Infectious Disease Specialist Key to Improving Hospital Care For HIV Patients

When people with HIV are hospitalized for conditions unrelated to the virus, mistakes are often made involving their complicated anti-retroviral therapy (ART) regimens, according to a new study by the Cleveland Clinic. Those errors, however, are more than twice as likely to be corrected when patients are seen by infectious diseases (ID) physicians. The study presented at IDWeek 2013 in San Francisco on Thursday, highlights one of the many indirect challenges faced by those living with HIV.

Most HIV patients are treated in their communities by physicians with HIV expertise who help them manage their complicated drug regimens. However, problems often occur when they are admitted to the hospital for other health problems, such as heart problems or surgery, since hospital doctors don’t usually manage HIV patients and their complex therapy. According to the study, outpatient-to-inpatient integration of health records, as well as ID physicians, are becoming increasingly critical to quality care.

The new study has shown that errors negatively impacting patients' treatment are more likely to be corrected, or hopefully avoided, if an ID physician sees HIV patients when they are hospitalized. In the Cleveland Clinic study, errors were corrected in 68% of patients who saw an ID specialist compared to 32% of those who did not.

The study also found that those errors can be reduced by employing a variety of interventions, including education, modification of the electronic drug file (used to guide the accurate prescribing of medications), and a daily medication profile review by a pharmacist specializing in HIV.

“Most HIV care has shifted from inpatient to outpatient, so hospital providers aren’t as familiar with complicated ART regimens – and as a result, medication errors are common,” said Elizabeth A. Neuner, PharmD, an ID clinical pharmacist at Cleveland Clinic and lead author of the study. “By enacting a multidisciplinary plan including pharmacists and physicians to prevent errors from happening or correcting them if they did, we were able to significantly reduce errors in ART medications.”

Michael A. Horberg, MD, who moderated the press briefing Wednesday in San Francisco, stressed the need to "get it right the first time," where integration of health records can deter medication errors once an HIV-positive patient is admitted. “Sometimes they remember to bring all of their meds, sometimes they don’t.  Sometimes they don’t recall all of their meds.” In some situations, he went on to say that, “In many cases the family doesn’t know, and if you can’t get a hold of the primary care or outpatient physician, you’re at a loss.” 

Touching on the actual cost associated with inpatient care, Horberg also highlighted a secondary impliation resulting from such medical errors. “Recent new rules by Medicare are not going to be paying for hospital readmission, and there is even talk about not paying for complications due to medication errors.” 

IDWeek 2013 is an annual meeting of the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA) and the Pediatric Infectious Diseases Society (PIDS). With the theme “Advancing Science, Improving Care,” IDWeek features the latest science and bench-to-bedside approaches in prevention, diagnosis, treatment, and epidemiology of infectious diseases, including HIV, across the lifespan. IDWeek 2013 is taking place October 2-6 at the Moscone Center in San Francisco.