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Pharmacy and Pharmaceutical Sciences
Title: Clinical Impact of an HIV Specialist Pharmacist Collaborative Practice Agreement: a 1-year Retrospective Review of Interventions
HIV continues to be one of the most complex disease states for patients and providers to manage. With new medications and guidelines being routinely updated, ensuring that patients are on optimal anti-retroviral therapy (ART) throughout their lives can be difficult. Previous studies on pharmacist-led HIV services have shown that utilizing a pharmacist to manage ART is beneficial. The purpose of this study is to add to that body of evidence by analyzing the clinical impact of a nascent collaborative practice agreement for an HIV specialist pharmacist to manage patients seeking care related to HIV.
This study was granted exempt status by the Providence Institutional Review Board. An electronic health record was utilized to identify patients whom were seen at an HIV clinic under the management of a pharmacist. Chart reviews were conducted to collect and analyze pharmacist interventions. Data collected included the following: number of ART changes (and rationale for each change to be categorized as for efficacy, safety, or simplification reasons), number of patients seen for HIV/AIDS, PrEP, and PEP, number of patients enrolled in medication assistance programs (MAPs), HIV viral loads (VLs) and CD4+ cell counts over 1 year (each patients’ level of control to be classified as improved, worsened, or no change), number of co-morbid disease state medication modifications, and number of coordination of care interventions. The data was recorded without patient identifiers to maintain confidentiality. Data analysis consisted of quantitative analyses.
A total of 100 patient charts were reviewed. Of those 100, 73 patients had their ART regimens modified. Of those 73 ART regimen changes, 54 were for safety related reasons (such as to avoid drug-drug interactions or to mitigate adverse drug reactions), 20 were for simplification reasons (such as to decrease pill burden), and 6 were related to improving efficacy due to genotype resistance testing. Some patients had their ART regimens changed for more than one reason. Of the 100 patients, 75 patients were living with HIV, 18 were on PEP, and 7 were on PrEP. Nearly half (49) were enrolled in MAPs with pharmacist assistance. Most patients’ HIV VLs and CD4+ cell counts improved or stayed the same (89% VL and 79% CD4+). Few changes were made to co-morbid disease state medications (9 total modifications). Only 7 patients required coordination of care interventions.
Because HIV medicine is so complex, there can possibly be a mentality of “don’t change what is working” when it comes to which ART regimen patients are on. Leaving patients on the same regimen for years and decades may lead to medication related problems. Pharmacists are uniquely trained to help mitigate medication related issues. This study appears to show that pharmacists are most valuable in HIV medicine in mitigating safety concerns (drug interactions and adverse drug events). Pharmacists may also be especially useful in enrolling patients in MAPs.
Graduate Medical Education
Conference / Event Name
Academic Achievement Day, 2020
Providence Portland Medical Center, PGY-1 Pharmacy Residency Program
Bartholomew, Rebekah; L'Heureux, Geoffrey; and Footer, Brent, "Clinical Impact of an HIV Specialist Pharmacist Collaborative Practice Agreement: a 1-year Retrospective Review of Interventions" (2020). Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020. 9.