April 25, 2002-Vol33n26: Certifying HIV specialists

Certifying HIV specialists
UB launches nation's first program for practicing pharmacists

By ELLEN GOLDBAUM
Contributing Editor

The School of Pharmacy and Pharmaceutical Sciences has launched the nation's first program to certify practicing pharmacists in the management of antiviral treatment for patients with HIV.

The program, much of which is conducted online through UB's HIV Pharmacotherapy Network at http://www.hiv.buffalo.edu, is designed to certify pharmacists around the world to a specific standard of care so that they can comfortably and knowledgeably work with HIV patients and their health-care providers.

"This is the first certificate program in HIV pharmacotherapy to establish a rigorous level of competency for practicing pharmacists," said Gene Morse, professor and chair of the Department of Pharmacy Practice, and director of the Laboratory for Antiviral Research at UB, a Pharmacology Support Laboratory for the National Institutes of Health Adult AIDS Clinical Trials Group (AACTG).

"Many pharmacists have never received training in HIV pharmacotherapy and trying to keep up with advances in the field is daunting, to say the least," Morse said.

"With HIV patients living longer, the likelihood that pharmacists in all kinds of communities around the nation and the world will have them as patients continues to increase."

The certificate program has its roots in the HIV Adherence-Pharmacology Clinic directed by Lori Esch, clinical assistant professor of pharmacy practice, who founded the HIV certificate program. That clinic is part of the larger Immunodeficiency Service Unit directed by Ross Hewitt at the Erie County Medical Center.

Through training and mentorship programs, as well as through a year-long HIV pharmacotherapy residency she developed, Esch has trained doctoral students, residents and practicing pharmacists in innovative patient-education techniques and in the overall management of HIV pharmacotherapy. The online certificate program was developed to provide more practicing pharmacists with access to these new techniques.

All practicing pharmacists with HIV patients are welcome to participate in the certificate program, which also is actively soliciting the participation of AIDS health-care providers, as well as pharmacy chains or insurers who sign up their affiliated pharmacists.

"We have plans to do this on a regional basis in cities where the incidence of the epidemic is highest," explained Morse.

The first provider to participate is the AIDS Healthcare Foundation in Florida. Its pharmacists now are involved in the program through Metropolitan Healthcare, the pharmaceutical management company that provides the foundation's pharmacy services.

The sheer number of medications, interactions, potential toxicities and issues such as adherence and side effects involved makes dealing with HIV patients more complex for pharmacists than dealing with patients suffering from any other chronic disease, according to Morse.

"UB has developed a program that allows patients to have confidence that a pharmacist who receives this certificate has achieved a level of competency that is higher than the standard of practice," said Lee Klevens, president of Metropolitan Healthcare.

The program is a rigorous one, Morse said, involving online tests, required readings and the submission of a total of 40 case submissions by each pharmacist drawn from the clinic or pharmacy where they practice, which then are reviewed by the HIV editorial board members.

Attendance at a live one-day workshop also is required. During the workshop, the first of which was held earlier this month in Florida, participants are provided detailed information regarding their test results and case submissions, and patient cases and management issues are discussed.

During the next three months, participants are required to submit 30 additional cases from their practice. These cases are evaluated by the editorial board and participants are provided feedback via email on each one. Certification then is awarded.

By the end of the program, participants will be competent in several integral areas, including successfully reviewing antiretroviral drug regimens for patients, reviewing drug interactions, including those arising from non-HIV, non-prescription and herbal medications; performing counseling with patients to identify potential factors that may complicate adherence; establishing individual plans for antiretroviral adherence and identifying ways to enhance adherence, and monitoring the toxicity of medications that may arise in individual patients based on medications they take for both HIV and concurrent diseases, such as hepatitis B or C.

The certificate program is part of the school of pharmacy's HIV Pharmacotherapy Network, the only interactive pharmacotherapy network that promotes HIV care, education and research for practicing pharmacists.

Morse founded the HIV Pharmacotherapy Network in 1998 to establish a mechanism for new research findings to be reviewed immediately and disseminated to practitioners who, in turn, could then help optimize HIV therapy.

Once the network was established, he said that he and other members of its editorial board began to regularly receive email messages from practicing pharmacists who had numerous questions about how best to manage the complicated issues involved with caring for their AIDS patients.

"At first, we were responding on a case-by-case basis. Then we realized that because many of the same concerns were popping up, we should formalize it, develop a database of cases and provide for pharmacists a standard level of care for HIV."

"By submitting the cases, the pharmacist shows how he or she understood what they have read," explained Morse. "It documents their competency. In this way, the program sets a standard."

For more information about the program, go to http://www.hiv.buffalo.edu/whatsnew.shtml and click on "full brochure."