A student case for discussion

MT is a 31-year-old Caucasian American woman who has been a long-term customer and patient of the pharmacy. Her initial experience with the pharmacy began 10 years ago when she was initially diagnosed with asthma.

The medications she takes are as follows:

  • Triamcinolone acetonide inhalation aerosol, two puffs twice daily
  • Albuterol inhalation aerosol, two puffs every four to six hours, as needed
  • Metformin, 500 mg BID
  • Hydrochlorothiazide, 25 mg QD
  • Atorvastatin, 10 mg QD

Upon refilling MT’s medications this month, the technician noted that MT who is typically exactly on track with refill dates is approximately eight days late filling the hydrochlorothiazide and atorvastatin and is 15 days late refilling her metformin and inhalers. The pharmacist who finalized the filling process step added a counseling note to follow-up with MT at pickup to identify barriers to adherence.

MT arrives to pick up her medications late on a Saturday evening. As FH approaches the pharmacy, she is extremely out of breath and asks to use the albuterol before the cash register transaction is complete. The pharmacist sees the note made by the filling pharmacist and is glad to see that MT is picking up the meds.

Given the situation as described, how should the pharmacist proceed with the counseling session? After reviewing the following points to consider discuss this case with your preceptor. During the discussion be sure to have the pharmacist share his/her approach given personal experience and use of profession judgment.

  1. What are MT’s potential barriers to adherence given the information presented at this point?
  2. What additional information would you like to know to properly assess and offer solutions for FH’s adherence issues?
  3. Discuss MT’s prescribed therapy considering her age, ethnicity, concurrent medical conditions, etc. Are there any adjustments that are recommended cased upon clinical guidelines?
  4. With MT’s suspected non-adherence, is a change in therapy warranted?
  5. How should the pharmacist address the adherence issue with the patient?

During the counseling session with the pharmacist MT shares that her mother recently passed away. She also shares that she stopped using multiple medications for about a week when she stayed with her mother during her hospice time. Her medications were very neglected while she managed the funeral arrangements and visiting family. Now that things are settling down at home she finally remembered to stop by. She is very concerned about her shortness of breath and in concerned that he may be hospitalized soon.

  1. What counseling should the pharmacist provide to MT given this additional information?