Combating Chronic Issues at the Corner Store

Planning brown bag consultations for your patients living with chronic diseases does not have to be a time-consuming scheduled event. You can also provide everyday assistance to select patients whom you believe need additional care following a counseling session. Offering to review a patient’s medications can give you, as the pharmacist, an opportunity to personally connect with a particular patient population. By reviewing prescription and OTC medications, herbal supplements, and vitamins, pharmacists have the opportunity to educate and assess safety and quality of care.

Type 2 Diabetes

Patients suffering from chronic diseases such as diabetes can benefit from suggested brown bag sessions and medication therapy management (MTM). A pharmacist’s involvement may aid in a patient’s understanding of therapy and help increase regimen adherence. Pharmacist intervention can also help with appropriate prescribing of medications, including angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, current vaccinations, and the use of aspirin therapy.

LO is a 72-year-old woman who has been coming to your pharmacy for the past 2 years. Over this time, you have noticed her become nonadherent to various drug regimens due to her multiple disease states. You also noticed in your last counseling session that LO does not have as much interest in her health as she has had in the past and that she appears physically exhausted. She seems depressed about her therapy, has gained significant weight, does not ask you questions, and seems stressed about the financial impact of her health.

You ask LO if she would be interested in participating in a brown bag session. You explain what happens during a brown bag consult and tell LO you are interested in reviewing and re-educating her on her medications. This will allow her to maximize their use. It may also have a positive financial impact and, ideally, improve her overall attitude and health. LO appreciates the opportunity to talk with you in depth, one-on-one. She schedules a time with you after her upcoming doctor’s appointment to bring in all of her medications and laboratory updates.

Upon reviewing LO’s medication profile at your pharmacy, you learn that LO is prescribed the following:

• OTC aspirin 325 mg daily
• Metformin 1000 mg twice daily
• Furosemide 40-mg tablet daily
• Lisinopril 20-mg tablet daily
• Atorvastatin 20 mg daily
• Isosorbide mononitrate 30 mg daily

When LO comes in for her scheduled appointment, you notice the following additional medications in her brown bag:

• OTC multivitamin daily
• OTC aspirin 81-mg tablets
• One Touch UltraMini meter and test strips
• Used insulin (insulin and insulin glargine) vials, expired 2/2015, unlabeled
• Various used and expired albuterol inhalers
• Digoxin 0.125 mg daily, filled at a competitor’s pharmacy
• Lipitor 20 mg daily, filled at a competitor’s pharmacy

After reviewing LO’s additional medications, you realize she would benefit from an MTM session and you schedule a follow-up appointment. An MTM session will allow you to further communicate with LO’s health care providers, review lab values, and evaluate LO’s medical goals. An MTM session also will give you the opportunity to offer detailed diabetes and congestive heart failure education, as requested by LO. In the meantime, you have some suggestions and questions surrounding her medications:

• LO admits that the inhalers are prescribed for her husband and she uses them to help her breathe better when she is walking and shopping. She admits that gaining weight has made it more difficult to exercise, sleep, and breathe. You suggest to LO that you contact her prescriber regarding the albuterol inhalers. You wonder if LO could be diagnosed with asthma or sleep apnea and, if so, she may need proper education and care.
• LO’s metformin directions instruct her to take 2 tablets daily. Yet, you notice that LO has too many tablets when you look in the bottle; her adherence has been sporadic. You ask her about this, and she tells you she was not following directions. To save costs, she cuts her pills in half or skips days altogether. She admits to you that her provider is unaware of her manipulation.
• You ask LO about her expired insulin vials and her blood sugar—testing regimen. She explains that she stopped using insulin on a regular basis without her provider’s knowledge and does not test her blood sugar on a consistent basis. The cost of medications and supplies has hurt her adherence. You educate her on the importance of knowing her numbers and goals. You offer to help make her an appointment and get her back on track with her medication, diet, and exercise. You also offer LO an opportunity to practice her injection technique so she becomes more comfortable with needles.

What else would you suggest to LO before her MTM session?

Dr. Drury works as a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin. She earned her Doctor of Pharmacy degree from Midwestern University College of Pharmacy. Her blog, Compounding in the Kitchen, an innovative amalgam of pharmacy and cooking, appears on www.PharmacyTimes.com/blogs/compounding- in-the-kitchen. Read, and enjoy!