Health System Pharmacy Services Are Positioned to Drive Access, Care for Patients Seeking HIV Post-Exposure Prophylaxis

In one program, hospital pharmacists received alerts whenever an antiretroviral was prescribed in the emergency department, enabling prompt action.

The implementation of a priority alert system can enable integrated health system specialty pharmacies to provide access to HIV post-exposure prophylaxis (PEP) to those who need it, including sexual assault victims and others, according to a poster presented at the virtual American Society of Health-System Pharmacists Specialty Pharmacy Conference.

Many sexual assault survivors and patients exposed to blood borne pathogens present to emergency departments to seek care and prevention of HIV infection, according to researchers at Trellis Rx. Because of their existing infrastructure and integrated services, health system specialty pharmacies are uniquely able to handle the complex and urgent needs of these patients.

To investigate how informational technology impacts the provision of PEP, health system specialty pharmacists worked with the information technology department to create a novel urgent alert within the electronic health care records. The alert would fire any time an antiretroviral was prescribed by an emergency department provider, indicating the need for PEP or for urgent need for a person living with HIV.

The on-site specialty pharmacist at one hospital in the Twin Cities Metro area used a mobile application version of the health records to have the alert sent to their mobile device, enabling a quick response. The program involved a collaboration with the local Infection Disease clinic, which would see occupational-PEP patients, as well as the contracted Sexual Assault Response System nurse team for non-occupational PEP.

In the first 15 months of the PEP program, the pharmacist received and completed evaluations for 89 patient alerts. The reasons for PEP evaluation included 49 sexual assaults (55.1%), 23 needle sticks (25.8%), 8 occupational fluid exposures (9%), 6 sexually transmitted infection tests (6.7%), 2 altercations (2.2%), and 1 ‘good Samaritan’ (1.1%).

After receiving an alert, the pharmacist would visit or call the emergency department to provide services to the patient. These services included medication access support, medication counseling and education including insurance status assessment, mental health care, and primary care access.

Eighty-six of the 89 patients received PEP medications, while 3 of the occupational PEP patients declined therapy after the orders were issued. Most PEP orders were filled by the hospital pharmacy. Although 44.9% of all patients were lost to follow up at any time during the program, the study authors noted that 80% of patients with orders sent to outside pharmacies were lost to follow up.

The pharmacist completed interventions to address barriers to medication access and adherence and to connect the patient to other social or support services, according to the poster. Patients were also followed to assess tolerability, medication adherence, and care access through their therapy and final 3-month lab reminder.

In total, 77 individual interventions were completed, most of which addressed drug-drug interactions with baseline medications and adverse events for sexual assault survivors. Four uninsured patients were connected to a benefits counselor at a local AIDS Service Organization and were able to enroll in medical assistance plans.

Based on these findings, the study authors said the priority alert successfully identified and connected patients to necessary pharmacy care. Many interventions were completed both for occupational and non-occupational PEP, and pharmacist value was exhibited by connecting patients to insurance coverage.

“Health systems should consider the value of similar programs to advance care for underserved populations, minimize revenue loss from outside workman’s comp claims, and retain revenue from the antiretroviral prescriptions to justify pharmacy care services,” the authors concluded.

REFERENCE

Jude D, and Mourani J. HIV post-exposure prophylaxis alerts in emergency departments: pharmacist-initiated linkage to care. Presented at: American Society of Health-System Pharmacists Specialty Pharmacy Conference; virtual. July 14-16, 2021.