Outcome of challenging HIV case consultations provided via teleconference by the Clinician Consultation Center to the Federal Bureau of Prisons.

OBJECTIVES: To describe the collaboration and prospective outcome of challenging human immunodeficiency virus (HIV) cases presented by Board of Prisons (BOP) pharmacists in consultation with Clinician Consultation Center (CCC) clinical pharmacists and physicians to improve correctional patient care. SETTING: Federal correctional facilities. PRACTICE DESCRIPTION: Pharmacists improve care of incarcerated persons infected with HIV. PRACTICE INNOVATION: Pharmacists evaluate, implement, and provide successful oversight of HIV/hepatitis C virus (HCV) care. EVALUATION: Retrospective review of the clinical outcomes of HIV and HCV coinfected cases implemented by BOP pharmacists following CCC clinical consultations from 2010 through 2012. RESULTS: Most cases focused on selecting optimal antiretroviral therapy (ART) regimens in patients experiencing treatment failure by interpreting resistance tests, limiting ART toxicity, identifying adherence strategies, and managing HIV/HCV coinfection. In 32 of the 34 cases presented, 87.5% (28/32) of CCC recommendations were implemented, resulting in 89% of those patients (25/28) achieving optimal virologic or clinical outcome. Complete virologic suppression occurred in 64% (18/28), and significant viral load reductions in 25% (7/28) of the cases. No changes occurred in 2 patients, and data were not available in 2 others lost to follow-up. BOP participation has increased since its inception from 6 to 12-15 pharmacists per call. Discussions also included updates in antiretroviral guidelines, screening and management of patients coinfected with HIV and HCV, and implications for BOP guidelines. CONCLUSION: BOP clinical consultant pharmacists can successfully implement CCC recommendations to achieve desired clinical outcomes. Consultations and educational efforts from CCC experts assist BOP pharmacists in ensuring excellence in management of complex HIV/HCV issues and medication regimens to achieve desired outcomes. CCC collaboration and BOP pharmacist involvement have improved patient care. Using a team approach to include BOP clinical pharmacists and obtaining expert opinion in management of other chronic illnesses may be a model that can be considered to improve correctional care.

Federal Bureau of Prisons clinical pharmacy program improves patient A1C.

OBJECTIVE: The Federal Bureau of Prisons (BOP) currently has over 13,000 patients with diabetes and has placed an emphasis on preventing and delaying the onset or progression of diabetes-related complications. In an ongoing effort to improve patient outcomes, BOP has implemented a nationwide, dynamic system of pharmacist-delivered patient care services via pharmacist clinicians working under the auspices of a physician-pharmacist collaborative practice agreement (CPA). SETTING: The BOP Clinical Pharmacy Workgroup targets improved patient outcomes via oversight and support of institution pharmacist clinicians and physicians in establishing and maintaining physician-pharmacist CPAs. A primary emphasis is diabetes and the pharmacist-run clinic clinical outcomes data are presented. PRACTICE INNOVATION: Seventy (nearly one-half) of eligible BOP pharmacists at 37 institutions offer pharmacist-delivered patient care services via an approved CPA. In total, BOP has 111 active physician-pharmacist CPAs. MAIN OUTCOME MEASURES: Pharmacist-run diabetes clinic outcomes from 5 institutions have been reported to date. A total of 126 patients were enrolled. Patient's hemoglobin A1C, blood pressure, and LDL cholesterol level are measured before (i.e., when accepted in the diabetes clinic) and after pharmacist-delivered care has been provided. The pharmacist-run diabetes clinics reported an average baseline A1C of 10.6% and produced an average outcome decrease in A1C of 2.3% from baseline. RESULTS: Specific pharmacist clinic interventions found to have the greatest impact are: 1) timely medication adjustment when indicated to help patients meet outcome goals; and 2) timely follow-up after a change in therapy is made (often within 1-2 weeks) with continued medication adjustment when indicated until outcome goal is achieved. CONCLUSION: BOP pharmacists have become respected and trusted clinicians within the team medicine model. As demonstrated by the pharmacist-run diabetes clinic outcomes, pharmacist clinicians are a valued link to the improvement of patient outcomes in BOP.

Federal Bureau of Prisons HIV consultant pharmacist monitoring and advisory program.

OBJECTIVE: To present outcomes resulting from the implementation of a pharmacist-run human immunodeficiency virus (HIV) medication management model. SETTING: Federal Bureau of Prisons (BOP) from December 2004 to December 2009. PRACTICE DESCRIPTION: The BOP instituted the National HIV Clinical Pharmacist Consultant (NHCPC) program in December 2004. NHCPCs monitor and provide guidance as to the appropriateness of antiretroviral therapy (ART) throughout the BOP. They also serve as readily accessible resources for all BOP providers, having the training and expertise necessary to affect positive patient outcomes. NHCPCs were provided intensive training through a Johns Hopkins University HIV/acquired immunodeficiency syndrome pharmacotherapy traineeship administered by the American Society of Consultant Pharmacists and have AAHIVE (HIV Expert) credentialing. PRACTICE INNOVATION: NHCPCs monitor HIV therapy and patient outcomes via BOP electronic medical records. MAIN OUTCOME MEASURES: The vision for this program encompasses an overall healthier BOP HIV patient population being treated in accordance with current Department of Health & Human Services guidelines. Specifically, all patients taking ART have the goals of (1) achieving undetectable viral loads (≥70%), (2) maintaining CD4 T-cell counts of 200 cells/mm3 or more (≥70%), and (3) taking at least 90% of prescribed doses. RESULTS: From April 2004 to December 2009, the overall percentage of BOP patients with undetectable viral loads increased from 32% to 66%. As of December 2009, 76% of patients receiving ART achieved CD4 counts of 200 cells/mm3 or greater and 73% were taking 90% or more of prescribed doses. CONCLUSION: The NHCPC program lends credence to the value of pharmacists in improving patient outcomes.