Impact of an Interprofessional HIV Quality Improvement Team on Patient Care and Resident Learning Opportunities.

Introduction: Although human immunodeficiency virus (HIV) care is a recommended competency for family medicine training, many programs report a lack of HIV expertise among faculty. After the departure of faculty with HIV care experience, an interprofessional HIV quality improvement team (HIV-QIT) of physicians and pharmacists aimed to maintain on-site HIV care and retain learning opportunities for residents, using process improvement and panel reviews with a remote HIV specialist faculty member. Methods: This study reports on a multicycle quality improvement pilot project with pre- and postintervention chart reviews between December 2019 and May 2021. All patients received primary care and HIV-QIT chart reviews on-site. We compared patients with integrated HIV care on-site to those receiving external HIV specialty care. Primary outcomes included virologic suppression, CD4 count ≥200 cells/mm3, and adherence to guideline-recommended HIV care. In cycle 1 (January-June 2020), the HIV-QIT reviewed patient charts and sent guideline-based recommendations to physicians. In cycle 2 (July 2020-May 2021), the HIV-QIT implemented several HIV-specific processes, including decision support updates, note templates, order sets, and reference materials. Sustained process improvements included HIV panel chart audits every 3 to 6 months and subsequent provider education. Results: Of 29 patients, more than half (55%, n=16) received integrated HIV care at the primary care site. We found no significant difference in care quality measures between primary and specialty care. Barriers to care completion included missed or canceled follow-up visits, on-site phlebotomy service closures, and declined HIV services. Conclusions: The HIV-QIT maintained on-site HIV treatment and retained experiential learning opportunities through process improvement and specialist-supported care recommendations to primary care physicians.

Informing the development of a transitions of care program between an emergency department and regional supermarket chain pharmacies.

OBJECTIVES: Pharmacist collaboration in transitions of care (TOC) programs is integral to increase patient education and adherence after discharge. This study aimed to conduct a qualitative evaluation of stakeholder perspectives to inform the design and implementation of a TOC program between an emergency department (ED) and regional supermarket chain pharmacies. METHODS: Pharmacies from a regional supermarket chain were identified for inclusion on the basis of geographic proximity to a local community hospital ED. Semistructured, one-on-one interviews with the primary investigator were conducted. Interview questions were based on the Consolidation Framework for Implementation Research (CFIR). The following 5 CFIR domains were used: (1) intervention characteristics, (2) outer setting, (3) inner setting, (4) characteristics of individuals, and (5) process. Interviews were audio-recorded and transcribed. Two investigators coded each transcript independently. A thematic analysis was performed. RESULTS: A total of 19 interviews were conducted, and the following 7 major themes emerged on analysis: (1) enhance real-time interprofessional communication, (2) establish data sharing between the ED and the community pharmacy, (3) provide timely resolution of prescription insurance issues for new therapies post-ED discharge, (4) use off-site pharmacy resources to support community pharmacy workflow, (5) increase patient education to prevent primary medication nonadherence, (6) reinforce discharge care plans, and (7) focus on community-dwelling older adult patients in an ED care transition program. CONCLUSION: Health care providers including pharmacists, physicians, nurses, and care managers, view an ED-to-community pharmacy TOC program as a valuable service to increase patient education on new medications and discharge planning. Establishment of data sharing and reimbursement is integral to the development, implementation, and sustainability of such programs. There is an untapped opportunity for community pharmacists to bridge the gap in care after ED discharge.