Counseling on Elemental Calcium

[3lindsy5]

How do you guys explain to a patient that elemental calcium is different than what is listed on the bottle (calcium carb or calcium citrate)? And how to help them calculate their total daily dose based on that.

I have tried math (0.4 x the bottles listed mg for carb & 0.21 for citrate), I've tried making a table with a column for "Mg listed on the Bottle," "Ca Carb elemental," and "Ca Citrate elemental."

I am located in a rheumatology clinic and we manage a lot of patient's osteoporosis.

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[radio frequency]

Honestly...I do not explain this to patients. I tell patients how many pills they need to take for which formulation. And that's it. If they are buying as OTC and they don't know what they need, I tell them to ask me in person at the counter which one they need before buying.

Most patients do not have the chemistry or math background to understand this, and I can't expect them to get it right.

I assume you are working MTM? Maybe you can just write up an Rx for what they need specifically, and send them with it to the pharmacy?

 

[3lindsy5]

Honestly...I do not explain this to patients. I tell patients how many pills they need to take for which formulation. And that's it. If they are buying as OTC and they don't know what they need, I tell them to ask me in person at the counter which one they need before buying.

Most patients do not have the chemistry or math background to understand this, and I can't expect them to get it right.

I assume you are working MTM? Maybe you can just write up an Rx for what they need specifically, and send them with it to the pharmacy?

I am working at the clinic with the doctor. The doctor wants me to make a handout to provide to patients and to do the education on this topic when I am in going over medications with patients. Most patients are buying OTC and will buy carbonate one month and then citrate the next or different strengths.

I agree with you about not expecting patients to understand this or get it right. I just dont want to tell them a set amount of tablets to take since they most likely will not be buying the same strength of type of calcium consistently.

 

[radio frequency]

I am working at the clinic with the doctor. The doctor wants me to make a handout to provide to patients and to do the education on this topic when I am in going over medications with patients. Most patients are buying OTC and will buy carbonate one month and then citrate the next or different strengths.

I agree with you about not expecting patients to understand this or get it right. I just dont want to tell them a set amount of tablets to take since they most likely will not be buying the same strength of type of calcium consistently.

You could make a handout...but I think you are probably better off writing it up as an Rx to take to the pharmacy, and let the pharmacy find the correct OTC product for them to buy that matches the Rx. Just because you wrote it as an Rx doesn't mean that they have to purchase it behind the counter.

If you want to make a handout, I would recommend using a table and giving some various common options (include how the calcium is listed on the bottle) and telling them how many pills to take to get the correct dose for each option, then you can go through this with them. Consider looking at how they write up tables for things like pediatric ibuprofen or acetaminophen dosing tables, and follow a similar format. Here's an example of one (I've seen better, but this is the top Google result): Acetaminophen (Tylenol) Dose Table

You want it easy enough that even your dumbest patient gets this right the first time. Don't expect them to do the math correctly. Even my college-educated mother still doesn't understand percentages. I mean, she's old now, so there's that, but there's just a lot of numerical illiteracy out there.

 

[zelman]

I’d probably steer people to the nutrition facts and the %RDA since that’s the most standardized figure.

 

[RxPreceptor]

Keep it simple...citrate salts generally for those with gastric bypass/absorption issues

 

[Dred Pirate]

it is funny how often many of the docs I work with don't understand the difference between calcium gluconate vs calcium cholride and that there is a 3 fold difference in elemental calcium received.

 

[lane one]

it is funny how often many of the docs I work with don't understand the difference between calcium gluconate vs calcium cholride and that there is a 3 fold difference in elemental calcium received.

"We want....the calcium one"

 

[VA Hopeful Dr]

Pick a handful of brands that are carried at most pharmacies which include the strengths/formulations you want. Print a picture of the exact bottle you want the patient to pick up on a piece of paper. On that paper write: "Take X of these pills every day".