Optimizing a Member’s Medication Regimen

Background

An 86-year-old female was referred to Mosaic to improve her medication regimen. The member’s medical history includes diabetes with neuropathy, atrial fibrillation, and chronic kidney disease. Her husband had been assisting with medications and was adjusting doses to avoid splitting tablets. In total, the member was taking 18 prescribed and over-the-counter medications.

Therapy problems that were identified during the home visit included: increased risk of bleed due to combination of OTC turmeric and Eliquis, and risk of hypoglycemia due to duplicate therapies.

In addition, the member was using extremely low dose, short-acting insulin and reported symptoms of low blood glucose on a monthly basis, with a recent blood glucose reading of 64.

Interventions

Following the clinical review, a Mosaic pharmacist communicated with the member to assess diabetic control, and coordinated with the member’s prescribers to improve the regimen for optimal diabetic treatment and to reduce bleed risk. The following interventions were conducted:

• Discussion with the member’s primary care provider on elderly risk of hypoglycemia and to identify reasonable glycemic goals for advanced age; the pharmacist also shared a recommendation to discontinue short-acting insulin.
• Member education on the treatment of hypoglycemia.
• Assessment of bleed risk, as the member was experiencing easy bruising on Eliquis and OTC turmeric; the member was unable to recall why taking turmeric, which was further discussed with the member’s provider.
• Started on Mosaic packaging to improve safety and adherence.

Outcomes

A Mosaic clinical pharmacist coordinated with the member’s prescribers, suggesting changes to the member’s medication regimen to simplify the regimen and reduce the risk of adverse side-effects. Outcomes include the following:

• With discontinuation of duplicate diabetic medication, the member is no longer experiencing hypoglycemia episodes; the lowest blood glucose measures in the 90’s and is not exceeding 150.
• The member’s husband and caregiver is pleased with the member’s improved glucose control.
• OTC turmeric was discontinued.
• The member and her husband are pleased with the ease of managing medications through adherence packaging using the Mosaic medication box.
• Synchronized refills are now being delivered to the member’s home.

 

Feedback from the member’s husband and caregiver:

Mosaic adherence packaging “is a whole lot easier. I like it because it’s easier for me to dispense to her and saves 3-5 visits to the pharmacy.”