CASE STUDY

AB is a 67 year old male patient recently diagnosed with high cholesterol.  During his first visit in the office he mentioned that his cholesterol had always been fine.  He was surprised that it was high since he also stayed active by going to the gym and playing in an intramural soccer league. After some discussion about possible dietary changes, he appeared apprehensive and stated that he enjoyed eating and didn’t have any issues until being told he had high cholesterol.  His blood pressure and blood glucose levels have been normal.

At the conclusion of the initial visit, it was decided to try a highly effective, super-potent, cholesterol-lowering medication (brand) and avoid fatty foods.  AB was provided samples of the medication along with a prescription plus refills to cover him for six months. On his way out of the office, AB scheduled an appointment for a follow-up visit in six months with blood work to be completed prior.


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Six months later, he returns for his office visit. Labs indicate that his cholesterol level has actually increased since the last visit. After some discussion, AB indicates that he took his medication rather regularly in the beginning when he had samples.  At that point, he we went to the pharmacy to fill his prescription and was informed that his medication had a $75 copay. He felt it was a bit high and was hesitant to pay for it since his construction jobs had started to slow down. He remembered that he had scheduled a follow-up visit so he paid for the medication.  He thought back to his visit and recalled it being referred to as a super potent cholesterol medication so he took it on the days he planned on eating poorly or not doing any activity. Since his original fill, he refilled his medication twice.  He states that he has been watching his salt intake and tried a low carb diet for a little while. He feels great and believes the medication is working well for him.

Based on the information provided, which of the following approaches would be recommended to help control AB’s cholesterol level?

A. Switch to a generic alternative

B. Provide education on medication use

C. Refer to a nutritionist

D. All of the above