title: 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.
authors.affiliation: Walgreen Co., Deerfield, Illinois 60015, USA. Patricia.Murphy@Walgreens.com
authors.forename: Patricia
authors.initials: P
authors.lastname: Murphy
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cocohoba
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.forename: Glen
authors.initials: G
authors.lastname: Pietrandoni
authors.forename: John
authors.initials: J
authors.lastname: Hou
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Guglielmo
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D000328:Adult; D000465:Algorithms; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000453:epidemiology; D015331:Cohort Studies; D003157:Community Pharmacy Services / Q000191:economics; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs; D006291:Health Policy; D006801:Humans; D008297:Male; D054539:Medication Therapy Management; D008875:Middle Aged; D018579:Patient Selection; D014481:United States / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents