Pharmacist Interventions Significantly Improve Clinical Outcomes in HIV Outpatients

Study suggests pharmacists are more than qualified to navigate outpatients with HIV through treatment options.

Drug-related problems (DRPs) among outpatients with human immunodeficiency virus (HIV) decrease significantly when pharmacists intervene, according to research published August 7, 2014, in Therapeutics and Clinical Risk Management.

For their study, researchers from the Department of Clinical Pathology at the University of Campinas in Sao Paulo, Brazil, studied 90 outpatients from the Hospital Dia-University of Campinas Teaching Hospital for 18 months between February 2009 and August 2010. All of the participants had confirmed HIV infection with or without acquired immunodeficiency syndrome and were aged between 18 and 60 years.

Half of the participants were assigned to the pharmacist intervention group, while the remaining 45 were placed in the control group. Pharmacist interventions were conducted immediately after the detection of DRPs such as low medication adherence and therapeutic inefficacy, in accordance with the Pharmacotherapy Workup method, though DRP and pharmacist intervention classifications were modified to apply to the specific participants in the study.

“In other countries, like the US and Canada, the pharmacist plays an indispensable role in patient care. In Brazil, however, pharmaceutical care is still in development,” study author Priscila Gava Mazzola, PhD, told Pharmacy Times. “The Brazilian public health system attends to all people who live in Brazil, which comprises all HIV patients. Mostly, those patients do not receive pharmaceutical care, due to not meeting the pharmacist, or because pharmacists might work in the pharmacy administration.”

According to Dr. Mazzola, the aim of the research was to “reveal that pharmaceutical care makes a difference for HIV outpatients (by) reducing their DRPs and improving their clinical outcomes.” The main outcome measures for the study were DRPs, CD4+ T-lymphocyte count, and HIV viral load.

At each pharmacist appointment, data on drug dosages and whether certain therapies were necessary for a patient were recorded. The goal of each appointment was to reduce and prevent DRPs, as well as increase quality of life.

Among 122 proposed pharmacist interventions, with an average of 2.7 per patient, 33 (27%) aimed to solve DRPs, 79 (65%) were to prevent DRPs, and 10 (8%) were related to improving quality of life. Following the interventions, the researchers discovered significant increases in CD4 counts in the intervention group, but no significant change in the control group.

“Patients without adherence to treatment … may be referred to pharmacists by the physician or other health professionals,” Dr. Mazzola concluded. “Patients assisted by pharmacists—besides physician routine care—will receive (more) health care with positive long-term outcomes.”

The findings supported the conclusions of prior studies that clinical pharmacists can identify, solve, and prevent DRPs, as well as assist multidisciplinary teams in improving treatment adherence.

“We were very pleased with the acceptance of our interventions by the multidisciplinary team, both doctors and nurses. Usually, in Brazil, pharmacists do not work in a multidisciplinary team,” Dr. Mazzola noted. “In the beginning, we didn´t know how our relationship with them would be. Fortunately, since we started our study, we and our interventions have always been well-received and accepted by staff.”