3 Opportunities for Health-System Pharmacists to Help HIV Patients Through the Care Continuum

Health-system pharmacists play a vital role in treating patients with HIV from the time they're admitted to their potential readmission, as well as through follow up after discharge.

Health-system pharmacists play a vital role in treating patients with HIV from the time they’re admitted to their potential readmission, as well as through follow up after discharge.

Linda Spooner, PharmD, RPh, BCPS, FASHP, a professor of pharmacy practice at MCPHS University, shared with Pharmacy Times 3 ways health-system pharmacists can assist HIV-infected patients through the care continuum.

1. Admission

When patients with HIV end up in the hospital, it may not be clear which medications they’re taking. Health-system pharmacists can help with medication reconciliation and make sure that nothing is omitted from patients’ records, especially if they’re taking a multitablet regimen instead of a 1-pill combination product.

Pharmacists can also check to see if a patient’s medications are available in the pharmacy, or determine whether patients have to obtain their own medications. If the pharmacy doesn’t carry a combination product, the pharmacist can assist with piecing together the individual components of the therapy, or seek alternative ways to find the medication.

During admission, pharmacists can help check for drug interactions when new medications are added. They can also facilitate management of the patient, create customizable order sets for antiretroviral therapy, and develop protocol for when HIV-infected patients are admitted to make sure there are no interruptions in their regimens.

“Even just missing 1 dose can compromise the efficacy of that regimen and potentially lead to resistance development,” Dr. Spooner said.

2. Readmission

If a patient with HIV is readmitted to the hospital, the first step is to figure out why. Dr. Spooner said that in her experience, the reason is often tied to something other than HIV.

The pharmacist can help recognize new conditions that have occurred, such as acute renal failure or congestive heart failure, and then assess whether these conditions could have an impact on medication dosing.

“Discharge counseling becomes even more of a focus for these folks,” Dr. Spooner said, noting that health care providers can work together to figure out how to prevent readmission the next time around.

3. Follow Up After Discharge

After discharge, pharmacists can speak with patients’ HIV care providers or primary care providers to inform them of adjustments made due to things like renal or hepatic function, or new additions to the patients’ drug regimens.

The key is to create a smooth transition and keep all providers in the loop so there isn’t any miscommunication, Dr. Spooner said.

Patient navigators can also be used to follow up with patients, ask them if they’re okay, and counsel them if something doesn’t seem right. The patient navigator may be able to prevent an emergency room visit and speed a primary care visit.

Additional Tips for Transitions of Care

Some patients taking expensive HIV or hepatitis C therapy may be scared to let the pharmacist hold the drugs in the pharmacy because they’re afraid that the treatments won’t be returned to them, Dr. Spooner mentioned. In addition to pharmacists reassuring patients that their medications will be safely stored and returned, nurses and patient navigators can confirm with patients that their medications will be returned to them on the day of their discharge.

Dr. Spooner also believes that empowering patients is a great way to help them to facilitate their own transitions of care and make them feel more comfortable.

Health-system pharmacists should also work with community pharmacists to create a better flow of communication about any issues, such as prescribing individual components of an HIV medication instead of the single tablet because of dosing problems, for example. Informing community pharmacists about what changes were made and why is critical because some patients may see multiple providers, and the community pharmacy may be the only place where all of their information is gathered.

“A key point of education that I think pharmacists can provide to patients is that it’s so important to use just 1 pharmacy,” Dr. Spooner said.

However, some patients, such as those with hepatitis C, need to also use a specialty pharmacy. Some HIV patients use specialty pharmacies for their antiretroviral prescriptions, as well.

“It’s even more important that a pharmacist connect both the retail pharmacy and the specialty pharmacy because the drug interactions that would go unrecognized could be dangerous to the patient, either causing toxicity or virologic failure,” Dr. Spooner said.

If a male patient goes to a retail pharmacy to get his new prescription filled, for example, the pharmacist may have no idea that he’s on a specialty medication, such as Harvoni. In cases like this, Dr. Spooner will often call the community pharmacy to tell the pharmacist that the patient just started taking Harvoni and to confirm that he won’t receive a proton pump inhibitor (PPI), for example. That way, the community pharmacist can load this information into the patient’s profile, and if a prescription for a PPI comes in, the health system can be notified to figure out the next steps.