Characterization of clinical pharmacy services in a pediatric HIV clinic

ObjectivesThe objectives of this study were to characterize and analyze clinical pharmacists' interventions in a pediatric human immunodeficiency virus clinic. MethodsThis retrospective review assesses interventions documented by pediatric pharmacists. The percent of patients with an undetectable viral load at baseline, prior to implementation of pharmacy services, was compared with the viral load at a 7-year follow-up visit. Mean log(10) viral loads at years 1 and 7 were compared to baseline and the mean change in viral load was compared. ResultsPharmacists were involved with the care of 53 patients at 2257 visits documenting 8893 interventions. Recommendations to physicians accounted for 1316 (14.8%) of the interventions. Pharmacists documented 3176 (35.7%) interventions to patients/caregivers. One-thousand and twenty-eight (11.6%) interventions were educational concepts taught to patients/caregivers. Pharmacists provided 1107 (12.4%) adherence aids and conducted 669 (7.5%) adherence assessments. The percentage of patients with undetectable viral loads increased from 12.1% (4/33) to 65.8% (25/38) (P = 0.0094). The mean log(10) viral load at years 1 and 7 were lower than those obtained prior to the first clinical pharmacy visit (year 1:3.95 +/- 1.22 copies/mL vs 4.37 +/- 1.09 copies/mL; P = 0.0042; year 7:2.88 +/- 1.21 copies/mL vs 4.42 +/- 1.11 copies/mL; P < 0.0001).The decrease in mean log(10) viral load (viral load change) was significantly greater in year 7 compared with year 1 (P = 0.04). A clinically significant mean viral load decrease occurred each year from years 2 to 7. ConclusionsIn 7 years of pediatric clinical pharmacy services, thousands of interventions were documented. An increase in the number of patients with an undetectable viral load and improvements in mean log(10) viral load occurred. These findings suggest that interventions by pediatric clinical pharmacists contributed to overall improvements in viral loads observed in this study. This analysis provides insight into the essential role of a clinical pharmacist in a pediatric HIV clinic.