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Rx Impact - NPX Newsletter Fall 2018

Pharmacist Intervention in the Ambulatory Clinic Setting

By Ana Simonyan, R.Ph., PharmDAna Simonyan

Pharmacists are in a unique position because they possess the necessary knowledge and skills to ensure the safest and most effective medication practices for patients. As a student, and now as a pharmacist, it has been a humbling and joyful experience to build relationships and meet the unmet medication needs of the patients we serve. Situations such as the one I experienced in our anti-coagulation clinic reinforce the idea that a pharmacist can synthesize compassion with medication expertise to provide individualized and comprehensive care.

A sweet elderly woman was running late to her appointment in our anti-coagulation clinic one afternoon. She was one of our regular patients, and my preceptor and I began to worry when we didn’t see her name on the check-in schedule. I noticed over the last several weeks the patient would alternate between “no-show” appointments and out of range INRs, attributing it to moving into a new home and frequent visits from her family. We conducted the visit as normal; the patient told stories about her grandchildren and their adventures around Cleveland. I asked how her husband was doing, since he frequently attended her appointments with her. Before she had the chance to respond, the INR machine beeped: the patient’s number was the highest it had been in weeks.  Without hesitation, the patient began explaining that she had been inconsistent with her diet and had been lacking an appetite as of lately. I could sense the patient was troubled, so I gently inquired about what might be contributing to her interrupted schedule.

The patient’s voice quivered as she told me that her husband had passed away several days prior after several months of severely declining. She expressed how deeply alone, lost, and confused she felt. She and her husband were married for over 50 years, and before his death, he couldn’t remember her name or who she was. The patient explained that she stopped taking all her medications and was too embarrassed to show up to any of her appointments. She had essentially isolated herself – not responding to family or friends or keeping up with any financial responsibilities. She had forgotten to pay rent for two months in a row and was now homeless. In that moment, I thought to myself, “if this were my grandmother, what would I want someone to do?”

The patient and I sat in silence for a long period of time. Once she was able to gather her thoughts, I asked the patient if I could call her daughter and explain the situation. We discussed her current mediations, identifying opportunities to simplify her regimen and help with adherence. I discussed this with her primary care provider in the clinic, and we walked the patient down to the pharmacy to make sure she obtained her medications. We connected her with a social worker and ensured that she had somewhere to stay that evening.

The patient came for an INR check every week for 3 weeks after that. After reaching out to her daughter, she was able to reconnect with her support system, re-enroll in her volunteering activities, and her health was the best it had been. And all I had to do was listen.

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