Foisy Michelle M, Akai Peter S
Northern Alberta HIV Program, Royal Alexandra Hospital and DOT for HAART Program, Boyle McCauley Health Centre, Edmonton, Alberta, Canada.
Ann Pharmacother. 2004 Apr;38(4):550-6. doi: 10.1345/aph.1D444. Epub 2004 Feb 27.
Inner-city patients infected with HIV can be a challenging group to treat. Homelessness, mental illness, substance abuse, and hepatitis C infection may serve as barriers to effective treatment. A multidisciplinary team including the pharmacist can impact upon the delivery of care to the inner-city HIV patient population.
To describe the implementation and provision of pharmaceutical care to inner-city patients taking directly observed therapy (DOT), as well as drug-related problems (DRPs) and their respective outcomes.
Pharmaceutical care, including the prospective identification and management of DRPs, was provided by a clinical pharmacist.
Fifty-seven patients were followed over a 14-month period. Overall, 149 DRPs were identified and >95% were resolved. Those included (1) adverse effects (n = 56; gastrointestinal, central nervous system effects, allergies, laboratory abnormalities), (2) drug interactions (n = 32), (3) drugs indicated for comorbidities (n = 24; safety in pregnancy, tuberculosis, Pneumocystis carinii pneumonia prophylaxis, oral candidiasis, herpes zoster, nutritional supplements), (4) adherence issues (n = 20; altering timing of medication, changing formulation, decreasing pill burden), (5) drugs no longer indicated (n = 10; opportunistic infection prophylaxis, treatment of primary infection), and (6) dosage adjustment (n = 7) for weight and renal insufficiency.
In the provision of pharmaceutical care to HIV-infected patients on DOT, an HIV pharmacist significantly contributed to antiretroviral selection, monitoring of drug therapy, and managing DRPs. An HIV pharmacist can assist in promoting patient adherence and improved outcomes in this setting.
感染艾滋病毒的市中心患者可能是一个具有挑战性的治疗群体。无家可归、精神疾病、药物滥用和丙型肝炎感染可能成为有效治疗的障碍。包括药剂师在内的多学科团队可以影响对市中心艾滋病毒患者群体的护理提供。
描述对接受直接观察治疗（DOT）的市中心患者实施和提供药学服务，以及药物相关问题（DRP）及其各自的结果。
由一名临床药剂师提供药学服务，包括对DRP进行前瞻性识别和管理。
在14个月的时间里对57名患者进行了跟踪。总体而言，共识别出149个DRP，其中>95%得到解决。这些问题包括：（1）不良反应（n = 56；胃肠道、中枢神经系统影响、过敏、实验室异常），（2）药物相互作用（n = 32），（3）用于合并症的药物（n = 24；孕期安全性、结核病、卡氏肺孢子虫肺炎预防、口腔念珠菌病、带状疱疹、营养补充剂），（4）依从性问题（n = 20；改变用药时间、更换剂型、减轻 pill负担），（5）不再需要的药物（n = 10；机会性感染预防、原发性感染治疗），以及（6）因体重和肾功能不全进行的剂量调整（n = 7）。
在为接受DOT的艾滋病毒感染患者提供药学服务时，艾滋病毒药剂师在抗逆转录病毒药物选择、药物治疗监测和DRP管理方面做出了重大贡献。在这种情况下，艾滋病毒药剂师可以协助促进患者依从性并改善治疗结果。
