Clinical Impact of the Capacity-Motivation-Opportunity Pharmacist-Led Intervention in People Living with HIV in Spain, 2019–2020

Abstract

Background

People living with HIV (PLWH) have significantly enhanced their life expectancy. Consequently, age-associated comorbidities and related health conditions are increasingly found in PLWH complicating their clinical management.

Objective

To determine the effect of the capacity-motivation-opportunity (CMO) structured pharmaceutical care intervention for improving clinical health-care results frequently associated to PLWH.

Methods

Multicenter, prospective, pre-post intervention study evaluating the CMO pharmacist-led program in adult PLWH was conducted between September 2019 and September 2020 with six months of follow-up. The primary objective of this study was to determine differences in clinical outcomes (total cholesterol, triglycerides, HDL, blood pressure and glycosylated hemoglobin) and variation in the patient’s activation measure before and after the intervention.

Results

A total of 61 patients were included, 72% were men with a median age of 53 years. After the implementation of the pharmacist-driven program, the percentage of patients with high levels of total cholesterol decreased significantly (18% to 4.9%; p < 0.001). Similarly, the prevalence of patients with high levels of triglycerides, HDL or with hypertension was significantly lower post intervention (13.1% to 6.6%, p < 0.001; 47.5% to 6.6%, p = 0.019 and 24% to 4%, p = 0.009, respectively). The number of patients who achieved the highest activation level increased from 69% to 77.6% (p < 0.001).

Conclusion

The CMO program resulted in significantly better health outcomes during the six months following the pharmacist-led intervention as well as improved activation in PLWH.

Keywords:

• pharmaceutical care
• HIV
• clinical outcomes

Abbreviations

ART, antiretroviral therapy; CMO, capacity, motivation and opportunity; NRTI, nucleoside reverse transcriptase inhibitors; PAM, Patient Activation Measure; PC, pharmaceutical care; PLWHIV, People living with HIV.

Acknowledgments

The authors thank the working groups on Pharmaceutical Care for HIV patients and drug therapy adherence (Adhefar) of the Spanish Society of Hospital Pharmacist (SEFH) for their support in the creation, development and dissemination of the project. Medical writing support was provided by Dr. Vanessa Marfil Vives of Medical Statistics Consulting S.L. (Valencia).

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors have no conflicts of interest in relation to this work to report.

Additional information

Funding

This work was supported by the Spanish Society of Hospital Pharmacist (SEFH) grant obtained in 2017.