Specialty Care in the Community

Brown bag counseling sessions do not have to be time-consuming or burdensome. They may be offered to select patients whom you identify as potential beneficiaries of extra counseling. Patients suffering from chronic autoimmune diseases can be particularly amenable to brown bag sessions and medication therapy management. By offering to review a patient’s medications, the pharmacist provides an opportunity to better connect with the patient and develop interpersonal skills essential for any community pharmacist. Ideally, brown bag sessions allow you to educate the patient and assess any safety and quality-of-care concerns. Plus, the sessions are an excellent way to foster the pharmacist—patient bond.

Managing Psoriatic Arthritis

PM is a 44-year-old male. He and his family have been filling their long- and short-term medications at your pharmacy for a few years. During that time, PM was diagnosed with psoriatic arthritis and has had many ups and downs.

When PM arrives at the pharmacy today, you note that he appears more depressed and lacks his usual positive energy. He appears frustrated with his therapy, its adverse effects, and the financial impact of his treatments and condition.

You ask PM if he would be interested in participating in a brown bag consult. You explain that a comprehensive review of his medications will allow maximization of his prescriptions, ensure safety, and possibly reduce his financial burden. PM appreciates your advice and offer. He schedules a time to meet with you and asks if he can bring his wife, because she helps him with his medications. PM agrees to bring in all of his medications, which you will review with him in detail.

Upon reviewing PM’s medication profile, you discover the following:

• Atorvastatin 20 mg daily

• Amlodipine 10 mg daily

• Ibuprofen 600 mg every 12 hours as needed

• Celecoxib 200 mg every 12 hours

• Etanercept 50 mg weekly

When PM and his wife arrive for the appointment, you note the following additional medications and supplements in his brown bag:

• OTC multivitamin daily

• OTC ibuprofen 200-mg tablets

• OTC acetaminophen 500-mg tablets

• Prednisone 5 mg as directed; last filled more than 1 year ago by a competing pharmacy

• OTC famotidine 20-mg tablets

• OTC calcium carbonate 500-mg chews

• OTC loratadine 20 mg daily

• OTC aspirin 325 mg daily

After reviewing PM’s medications and supplements, you realize that PM would benefit from a more extensive counseling session. Because you are unexpectedly pressed for time, you schedule a follow-up appointment. You would like to further communicate with PM’s health care providers, obtain lab values, and evaluate PM’s medical goals, especially those relating to his psoriatic arthritis. This research will help you provide more in-depth disease state education to PM, as he requested. In the meantime, you have the following questions and suggestions regarding his current medications and health:

• PM is taking many OTC medications on a regular basis. It appears that he is self-treating and managing adverse effects that may be due to his prescribed medications. You offer to help PM get in touch with his providers so they can professionally assess his health.

• PM’s wife admits to you that PM has missed numerous physical therapy sessions and has even postponed recommended surgery for his arthritis. She also expresses her concerns about her husband’s diet and lack of physical activity. Stress regarding his condition and the cost of treatment are starting to take a mental and financial toll. PM tells you that these factors are affecting his adherence and overall quality of life. You suggest to PM and his wife that they get in touch with their primary health care provider to discuss available support options.

• PM may be taking too much ibuprofen through his OTC and prescription medications. You counsel him on the daily recommended dose of ibuprofen and the potential adverse effects of excessive use.

• PM has not had his cholesterol levels checked in more than a year. You take 3 blood pressure readings, all of which indicate an elevated level. You suggest to PM that he contact his primary health care provider about obtaining new lab data to ensure that the doses of his medications are correct.

What else would you suggest to PM before his extended counseling 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. Her blog, Compounding in the Kitchen, appears on www.PharmacyTimes.com.