Implementation of a comprehensive intervention focused on hospitalized patients with HIV by an existing stewardship program: successes and lessons learned

Abstract

Background: Several national organizations have advocated for inpatient antiretroviral stewardship to prevent the consequences of medication-related errors. This study aimed to evaluate the impact of a stewardship initiative on outcomes in people with HIV (PWH). Methods: A pharmacist-led audit and review of adult patients admitted with an ICD-10 code for HIV was implemented to an existing antimicrobial stewardship program. A quasi-experimental, retrospective cohort study was conducted comparing PWH admitted during pre- and post-intervention periods. Rates of antiretroviral therapy (ART)-related errors and infectious diseases (ID) consultation with linkage to care were evaluated through selection of a random sample of patients receiving ART in each period. Length of stay (LOS) and mortality were assessed by analyzing all admissions in the post-intervention period. Clinical outcomes including LOS, 30-day all-cause hospital readmission, and in-hospital and 30-day mortality in the post-intervention group were stratified by patients not on ART, on ART at admission, and started on ART as a result of the intervention. Results: A total of 100 patients in the pre-intervention period and 103 patients in the post-intervention period were included to assess ART-related errors and linkage to care. A reduction in errors (70.0 versus 25.7%, p < 0.001) and increased linkage to care (19.0 versus 39.6%, p < 0.01) were demonstrated. Of 389 admissions during the post-intervention period, 30-day mortality rates were similar between PWH on ART at admission and those initiated on ART during admission (5% versus 8%, respectively), but less than those not on ART (21%). A longer LOS was observed in the patients started on ART during admission (5 days if ART started during admission versus 3 days if not started during admission, p < 0.01). Conclusions: This interdisciplinary intervention was successful in reducing inpatient ART-related errors and increasing ID consultation with linkage to care among PWH.

A Multicomponent Intervention to Reduce Readmissions Among People With HIV

“…34 Similarly, a quasi-experimental study of antimicrobial stewardship for inpatients with HIV (N = 203) resulted in reduced medication errors and improved linkage to HIV care (19% pre-intervention v 40% postintervention), although 30-day readmissions were not different between those who were and those who were not on ART. 35 In this study, we did not find a dose-response effect, and in fact those who received interventions had higher or similar readmissions rates to those who received case management alone. Although interventions were directed at those who were at higher risk of readmission, adjusting for confounding by indication by using a propensity score analysis did not identify a relationship between intervention receipt and reduced readmissions.…”

“…34 Similarly, a quasi-experimental study of antimicrobial stewardship for inpatients with HIV (N = 203) resulted in reduced medication errors and improved linkage to HIV care (19% pre-intervention v 40% post-intervention), although 30-day readmissions were not different between those who were and those who were not on ART. 35…”