Clinical Impact of the Capacity-Motivation-Opportunity Pharmacist-Led Intervention in People Living with HIV in Spain, 2019–2020

Abstract

Background People living with HIV (PLWH) have significantly enhanced their life expectancy. Consequently, age-associated comorbidities and related health conditions are increasingly found in PLWH complicating their clinical management. Objective To determine the effect of the capacity-motivation-opportunity (CMO) structured pharmaceutical care intervention for improving clinical health-care results frequently associated to PLWH. Methods Multicenter, prospective, pre-post intervention study evaluating the CMO pharmacist-led program in adult PLWH was conducted between September 2019 and September 2020 with six months of follow-up. The primary objective of this study was to determine differences in clinical outcomes (total cholesterol, triglycerides, HDL, blood pressure and glycosylated hemoglobin) and variation in the patient’s activation measure before and after the intervention. Results A total of 61 patients were included, 72% were men with a median age of 53 years. After the implementation of the pharmacist-driven program, the percentage of patients with high levels of total cholesterol decreased significantly (18% to 4.9%; p < 0.001). Similarly, the prevalence of patients with high levels of triglycerides, HDL or with hypertension was significantly lower post intervention (13.1% to 6.6%, p < 0.001; 47.5% to 6.6%, p = 0.019 and 24% to 4%, p = 0.009, respectively). The number of patients who achieved the highest activation level increased from 69% to 77.6% ( p < 0.001). Conclusion The CMO program resulted in significantly better health outcomes during the six months following the pharmacist-led intervention as well as improved activation in PLWH.

Patient Experience Evaluation of the CMO-Based Pharmaceutical Care Model vs Usual Care in People Living with HIV

“… 8 CMO model reduces the cardiovascular risk, 19 and it has been recently shown to improve biochemical parameters, such as cholesterol, triglycerides, HDL and blood pressure. 16 We found that cardiovascular variables remained unchanged, except for blood pressure and HbA1c. In the traditional group, end-of-treatment blood pressure was more likely to be middle to high.…”

“…12 However, in 2017, a new model based on Capacity-Motivation-Opportunity (CMO) pillars changed this paradigm, strengthening the idea that the patient and their circumstances, in terms of complexity, adherence or polypharmacy, needed to be at the centre of the model and managed according to a multidisciplinary and multidimensional perspective. 13,14 To test this new model, patient activation, 15,16 adherence to ART, 17,18 adherence to concomitant medication, 15,18 clinical outcomes 16,17,19 and patient experience 20 were assessed in PLWH treated using the CMO model. Studies showed that this approach positively influenced these variables, and that both patients and healthcare professionals generally agreed on the benefit of the pharmacy intervention.…”

“…Studies showed that this approach positively influenced these variables, and that both patients and healthcare professionals generally agreed on the benefit of the pharmacy intervention. 17 Although the CMO model has been successfully applied in single and multicentre studies, [16][17][18][19][20] no direct comparison with the traditional model has been made.…”

“…To test this new model, patient activation, 15 , 16 adherence to ART, 17 , 18 adherence to concomitant medication, 15 , 18 clinical outcomes 16 , 17 , 19 and patient experience 20 were assessed in PLWH treated using the CMO model. Studies showed that this approach positively influenced these variables, and that both patients and healthcare professionals generally agreed on the benefit of the pharmacy intervention.…”

“…Although the CMO model has been successfully applied in single and multicentre studies, 16–20 no direct comparison with the traditional model has been made.…”