Surgical Health Services Research Unit, Department of Surgery, 1070 Arastradero Rd, Palo Alto, CA 94304, USA.
School of Pharmacy, University of Wisconsin, 777 Highland Ave., Madison, WI 53705, USA.
Res Social Adm Pharm. 2018 Feb;14(2):153-161. doi: 10.1016/j.sapharm.2017.02.005. Epub 2017 Feb 24.
The VA system is the largest single provider of healthcare in the United States and to individuals infected with HIV specifically. High quality medication management is particularly important since HIV is a chronic infectious condition which requires taking multiple medications with strict requirements for adherence to medication regimens. Veterans Administration (VA) patients are required to obtain all chronic medications using the VA mail-order pharmacy system.
Drawing on Donabedian's Quality Improvement framework, this study sought to examine experiences that Veterans with HIV have with the Veterans Administration medication mail-order system, and to explore opportunities for quality improvement.
A sequential, explanatory mixed-methods design was used to interview Veterans receiving care at a Midwestern Veterans Administration Hospital using a mail-order experience survey followed by in-depth interviews. All 57 Veterans, out of 72, who were successfully contacted consented to participate.
Overall, Veterans evaluated the mail-order service positively and valued the accuracy (correct medication delivery). However, a notable problem emerged with respect to assuring access to HIV medications with about half (47%) indicating running out of HIV medication. Respondents identified structural issues with respect to days covered by mailed medications (90 versus current 30 days) and process issues with scheduling new refills. Veterans also indicated the information sheets were too long, complex and not helpful for their queries. Patients were open to pharmacists playing an active role during clinic visits and felt this would help manage their conditions better.
Veterans generally reported that the VA Mail-order service was of high quality. However, some findings indicate there are opportunities to improve this service to be more patient-centered particularly for vulnerable HIV patients.
VA 系统是美国最大的单一医疗保健提供商，特别是为感染 HIV 的个人提供服务。高质量的药物管理尤为重要，因为 HIV 是一种慢性传染病，需要服用多种药物，并严格遵守药物治疗方案。VA 患者需要通过 VA 邮购药房系统获得所有慢性药物。
本研究借鉴 Donabedian 的质量改进框架，旨在探讨感染 HIV 的退伍军人对 VA 药物邮购系统的体验，并探索质量改进的机会。
采用顺序、解释性混合方法设计，对中西部 VA 医院接受护理的退伍军人进行了邮购体验调查，随后进行了深入访谈。所有成功联系的 72 名退伍军人中有 57 名同意参与。
总体而言，退伍军人对邮购服务的评价是积极的，他们重视准确性（正确的药物交付）。然而，在确保获得 HIV 药物方面出现了一个明显的问题，约有一半（47%）的退伍军人表示 HIV 药物已经用完。受访者指出了邮寄药物覆盖天数（90 天与当前 30 天）的结构问题以及安排新处方的流程问题。退伍军人还表示，用药信息表太长、太复杂，对他们的问题没有帮助。患者对药剂师在就诊期间发挥积极作用持开放态度，并认为这将有助于更好地管理他们的病情。
退伍军人普遍报告说，VA 邮购服务质量很高。然而，一些发现表明，有机会改善这项服务，使其更加以患者为中心，特别是对脆弱的 HIV 患者。
