The VA MOPP Study: VA Mail-Order Prescriptions and Patients' Perspectives.

摘要

Objective: This quality improvement research sought to: 1) explore HIV patients' experience using VA mail-order pharmacy to identify areas for improvement, 2) evaluate HIV patients' self-reported adherence to HIV medications and its association to mail-order experience, 3) examine HIV patients' self-efficacy (confidence) in medication & disease management and its association to adherence and mail-order experience and 4) help explain and contextualize survey findings with a focus on identifying preferences and mail order system alterations to help improve patients' HIV medication management.;Design: A sequential, explanatory mixed-methods design was used to collect quantitative data using a survey (Phase I) and then to collect qualitative data (Phase II) to explore and help explain the quantitative results.;Setting and Participants: For Phase I, all veterans living with HIV were recruited through systematic telephone calls and infectious disease clinic visits at Veteran Hospital, Madison. For Phase II, a subset of the patients surveyed were interviewed.;Measurement: The Phase I survey included three scales: 1) Mail-order Experience, 2) Brief Medication Questionnaire and 3) Self-efficacy for medication management. For Phase II, an interview guide was developed based on the findings of Phase I.;Results: Fifty seven out of a possible 76 veterans consented to answering the survey. The sample consisted primarily of white (66.7%), male (96.5%) respondents 51-60 years (56%) old with a High School Diploma (57.9%). Although veterans evaluated the mail-order service positively overall, some issues existed with; 1) information sheets, 2) amount of medication received (30 days verses 90 days) and 3) scheduling and planning refills. Moreover, about 47% were non-adherent with HIV medications. The qualitative interviews identified concerns that information sheets were too long and complex and a preference for 90 day medication supply to help with access. Patients were open to pharmacists playing a more active role during clinic visits and felt it could help manage their conditions better.;Conclusion: Veterans generally reported being served well with medication care. However, their nonadherence and access barriers suggest considering opportunities to improve the refill processing/ prescription renewal system, increasing days supplied with medications, improving information sheets and more active roles for pharmacists with patients.