Catching patients falling through the cracks of a hurried health care system: Opportunities and challenges for community-based pharmacists in HIV patient care

Background: Inconsistent adherence to antiretroviral therapy (ART) is a severe and pervasive problem for many persons living with HIV (PLWH) with serious individual and public health implications. Community-based pharmacists are well positioned to promote adherence to ART, given their access to medication refill histories and frequent contacts with patients. We examined pharmacists' self-reported competence in providing care to PLWH, self-identified needs for HIV-related training and experience, and their vision for an expanded patient role. Methods: We conducted qualitative face-to-face interviews with 28 pharmacists (11 specialty, 17 nonspecialty) in 4 Midwest cities. Data coding and analysis was done in MAXQDA. Results: Pharmacists reported being strategically positioned to promote adherence given their advanced training in pharmacology and unique location in community-based settings. Nonetheless, many pharmacists reported feeling underutilized in providing patient care, and overqualified in their day-to-day tasks (e.g., billing and resolving insurance issues) that could be delegated to less qualified pharmacy technicians. Pharmacists envisioned opportunities for greater patient involvement as intermediaries between other health care providers and patients, playing a more proactive patient-centered role instead of the current ‘damage-control' approach. However, less than half of pharmacists (46%) considered themselves competent to provide PLWH care. Pharmacists self-identified training needs were as follows: specialty pharmacists in opportunistic infections and HIV-related comorbidities; nonspecialty pharmacists in patient communications skills; and all pharmacists require a mechanism to keep updated in HIV treatment guidelines. Conclusion: HIV is now a complex chronic condition largely due to advancements in treatment. While pharmacists are highly skilled in pharmacology, many pharmacists report needing additional training to play a more effective role in the pharmacological management of HIV that is beyond providing traditional prescription dispensing services. Changes in pharmacy school curricula and continuing professional education are needed to meet HIV-related knowledge and competency needs of community-based pharmacists. Because the population living with HIV illness is growing, aging and developing a wide range of multiple non-AIDS disease comorbidities (e.g., diabetes and heart disease), and by 2015 at least half will be over 50 years, pharmacists have an opportunity to carve out a more strategic role in the management of HIV infection and related comorbidities. To effectively meet these opportunity, current challenges, including acquiring HIV-related training and reimbursement for adherence promotion activities, need to be addressed.