Impact of pharmacist interventions on drug-related problems and laboratory markers in outpatients with human immunodeficiency virus infection

Abstract

BackgroundSubstantial complexity has been introduced into treatment regimens for patients with human immunodeficiency virus (HIV) infection. Many drug-related problems (DRPs) are detected in these patients, such as low adherence, therapeutic inefficacy, and safety issues. We evaluated the impact of pharmacist interventions on CD4+ T-lymphocyte count, HIV viral load, and DRPs in patients with HIV infection.MethodsIn this 18-month prospective controlled study, 90 outpatients were selected by convenience sampling from the Hospital Dia–University of Campinas Teaching Hospital (Brazil). Forty-five patients comprised the pharmacist intervention group and 45 the control group; all patients had HIV infection with or without acquired immunodeficiency syndrome. Pharmaceutical appointments were conducted based on the Pharmacotherapy Workup method, although DRPs and pharmacist intervention classifications were modified for applicability to institutional service limitations and research requirements. Pharmacist interventions were performed immediately after detection of DRPs. The main outcome measures were DRPs, CD4+ T-lymphocyte count, and HIV viral load.ResultsAfter pharmacist intervention, DRPs decreased from 5.2 (95% confidence interval [CI] =4.1–6.2) to 4.2 (95% CI =3.3–5.1) per patient (P=0.043). A total of 122 pharmacist interventions were proposed, with an average of 2.7 interventions per patient. All the pharmacist interventions were accepted by physicians, and among patients, the interventions were well accepted during the appointments, but compliance with the interventions was not measured. A statistically significant increase in CD4+ T-lymphocyte count in the intervention group was found (260.7 cells/mm3 [95% CI =175.8–345.6] to 312.0 cells/mm3 [95% CI =23.5–40.6], P=0.015), which was not observed in the control group. There was no statistical difference between the groups regarding HIV viral load.ConclusionThis study suggests that pharmacist interventions in patients with HIV infection can cause an increase in CD4+ T-lymphocyte counts and a decrease in DRPs, demonstrating the importance of an optimal pharmaceutical care plan.

<p>Drug-Related Problems and Pharmacist Intervention at a General Hospital in the Jazan Region, Saudi Arabia</p>

“…13 Molino et al also had similar findings in a prospective controlled study, reporting that pharmacist interventions were generally accepted by physicians, leading to a change in medication therapy. 15 Furthermore, the interventions were well accepted by patients as well, although the compliance with the interventions was not measured. 14 These findings suggest that the importance of the pharmacist in healthcare is well recognized by physicians, as is the significance of the pharmaceutical practices in clinical settings.…”

“…These findings differ somewhat from those found in a previous study in which DRPs commonly involved adverse drug reactions (30.4%) and patient non-compliance (30.4%), followed by untreated indications (10.7%), drug interactions and supratherapeutic/sub-therapeutic doses (7.1% each), improper drug selection (5.4%), and drug use without indication (1.8%). 15 Another study was conducted at a private hospital in Riyadh City, Saudi Arabia to investigate the intervention of clinical pharmacist's services at critical care units. This study reported that the most common DRPs were inappropriate dose (20.05%), followed by drug duplication (11.29%), and unsuitable route (6.87%) and DDIs (1.96%).…”

Cost analysis of pharmaceutical care provided to HIV-infected patients: an ambispective controlled study

“…The clinical pharmacy team performed written and verbal pharmacist interventions with the intervention group, which were accounted for and classified as pharmacist-patient or pharmacist-physician interventions and as resolutive pharmacotherapy problems, preventive pharmacotherapy problems, quality of life, or referral to other medical specialties interventions. The classifications used for pharmacotherapy problems and pharmacist interventions are in accordance with those used in another publication by the authors [ 22 ].…”

The Effectiveness of a Pharmaceutical Care Model on Adherence to Antiretroviral Therapy: A SAME-Based Cohort Study in Brazil

“… 2 Partial adherence or non-adherence to ART is one of the main barriers to its effectiveness. 3 , 4 In this context, studies that identify the benefits of different pharmaceutical care practices in supporting adherence to antiretroviral therapy are necessary.…”