title: Mail-order pharmacy experience of veterans living with AIDS/HIV.
abstract: The VA system is the largest single provider of healthcare in the United States and to individuals infected with HIV specifically. High quality medication management is particularly important since HIV is a chronic infectious condition which requires taking multiple medications with strict requirements for adherence to medication regimens. Veterans Administration (VA) patients are required to obtain all chronic medications using the VA mail-order pharmacy system.
  
  
  
  Drawing on Donabedian's Quality Improvement framework, this study sought to examine experiences that Veterans with HIV have with the Veterans Administration medication mail-order system, and to explore opportunities for quality improvement.
  
  
  
  A sequential, explanatory mixed-methods design was used to interview Veterans receiving care at a Midwestern Veterans Administration Hospital using a mail-order experience survey followed by in-depth interviews. All 57 Veterans, out of 72, who were successfully contacted consented to participate.
  
  
  
  Overall, Veterans evaluated the mail-order service positively and valued the accuracy (correct medication delivery). However, a notable problem emerged with respect to assuring access to HIV medications with about half (47%) indicating running out of HIV medication. Respondents identified structural issues with respect to days covered by mailed medications (90 versus current 30 days) and process issues with scheduling new refills. Veterans also indicated the information sheets were too long, complex and not helpful for their queries. Patients were open to pharmacists playing an active role during clinic visits and felt this would help manage their conditions better.
  
  
  
  Veterans generally reported that the VA Mail-order service was of high quality. However, some findings indicate there are opportunities to improve this service to be more patient-centered particularly for vulnerable HIV patients.
authors.affiliation: Surgical Health Services Research Unit, Department of Surgery, 1070 Arastradero Rd, Palo Alto, CA 94304, USA. Electronic address: kdesai2@stanford.edu.
authors.forename: Karishma Rohanraj
authors.initials: KR
authors.lastname: Desai
authors.affiliation: School of Pharmacy, University of Wisconsin, 777 Highland Ave., Madison, WI 53705, USA.
authors.forename: Betty
authors.initials: B
authors.lastname: Chewning
authors.affiliation: William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilcox
authors.affiliation: ACOS for R&D, Research Service/HSR&D QUERI, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA.
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
mesh_terms: D000368:Aged; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010593:Pharmaceutical Services / Q000458:organization & administration*; D010595:Pharmacists; D011177:Postal Service; D024382:Professional Role; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
keywords: HIV; Mail-order pharmacy; Mixed-methods; Quality improvement; Veterans