Patient Information Sheet

Attachment 9a

Patient Centered HIV Care Model

Information Sheet

Why we are doing this project?

HIV is the virus that causes AIDS. Your medical provider, Walgreens pharmacies, the Centers for Disease Control and Prevention (CDC), the University of North Texas Health Science Center (UNTHSC) and HealthHIV are working together to create an HIV care program to improve HIV care quality. Your HIV care provider shares your personal information with pharmacists when prescribing your medicines. This program will look at how the information shared between your HIV medical provider and Walgreens pharmacies affects your care. The purpose of the project is to see if the program helps people stay in HIV care, continue their HIV medications and achieve good HIV outcomes. Your participation will help us learn if the program may improve care for others.

What does is means to participate?

If you agree to participate, you will receive, at no additional cost to you, Medication Therapy Management (MTM) from a Walgreens pharmacist. MTM is a scheduled visit (or telephone call) with your pharmacist to talk about your health and your medications. During these MTM visits, the pharmacist will review your current medications. The pharmacist will talk with you about your health history. The pharmacist will discuss how to best take each medicine you are taking. The pharmacist may also give you other helpful information about your medical conditions. The pharmacist may contact your HIV care provider to discuss medicines you are taking or need to take. At the end of each of these visits, the pharmacist will give you a plan for taking each of your medicines. The pharmacist will also inform your HIV care provider about the plan. The MTM will be provided to you at no additional cost, but you will still be responsible for any costs related to your medicines.

What will we need from you?

• Fill all of your medications from the Walgreens pharmacy located at (insert project Walgreens’ address)

• Keep your regularly scheduled clinic appointments. Clinic appointments will be scheduled at least every 6 months.

• Keep your scheduled MTM appointments either at the Walgreens pharmacy located at (insert address here) or by telephone. These visits will be at least every 3 months for up to two years. Each MTM visit will last about 20 – 60 minutes.

Your HIV care provider and Walgreens’ pharmacist will:

• look at your medical and pharmacy records

• share information about your medical care and prescriptions

• review all your medications and discuss if changes are needed

• contact you to talk about health and medication changes

Your HIV care provider and Walgreens’ pharmacist will share with the rest of the project team the following information that will not identify you:

• medical history (including mental health)

• medications

• laboratory test results

• alcohol and drug use

• use of medical and social services

• appointments kept with your HIV care provider and Walgreens pharmacist

• identified problems with medications

If you have any questions, please speak with your medical provider at (insert clinic name and address) or a Walgreens’ pharmacist at (insert project Walgreens’ address).

Patient Centered HIV Care model 2014