One size does not fit all patients (Suzanne Elvin)

No matter the medical condition, no one drug regimen suits all patients — part of being a successful prescriber involves learning how to identify what regimen will suit each individual patient.

In my role as a HIV specialist pharmacist, I work with a small number of patients from a variety of groups, for example:

• women diagnosed through routine antenatal screening
• people from Africa
• men who have sex with men
• heterosexual people

As a prescriber, I aim to build trusting relationships through engaging with patients early in the decision-to-treat process.

When prescribing I carefully consider what I know about my patients. Of course this involves clinical parameters, but it also includes their work patterns, lifestyle choices and level of education.

Do they have children keeping them awake during the night? Who else knows about the diagnosis? Where can they keep their tablets without disclosure of their HIV status? Perhaps treatment choice is dictated by the side effect profile that will best suit a healthcare worker on night shifts; or by the need for a simple regimen that will suit a chaotic lifestyle.

I also need to consider whether or not patients can read the English patient information. Through discussion and careful questioning of my patients I can gain insight into what is important to them and the situation they are in.

Clinicians should never undervalue the concerns of individual patients. For some, the biggest worry is the size of the boxes of tablets — by choosing the best treatment that fills the smallest space I am able to maximise adherence.

Both the independent prescribing course and the British HIV Association treatment guidelines emphasise the importance of treating the whole patient, not just the disease; successful adherence depends on the patient’s perception of the necessity of treatment.

In my experience, in order to understand my patients’ viewpoints it is necessary to begin discussions early and try to get to know them.

Although the aim for patients with HIV is always the same — to increase CD4 count and achieve an undetectable viral load as safely as possible — the regimen that gets them there must be tailored to their individual circumstances.

 

Suzanne Elvin is HIV specialist pharmacist at Royal Hampshire County Hospital, Winchester