Characterization of clinical pharmacy services in a pediatric HIV clinic

Abstract

Objectives The objectives of this study were to characterize and analyze clinical pharmacists' interventions in a pediatric human immunodeficiency virus clinic. Methods This retrospective review assesses interventions documented by pediatric pharmacists. The percent of patients with an undetectable viral load at baseline, prior to implementation of pharmacy services, was compared with the viral load at a 7‐year follow‐up visit. Mean log10 viral loads at years 1 and 7 were compared to baseline and the mean change in viral load was compared. Results Pharmacists were involved with the care of 53 patients at 2257 visits documenting 8893 interventions. Recommendations to physicians accounted for 1316 (14.8%) of the interventions. Pharmacists documented 3176 (35.7%) interventions to patients/caregivers. One‐thousand and twenty‐eight (11.6%) interventions were educational concepts taught to patients/caregivers. Pharmacists provided 1107 (12.4%) adherence aids and conducted 669 (7.5%) adherence assessments. The percentage of patients with undetectable viral loads increased from 12.1% (4/33) to 65.8% (25/38) (P = 0.0094). The mean log10 viral load at years 1 and 7 were lower than those obtained prior to the first clinical pharmacy visit (year 1:3.95 ± 1.22 copies/mL vs 4.37 ± 1.09 copies/mL; P = 0.0042; year 7:2.88 ± 1.21 copies/mL vs 4.42 ± 1.11 copies/mL; P < 0.0001).The decrease in mean log10 viral load (viral load change) was significantly greater in year 7 compared with year 1 (P = 0.04). A clinically significant mean viral load decrease occurred each year from years 2 to 7. Conclusions In 7 years of pediatric clinical pharmacy services, thousands of interventions were documented. An increase in the number of patients with an undetectable viral load and improvements in mean log10 viral load occurred. These findings suggest that interventions by pediatric clinical pharmacists contributed to overall improvements in viral loads observed in this study. This analysis provides insight into the essential role of a clinical pharmacist in a pediatric HIV clinic.

Antiretroviral stewardship in a Tertiary Academic Hospital: The need for a clinical pharmacist

“…This statement can be justified by the significant increase of patients with an undetectable viral load based on interventions made by clinical pharmacists. These results can be concurred by another report, which found nearly 1500 clinical interventions made by pharmacists who cared for HIV-positive patients at a Veteran’s Affairs Medical Centre (VAMC) (Morris et al 2019 ). Currently, there are no data available from South Africa that investigate the role of the clinical pharmacist in the utilisation of an ARV-stewardship programme.…”

“…Morris et al ( 2019 ) reported that interventions made by clinical pharmacists, as part of the interdisciplinary care team, contributed towards improved viral loads in paediatric patients. This statement can be justified by the significant increase of patients with an undetectable viral load based on interventions made by clinical pharmacists.…”

Evidence demonstrating the pharmacist's direct impact on clinical outcomes in pediatric patients: An opinion of the pediatrics practice and research network of the American College of Clinical Pharmacy

“…Specifically looking at clinical endpoints, the percentage of patients with an undetectable viral load increased from 12.1% to 65.8% during the study period ( P = .0094). The mean viral load decreased from baseline (4.37 SD 1.09 copies/mL vs 3.95 SD 1.22 copies/mL P = .0042) (Table ) …”