Study: Community Pharmacy HIV Services Provide Support, but Could Improve

In a new study published in the Journal of Managed Care Pharmacy, investigators interviewed patients and pharmacists about the costs and benefits of obtaining antiretroviral therapies from a community pharmacy.

HIV-focused community pharmacies in the San Francisco area have a distinct post in helping patients manage their therapies, although pharmacists practicing in that setting felt additional training would be beneficial, according to the results of a recent study.

The study appeared in the July/August issue of the Journal of Managed Care Pharmacy.

Researchers conducted semistructured interviews with 19 HIV-positive participants who met study inclusion criteria. The 19 participants represented 13 unique pharmacy locations, with most using their pharmacy for an average of 4 years. During their interviews, patients described their pharmacy and pharmacy staff and a recent visit to their pharmacy.

Researchers also interviewed 9 pharmacists practicing at 9 different community pharmacies offering HIV services, and inquired about their career, the patient population they serve, and the patients who typically receive adherence support services.

All participants were asked about their experiences with antiretroviral therapy (ART) services, the importance of the support, and any barriers to adherence communication.

The research established 5 specific themes within patient—participant and pharmacist–participant responses: description of support services, roles and responsibility for therapy adherence, adherence support barriers, establishing personal connections with patients, and perceived need for adherence communication training.

Participants tended to consider the pharmacist’s role to be very important in ensuring they received their ART; however, most participants did not think their pharmacist was responsible for supporting adherence. Instead, most participants felt complying with their therapy was a personal responsibility, and felt they should sort out any adherence issues with a clinician rather than a pharmacist.

“I think that a pharmacist has their job cut out for them. . . I think it’s pretty much up to the person to take their medication,” quoted a female participant. “. . . I mean, he can’t be on everybody for their medication. . . They’re busy, and they got to focus on keeping a clear mind on what they’re doing, making sure that the right medicine is getting in the right bottle, going to the right person.”

For patient-participants, several factors could obstruct them from using community pharmacy counseling services; however, several of the factors, such as concerns about pharmacy location, the presence of drug-seeking pharmacy patrons, or frustration at complicated insurance systems, were independent of pharmacy services, such as the lack of privacy in the counseling area.

“It’s, like, the whole lobby doesn’t need to know what I’m getting,” the study quoted one participant. “. . .I’ll be trying to whisper. . . and [the pharmacists will] be all loud, and I’m, like, ‘Oh, god, please just let me get my medication and get out of here.’”

In addition, some patient-participants felt pharmacists were “too busy” to provide counseling services and were unapproachable.

Despite the barriers, patient-participants valued a personal relationship with someone at their pharmacy and found it important to their health.

Pharmacist-participants, meanwhile, reported using several programs to influence patient adherence and felt that automatic refill programs, telephone or text refill reminders, synchronizing medication fill dates, and reminder packaging (eg, bubble packs or medication boxes) were particularly effective. They also considered counseling to be an important factor, particularly for new patients. Despite this, counseling nonadherent patients presented a problem, which led most pharmacist-participants to question the impact of their communication skills, as well as whether patients were being truthful about their level of medication adherence.

Despite this, pharmacists felt that detecting nonadherence and offering counseling and support were as important as dispensing duties.

“I try to catch people when they’re first here at the pharmacy so that they get my name,” the study quoted one participant. “They know who the pharmacists are. They know that they’re free to call if they have questions and we’ll help them. . . I think that relationship’s vital. It’s been done away with a little bit in the last decade or 2 in the pharmacy world, but I do think it’s important.”

Noting the importance of counseling for ART, several pharmacists recommended additional training to improve relationships with their patients.

“I guess maybe there’s a certain kind of skill set of certain things that we would be able to learn to say to them, to drive the point home,” 1 pharmacist quoted in the study said. “Or maybe some kind of a script that would give us a guideline of, okay, here are the things that you want to say to people and what not to say to people.”

The authors noted that the study findings may be specific to the surveyed region and may not relate to areas outside that region. In addition, the authors did not analyze therapy adherence and could not determine whether high adherence rates affected counseling requests or the occurrence of counseling sessions.

Despite the study limitations, pharmacies developing HIV-focused specialty services have several key areas on which to concentrate, particularly promoting the benefits of adherence support services, improving patient-pharmacist communication skills, and creating private counseling spaces to ease patient trepidation, the authors concluded.

“Developing relationships with relevant HIV/AIDS community-based organizations and providers can also serve to solidify the pharmacist’s role on the adherence health care team,” the authors noted. “These changes are important steps to shift the role of community pharmacists from medication dispensers to treatment advocates who improve the effectiveness of HIV therapy.”