Wednesday, June 25, 2014

A qualitative study HIV Antiretroviral Adherence Counseling and Support in Community Pharmacies - Jen Cocohoba

Review of Jennifer Cocohoba’s research paper on ART adherence in Community pharmacies


Main researcher
Jen Cocohoba is HIV Clinical Pharmacist in the Department of Clinical Pharmacy UCSF

Research objective
Dr Cocohoba’s primary interest was to examine the pharmacist-patient dynamic and facilitators and barriers of pharmacy-based ART adherence support.

Methodology
Recorded interviews with patients and HIV-focused pharmacies


Adherence support comments by patients and pharmacists


Patients said...
Patients often highlighted the pharmacist role in facilitating access when insurance or other health-system delays happen. Patients expressed frustration regarding complicated insurance systems  and axiety about not being able to receive medication in a timely manner.

Patients had difficulty imagining how a pharmacist could have adequate time to support adherence and most did not include their pharmacist as an integral member of the adherence team. Most patients could not recall their pharmacist ever speaking with them about ART adherence.

Patients perceived pharmacists as unapproachable and too busy.

Patients find valuable to have a personal relationship with the pharmacist (first name and treatment knowledge) and more privacy.

Pharmacists said...
They reported adherence support in the form of automatic refill programs, patient telephone or text refill reminders, preparation of reminder packaging such as med boxes or bubble packages.

Pharmacists reported that detecting non-adherence and providing counseling and support was as important as dispensing the ART correctly.

Pharmacists stated that time stress was a major barrier to discussing adherence with patients.

Pharmacists were more confident providing adherence reminder devices and services such as reminders and home delivery and they appeared less confident regarding their effectiveness in adherence counseling.  


Discussion

Jennifer Cocohoba acknowledges the patients low expectations with regards to pharmacists providing adherence support and suggests pharmacies to invest more time and establishing a deeper personal connection with patients and increase the frequency with which they assess ART adherence.

Pharmacist counseling efforts should strive to influence more complex adherence issues such as motivation.


Manuel Acevedo’s personal opinion

Patients perceive pharmacists as too busy for adherence support and they don’t think the pharmacist role is to provide adherence support (they believe it’s the patient’s role). Pharmacists would like to provide more counseling but they report time stress as a major barrier, thus confirming the patients perception of them being too busy. Obviously time stress comes from economic efficiency pressure from the pharmacy top management and it is hard for the pharmacist to convince management that spending more time (thus money?) will be a better choice for the store.

Interviewed pharmacists are more confident providing adherence devices and services and are less confident about adherence counseling. Thus, besides trying to encourage pharmacists to spend more time with patients we should also provide pharmacists with whatever they are actually asking: better devices and services.


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