Background and Importance In recent years, hospital pharmacists have been approaching population-based risk stratification models for selected groups of patients. The implementation of these strategies as routine would facilitate the adequation of the pharmaceutical care to patient complexity.
Aim and Objectives To analyse the health outcomes of HIV+ patients on Antiretroviral Therapy (ART) in a comparative manner according to their classification in the Kaiser Permanente Pyramid (KPP).
Material and Methods Retrospective observational study including all HIV+ patients with active ART on 2022/01/03 followed up in the outpatient pharmacy of a tertiary hospital. The results extracted on 2022/01/03 from the clinical history were analysed according to the KPP risk stratification model. Data collected: sex, age, HIV Viral Load (VL), CD4+, polypharmacy (≥6 drugs, ART included), ART cost/patient/Undetectable VL (UVL; <50 copies/mL), Emergency Department Attendances (EDA)/previous year, and stratum of KPP (General population: Promotion and Prevention (PP); Chronic patients: Self-management Support (SS); High-risk patients: Illness Management (IM); Patients with severe complications: Case Management (CM)).
Results 947 (68% men) with a median (IQR) age of 54 years [46-59] were included. 92% had UVL and 2% >200 copies/mL. 5% had <200 CD4+/µL, 23% 200-500 CD4+/µL and 72% >500 CD4+/µL. 39% of patients had polypharmacy. EDA/previous year was: 0, 67% patients; 1-3, 29% patients; 4-8, 3.5%; >8, 0.5%.
Classification according to KPP: 3.5% unclassified, 3%PP, 45%SS, 33%IM and 15.5%CM. 4% of PP, 16%SS, 88%IM and 85%CM had polypharmacy.
91% of PP, 93%SS, 93%IM and 87%CM had UVL. No PP patients, 2%SS, 1% IM and 5% CM had CV>200 copies/mL.
No PP patients, 3% SS, 4% IM and 10% CM had <200 CD4+/L. 82% of PP patients, 79% SS, 71% IM and 57% CM had >500 CD4+/L.
EDA/previous year was 0, 77% PP-75% SS-65% IM-38% CM; 1-3, 23% PP-23% SS-33% IM-44% CM; 4-8, No PP-1% SS-2% IM-16% CM; >8, No PP or SS-1% IM-2% CM.
The ART/patient/UVL cost was the same as the overall cost in PP and IM patients, 9% lower in SS and 22% higher in CM.
Conclusion and Relevance The study shows a worsening in HIV health outcomes and an increase in resource consumption as patient complexity enhances.
The KPP model allows us to identify patients at greater risk of sickness-related complications and with a potentially high consumption of resources, who may require an individualised and more specific pharmaceutical care in our setting.
Conflict of Interest No conflict of interest