Q&A: Antiretroviral stewardship in inpatient practice

David Koren, PharmD, BCPS, AAHIVP
David Koren

Medication errors during hospitalization and during care transitions are common for patients living with HIV and others who receive antiretrovirals, and these errors can cause adverse effects and viral resistance, resulting in limited options for future treatment, researchers noted.

David Koren, PharmD, BCPS, AAHIVP, clinical pharmacist specialist in infectious diseases at Temple University Hospital, and colleagues published a call to action in Clinical Infectious Diseases to bring awareness to antiretroviral stewardship. The policy paper, which was endorsed by the Infectious Diseases Society of America, the HIV Medicine Association and the American Academy of HIV Medicine, details resources and strategies for implementing antiretroviral stewardship, and clearly defines what these programs are.

Infectious Disease News spoke with Koren about the call to action, how it might benefit patients and providers, and what a successful antiretroviral stewardship program looks like. – by Marley Ghizzone

Q: What is antiretroviral stewardship?

A: In the paper, we collectively define antiretroviral stewardship as “coordinated interventions designed to improve continuity of care for patients receiving antiretrovirals through the utilization of evidence-based antiretroviral practices including medication reconciliation, dosing, mitigation of drug interactions, and prevention of viral resistance.” It can be thought of in the broadest sense as antiretroviral-related patient safety.

Q: How can it benefit patients and providers?

A: Reported antiretroviral-related inpatient errors are high, therefore, antiretroviral stewardship can create a framework to aid providers and institutions to help manage medications that they may not use on a regular basis.

Q: What does a successful antiretroviral stewardship program look like?

A: Different models have been published in the literature: retrospective review of antiretroviral orders placed, specific computerized physician order entry (CPOE) safeguards, or clinical checklists (all with successful implementation). Any approach can be bolstered with education and awareness that such initiatives/interventions exist.

Q: What is the first step to beginning a program like this?

A: The first step in creating a program would be for an institution to assess the needs of their community. Do they see a large population of patients living with HIV or who use antiretrovirals for another indication? Are local experts (whether infectious disease or otherwise) routinely present for questions, or to perform an assessment of medication accession policies (such as if a patient presents reporting a home medication that the institution does not carry).

Q: Will this call to action have an impact on clinical practice?

A: I believe that this call to action brings together a broad array of published literature to name/define antiretroviral stewardship in a way that has not been done before. I hope that this will embolden current programs and spur the development of individualized approaches based on the needs of individual institutions to increase patient safety.

Reference:

Koren DE, et al. Clin Infect Dis. 2019;doi:10.1093/cid/ciz792.

Disclosures: Koren reports serving on a medical advisory board for and receiving investigator-initiated research funding from Gilead Sciences. Please see the study for all other authors' relevant financial disclosures.

David Koren, PharmD, BCPS, AAHIVP
David Koren

Medication errors during hospitalization and during care transitions are common for patients living with HIV and others who receive antiretrovirals, and these errors can cause adverse effects and viral resistance, resulting in limited options for future treatment, researchers noted.

David Koren, PharmD, BCPS, AAHIVP, clinical pharmacist specialist in infectious diseases at Temple University Hospital, and colleagues published a call to action in Clinical Infectious Diseases to bring awareness to antiretroviral stewardship. The policy paper, which was endorsed by the Infectious Diseases Society of America, the HIV Medicine Association and the American Academy of HIV Medicine, details resources and strategies for implementing antiretroviral stewardship, and clearly defines what these programs are.

Infectious Disease News spoke with Koren about the call to action, how it might benefit patients and providers, and what a successful antiretroviral stewardship program looks like. – by Marley Ghizzone

Q: What is antiretroviral stewardship?

A: In the paper, we collectively define antiretroviral stewardship as “coordinated interventions designed to improve continuity of care for patients receiving antiretrovirals through the utilization of evidence-based antiretroviral practices including medication reconciliation, dosing, mitigation of drug interactions, and prevention of viral resistance.” It can be thought of in the broadest sense as antiretroviral-related patient safety.

Q: How can it benefit patients and providers?

A: Reported antiretroviral-related inpatient errors are high, therefore, antiretroviral stewardship can create a framework to aid providers and institutions to help manage medications that they may not use on a regular basis.

Q: What does a successful antiretroviral stewardship program look like?

A: Different models have been published in the literature: retrospective review of antiretroviral orders placed, specific computerized physician order entry (CPOE) safeguards, or clinical checklists (all with successful implementation). Any approach can be bolstered with education and awareness that such initiatives/interventions exist.

Q: What is the first step to beginning a program like this?

A: The first step in creating a program would be for an institution to assess the needs of their community. Do they see a large population of patients living with HIV or who use antiretrovirals for another indication? Are local experts (whether infectious disease or otherwise) routinely present for questions, or to perform an assessment of medication accession policies (such as if a patient presents reporting a home medication that the institution does not carry).

Q: Will this call to action have an impact on clinical practice?

A: I believe that this call to action brings together a broad array of published literature to name/define antiretroviral stewardship in a way that has not been done before. I hope that this will embolden current programs and spur the development of individualized approaches based on the needs of individual institutions to increase patient safety.

Reference:

Koren DE, et al. Clin Infect Dis. 2019;doi:10.1093/cid/ciz792.

Disclosures: Koren reports serving on a medical advisory board for and receiving investigator-initiated research funding from Gilead Sciences. Please see the study for all other authors' relevant financial disclosures.