CVS Health pharmacists are often called on to employ not only clinical services, but a fair amount of detective work as well. Patients often report that their diet, exercise, and medications are all in check, but if they’re not experiencing results to match, then it’s time to dig a little deeper.
Elderly or infirm patients can pose special challenges: They can be mistrustful of medical professionals, stuck in old habits, and might not even be physically able to visit their local CVS for prescription recommendations and tests. Often, all the pharmacist has to go on is phone consultations and lab results. And yet, often that’s enough to produce life-changing results.
Pharmacist Angela Stigliano realizes that building trust with patients is a necessary part of the job. She’s a clinical pharmacist for CVS Health’s Medication Therapy Management (MTM) service, and provides care to members over the phone or via video chat.
She shared a recent success story about a patient with diabetes that demonstrates why trust is so important. The percentage of Americans 65 and older with diabetes is high, at about 25.2 percent or 12.0 million seniors (diagnosed and undiagnosed).https://www.diabetes.org/resources/statistics/statistics-about-diabetes It is a disease that can be well-controlled with diet and lifestyle changes — but they’re not always easy to make and adhere to without a helping hand.
Asking the Right Questions to Get a Diabetes Patient Back on Track
In March 2018 Stigliano began working with Vicki, a woman in her sixties who reported having a stroke that had left her with mild physical impairments. Though she had a long history with diabetes and high cholesterol, her doctors were confident that she would make a full recovery.
In their initial phone call, Vicki insisted that she followed a strict diet and was very mobile, but given the precarious state of her health, that “didn’t make sense,” says Stigliano: She was gaining weight, her A1C was unstable, and she wasn’t taking her cholesterol medication as prescribed. These factors put her at risk not only for another stroke, but heart disease as well.
Through a series of thirty-minute phone calls every few months, Stigliano fostered a friendly relationship with Vicki.
“I would use phrasing like ‘Tell me about your diet these days,’ instead of saying, ‘Have you been dieting?’ This allowed her to tell me about her diet without the feeling I was searching for a ‘correct answer,’” she says. “It can be difficult to be forthcoming with a stranger about a sensitive topic like being overweight or unable to walk and care for yourself properly.”
These days, there’s a lot of confusion about what a “healthy diet” actually means. Vicki reported trying a keto diet, and skipping meals, both unwise choices for a diabetic.
“Purposely not eating enough can be just as unhealthy as eating fast food every day. Not having enough range in your diet can also become unhealthy as well,” says Stigliano. She recommends the easy-to-follow MyPlate tactic to patients like Vicki. “You’re not telling them what to eat and what not to eat, but to focus more on portion sizes; to look at their diet and their plate a little bit differently.”