Chapter 5: The Importance of Addressing Financial Barriers

BACKGROUND

Identifying and addressing financial barriers is an important intervention which can facilitate safe and effective transitions of care. When optimizing medication therapy, pharmacist interventions should include addressing cost. This may include initiating prior authorizations, selecting cheaper alternatives when available, or identifying resources to supplement the cost of medications. When available, collaboration with case management and social work can be valuable in meeting the unique and individual needs of the patient.

PATIENT PRESENTATION

Chief Complaint

“My chest hurts bad. It felt like heartburn at first, now it’s a stabbing pain!”

History of Present Illness

JJ, a 43-year-old African American male with a medical history of hypertension, is admitted to the coronary care unit with chest pain. He reports the pain started this morning at work and felt like bad heartburn. Over the next few hours, it progressed to a sharp, shooting pain that is 8 out of 10 on a severity pain scale. He chewed four baby aspirin tablets with no relief, but he recalled you were to take aspirin if you think you are having a heart attack. When asked about adherence, he reports taking his medication only when his blood pressure is high, which he believes is indicated by a headache. He also says this way his prescription lasts much longer. Patient states he does not have a blood pressure monitor at home. Patient often forgets his cholesterol medication at bedtime as he often falls asleep on the couch after a few beers.

Past Medical History

Hypertension, hyperlipidemia

Family History

Both parents with hypertension and coronary artery disease (CAD)

Social History

High school janitor. On his feet all day at work but limited physical activity outside of work.

Smokes one pack per day × 20 years, denies illicit drug use.

He lives alone.

Drinks 2 to 3 beers in the evenings and on weekends.

Diet consists of fast food, eats at a local diner, and microwave meals.

Insurance

Medicaid

Immunization

Up to date

Allergies

No known drug allergies

Home Medications

• Amlodipine 10 mg PO daily

• Simvastatin 20 mg daily at bedtime

• Aleve 220 mg PRN pain/headache

• Aspirin 81 mg PRN pain

Physical Examination

Vital Signs

Temp 98.6°F, P 110, RR 22, BP 170/98 mmHg, pO₂ 98%, Ht: 5′10″, Wt: 129 kg

General

Anxious, disheveled, overweight male in distress.