The US Veterans Administration (VA) health care system is the largest in the United States, serving 22 million former military members. The system also provides care to the largest number of individuals with HIV, allowing patients to obtain all chronic medications using the VA mail-order pharmacy system.

Researchers from the VA system examined how mail-order delivery of drugs affects their patients with HIV. Their study, published in the journal Research in Social and Administrative Pharmacy, indicates that the system is generally of high quality, but there are areas where improvement is possible.

Using a sequential, explanatory mixed-methods design, the researchers interviewed veterans with HIV who used the VA mail-order system and who received care at a Midwestern Veterans Administration Hospital.

The overall trend was positive. Veterans reported that the mail-order service delivered the correct medication almost all the time; errors were rare. However, about half (47%) of the veterans reported running out of HIV medication at least once.

Veterans expressed concerns about days covered by mailed medications. Currently, they receive a 30-day supply and must ask for refills 10 days in advance, but many would like a 90-day supply. They also disliked the process used to order refills. Several work-around mechanisms were suggested, such as visiting the local VA clinic for a 10 day supply, using phone alerts, and asking for overnight delivery when medications were late.

Additionally, veterans cited the information sheets that accompanied medication as being too long, too difficult to read, and unhelpful.

Veterans also indicated that prescription renewal could be a barrier to complete adherence. Currently, the Infectious Disease Clinic must generate the prescription renewal even if the patient has no medication changes. The system allows only 6, 30-day prescription fills before the patient needs a renewal for HIV-related medications.

Patients welcomed an expanded role for pharmacists during clinic visits, indicating that greater pharmacist access would help them manage their conditions better.

Reference

Desai KR, Chewning B, Wilcox A, Safdar N. Mail-order pharmacy experience of Veterans living with AIDS/HIV. Res Social Adm Pharm. 2017 Feb 24. pii: S1551-7411(17)30098-0. doi: 10.1016/j.sapharm.2017.02.005. [Epub ahead of print]