Impact of an Antiretroviral Stewardship Team on the Care of Patients With Human Immunodeficiency Virus Infection Admitted to an Academic Medical Center

Abstract

Background

Interdisciplinary antiretroviral stewardship teams, comprising a human immunodeficiency virus pharmacist specialist, an infectious diseases physician, and associated learners, have the ability to assist in identification and correction of inpatient antiretroviral-related errors.

Methods

Electronic medical records of patients with antiretroviral orders admitted to our hospital were evaluated for the number of interventions made by the stewardship team, number of admissions with errors identified, risk factors for occurrence of errors, and cost savings. Risk factors were analyzed by means of multivariable logistic regression. Cost savings were estimated by the documentation system Clinical Measures.

Results

A total of 567 admissions were included for analysis in a 1-year study period. Forty-three percent of admissions (245 of 567) had ≥1 intervention, with 336 interventions in total. The following were identified as risk factors for error: multitablet inpatient regimen (odds ratio, 1.834; 95% confidence interval, 1.160–2.899; P = .009), admission to the intensive care unit (2.803; 1.280–6.136; P = .01), care provided by a surgery service (1.762; 1.082–2.868; P = .02), increased number of days reviewed (1.061; 1.008–1.117; P = .02), and noninstitutional outpatient provider (1.375; .972–1.946; P = .07). The 1-year cost savings were estimated to be $263 428.

Conclusions

Antiretroviral stewardship teams optimize patient care through identification and correction of antiretroviral-related errors. Errors may be more common in patients with multitablet inpatient regimens, admission to the intensive care unit, care provided by a surgery service, and increased number of hospital days reviewed. Once antiretroviral-related errors are identified, the ability to correct them provides cost savings.

Abstract

Interdisciplinary antiretroviral stewardship teams optimize patient care and provide institutional cost savings. At the highest risk for errors are patients with multitablet inpatient regimens, intensive care unit admission, care provided by a surgery service, and increased number of days reviewed.