The impact of medication therapy management on polypharmacy in people living with HIV/AIDS
Orimoloye, Helen Tolulope
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Polypharmacy, defined as the concurrent use of multiple medications simultaneously, is increasingly common in people living with HIV/AIDS (PLWHA) due to the use of antiretroviral and non-antiretroviral drugs for the treatment of multiple chronic diseases. Polypharmacy is a growing concern among PLWHA because of their complex medication regimen, the risk of adverse drug events, drug-drug interactions, medication non-adherence, medication errors, and antiretroviral treatment failure. Medication therapy management (MTM), which are pharmacist-led interventions, have been useful in resolving medication-related problems and optimizing clinical outcomes. However, there are limited studies on the effectiveness of pharmacist-provided MTM services in reducing polypharmacy in HIV/AIDs patients. MTM services should enable the identification and reduction of polypharmacy. Hence, the central goal of this dissertation was to evaluate the impact of MTM services on polypharmacy in PLWHA. A secondary data analysis of a new MTM project by the CDC, UNTHSC, and Walgreens that involved the collaboration of pharmacists and clinicians to provide patient-centered care for HIV patients was done. The study involved 765 participants from 10 states in the United States. Polypharmacy was measured by the number of polyactive substances (pharmacologically active ingredients) in medications used. A paired T-test was used to find the difference between the pill count and the polyactive substances in medicines used by PLWHA. A longitudinal data analysis using a generalized estimating equation was used to assess the impact of MTM intervention on polypharmacy over time by determining the change in polyactive substances in medication pre-post MTM intervention. The relationship between the changes in HIV outcomes CD4 count and HIV RNA count and the change in polyactive substances pre-post MTM intervention was also determined. The results showed a significant average difference between the polyactive substance count and the pill count of about 2.15. Also, the number of polyactive substances in medications used by study participants reduced by an average of 3 from pre- to post- MTM intervention. There was a relationship between the change in HIV outcomes and the change in polyactive substance pre-post MTM intervention. As polyactive substances decrease over time in the study, there is a higher chance that there is viral suppression and improvement in CD4 count at the end of the study. Medication therapy management involving pharmacists and clinicians may be useful in addressing polypharmacy in PLWHA. The MTM program in this study was not designed to address polypharmacy. But the results indicated that the intervention had a positive impact on polypharmacy. Further studies, such as a case-control study or a randomized control trial, are required to assess the effect of MTM on polypharmacy better.