评估在以患者为中心的药师主导的 HIV 护理模式下 HIV 感染者的药物治疗问题、解决方案和用药依从性。

Evaluation of Medication Therapy Issues, Resolutions, and Adherence Among Persons With HIV in the Pharmacist-Led Patient-Centered HIV Care Model.

机构信息

US Insights, Walgreens, Deerfield, IL.

Local Specialty at Howard Brown, Walgreens, Deerfield, IL.

出版信息

J Acquir Immune Defic Syndr. 2021 Sep 1;88(1):96-102. doi: 10.1097/QAI.0000000000002732.

DOI:10.1097/QAI.0000000000002732

PMID:34034304

Abstract

OBJECTIVE

To identify medication therapy issues and resolutions and assess their relationship to antiretroviral therapy (ART) adherence among participants of the Patient-Centered HIV Care Model demonstration project.

METHODS

Adult persons with HIV (PWH) in the United States were enrolled in the Patient-Centered HIV Care Model from August 2014 to September 2016. Pharmacists conducted regular medication therapy reviews and documented ART and non-ART issues and suggested resolutions. Adherence to ART was calculated using proportion of days covered (PDC), and the mean PDC by the number of ART issues was compared using a generalized linear model with linear trend estimation.

RESULTS

The most common ART issue was adherence (57%). Adherence ART issues were resolved by adherence management (48%) or patient education (36%). Participants had a mean of 4.2 ART issues and 6.4 non-ART issues. PDC was 89% for those with 0 ART issues and 73% for those with ≥3 ART issues. Persons with 0 ART issues had an increase in adherence (+8%) in the postperiod, whereas those with ≥3 ART issues had a decrease in adherence (-6%) (P = 0.02) in the postperiod.

CONCLUSIONS

Identifying therapy issues could help pharmacists improve care for PWH. Because PWH are an aging population with an increased risk of comorbidities and polypharmacy, pharmacists and providers should collaborate to provide holistic, primary care solutions to address both the number and nature of therapy issues.

摘要

目的

在“以患者为中心的艾滋病护理模式”示范项目中，确定药物治疗问题和解决方案，并评估其与抗逆转录病毒治疗（ART）依从性的关系。

方法

美国的成年艾滋病毒感染者（PWH）于 2014 年 8 月至 2016 年 9 月参加了“以患者为中心的艾滋病护理模式”。药剂师定期进行药物治疗审查，并记录 ART 和非 ART 问题及建议解决方案。采用覆盖天数比例（PDC）计算 ART 依从性，使用具有线性趋势估计的广义线性模型比较按 ART 问题数量计算的平均 PDC。

结果

最常见的 ART 问题是依从性（57%）。通过依从性管理（48%）或患者教育（36%）解决了依从性 ART 问题。参与者平均有 4.2 个 ART 问题和 6.4 个非 ART 问题。无 ART 问题者的 PDC 为 89%，有≥3 个 ART 问题者的 PDC 为 73%。无 ART 问题者的依从性在后期增加了（8%），而有≥3 个 ART 问题者的依从性在后期减少了（6%）（P = 0.02）。