Impact of Pharmacist-Driven Antiretroviral Stewardship and Transitions of Care Interventions on Persons With Human Immunodeficiency Virus

Marisa B Brizzi; Rodrigo M Burgos; Thomas D Chiampas; Sarah M Michienzi; Renata Smith; Paa Kwesi Yanful; Melissa E Badowski

doi:10.1093/ofid/ofaa073

Impact of Pharmacist-Driven Antiretroviral Stewardship and Transitions of Care Interventions on Persons With Human Immunodeficiency Virus

Open Forum Infect Dis. 2020 Aug 24;7(8):ofaa073. doi: 10.1093/ofid/ofaa073. eCollection 2020 Aug.

Authors

Marisa B Brizzi¹, Rodrigo M Burgos², Thomas D Chiampas², Sarah M Michienzi², Renata Smith², Paa Kwesi Yanful³, Melissa E Badowski¹

Affiliations

¹ Department of Pharmacy, University of Cincinnati Health, Cincinnati, Ohio, USA.
² Department of Pharmacy Practice, Section of Infectious Diseases Pharmacotherapy, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois, USA.
³ Department of Pharmacy, Methodist Health System, Dallas, Texas, USA.

Abstract

Background: Persons with human immunodeficiency virus (HIV) experience high rates of medication-related errors when admitted to the inpatient setting. Data are lacking on the impact of a combined antiretroviral (ARV) stewardship and transitions of care (TOC) program. We investigated the impact of a pharmacist-driven ARV stewardship and TOC program in persons with HIV.

Methods: This was a retrospective, quasi-experimental analysis evaluating the impact of an HIV-trained clinical pharmacist on hospitalized persons with HIV. Patients included in the study were adults following up, or planning to follow up, at the University of Illinois (UI) outpatient clinics for HIV care and admitted to the University of Illinois Hospital. Data were collected between July 1, 2017 and December 31, 2017 for the preimplementation phase and between July 1, 2018 and December 31, 2018 for the postimplementation phase. Primary and secondary endpoints included medication error rates related to antiretroviral therapy (ART) and opportunistic infection (OI) medications, all-cause readmission rates, medication access at time of hospital discharge, and linkage to care rates.

Results: A total of 128 patients were included in the study: 60 in the preimplementation phase and 68 in the postimplementation phase. After the implementation of this program, medication error rates associated with ART and OI medications decreased from 17% (10 of 60) to 6% (4 of 68) (P = .051), 30-day all-cause readmission rates decreased significantly from 27% (16 of 60) to 12% (8 of 68) (P = .03), and linkage to care rates increased significantly from 78% (46 of 59) to 92% (61 of 66) (P = .02).

Conclusions: A pharmacist-led ARV stewardship and TOC program improved overall care of persons with HIV through reduction in medication error rates, all-cause readmission rates, and an improvement in linkage to care rates.

Keywords: antiretroviral therapy; medication errors; stewardship; transitions of care.