P156 Streamlining rifaximin access: a digital innovation for improved medication access and cost efficiency

<h3></h3> Rifaximin, indicated for reduction in recurrence of overt hepatic encephalopathy (HE), is initiated in hospital settings. In England, a shared care agreement (SCA) allows general practitioners (GPs) to continue prescriptions in community. Due to the clinical complexity of this patient population, ease of medication access is paramount. However, the majority of rifaximin prescribing occurs in hospital requiring patients to travel long distances to collect medication. This can be challenging for patients with decompensated cirrhosis; logistical challenges mean patients may miss doses and health inequalities are exacerbated for those unable to afford travel costs. Improved medication access to this vulnerable group can promote adherence, improve patient experience, and prevent admissions as a complication of missed doses. SCA referral processes lacked standardisation resulting in poor referral rates, suboptimal medication access and financial inefficiencies. This initiative aimed to streamline SCA referral process to improve referral rates and medication access. Using process mapping, automation and iterative design, a digital tool was developed to streamline SCA referrals from tertiary to primary care via a secure information governance compliant interface. Training guides were developed, and a pilot commenced at Royal Free London in May 2021. The tool was promoted through local and regional stakeholder engagement events and further user experience research informed additional iterations. Data was collected from May 2021 to June 2025.Patient selection for SCA adhered to NICE guidance. Since launch, the tool enabled referrals for 100% (150) of suitable patients with a clear audit trail at each stage of the pathway offering previously unavailable insights. GP response rates were lower than anticipated (55.3%) but acceptance rates were high (84.3%) currently shifting £186,600 drug costs p.a. from tertiary care. 60% of currently accepted referrals are outside the local Integrated Care System providing care closer to home and financial benefits to the local health economy. Administrative burden significantly reduced, with SCA referral process time decreasing from over 30 minutes to approximately 5 minutes per referral. This proof-of-concept project focusing on digitising and automating pathways to improve medication access in primary care, successfully addressed challenges associated with rifaximin prescribing, providing a robust, auditable, and efficient pathway for SCA referrals. The improved process resulted in care closer to home, cost savings to the local health economy, and aligns with multiple national policy drivers. Ongoing engagement with primary care, technical advancements, and expansion possibilities demonstrate a sustainable and scalable model for seamless specialist-to-GP referrals for other drugs requiring SCAs.