Reaching Patients Who Are Falling Through the Cracks

For patients without reliable primary care, a brown bag session can be a new beginning.

MP, a middle-aged woman, shared the following during your counseling session: “I don’t understand what all of these medications are treating. I take so many pills that I feel like I live at the pharmacy. I mostly pay out of pocket for my medications. I see the doctors when I’m supposed to, yet I never feel in tune with what is going on with my health. I know one thing: I’m not feeling better. The colors and shapes of these medications always seem to change, too. Are they supposed to? It’s so confusing! Every time I think I have it down, something changes or I have some reaction. I try to be responsible, but it’s difficult.”

Unfortunately, this refrain is all too common among patients. MP’s concerns are valid. Various referral sources have confirmed that she does keep appointments and routinely visits the lab for relevant testing. MP does pay out of pocket, but still picks up all her new and refill branded and generic medications. On the other hand, is she truly adherent if she does not know the names of her medications and what each medication is treating? It is the responsibility of both the provider(s) and the pharmacist to keep the patient informed as necessary.

Becoming a Source of Primary Care

It is important for MP to maintain an understanding of her ever-changing medications and possible interactions. Unfortunately, MP no longer has a primary care provider following the retirement of her trusted family physician. As a result, MP has confessed that she used the local emergency department once as she felt she had nowhere else to go.

As a pharmacist, you can make a difference by reviewing MP’s medication profile and stepping in as a hub of care. After your review, you learn that her referral sources are a variety of disease state specialists from various organizations. Your concern grows. With a number of specialists treating MP, you have to make yourself aware of potential overlapping or conflicting prescriptions. MP already is frustrated and confused, as there is an obvious breakdown in communication. You have the ability to counsel MP and get her back on track.

Restoring Communication

By offering a brown bag session to MP, you can gain her trust, reduce her frustrations, and help her live a healthier and simpler life. In your consult, you can describe possible services that can be offered in the pharmacy setting, including medication therapy management (MTM), screenings, and immunizations. Brown bag sessions allow pharmacists to demonstrate value to their patients, engage them in a meaningful way, nurture their needs as a patient, ensure that they are not being neglected, and inspire trust.

Without a comprehensive patient history or medical chart, performing a brown bag can fill you in on MP’s habits related to her prescribed medication. It can also give you insight on a referral source’s prescribing trends. By having MP bring in all her medications for you to look over, you discover the following:

• Acetaminophen, expired 1/2004
• Levothyroxine 100 mcg once daily
• Simvastatin 80 mg once daily
• Synthroid 75 mcg once daily every morning—not filled at your pharmacy
• Niaspan 1000 mg once daily at bedtime—not filled at your pharmacy
• OTC ibuprofen 200 mg
• OTC multivitamin once daily
• Enteric-coasted aspirin 81 mg once daily
• Aspirin 325 mg as needed
• Albuterol inhaler, expired 6/2012
• Clopidogrel 75 mg once daily
• Atenolol 25 mg once daily
• Diovan samples
• Levothyroxine 50 mcg once every morning

After looking at MP’s medications, what are your initial thoughts? Because a brown bag session is a quick tool used to help identify problems and areas for follow-up, an MTM session may be needed in this case to address MP’s medication regimen as well as her initial concerns.

Before an MTM session, determine who is prescribing each medication so you can direct questions to them or share concerns about MP’s treatment plan. What are some open-ended questions you may have for MP about her health and medications? Be sure to ask MP what her goal is in taking medications so that you can guide her in the correct direction.

What else would you suggest to MP before MTM session?

Dr. Drury works as a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin. She earned her doctor of pharmacy from Midwestern University College of Pharmacy in 2007. In addition to her current work, she is a blogger for PharmacyTimes.com and a speaker for Abbott Pharmaceuticals.