Addressing Latent Tuberculosis Infection Treatment Through a Collaborative Care Model With Community Pharmacies and a Health Department

Bernadette Jakeman, PharmD; Stefanie J. Logothetis, PharmD; Melissa H. Roberts, PhD; Amy Bachyrycz, PharmD; Diana Fortune, BSN; Matthew E. Borrego, PhD; Julianna Ferreira, MSN, MPH; Marcos Burgos, MD

Disclosures

Prev Chronic Dis. 2020;17(2):e14 

In This Article

Results

Of the 41 patients who consented to participate in the study during the evaluation period, 40 initiated treatment and were included in the data analysis (Figure). Thirty patients received LTBI treatment at an Albuquerque community pharmacy, and 10 patients received LTBI treatment at a Santa Fe community pharmacy. Most patients were female (55%; n = 22), Hispanic white (37.5%; n = 15), and had an average age of 46 years (SD, 12.6 y) (Table 1).

Figure.

Flow diagram for patient enrollment, study on using a collaborative care model to treat LTBI, New Mexico, 2017–2018. Abbreviation: LTBI, latent tuberculosis infection.

Of 40 patients who initiated treatment, 75% (n = 30) completed LTBI treatment with 3HP at 1 of the participating community pharmacy sites. Seven patients discontinued 3HP because of potential ADEs, and 3 patients were lost to follow-up. A higher percentage of patients who completed treatment were of Hispanic ethnicity compared with patients who discontinued treatment (76.7% vs 40.0%, P = .04) (Table 1). Other demographic characteristics, including age, sex, and substance use (ie, tobacco or alcohol) did not differ between patients who completed or discontinued LTBI treatment. Most patients (60%; n = 24) reported experiencing an ADE with 3HP therapy (Table 2). The most common ADEs reported were dark urine (27.5%; n = 11), excessive fatigue (22.5%; n = 9), and nausea/vomiting (22.5%; n = 9). Differences between the groups were significant with regard to ADEs. Fewer patients who completed treatment experienced any ADE compared with patients who discontinued treatment (50% vs 90%, P = .03). ADEs that patients who completed treatment experienced less often than those who discontinued treatment were excessive fatigue (13.3% vs 50.0%, P = .03) and nausea/vomiting (13.3% vs 50.0%, P = .03). Potentially serious ADEs were reported to the NM DOH TB Program and reviewed by the TB physician. In 7 cases (17.1%) it was determined that the patient should discontinue 3HP treatment. Of the 7 patients who discontinued 3HP therapy at a community pharmacy site, 1 was able to complete LTBI therapy with another LTBI regimen through the NM DOH, bringing the overall completion rate to 77.5%. No cases of active tuberculosis or death were reported during the study period. The average number of doses received by patients who discontinued therapy at a community pharmacy was 3.8 (SD, 2.3).

Pharmacists performed 398 LTBI treatment visits (40 initial visits, 358 follow-up visits) during the evaluation period. Pharmacists recorded the estimated time for initial and follow-up visits for 26 patients. The average time for an initial visit was 25 (SD, 10.1) minutes. The average time for follow up visits was 22 (SD, 9.7) minutes. The initiative saved the NM DOH more than 8,876 minutes (148 hours) in patient visit time. Most patients (62.5%; n = 25) lived 5 miles or less from the pharmacy where they received 3HP treatment (Table 3).

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