Presentation
Using Co-Design to Establish a Workflow for Administration of Long-Acting Cabotegravir + Rilpivirine in Outpatient Pharmacies
SessionPoster Session 1
DescriptionLong-acting cabotegravir and rilpivirine (LA CAB/RPV), the first fully injectable antiretroviral therapy (ART) for people living with HIV (PWH), is administered intramuscularly typically by a nurse in an infectious disease clinic. There are limitations to this approach and alternate models of care are needed to improve access to LA CAB/RPV. We used a participatory approach to co-design (CD) a workflow adapting in-clinic administration of LA CAB/RPV to community pharmacies.
Method
The study took place at an academically-affiliated safety net hospital. Our CD design team consisted of 12 members, including HIV providers, pharmacists, nurses, an informaticist, and PWH receiving LA CAB/RPV. The team met weekly for 5 sessions to delineate current practices and iteratively produce a modified workflow.
We conducted semi-structured interviews with members of the CD design team to identify barriers and facilitators to the CD process. Interviews were conducted by trained members of the study team upon completion of the five CD sessions. Interviews were recorded and transcribed verbatim for qualitative analysis. An iterative approach to coding and theme identification was used involving two trained coders with experience in qualitative approaches.
Results
Through CD sessions, four key tasks and three required design elements emerged as necessary in administering long acting injectables (LAI) in the outpatient pharmacy. These include: referral to pharmacy, transition to pharmacy, pre-injection work, and injection visit. Three design elements emerged as necessary characteristics to retain in the modified workflow for LAI in outpatient. These characteristics include the need to patient privacy and confidentiality, LA CAB/RPV care coordination housed within the infectious disease department, and convenience of the pharmacy, were identified by the CD team. Key tasks and design elements were integrated into the redesigned workflow for LA CAB/RPV administration in outpatient pharmacies.
Six design team members participated in a semi-structured interview evaluating CD practices. Four themes emerged for successful CD. First, meeting modality created essential infrastructure for collaboration with in-person interactions enabling more effective engagement. Second, strategic leadership shaped the process with atomization of a complex workflow into manageable steps which involved work between meetings to frame and organize discoveries. Third, team composition and inclusivity enriched the process where multidisciplinary representation contributed critical insights. Last, collaborative humility fostered participation across power differentials aiding the integration of expertise from all participants.
Conclusions
Using CD, we were able to adapt the workflow for in-clinic administration of LA CAB/RPV to community pharmacies. Structural, compositional and interpersonal team factors contributed to the successful co-design process.
Method
The study took place at an academically-affiliated safety net hospital. Our CD design team consisted of 12 members, including HIV providers, pharmacists, nurses, an informaticist, and PWH receiving LA CAB/RPV. The team met weekly for 5 sessions to delineate current practices and iteratively produce a modified workflow.
We conducted semi-structured interviews with members of the CD design team to identify barriers and facilitators to the CD process. Interviews were conducted by trained members of the study team upon completion of the five CD sessions. Interviews were recorded and transcribed verbatim for qualitative analysis. An iterative approach to coding and theme identification was used involving two trained coders with experience in qualitative approaches.
Results
Through CD sessions, four key tasks and three required design elements emerged as necessary in administering long acting injectables (LAI) in the outpatient pharmacy. These include: referral to pharmacy, transition to pharmacy, pre-injection work, and injection visit. Three design elements emerged as necessary characteristics to retain in the modified workflow for LAI in outpatient. These characteristics include the need to patient privacy and confidentiality, LA CAB/RPV care coordination housed within the infectious disease department, and convenience of the pharmacy, were identified by the CD team. Key tasks and design elements were integrated into the redesigned workflow for LA CAB/RPV administration in outpatient pharmacies.
Six design team members participated in a semi-structured interview evaluating CD practices. Four themes emerged for successful CD. First, meeting modality created essential infrastructure for collaboration with in-person interactions enabling more effective engagement. Second, strategic leadership shaped the process with atomization of a complex workflow into manageable steps which involved work between meetings to frame and organize discoveries. Third, team composition and inclusivity enriched the process where multidisciplinary representation contributed critical insights. Last, collaborative humility fostered participation across power differentials aiding the integration of expertise from all participants.
Conclusions
Using CD, we were able to adapt the workflow for in-clinic administration of LA CAB/RPV to community pharmacies. Structural, compositional and interpersonal team factors contributed to the successful co-design process.
Event Type
Poster Presentation
TimeMonday, March 234:45pm - 6:15pm EDT
LocationRhinelander Gallery
Hospital Environments