592. Determining the Impact of an Antiretroviral Stewardship Team on the Care of HIV-Infected Patients Admitted to an Academic Research Institution

Abstract

Background. The American Society of Health-System Pharmacists and The American Academy of HIV Medicine have established guidelines on the pharmacist's involvement in HIV care. Despite expanding roles, there is a paucity of data regarding the impact of collaboration amongst pharmacists and physicians on inpatient anti-retroviral management. We evaluated the efects of an antiretroviral stewardship team, comprised of an HIV specialized pharmacist, Infectious Disease physician, and associated learners on reducing inpatient antiretroviral-related errors. Methods. In this single-centered retrospective cohort study, electronic medical records of adult patients with an antiretroviral ordered between July 1, 2017 and December 31, 2017 were evaluated for the following outcome measures: number of interventions made, number of admissions with errors, predisposing risk factors for errors, and cost savings from interventions. Categorical data were expressed as a total (percent), continuous data were expressed as a median [interquartile range], and predisposing risk factors were analyzed by a multivariate logistic regression. Cost savings were estimated by the documentation system Clinical Measures©. Results. Two hundred ninety-seven admissions were evaluated of which 15 were excluded due to treatment for Hepatitis B and PrEP. Forty-eight percent of included admissions (134/282) had at least one intervention made, with 196 interventions made in total. The following variables were assessed to identify predisposing risk factors for errors: non-institutional outpatient provider (OR 1.890 [95% CI 1.136-3.143]; P = 0.014), admission to the intensive care unit (OR 3.836 [95% CI 1.192-12.340]; P = 0.024), change in GFR (OR 3.332 [95% CI 1.144-9.710]; P = 0.027), CD4 count <200 cells/mm3 (OR 1.196 [95% CI 1.015-3.617]; P = 0.045), and multi-tablet inpatient regimen (OR 1.768 [95% CI 0.916-3.412]; P = 0.090). Cost savings from interventions were estimated to be $137,040. Conclusion. Interprofessional antiretroviral stewardship teams optimize patient care and provide cost savings. Patients at highest risk for errors include those with non-institutional outpatient providers, admission to the intensive care unit, changes in GFR, and CD4 counts <200 cells/mm3.