267086 Is Mail-Order Pharmacy Appropriate for People Living With HIV? Community-based and Mail-order Pharmacists Perspectives

Wednesday, October 31, 2012

Jennifer Kibicho , Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI
Jill Owczarzak, PhD , CENTER for AIDS INTERVENTION RESEARCH, MEDICAL COLLEGE OF WISCONSIN, Milwaukee, WI
Steven D. Pinkerton, PhD , Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI
Andrew Petroll, MD , Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI
Dave Mott, PhD , Sonderegger Research Center, University of Wisconsin-Madison, Madison, WI
Andrew M. Muriuki, PhD , Center for Global Health, University of Wisconsin, Madison, WI
Background: Growth of mail-order pharmacies is attributed to cost containment advantages, and research has demonstrated better therapeutic outcomes for patients with chronic conditions (e.g., diabetes) compared to patients who use community-based pharmacies. Many AIDS Drug Assistance Programs mandate mail-order use for their beneficiaries. Research is needed on the impact of mail-order pharmacies for persons living with HIV (PLWH). Methods: We interviewed 31 pharmacists (11 specialty, 17 nonspecialty, 3 mail-order) regarding mail-order pharmacy use by PLWH. Data coding and analysis was done in MAXQDA software. Results: While mail-order is convenient and cheaper than community pharmacy, the lack of patient face-to-face interaction particularly for newly diagnosed PLWH, loss of control of therapy, and medication delivery delays are concerns that could influence adherence outcomes. Nonspecialty community and mail-order pharmacists face similar challenges but for different reasons (lack of patient interaction because of high volumes in community pharmacies and no patient interface in mail-order pharmacies). Specialty community and mail-order pharmacies monitor adherence through frequent patient contacts (by phone) and provider collaborations. Each setting complements the other: community pharmacies serve mail-order patients needing pharmacist interaction, and mail-order pharmacies reduce patient traffic at community pharmacies. Conclusions: The design of insurance contracts determines pharmacists' level of interaction with patients irrespective of pharmacy setting (mail-order or community). Specialty pharmacists use similar strategies (regular patient contacts, provider collaborations) and nonspecialty pharmacists face common challenges (lack of patient interaction) promoting adherence. More research is needed to identify appropriate candidates for mail-order, and evaluate the cost-effectiveness of mail-order versus community-based pharmacies.

Learning Areas:
Chronic disease management and prevention
Provision of health care to the public
Public health or related public policy

Learning Objectives:
1. To assess community-based and mail-order pharmacists perspectives on the use of mail-order pharmacy by persons living with HIV. 2. To differentiate community-based and mail-order approach to promoting adherence to antiretroviral therapy.

Keywords: Pharmacists, Adherence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Did the data analysis.....have a Ph.D. in Economics.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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