One of the pharmacists and pharmacy students' tasks in the community setting is to conduct adherence check-in calls with our patients. Our computer system flags patients who have not been filling their medications on time, and prompts us to reach out to them, provide counseling, and inquire if there is anything we can do to help them with their medications.
One intervention specifically was an >88 year old woman, EL, about her blood pressure medication, quinapril. When EL answered, I introduced myself and asked her if she was still taking her quinapril. She said, “No, last time I was at the pharmacy they didn’t have enough (of the medication). I’ve been out of quinapril for 2 weeks now”. Later I reviewed EL’s dispensing profile and saw that she normally receives 90 day supplies of her medications, but her most recent fill of quinapril was only for 30 days on 12/1/2022 and this phone call was made on 1/17/23.
EL also told me that since she has been without the quinapril, her blood pressure has been in the 140s. She reported her blood pressure is normally in the 130s.
After my initial phone call with EL, I checked with our pharmacist and learned that quinapril was recalled and we are not able to get any in stock. I took this information to my preceptors, Drs. Nicole Pezzino and Rachel DiPaolantonio to brainstorm options for our patient. EL was taking quinapril 20 mg by mouth once daily, so we needed to find an equivalent dose of an alternative ACE inhibitor. I utilized a conversion chart on GlobalRPh to identify that lisinopril 20 mg by mouth once daily is an equivalent dose.
I then called EL and explained the situation. Quinapril was recalled and we do not know when we will receive more of the medication. However, there are other medications in the same drug class that are available. Would she permit us to call her provider and suggest switching to a different medication for her blood pressure? She agreed and thanked me for my help.
When I contacted her provider’s office, I was prompted to leave a message on the nurse line.
“Hello, this is Hannah calling from Weis pharmacy. I am calling in regards to a mutual patient, ‘EL’. She normally takes quinapril 20 mg, 1 tablet by mouth once daily for her blood pressure. Quinapril was recently recalled and we are not able to order this medication for her. She has been out of quinapril for two weeks now. Would you please send over a prescription for lisinopril 20 mg, 1 tablet by mouth once daily. We have lisinopril in stock and would be able to fill that medication for her. Thank you!”.
By next day we received a prescription for lisinopril from the provider! I called EL and shared the good news. I also counseled her on the new medication including how it is in the same drug class as quinapril, reviewed potential side effects, and that it was ready for pick up. EL thanked me and told me she would have her daughter come over and pick up the new medication for her right away.
One week later, I gave EL a follow-up call to check in and see how she was doing on the new medication. She reported no issues with lisinopril and that her blood pressure was back down to the 130s!
Going above and beyond to help patients with their medications like this makes me proud to be a future community pharmacist!
Written by:
Hannah Fritz, PharmD Candidate 2023, Public Health Concentration
Preceptors:
Nicole Pezzino, PharmD, BCACP, CDCES
Rachel DiPaolantonio, PharmD
Reference:
GlobalRPh. Drug Comparisons - ACE Inhibitors - Med Equivalents. Globalrph.com. Updated October 11, 2017. Accessed January 17, 2023. https://globalrph.com/medcalcs/drug-comparisons-ace-inhibitors-medication-equivalents/