Application of the CMO methodology to the improvement of primary adherence to concomitant medication in people living with-HIV. The PRICMO Project

Farm Hosp. 2021 Jul 7;45(5):247-252.


Objective: To determine the effectiveness of a pharmaceutical care intervention based on the CMO methodology (Capacity, Motivation and Opportunity) in improving primary adherence to concomitant treatment in HIV+ patients on antiretroviral treatment.

Method: This was a longitudinal prospective multicenter study carried out between September 2019 and September 2020, which included HIV+ patients older than 18 years who were on antiretroviral treatment and were taking concomitant medications. Demographic, clinical, and pharmacotherapeutic variables were collected. As required by the CMO methodology, all patients were followed for 6 months and stratified into three levels of care. Individualized pharmaceutical care was provided according to the interventions established for each level. At every consultation, a motivational interview was conducted based on each patient's alignment with and achievement of their pharmacotherapeutic objectives. A website was developed to deal with the opportunity pillar. The main variable was the percentage of patients considered primary adherents to the prescribed concomitant medication. Adherence over the six months prior to the study was compared to adherence at the end of the study. Additionally, the percentage of patients considered secondary adherents to concomitant treatment and antiretroviral treatment during the 6 months prior to the start of the study was compared to the percentage of such patients at the end of the study. Adherence was measured based on dispensation records and specific validated questionnaires. Patients were only considered adherent if they were deemed adherent by both methods.

Results: A total of 61 patients were included in the study, 72% male. Median age was 53 years and the median number of concomitant drugs prescribed was 7. A total of 60.6% of patients were polymedicated. The percentage of patients considered primary non-adherent was 52.5% at baseline (n = 32) and 4.9% (n = 3, p < 0.001) at the end of the study. Secondary adherence to both concomitant medication (41.6% vs 88.3%) and antiretroviral treatment (85.2% vs 95.1%) improved at the end of the study (p < 0.0001).

Conclusions: Pharmaceutical care based on the CMO methodology significantly improved both primary and secondary dherence to concomitant drugs and to antiretroviral treatment.

Objetivo: Determinar la efectividad de una intervención farmacéutica, basada en la metodología CMO (Capacidad, Motivación, portunidad), para mejorar la adherencia primaria al tratamiento concomitante en pacientes VIH+ en tratamiento antirretroviral.Método: Estudio longitudinal, prospectivo, multicéntrico, realizado entre septiembre de 2019 y septiembre de 2020. Se incluyeron pacientes VIH+ mayores de 18 años, en tratamiento antirretroviral y prescripción de fármacos concomitantes. Se recogieron variables demográficas, clínicas y farmacoterapéuticas. Se realizó atención farmacéutica durante 6 meses según el modelo CMO en cada paciente, basado en su nivel de estratificación y las intervenciones establecidas para cada umbral. En cada consulta se realizó una entrevista motivacional basada en el alcance de los objetivos farmacoterapéuticos para cada paciente. Para desarrollar el pilar de oportunidad se creó y desarrolló la web: La variable principal fue el porcentaje de pacientes considerados adherentes primarios a la medicación concomitante prescrita, comparando los 6 meses previos al estudio, frente al mismo valor al finalizar el estudio. Adicionalmente, se comparó el porcentaje de pacientes adherentes secundarios al tratamiento concomitante y al tratamiento antirretroviral durante los 6 meses previos al inicio del estudio frente al mismo valor en los pacientes al finalizar el estudio. Para medir la adherencia se consideraron dos métodos: registros y cuestionarios validados específicos. Solo se consideraron adherentes si lo fueron a ambos métodos.Resultados: Se incluyeron 61 pacientes. El 72,0% fueron hombres, con una mediana de edad de 53 años. La mediana de fármacos oncomitantes fue de 7. El 60,6% de los pacientes tenían presencia de polifarmacia. El porcentaje de pacientes considerados no adherentes primarios basalmente fue del 52,5% (n = 32), mientras que a la finalización fue del 4,9% (n = 3, p < 0,001). Tanto la adherencia secundaria a la medicación concomitante (41,6% versus 88,3%) como al tratamiento antirretroviral (85,2% versus 95,1%) mejoraron al finalizar el estudio (p < 0,001).Conclusiones: La intervención farmacéutica basada en la metodología CMO mejoró significativamente tanto la adherencia primaria como secundaria a la medicación concomitante y la secundaria al tratamiento antirretroviral.

Publication types

  • Multicenter Study

MeSH terms

  • Anti-Retroviral Agents / therapeutic use
  • Female
  • HIV Infections* / complications
  • HIV Infections* / drug therapy
  • Humans
  • Male
  • Medication Adherence
  • Middle Aged
  • Pharmaceutical Services*
  • Prospective Studies


  • Anti-Retroviral Agents