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Jessica de Lambert – Assignment 3: Patient Centred Care Mr C, an educated, independent and friendly man of 68 years, seemed to be the picture of perfect health – a stringent diet, frequent exercise and a healthy lifestyle anyone would admire. His regular dispensing history revealed simvastatin 20mg, quinapril 20mg, omeprazole 20mg, combination quinapril 20mg and hydrochlorothiazide 12.5mg, aspirin 100mg, amiodarone 100mg and latanoprost eye drops, all given once daily. Diagnosed with the frequently-seen combination of atrial fibrillation (AF), hypertension, hyperlipidaemia, type 2 diabetes and ischaemic heart disease over several years, it appeared cardiovascular health would be my main focus. Glaucoma, oesophageal reflux and oesophagitis and the occasional muscle strain also affected Mr C. After an interview in his home and a meeting with his doctor, his health conditions grew and more was revealed than what his medicines let on. Burdened with multiple conditions, Mr C’s high cardiovascular risk revealed he should be on warfarin. However, after a discussion with his GP in 2011 Mr C chose to not start it, despite its benefits in preventing AF-related stroke. The patient not wanting to take warfarin is an important enough contraindication, especially for a medicine that requires such strict patient adherence. Several of Mr C’s conditions had worsened over the last year and I made several suggestions to his GP. His atrial fibrillation episodes were increasing in frequency and severity so I suggested the amiodarone dose be increased to 150mg daily. Mr C’s blood pressure was not well controlled (155/75 average) and I recommended amlodipine be re-introduced slowly. His most recent HbA1c readings revealed worsening diabetes despite strict diet and exercise interventions and I recommended starting metformin 500mg daily. The “triple whammy” of a diuretic, an ACE inhibitor and an NSAID was discovered, when I saw high-dose ibuprofen had been recently prescribed for a muscle injury. Regular paracetamol and a topical rub would be more appropriate analgesia choices for Mr C. The importance of always keeping a phone on hand if an atrial fibrillation episode arose was emphasised to Mr C in our second interview. I highlighted several warning signs for him for when to call an ambulance for an episode (shortness of breath, exhaustion, increasing dizziness, stronger palpitations or a highly irregular pulse). Further recommendations were made to his diet and exercise (reducing salt intake, increasing oily fish consumption and walking further or faster each day) which aimed to improve his HbA1c levels. I counselled Mr C on the importance of regularly examining his feet and continuing to get his eyes checked. In our first interview, Mr C was unsure what some of medications were for. The Patient Information Sheet I made Mr C included information about what his medicines were for and how they help to improve his medical conditions. For example, “aspirin makes your blood less sticky and prevents blood clots from blocking your blood vessels”. Hearing the excitement in his voice and seeing Mr C put the Patient Information Sheet in a safe place made me realise what an impact I had made. The challenge of assessing his entire medical history and deciding on courses of action was made worthwhile by the gratitude received from Mr C. My role as a community pharmacist of imparting knowledge in a way that patients understand is crucial and the benefits from this on their healthcare is very evident.
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