Keeping Teachers Healthy

Preventive health care should be woven into every aspect of our lives. Creating a healthier self can help guarantee better health care—related outcomes and quality of life. By eating healthier, being active, staying on top of wellness screenings, and maintaining a healthy environment, everyone has an equal chance to be their best self.

The corner pharmacy is a hub for clinical preventive services. Pharmacists can play a big role in keeping patients safe and helping them identify conditions early, potentially preventing hospitalizations and unnecessary visits with other health care providers. Pharmacists can also offer vaccines, screenings, and services, such as medication therapy management (MTM), that can reduce costs and financial burden.

The Case

PK is a 31-year-old woman who is a frequent customer at your pharmacy. She is a teacher at the local elementary school, and her husband is a teacher at the middle school. During counseling sessions, PK often mentions sick students in her classroom and how she needs to do a better job of helping her students understand the importance of hand washing.

PK says she seems to always be stocking up on hand sanitizer. She laughs about how frequently she gets the flu, but she is serious about what a nuisance it is. Each year, she can predict when she and her husband will become debilitated with an illness. Missing work is a hard financial consequence. PK loves to embrace the children in her classroom and assist them in their activities, but she knows she has to do a better job at preventing illness for everyone’s sake.

Today, PK stops in the pharmacy to pick up her refill prescriptions for her epinephrine injection and albuterol inhaler. When you ask how she is doing, she does not give you her typical smile and you notice she is not her usual high-spirited self. School has started, and you notice PK coughing and blowing her nose. You counsel her on the medication refills and quickly explain the concept behind brown bag and MTM sessions.

You are actively trying to do more comprehensive medication reviews and stress the value of preventive services your pharmacy can offer. You tell PK that she would be an ideal candidate for a brief consultation because she suffers from asthma, has allergies, and is at high risk for illness due to her workplace. You ask PK if she would be interested in bringing in all her medications and reviewing them with you for proper use. PK says she is not feeling well again and would be happy to have your attention. She sets up an appointment with you for the next day.

To prepare for the session, you pull up PK’s active pharmacy profile, which lists the following:

• Albuterol inhaler: 1 or 2 puffs every 4-6 hours, as needed
• EpiPen (epinephrine injection): inject as directed during an attack
• Fluticasone propionate 250 mcg/salmeterol 50 mcg Diskus twice daily
• Ibuprofen: 600 mg every 6-8 hours, as needed for pain

PK arrives for her appointment and empties her brown bag, which includes the following additional medications:

• OTC famotidine 20 mg twice daily
• Azithromycin 500 mg daily for 3 days (filled 2 months ago; 1 pill remaining)
• OTC cetirizine 5 mg/pseudoephedrine 120 mg every 12 hours, as needed
• Adult multivitamin with iron once daily
• OTC omeprazole 20 mg once daily
• OTC loratadine 10 mg daily
• OTC brand Advil (ibuprofen) 200 mg, as needed
• Amoxicillin/clavulanate 875 mg/125 mg every 12 hours for 7 days (filled 4 months ago; 4 pills remaining)

As you review the medications for accuracy and adherence, PK tells you about her new throat pain, which makes swallowing difficult. You mention that your pharmacy has a nurse practitioner (NP) on staff, and you recommend that PK make a drop-in appointment after your counseling session.

Because PK has a history of sinus infections and strep throat, you want to make sure she gets proper attention and testing. You ask if she has any other symptoms, and she claims her medications only seem to provide temporary relief. Her quality of life is not ideal, and she wants to be happy and energetic around her students. However, when you ask PK if she takes her medications as prescribed or if she asks enough questions about how to use prescription or OTC medications, she says she does not and that she prefers make treatment decisions on her own. To make her decisions, she uses the Internet and what she hears from other teachers.

When you ask PK about her goals, she tells you she does not want to be sick, miss school, or get her husband sick. PK admits that her health care providers have not recommended many of the OTC medications she takes, and they are not aware she is taking them. PK has never received an annual flu shot and is not up-to-date on her vaccinations. PK does have a consistent primary care physician, but explains that using him as a primary resource is inconvenient. It is hard to get appointments, and PK has a high insurance deductible.

Because of your brown bag session, PK is very interested in participating in the MTM session you offered to help further investigate some of her issues and concerns. In the meantime, she will see your pharmacy’s NP. Stay tuned...

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. Read and enjoy!