A Retrospective Study of the Impact of Pharmacist's Medication Review and Counseling in the Interdisciplinary Medication Adherence Clinic (IMAC) on Use of Non-HAART Chronic Medications in HIV-infected Patients

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Authors (including presenting author) :
Lee SK(1)(2), Lee MP(3), Leung WYS(1), Ewig CLY(2), Ng TM(1)
Affiliation :
(1)Pharmacy Department, Queen Elizabeth Hospital, (2)School of Pharmacy, The Chinese University of Hong Kong, (3)AIDS Clinical Service, Queen Elizabeth Hospital
Introduction :
The pharmacotherapy of aging HIV-infected patients is complicated by their increased comorbidities. As the specialist nurse clinic in Queen Elizabeth Hospital mainly supervises patients’ use of HAART, a pilot service, IMAC where pharmacists provide medication review and counseling to optimize their use of non-HAART chronic medications was established.
Objectives :
To evaluate the impact of IMAC by the drug-related problems (DRP), pharmacist’s interventions, the change in adherence to non-HAART chronic medications and the therapeutic markers, and patients’ satisfaction
Methodology :
Patient referred to IMAC from 29/6/2017 to 31/3/2018 were included and their clinic notes were reviewed retrospectively. The primary outcomes were DRP identified and the significance of pharmacist’s interventions, which were respectively classified by PCNE and rated by a consultant physician, two specialist nurses and an uninvolved pharmacist based on the Overhage’s assessment scale. The secondary outcomes were the change in adherence to non-HAART chronic medications, therapeutic markers including blood pressure, lipid panel, fasting glucose and HbA1c, and patient satisfaction to IMAC.
Result & Outcome :
29 patients aged from 43 to 81 years old were included. 26 DRP and 32 pharmacist interventions were recorded. The most prevalent DRP were inappropriate timing or dosing intervals (N=12) and taking less drug than prescribed (N=9). Antidiabetic drugs (N=10) and antihypertensive drugs (N=6) were most likely to be associated with DRP. The most frequent types of pharmacist interventions were patient (drug) counseling (N=23) and patient referred to prescriber (N=3). All DRP were completely solved and all pharmacist interventions were rated as significant. The adherence to non-HAART chronic medications showed a statistically significant improvement from 65.4% to 100% (p=0.004). Fasting glucose also showed statistically significant improvement from 9.3mmol/L to 7.6mmol/L (p=0.048), though the change of therapeutic markers in patients without therapy modification was not statistically significant. The patient satisfaction survey showed overall support for IMAC. This study showed that pharmacists optimized the use of non-HAART chronic medications in HIV-infected patients through identifying DRP and improving medication adherence. IMAC should be further assessed and continued for better clinical outcomes in this patient group.

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