Introduction The HIV department of Southend University Hospital NHS Foundation Trust UK, care for 370 patients of which 80% are taking antiretroviral therapy(ART).
Monthly ART spend is approximately £200,000. A proposal for ART home delivery was made by the HIV multidisciplinary team(MDT) and local procurement pharmacists. The desired outcome being patient convenience, whilst making financial savings for the Trust in view of 0% value added tax for delivered medication.
Methods A delivery scheme began in June 2011. 60% of patients on ART chose to enter it. 3 months later, however, failed deliveries were reported. This continued despite efforts to rectify issues with the delivery provider.
In November 2011, an alternative provider, with greater experience in ART, was recruited. Now, 15 months later, the scheme continues successfully, with 55% of patients on ART entered.
Outcomes: Initial patient survey identified potential concerns regarding entering the scheme - firstly, reliability of timing of medication delivery and secondly, protection of patient identifiable information.
The convenience of not waiting for ART to be dispensed in the hospital pharmacy is a key patient reported benefit. From the hospital perspective, home delivery is resulting in savings of £9300 per month. Additionally, there is less pharmacy storage space consumption.
Additional administration time consumption, however, is noted in ‘trouble-shooting’ and coordinating the process.
Conclusion We propose that with good interagency and MDT working, an efficient and effective ART delivery service is feasible, with patient and hospital benefits. Collaborative approaches between the delivery service and HIV MDT should be established and regularly evaluated with patient input. Identifying a key contact person for the delivery service is important to ensure continuity of communication, together with a local contractual service level agreement to ensure clear terms of reference and accountability. Results of a qualitative patient survey evaluating the delivery service are imminent.
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