Dong Betty J, Williams Michelle R, Bingham J Tyler, Tokumoto Jason, Allen Jeffery D
J Am Pharm Assoc (2003). 2017 Jul-Aug;57(4):516-519. doi: 10.1016/j.japh.2017.05.002. Epub 2017 Jun 10.
To describe the collaboration and prospective outcome of challenging human immunodeficiency virus (HIV) cases presented by Board of Prisons (BOP) pharmacists in consultation with Clinician Consultation Center (CCC) clinical pharmacists and physicians to improve correctional patient care.
Federal correctional facilities.
Pharmacists improve care of incarcerated persons infected with HIV.
Pharmacists evaluate, implement, and provide successful oversight of HIV/hepatitis C virus (HCV) care.
Retrospective review of the clinical outcomes of HIV and HCV coinfected cases implemented by BOP pharmacists following CCC clinical consultations from 2010 through 2012.
Most cases focused on selecting optimal antiretroviral therapy (ART) regimens in patients experiencing treatment failure by interpreting resistance tests, limiting ART toxicity, identifying adherence strategies, and managing HIV/HCV coinfection. In 32 of the 34 cases presented, 87.5% (28/32) of CCC recommendations were implemented, resulting in 89% of those patients (25/28) achieving optimal virologic or clinical outcome. Complete virologic suppression occurred in 64% (18/28), and significant viral load reductions in 25% (7/28) of the cases. No changes occurred in 2 patients, and data were not available in 2 others lost to follow-up. BOP participation has increased since its inception from 6 to 12-15 pharmacists per call. Discussions also included updates in antiretroviral guidelines, screening and management of patients coinfected with HIV and HCV, and implications for BOP guidelines.
BOP clinical consultant pharmacists can successfully implement CCC recommendations to achieve desired clinical outcomes. Consultations and educational efforts from CCC experts assist BOP pharmacists in ensuring excellence in management of complex HIV/HCV issues and medication regimens to achieve desired outcomes. CCC collaboration and BOP pharmacist involvement have improved patient care. Using a team approach to include BOP clinical pharmacists and obtaining expert opinion in management of other chronic illnesses may be a model that can be considered to improve correctional care.
描述监狱管理局（BOP）药剂师与临床医生咨询中心（CCC）临床药剂师和医生协商处理具有挑战性的人类免疫缺陷病毒（HIV）病例的合作情况及预期结果，以改善惩教患者的护理。
联邦惩教设施。
药剂师改善对感染HIV的被监禁人员的护理。
药剂师评估、实施并成功监督HIV/丙型肝炎病毒（HCV）护理。
对2010年至2012年BOP药剂师在CCC临床咨询后实施的HIV和HCV合并感染病例的临床结果进行回顾性审查。
大多数病例集中在通过解读耐药性检测为治疗失败的患者选择最佳抗逆转录病毒疗法（ART）方案、限制ART毒性、确定依从性策略以及管理HIV/HCV合并感染。在提交的34例病例中的32例中，CCC建议的87.5%（28/32）得到实施，这些患者中有89%（25/28）实现了最佳病毒学或临床结果。64%（18/28）的病例实现了完全病毒学抑制，25%（7/28）的病例病毒载量显著降低。2例患者无变化，另外2例失访，无可用数据。自成立以来，每次咨询参与的BOP药剂师人数已从6名增加到12 - 15名。讨论还包括抗逆转录病毒指南的更新、HIV和HCV合并感染患者的筛查和管理以及对BOP指南的影响。
BOP临床顾问药剂师可以成功实施CCC建议以实现预期的临床结果。CCC专家的咨询和教育工作协助BOP药剂师确保在复杂的HIV/HCV问题和药物治疗方案管理方面达到卓越水平，以实现预期结果。CCC的合作以及BOP药剂师的参与改善了患者护理。采用团队方法纳入BOP临床药剂师并在其他慢性病管理中获取专家意见可能是一种可考虑用于改善惩教护理的模式。
