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Beer L, Williams D, Tie Y, McManus T, Yuan A(X, Crim SM, Demeke HB, Creel D, Blackwell AD, Craw JA, Weiser J. The Capacity of HIV Care Facilities to Implement Strategies Recommended by the Ending the HIV Epidemic Initiative: The Medical Monitoring Project Facility Survey. J Acquir Immune Defic Syndr 2023; 94:290-300. [PMID: 37643411 PMCID: PMC10615730 DOI: 10.1097/qai.0000000000003290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Data are needed to assess the capacity of HIV care facilities to implement recommended Ending the HIV Epidemic activities. SETTING US HIV care facilities. METHODS We analyzed 2021 survey data from 514 facilities that were recruited from a census of facilities providing care to a national probability sample of US adults with HIV. We present weighted estimates of facility characteristics, services, and policies and estimates of the proportion of all US HIV patients attending these facilities. RESULTS Among HIV care facilities, 37% were private practices, 72% were in areas with population >1 million, and 21% had more than 1000 HIV patients. Most provided preexposure prophylaxis (83%) and postexposure prophylaxis (84%). More than 67% of facilities provided HIV-specific stigma or discrimination training for all staff (covering 70% of patients) and 66% provided training on cultural competency (covering 74% of patients). A majority of patients attended facilities that provided on-site access to HIV/sexually transmitted infection (STI) transmission risk reduction counseling (89%); fewer had on-site access to treatment for substance use disorders (35%). We found low provision of on-site assistance with food banks or meal delivery (14%) and housing (33%). Approximately 71% of facilities reported using data to systematically monitor patient retention in care. On-site access to adherence tools was available at 58% of facilities; 29% reported notifying patients of missed prescription pickups. CONCLUSION Results indicate some strengths that support Ending the HIV Epidemic-recommended strategies among HIV care facilities, such as high availability of preexposure prophylaxis/postexposure prophylaxis, as well as areas for improvement, such as provision of staff antistigma trainings and adherence supports.
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Affiliation(s)
- Linda Beer
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Yunfeng Tie
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Timothy McManus
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Stacy M. Crim
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hanna B. Demeke
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Angela D. Blackwell
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jason A. Craw
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Weiser
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Golob AL, Geyer J, O'Keeffe C, Nelson K, Song C, Vanderwarker C, Britton J, Reddy A, Wong E, Schuttner L. Automatic medication refills to improve glycaemic control among patients with diabetes and low medication adherence. BMJ Open Qual 2023; 12:bmjoq-2022-001985. [PMID: 36746551 PMCID: PMC9906179 DOI: 10.1136/bmjoq-2022-001985] [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: 05/13/2022] [Accepted: 01/06/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Medication adherence impacts health outcomes. Healthcare organisations implementing system-level interventions have potential for greater spread and sustainability than individual-level interventions. Within the integrated US Veterans Health Administration, a multidisciplinary team developed and evaluated a pilot quality improvement programme to assess the feasibility of automatic mailed prescription refills for patients with diabetes and low medication adherence (assessed by medication possession ratio <80%). METHODS Patients were randomised to usual care with self-initiated refills versus automatic mailed refills for 6 months. Process outcomes included glycaemic control measures (HgbA1C), medication possession ratios for both automatic and self-initiated (reference) refills of medications, patient satisfaction and workforce effort (pharmacist time). RESULTS Overall, 199 patients were randomised to automatic refills (n=99; 40 of whom participated) versus usual care (n=100). In multivariable analysis adjusting for baseline differences, after 6 months there was no difference in the proportion of patients with follow-up HgbA1C <8% (60.8% automatic refills vs 60.5% usual care, p=0.96). In the automatic refill group, the medication possession ratio for reference medicines was significantly higher than usual care (63.9% vs 54.5%, 95% CI (for difference) 3.1% to 15.9%, p<0.01). CONCLUSIONS Implications and lessons from this pilot programme include potential beneficial indirect effects from automatic medication refills on patient self-initiated refills of other medications; the importance of tailoring solutions to patient subgroups and specific adherence barriers; and recognition that the rapid deployment, iteration and evaluation of the project was facilitated by a multidisciplinary team embedded within an organisational learning health system.
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Affiliation(s)
- Anna L Golob
- General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA .,Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - John Geyer
- General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA,Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Chatty O'Keeffe
- Patient Care Services, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Kaylen Nelson
- Pharmacy Clinical Services, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Cassandra Song
- Pharmacy Clinical Services, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Christopher Vanderwarker
- General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA,Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jacqueline Britton
- Rehabilitation Services, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Ashok Reddy
- General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA,Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA,Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Edwin Wong
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA,Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA
| | - Linnaea Schuttner
- General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA,Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA,Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA
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Toscos TR, Coupe A, Wagner S, Drouin M, Roebuck AE, Daley CN, Carpenter MD, Mirro MJ. Can nurses help improve self-care of patients living with atrial fibrillation? A focus group study exploring patients' disease knowledge gaps. Nurs Open 2020; 7:998-1010. [PMID: 32587718 PMCID: PMC7308702 DOI: 10.1002/nop2.472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/07/2019] [Accepted: 02/16/2020] [Indexed: 12/18/2022] Open
Abstract
Aims To identify knowledge gaps and preferences for educational material to improve nurse-patient communication and self-care. Design Using a mixed-methods design, we conducted focus groups and quantitative surveys. Methods We conducted three focus groups with atrial fibrillation (AF) patients and support persons (N = 17 participants; 66 ± 16 years) at critical treatment junctures (recent diagnosis or medication switch). Patients and support persons were also surveyed on patient activation (self-management skills and knowledge), medication adherence, AF knowledge and health literacy. Iterative thematic analysis was performed using focus group transcripts. Results Although most participants had adequate health literacy, most reported gaps in AF knowledge. Participants lacked disease-related knowledge and were unsure how to manage health behaviours (e.g. diet and exercise). Few felt they received adequate education from their healthcare provider. Results emphasize the need for consistent information from nursing staff, in lay language, via both electronic and printed means.
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Affiliation(s)
- Tammy R. Toscos
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
- Indiana University School of Informatics and ComputingIndianapolisIndiana
| | - Amanda Coupe
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
| | - Shauna Wagner
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
| | - Michelle Drouin
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
- Psychology DepartmentPurdue University Fort WayneFort WayneIndiana
| | - Amelia E. Roebuck
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
| | - Carly N. Daley
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
- Indiana University School of Informatics and ComputingIndianapolisIndiana
| | - Maria D. Carpenter
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
| | - Michael J. Mirro
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
- Indiana University School of Informatics and ComputingIndianapolisIndiana
- Indiana University School of MedicineIndianapolisIndiana
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Pharmacy Data as an Alternative Data Source for Implementation of a Data to Care Strategy. J Acquir Immune Defic Syndr 2020; 82 Suppl 1:S53-S56. [PMID: 31425396 DOI: 10.1097/qai.0000000000001969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Data to Care (D2C) is a strategy for using health departments' HIV surveillance data (HIV viral load and CD4 laboratory reports) to identify and re-engage not-in-care persons with HIV. In the current D2C model, there is a delay in the identification of persons not in care due to the time interval between recommended monitoring tests (ie, every 3-6 months) and the subsequent reporting of these tests to the health department. METHODS Pharmacy claims and fulfillment data can be used to identify persons with HIV who have stopped filling antiretroviral therapy and are at risk of falling out of care. Because most antiretrovirals (ARVs) are prescribed as a 30-day supply of medication, these data can be used to identify persons who are not filling their medications on a monthly basis. The use of pharmacy claims data to identify persons not filling ARV prescriptions is an example of how "big data" can be used to conduct a modified D2C model. RESULTS Although a D2C strategy using pharmacy data has not been broadly implemented, a few health departments are implementing demonstration projects using this strategy. As the projects progress, processes and outcomes can be evaluated. CONCLUSIONS Tracking ARV refill data can be a more real-time indicator of poor adherence and can help identify HIV-infected persons at risk of falling out of HIV medical care.
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Singh N, Varshney U. IT-based reminders for medication adherence: systematic review, taxonomy, framework and research directions. EUR J INFORM SYST 2019. [DOI: 10.1080/0960085x.2019.1701956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Neetu Singh
- Department of Management Information Systems, University of Illinois at Springfield, Springfield, Illinois
| | - Upkar Varshney
- Department of Computer Information Systems, J. Mack Robinson College of Business, Georgia State University, Atlanta, Georgia
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Abstract
The word ‘compliance' comes from the Latin word complire, meaning to fill up and hence to complete an action, transaction, or process and to fulfil a promise. In the Oxford English Dictionary, the relevant definition is ‘The acting in accordance with, or the yielding to a desire, request, condition, direction, etc.; a consenting to act in conformity with; an acceding to; practical assent”. Compliance with therapy is simply patients understanding of medication, motivation toward having this medication is a prescribed manner with the belief that the prescriber and prescribed medicine will be beneficial for his well-being. Although this is often the case, in a number of situations, the physician and pharmacist have not provided the patient with adequate instructions or have not presented the instructions in such a manner that the patient understands them. Nothing should be taken for granted regarding the patient's understanding of how to use medication, and appropriate steps must be taken to provide patients with the information and counseling necessary to use their medications as effectively and as safely as possible. 20% to 30% of new prescriptions are never filled at the pharmacy. Medication is not taken as prescribed 50% of the time. For patients prescribed medications for chronic diseases, after six months, the majority take less medication than prescribed or stop the medication altogether. There are both federal and state laws that make using or sharing prescription drugs illegal. If someone take a pill that was prescribed to someone else or give that pill to another person, not only is it against the law, it's extremely dangerous.
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Affiliation(s)
- A K Mohiuddin
- Department of Pharmacy, World University of Bangladesh
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