Evaluation of a Medicines Review toolkit for people living with HIV
Research type
Research Study
Full title
A multicentre randomised controlled open study of the utility and acceptability of the Medicines Optimisation Review (MOR) toolkit compared with standard pharmaceutical care in HIV outpatients
IRAS ID
222436
Contact name
Jaime Vera
Contact email
Sponsor organisation
Brighton and Sussex University Hospital NHS Trust
Duration of Study in the UK
1 years, 6 months, 0 days
Research summary
Research Summary:
The introduction of combination antiretroviral therapy (cART) has transformed HIV disease from a life-threatening disease into a chronic condition, where comorbidities are becoming more prevalent, and are presenting earlier than in the general population. In the general population older age, multiple comorbidities and polypharmacy are significantly associated with adverse drug events, drug-drug interactions, medication related problems (MRPs), and poor adherence to medications. Older people with HIV are at particular risk of MRPs because they often have multiple comorbidities that required patients to take several medications along with cART. Moreover, treatment for people with HIV with cART is complex with significant propensity for two of the most common MRPs, prescribing errors and drug to drug interactions. The aim of this study is to evaluate the utility, acceptability and feasibility of incorporating pharmacist Medicines Optimisation Reviews (MORs) into routine HIV outpatient care, to reduce the number of medication related problems and polypharmacy in people living with HIV taking combination antiretroviral therapy
and other medicines.Summary of Results:
Objectives: Polypharmacy in people living with HIV (PLWH) increases the risks of medicine-related problems (MRPs). We aimed to examine the feasibility and acceptability of a Medicines Management Optimisation Review (MOR) toolkit in HIV outpatients.Methods: Multicentred randomised controlled study across 4 HIV centres. 200 PLWH on cART, either over 50 years old or under 50 years with other comorbidities, were enrolled to have a MOR or received standard pharmaceutical care. The primary outcome was the difference in the number of MRPs between intervention and standard of care groups at baseline and 6 months. Acceptability, cost of the intervention and health related quality of life were also examined.
Results: 164 patients were analysed: 70 in the intervention group and 94 in the standard of care group. A significant number of MRPs were detected in those patients receiving MOR compared to standard of care group at baseline [93 vs 2; (p=0.001; z=-8.6; r: 0.6)] and 6 months [33 vs 3; (p=0.001; z=-5.7;r =0.4)]. A significant reduction in the number of new MRPs at 6 months in the intervention group compared to baseline was also observed (p=0.001; Z= -3.7; r:0.2). 44% of MRPs were fully resolved at baseline and 51% at 6 months. No changes in health-related quality of life following MOR or between MOR and standard of care groups were observed. MORs were highly acceptable among patients and health care professionals.
Conclusions: MOR toolkit was feasible and acceptable suggesting HIV outpatient services might consider implementing MOR for targeted populations under their care
REC name
East of Scotland Research Ethics Service REC 2
REC reference
17/ES/0114
Date of REC Opinion
21 Sep 2017
REC opinion
Further Information Favourable Opinion