Optimizing Medications and Lung Health in People with HIV through Pharmacist-led Proactive E-Consults (OPTIMIZE Lung-HIV) - PROJECT SUMMARY/ABSTRACT Despite effective antiretroviral therapy (ART) for people with HIV (PWH), community acquired pneumonia remains a common cause of hospitalization, respiratory failure, extrapulmonary complications, and mortality. Pneumonia continues to be substantially more common among PWH compared to people without HIV, and risk increases with age and comorbidity. Modifiable risk factors for pneumonia in PWH include active smoking, inadequate vaccinations, and commonly used potentially inappropriate medications such as inhaled corticosteroids (ICS) and proton-pump inhibitors (PPIs). Our overarching objective is to improve guideline- concordant care and decrease population risk of pneumonia in PWH. We will test whether a proactive pharmacist-driven E-consult intervention increases uptake of appropriate smoking cessation pharmacotherapy, vaccinations and deprescribing of inappropriate ICS and PPIs for PWH compared to usual care. We leverage a successful pulmonologist-driven proactive E-consult intervention that improved quality of care for chronic obstructive pulmonary disease in PWH in the Veterans Health Administration (VHA), and adapt our intervention by partnering with pharmacists. As pharmacists are integrated into primary and specialty care in VHA, this model can extend the national reach of our intervention and may be more realistic, cost-effective, and scalable than pulmonologist delivered E-consults. We will conduct a multicenter, patient-level randomized controlled, hybrid Type 1 effectiveness-implementation trial and achieve the following specific aims (SA): 1. Test whether a pharmacist-led proactive E-consult intervention for HIV providers improves evidence-based pulmonary pharmacotherapy in PWH; 2. Identify key factors influencing the process of adoption, implementation, maintenance and scalability of pharmacist-led proactive E-consults. We will determine clinical effectiveness by the proportion of medication recommendations enacted within 3 months (primary outcome) and at 12 months for maintenance (secondary outcome) comparing results between E-consult and usual care. We will conduct mixed methods assessments to evaluate barriers and facilitators to implementation and for effective adoption and maintenance of a proactive E-consult program, guided by the Consolidated Framework for Implementation Research (CFIR). We will use the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework to evaluate program outcomes and assess adoption, appropriateness and acceptability to patients and providers as well as implementation costs to inform wider dissemination, and understanding of what factors may be critical for the success, maintenance and scalability of the program. This project will yield critical findings on effectiveness and sustainability of pharmacist-led proactive E-consults to improve delivery of pharmacotherapy. Our initial focus is on improving guideline-concordant pharmacotherapy and decreasing excess risk for pneumonia in PWH. If successful, our approach could be expanded to include pharmacist led interventions focused on other medications that are commonly under or over-prescribed.
