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Clinical Pharmacists Can Positively Contribute to Clinical Outcomes for HIV-Infected Patients

OAKLAND, Calif., Jan. 22, 2007 /PRNewswire/ -- Clinical pharmacists have a strong impact on promoting positive clinical outcomes for HIV-infected patients being treated with new regimens of anti-retroviral therapy. Pharmacists also contribute to lower office visit rates for these patients, according to a Kaiser Permanente study that appears online in the Journal of Acquired Immune Deficiency Syndrome (JAIDS). The study is among the largest analyses of the contribution of clinical pharmacists to clinical outcomes in untreated HIV-infected patients starting highly active anti-retroviral therapy (HAART).

"There has been limited data on the impact of the clinical pharmacist on clinical outcomes and even less data on the impact clinical pharmacists have on utilization of health care resources," said Michael Horberg, MD, MAS, FACP, AAHIVS, a researcher with the Kaiser Permanente Division of Research in Oakland, Calif., and lead author of the study. "Being able to really quantify the benefit of clinical pharmacists will help health systems to better direct resources in the care of these patients."

Specifically, the researchers found that patients whose care team included HIV clinical pharmacists had two times greater odds of achieving complete viral control and a 19 percent decrease in office visit rates compared with those who were not seen by a clinical pharmacist. The decrease in office visits were especially true when the HIV clinical pharmacists were working with providers who had less HIV care experience, explained the researchers.

"Improved adherence to therapy accounted for some of the benefit of a clinical pharmacist," said Horberg. "It may also be true that pharmacists were able to help with monitoring of any potential lab abnormalities and counseling for patients about HAART consumption."

Also, in further analysis, the impact of the HIV clinical pharmacist was most dramatic among HIV-infected patients who live in more economically disadvantaged areas. Among these patients, the odds of achieving total viral control were over three times as great, compared with patients whose care team did not include HIV clinical pharmacists. In addition, hospitalization days for these patients were 66 percent fewer and office visit rates were 43 percent fewer, compared with patients whose care did not include HIV clinical pharmacists, according to the researchers.

"This means that clinics that care for more poverty stricken patients may benefit from clinical pharmacists more than clinics that care for patients less impacted by socioeconomic status," said Horberg.

Researchers analyzed 1,571 Kaiser Permanente patients who were HIV infected and starting HAART between 1977 and 2002. They compared clinical utilization measures in patients receiving care at clinics with a clinical pharmacist (all of whom had a pharmacy degree with specialization in HIV disease) to patients receiving care at clinics without a clinical pharmacist over a 24-month period after initiation of HAART.

Additional researchers, all with the Kaiser Permanente Division of Research in Oakland, include: Leo B. Hurley, MPH, senior data analyst and programmer; Michael Jonah Silverberg, PhD, MPH, research scientist; Charles P. Quesenberry, PhD, biostatistician; and C. James Kinsman, BA. The study was funded by The Garfield Memorial Research Fund of The Permanente Federation.

The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR's 400-plus staff is working on more than 250 epidemiological and health services research projects.

Posted: January 2007