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Walking in Discouraged, Walking out oPENtimistic

A patient reported to the pharmacy frustrated with his GLP-1 pen “Victoza Injection.” The pharmacy referred him to our pharmacy clinic for further evaluation.

We asked the patient to demonstrate how he uses his pen to ensure he knew how to properly use it with one of our demo pens. The patient found the dose button of the Victoza Pen challenging to use. As the dose increased, the length of the dose button grew taller. The patient also shared that the dose button is “difficult to press down on,” making administration of the dose difficult. He expressed concern about the high cost of the medication and inability to properly administer it, potentially leading to not getting the full benefit.

After collecting all relevant information from the patient, we assessed that the patient’s dexterity may have been a barrier to proper use of the pen. We showed him the Ozempic pen and asked him to try using it. He compared the two, and together, we created a plan to help with his GLP-1 administration.

We offered to call the prescriber on behalf of the patient to try to switch pens. As a pharmacy student, this was a rewarding process to see since my one preceptor, Dr. Nicole Pezzino, taught us these skills in our skills-based lab. We were able to see the impact on dexterity and the real impact of what seem like small interventions on the patient and experience. His whole mood shifted during this encounter.

At the beginning of our encounter, the patient was frustrated. After listening to his concerns and allowing him to see the differences between the pens, the patient was much happier. He felt like our pharmacy team listened to his concerns and helped offer a solution. The patient was skeptical about changing his medication since he was used to his regular routine and still had a lot of product left (which cost him money); he would change from injecting daily to injecting weekly. We assured him that no changes would be made without his consent, which we will follow up prior to his next refill. In addition, through our efforts we were able to enroll him into a new cardiovascular preventative program, and he was interested in our diabetes self-management education and support (DSMES) classes!! These were two of our enhanced services. We started his first encounter this same day!!

There are only two pharmacies that are offering this cardiovascular prevention education program, and one is Weis in Schnecksville, PA. This program will follow patients for six months and is designed to educate them on cardiovascular disease and provide steps to take to reduce ASCVD risk. By offering these services to our patients, we are able to provide education in order to help them make healthy lifestyle changes. We are also able to build relationships with our patients. Since we will be following up with this patient for the next six months, we will inquire about his Victoza during our next meeting, which we aligned with his refill date. We will have an opportunity to ensure the patient feels comfortable with his medication and reassess if this is the best option. The patient also expressed interest in our DSMES classes, so this will provide us with an additional opportunity to ensure the patient is taking the best steps to manage his diabetes. I believe this is a direct result of the relationships we were able to form with the patient!

Community pharmacists have a unique opportunity to make a difference in patients’ lives. They are able to have one-on-one interactions with patients and get to listen to their concerns in real time. We are accessible and when we take the time to listen, are truly #ChangingTheWorld :) The services community pharmacies can offer can help the patient feel more in control of their own health.

Written by:

Morgan Casciole

Wilkes University, PharmD Candidate 2023

Community APPE Rotation at Weis Markets in Schnecksville, PA

Preceptors: Nicole Pezzino and Isabelle Litvak, PharmD

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