Patients assessed by clinicians in Out-of-Hours services may need to start medication promptly, but in some settings (e.g. remote areas) they have trouble getting this medication in a timely way as there are no nearby community pharmacies open. This problem has worsened recently for a number of reasons, including unfilled professional staff vacancies and an increase in the use of remote forms of care. Patients calling the national urgent care line 111 can receive a consultation via telephone or video from a clinician based anywhere in the country, but there may be no local community pharmacy open to dispense the medication which has been prescribed. For some patients in rural parts of the UK it may be a long journeys to reach a pharmacy, which can be impossible for anyone without access to their own transport. This represents a source of inequity in the provision of health care in the UK and may result in adverse health outcomes and associated costs (e.g., when delayed medication leads to worsening of their condition) and pressures (e.g., increased demand for in-hours urgent care the next day) elsewhere in the system.
The aim of the REMEDY project is to develop, study and evaluate a technological solution – a medication issuing machine- to supply medicines local to a patient’s home. The machine will contain a restricted selection of medicines frequently prescribed after an Out -of Hours consultation (e.g., antibiotics, steroids, inhalers), which the patient or their representative can access. . A code number enables the correct medicine to be issued (in a similar way to a parcel collection locker, but with additional safety features). Such machines would be typically installed at local community sites and kept stocked by local pharmacy teams. The machines would be integrated within the Out-of-Hours clinical workflows, creating potential for them to be used in remote areas when local pharmacies are closed. The unit offers secure storage and issuing of up to 100 medications, which can be released via a pin code sent to a patient’s mobile, email or read out over the phone. Medicines stored in the machine will be selected from the local Out-of-Hours formulary by the care provider.
Similar machines already are in use, such as the Pharmaself 24. This machine has been installed in over 800 community pharmacies across the UK and Netherlands, to allow contactless collection of prescription medication which has been dispensed in a community pharmacy and placed into a bag ready for collection. The patient then receives a text with a PIN code allowing them to collect from the machine at a convenient time which may be when the community pharmacy is closed.
Working with the manufacturers and suppliers of Pharmaself 24, new software has been developed to repurpose the machine to become a pre-loaded remote issuing point for medication following a telephone or video consultation with clinical Out-of-Hours services. The first machine was installed in Dolgellau, North Wales in July 2024. We have called this the Pharmaself REMEDY.
Who is doing the service development project?
The project is led from Bangor University by Out-of Hours GP and clinical academic Dr Rebecca Payne alongside Prof Dyfrig Hughes and Dr Adam Mackridge. Other team members include Dr Archie Lodge, who is a dual trained doctor and engineer, and Nadia Swann, health services researcher and patient/carer representative from the University of Oxford, and Aberdeen University's Professor Emeritus Christine Bond who brings expertise in tele-pharmacy.
The key questions we would like to answer in this project are:
1. What are the human, organisational, technological, and regulatory challenges of installing a remote-controlled machine for supplying Out-of-Hours medications (REMEDY) in underserved communities, and how might these be addressed?
2. What is the potential impact of a Pharmaself REMEDY machine on access to medications following an Out-of-Hours teleconsultation for individuals within the community it serves?
3. Do the Pharmaself REMEDY medications machines have the potential to provide a cost-effective mechanism to improve access to medications in rural and underserved communities in Wales?
4. Should further studies be conducted to assess the effectiveness and cost-effectiveness of the Pharmaself REMEDY machine; and if so, what methods would best determine its benefits and value?
What methods will we use?
We are using a Researcher-in-Residence model, where the researcher, health service, and industrial partner (Videosystem/Omnicell) work together to develop, implement, and study the medication machine. The research team are providing expert help and support to each site in the planning and implementation of patient facing medication machines, and performing an evaluation tailored for each site. Health Boards are responsible for developing internal procedures for the implementation of the machine, such as deciding an appropriate formulary, integrating the machine into their existing processes and developing a mechanism to restock the machine. The sites are responsible for engaging with their existing governance mechanisms and retain full control of the planning and implementation at their site, with evaluation facilitated by the research team.
We are adopting an Agile roll out approach, with new research sites going live on a staggered basis, allowing learning from the first site to inform implementation in the second.
The initial study of the remotely operated patient facing medication machine supply robot service will run for 2 years, with the service being delivered during any part of the Out of Hours period where access to community pharmacy services are not available. Health Boards will install the Pharmaself REMEDY machine at the pilot sites, and install software for remote access onto the Out-of-Hours computer systems.
We will be using a Researcher-in-Residence approach where researchers are embedded within the project team and feeding back insights to optimise the chances of success. Interviews will also be conducted with staff and patients and machine and service data analysed.
The care provider’s pharmacy teams will be responsible for the restocking of the machine which will be carried out weekly, or more often when needed, e.g., during public holiday periods.
Counselling on prescribed medicines will be provided by the Out-of-Hours clinician during the advice call with the patient.
Implementation will be studied using the NASSS-CAT framework.
This study is sponsored by Bangor University