PRACTICE PEARLS

 

Fam Pract Manag. 2021 Jan-Feb;28(1):36.

TRY THIS MENTAL STATUS EXAM FOR TELEHEALTH VISITS

Many of us are doing more telehealth visits during the COVID-19 pandemic. But when those visits call for a mental status exam, things can get tricky. The Mini-Mental State Examination, Montreal Cognitive Assessment, and St. Louis University Mental Status Exam all require reading and writing, which are difficult to do via telehealth.

Instead, I use an old but validated 10-question screen: the Short Portable Mental Status Questionnaire (SPMSQ). It includes 10 standard questions with no need for the patient to write or read, which makes it a very useful test in hospitals, in nursing homes, and via telephone or telehealth visits. The SPMSQ gives an overall score of 0–10, and I usually note the questions patients got right if they missed most of them, or the ones they missed if they got most right.

Documenting the patient's correct or incorrect answers can help indicate the complexity of the medical decision making or the extended time required for the visit, and support higher level coding.

For patients who do poorly on the SPMSQ, I usually estimate the Glasgow Coma Scale to get a quantitative estimate of their verbal and command-following abilities. If mood is a consideration, the Patient Health Questionnaire-2 is a quick screen that also produces a numerical score.

USE PERSONAL STORIES TO PREPARE PATIENTS FOR A COVID-19 VACCINE

Multiple COVID-19 vaccine manufacturers have now received, or will soon receive, Food and Drug Administration (FDA) emergency use authorization, fore-shadowing a potential path out of the pandemic. But polls have shown a significant percentage of Americans are hesitant to get a COVID-19 vaccine, which could delay or even prevent the United States from reaching immunization levels

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Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Send us your best pearl (250 words of less), and you'll earn $50 if we publish it. We also welcome questions for our Q&A section. Send pearls, questions, and comments to fpmedit@aafp.org, or add your comments below.

 
 

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