592. Determining the Impact of an Antiretroviral Stewardship Team on the Care of HIV-Infected Patients Admitted to an Academic Research Institution

Ashley DePuy, Rafik Samuel, David Koren
2018 Open Forum Infectious Diseases  
Poster Abstracts • OFID 2018:5 (Suppl 1) • S217 toxicity, drug-to-drug interactions, and noncompliance. The objectives of this study were to describe clinical characteristics and treatment history of currently treated HIV-1 patients in commercial and Medicare Advantage health plans in the United States. Methods. A retrospective cohort study of adults (≥18 years) with ≥1 ARV pharmacy claim from January 1, 2012 to March 31, 2017 and ≥1 HIV-1 diagnosis code in the Optum Research Database. A
more » ... Database. A claims-based algorithm was used to identify lines of therapy (LOT), including the most recent LOT (LOT0) and previous LOTs dating back to January 1, 2007. Subjects were continuously enrolled 12 months prior to the start of LOT0 (baseline) and comorbidities assessed. Treatment-naïve subjects were defined as having LOT0 only during baseline, while subjects with >1 LOT were defined as treatment-experienced. Study variables were summarized descriptively and results were stratified by treatment status, insurance type, and age groups. Results. There were 18,699 eligible subjects, of whom 27% were treatment naïve. Average age was 47 years (±12), 84% were male, 51% Caucasian, and 82% had commercial insurance. Common baseline comorbidities among subjects were hyperlipidemia (41%), cardiovascular disease (41%), hypertension (34%), and depression (17%). Most comorbidities increased with age except for depression and anxiety, which were mostly constant across age groups. Among all subjects, the average cumulative proportion of days covered with an ARV was 85%. Average total pills per day, ARV and non-ARV, increased with age corresponding with Medicare subjects having 9.2 and commercial subjects having 3.7 pills per day. Conclusion. As ARV regimens have improved the life expectancy for patients with HIV, management of comorbidities and overall medication burden has become increasingly complex. HIV treatment guidelines suggest streamlined ARV regimens may be considered as patient complexity evolves over time to decrease disease burden taking into account co-morbidities, drug-drug interactions and total pill burden. Session: 62. HIV: Management and Clinical Outcomes Thursday, October 4, 2018: 12:30 PM Background. Advancements in the development of antiretrovirals (ARVs) have led to reduced HIV-related morbidity and mortality and improved patient adherence. Despite the simplicity of current ARV regimens, medication errors still frequently occur. This study evaluated the impact of an antimicrobial stewardship (ASP) team in identifying and reducing ARV medication errors. Methods. A retrospective study was conducted to evaluate ARV medication errors pre -and post-implementation of an ASP initiative in HIV-positive patients admitted between July 2016 and December 2017. The ASP team consisted of a PGY2 infectious diseases (ID) pharmacy resident and an ID clinical specialist. The ASP intervention occurred upon admission and consisted of a comprehensive ARV review to assess for dosing, drug-drug interaction, and completeness of regimen. The following endpoints were assessed: incidence of errors, classification of errors, and the number of errors detected/corrected. Results. Three hundred and fifty-six patients were included in the analysis; 153 patients in the pre-intervention group and 203 patients in the post-intervention group. A total of 243 errors were identified in 175 patients; 119 errors (n = 78) in the pre-intervention group and 124 (n = 97) in the post-intervention group. The overall number of errors were stratified by classification: dosing (42/243; 17%), drug-drug interaction (159/243; 66%), and completeness of regimen (42/243; 17%). Drug-drug interactions involving integrase inhibitors and cations were the most frequently occurring medication error in both cohorts. There was a statistically significant difference in errors detected, and subsequently corrected in the pre-intervention group compared with the post-intervention group (12/119 vs. 85/124, P < 0.001). Of the 39 errors that were missed by the ASP team, six were not detected,
doi:10.1093/ofid/ofy210.599 fatcat:3s3bkzzvzzcxnc5ybfbrjv56bi