Effects of pharmacists’ interventions on patient outcomes in an HIV primary care clinic

March, Kristi L.; Mak, May; Louie, Stan G.

doi:10.2146/ajhp070048

Cited by 64 publications

(68 citation statements)

References 23 publications

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“…This finding is consistent with that of March et al who reported a positive effect of pharmacist MTM services on medication side effects, expressed in their study as a reduction in drug-related toxicities. 9 In addition to treating side effects, the pilot pharmacy patients appear to receive more medications for psychiatric comorbidities, which is consistent with the increased expenditures on mental health services. These findings suggest that the pilot pharmacy patients may receive more appropriate HIV treatment and perhaps more comprehensive medical access and care for their other conditions, often related to their primary therapy.…”

Section: Evaluation Of the First Year Of A Pilot Program In Communitymentioning

confidence: 56%

“…8 The second, a prospective study of patients (n = 34) who had an extensive history of treatment and attended a pharmacist-managed drug optimization clinic, reported significant improvement from baseline in CD4 + T-lymphocyte counts (mean [SD] ]; P < 0.001) and viral loads (mean reduction 1.02 log 10 copies per milliliter [mL]; P = 0.004). 9 A significant decrease in the mean drug-related toxicity score was also observed among patients experiencing drug-related toxicities (n = 25, mean [SD] reduction of 1.0 [0.8] on the 4-point Radiation Therapy Oncology Group common toxicity scale, P < 0.001). However, that study lacked a comparison group.…”

mentioning

confidence: 90%

“…Following up on previous work suggesting a potential impact of pharmacist-provided MTM services on adherence and viral load in HIV/AIDS patients who were treated in the community setting, 8,9 the California HIV/AIDS pharmacy MTM services pilot program provided an opportunity to investigate a broader range of outcomes using a larger sample of patients with HIV/AIDS. The California study examined patients receiving care at pharmacies providing a wide range of MTM services and compared their outcomes with those of similar patients at other pharmacies throughout the state.…”

Section: What This Study Addsmentioning

confidence: 99%

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Evaluation of the First Year of a Pilot Program in Community Pharmacy: HIV/AIDS Medication Therapy Management for Medi-Cal Beneficiaries

Hirsch¹,

Rosenquist²,

Best³

et al. 2009

JMCP

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BACKGROUND: The advent of combined antiretroviral therapy (ART) has increased treatment effectiveness but created new challenges for patients infected with human immunodeficiency virus (HIV) and for community pharmacists managing patients' drug therapy. The ability of pharmacistprovided medication therapy management (MTM) services to increase medication adherence, improve health outcomes, and reduce overall medical costs has been demonstrated in community pharmacies for chronic diseases such as diabetes and hypertension. However, the effectiveness of pharmacist-provided MTM services in HIV/acquired immune deficiency syndrome (AIDS) has not been well studied. In January 2005, a pilot program to evaluate MTM services for patients with HIV/AIDS began in California, allowing 10 HIV/AIDS specialty pharmacies to receive compensation for the MTM services that they provided to HIV/AIDS patients.OBJECTIVES: To examine the first year of the HIV/AIDS pharmacy MTM compensation pilot program, which described and compared pilot and nonpilot pharmacies with respect to (a) patient characteristics; (b) intermediate outcomes including type and number of ART medication regimens used, rates of adherence and excess medication fills for ART, use of contraindicated ART regimens, and occurrence of opportunistic infections; and (c) pharmacy and medical costs.METHODS: This was a cohort study examining 2005 Medi-Cal pharmacy and medical claims data for patients with HIV/AIDS who were served by pilot pharmacies versus other pharmacies. The HIV/AIDS patients were Medi-Cal beneficiaries aged 18 years or older as of January 1, 2005, who were continuously enrolled from January 1, 2004, through December 31, 2005, and diagnosed with HIV/AIDS, identified by receipt of at least 1 ART prescription and at least 1 medical claim with a diagnosis (primary or secondary) of HIV/AIDS (ICD-9-CM code 042.0) during both the index period (the year before pilot program implementation, 2004) and the intervention period (the study year, 2005). The only difference in the inclusion criteria for the 2 cohorts was that the pilot pharmacy patients were required to have filled 50% or more of their antiretroviral prescriptions in 2005 at 1 of the 10 pilot pharmacies. Adherence was defined as a medication possession ratio (MPR) of 80%-120% and excess medication fills as MPR greater than 120%. Comparisons were made between groups using bivariate statistics (Pearson chi-square for categorical variables and t-tests for continuous variables). For comparisons of costs, generalized linear models assuming a gamma distribution and log link function were used; predictor variables for the models included age, gender, race/ethnicity, and dual coverage under Medicare.RESULTS: A total of 7,018 HIV/AIDS patients in the Medi-Cal population were identified as meeting the study criteria. Of these, 19.3% (n = 1,353) were pilot pharmacy patients. The demographic profile of pilot pharmacy patients was similar, but not identical, to that of patients receiving medications at other ph...

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Section: Evaluation Of the First Year Of A Pilot Program In Communitymentioning

confidence: 56%

mentioning

confidence: 90%

Section: What This Study Addsmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of the First Year of a Pilot Program in Community Pharmacy: HIV/AIDS Medication Therapy Management for Medi-Cal Beneficiaries

Hirsch¹,

Rosenquist²,

Best³

et al. 2009

JMCP

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show abstract

“…E-mail: r.vanmali@usciences.edu working as part of a multidisciplinary team. 4,5,6,7,8,9 March, et al described the impact of pharmacists' interventions on patient outcomes in a federally funded HIV clinic in Los Angeles, CA. At the conclusion of the study, patients being followed by the pharmacists in the clinic had a significant improvement in CD4 count, viral load (VL), and drug-related toxicities.…”

Section: 2mentioning

confidence: 99%

The Role of Ambulatory Care Pharmacists in an HIV Multidisciplinary Team within a Free and Bilingual Clinic

Vanmali¹,

Mayer²,

Fugit³

2013

Innov Pharm

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Results: Total of 32 patients accounted for 55 patient-pharmacist visits and 296 interventions. The most common interventions were medication review (66.9%), patient education (23.3%), and adherence monitoring (9.8%). Post-hoc analysis suggests Hispanic patients are more likely to be diagnosed with Acquired Immune Deficiency Syndrome (AIDS) (P = 0.01), have current or history of opportunistic infection (OI) (P=0.01), and have current or history of OI prophylaxis (P = 0.03). Adherence monitoring was less common amongst the non-Hispanics (7.1%) compared to the Hispanic sub-population (16.5%), (P = 0.04). Conclusion

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“…7 Some studies have shown positive benefit from MTM provided in specialty practice settings. [8][9][10] Success has also been reported where MTM included pharmacist management of medication side effects and adverse drug Letter (nonpsychiatric, medical) diagnoses, primary care and pharmacy contact information, current medications, and potential MRPs. Six charts were not reviewed because the subjects were aged 18 years or older.…”

mentioning

confidence: 99%

Examination of MTM Opportunities in Pediatric Behavioral Health

Oji¹

2009

JMCP

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HealthWe performed a retrospective and exploratory chart review, based on a convenience sample, to assess the need for medication-related services in a primarily child and adolescent, nonMedicare population served by a private, ambulatory behavioral center providing primarily outpatient psychiatry, psychotherapy, and partial hospitalization services. We (a) collected demographic data; (b) defined eligibility for a potential MTM program for this patient population based on criteria that were derived from CMS, facility stakeholders, and pharmacist specialists; and (c) identified existing aspects of sound MTM that could potentially be applied to the sample. CMS criteria were adapted to define eligibility for MTM: (a) the presence of at least 1 psychiatric (Axis I) and 1 nonpsychiatric medical condition (Axis III) as the minimal criterion for the existence of multiple chronic conditions, and (b) multiple medications (4 or more, in this instance). Facility stakeholders had particular concern for monitoring medications consistent with Joint Commission medication management standards for behavioral health. From this position, additional criteria for patient selection were included: medications with potential for producing tardive dykinesia and high-dose psychopharmacology (above recommended dosage ranges). Pharmacist specialist criteria were based on MRPs as categorized by routine drug regimen review and services. Potential needs as documented in the records were considered as part of fulfillment of the 3 principles of sound MTM: (a) need for medication management assistance, (b) availability of health professionals who intervene with patients and physicians to improve drug regimens, and (c) established performance outcomes measures.

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Effects of pharmacists’ interventions on patient outcomes in an HIV primary care clinic

Abstract: HIV-infected patients who were managed by pharmacists in a DOC demonstrated significant improvement from baseline in their CD4+ lymphocyte counts, viral loads, and drug-related toxicities.

Cited by 64 publications

References 23 publications

Evaluation of the First Year of a Pilot Program in Community Pharmacy: HIV/AIDS Medication Therapy Management for Medi-Cal Beneficiaries

Evaluation of the First Year of a Pilot Program in Community Pharmacy: HIV/AIDS Medication Therapy Management for Medi-Cal Beneficiaries

The Role of Ambulatory Care Pharmacists in an HIV Multidisciplinary Team within a Free and Bilingual Clinic

Examination of MTM Opportunities in Pediatric Behavioral Health

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