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2006 HSR&D National Meeting Abstract


3085 — Implementing Pharmacist Support and Pager Reminders for Antiretroviral (ARV) Adherence in Veterans

Author List:
Groessl EJ (VA San Diego Healthcare System, University of California, San Diego )
Goetz MB (VA Greater Los Angeles Healthcare System, University of California, Los Angeles)
Looney DJ (VA San Diego Healthcare System, University of California, San Diego)
Holodniy M (VA Palo Alto Healthcare System, Stanford University)
Ampel NM (Southern Arizona VA Healthcare System, University of Arizona)
Glaser D (VA San Diego Healthcare System)
Gifford AL (VA San Diego Healthcare System, University of California, San Diego)

Objectives:
Medication adherence is crucial for achieving good HIV care outcomes, but improving patient medication adherence behaviors is difficult. Programs to support medication adherence in HIV care should be feasible, acceptable, and effective. Our objectives were to implement two pharmacist adherence interventions (behavioral self-management [ACE] and pager dose reminders [PAGE]) and evaluate them compared to usual care.

Methods:
HIV-positive adults in care at four VA Centers were invited to participate if starting or switching to a new ARV regimen, or with elevated plasma HIV on ARVs. In a quasi-experimental pre-post evaluation design, enrolled patients (N=291) received ACE (4 individualized 60-minute self-management pharmacist intervention sessions), PAGE (computer-automated pager alert dosing time reminders), or usual care. ARV adherence was measured with electronic medication event monitors (MEMS). Multilevel mixed models analyzed changes in adherence, and survival analyses compared times to regimen switch or failure. We conducted qualitative interviews to further evaluate processes of program implementation.

Results:
Patients were 97% male, 50% non-white, and 32% with CD4 <200 cells/mcl. Mean adherence was 81% (SD 0.24) during the initial period of MEMS monitoring and decreased to 47% (SD 0.41) over 18 weeks. Patients assigned to ACE, PAGE, and Usual Care all had similar ARV adherence over time. Patients who received all 4 ACE sessions (64% of ACE-assigned patients) had significantly better adherence than usual care over time (64% vs 46% at 18 weeks) [p<0.05], and less regimen switch or failure than usual care (15% vs. 30% at 18 weeks) [p<0.05]. Qualitative themes suggested (1) coordinating visits between pharmacists and patients–particularly patients in need of adherence help–was difficult; (2) pharmacists were on-site, but often pulled in many directions by clinical needs, both in busy HIV clinics, and in other clinical areas.

Implications:
Adherence to medications was low, and worsened substantially over time. Neither behavioral self-management nor reminder pharmacist interventions significantly impacted HIV medication adherence overall, but receipt of all 4 pharmacist intervention sessions was associated with better adherence.

Impacts:
More intensive behavioral adherence support may be necessary in order to change adherence to HIV medications, and in real-world settings, issues of staffing and coordinating interventions may be very important.


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