592. Determining the Impact of an Antiretroviral Stewardship Team on the Care of HIV-Infected Patients Admitted to an Academic Research Institution

Abstract

BackgroundThe American Society of Health-System Pharmacists and The American Academy of HIV Medicine have established guidelines on the pharmacist’s involvement in HIV care. Despite expanding roles, there is a paucity of data regarding the impact of collaboration amongst pharmacists and physicians on inpatient antiretroviral management. We evaluated the effects of an antiretroviral stewardship team, comprised of an HIV specialized pharmacist, Infectious Disease physician, and associated learners on reducing inpatient antiretroviral-related errors.MethodsIn 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©.ResultsTwo 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.ConclusionInterprofessional 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.Disclosures D. Koren, Gilead Sciences: Grant Investigator, Research grant. ViiV Healthcare: Scientific Advisor, Consulting fee.