Category: Federal Forum Posters
Purpose: The purpose of this study was to determine the effectiveness of a coordinated, intensive, programmed and structured pharmaceutical intervention, based on pharmaceutical care concepts: capacity, motivation and opportunity (CMO model) to reduce the percentage of readmission in HIV patients who are at high risk of hospital readmission.
Methods: Prospective, randomized, single-center study of a structured health intervention with HIV+ patients who were admitted to hospital between mar/2017 and mar/2018. Patients were eligible if they were over 18 years of age, had been taking antiretroviral treatment for more than six months, had signed the informed consent and had a high risk of readmission. The risk of readmission was calculated with published tools (Montes-Escalante et.al EJHP-2016). The selected patients were randomized 1:1 to a control group (usual pharmaceutical care) or intervention group (intensive pharmaceutical care based on CMO model). This model consisted of stratification of patients according to risk-stratified model for pharmaceutical care in HIV-patients of Spanish-Society-of-Hospital-Pharmacy; motivacional interviews to improve adherence, complexity, cardiovascular risk and lifestyle habits; and the use of new technologies. The primary end point was the percentage of readmission at one year of follow-up in each of the groups. Other secondary objectives included the following: percentage of patients who increased adherence to HIV and non-HIV treatments and who achieved optimal virological control; absolute mean reduction in the Medication-Regimen-Complexity-Index (MRCI) and in cardiovascular risk (COMVIH-COR); rates of patients who stopped smoking, alcohol and drugs. To compare whether there were measurable differences in the main numerical variables between the intervention/control groups, the Student t-tes was calculated. In the case of qualitative variables, Pearson´s-X2-test (for independent samples) and McNemar-test (for dependent samples) was used.
Results: A total of 39 patients were included in the study. Of which 23 patients completed follow-up study (14 in the intervention group and 9 in the control group). Of the patients who did not complete follow-up study, 4 were lost to follow-up (all in the control group), and 12 died (6 in the intervention group and 6 in the control group). In all, 82,60% were male, with a mean age of 55,19 ± 11,00 years. Baseline characteristics of the study population were similar for both groups. Regarding the main outcome, in the intervention group, 21,43% (n=3) of patients were readmission at one year of follow-up versus 66,66% (n=6) in the control group (p=0,042). In the intervention group, the percentage of patients who increased adherence to HIV and non-HIV treatments was 42,85% (p=0,031) while it worsened in the control group; the percentage of patients who achieved optima virological increased by 21,42% (p=0,250) while it worsened in the control group. The mean decrease in absolute in the MRCI was 1,57 points for the intervention groups while it worsened in the control groups; 1,43 versus 1,11 for cardiovascular risk. In the intervention group 7,14% of patients were stopped smoking and 7,14% stopped alcohol.
Conclusions: A tailored pharmaceutical care based on risk stratification, motivational interviewing, and new technologies might lead to reduce readmission hospital and improved health outcomes in HIV+ patients at high risk of hospital readmission.