Thomas Walczyk, 2017 PharmD Candidate

Approximately 1.2 million individuals live with HIV/AIDS in the United States. This population is at an increased risk of opportunistic infections (OIs), an area where pharmacists have significant potential to make meaningful interventions. The 

published a study online in its December 2016 issue that examines pharmacists' impact on OI prophylaxis in patients with HIV/AIDS.

Immune function deteriorates as HIV progresses and develops into AIDS, and thus the risk of OIs increases. In patients with normal immune function, OIs are not a major threat. In immunocompromised patients, they can be deadly. When CD4 cell counts (a marker of immune function) fall below 200 cells/microliter, clinicians usually start OI prophylaxis. Studies indicate that appropriate OI prophylaxis in patients with HIV/AIDS adds survival benefit. Multiple studies show the benefit of pharmacists’ interventions in antiretroviral therapy, but none specifically address OI prophylaxis.

A group of researchers based at the Carolinas Medical Center in North Carolina conducted a single-center, prospective intervention study. They examined  pharmacists' recommendations on appropriate OI prophylaxis. Then, they compared the results to a retrospective, pre-intervention control group.

Forty-two patients were included in the prospective group. Pharmacists made 27 recommendations in 15 patients. The most common recommendation was the addition of an OI prophylaxis medication and 89% of recommendations were accepted by providers. Baseline prescribing rates of OI prophylaxis increased from 58% in the retrospective cohort to 93% in the prospective cohort. However, 83% of patients had OI prophylactic medications prescribed to them at discharge. This data suggests an opportunity for pharmacists to be more involved in the transitions of care in these patients.

The researchers estimate that an average health-system stay for patients with HIV costs $13,000, with 9% attributed to OIs. Involving pharmacists in the care of these patients can lead to a health-system cost-savings initiative and reduce the morbidity and mortality associated with OIs.

As drug experts, pharmacists are positioned to make important clinical contributions in the care of these complex patients. They make a great addition to the health care team.

Schatz K, Guffey W, Maccia M, Templin M, Rector K. Pharmacists’ impact on opportunistic infection prophylaxis in patients with HIV/AIDS. 

. 2016; doi.org/10.1016/j.jhin.2016.09.016.

Articles

Approximately 1.2 million individuals live with HIV/AIDS in the United States. This population is at an increased risk of opportunistic infections (OIs), an area where pharmacists have significant potential to make meaningful interventions. 

Opportunistic Infections: Better Have a Pharmacist Onboard

Healthy People 2020, the national health promotion and disease intervention initiative, set the goal influenza vaccination rate in the community at 70%. Despite this goal, reports show that vaccination rates are way under expectations at 44%.

Logistics, personal beliefs about vaccines, and seasonal changes in vaccine effectiveness are some of the obstacles that stand in the way of increasing the vaccination rate. Nationwide efforts, such as the Affordable Care Act mandating vaccinations be a part of basic care, have helped only slightly. To see dramatic increases, multi-strategy, evidence-based interventions are needed and recommended by the US Department of Health and Human Services.

 Practice Transformation Program (4P) addresses such needs. It is an evidence-based best practices toolkit based on decades of research aimed at increasing vaccination rates in primary care settings. The 4P are founded on:

2. Communication with patients about the importance of immunization and the availability of vaccines

3. Enhanced office systems to facilitate immunization

4. Motivation among coworkers through a competitive challenge and crowning of an office immunization champion

A team of researchers affiliated with the University of Pittsburgh and the Baylor College of Medicine published the effects of the 4P in the 2016 November issue of 

. They analyzed 4P's effects in a randomized controlled cluster trial at 25 primary care practices based in the Houston and Pittsburgh areas.

A total of 70,549 adult patients were studied for a duration of 2 years. Vaccination rates increased in both the 4P arm and the control arm. The researchers found that 4P was not more effective than secular trends.

Missed opportunities are a known cause for low vaccination rates. The researchers found a higher rate of vaccination with sites that decreased missed opportunities. They employed mechanisms such as reviewing vaccination status at every visit and offering express vaccine service.

The 4P addresses missed opportunities and provides strategies to decrease it. In the midst of influenza season, the 4P can increase vaccination rates in the outpatient setting. It is one of many approaches that can help pharmacists increase vaccination. The most important thing is to have a plan and follow it!

Lin CJ, Nowalk MP, Pavlik VN, et al. Using the 4 pillarsTM practice transformation program to increase adult influenza vaccination and reduce missed opportunities in a randomized cluster trial. 

Healthy People 2020, the national health promotion and disease intervention initiative, set the goal influenza vaccination rate in the community at 70%. Despite this goal, reports show that vaccination rates are way under expectations at 44%.
 