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  1. Issues

    1. Medication nonadherence

      1. Medications prescribed to patient and patient’s administration habits:

        1. Basaglar inject subcutaneously 20 units qhs, patient is currently not taking because of fear of injection and lack of understanding how to use the device.

        2. Metformin regular release 1000 mg tablet by mouth twice daily is prescribed and patient takes a range of 500–1000 mg daily. Per patient: medication “gets stuck in my throat,” pt has resolved problem by cutting a 1000 mg tablet in half. Pt regularly takes 500 mg by mouth every morning and remembers to take the other half in the evening 1–2 times weekly.

        3. Glucometer, test strips, lancets: SMBG qam and qhs. Pt does not SMBG because (1) the resulting pain, and (2) does not see the point of checking blood glucose.

        4. Lisinopril 20 mg by mouth once daily, patient is taking this regularly and should be commended.

    2. Patient education interests should be explored.

    3. Patient goals for diabetes care should be determined and defined by the patient.

    4. Patient’s medication adherence with Lisinopril and improved blood pressure control should be recognized and patient should be commended.

    5. Patient’s interest in an alternative dosage form should be explored.

  2. Solutions

    1. Utilize an appropriate communication technique.

      1. Partner with the patient

        1. Listen to the patient’s problem(s).

        2. Learn what is important to the patient.

        3. Verbalize to the patient your point of view about a problem only AFTER listening to all the patient has to say.

        4. Negotiate a care plan around patient’s interests.

      2. Assess the patient’s understanding of the care plan.

      3. Assess the patient’s ability to carry out the care plan.

    2. Educate the patient about the importance of treatment and self-monitoring blood glucose as it aligns with the patient’s education interests.

    3. Identify which pharmacotherapy or dosage form could improve adherence.

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