Combating Stress: How Brown Bagging Can Bring Clarity

Brown bag consults can be essential educational and safety tools to measure and ensure quality care. By asking patients to bring in all their current medications, including OTC, mail-order, specialty, and herbal products, pharmacists can guarantee appropriate and up-to-date care.

Pharmacists are key providers in the continuum of care, consistently helping to identify potential problems and concerns that may require follow-up with prescribers or a medication therapy management session. It is essential that a pharmacist’s work-flow allow for brown bag consults, which can do the following:

• Develop the patient—pharmacist relationship to help create better individualized service, forge patient loyalty and trust, and prevent medical errors
• Provide insight into a patient’s lifestyle and quality of care
• Show how well patients understand their conditions and medications

Because of their patient access, community pharmacists can provide frontline health education and screenings to women. Pharmacists can target women at increased risk for various diseases and help with early detection.

AM is a 42-year-old hardworking executive by day and an even harder-working mother by night. She stops into the pharmacy to refill her monthly prescriptions. You notice that AM seems tired and disorganized as she panics trying to find her new insurance card. When you say hello and ask how she is doing, she does not respond with a smile. AM seems hesitant to discuss the issue that apparently is causing her stress. Given the public setting, you choose not to press the issue. You refill AM’s prescriptions and notice that she is late refilling some of her medications. When you walk over to counsel her, she appears upset. AM says that she cannot seem to focus, is extra emotional lately, feels behind, and has a throbbing headache. You briefly explain the concept of a brown bag session. You tell AM that she would be an ideal candidate to participate in a brief review of her health and medication. You ask whether she would be interested in bringing in all her medications and going over them with you for proper use. Although AM initially says that she does not have time to participate, she is happy to have your attention and ultimately decides to. She sets up an appointment.

To prepare for the session, you pull up and print AM’s pharmacy profile so that you can compare it with what is in her brown bag:

• Propafenone, 3 mg, and ethinyl estradiol, 0.02 mg tablets, once daily
• Esomeprazole, 20 mg, daily
• Ibuprofen, 600 mg, every 6 to 8 hours as needed for cramps or stomach pains
• NuvaRing, prescription dated 5 months ago, on hold
• Retin-A Micro 0.06% gel, use as directed
• Vitamin D 1000 IU, daily

AM arrives for the appointment. She empties her brown bag, and you notice these additional medications:

• Adult multivitamin with iron, once daily
• Calcium carbonate, 500 mg, as needed
• Fluoxetine, 20 mg, daily (filled at a competitor’s pharmacy)
• OTC brand Advil (ibuprofen), 200 mg, as needed
• OTC ranitidine, 1500 mg, twice daily

As you review the medications for accuracy, AM tells you that she appreciates being able to talk to a pharmacist, adding that she always sees a pharmacist behind the computer or on the phone, and she does not want to be a bother. You thank her for her appreciation, but also tell her that counseling is part of your job and you are never too busy to help. AM says that has been under increased stress lately, as her child’s activity and school schedules have become more demanding, along with her daily responsibilities at work. AM has also not been sleeping well. she has been self-medicating because of her frequent headaches and stomach irritations. In addition, AM has not been maintaining a healthy diet, and admits to secretly eating a lot of junk food, and drinking more alcohol outside social settings. You ask about her headaches. AM says that her medications provide only temporary relief, and her quality of life is not what it was a year ago. When you ask her to describe her symptoms, she admits that her headaches and other health issues worsen before her irregular menstrual cycle. At times, nothing relieves the pain in AM’s forehead, except pressure and a dark room. You ask about her health and medication goals, and she tells you that she just wants relief so she can feel happy again.

You tell AM that her increased stress is likely the main contributing factor to her health issues. You tell her, however, that the symptoms surrounding her menstrual cycle concern you, and you would like her to follow up with her obstetrician/gynecologist. AM is taking more than the recommended amount of ibuprofen daily, and you express concern about her headaches and stomach issues. AM also cannot tell you the last time she had blood work drawn, and says she needs to find a new primary care provider. A return to healthy eating, regular exercise, and time management techniques will help reduce her stress. You also explain how lab work, and understanding her baseline numbers will give AM a fresh start on her health goals.

You encourage her to come into the pharmacy for additional counseling. You tell her that a community pharmacist can help manage her medications, assist in reducing health care and medication costs, and, most important to AM, reduce her stress level. You also mention that frequent communication with a community pharmacist can be a key step in preventing chronic issues. You tell AM that you can also recommend OTC remedies and set up affordable health screenings and vaccines. You emphasize that communication is essential in advancing a healthy lifestyle.

Editor’s note: Case is not based on an actual patient.

Jill Drury, PharmD, is a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin. She earned her doctor of pharmacy degree from Midwestern University College of Pharmacy.