Erie County Medical Center – Immunodeficiency Services


Erie County Medical Center – Immunodeficiency Services | Women, Infants, Children and Youth (WICY) | Personnel


 

Erie County Medical Center Corporation is the only Designated AIDS Center (DAC) in Western New York.  ECMC’s Immunodeficiency Services department provides HIV/AIDS clinical consultation and educational services to clinic patients and the community at large.  A multidisciplinary team was established that included physicians, nurse practitioners, nurses, social workers, pharmacists, a registered dietician, mental health counseling, HIV testing and counseling services, and community outreach. 

 

Immunodeficiency Services

 

The ambulatory and in-patient components of the program utilize the Adherence-Pharmacology Unit (APU) as a central point for coordinating antiretroviral (ARV) medication management.  The program’s pharmacists collaborate with prescribers to optimize HIV pharmacotherapy and adherence to the chosen regimens while also providing education and training programs to foster the development of new HIV pharmaceutical care specialists. 

 

At clinic intake, every patient, whether newly diagnosed or re-linking for care, meets with a member of the APU to discuss living with HIV/AIDS, the expected clinical outcomes of a patient living with HIV, laboratory markers and antiretroviral treatment options. Further education is personalized to meet the patient’s individual needs and include but are not limited to, debunking common myths and misconceptions of living with HIV/AIDS, living with the stigma of HIV disease, the management of adverse events related to a patient’s antiretroviral regimen, opportunistic infection treatment and prevention, and optimizing a patient’s quality of life and adherence to complex medication regimens. 

 

Patients enrolled in the treatment adherence protocol meet with a member of the APU at each clinic visit to discuss potential barriers to adherence and to reinforce education regarding interpretation of surrogate markers, expected outcomes related to HIV, the implications of missed antiretroviral doses (i.e. resistance), and living with HIV/AIDS.  Patients will continue to see members of the APU until such time as they have two consecutive viral loads less than 200 copies/ml, an arbitrary level of viral suppression derived from evidence based medical guidelines pertaining to the treatment of HIV/AIDS in adults and adolescents.  In addition to clinic visits, patients receive weekly follow up from members of the APU which allow for the formation of a strong rapport between the patient and the APU staff member as well as a method of constant communication between the patient and the Immunodeficiency Services Clinic.

 

Pharmacists are also available to review HIV resistance test results for treatment-experienced patients, to assess drug interactions and likelihood for adverse effects, and to facilitate prior authorization requests from a patient’s health insurance company.  Pharmacists or pharmacy students also serve as vital sources of drug information by researching and presenting the answers to questions posed by clinic staff or patients themselves.

 

This unit has developed a formalized inpatient consultation program whereby pharmacists and pharmacy students provide specialized pharmaceutical care services to hospitalized HIV-positive patients in order to optimize clinical benefit from ARV regimens, avoid adverse drug drug interactions, ensure appropriate dosing of antiretroviral medications in the context of renal or hepatic disease, minimize ARV treatment disruption during periods of hospitalization, and facilitate the transition back to primary care following discharge.  Adherence Pharmacology Unit members also serve as a vital member of the interdisciplinary team when working with patients co-morbid conditions.  The APU staff are involved in optimizing health outcomes as they relate to Hepatitis C Virus (HCV), where staff members are involved in health education, optimizing adherence to therapy or management of adverse events, but are also involved in more common co-morbid conditions including diabetes mellitus, dyslipidemia, and hypertension.  

 

Immunodeficiency Services Clinic patients living at Benedict House, a local transitional housing organization for patients living with HIV/AIDS, also receive individualized care from members of the APU staff.  Weekly medication reconciliation occurs with assistance from the staff at Benedict House and ambulatory pharmacies to maintain health outcomes for these patients.  In addition, APU staff members serve as integral members of bi-weekly Benedict House case conferences, where IDS staff, Benedict House staff, home health care (Schofield Nursing) staff and staff from ambulatory care pharmacies discuss the health care plan for individual patients.

 

 

 

 

Related Publications

Catanzaro LM, Slish JC, DiCenzo R, Morse GD. Drug interactions with antiretrovirals. Current HIV/AIDS Reports 2004; 1(2):89-96. PMID: 16091228

Slish JC, Catanzaro LM, Ma Q., Okusanya O.O., Demeter L, Albrecht M. and Morse GD, Update on the Pharmacokinetic Aspects of Antiretroviral Agents:  Implications in Therapeutic Drug Monitoring. Current Pharmaceutical Design 2006; 12(9):1129-1145. PMID: 16515491

Higgins N, Zingman BS, Slish J, Reichman RC, Fischl MA Gripshover B, Tooley K,  Boston N, Forrest A, Brazeau D, Catanzaro LM, DiFrancesco R, Lliguicota F, Ma Q, Morse GD. Factors Associated with Altered Pharmacokinetics in Substance Users and Non-Substance Users Receiving Lopinavir and Atazanavir. Amer J Addiction 2007 Nov-Dec;16(6):488-94. PMID: 18058416

McCabe SM, Ma Q, Slish JC, Catanzaro LM, Sheth N, DiCenzo R, Morse GD. Antiretroviral Therapy:  Pharmacokinetic Considerations in Patients with Renal or Hepatic Impairment. Clin Pharmacokinetics2008;47(3):153-72. PMID: 18307370

Related Presentations

Boston, NS, Slish JC, Catanzaro LM, Redlinski AM, Hsiao CB, Sulaiman A, Morse GD.  Therapeutic Drug Monitoring (TDM) in Patients Co-infected with HIV and Hepatitis C (HCV).  American College of Clinical Pharmacy (ACCP) Annual Meeting, San Francisco, CA, October, 2005.

Catanzaro LM, Brody PM, Fiebelkorn KD, Felton CM, Bellnier T, Morse GD.  Integrated Approach to Community Pharmacy Medication Therapy Management (MTM) and Doctor of Pharmacy Experiential Programs.  American College of Clinical Pharmacy (AACP), Lake Buena Vista, FL, July, 2007.

Catanzaro L, Nelson M, Lliguicota F, Warrick J, Morse GD.  Development and Implementation of Web-based HIV Pharmaceutical Care Continuing Education and Certificate Programs.  2008 American College of Clinical Pharmacy (ACCP) and Association of the Faculties of Pharmacy of Canada (AFPC) Annual Meeting, Chicago, IL, July, 2008.

Felton C, Sayidine F, Wrobel M, Purdy C, Ellis D, Venuto R, Dombroski E, Gbadamosi F,  Grieser J, Govindaraju V, Dandona P, Sanders E,  Morales A, Seelman D, Hughes A, Lliguicota F, Manzella K, Ma Q, Bessette R, Morse GD.  Pharmaceutical Safety Initiative: Enhancing Patient Safety with Information Technology and Biomedical Informatics.  Pharmacy Safety Forum, Albany, NY, June, 2010.