A feasibility study to explore the introduction of a remotely controlled medication issuing machine during the out-of-hours period in rural and under-served areas of Wales: the REmote MEdication maDe easY (REMEDY) study—study protocol

Abstract Background Patients have difficulties accessing medications promptly following out-of-hours remote consultations when local pharmacies are closed. Delaying initiation of medications may turn a minor condition into a serious one with both clinical and economic implications. This is a particular problem in rural and socially deprived areas of Wales. One solution is a remotely controlled machine allowing medication supply to patients (REMEDY). This project will undertake a feasibility study of the impact of REMEDY machines in Dolgellau and Holyhead. Aims We will use the NASSS framework, within case study methodology, to undertake a feasibility study which aims to (1) explore whether such machines have the potential to improve access to medications during the out-of-hours period; (2) capture user experience in accessing and using the technology, including the fidelity of use, and feedback into machine and service developments; (3) examine the potential for patient harm arising from the use of the machine over standard methods of care; (4) provide a detailed description of the operationalisation of the machine in the out-of-hours context and develop methods and resources to optimise this for future rollout; and (5) inform methods for a future definitive study to assess the effectiveness and cost-effectiveness of implementing the REMEDY machine within the National Health Service (NHS) Wales out-of-hours system. Methods A mixed-methods feasibility study will be undertaken, guided by the NASSS framework, and health economic decision analytic modelling. Data sources will include qualitative (interviews with stakeholders, Out-of-Hours and NHS111 Wales staff, and patients and their carers; public meetings with local community members; documents (e.g. plans, business cases); ethnographic observation of REMEDY machine use), and quantitative (surveys of patients/carers; and routine data (e.g. items dispensed, machine logs, clinical data) data. The constant comparative method will be used for analysis of qualitative data, and descriptive statistics will be used to summarise quantitative data. Data collection will start in October 2025 with early insights fed back iteratively to support agile implementation. Discussion If the evaluation shows that the machine has the potential to improve access to medications and is acceptable to users, learning from this feasibility study will inform future research including the design of a definitive evaluation. Protocol registration ISRCTN 48012, Protocol date and version no. 04/09/2025 v10