Dr Milena Murray: We Must Make Sure Patients at Risk for, Living With HIV Are Engaged in Their Care

Clinicians must make sure patients are engaged in their care, stressed Milena Murray, PharmD, MSc, BCIDP, AAHIVP, associate professor at Midwestern University College of Pharmacy.

Clinicians must talk to their patients, because it may help to uncover possible gaps in their medication access, which can be helpful to addressing overall medication persistence and care engagement, stressed Milena Murray, PharmD, MSc, BCIDP, AAHIVP, associate professor at Midwestern University Chicago College of Pharmacy, who practices at Northwestern Medicine's Infectious Disease Center in Chicago.


How can managed care professionals collaborate with clinicians to ensure persons living with or at risk of HIV remain engaged in their care?

We know that there's literature showing that attending clinic appointments is associated with medication persistence. So medication persistence is filling every month, being adherent over a span of time. And this type of question could be added into just the general questions, such as shipping information, if they're coming from a mail order pharmacy, or just even at the point of dispense, [such as asking], “Oh, when's your next follow-up appointment?” And if somebody hasn't been there in over a year or it's coming up on a year to get that appointment scheduled, specialty pharmacies are really able to get this information from the electronic medical record. So for example, if I'm looking and trying to refill a prescription, I might, you know, say, “Oh, gosh, this patient hasn't been here in however many months,” or the last note said, “Follow up in 3 months,” and it's been more than that now.

And we want to make sure they're seen at least once a year, that they're considered engaged in care, as well as if managed care can give feedback on refill history to the prescriber so that when that patient comes to an appointment, the prescriber can look and say, “Okay, you fill basically exactly on the 28th of every month. This is really great,” or, “Hey, back in July, I see there was a 2-week time where you didn't have a medication supply, based on this refill history,” and the patient might say, “Oh, yeah, I was out of town, I forgot,” or they might say, “Well, you know, I had pills built up over time, so I had all these extra. I was just letting those run out before I went and got my next refill.” So I think having that conversation can really lead to ideas about gaps in medication access, and that might be something that's helpful.