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.
D. Koren, Gilead Sciences: Grant Investigator , Research grant . ViiV Healthcare: Scientific Advisor , Consulting fee .