Finding ways to triage patients and identify those with the greatest need is important.
HIV is like every other chronic medical condition; some patients are able to control the infection and its subsequent manifestations quite well, while others deal with serious complications. Pharmacists don't always have time to counsel every patient with HIV. Such is the case with pharmacists who work in HIV clinics or community pharmacies. Finding ways to triage patients and identify those with the greatest need is important.
Pharmacists from the University of Montréal and McGill University Health Center in Montréal, QC, Canada, faced with limited resources, have developed a scoring system to prioritize patients into referral urgency categories. They tried 3 different ways of developing scoring systems, but were unable to come to consensus about which was best.
The pharmacists reported that patient characteristics were often synergistic, additive, or antagonistic. Depending on each patient's unique combination of characteristics, the patient's scores could be affected adversely, incorrectly moving the patient from a high to a low priority or vice versa.
The Delphi method was able to give each characteristic a specific weight, but there were significant discrepancies between scores calculated using the Delphi method in those using statistical analysis. The researchers reported that it was difficult to capture the chronology of events, and other prioritization factors like rare interactions, the trajectory of renal failure, allergies, and drug access problems were poorly reflected.
They also used a method in which each characteristic was given equal weight. Once they applied the 3 systems, they prioritized patients into urgency categories that dictated how soon a pharmacy should see the patient. Time frames included within 2 days, within a month, and within 3 months. The statistical and equal weight methods were inconsistent.
The researchers noted that creating prioritization tools for patients who have HIV and are seen in outpatient locations was too complex. They agreed that creation of a decision algorithm—a set of rules or finite steps to help pharmacists identify characteristics that indicate the patient needs to be counseled immediately—would be a better way to prioritize patients.
Interestingly, the experts on the panel created to develop prioritization tools could almost always agree upon which patients did not need concerted attention. They also agreed on which patients needed the most attention.
Pharmacists who wish to increase clinical care for their HIV patients and pinpoint those who are most likely to need counseling could focus on some of the nuanced issues that these prioritization models were unable to capture. By working with HIV providers in the community, pharmacists can develop their own tools and incorporate triggers that suggest the patient needs additional attention. These might be simple questions for patients or other health care clinicians to answer about adverse effects, failure to fill a prescription, or development of an opportunistic infection.
In HIV, like in all chronic conditions, simply thinking about the factors and events that should prompt pharmacists to speak with the patient can increase the likelihood that it will actually happen.
This study appears in the journal AIDS Care.
Awad C, Canneva A, Chiasson CO, et al. PHIRST Trial - pharmacist consults: prioritization of HIV-patients with a referral screening tool. AIDS Care. 2017 Jun 14:1-10.