Patient Experience Evaluation of the CMO-Based Pharmaceutical Care Model vs Usual Care in People Living with HIV

Abstract

Objective

To compare patient experience in a real-life population of people living with HIV (PLWH) who received pharmaceutical care (PC) based on the Capacity-Motivation-Opportunity (CMO) model versus the traditional model.

Methods

Prospective cohort study in PLWH receiving either CMO-based PC or traditional PC in Spain between October 2019 and June 2021 (24 weeks), performed by the pharmacy department of 14 Spanish hospitals. Participants were adult patients with a clinical diagnosis of HIV treated with antiretrovirals who had been monitored in the participating hospital pharmacies for >1 year. Patient experience (IEXPAC questionnaire), clinical outcomes (cholesterol, triglycerides, HDL, glycated haemoglobin, and blood pressure), adherence to treatment, virologic control and patient satisfaction were determined.

Results

Patient experience in the CMO group at week 24 was significantly better (7.6 vs 6.9) than in the traditional group, with a higher mean improvement. Adherence was better in the CMO group, particularly with regard to concomitant medications (53.2% to 91.7%, p<0.001); no changes were observed in the traditional group. Patient satisfaction improved in the CMO group vs the traditional group (48 vs 44, p<0.001).

Conclusion

To our knowledge, this is the first study to compare CMO vs traditional methodology. The CMO model showed an overall improvement in real-life patient experience, satisfaction, and adherence to treatment compared to the traditional methodology.

Keywords:

• pharmaceutical care
• HIV/AIDS
• medication adherence
• patient satisfaction
• outcome assessment

Abbreviations

ART, antiretroviral therapy; CMO, capacity, motivation and opportunity; NRTI, nucleoside reverse transcriptase inhibitors; PC, pharmaceutical care; PLWH, People living with HIV.

Acknowledgments

The authors would like to thank the pharmaceutical care human immunodeficiency virus group of the Sociedad Española de Farmacia Hospitalaria (Spanish Society of Hospital Pharmacists, SEFH) and the participant centres: Hospital Clínico San Carlos (Madrid, Spain), Hospital Universitario de Guadalajara (Guadalajara, Spain), Hospital Universitario Virgen de Valme (Sevilla, Spain), Hospital Clinic i Provincia (Barcelona, Spain), Complejo Hospitalario A Coruña (A Coruña, Spain), Hospital Miguel Servet, Hospital Universitario La Paz (Madrid, Spain), Hospital del Tajo (Madrid, Spain), Hospital de Ciudad Real (Ciudad Real, Spain), Hospital Puerta del Mar (Cádiz, Spain), Hospital de Torrecárdenas (Almería, Spain), Hospital Lozano Blesa (Zaragoza, Spain), Hospital Virgen de la Candelaria (Tenerife, Spain), Hospital Virgen de la Luz (Cuenca, Spain). We also acknowledge Dr Alfonso Picó, Dr Carlos Fernández-Escobar (Medical Science Consulting; Valencia, Spain) and Dr Emilio García (Delos Clinical; Sevilla, Spain) for the statistical support, and Dr Elena Rebollo-Gómez and Dr Vanessa Marfil (Medical Science Consulting; Valencia, Spain) for medical writing support and editing.

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

R.M.V. has received speaker honoraria from Gilead, Janssen, MSD, and ViiV Healthcare; A.L.L. has received speaker honoraria from Gilead, Janssen, MSD, ViiV Healthcare and Abbvie; E.A.G declares no conflicts of interest; M.M.C has received speaker honoraria from Gilead, Janssen, MSD and ViiV Healthcare; P.D.R declares no conflicts of interest; E.M.C. has received honoraria from Abbvie, AstraZeneca, Merck, Almirall, Celgene, CSL Behring, and Galapagos; M.J.H. declares no conflicts of interest; H.N.A. declares no conflicts of interest; V.A.A. declares no conflicts of interest; M.G.G has received speaker honoraria from Gilead, Janssen, MSD and ViiV Healthcare; L.M.F. declares no conflicts of interest; J.M.M.S. has received consultancy honoraria from MSD, ViiV Healthcare, Gilead and Janssen. The authors report no other conflicts of interest in this work.

Additional information

Funding

This study was founded by Merck Sharp & Dohme through the MSD Investigator Studies Program (IIS# 56071). Medical writing support and editing was provided by Medical Science Consulting, funded by the SEFH.