How Brown Bagging Can Bring Clarity

Patients who suffer from chronic conditions may be at a higher risk for medical-related errors and adverse events. These patients take a number of different medications, visit a variety of health care providers, and may use more than 1 pharmacy. Refill medication counseling is an excellent opportunity for pharmacists to identify patients who are vulnerable to medical-related problems.

Pharmacists can offer brown bag consults to patients as an introduction to more extensive counseling, such as medication therapy management (MTM). These consultations are also essential safety and educational tools pharmacists can use to measure and ensure quality care. By asking patients to gather their current medications, including OTC, mail order, specialty, and herbal products for review, pharmacists can ensure up-to-date and appropriate care.

Pharmacists are key providers in the continuum of care, consistently helping to identify potential prob- lems and concerns that may require additional follow-up with prescribers or an MTM session. Brown bag consults can do the following:

• Show how well patients understand their condi- tions and medications.
• Provide insight into a patient’s lifestyle and quality of care.
• Develop the patient—pharmacist relationship to help guarantee patient loyalty and trust, medical error prevention, and better individualized services. Incorporating brown bag consults into your workflow is essential.

THE CASE

KM is a 53-year-old overweight female who is a relatively new customer to your pharmacy. She is a stay-at-home mother who also organizes events as a volunteer at her community center. KM has become more aware of her weight issue and prescribed medications in light of a recent serious health scare involving a family member and stories on TV regarding health care changes.

You notice her growing concern because she has more questions during your counseling sessions, specifically related to her heart, diet, and finances. Today, KM stops in the pharmacy to pick up her late prescription refill for levothyroxine. You counsel her on potential misuse and explain what a brown bag session is. You tell her that due to her chronic disease states, she would be an excellent candidate to participate in a review. You ask her if she could bring her medications to the pharmacy and review them with you for proper use.

KM is happy to have your attention. She explains that she gets confused trying to keep her medications straight and is sometimes embarrassed to ask questions, so she turns to the Internet instead. KM admits that she cannot afford a hospitalization like the one her family member recently had. She schedules an appointment to meet with you tomorrow.

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

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

KM arrives for the appointment, and you notice these additional medications in her brown bag:

• OTC aspirin 325 mg once daily
• Calcium carbonate 1000 mg once daily
• Adult multivitamin once daily
• OTC omeprazole 20 mg once daily
• OTC fish oil 4 capsules daily
• Expired clopidogrel 75 mg once daily, last filled at competitor’s pharmacy 3 years ago
• Expired Crestor (rosuvastatin) samples

As you review the medications for accuracy, KM admits to no longer having a primary care provider she trusts, so she relies on urgent care clinics or emergency departments to monitor her medication refills. KM cannot remember the last time she had laboratory work performed. She has been monitoring her blood pressure more frequently at your pharmacy using a free kiosk and has questions about blood pressure goals and a heart-healthy diet.

You teach KM how to properly take her blood pressure, and she purchases a cuff for home use. She says she is grateful for this review because she has been using the machine incorrectly. While obtaining a thorough medical history from KM, you discover she has a cardiac stent and has not seen a cardiologist for more than 3 years. Therefore, she is interested in participating in the MTM session you offered.

How would you review KM’s medication profile, and what advice could you offer her during the brown bag session? KM needs to find a regular health care provider in her community to help her effectively manage her conditions. Because of her cardiac disease, she should also find a cardiologist. Your referrals are critical to KM’s long-term health.

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 PharmacyTimes.com/blogs/compounding-in-the-kitchen.