Pharmacists' strategies for promoting medication adherence among patients with HIV

Objectives: To provide pharmacists' perspectives on medication adherence barriers for patients with human immunodeficiency virus (HIV) and to describe pharmacists' strategies for promoting adherence to antiretroviral medications. Design: Multisite, qualitative, descriptive study. Setting: Four midwestern U.S. states, from August through October 2009. Participants: 19 pharmacists at 10 pharmacies providing services to patients with HIV. Intervention: Pharmacists were interviewed using a semistructured interview guide. Main outcome measures: Barriers to medication adherence, pharmacist interventions, challenges to promoting adherence. Results: Pharmacists reported a range of adherence barriers that were patient specific (e.g., cognitive factors, lack of social support), therapy related (e.g., adverse effects, intolerable medications), and structural level (e.g., strained provider relationships). They used a combination of individually tailored, patient-specific interventions that identified and resolved adherence barriers and actively anticipated and addressed potential adherence barriers. Pharmacist interventions included medication-specific education to enhance patient self-efficacy, follow-up calls to monitor adherence, practical and social support to motivate adherence, and patient referrals to other health care providers. However, the pharmacists faced internal (e.g., lack of time, lack of trained personnel) and external (e.g., insurance policies that disallowed patient enrollment in automatic prescription refill program) challenges. Conclusion: Pharmacists in community settings went beyond prescription drug counseling mandated by law to provide additional pharmacy services that were tailored to the needs of patients with HIV. Given that many individuals with HIV are living longer, more research is needed on the effectiveness and cost effectiveness of pharmacists' interventions in clinical practice, in order to inform insurance reimbursement policies.