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Tsui J, Gojic A, Pierce K, Tung E, Connolly N, Radick A, Hunt R, Sandvold R, Taber K, Ninburg M, Kubiniec R, Scott J, Hansen R, Stekler J, Austin E, Williams E, Glick S. Pilot study of a community pharmacist led program to treat hepatitis C virus among people who inject drugs. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 10:100213. [PMID: 38261893 PMCID: PMC10796962 DOI: 10.1016/j.dadr.2023.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
Background People who inject drugs (PWID) are a key population for treatment with direct-acting antiviral medications (DAAs) to eliminate hepatitis C virus (HCV). We developed a Pharmacist, Physician, and Patient Navigator Collaborative Care Model (PPP-CCM) for delivery of HCV treatment; this study describes clinical outcomes related to HCV treatment (initial evaluation, treatment initiation, completion, and cure), as well as patient satisfaction. Methods We conducted a single-arm prospective pilot study of adult PWID living with HCV. Participants completed baseline and six-month follow-up surveys, and treatment and outcomes were abstracted from electronic health records. Primary outcome was linkage to pharmacist for HCV evaluation; secondary outcomes included DAA initiation, completion, and cure, as well as patient-reported satisfaction. Results Of the 40 PWID enrolled, mean age was 43.6 years, 12 (30 %) were female, 20 (50 %) were non-white, and 15 (38 %) were unhoused. Thirty-eight (95 %) were successfully linked to the pharmacist for initial evaluation. Of those, 21/38 (55 %) initiated DAAs, and 16/21 (76 %) completed treatment. Among those completing treatment who had viral load data to document whether they achieved "sustained virologic response", i.e. cure, 10/11 (91 %) were found to be cured. There was high satisfaction with 100 % responding "agree or strongly agree" that they had a positive experience with the pharmacist. Conclusion Nearly all participants in this pilot were successfully linked to the pharmacist for evaluation, and more than half were started on DAAs; results provide preliminary evidence of feasibility of pharmacist-led models of HCV treatment for PWID. Clinicaltrialsgov registration number NCT04698629.
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Affiliation(s)
- J.I. Tsui
- Department of Medicine, University of Washington School of Medicine, Division of General Internal Medicine University of Washington, Seattle, WA, United States
| | - A.J. Gojic
- Department of Medicine, University of Washington School of Medicine, Division of General Internal Medicine University of Washington, Seattle, WA, United States
| | - K.A. Pierce
- Kelley-Ross Pharmacy Group, Seattle, WA, United States
| | - E.L. Tung
- Kelley-Ross Pharmacy Group, Seattle, WA, United States
- Department of Pharmacy, University of Washington, Seattle, WA, United States
| | - N.C. Connolly
- Department of Medicine, University of Washington School of Medicine, Division of General Internal Medicine University of Washington, Seattle, WA, United States
| | - A.C. Radick
- Department of Medicine, University of Washington School of Medicine, Division of General Internal Medicine University of Washington, Seattle, WA, United States
| | - R.R. Hunt
- Des Moines University College of Osteopathic Medicine, Des Moines, IA, United States
| | - R. Sandvold
- Hepatitis Education Project, Seattle, WA, United States
| | - K. Taber
- Hepatitis Education Project, Seattle, WA, United States
| | - M. Ninburg
- Hepatitis Education Project, Seattle, WA, United States
| | - R.H. Kubiniec
- Evergreen Treatment Services, Seattle, WA, United States
| | - J.D. Scott
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States
| | - R.N. Hansen
- Kelley-Ross Pharmacy Group, Seattle, WA, United States
- Department of Pharmacy, University of Washington, Seattle, WA, United States
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - J.D. Stekler
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States
| | - E.J. Austin
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - E.C. Williams
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle WA, United States
| | - S.N. Glick
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States
- HIV/STI/HCV Program, Public Health - Seattle & King County, Seattle WA, United States
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Sauk MK, Sonoda K, Gabriel CT, Patel A, Salter CL, McAnaney CR, Ballard SL. Impact of an Interprofessional HIV Quality Improvement Team on Patient Care and Resident Learning Opportunities. PRIMER (LEAWOOD, KAN.) 2023; 7:32. [PMID: 37791049 PMCID: PMC10544635 DOI: 10.22454/primer.2023.691851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Although human immunodeficiency virus (HIV) care is a recommended competency for family medicine training, many programs report a lack of HIV expertise among faculty. After the departure of faculty with HIV care experience, an interprofessional HIV quality improvement team (HIV-QIT) of physicians and pharmacists aimed to maintain on-site HIV care and retain learning opportunities for residents, using process improvement and panel reviews with a remote HIV specialist faculty member. Methods This study reports on a multicycle quality improvement pilot project with pre- and postintervention chart reviews between December 2019 and May 2021. All patients received primary care and HIV-QIT chart reviews on-site. We compared patients with integrated HIV care on-site to those receiving external HIV specialty care. Primary outcomes included virologic suppression, CD4 count ≥200 cells/mm3, and adherence to guideline-recommended HIV care. In cycle 1 (January-June 2020), the HIV-QIT reviewed patient charts and sent guideline-based recommendations to physicians. In cycle 2 (July 2020-May 2021), the HIV-QIT implemented several HIV-specific processes, including decision support updates, note templates, order sets, and reference materials. Sustained process improvements included HIV panel chart audits every 3 to 6 months and subsequent provider education. Results Of 29 patients, more than half (55%, n=16) received integrated HIV care at the primary care site. We found no significant difference in care quality measures between primary and specialty care. Barriers to care completion included missed or canceled follow-up visits, on-site phlebotomy service closures, and declined HIV services. Conclusions The HIV-QIT maintained on-site HIV treatment and retained experiential learning opportunities through process improvement and specialist-supported care recommendations to primary care physicians.
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Affiliation(s)
- Marilyn K Sauk
- Family Medicine Residency, UPMC Shadyside, Pittsburgh, PA | Pharmacy, Devoted Health, Houston, TX | Department of Pharmacy, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Kento Sonoda
- Family Medicine Residency, UPMC Shadyside, Pittsburgh, PA | General Internal Medicine, University of Pittsburgh, Pittsburgh, PA | Department of Family and Community Medicine, Saint Louis University, St. Louis, MO
| | - Carly T Gabriel
- Family Medicine Residency, UPMC Shadyside, Pittsburgh, PA | Department of Pharmacy, UPMC Presbyterian-Shadyside, Pittsburgh, PA | General Internal Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Akruti Patel
- Family Medicine Residency, UPMC Shadyside, Pittsburgh, PA | Hospital Medicine Division, Trinity Health IHA, Ann Arbor, MI
| | - Cynthia L Salter
- Family Medicine Residency, UPMC Shadyside, Pittsburgh, PA | School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Cara R McAnaney
- Family Medicine Residency, UPMC McKeesport, McKeesport, PA | Department of Family Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Stephanie L Ballard
- Family Medicine Residency, UPMC Shadyside, Pittsburgh, PA | Department of Pharmacy, UPMC Presbyterian-Shadyside, Pittsburgh, PA
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Qin W, Yuan S, Zhao L, Liu Y, Xu L, Zhang Y, Liu L, Fan B. Pain Physicians' Attitudes and Experiences Regarding Clinical Pharmacy Services in China: A National Cross-Sectional Survey. J Multidiscip Healthc 2023; 16:21-29. [PMID: 36644709 PMCID: PMC9836825 DOI: 10.2147/jmdh.s397039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
Purpose Pharmacists are key members of the pain management interdisciplinary team in many developed countries. However, the implementation of clinical pharmacy services in pain management is impeded by the imbalance between the pain physicians and clinical pharmacists specializing in pain management in China. The purpose of this study was to elucidate the perceptions, expectations and current experience of Chinese pain physicians regarding clinical pharmacy services. Patients and Methods An anonymous, self-administered questionnaire was designed according to previously published studies with minor modifications and distributed online to 1100 pain physicians selected randomly in hospitals across all 31 provinces of mainland China in 2021. Data were analyzed using descriptive and inferential statistics. Results A total of 1071 valid questionnaires were included for analysis. The pain physicians were from all 31 provinces of mainland China and most of them were from tertiary hospitals holding an undergraduate degree. Among listed kinds of clinical pharmacy services, pain physicians were less comfortable with pharmacists treating minor illnesses (p < 0.001). Pain physicians' experiences with clinical pharmacy services were far less than their expectations (p < 0.001), which is in line with the results that most of pain physicians (65.9%) interacted with pharmacists at a frequency of less than once a week. Significant differences in the experiences were found among ages (p < 0.01) and among years of work experience (p < 0.05) of pain physicians. Pain physicians' expectations of pharmacists were positively correlated with their experiences with clinical pharmacy services (p < 0.001). Conclusion Pain physicians in China had positive perceptions and high expectations, but relatively low experiences regarding clinical pharmacy services. Expanding clinical pharmacist pain management credentialing and increasing pain physicians' exposure to clinical pharmacy services are favourable to support the interdisciplinary collaboration in pain management in China.
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Affiliation(s)
- Wangjun Qin
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Siyu Yuan
- Department of Pharmacy, Siping Central Hospital, Siping, Jilin Province, People’s Republic of China
| | - Li Zhao
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Ying Liu
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Liyuan Xu
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Yi Zhang
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Lihong Liu
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, People’s Republic of China,Correspondence: Lihong Liu; Bifa Fan, China-Japan Friendship Hospital, 2 Yinghua Road, Heping District, Beijing, 100029, People’s Republic of China, Tel +860184205959, Fax +860184205559, Email ;
| | - Bifa Fan
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, People’s Republic of China
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Austin EJ, Gojic AJ, Bhatraju EP, Pierce KA, Pickering EI, Tung EL, Scott JD, Hansen RN, Glick SN, Stekler JD, Connolly NC, Villafuerte S, McPadden M, Deutsch S, Ninburg M, Kubiniec R, Williams EC, Tsui JI. Barriers and facilitators to implementing a Pharmacist, Physician, and Patient Navigator-Collaborative Care Model (PPP-CCM) to treat hepatitis C among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103924. [PMID: 36521197 PMCID: PMC9868078 DOI: 10.1016/j.drugpo.2022.103924] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Direct-acting antivirals (DAAs) offer an unprecedented opportunity to eliminate hepatitis C virus (HCV) infection, yet barriers among people who inject drugs (PWID) remain. Having pharmacists provide care through collaborative drug therapy agreements (CDTAs) offers a promising solution. We developed and piloted a Pharmacist, Physician, and Patient Navigator-Collaborative Care Model (PPP-CCM) which utilized pharmacists to directly deliver HCV care at community organizations serving PWID. We conducted formative evaluation of the PPP-CCM pilot to characterize implementation experiences. METHODS The PPP-CCM was implemented from November of 2020 through July of 2022. Formative evaluation team members observed implementation-related meetings and conducted multiple site visits, taking detailed fieldnotes. Fieldnotes were iteratively reviewed to identify barriers and facilitators to implementation and used to inform 7 key informant interviews conducted with programmatic staff at the end of the pilot. All data were analyzed using a Rapid Assessment Process (RAP) guided by the Consolidated Framework for Implementation Research (CFIR). The formative evaluation team shared results with program stakeholders (pharmacists, physicians, and other site staff) to verify and expand on learnings. RESULTS Evaluation of PPP-CCM revealed 5 themes, encompassing all CFIR domains: 1) PPP-CCM was feasible but challenging to deliver efficiently; 2) the pharmacist role and characteristics (e.g., being flexible, available, and patient-centered) were key to PPP-CCM successes; 3) the PPP-CCM team met challenges engaging patients over time, but some team-based strategies helped; 4) community site characteristics (e.g., existing trusting relationships with PWID and physical space that enabled program visibility) were important contributors; and 5) financial barriers may limit PPP-CCM scale-up and sustainability. CONCLUSION PPP-CCM is a novel and promising approach to HCV care delivery for PWID who may previously lack engagement in traditional care models, but careful attention needs to be paid to financial barriers to ensure scalability and sustainability.
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Affiliation(s)
- Elizabeth J Austin
- Department of Health Systems and Population Health, University of Washington, Seattle WA, United States.
| | - Alexander J Gojic
- Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States
| | - Elenore P Bhatraju
- Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States
| | - Kathleen A Pierce
- Department of Pharmacy, University of Washington, Seattle WA, United States; Kelley-Ross Pharmacy Group, Seattle WA, United States
| | - Eleanor I Pickering
- Department of Social and Behavioral Sciences, Yale School of Public Health, United States
| | - Elyse L Tung
- Department of Pharmacy, University of Washington, Seattle WA, United States; Kelley-Ross Pharmacy Group, Seattle WA, United States
| | - John D Scott
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States
| | - Ryan N Hansen
- Department of Pharmacy, University of Washington, Seattle WA, United States; Kelley-Ross Pharmacy Group, Seattle WA, United States
| | - Sara N Glick
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States; HIV/STD Program, Public Health - Seattle & King County, Seattle WA, United States
| | - Joanne D Stekler
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States
| | - Nancy C Connolly
- Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States
| | - Sarah Villafuerte
- Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)
| | - Madison McPadden
- Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)
| | - Sarah Deutsch
- Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)
| | - Michael Ninburg
- Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)
| | | | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington, Seattle WA, United States; Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle WA, United States
| | - Judith I Tsui
- Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States
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5
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Ahmed A, Tanveer M, Dujaili JA, Chuah LH, Hashmi FK, Awaisu A. Pharmacist-Involved Antiretroviral Stewardship Programs in People Living with HIV/AIDS: A Systematic Review. AIDS Patient Care STDS 2023; 37:31-52. [PMID: 36626156 DOI: 10.1089/apc.2022.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
People living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS; PLWHA) frequently encounter antiretroviral (ARV) therapy-related problems. Clinical pharmacists with specialized training in ARV stewardship play an important role in managing these problems. However, there is a paucity of evidence to clarify the impact of clinical pharmacists' interventions on managing ARV therapy-related problems in PLWHA. Therefore, we aim to systematically review the literature to determine the nature and impact of pharmacists' interventions on managing medication-related problems in PLWHA. The review protocol was registered on International Prospective Register of Systematic Reviews (PROSPERO; CRD42020173078). Relevant records were identified from six electronic bibliographic databases (PubMed, Embase, EBSCOhost, ProQuest, Scopus, and the Cochrane Central Register) from their inception until September 2022. We included all randomized and nonrandomized interventional studies that were published in English. After the abstract and full-text screening, data were extracted from the selected studies, and the quality of the studies was assessed. The electronic database search and citation tracking identified two thousand and three citations. The review included 21 of these studies, involving 2998 PLWHA, published between 2014 and 2022. Pharmacists' interventions, working alone or in a multi-disciplinary team, comprised ARV medication review, management of adverse drug reactions (ADRs), therapeutic drug monitoring, prevention of drug interactions, and provision of drug information to PLWHA or the health care team. The pharmacist-involved interventions significantly reduced incorrect/incomplete ARV regimens, drug interactions, incorrect dosages, duplicate therapy, polypharmacy, administration errors, missing medication, wrong formulation, ADRs, and prescribing errors. Most studies reported that physicians usually accept more than 90% of the pharmacists' recommendations. ARV medication-related problems remain highly prevalent in PLWHA. Pharmacist-led interventions and stewardship significantly reduce ARV therapy-related problems in PLWHA and are widely accepted by physicians. Dedicated pharmacists with specialized training and credentialing in infectious diseases or HIV/AIDS have a great potential to improve health outcomes in PLWHA.
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Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Malaysia
| | - Maria Tanveer
- Department of Pharmacy, Quaid I Azam University, Islamabad, Pakistan
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Malaysia.,Current affiliation: Swansea University Medical School, Singleton Campus, Swansea University, Wales, United Kingdom
| | - Lay Hong Chuah
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Malaysia
| | - Furqan Khurshid Hashmi
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, Pakistan
| | - Ahmed Awaisu
- Department of Clinical Pharmacy & Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
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Dial H, Owens W, DeClercq J, Choi L, Zuckerman AD, Shah NB, Johnson K. Prescription cannabidiol for seizure disorder management: Initial drug-drug interaction management by specialty pharmacists. Am J Health Syst Pharm 2022; 79:1592-1598. [PMID: 35675751 DOI: 10.1093/ajhp/zxac155] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE To describe the presence, type, and management of drug-drug interactions (DDIs) at prescription cannabidiol (CBD) therapy initiation. METHODS We conducted a single-center, retrospective study of patients prescribed CBD from a medical center's neurology clinic for seizure management from January 2019 through April 2020. Patients were excluded if they were enrolled in a CBD clinical trial or the insurance approval or medication fulfillment process was not completed by the center's specialty pharmacy. The primary outcomes were the numbers, types, and management of DDIs identified at the time of CBD prescribing. RESULTS Of the 136 patients included, 109 (80%) had a DDI identified at baseline. Of the 260 DDIs, 71% (n = 184) were pharmacodynamic and 29% (n = 76) were pharmacokinetic in nature. Management of the 260 DDIs detected included counseling only (89% [n = 232 interactions]), discontinuation of the interacting agent [9% (n = 22 interactions]), and dosage change for the interacting agent [2% (n = 6 interactions]). Clobazam was the most commonly identified interacting medication (n = 63, 24%), while valproic acid accounted for 10% (n = 26) of the DDIs. The population was predominantly white (n = 115, 85%), 18 years of age or younger (n = 92, 68%), and had an indication for prescription CBD treatment of Lennox-Gastaut syndrome (n = 117, 86%). CONCLUSION This study provides new information on the role that integrated specialty pharmacists can play in identifying and managing initial DDIs in patients starting prescription CBD.
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Affiliation(s)
- Holly Dial
- Lipscomb University College of Pharmacy, Nashville, TN, USA
| | - Wendi Owens
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Josh DeClercq
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leena Choi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Autumn D Zuckerman
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nisha B Shah
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kayla Johnson
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
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7
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Duong M, Delcher C, Freeman PR, Young A, Cooper H. Attitudes toward pharmacy-based HCV/HIV testing among people who use drugs in rural Kentucky. J Rural Health 2022; 38:93-99. [PMID: 33666274 PMCID: PMC8418619 DOI: 10.1111/jrh.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Rural areas of the United States have experienced outbreaks of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections among people who use drugs (PWUD). Pharmacy-based interventions may play a crucial role in prevention and entry into care, especially when traditional health care access is limited. The willingness of rural PWUD to use pharmacies for HIV/HCV-related services remains unknown. The purpose of this study was to describe the factors associated with the perceived likelihood of participating in free pharmacy-based HIV and HCV testing among PWUD living in rural Kentucky. METHODS Baseline data from the CARE2HOPE study in five Appalachian counties in eastern Kentucky were used. Participants were recruited using respondent-driven sampling and completed interviewer-administered surveys. Guided by the Andersen and Newman Framework of Health Services Utilization, we examined distributions and correlates of items regarding willingness to participate in free pharmacy-based HIV/HCV testing using logistic regression. Analyses included individuals who reported being HIV (N = 304) or HCV (N = 185) negative. FINDINGS Seventy-five percent of PWUD reported being "very likely" to participate in free pharmacy-based HIV testing and 80% for HCV testing. Two factors were associated with being less willing to participate in free HIV testing: PWUD who previously tested for HIV (OR: 0.47, CI: 0.25-0.88) and PWUD who obtained a high school diploma or equivalent compared to those who completed less (OR: 0.50, CI: 0.26-0.99). CONCLUSION Free pharmacy-based HIV and HCV testing was invariably acceptable among most of the rural PWUD in our sample, suggesting that pharmacies might be acceptable testing venues for this population.
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Affiliation(s)
- Michelle Duong
- Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Chris Delcher
- Department of Pharmacy Practice & Science, University of Kentucky, Lexington, Kentucky
| | - Patricia R. Freeman
- Department of Pharmacy Practice & Science, University of Kentucky, Lexington, Kentucky
| | - April Young
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky,Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky
| | - Hannah Cooper
- Department of Behavioral, Social and Health Education Sciences, Emory University, Atlanta, Georgia
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8
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Choi D, Patel S, Trivedi I, Rubin DT, Moss A, Bhat S. A survey of pharmacists' roles in gastroenterology and hepatology. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- David Choi
- Department of Medicine, Division of Gastroenterology and Hepatology University of Illinois at Chicago Chicago Illinois USA
| | - Shivani Patel
- University of Chicago Medicine Inflammatory Bowel Disease Center Chicago Illinois USA
| | - Itishree Trivedi
- Department of Medicine, Division of Gastroenterology and Hepatology University of Illinois at Chicago Chicago Illinois USA
| | - David T. Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center Chicago Illinois USA
| | - Alan Moss
- Department of Medicine and Section of Gastroenterology, Boston Medical Center Boston University School of Medicine Boston Massachusetts USA
| | - Shubha Bhat
- Departments of Pharmacy and Gastroenterology Digestive Disease and Surgery Institute, Cleveland Clinic Cleveland Ohio USA
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9
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Tsui JI, Barry MP, Austin EJ, Sweek EW, Tung E, Hansen RN, Ninburg M, Scott JD, Glick SN, Williams EC. 'Treat my whole person, not just my condition': qualitative explorations of hepatitis C care delivery preferences among people who inject drugs. Addict Sci Clin Pract 2021; 16:52. [PMID: 34384494 PMCID: PMC8358259 DOI: 10.1186/s13722-021-00260-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 08/03/2021] [Indexed: 12/20/2022] Open
Abstract
Background The advent of direct-acting antivirals (DAAs)—a form of hepatitis C (HCV) treatment associated with shorter treatment course and greater efficacy—offers an unprecedented opportunity to eliminate HCV, but only if care delivery systems are developed to extend treatment to people who inject drugs (PWID). To support the design of a community-pharmacy program, we explored perspectives of PWID with chronic HCV with regard to barriers, motivators, preferences, and prior experiences related to HCV treatment and pharmacists. Methods We conducted semi-structured interviews with people living with HCV who reported active injection drug use. Participants were recruited from local community service and clinical organizations in the Seattle, Washington region, and focus groups and interviews were conducted in-person or via phone/video-conference. Rapid Assessment Process was used to analyze qualitative data. Dual coders used structured templates to summarize findings and engaged in iterative review to identify themes. Results Among the 40 participants, 65% were male, 52.5% were white, and 80% were not stably housed. On average, participants had been injecting drugs for 14 years and living with HCV for 6 years. Analyses revealed 3 themes: (1) limited knowledge regarding HCV and DAA treatments; (2) barriers/motivators for receiving treatment included fear of side effects, prior stigmatizing behaviors from physicians, and desire to protect relatives and the PWID community from HCV transmission; and (3) preferences for HCV care delivery, including a need for person-centered, low-barrier, and collaborative treatment integrated with other care (e.g. primary care and addiction treatment) for PWID. Participants were generally receptive to a community-pharmacy model for HCV treatment, but prior interactions with pharmacists were mixed and there were some concerns expressed that care delivered by pharmacists would not be equivalent to that of physicians. Conclusions Even in the direct-acting antivirals era, people who inject drugs still face major barriers to hepatitis C treatment which may be reduced by providing low-barrier points of access for care through pharmacists. Key recommendations for community-pharmacy design included providing care team training to reduce stigma and ensuring care team structures and culture target PWID-specific needs for education and engagement. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00260-8.
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Affiliation(s)
- Judith I Tsui
- Department of Medicine, Division of General Internal Medicine, University of Washington, Box 359780 - 325 9th Avenue, Seattle, WA, 98104, USA.
| | - Michael P Barry
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,HIV/STD Program, Public Health - Seattle & King County, Seattle, WA, USA
| | - Elizabeth J Austin
- Department of Surgery, University of Washington, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Elsa W Sweek
- Department of Surgery, University of Washington, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA.,Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle, WA, USA
| | - Elyse Tung
- Department of Pharmacy, University of Washington, Seattle, WA, USA.,Kelley-Ross Pharmacy Group, Seattle, WA, USA
| | - Ryan N Hansen
- Department of Pharmacy, University of Washington, Seattle, WA, USA.,Kelley-Ross Pharmacy Group, Seattle, WA, USA
| | | | - John D Scott
- Department of Medicine, Division of General Internal Medicine, University of Washington, Box 359780 - 325 9th Avenue, Seattle, WA, 98104, USA
| | - Sara N Glick
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA.,HIV/STD Program, Public Health - Seattle & King County, Seattle, WA, USA
| | - Emily C Williams
- Department of Health Services, University of Washington, Seattle, WA, USA.,Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle, WA, USA
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10
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Ahmed A, Abdulelah Dujaili J, Rehman IU, Lay Hong AC, Hashmi FK, Awaisu A, Chaiyakunapruk N. Effect of pharmacist care on clinical outcomes among people living with HIV/AIDS: A systematic review and meta-analysis. Res Social Adm Pharm 2021; 18:2962-2980. [PMID: 34353754 DOI: 10.1016/j.sapharm.2021.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pharmacists play a significant role in the multidisciplinary care of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA). However, there is less evidence to clarify the impact of pharmacist as an individual team member on HIV care. OBJECTIVE This study aims to determine the effects of pharmacist intervention on improving adherence to antiretroviral therapy (ART), viral load (VL) suppression, and change in CD4-T lymphocytes in PLWHA. METHODS We identified relevant records from six databases (Pubmed, EMBASE, ProQuest, Scopus, Cochrane, and EBSCOhost) from inception till June 2020. We included studies that evaluated the impact of pharmacist care activities on clinical outcomes in PLWHA. A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and mean difference (MD) for continuous data] with 95% confidence intervals (CIs). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to evaluate the quality of evidence. The review protocol was published on PROSPERO (CRD42020167994). RESULTS Twenty-five studies involving 3206 PLWHA in which pharmacist-provided intervention either in the form of education with or without pharmaceutical-care either alone or as an interdisciplinary team member were included. Eight studies were randomized controlled trials (RCTs), while 17 studies were non-RCTs. Pooled-analyses showed a significant impact of pharmacist care compared to usual care group on adherence outcome (OR: 2.70 [95%, CI 1.80, 4.05]), VL suppression (OR: 4.13 [95% CI 2.27, 7.50]), and rise of CD4-T lymphocytes count (MD: 66.83 cells/mm3 [95% CI 44.08, 89.57]). The strength of evidence ranged from moderate, low to very low. CONCLUSION The findings suggest that pharmacist care improves adherence, VL suppression, and CD4-T lymphocyte improvement in PLWHA; however, it should be noted that the majority of the studies have a high risk of bias. More research with more rigorous designs is required to reaffirm the impact of pharmacist interventions on clinical and economic outcomes in PLWHA.
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Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia.
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia.
| | - Inayat Ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan, Pakistan.
| | - Alice Chuah Lay Hong
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia.
| | - Furqan Khurshid Hashmi
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, 54000, Lahore, Pakistan.
| | - Ahmed Awaisu
- College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia; College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
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11
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Singleton JA, Lau ET, Nissen LM. Exploring Australian pharmacists’ perceptions and attitudes towards dispensing HIV medicines in the community setting. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Judith A. Singleton
- Faculty of Health School of Clinical Sciences Queensland University of Technology(QUT) Brisbane Australia
- Institute of Health and Biomedical Innovation (IHBI) Queensland University of Technology Brisbane Australia
| | - Esther T.L. Lau
- Faculty of Health School of Clinical Sciences Queensland University of Technology(QUT) Brisbane Australia
- Institute of Health and Biomedical Innovation (IHBI) Queensland University of Technology Brisbane Australia
| | - Lisa M. Nissen
- Faculty of Health School of Clinical Sciences Queensland University of Technology(QUT) Brisbane Australia
- Institute of Health and Biomedical Innovation (IHBI) Queensland University of Technology Brisbane Australia
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12
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Hunt BR, Cetrone H, Sam S, Glick NR. Outcomes of a Pharmacist-Led Hepatitis C Virus Treatment Program in an Urban Safety-Net Health System, Chicago, 2017-2019. Public Health Rep 2021; 137:702-710. [PMID: 34043923 DOI: 10.1177/00333549211015664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVE A recommendation in March 2020 to expand hepatitis C virus (HCV) screening to all adults in the United States will likely increase the need for HCV treatment programs and guidance on how to provide this service for diverse populations. We evaluated a pharmacist-led HCV treatment program within a routine screening program in an urban safety-net health system in Chicago, Illinois. METHODS We collected data on all patient treatment applications submitted from January 1, 2017, through June 30, 2019, and assessed outcomes of and patient retention in the treatment cascade. RESULTS During the study period, 203 HCV treatment applications were submitted for 187 patients (>1 application could be submitted per patient): 49% (n = 91) were aged 55-64, 62% (n = 116) were male, 67% (n = 125) were Black, and 15% (n = 28) were Hispanic. Of the 203 HCV treatment applications, 87% (n = 176) of patients were approved for treatment, 91% (n = 161) of whom completed treatment. Of the 161 patients who completed treatment, 81% (n = 131) attended their sustained virologic response (SVR) follow-up visit, 98% (n = 129) of whom reached SVR. The largest drop in the treatment cascade was the 19% decline from receipt of treatment to SVR follow-up visit. CONCLUSION The pharmacist-led model for HCV treatment was effective in navigating patients through the treatment cascade and achieving SVR. Widespread implementation of pharmacist-led HCV treatment models may help to hasten progress toward 2030 HCV elimination goals.
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Affiliation(s)
- Bijou R Hunt
- 24192 Sinai Infectious Disease Center, Sinai Chicago, Chicago, IL, USA
| | - Hollyn Cetrone
- 12244 Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sharon Sam
- 24192 Sinai Infectious Disease Center, Sinai Chicago, Chicago, IL, USA
| | - Nancy R Glick
- 24192 Sinai Infectious Disease Center, Sinai Chicago, Chicago, IL, USA.,2473 Department of Medicine, Sinai Chicago, Chicago, IL, USA
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13
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Rathbun RC, Durham SH, Farmer KC, Zuckerman AD, Badowski ME. Evaluation of human immunodeficiency virus curricular content in schools of pharmacy in the United States. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:910-917. [PMID: 32564992 DOI: 10.1016/j.cptl.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/05/2020] [Accepted: 04/04/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Human immunodeficiency virus (HIV) is an important educational topic for student pharmacists given extended patient life expectancy and expanding pharmacist roles in HIV treatment and prevention. Data are lacking in regard to curricular content and type of training received by faculty to provide didactic and experiential HIV training. METHODS A cross-sectional, population-based survey of United States (US) pharmacy schools was conducted using a 15-item questionnaire. HIV content experts were surveyed at 135 four-year, accredited programs. RESULTS Thirty-seven responses were received from schools in the Midwestern (34%), Northeastern (26%), Southern (26%), and Western (14%) regions. Time devoted to didactic HIV education ranged from 0.5 to 60 hours. The majority of respondents (78%, n = 29) reported 10 or fewer hours of HIV-related content, with 41% (n = 15) reporting five or less hours of content. Experiential practice sites for HIV training were variable, with a majority (80%) including an outpatient infectious diseases/HIV clinic. Eighty percent of respondents also reported students receiving fewer than 25 encounters with people living with HIV (PLWH) throughout their entire experiential training. Over half (54%) of respondents reported that the primary HIV instructor devoted four hours per week or less to HIV care. CONCLUSIONS Diversity in the amount of time devoted to HIV didactic education existed among reporting US pharmacy schools. Few schools have dedicated faculty spending a substantial amount of time in direct care of PLWH. Minimum standards for HIV education in schools of pharmacy should be established.
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Affiliation(s)
- R Chris Rathbun
- Clinical and Administrative Sciences, University of Oklahoma Health Sciences Center College of Pharmacy, 1110 N. Stonewall Ave., Oklahoma City, OK 73117, United States.
| | - Spencer H Durham
- Auburn University Harrison School of Pharmacy, 1202a Walker Building, Auburn, AL 36849, United States.
| | - Kevin C Farmer
- Clinical and Administrative Sciences, University of Oklahoma Health Sciences Center College of Pharmacy, 1110 N. Stonewall Ave., Oklahoma City, OK 73117, United States.
| | - Autumn D Zuckerman
- Specialty Pharmacy, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, United States.
| | - Melissa E Badowski
- University of Illinois at Chicago College of Pharmacy, 833 S. Wood Street, MC 886, Room 164, Chicago, IL 60607, United States.
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14
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Zuckerman AD, Douglas A, Whelchel K, Choi L, DeClercq J, Chastain CA. Pharmacologic management of HCV treatment in patients with HCV monoinfection vs. HIV/HCV coinfection: Does coinfection really matter? PLoS One 2019; 14:e0225434. [PMID: 31751399 PMCID: PMC6872158 DOI: 10.1371/journal.pone.0225434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/03/2019] [Indexed: 02/07/2023] Open
Abstract
Introduction Sustained virologic response (SVR) rates in patients with hepatitis C virus (HCV) monoinfection and human immunodeficiency virus (HIV)/HCV coinfection treated with direct acting antiviral (DAA) therapy are similar in clinical trials. The objective of this study was to examine differences in patient characteristics, drug-drug interactions, and treatment pathways between these groups in a real-world clinical setting. Methods We performed an ambispective review of patients prescribed DAA therapy between September 2015 and April 2018 at a tertiary academic center. The primary endpoint was time from a decision to treat to treatment initiation. Secondary endpoints included patient characteristics; frequency and type of DAA medication interactions; frequency, type, and timing of antiretroviral therapy (ART) changes; and treatment outcomes. Results Three hundred and twelve patients were included. Almost half (43%) were HIV/HCV coinfected. Patients with HIV/HCV coinfection were more likely to be African American (p<0.001), have a diagnosed psychiatric disorder (p<0.001) and have a higher pill burden (p = 0.014). Patients with HIV/HCV coinfection were more likely to report an alcohol abuse history (p<0.001), injection drug use history (p<0.024), or active use of illicit substances (p = 0.019). In a multivariable regression model assessing the primary endpoint, time to treatment initiation was increased in patients requiring a change in ART therapy (OR = 9.2, p < 0.001) or a non-ART medication adjustment (OR = 2.4, p = 0.003), and in patients with Medicaid (OR = 6.7, p < 0.001). After controlling for all these factors, HIV/HCV coinfection still significantly impacted time to treatment initiation (OR = 1.7, p = 0.020). The groups had similar rates of drug interaction frequency, treatment completion, observed SVR, and side effects. Conclusions Patients with HIV/HCV coinfection are more likely to have a variety of factors that add complexities to HCV treatment. In addition to these challenges, patients with HIV/HCV coinfection experience a longer time to treatment initiation while patients with HCV monoinfection were more frequently lost to care. Care delivery models may incorporate this data to improve patient engagement, access, and outcomes.
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Affiliation(s)
- Autumn D. Zuckerman
- Specialty Pharmacy Services, Vanderbilt University Medical Center,; Nashville, Tennessee, United States of America
- * E-mail:
| | - Andrew Douglas
- Christy Houston Foundation Drug Information Center, Belmont University College of Pharmacy; Nashville, Tennessee, United States of America
| | - Kristen Whelchel
- Specialty Pharmacy Services, Vanderbilt University Medical Center,; Nashville, Tennessee, United States of America
| | - Leena Choi
- Department of Biostatistics, Vanderbilt University Medical Center,; Nashville, Tennessee, United States of America
| | - Joshua DeClercq
- Department of Biostatistics, Vanderbilt University Medical Center,; Nashville, Tennessee, United States of America
| | - Cody A. Chastain
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center,; Nashville, Tennessee, United States of America
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15
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Koren DE, Zuckerman A, Teply R, Nabulsi NA, Lee TA, Martin MT. Expanding Hepatitis C Virus Care and Cure: National Experience Using a Clinical Pharmacist-Driven Model. Open Forum Infect Dis 2019; 6:5528030. [PMID: 31363775 PMCID: PMC6667715 DOI: 10.1093/ofid/ofz316] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/02/2019] [Indexed: 12/25/2022] Open
Abstract
Background The US National Viral Hepatitis Action Plan depends on additional providers to expand hepatitis C virus (HCV) treatment capacity in order to achieve elimination goals. Clinical pharmacists manage treatment and medication within interdisciplinary teams. The study’s objective was to determine sustained virologic response (SVR) rates for clinical pharmacist–delivered HCV therapy in an open medical system. Methods Investigators conducted a multicenter retrospective cohort study of patients initiating direct-acting antivirals from January 1, 2014, through March 12, 2018. Data included demographics, comorbidities, treatment, and clinical outcomes. The primary outcome of SVR was determined for patients initiating (intent-to-treat) and those who completed (per-protocol) treatment. Chi-square tests were conducted to identify associations between SVR and adverse reactions, drug–drug interactions, and adherence. Results A total of 1253 patients initiated treatment; 95 were lost to follow-up, and 24 discontinued therapy. SVR rates were 95.1% (1079/1134) per protocol and 86.1% (1079/1253) intent to treat. The mean age (SD) was 57.4 (10.1) years, the mean body mass index (SD) was 28.7 (6.2) kg/m2, 63.9% were male, 53.7% were black, 40.3% were cirrhotic, 88.4% were genotype 1, and 81.6% were treatment-naïve. Patients missing ≥1 dose had an SVR of 74.9%; full adherence yielded 90% (P < .0001). Conclusions HCV treatment by clinical pharmacists in an open medical system resulted in high SVR rates comparable to real-world studies with specialists and nonspecialists. These findings demonstrate the success of a clinical pharmacist–delivered method for HCV treatment expansion and elimination.
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Affiliation(s)
- David E Koren
- Temple University Health System, Philadelphia, Pennsylvania
| | - Autumn Zuckerman
- Specialty Pharmacy Services, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robyn Teply
- Creighton University School of Pharmacy & Health Professions, Omaha, Nebraska
| | - Nadia A Nabulsi
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
| | - Michelle T Martin
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois.,University of Illinois Hospital and Health Sciences System, Chicago, Illinois
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