Intervención farmacéutica basada en la metodología CMO para la mejora de la adherencia primaria a la medicación concomitante en pacientes con infección por VIH: Proyecto PRICMO

Objective: To determine the effectiveness of a pharmaceutical care intervention based on the CMO methodology (Capacity, Motivation  and Opportunity) in improving primary adherence to concomitant  treatment in HIV+ patients on antiretroviral treatment. Method: This was a longitudinal prospective multicenter study carried out  between September 2019 and September 2020, which included HIV+  patients older than 18 years who were on antiretroviral treatment and  were taking concomitant medications. Demographic, clinical, and pharmacotherapeutic variables were collected. As required by the CMO methodology, all patients were followed for 6 months and stratified  into three levels of care. Individualized pharmaceutical care was provided according to the interventions established for each level. At every consultation, a motivational interview was conducted based on each  patient’s alignment with and achievement of their pharmacotherapeutic  objectives. A website was developed to deal with the opportunity pillar.  The main variable was the percentage of patients considered primary  adherents to the prescribed concomitant medication. Adherence over the  six months prior to the study was compared to adherence at the end of the study. Additionally, the percentage of patients considered secondary  adherents to concomitant treatment and antiretroviral treatment during  the 6 months prior to the start of the study was compared to the  percentage of such patients at the end of the study. Adherence was  measured based on dispensation records and specific validated  questionnaires. Patients were only considered adherent if they were  deemed adherent by both methods. Results: A total of 61 patients were included in the study, 72% male. Median age was 53 years and the median number of concomitant drugs prescribed was 7. A total of 60.6% of patients were polymedicated. The percentage of patients considered primary non-adherent was 52.5% at baseline (n = 32) and 4.9% (n = 3, p < 0.001) at the end of the study. Secondary adherence to both concomitant medication (41.6% vs 88.3%) and antiretroviral treatment (85.2% vs 95.1%) improved at the end of the study (p < 0.0001). Conclusions: Pharmaceutical care based on the CMO methodology significantly improved both primary and secondary  dherence to concomitant drugs and to antiretroviral treatment.