Patient-centered community pharmacy based HIV care model
Location(s): United States
Despite being only 12% of the US population, African-Americans (AA) represent 45% of all persons with HIV. Although evidence that >90% of all persons with HIV can achieve virologic suppression, only 28% of AA are (lowest of all reported races). This disparity is not fully explained by socio-economic factors. Moreover, within HIV populations AA have both higher rates and poorer control of both diabetes and hypertension (all p<0.001). Recent evidence demonstrates even within HIV populations, AA have significantly (p<0.001) fewer years of productive life than whites. This disparity can be eliminated.
In 2003, community pharmacist-provided comprehensive medication therapy management (CMTM) became a standard of care for all Medicare Part D patients (CFR 423.153(d), www.cms.gov). CMTM is substantially more than patient counseling. In CMTM, pharmacists conduct visits with patients to provide individualized, patient-centered services addressing known domains and levels influencing health disparities in urban AA. Pharmacists, using the patient’s language of choice (limited English) in the community pharmacy (stigma, availability of health services) or via telephone (mobility) educate on diagnoses and medications (health literacy), assess patient understanding (medical decision making) of medical provider’s treatment plan (patient-clinician relationship) while optimizing medications (individual health outcome), adherence (adherence) and provide medication acquisition assistance (insurance coverage). A decade of evidence supports pharmacists delivering CMTM results in improved control of diabetes and hypertension. Populations include complex patients (> 3 medical conditions and > 6 medications and AA. Could CMTM work for AA with HIV?
In 2013, the CDC, in a novel public-private partnership with Walgreens, funded University of North Texas Health Science Center (UNTHSC, Clay, PI) to conduct a multi-year, nationwide, patient-centered, community pharmacy-based, CMTM demonstration/pilot project in HIV patients (HIV-CMTM). The innovation of HIV-CMTM compared to CMTM was pharmacists obtained subjects’ medical information quarterly. This project is a collaboration with Dr Clay's work.