title: Evaluating the Effects of an Interdisciplinary Practice Model with Pharmacist Collaboration on HIV Patient Co-Morbidities.
abstract: Treatment of HIV now occurs largely within the primary care setting, and the principal focus of most visits has become the management of chronic disease states. The clinical pharmacist's potential role in improving chronic disease outcomes for HIV patients is unknown. A retrospective cohort study was performed for HIV-positive patients also diagnosed with diabetes, hypertension, or hyperlipidemia. Characteristics and outcomes in 96 patients treated by an interdisciplinary team that included a clinical pharmacist (i.e., the intervention group) were compared to those in 50 patients treated by an individual healthcare provider (i.e., the control group). Primary outcomes were changes from baseline over 18 months of HbA1c, low density lipoprotein (LDL), and blood pressure, respectively. Secondary outcomes included number of drug-drug interactions, HIV viral load, CD4 count, percent change in smoking status, and percent of patients treated to cardiovascular guideline recommendations. The interdisciplinary team had a significant improvement in lipid management over the control group (LDL: -8.8 vs. +8.4 mg/dL; p=0.014), and the smoking cessation rate over the study period was doubled in the interdisciplinary group (20.4% vs. 11.8%). Among those with an indication for aspirin, a significantly higher percentage of patients were prescribed the medication in the interdisciplinary group compared to the control group (85.5% vs. 64.9%; p=0.014). An informal cost analysis estimated savings of more than $3000 per patient treated by the interdisciplinary team. Based on these results, pharmacist involvement in an HIV primary care clinic appears to lead to more appropriate management of chronic co-morbidities in a cost-effective manner.
authors.affiliation: 1 Touro College of Pharmacy , New York, New York.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cope
authors.affiliation: 2 Division of Infectious Diseases, The Brooklyn Hospital Center , Brooklyn, New York.
authors.forename: Leonard
authors.initials: L
authors.lastname: Berkowitz
authors.affiliation: 3 Pharmacotherapy Services, The Brooklyn Hospital Center , Brooklyn, New York.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Arcebido
authors.affiliation: 4 College of Pharmacy, Long Island University , Brooklyn, New York.
authors.forename: Jun-Yen
authors.initials: JY
authors.lastname: Yeh
authors.affiliation: 4 College of Pharmacy, Long Island University , Brooklyn, New York.
authors.forename: Nathan
authors.initials: N
authors.lastname: Trustman
authors.affiliation: 4 College of Pharmacy, Long Island University , Brooklyn, New York.
authors.forename: Agnes
authors.initials: A
authors.lastname: Cha
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010593:Pharmaceutical Services; D010820:Physicians; D011320:Primary Health Care / Q000379:methods*; D024382:Professional Role; D015397:Program Evaluation; D012189:Retrospective Studies