Evaluation of clinical pharmacist interventions on drug interactions in outpatient pharmaceutical HIV-care

Abstract

Objective: To evaluate the usefulness of intervention in drug interactions of antiretroviral drugs with coadministered agents by a clinical pharmacist in outpatient HIV-treatment. Methods: The study design included two intervention arms (A and B), which were both preceded by a control observation period. In arm A, a complete list of the currently used drugs, extracted from pharmacy records was provided to the treating physician. In arm B the same list was provided but with a notification when a drug interaction was present and an advice how to handle this. The infectious disease specialist obtained the information before the patient's visit to the outpatient clinic (time point 0). Three months prior (time point )3) and 3 months after (time point +3) the intervention, pharmacy records were also screened for drug interactions. The number of drug interactions (total and per patient) was determined at the three different time points ()3, 0, +3). In addition, drug interactions encountered at time points )3 and 0 were checked for their presence at time points 0 and +3, respectively, for both intervention arms. Results: Arms A and B included 115 and 105 patients, respectively. Patient characteristics of both intervention arms were similar at time point 0. The number of interactions and the number of patients with interactions were similar in both intervention arms at time point 0. There were 42 and 40 potential drug interactions in 30 and 24 patients in arms A and B, respectively. The reduction in the number of interactions per patient over time and after intervention was small but significant, and was equal in both intervention arms. The advice of the clinical pharmacist had thus no additional value. Conclusion: Both interventions were effective in reducing the number of drug interactions per patient. The advice of a clinical pharmacist was, however, redundant in the studied setting.

Identification of potential clinically significant drug interactions in HIV‐infected patients: a comprehensive therapeutic approach

“…Clinically significant drug interactions in HIV patients 277 knowledge and collaborating with the physician, thus optimizing drug treatments in HIV-infected patients. Several studies have shown that treatment reviews by pharmacists integrated in multidisciplinary teams can reduce the number of prescription drugs and reduce the rate of mortality and morbidity associated with iatrogenic diseases caused by drug use [4,25,26]. The authors consider it necessary to select only those alerts that identify important interactions in clinical practice, as an excess of information may lead to saturation at the time of clinical decision making [27].…”

“…Clinically significant drug interactions (CSDIs) involving antiretroviral agents have been reported in 30-41.2% of HIV-positive patients in the USA [3], and 20-23% in the Netherlands [4]. Several studies have suggested a positive correlation between increased age and increased risk for drug interactions in HIV-positive patients [5].…”

Effect of a clinical pharmacist’s interventions on duration of antiretroviral-related errors in hospitalized patients

“…[17][18][19][20][21] This is the first study we are aware of that demonstrates a reduction in the duration of HAART errors in a hospital as a result of a clinical pharmacist's interventions.…”

Directly acting antivirals for hepatitis C and antiretrovirals

“…It therefore follows that significant changes in HCV therapy could profoundly improve the treatment outcomes of this patient group. However, the addition of combination therapies, which include novel agents, for patients who are taking ARV regimens is unlikely to be without complication; clinically significant DDIs involving ARVs are common, affecting 27% of 159 HIV-infected outpatients in a UK study [9] and 23-26% of 220 HIVinfected outpatients in a study in The Netherlands [10].…”