Four life-changing MTM sessions: Crucial information patients
need
Pharmacist Cunningham argues for medication therapy management
expansion.
Through a post on healthreform.gov, Iowa’s Joe Cunningham,
BPharm, provided President Obama with first-hand accounts of
life-changing interventions with four of his patients. Through
medication therapy management (MTM) sessions, this recently retired
pharmacist helped many patients during his 34 years in practice.
“I have always felt a responsibility toward [my] patients to
manage not just the prescriptions I was dispensing, but all their
disease states and medications,” Cunningham wrote
on healthreform.gov. “Based on the [cases described here],
which were discovered in the process of dispensing prescriptions, I can
only imagine what [could be] found when focused on therapy review in the
context of current definitions of medication therapy management.”
Shown below are the four Cunningham provided showing how a
pharmacist’s care successfully changed a patient’s life.
Post your own stories on heathreform.gov, making sure to
send a copy of your message to Allison Wiley, APhA’s
Political Action Coordinator, for possible inclusion in
pharmacist.com’s “Stories Pharmacists Can Tell”
section.
Case A
As I was filling a prescription, a familiar customer approached the
counter. I greeted her and stated that I would be right with her. As I
finished up the prescription I was filling, I couldn’t help but
notice her “tan.” “Did Norma and her husband get away
on a vacation to a sunny spot?” I thought to myself. When I
finally got around to waiting on her, she asked for medication that
would help her with some itching. I asked about a rash, and she stated
that there wasn’t a rash but that she itched all over. I looked at
her eyes and asked her to remove her glasses. She wasn’t
“tan” at all but extremely jaundiced. I suggested that she
see her physician as soon as possible, stating that no cream would help
her rash and that sometimes when our bodies aren’t working right
on the inside we can get symptoms (such as her nonspecific itching). Not
wanting to alarm her, I did not comment on her color but rather
emphasized that it would be best if she saw her physician soon. I told
her that if she experienced any difficulty in getting an appointment
soon, she should let me know. She was diagnosed with cirrhosis and had a
liver transplant about 13 weeks after our visit in the pharmacy. When
her physician at a world-renowned medical center asked her when she
first realized that she was sick, she said, “When my pharmacist
told me to see my doctor soon.” To this day, she credits our
conversation with saving her life.
Case B
A gentleman asked for help locating an OTC item in the store. I left the
pharmacy and escorted him to the item. On the way to the checkout, he
noticed an OTC Tagamet (Cimetidine—GlaxoSmithKline) endcap. He
asked how long the medicine was good for. I checked the expiration date
on the item at hand and noted that it was good for about 2 years. Not
letting the conversation drop, I asked why he was curious about the
expiration date. Quietly he bent near me to share that he had a large,
bloody bowel movement that morning. He found some 2-year-old
prescription Tagamet at home from when he had a G.I. bleed and just
wanted to be sure that it was still okay to use. Recalling that the
patient took warfarin regularly, I was alarmed that he was planning to
self-medicate. I asked if he was taking any medication other than the
warfarin. He said that he had seen a neurologist within the last 60 days
who suggested that he take an aspirin a day for [transient ischemic
attacks]. He further stated that if a little aspirin would work, then he
would take a long-acting 650 mg aspirin with breakfast and supper. I
explained what I thought was happening and said that it was very
important for him to see a physician immediately. I even offered to take
him to the hospital. He did not appear to be weak and insisted that he
could make it to his doctor’s office. He was admitted to the
hospital overnight, received 2 units of blood, and was discharged on
Plavix (clopidogrel—Bristol–Myers Squibb). The warfarin was
stopped. His physician called in the prescription and thanked me for
insisting that the patient seek medical advice.
Case C
A mentally impaired patient with chronic hypotension, among other
ailments, who had been using our pharmacy for a long time, approached
the prescription counter with an prescription for ephedrine 25 mg
capsules. She excitedly exclaimed that her doctor had talked to a
“kidney doctor” about her low blood pressure. She was eager
to start her new medication. I typed the ephedrine prescription into my
computer and got an alert for a drug interaction with Nardil
(Phenelzine—Pfizer), a monoamine oxidase inhibitor (MAOI) with the
potential for a fatal hypertensive crisis. I notified her physician, who
decided to cancel the prescription and said to tell the patient that he
would reevaluate her hypotension on her next visit. He apologized for
the predicament he placed both of us in and thanked me profusely for my
attentiveness in detecting the interaction. He stated that on his way to
the exam room he had bumped into a nephrologist and “picked his
brain” on how he might treat this refractory patient. He admitted
that he didn’t review the patient’s medical history but also
noted that it was another practitioner who had originally ordered the
Nardil. This patient used our pharmacy for all her prescriptions. At the
time, I wondered if I would have caught the interaction if the patient
had been required to mail away for her chronic medications (including
Nardil) and had been using our pharmacy for her first filling of
ephedrine. With her mental impairment, I doubt if I could have gotten a
medical history that would have alerted me to the MAOI’S
presence.
Case D
During volunteer service—to an
area council on aging to help seniors identify Medicare Part D plans
that covered their medications—I found a patient taking both
simvastatin and Lipitor (atorvastatin calcium—Pfizer) for her
cholesterol. When I questioned her, she was confused, but I was able to
figure out that her physician had changed her Lipitor prescription to
one of generic simvastatin to save her money. For whatever reason, she
failed to understand what her physician was attempting to do and
continued to take both medications. This patient was a stranger to me,
so I explained what my concern was and gave her a note that stated my
concern to share with her physician, and I suggested that she call her
physician very soon.
Related resources on www.pharmacist.com
Related resources on the Web:
Beth Farnstrom (bfarnstrom)
Posted September 3, 2009, 3:00 pm EDT
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