Ma Angela, Chen David M, Chau Fern M, Saberi Parya
Department of Pharmacy, Kaiser Permanente Medical Care Program, Vallejo, CA, USA.
AIDS Care. 2010 Oct;22(10):1189-94. doi: 10.1080/09540121003668102.
Human immunodeficiency virus (HIV) positive individuals who adhere to their antiretroviral (ARV) regimens are more likely to achieve suppressed HIV viral load and improved immunologic response; however, for most patients, medication adherence remains a challenge. Prior studies have shown that clinical pharmacists contribute to the management of HIV-infected patients; but due to variability in clinical responsibilities and study limitations, their value has not been fully realized. The objective of this study was to investigate clinical outcomes of an HIV clinical pharmacist's interventions at Kaiser Permanente Medical Care Program, who utilizes medication expertise to provide recommendations for ARV regimen changes. The pharmacist suggests new ARV regimens in order to attain virologic suppression, improve immunologic response, or minimize ARV adverse effects, while aiming to optimize patients' adherence by decreasing pill burden and/or dosing frequency. This retrospective study assessed the effectiveness of the pharmacist's interventions that occurred between 11 September 2006 and 30 September 2008 on pill burden, dosing frequency, and medication adherence. Additionally, CD4+ cell count and HIV viral load pre- and post-intervention were evaluated. Medication adherence was assessed utilizing electronic pharmacy refill records and calculated based on the formula: [(pills dispensed/pills prescribed per day)/days between refills] x 100. From a cohort of 75 patients, mean daily pill quantity and dosing frequency decreased from 7.2 pills/day and 2.0 times/day in the control phase to 5.4 pills/day and 1.5 times/day in the study phase, respectively ( p < 0.001). Medication adherence increased from a mean of 81% in the control phase to 89% in the study phase ( p = 0.003). Clinical outcomes measured by CD4+cell count and CD4% were statistically improved and more individuals achieved undetectable HIV viral loads postintervention ( p < 0.001). In conclusion, HIV clinical pharmacists may play an important role in reducing pill burden and dosing frequency, increasing medication adherence, and improving clinical outcomes.
坚持抗逆转录病毒（ARV）治疗方案的人类免疫缺陷病毒（HIV）阳性个体更有可能实现HIV病毒载量的抑制和免疫反应的改善；然而，对于大多数患者来说，药物依从性仍然是一个挑战。先前的研究表明，临床药剂师有助于HIV感染患者的管理；但由于临床职责的差异和研究局限性，他们的价值尚未得到充分认识。本研究的目的是调查凯撒医疗保健计划中一名HIV临床药剂师干预措施的临床结果，该药剂师利用药物专业知识为ARV治疗方案的改变提供建议。药剂师建议新的ARV治疗方案，以实现病毒学抑制、改善免疫反应或最小化ARV不良反应，同时旨在通过减少药片负担和/或给药频率来优化患者的依从性。这项回顾性研究评估了2006年9月11日至2008年9月30日期间药剂师干预措施对药片负担、给药频率和药物依从性的有效性。此外，还评估了干预前后的CD4+细胞计数和HIV病毒载量。利用电子药房补货记录评估药物依从性，并根据公式计算：[（配发的药片数/每天规定的药片数）/补货间隔天数]×100。在一组75名患者中，平均每日药片数量和给药频率分别从对照阶段的7.2片/天和2.0次/天降至研究阶段的5.4片/天和1.5次/天（p<0.001）。药物依从性从对照阶段的平均81%提高到研究阶段的89%（p=0.003）。通过CD4+细胞计数和CD4%衡量的临床结果在统计学上得到改善，干预后更多个体实现了无法检测到的HIV病毒载量（p<0.001）。总之，HIV临床药剂师在减轻药片负担和给药频率、提高药物依从性以及改善临床结果方面可能发挥重要作用。
