Implementation of a comprehensive intervention focused on hospitalized patients with HIV by an existing stewardship program: successes and lessons learned

Danya Roshdy; Maggie McCarter; Jacqueline Meredith; Rupal Jaffa; Katie Hammer; Barbara Santevecchi; Nigel Rozario; Jamie Campbell; Michael Leonard; Christopher Polk

doi:10.1177/20499361211010590

Implementation of a comprehensive intervention focused on hospitalized patients with HIV by an existing stewardship program: successes and lessons learned

Ther Adv Infect Dis. 2021 Apr 19:8:20499361211010590. doi: 10.1177/20499361211010590. eCollection 2021 Jan-Dec.

Authors

Affiliations

¹ Department of Pharmacy, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC 28203, USA.
² Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC, USA.
³ Department of Pharmacy, Atrium Health, Charlotte, NC, USA.
⁴ Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA.
⁵ Department of Internal Medicine, Atrium Health, Charlotte, NC, USA.

Abstract

Background: Several national organizations have advocated for inpatient antiretroviral stewardship to prevent the consequences of medication-related errors. This study aimed to evaluate the impact of a stewardship initiative on outcomes in people with HIV (PWH).

Methods: A pharmacist-led audit and review of adult patients admitted with an ICD-10 code for HIV was implemented to an existing antimicrobial stewardship program. A quasi-experimental, retrospective cohort study was conducted comparing PWH admitted during pre- and post-intervention periods. Rates of antiretroviral therapy (ART)-related errors and infectious diseases (ID) consultation with linkage to care were evaluated through selection of a random sample of patients receiving ART in each period. Length of stay (LOS) and mortality were assessed by analyzing all admissions in the post-intervention period. Clinical outcomes including LOS, 30-day all-cause hospital readmission, and in-hospital and 30-day mortality in the post-intervention group were stratified by patients not on ART, on ART at admission, and started on ART as a result of the intervention.

Results: A total of 100 patients in the pre-intervention period and 103 patients in the post-intervention period were included to assess ART-related errors and linkage to care. A reduction in errors (70.0 versus 25.7%, p < 0.001) and increased linkage to care (19.0 versus 39.6%, p < 0.01) were demonstrated. Of 389 admissions during the post-intervention period, 30-day mortality rates were similar between PWH on ART at admission and those initiated on ART during admission (5% versus 8%, respectively), but less than those not on ART (21%). A longer LOS was observed in the patients started on ART during admission (5 days if ART started during admission versus 3 days if not started during admission, p < 0.01).

Conclusions: This interdisciplinary intervention was successful in reducing inpatient ART-related errors and increasing ID consultation with linkage to care among PWH.

Keywords: HIV; antiretroviral stewardship; medication-related errors; transitions of care.