Implementing Semi-Automated Medication Dispensing for People with HIV: A Community-Based Alternative to Traditional...

Introduction: Maintaining adherence and access to antiretroviral treatment is basic for good management of people with HIV (PWH), while enhancing patient satisfaction. With the aim of shifting from drug-centered into patient-centered care and integrating care interventions into community settings, here we share an outpatient hospital pharmaceutical care implementation model for PWH. This model involves the delivery of medication through a community center, BCN-Checkpoint, using a proprietary app and coordinated with automated locker systems. Methods: During the pre-implementation phase the circuit was defined and seven steps were considered critical for successful implementation: (1) assignation of teams and roles; (2) adaptation of the self-developed app; (3) development of a patient journey map; (4) locker installation and system integration with data from the electronic records; (5) staff training; (6) review of data protection regulations; (7) simulation tests. A two-phase simulation-with fictitious users and with real ones-validated the system. The implementation phase included an initial pilot study, in which 46 patients were included in the project. Results: System uptake was high, with strong adherence to the dispensing pathway; only five discontinuations due to personal preferences or availability of alternative dispensing pathways. Several barriers to implementation emerged, primarily categorized into technical issues, process and operational challenges, coordination, and user-related difficulties. However, a communitarian setting, flexible attention times and protocols, and the strong intersectoral collaboration between specialists are believed to increase patient retention and overall satisfaction. Conclusions: The implementation of an outpatient dispensing hospital medication model using an app and automated locker systems is feasible, considering detail to procedures, timely adaptations, and staff training.