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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