Impact of HIV-Specialized Pharmacies on Adherence and Persistence with Antiretroviral Therapy

Abstract

Patient adherence (the degree to which patients follow their therapeutic regimen as prescribed within a set period of time) and persistence (the time to treatment discontinuation, with a permissible gap) with drug therapy are essential components of HIV/AIDS treatment. Select community pharmacies offer specialized services for HIV/AIDS patients to help combat some of the barriers to adherence and persistence. We assessed adherence and persistence with antiretroviral therapy (ART) for patients using HIV-specialized pharmacies in nine cities from seven states compared to traditional community pharmacy users over a 1-year period. Data were limited to one pharmacy chain. Propensity scoring was used to obtain 1:1 matches for ''Specialized'' and ''Traditional'' pharmacy users based on age, gender, number of prescription-inferred chronic conditions (obtained by mapping a patient's prescriptions to the Medi-Span Drug Indications Database), and presence of prescription anxiety and/or depression medication, resulting in 7064 patients in each group. Proportion of days covered (PDC) was used to measure adherence. Specialized pharmacy users had a significantly greater mean (74.1% versus 69.2%, p < 0.0001) and median (90.3% versus 86.3%, p < 0.0001) PDC. A greater percentage of patients in the Specialized group were able to obtain a PDC of 95% or better (39.3% versus 35.5%). Patients in the Specialized group were significantly more persistent ( p = 0.0117). Community pharmacies specialized in HIV services may be effective avenues for helping patients achieve greater adherence and persistence with ART. Given the value of specialized community pharmacies, payers should consider implementing policies to encourage the use of such pharmacies for filling ART.

Managing Specialty Medication Services Through a Specialty Pharmacy Program: The Case of Oral Renal Transplant Immunosuppressant Medications

“…Lastly, a study by Barlow et al (2012) showed that, in addition to improvements in medication adherence, significant reduction in medical costs was documented for 3 years of participation in specialty pharmacy services versus retail pharmacy services for RA patients. 22,[34][35][36][37][38] Our findings suggest that specialty pharmacy programs can improve the management and medication adherence of patients with renal transplants and simultaneously reduce overall health care costs, which is similar to findings in previous studies. 1,17,22,[34][35][36][37][38] This study demonstrates the value of specialty pharmacy programs in improving adherence to oral transplant products in the first year post-implementation of the program.…”

“…22,[34][35][36][37][38] Our findings suggest that specialty pharmacy programs can improve the management and medication adherence of patients with renal transplants and simultaneously reduce overall health care costs, which is similar to findings in previous studies. 1,17,22,[34][35][36][37][38] This study demonstrates the value of specialty pharmacy programs in improving adherence to oral transplant products in the first year post-implementation of the program. Substantial increases in several measures of adherence, including the number of oral transplant prescriptions filled and fewer gaps in therapy and discontinuation, were seen in patients who used the specialty pharmacy program in the first year.…”

HIV medication therapy management services in community pharmacies

“…24 The study demonstrated improvements in adherence as measured by proportion of days covered by antiretroviral drug prescriptions as well as persistence with remaining on antiretroviral therapy, though the absolute differences were modest.…”

“…Five of these articles described community-based pharmacist-provided MTM. [21][22][23][24][25] Three community-based articles were related to the California HIV/AIDS specialty pharmacies selected to provide MTM services to HIV/AIDS Medi-Cal patients. 21 That study compared medical claims of HIV-infected patients in pilot pharmacies offering HIV MTM services with medical claims of HIVinfected patients in other Medi-Cal pharmacies that did not offer MTM services.…”

Psychosocial factors associated with adherence to treatment and quality of life in people living with HIV/AIDS in Brazil

“…It contributes to a greater adherence to treatment and an increase in quality of life. From this health-illness process perspective, many HIV carriers face an impact on their quality of life, which is understood as a person's perception of his position in life within the context of culture and system of values, in relation to his objectives, expectations, standards and preoccupations 3,4 . Quality of life related to health involves concepts associated with one's own health, functional status, psychological well-being, happiness and satisfaction of needs 1 .…”