1 2 3 4 5 |Explained the need for early |1 2 3 4 5 |

|HIV transmission including the | |OB-GYN and HIV-related medical | |

|prognosis for infected infants | |intervention services and made | |

| | |referral to appropriate | |

| | |clinician | |

|Explored reproductive options and |1 2 3 4 5 |Recommended testing for all of |1 2 3 4 5 |

|alternatives to breast-feeding | |mother’s other children (even | |

| | |those who are asymptomatic) | |

Based on:

1. Materials written by M.F. Annesse for HRSA Grant 1 H4A HA 00051-01 at the University of Washington, Northwest AIDS Education and Training Center, Seattle, WA (latest revision: October 2004)

2. Public Health – Seattle and King County: health/basic/

3. U.S. Preventative Task Force, guidelines./gov.summary/summary

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