1. In August of 2008, the Minnesota Department of Human Services (DHS) and the University of Minnesota MATEC collaborated to create an online adherence program to provide adherence support tools to HIV care providers. Clinicians ordered adherence support tools from an online pharmacy supply vendor. The University of Minnesota was notified of the orders and DHS was billed directly. As of May 2010, HIV care providers had ordered $4526.78 in tools (4 PharmD, 3 RN, 1 health educator). Fifty-five percent of the total was spent on pill boxes; 24% on pill fob key chains; 7% on pill crushers/cutters; 6% on pill boxes with timers; 3% on single dose pill boxes; 3% on adherence tools for pediatric patients; and 2% on pill box drinking cups. The online ordering program provides a replicable model of an efficient way to make adherence support tools available to HIV providers to meet the individual needs of their patients. Introduction Lessons Learned Bibliography Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. December 1, 2009; 1-161. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf ….) Abstract Results Minnesota’s Online Medication Adherence Tool Ordering Program for HIV Providers Sarah Rybicki, MSW, MPH, Alan Lifson, MD, MPH, Anne Cain-Nielsen, BA University of Minnesota, Minneapolis, Minnesota In order to provide adherence support materials, the Minnesota MATEC Site Director set up a shopping account with an online pharmacy supply vendor. MATEC Minnesota was notified of all products ordered from this account, and DHS was billed directly by the University of Minnesota through quarterly invoicing. Pharmacists and other clinicians who wanted to order adherence tools contacted the MATEC Minnesota Site Director. MATEC provided them with the online login ID and password needed to access the tool ordering account. Clinicians directly ordered adherence tools from the website, and could freely choose type and quantity of tools ordered from the vendor’s catalog. Clinicians were not given an explicit spending limit, although they were notified of the total budget of the program. The initial target audience for this program was clinic-based providers funded through Ryan White Part A, B, C, and D in the State of Minnesota. As the program expanded, services were also offered to all clinic-based providers, specialty HIV pharmacy retail providers, and community-based organization case management programs that provide adherence counseling. We did not directly advertise the availability of the tool-ordering program. Providers who expressed an interest in this program and who were approved registered and were enrolled by email. After logging on, providers had full access to the vendor’s online catalog, including a wide variety of adherence-related materials. When the provider completed his or her order, the MATEC Site Director received a copy and was able to review it. Adherence support tools were shipped directly to the clinicians. The vendor was a local business and most providers were able to receive their order within one to two days of the order being finalized. Although highly active antiretroviral therapy has significantly reduced morbidity and mortality in HIV infected patients, adherence continues to be a major challenge for HIV clinics. A number of strategies and tools have been developed for physicians, nurses, and pharmacists counseling HIV patients about adherence. Pharmacists play an important role in dispensing HIV medications and counseling patients about their treatment, but have not always had adequate resources and support to help promote treatment adherence. This project worked specifically with pharmacists and nurses to provide greater availability of adherence support materials. Methods This program was used by 8 local HIV care providers: 4 pharmacists, 3 RNs, and 1 health educator. Between August 2008 and May 2010, 15 orders totaling $4526.78 were processed using the online adherence tool ordering account. Orders ranged in cost from $51.12 to $1035.12. The mean order cost was $308.58 and median order cost was $106.98. The most commonly ordered supplies were pill boxes (55% of total supplies ordered) and pill fob key chains (24%). In addition: 7% of the total was spent on pill crushers/cutters; 6% on pill boxes with timers; 3% on single dose pill boxes; 3% adherence tools for pediatric patients; and 2% on pill box drinking cups. An online ordering system for adherence support materials for pharmacists and other clinicians was established in Minnesota. The main program users were clinicians providing a multi-faceted adherence counseling intervention. This program was easy to set up, flexible, and efficient. Providers informally reported high satisfaction with the program. A variety of adherence support materials were ordered with pillboxes and pill-fob key chains being the most common. A user-friendly and accessible online ordering system allowed MATEC Minnesota to partner with DHS in making adherence support materials more available to clinical care providers in Minnesota. Acknowledgements “Thanks so much for making this happen!” --PharmD Program Participant We thank the staff of the HIV/AIDS Unit, Disability Services Division, Minnesota Department of Human Services, including David Rompa, Director, Andy Ansell and April Beachem, Program Development Specialists. Special thanks to Diane M. Knust, MSW, LISW for her essential role in program development. www.mnmatec.umn.edu Figure 1: Font size reflects number of supplies ordered in the program