Number of interventions identified in the initial comprehensive medical review for HIV patients and its association to patient complexity
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Background: Over the past decades, there has been a marked decrease in HIV infection and morbidity rates, which has resulted in a growing and aging population of people living with HIV (PLWH) worldwide. In comparison to the general population, PLWH experience an increased risk of age-related morbidity. Among these, hypertension, hyperlipidemia, and endocrine disease (including diabetes) have been identified as the three most common comorbidities for this population, not including HIV. Furthermore, previous projections have indicated that the growth of the workforce providing HIV care is not enough to meet the needs of the growing PLWH population. To address the concerns associated with the care of this population, the patient-centered HIV care model designed to enhance medication therapy management (MTM) services provided by community-based pharmacists through partnerships with medical providers, has been suggested as a possible effective strategy. MTM are pharmacist-driven interventions (action plans) that aim to resolve medication-related issues. First, a systematic review of the patient’s entire medication regimen is conducted. After the review, the pharmacist will compile a medical action plan that consists of recommended actions for the patient, his/her care provider(s), or the pharmacist themselves to resolve the issues identified in the medication review process. Previous studies have noted the benefits of MTM for both HIV and certain chronic conditions. Despite this, there appear to be barriers to implementing these services on a regular basis. Surveyed pharmacists often cite lack of time as their top barrier to integrating MTM services within their practices and carrying out the actions plans identified. A few published studies have documented the amount of time that is allocated to providing MTM services, but no study has investigated the amount of time necessary to provide MTM to PLWH, a subpopulation whose needs are unique and complex. As most pharmacies have established industry standards for the time it takes for each intervention, a crucial first step for the regular adaptation of MTM services for PLWH is to quantify the number of interventions that they require to determine the time that would be required to care for these patients. Purpose: The purpose of this research is to determine the relationship between the three most common comorbidities for PLWH (i.e., hypertension, hyperlipidemia, and diabetes) and the number of interventions (as a proxy for time) identified on the comprehensive medication review at the baseline of a patient-centered HIV care model study. Methods: Data for this project were obtained from a patient-centered HIV care model study which was built as a part of a collaboration project between the CDC, Walgreens, and UNTHSC. Patients were recruited into the study across 10 different sites across 8 different states. Regression analysis was conducted for the analysis. Results and Conclusions: The analyses are still being conducted. We expect to find that there is an association between the complexity of the patient, i.e., more comorbidities, and the number of interventions. Such findings will help practitioners determine the amount of time that should be allocated for PLWH.