Editor’s note: Case is not based on an actual patient.


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 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 gives pharmacists the opportunity to connect with patients by serving as trusted medical professionals in the community. Brown bag sessions 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.

Patients should weave preventive health care into every aspect of their lives, as it paves the way for better outcomes and quality of life. By being active, eating more nutritious foods, maintaining a healthy environment, and staying on top of wellness screenings, individuals can be their best selves. The community pharmacy is a hub for preventive care and services. Pharmacists can play a big role in keeping patients safe and helping them identify conditions early, potentially preventing hospitalizations and unnecessary doctor visits. They can also offer vaccines, screenings, and MTM services that can reduce costs.

Through offering these services, pharmacists have chances to connect with patients. By understanding what OTC and prescription medications a patient may be taking, in addition to any herbal supplements and vitamins, pharmacists can better assess quality of care and safety.

Flu prevention is key, and pharmacists know how many patients, despite their best efforts, will succumb to the flu and winter colds. Health care professionals spend the fall actively encouraging patients to cover their mouths when they cough or sneeze, receive annual flu shots, and wash their hands.

Pharmacists have the opportunity to help identify and counsel patients with flu-like symptoms. Although patients frequently visit multiple physician specialists for various conditions, pharmacists are the cornerstone health care providers and resources.

AN is a 32-year-old man who fills prescriptions at your pharmacy. You know from past counseling sessions that he is a chef at a trendy area restaurant. You see AN browsing the cold and cough products aisle, picking up box after box to read ingredients and labels. He coughs without covering his mouth and wipes his nose frequently. When AN comes to the counter to collect 2 monthly prescriptions he refilled, he hands over various OTC medications. You ask him how he is feeling and what you can do to help. AN says that his nose feels “pretty stuffed,” and that he just “cannot stop coughing up green stuff.” He mentions that one of his cooks was sick so he sent him home from work. AN is anxious because the busy weekend is approaching and he fears getting behind on prep work. The restaurant has been packed lately, and he cannot afford time away from the kitchen.

You sympathize with AN and ask if he would be interested in participating in a brown bag session. You explain what happens during a brown bag consult and tell him that you are interested in reviewing and reeducating him on his medications. It might even result in cost savings and less anxiety. AN wants to start feeling better as soon as possible and appreciates your advice, feedback, and time.

Upon reviewing his medication profile and the OTC products that he is purchasing at your pharmacy, you find the following:
  • Alprazolam, 0.5 mg by mouth, every 12 hours as needed
  • Acetaminophen/hydrocodone, 5/500 every 4 to 6 hours daily as needed for back pain
  • Cyclobenzaprine, 5 mg twice daily as needed for back pain
  • Duloxetine, 30 mg daily
  • Ibuprofen, 600 mg every 6 hours as needed
  • OTC Mucinex Fast-Max Cold & Sinus
  • OTC NyQuil Severe Cold and Flu
You have some questions and suggestions related to AN’s health and medications. During your discussion, he says that he recently started vaping and using CBD oil and never received this year’s recommended flu shot. AN knows and understands the potential consequences of vaping but says that it eases periodic depression, helps him relax, and reduces stress. You ask about his anxiety, and he attributes it to his workload. AN also says that he does not exercise and has not been eating or sleeping much lately. You show him a few recommended phone applications to help manage exercise and sleep and even recommend orthotics for his shoes to help with his back pain from standing in a kitchen each night. You explain how depression and stress can lead to illness and recommend that AN learn to manage his anxiety without the crutch and potential long-term effects of medications and vaping. He agrees to explore healthy stress management options and talk with his primary care physician about the dosing of his alprazolam and duloxetine, which has never been titrated.

You review AN’s OTC medications and pull out duplicate products, explaining that he does not need to take anything else containing acetaminophen because of the potential for drug toxicity. You also explain that the hydrocodone in the acetaminophen combination product should help reduce pain and suppress his cough. AN says that he has been taking his prescription ibuprofen and acetaminophen/hydrocodone on a regular basis because of back pain. Despite this increase in usage, the hydrocodone has not reduced his coughing episodes. AN admits to being noncompliant with his medications and appreciates your suggestions of using phone apps and timers to increase adherence. You also tell him that because he is taking an antidepressant, you would not recommend any OTC product with dextromethorphan without his provider’s permission. You also make some temporary nonpharmacologic suggestions to AN: a humidifier, a chest and throat aromatic, plenty of water, rest, and throat lozenges.

What other recommendations do you have?
 

Jill Drury, PharmD, is a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin.