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Tuesday, August 21, 2012

Do AIDS patients benefit from going to specialized pharmacies?

Nowadays, HIV patients can expect to live reasonably long lives. However, to do so, they must vigilantly take all their medication. Unfortunately, only a third of patients take at least 90% of their drugs as prescribed and on time. Doctors wondered whether sending their patients to specialized HIV pharmacies would increase compliance with drug protocols. The short answer is ‘maybe’.

HIV-specialized pharmacies employ pharmacists specifically trained in the care and treatment of AIDS patients. The training of these professionals includes the cultural impacts of living with HIV, as well as ways to educate AIDS patients and encourage compliance. In addition, these pharmacies are stocked with HIV/AIDS medications at all times.

The researchers compared the ‘proportion of days covered’ (PDC) of patients using HIV-specialized pharmacies to that of patients using ordinary pharmacies. The PDC is simply the number of days/month a patient could be taking his full drug regimen, based on refill data. For example, if a drug is to be taken twice daily but the patient only refills a 60 pill bottle every other month, his PDC for that drug is 50%. The measure is a bit more complicated because the patients in the study were each taking at least three different medications, but you get the idea. Patients were also ranked for persistence, that is, for continuing with their drug protocols.

The roughly 7000 patients using HIV-specialized pharmacies had slightly higher PDCs than a similar group of people using traditional pharmacies. In addition, patient persistence was greater among specialized pharmacy users. This certainly seems like a win for HIV-specialized pharmacies, doesn’t it?

Just a couple of problems with this study. First, the data was collected from a single pharmacy chain. This means that some patients might have received low marks for PDC or persistence when they were actually filling their prescriptions at other pharmacies. Second, patients who had been told to discontinue a medication also received a low PDC rating when they failed to refill that prescription. It’s impossible to say how much these two factors affected the overall results.

Finally, four of the six authors on the paper work for Walgreens, including lead author Patricia Murphy (the other two researchers are from the University of California, San Francisco). Not surprisingly, the single pharmacy chain used in the study was Walgreens and Walgreens also funded the study. Perhaps this wasn’t a source of conflict, but it may have been.

I would have liked to see data on whether HIV/AIDS patients felt more comfortable using a pharmacy they knew specialized in HIV treatment. I also wonder how non-AIDS sufferers feel about using a pharmacy that specializes in HIV treatment. As it is, there may be a slight benefit to the AIDS community of establishing specialized pharmacies, but it probably isn’t dramatic.