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Case Example: How Comprehensive Medication Management (CMM) Supports and Aligns with the 4 Cs of Primary Care
Complex patient case: RF is a 72-year-old male who lives with his wife. He has limited financial resources and limited means of transportation. RF has a history of poorly controlled type 2 diabetes, heart failure, dementia, depression, chronic obstructive pulmonary disease, and pain. He often has difficulty affording medications. He recently had an emergency room visit as a result of a fall. 4 Cs Pillar How CMM Supports Primary Care in Achieving the 4 Cs How Practice of CMM Aligns with the 4 Cs of Primary Care First contact RF and his wife noted blood sugar readings over the past month are elevated. He scheduled an appointment with a pharmacist providing CMM who he has met with in the past. This increases access and “contact” to the health care team for RF. After RF's hospitalization, his wife sent the pharmacist providing CMM in the clinic a message to clarify if a symptom he was experiencing may be a side effect of a new medication. Continuity RF was referred to CMM services as a part of a providers' panel of patients not meeting diabetes goals. The pharmacist providing CMM for RF will continue to follow up with the patient until the patient's goals are achieved. Comprehensiveness Although RF was referred to CMM services because he was not meeting diabetes goals, the pharmacist providing CMM will comprehensively review all medications the patient is taking and help resolve all issues, such as inhaler affordability, not only concerns related to diabetes medications. When RF started to follow up with CMM services, the pharmacist identified that he had difficulty taking twice-daily medications and was able to work with the care team to create a regimen with more once-daily medications. This helped RF to better meet his health goals. Coordination During RF's CMM appointment, it became unclear which medications RF was actually taking. To clarify the current medication regimen, the pharmacist coordinated with RF, his wife, RF's pharmacy, and his cardiology team in a different health system. When the pharmacist was working with RF to help manage his congestive heart failure, the pharmacist, working in collaboration with the patient's pain management provider, decreased nonsteroidal anti-inflammatory drug use and found an alternative, safer treatment option.
