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社区艾滋病诊所的跨学科护理团队与药剂师

Interdisciplinary Care Team with Pharmacist in a Community-based HIV Clinic.

机构信息

Chemonics International, 1717 H Street, NW Washington, DC, 20006, United States.

Howard University College of Pharmacy, Center of Excellence, 2300 4th St., NW Washington, DC, 20059, United States.

出版信息

J Natl Med Assoc. 2018 Aug;110(4):378-383. doi: 10.1016/j.jnma.2017.07.005. Epub 2017 Aug 7.

Abstract

BACKGROUND

Human immunodeficiency virus (HIV) infection presents a significant burden, especially in the Washington, DC area. Literature is limited in describing the role of pharmacists in the outpatient clinic setting to provide patient-centered pharmaceutical care for patients with HIV.

OBJECTIVE

Our study aims to describe an interdisciplinary HIV care model including a clinical pharmacist at a community-based transcultural clinic in the Washington, DC area, and to describe the role of the pharmacist as indicated by an association between non-adherence to antiretroviral therapy (ART) and an ART regimen change.

METHODS

Using the electronic health record at the clinic from May 2011 through July 2013, 53 patients were identified who were referred to the clinical pharmacist.

RESULTS

The average age of the patients with HIV was 46.57 years in the clinic. About 28% of patients had documented non-adherence to ART and 30% of patients had one or more ART regimen changes during the study period. Medication non-adherence was a significant predictor of ART regimen change (OR 8.44; 95% CI 1.91-37.29). Substance use was a strong predictor of ART regimen change (OR 3.47; 95% CI 1.02-11.81), but the relationship disappeared in the multivariate analysis.

CONCLUSIONS

A strong association between pharmacist's evaluation of non-adherence to ART and a regimen change was demonstrated and the role of the pharmacist as the interdisciplinary team member was described. A follow-up study should be made to assess the services provided by the pharmacist on clinical, economic, and humanistic outcomes in the community-based clinical setting.

摘要

背景

人类免疫缺陷病毒(HIV)感染带来了巨大的负担,尤其是在华盛顿特区地区。文献在描述药剂师在门诊环境中为 HIV 患者提供以患者为中心的药物治疗方面的作用方面有限。

目的

我们的研究旨在描述一种包括社区跨文化诊所的临床药剂师在内的跨学科 HIV 护理模式,并描述药剂师的作用,表现为抗逆转录病毒疗法(ART)不依从与 ART 方案改变之间的关联。

方法

使用 2011 年 5 月至 2013 年 7 月诊所的电子健康记录,确定了 53 名被转介给临床药剂师的 HIV 患者。

结果

在诊所中,HIV 患者的平均年龄为 46.57 岁。大约 28%的患者有记录的 ART 不依从,在研究期间 30%的患者有一个或多个 ART 方案改变。药物不依从是 ART 方案改变的显著预测因素(OR 8.44;95%CI 1.91-37.29)。药物滥用是 ART 方案改变的一个强有力的预测因素(OR 3.47;95%CI 1.02-11.81),但在多变量分析中这种关系消失了。

结论

证明了药剂师对 ART 不依从的评估与方案改变之间存在很强的关联,并描述了药剂师作为跨学科团队成员的作用。应进行后续研究,以评估社区临床环境中药剂师提供的服务在临床、经济和人文结果方面的效果。

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