Division of Pharmacy, Atrium Health, Charlotte, North Carolina.
Center for Outcomes Research and Evaluation.
J Manag Care Spec Pharm. 2020 Feb;26(2):95-102. doi: 10.18553/jmcp.2020.26.2.95.
Adherence to antiretroviral (ARV) therapy is critical in order to achieve and maintain viral suppression and improve immune function. Clinical pharmacists and pharmacies focused on human immunodeficiency virus (HIV) have demonstrated the ability to increase ARV medication adherence and subsequently have a positive effect on these lab markers.
To evaluate the effect of an integrated health system specialty pharmacy service with a clinic-embedded, HIV-trained pharmacist and pharmacy technician on ARV medication adherence rate, viral load, and CD4 count.
This was a single-center, retrospective cohort study conducted from August 7, 2017, to June 30, 2018, at an indigent outpatient infectious disease clinic within Atrium Health (AH), a not-for-profit health system based in Charlotte, NC. The intervention group (opt-in group) received HIV patient care that involved the health system specialty pharmacy service. Once a patient was enrolled in the specialty pharmacy service, medication reconciliation was completed by the pharmacist, financial assistance and prior authorizations were completed if needed; prescriptions were delivered to the patient; and monthly refills calls were conducted to assess adherence, tolerability, and medication changes. The control group (opt-out group) received HIV patient care that did not incorporate the health system specialty pharmacy. The primary endpoints were medication adherence, viral suppression, and CD4 counts. Within-group comparisons from baseline to follow-up were made along with group-to-group comparisons. Adherence was calculated using medication possession ratio.
For those patients using Atrium Health Specialty Pharmacy Service (AH SPS; n = 46), the overall median adherence rate was higher at 100% versus only 94% for those patients (n = 50) that opted out of the service ( < 0.01). All but 3 patients (21.7% at baseline vs. 6.5% at follow-up, = 0.03) using AH SPS reached viral suppression, and all but 1 had improved immune function with a CD4 count of 200 or greater by the end of the observation period ( = 0.03). The change in viral suppression and CD4 count of 200 or greater was not statistically improved between baseline and follow-up in those opting out of using AH SPS. When comparing the 2 groups at reaching these endpoints, there was no statistically significant difference in viral suppression and CD4 count.
AH SPS was able to demonstrate improved ARV adherence in those patients using an integrated specialty pharmacy with an embedded pharmacy team, coordinated monthly medication delivery, and refill reminder and adherence calls. This in turn led to improved viral suppression and immune markers by the end of the observation window for patients using AH SPS.
No outside funding supported this study. The authors have nothing to disclose.
为了实现并维持病毒抑制和改善免疫功能，抗逆转录病毒（ARV）治疗的依从性至关重要。专注于人类免疫缺陷病毒（HIV）的临床药剂师和药房已经证明了提高 ARV 药物依从性的能力，随后对这些实验室指标产生了积极影响。
评估与诊所嵌入式 HIV 培训药剂师和药剂技术员相结合的综合卫生系统专业药房服务对 ARV 药物依从率、病毒载量和 CD4 计数的影响。
这是一项单中心、回顾性队列研究，于 2017 年 8 月 7 日至 2018 年 6 月 30 日在北卡罗来纳州夏洛特市非营利性卫生系统 Atrium Health（AH）的一家贫困门诊传染病诊所进行。干预组（选择加入组）接受涉及卫生系统专业药房服务的 HIV 患者护理。一旦患者加入专业药房服务，药剂师就会完成药物调整，如有需要，完成财务援助和事先授权；将药物送到患者手中；并进行每月的药物补充电话评估，以评估依从性、耐受性和药物变化。对照组（选择退出组）接受不包括卫生系统专业药房的 HIV 患者护理。主要终点是药物依从性、病毒抑制和 CD4 计数。对从基线到随访的组内比较以及组间比较进行了评估。药物依从性通过药物持有率来计算。
对于使用 Atrium Health 专业药房服务（AH SPS；n=46）的患者，整体中位数依从率更高，为 100%，而选择不使用该服务的患者（n=50）的依从率为 94%（<0.01）。除 3 名患者（基线时为 21.7%，随访时为 6.5%，<0.03）外，所有使用 AH SPS 的患者均达到病毒抑制，所有患者（除 1 名患者外）的免疫功能均有所改善，CD4 计数达到 200 或更高在观察期结束时（<0.03）。在选择不使用 AH SPS 的患者中，从基线到随访时，病毒抑制和 CD4 计数增加 200 或更高的变化在统计学上没有改善。当比较两组达到这些终点时，在病毒抑制和 CD4 计数方面没有统计学上的显著差异。
AH SPS 能够通过整合专业药房、嵌入药房团队、协调每月药物交付、补充提醒和依从性电话，提高使用该服务的患者的 ARV 依从性。这反过来又导致使用 AH SPS 的患者在观察期结束时病毒抑制和免疫标志物得到改善。
本研究没有得到外部资金的支持。作者没有什么可透露的。
