Evaluating the Effects of an Interdisciplinary Practice Model with Pharmacist Collaboration on HIV Patient Co-Morbidities

Abstract

Treatment of HIV now occurs largely within the primary care setting, and the principal focus of most visits has become the management of chronic disease states. The clinical pharmacist's potential role in improving chronic disease outcomes for HIV patients is unknown. A retrospective cohort study was performed for HIV-positive patients also diagnosed with diabetes, hypertension, or hyperlipidemia. Characteristics and outcomes in 96 patients treated by an interdisciplinary team which included a clinical pharmacist (i.e., the intervention group) were compared to those in 50 patients treated by an individual healthcare provider (i.e., the control group). Primary outcomes were changes from baseline over 18 month period of HbA1c, low density lipoprotein (LDL), and blood pressure, respectively. Secondary outcomes included number of drug-drug interactions, HIV viral load, CD4 count, percent change in smoking status, and percent of patients treated to cardiovascular guideline recommendations. The interdisciplinary team had a significant improvement in lipid management over the control group (LDL:-8.8 vs. +8.4 mg/dL; p=0.014), and the smoking cessation rate over the study period was doubled in the interdisciplinary group (20.4% vs. 11.8%). Among those with an indication for aspirin, a significantly higher percentage of patients were prescribed the medication in the interdisciplinary group compared to the control group (85.5% v. 64.9%; p=0.014). An informal cost analysis estimated savings of more than $3000 per patient treated by the interdisciplinary team. Based on these results, pharmacist involvement in an HIV primary care clinic appears to lead to more appropriate management of chronic comorbidities in a cost-effective manner.

Clinical outcomes of pharmaceutical care intervention in HIV positive patients with hypertension: A randomized controlled study

“…Similar results have been reported among hypertensive patients 36,37 . Cope et al, 38 however, did not find a significant improvement in BP in the group which received care from a clinical pharmacist in collaboration with other healthcare providers.…”

“…Similarly, previous studies did not find significant improvement in the number of PLWHV with UPVL following PC intervention 24,26,42 . Furthermore, a retrospective evaluation of the interventions of a pharmacist, working in collaboration with other providers of care for PLWHV and comorbidities did not find any statistically significant difference in viral load between the IA and the CA 38 …”

Economic evaluations of clinical pharmacy services in the United States: 2011‐2017

“…A total of 47 (41%) economic evaluations focused on general pharmacotherapeutic management (Table S1). Most studies used study designs with a high risk of bias—38% were single‐group posttest, 15% were nonrandomized posttest using a historical control group, and 11% were single‐group pretest‐posttest. Study designs with a medium risk of bias comprised the rest of the studies: 15% were nonrandomized pretest‐posttest and 11% were nonrandomized posttest.…”

Role of Pharmacists in the Interprofessional Care Team for Patients with Chronic Diseases

“…10 The presence of an interprofessional healthcare team, namely doctors, pharmacists, nurses, and social workers, resulted in patients showing a preference for a particular healthcare location for their care. 11 The team included various types of professions, with a team that actually collaborated with each other. This collaboration required a certain level of openness, a willingness to compromise, and a clear understanding of each person's role.…”