Medication Reviews Can Help Patients With Diabetes

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 identifying potential problems and concerns that may require follow-up with prescribers or a medication therapy management (MTM) session. It is essential that a pharmacist’s workflow allow for brown bag consults, which can do the following:

• Develop the pharmacist-patient 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

Offering to review medications one-on-one gives pharmacists the opportunity to connect with patients by serving as trusted medical professionals in the community. Brown bag sessions do not have to be time-consuming scheduled events. They can be offered anytime a pharmacist thinks that a patient needs follow-up care after a typical counseling session.

Patients should weave preventive health care into every aspect of their lives, as it paves the way for better outcomes and quality of life. By being active, eating more nutritious foods, maintaining a healthy environment, and staying on top of wellness screenings, individuals can be their best selves. The community pharmacy is a hub for preventive care and services. Pharmacists can play a big role in keeping patients safe and helping them identify conditions early, potentially preventing hospitalizations and unnecessary doctor visits. They can also offer vaccines, screenings, and services such as MTM that can reduce costs.

The opportunity gives the pharmacist a chance to connect with patients. By understanding what OTC and prescription medications a patient may be taking, in addition to any herbal supplements and vitamins, pharmacists can better assess quality of care and safety.

Patients with a diabetes diagnosis can benefit from medication reviews. A pharmacist’s involvement may help patients understand therapy and help increase adherence. Pharmacist intervention can also help with appropriate prescription of medications and ensure that patients are up-to-date on their laboratory work and vaccinations.

PS is a 68-year-old man who has been coming to the pharmacy for the past few years. Lately, he has seemed less interested in his health. PS no longer asks questions or engages in much counter conversation. You bring up his medication profile and notice that he has been nonadherent with some key medications that treat his diabetes.

PS appears physically exhausted, has lost some weight, and seems agitated. You ask whether he would be interested in participating in a brief medication review. You explain what happens during a brown bag consult and tell PS that you are interested in reviewing his medications and reeducating him, in turn allowing him to maximize their use and possibly detect any underlying issues. The review may also lead to a positive impact on his attitude, finances, and overall health. PS appreciates the opportunity to talk in depth, one-on-one. He schedules a time after his upcoming doctor’s appointment and says he will bring in all his medications and new laboratory paperwork.

Upon reviewing his medication profile at the pharmacy, you find the following:

• Atorvastatin, 40 mg, daily
• Furosemide, 80-mg tablet, daily
• Humalog mix 70/30, use as directed by endocrinologist
• Lisinopril, 40-mg tablet, daily
• Metformin, 1000 mg, twice daily
• OTC aspirin, 325 mg, daily

When PS comes in for his appointment, you notice the following additional medications in his bag:

• Albuterol inhaler, use as directed
• Bromocriptine, 1 mg, daily
• Digoxin, 0.125 mg daily, filled at competitor pharmacy
• OneTouch UltraMini meter and test strips
• OTC aspirin, 81-mg tablets
• OTC multivitamin, daily
• Used insulin (insulin + insulin glargine) vials, expired May 2019, unlabeled; filled at competitor pharmacy, according to PS

After reviewing the medications, you realize that PS would benefit from an MTM session, and you schedule a follow-up appointment. An MTM session will allow you to further communicate with his health care providers, review lab values in detail, and evaluate his medical goals. An MTM session will also allow you to offer detailed diabetes education, as requested by PS. In the meantime, you have some questions about his medications as well as suggestions:

• PS says that his inhaler does not seem to provide the relief it once did. He says that exercising and outdoor humidity make breathing difficult. PS adds that he uses the inhaler more than he should and that it sometimes gives him palpitations. You review his technique and notice he is not using the inhaler correctly. You show PS how to use the inhaler properly and suggest that he contact his prescriber regarding the albuterol inhaler. You wonder whether PS could have asthma or sleep apnea; if so, he may need proper care and education.
• His metformin directions instruct him to take 2 tablets daily. Yet when looking at the bottle, you notice that PS has too many tablets and his adherence has been sporadic. You ask him about this, and he tells you he was not following directions because of worsening diarrhea as an adverse effect. PS also feels arthritic pain and thinks he takes too many medications and is lethargic. He often skips days altogether and admits that his provider is unaware of this.
• You ask PS about his expired insulin vials and his blood sugar testing regimen. He says that he stopped using insulin on a regular basis without his provider’s knowledge and does not test his blood sugar on a regular basis. The cost of medications and supplies has hurt his adherence. You review his labs and notice changes in kidney function. You counsel PS on the importance of knowing his goals and numbers. You offer to help make a follow-up appointment with a diabetes nurse educator to help him get back on track with his diet, exercise, and medications. You also offer PS an opportunity to practice his injection technique so he can increase his comfort with needles.

What else would you suggest before the MTM session?

Jill Drury, PharmD, is a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin.