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 to 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 can give pharmacists the opportunity to connect with patients by serving as trusted medical professionals in the community. Brown bag sessions for patients living with chronic disease states 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.

Many medication-related barriers that elderly patients face can be overcome by establishing strong relationships with the patients and their caregivers. Monitoring for proper medication use and creating a familial atmosphere in the pharmacy can encourage others to ask questions and seek help when needed.

LA is an 89-year-old woman who is a returning customer. She or her daughter stops by at least once a week to pick up or refill medications, shop in the store, or visit the consult window and ask medical questions. LA and her daughter are not very internet savvy or up-to-date on basic technology. They rely heavily on the pharmacy and LA’s medical team for health-related information.

LA comes in to pick up her refill prescription for her thyroid medication. You notice that she is refilling the prescription late. You also make note in her profile of some other medications that LA has recently refilled late or early. When you walk over to counsel her, you notice that she is not acting like herself and appears disorganized. You ask LA how she is doing, and she shakes her head and says she is not doing very well. She is unable to explain how she is taking her medications or what conditions they treat. You briefly review LA’s adherence issues, note that she is on multiple medications, and conclude that she would be an ideal candidate to participate in a medication review. You ask whether she would be interested in bringing in all her medications and reviewing them with you for proper use. LA sets up an appointment for the next day when you have some overlap coverage.

To prepare for the session, you pull up her pharmacy profile so you can compare it with what is in her brown bag. You find the following:
  • Alendronate, 70 mg, weekly
  • Atorvastatin, 40 mg, once daily
  • Levothyroxine, 100 μg, every morning
  • Magic mouthwash compound, as directed, as needed
  • Omeprazole, 20 mg, daily
  • Tamoxifen, 20 mg, daily
  • Valsartan-hydrochlorothiazide, 160.0 mg/12.5 mg
When LA arrives for the appointment, she empties her brown bag, and you notice these additional medications:
  • Adult multivitamin with iron, once daily
  • Alprazolam, 0.5 mg, twice daily as needed
  • Aspirin, 81 mg, daily
  • Lisinopril, 5 mg, daily
  • OTC brand Advil (ibuprofen), 200 mg, as needed
  • OTC brand Tylenol, as needed
  • OTC famotidine, 20 mg, twice daily
  • Vitamin D, 1000 IU, 3 times a day
As you review the medications for accuracy, LA tells you in confidence that because of her insecurity about maintaining her independence, she is not always willing to seek medical advice or talk to her daughter about her health. Her daughter has been helping her manage her medications and appointments for the past few years. Yet LA mentions that her daughter is also not in the best health, and LA worries about being a burden and having to move into an assisted-living facility.

LA has not renewed her eyeglass prescription in more than 3 years and mentions to you that she has trouble reading fine print. This may be a reason why she is not taking her medications as prescribed, as she admits to often forgetting, causing her to skip or double up on doses. LA also acknowledges that she has been having difficulty hearing and remembering specific information that she does not immediately write down. You ask LA about her health-related goals. She tells you that she wants to maintain a good quality of life at home and wants to stay out of the hospital. You briefly discuss LA’s diet, some nonpharmacologic ways to help prevent memory loss, and some of your concerns about her hearing and vision. You also review her brown bag and explain that there are multiple medications for treating the same condition. LA tells you that she has not had lab work in more than 10 months, when she last saw her primary care provider. You want her to get new lab work and see her care team, as some of her medications have been prescribed by urgent care providers who do not provide follow-up.

Because of the brown bag session, LA is very interested in participating in the MTM session you offer as follow-up and thanks you for your help.

What else would you suggest to her before her MTM session?

Would you have made additional or fewer recommendations?