A Checkup Visit to the Pharmacy: How Brown Bagging Can Bring Clarity

Patients with chronic conditions may be at a higher risk for medical-related errors. These patients take a number of different medications, see a variety of health care providers, and may use more than 1 pharmacy. Often, patients experience short- or long-term changes in their health, possibly requiring adjustment of maintenance therapy. Community pharmacists may communicate consistently with patients to help provide necessary “checkups” or follow-up care. Refill medication counseling is an excellent opportunity for pharmacists to identify vulnerable patients. Asking open-ended questions about possible concerns or changes can help to determine whether further review is necessary.

Brown bagging provides a smooth introduction for a pharmacist to participate in and offer extended counseling concepts such as medication therapy management (MTM). Brown bagging is also an essential safety and educational tool that the pharmacist can use to measure and instill quality care within the health care system.

A brown bag checkup requires patients to gather all of their current medications, including OTC, mail order, or herbal products, into a “brown bag” The patient can then review these medications with the pharmacist, who can help identify potential problems or concerns that may require additional follow-up with the prescriber or can offer an MTM session. During the checkup, the pharmacist should first compare the medications in hand to those listed on the patient’s pharmacy profile. The pharmacist should then check for duplication of therapy and identify any interactions. Medications need to be verified for the correct dosage strength and frequency. The pharmacist should also identify whether the patient is using any outdated or discontinued medications. Giving patients an updated medication list at the end of the brown bag checkup can help ensure that patients will be able to share accurate information about their medications to any provider.

Participating in a brown bag checkup session not only helps a patient with a chronic condition but also is a useful safety tool for pharmacists to help access patient adherence. Brown bag checkups can show how well patients understand their conditions, medications and their purpose, and directions. These checkups provide insight into a patient’s lifestyle and quality of care as well as the opportunity to develop the patient—pharmacist relationship to help guarantee loyalty, trust, medical error prevention, and overall better individualized services.

Take the Brown Bagging Pharmacist Challenge: Heart Health

MM is a 59-year-old overweight woman who is a newer customer at your pharmacy. She is a former insurance adjuster who recently lost her job. In addition to job hunting, MM spends most of her free time worrying about the future. MM has become more aware of her disease states and medications in light of the numerous news stories regarding health care. You notice her growing concern by her increased number of questions during counseling sessions, specifically related to her heart, diet, and financial issues.

Today, MM stops in the pharmacy to pick up her new prescription for enalapril. You counsel her on the medication strength (as it has changed) and explain the concept of a brown bag session. You tell her that due to her chronic disease states, you believe she would be an excellent candidate for a review. You ask MM if she would be interested in bringing in all of her medications and reviewing them with you for proper use. MM is excited to have your attention. She explains that she feels confused trying to keep her medications straight. MM cannot afford a hospitalization. She schedules an appointment to meet with you tomorrow.

To prepare for the session, you pull up MM’s pharmacy profile to compare it with what is in her “brown bag”:

• Enalapril 10 mg once daily
• Furosemide 40 mg once daily every morning
• Atorvastatin 40 mg once daily every evening
• Fenofibric acid 135 mg once daily every evening
• Levothyroxine 25 mcg once daily every morning
• Esomeprazole 40 mg once daily
• Paroxetine 20 mg once daily

MM arrives the next day with pen and paper ready to create a list. She empties her brown bag, and you notice these additional medications:

• OTC aspirin 325 mg once daily
• Calcium carbonate 1000 mg once daily
• Valsartan 160 mg once daily
• Adult multivitamin once daily
• OTC omeprazole 20 mg once daily
• OTC fish oil 4 capsules daily
• Enalapril 5 mg tablets once daily, longer than 1 year
• Expired Crestor (rosuvastatin) samples

As you review the medications for accuracy, MM confides that, due to her limited budget, she is not always adherent to her medications or loyal to 1 pharmacy. She has been monitoring her blood pressure more frequently and has questions about her goals and diet. Thus, she is very interested in participating in the offered MTM session. How would you properly review MM’s medication profile, and what advice could you offer her during the brown bag checkup?

Dr. Drury works as a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin. She earned her doctor of pharmacy from Midwestern University College of Pharmacy. Her blog, Compounding in the Kitchen, appears on www.PharmacyTimes.com.