IMPLEMENTATION OF A PHARMACEUTICAL CARE CIRCUIT FOR LONG-ACTING ANTIRETROVIRAL TREATMENTS IN HIV PATIENTS IN A REGIONAL HOSPITAL
European Statement
Patient Safety and Quality Assurance
Author(s)
AGUILAR GUISADO, CAROLINA. PHARMACY SERVICE. EL ESCORIAL UNIVERSITY HOSPITAL
SANCHEZ SUAREZ , SUSANA.PHARMACY SERVICE. EL ESCORIAL UNIVERSITY HOSPITAL
GARCIA GIMENO, M MERCEDES.PHARMACY SERVICE. EL ESCORIAL UNIVERSITY HOSPITAL
OTERINO MOREIRA, IVAN.PHARMACY SERVICE. EL ESCORIAL UNIVERSITY HOSPITAL
FIORANTE EMILSE SILVANA. INTERNAL MEDICINE SERVICE.EL ESCORIAL UNIVERSITY HOSPITAL
BARCIA MARTIN M ISABEL.PHARMACY SERVICE. EL ESCORIAL UNIVERSITY HOSPITAL
SAAVEDRA QUIROS VIRGINIA.PHARMACY SERVICE. EL ESCORIAL UNIVERSITY HOSPITAL
Why was it done?
Current antiretroviral therapies are effective, but adherence can be difficult for some patients, so innovation in parenterally administered antiretroviral treatments can help with adherence, as well as reducing the burden on patients with chronic HIV infection.
What was done?
Aim and Objectives: to implement a pharmaceutical care circuit for dispensing long-acting antiretroviral treatments in adult HIV patients.
How was it done?
Expected Improvements: Optimize antiviral use, enhance patient satisfaction, address adherence and maintain clinical effectiveness.
Circuit Design and Stages: In 2023, Pharmacy and Therapeutics Committee introduced intramuscular antiviral treatment with cabotegravir and rilpivirine, and established use criteria, in collaboration with the Internal Medicine service and Nursing consultation involved in the administration(NP):
1. Adults with undetectable Viral Load (VL) for at least 12 months
2. Treatment duration of 6-12 months
3. No prior resistance to non-nucleoside reverse transcriptase inhibitors or integrase inhibitors
4. Absence of HBV co-infection
5. Not pregnant or planning to conceive
6. Good treatment adherence
Pre-Treatment Circuit:
1. Medical Consultation: Clinical assessment and criteria evaluation.
2. Treatment Request: Physicians submit requests electronically.
3. Pharmacy Evaluation: Assessment of adherence to criteria with communication to the physician. Approved requests result in electronic prescriptions, ensuring correct dispensing.
In-Person Pharmaceutical Care Consultations (FCC):
• The first two visits confirm patient commitment and deliver dosing schedules.
• Medications are dispensed by pharmacy technicians and administered at Nursing practice
• From the third dose, consultations are conducted remotely to monitor adherence and effectiveness.
Nursing practice tasks:
• Confirm patient attendance the day before administration.
• Request medication from the pharmacy for the patient.
• Administer treatment and schedule future appointments based on the established calendar.
Implementation: The program began in November 2023.
What has been achieved?
8 patients were included, achieving 100% compliance from all services involved. Patient satisfaction is high, with undetectable VL maintained for 6-12 months post-treatment change. Mild flu-like symptoms were reported by 2 patients, and 2voluntarily discontinued due to mood concerns. 3 patients are awaiting treatment changes. All patients included underwent face-to-face FCC for the first and second doses, and telematic consultation for successive doses.
Limitations: small sample size.
What next?
This pharmaceutical care circuit can be adapted to various pharmacy services, providing a promising approach for HIV treatment adherence.The sample size needs to be enlarged for further studies.