Patient-Centered HIV Care Model

Pharmacists are trained to help patients manage and adhere to complex medication regimens and can assist healthcare providers with selection or modification of appropriate antiretroviral therapy regimens. Community pharmacists with HIV specialty training also have in-depth knowledge of interactions between antiretroviral therapy and medications used to treat comorbid conditions, medication adverse events that can affect adherence to and effectiveness of treatment, and patient education and adherence counseling.

Medication therapy management¹ is a distinct service or group of services provided by health care providers, including pharmacists, to ensure the best outcomes for patients. 

Medication therapy management consists of five key components: 

1. Medication therapy review 
2. Personal medication record 
3. Medication-related action plan 
4. Intervention and/or referral 
5. Documentation and follow-up

The medication therapy review is a process of assessing medication regimens for indication, effectiveness, safety, and adherence. It may also include review of response to therapy and appropriateness of each medication. The review could be comprehensive where all of a patient’s medications and health conditions are reviewed by the pharmacist, or it can be targeted toward specific medications or medical conditions.

The personal medication record is a comprehensive record of each patient’s current medications, compiled by the pharmacist for use by the patient. A medication-related action plan is a list of actions for the patient to use in tracking progress for self-management. Intervention and/or referral occurs when the pharmacist provides consultative services and intervenes to address medication-related problems. Referral to a healthcare provider may occur when the patients’ needs extend beyond the pharmacists’ expertise or scope. The final steps in the medication therapy management model include documentation of services provided and scheduling of a follow-up visit, as needed.

The PCHCM structure expanded upon the existing medication therapy management model to be inclusive of clinical medical providers. The key differences between PCHCM and medication therapy management are: 

• Information sharing between pharmacy and clinic teams 
• Collaborative medication-related action planning between pharmacists, medical providers, and patients
• Quarterly follow-up pharmacy visits 

In order for the pharmacists to conduct broader and more precise medication therapy management, nursing staff provided the pharmacists with patients’ medical history. This information included current and previous medical conditions, HIV viral load and CD4 test results, other laboratory test results, current and discontinued medications, drug allergies, immunizations, and social history.

To assess treatment response and identify potential medication-related adverse events, pharmacists also: 

• Proactively monitored prescription refills—consistent with the HIV-specialized pharmacy program of the participating pharmacy—to ensure continuous adherence to treatment
• Provided individualized adherence support
• Monitored medical history, including clinical and laboratory test results

When issues were identified during the medication therapy management sessions or review of patients’ medical and prescription refill histories, the pharmacists worked directly with their partnered clinic to make recommendations and discuss potential action plans and intervention strategies. Pharmacists, patients, and medical providers worked together to implement the action plans, and progress was reviewed at subsequent visits.