Patient Assessment Checklist

Patient Assessment Checklist

Description: 
Before starting office-based buprenorphine treatment, the following Patient Assessment Questions should be answered for each patient. Topics addressed in these questions include: Diagnosis, Medications, Drugs/Alcohol, Psychiatric and Medical Comorbidities, Psychosocial Issues, Treatment, Patient Management, and Resources.

Diagnosis

Does the patient have a diagnosis of opioid dependence?

  • Approximately how long has the patient been dependent?
  • On which opioid(s) is the patient dependent, and how is the drug ingested?
  • How much of the drug does the patient use daily/weekly?

Other Medications

Is the patient currently abstaining from medications that may interact with buprenorphine?

  • Is the patient taking benzodiazepines? If so, what is your plan for tapering use?
  • Is the patient taking other prescription drugs that may interact with buprenorphine?

Other Drugs/Alcohol

Does the patient use other illicit drugs?

  • Is he/she dependent on other drugs and/or alcohol? If so, what others?
  • Does the patient drink alcohol? If so, approximately how many drinks a day/week?

Psychiatric Comorbidities

Is the patient psychiatrically stable?

  • Does the patient have any other psychiatric diagnoses besides opioid dependence? If so, are the other conditions being treated by you? By another professional?
  • What is the patient's history of psychological problems, including past substance abuse?
  • Does the patient exhibit suicidal/homicidal ideation?

Medical Comorbidities

What chronic or acute medical problem does the patient have that might complicate treatment?

  • Are these conditions related to drug use (hepatitis B, hepatitis C, HIV)?
  • Do you expect the condition to complicate treatment?
  • Is the patient pregnant?

Psychosocial Issues

Are the psychosocial circumstances of the patient stable and supportive?

  • Does the patient have healthy family relationships?
  • Does the patient have supportive friendships?
  • Is the patient employed?
  • Does the patient have a stable living environment?
  • Are others in the patient's life substance abusers?

Anticipated Success of Treatment

Is the patient interested in office-based buprenorphine treatment?

  • Is this the patient's first attempt at buprenorphine treatment?
  • What is the patient's treatment history (success and failures, type of treatment)?
  • Is the patient at risk for a difficult induction to buprenorphine?
  • Is there a high risk for severe withdrawal?
  • Is there a high risk of relapse?

Patient Management

Is the patient expected to be compliant with treatment?

  • Does the patient keep appointments and arrive promptly? Can you ascertain the patient's patterns with other treatment providers?
  • What stage of change is the patient in (contemplation or higher)?
  • Is the patient expected to follow safety procedures?

Resources

Can the office, either on site or through referral, provide the needed resources for the patient?

  • Do you employ or can you refer the patient to a drug abuse (psychosocial) counselor?
  • Are you familiar with other, good psychosocial services in your area?
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