University of Nebraska Medical Center, College of Pharmacy, Omaha, NE, United States of America.
University of Nebraska Medical Center, College of Public Health, Omaha, NE, United States of America.
PLoS One. 2023 May 23;18(5):e0285694. doi: 10.1371/journal.pone.0285694. eCollection 2023.
Adherence to antiretroviral therapy (ART) remains the main predictor of sustained HIV virologic suppression for people with HIV (PWH). Mail-order pharmacy services are often offered to patients as an alternative option to traditional pharmacy services. Some payers mandate ART to be dispensed from specific mail-order pharmacies regardless of patient choice complicating ART adherence for patients affected by social disparities. Yet, little is known about patient perspectives regarding mail-order mandates.
Eligible patients of the HIV program at University of Nebraska Medical Center with experience receiving ART from both a local and mail-order pharmacy were invited to complete a 20-question survey with three core sections: experiences/perspectives on local and mail-order pharmacy settings; pharmacy attributes rankings; and pharmacy preference. Paired t-tests and Mann-Whitney tests were used to compare the agreement scores of pharmacy attributes.
Sixty patients (N = 146; 41.1%) responded to the survey. Mean age was 52 years. Most were male (93%) and White (83%). The majority of participants were on ART for HIV treatment (90%) and 60% were using mail-order pharmacies for their prescription services. Significant scoring differences (p<0.05) were observed for all pharmacy attributes favoring local pharmacies. Refilling ease was the most important attribute noted. More respondents (68%) preferred local pharmacies versus mail-order pharmacies. Payer associated mail-order pharmacy mandates were experienced by 78% with half believing the mandates impacted their medical care negatively.
In this cohort study, respondents preferred local pharmacies compared to mail-order pharmacy for ART prescription services and noted ease of refilling as the most important pharmacy attribute. Two-thirds of respondents believed mail-order pharmacy mandates negatively affected their health. Insurance payers should consider the removal of mail-order pharmacy mandates to allow patient choice of pharmacy, which may help remove barriers to ART adherence and improve long-term health outcomes.
抗逆转录病毒疗法（ART）的依从性仍然是艾滋病毒感染者（PWH）持续病毒学抑制的主要预测因素。邮购药房服务通常作为传统药房服务的替代选择提供给患者。一些付款人规定无论患者选择如何，都必须从特定的邮购药房发放 ART，这使得受社会差异影响的患者在遵守 ART 方面变得复杂。然而，人们对患者对邮购命令的看法知之甚少。
内布拉斯加大学医学中心艾滋病毒项目的合格患者，有从当地和邮购药房接受 ART 的经验，被邀请完成一份包含三个核心部分的 20 个问题的调查：在当地和邮购药房环境中的经验/观点；药房属性排名；和药房偏好。使用配对 t 检验和曼-惠特尼检验比较药房属性的一致评分。
60 名患者（N=146；41.1%）对调查做出了回应。平均年龄为 52 岁。大多数是男性（93%）和白人（83%）。大多数参与者正在接受艾滋病毒治疗的 ART（90%），60%正在使用邮购药房提供处方服务。所有药房属性的评分差异均有显著差异（p<0.05），均有利于当地药房。取药方便是最被重视的属性。更多的受访者（68%）更喜欢当地药房而不是邮购药房。78%的人经历过与支付方相关的邮购药房命令，其中一半人认为这些命令对他们的医疗护理产生了负面影响。
在这项队列研究中，与邮购药房相比，受访者更喜欢当地药房提供的 ART 处方服务，并指出取药方便是最重要的药房属性。三分之二的受访者认为邮购药房命令对他们的健康产生了负面影响。保险支付人应考虑取消邮购药房命令，允许患者选择药房，这可能有助于消除 ART 依从性的障碍，改善长期健康结果。
