Implementation of BRIDGE (Building Rural medication safety through Interdisciplinary, Data-driven, clinical Governance focused on Equity): A Feasibility Study

1. Intervention: This feasibility study evaluates a technology-enabled intervention designed to support medication safety within five rural general practice. The intervention consists of deploying a health information technology framework to evaluate how rural general practice systems can identify and track care pathways for patients meeting predefined medication-risk metrics. It also facilitates GP–pharmacist communication and coordinated referrals through a secure tracking system, supporting referral completion, pharmacist feedback to GPs, and improved patient understanding and management of their medicines. The tools include: 1.1. Electronic case-finding: The BRIDGE research team collaborated with PenCS to co-develop and integrate a cloud-based electronic case-finding dashboard (PenCS-BRIDGE) within general practice systems. The dashboard systematically identifies priority patients using prescribing-related medication safety indicators and Australian HMR referral criteria. 1.2. Coordinated care workflow: In collaboration with Simple HealthCare Solutions, the study will utilise a secure, dedicated digital tracking platform (HMR Tracker by Simple HealthCare Solutions) to facilitate GP-pharmacist communication, streamline the referral pathway, monitor referral completion, and securely transmit pharmacist feedback reports to the general practitioners (GPs). Indicators used in the development of case-finding tool: 1. Co-prescriptions of medicines with renal risk (e.g., (Angiotensin-Converting Enzyme inhibitors/Angiotensin Receptor Blockers, diuretics, Non-Steroidal Anti-inflammatory Drugs, lithium, quinolones, sulfonamide, etc). 2. Long-term antipsychotics and no fasting serum lipids in the previous 6 months (olanzapine) and in the previous 12 months (all others). 3. Asthma/ Chronic Obstructive Pulmonary Disease and no record of influenza vaccine in the previous year. 4. Co-prescription of falls/fractures risk medications (e.g., opioid, benzodiazepine, antidepressants, antihypertensives) 5. Co-prescription of opioid and benzodiazepine for 3 months or more 6. 65 years (or older) with a history of falls/fracture with co-prescription of falls/fracture risk medications (e.g., opioid, benzodiazepine, antidepressants, antihypertensives etc.) 7. Co-prescription of QT prolonging drugs (e.g., amiodarone, haloperidol, fluconazole, citalopram etc.) 8. Myocardial infarction or heart failure with a prescription of Non-Steroidal Anti-inflammatory Drugs 9. Long-term PPI therapy (more than 8 weeks) without a history of gastrointestinal ulcer or use of high-risk medications (e.g., antithrombotic) 2. Who will deliver the intervention? The intervention is a software-and-workflow feasibility utilised by existing clinic staff within their routine operational roles: 2.1 Practice Staff (Nurses and GPs): Access the case-finding dashboard and tracking platforms to evaluate how these tools fit into existing daily practice activities. 2.2 Credentialed Pharmacists: Practice nominated credentialed pharmacists will access the HMR tracker to interact with GP generated medication review referrals and will provide feedback documentation to the GPs. Practice nurses will support patient identification, workflow coordination, and implementation processes within the practice. Participating GPs will facilitate HMR workflows, by engaging with eligible patients to start the HMR review process, submit the referral letter and discuss the HMR report with the patient, so that medication management strategies are agreed. 2.3 Technology Partners (PenCS and Simple HealthCare Solutions): Deliver the software installation, technical optimisation, and standardised user training to the participating clinic staff 3. Mode of Delivery: The intervention is delivered entirely at the organisational level via remote digital health delivery methods: 3.1 Technical Deployment: Remote software configuration and deployment into the existing IT infrastructure of the five participating clinics. 3.2 Provider Training: Delivered virtually via Microsoft Teams through a mix of structured group training and tailored one-on-one technical walkthroughs for the practice staff. All training sessions will be delivered by Simple HealthCare Solutions and PenCS team. There is no patient-level recruitment, no patient-facing intervention, and no direct clinical delivery by the research team; evaluation relies solely on the analysis of aggregated, de-identified practice data. At the practice level, the HMR consultation will be delivered as an individual consultation between the patient and credentialed pharmacist followed by patient-GP interaction and may occur face-to-face or via telehealth, depending on patient preference, clinical appropriateness, and service arrangements. 4. Time duration: The feasibility intervention timeline is structured as follows: 4.1 Practice Onboarding: A single 30–45 minute virtual onboarding session per practice. 4.2 IT Installation: A single 30–60 minute remote software installation and calibration session per practice. 4.3 Technical Training: A single 120-minute virtual group training session for practice staff, supplemented by remote, ad-hoc technical support throughout the active study period as requested by the sites. 4.4 Data Collection Window: The software tools remain active in the clinics for the duration of the feasibility trial window (June 2026-Dec 2026) to gather automated metrics on system utility and aggregated workflow data. At the practice level, participants will receive one HMR consultation with the credentialed pharmacist (approximately 45–60 minutes), followed by a GP review appointment (approximately 10-15 minutes) to discuss recommendations and ongoing management. Duration of the broader intervention workflow, including referral and follow-up processes, will align with routine clinical care. Research team will not be involved in this process. 5. Location: 5.1 Technical Training and Support: Conducted virtually/remotely. 5.2 System Deployment: Embedded digitally within the local or cloud-based clinical server environments of the five participating rural general practice clinics At the practice-pharmacist level, the BRIDGE HMR consultation may be conducted at the general practice clinic, or at a mutually convenient location, or via telehealth, depending on patient preference, accessibility, and local practice arrangements. Research team will not be involved in this process. 6. Compliance and Adherence monitoring: 6.1 Practice-Level Feasibility Monitoring: Technical adherence, system usability, and workflow barriers are documented by the participating practices using a standardized digital implementation log. 6.2 Automated Workflow Triggers: To support the natural integration of the tool without creating administrative burden, the system utilizes pre-existing, automated clinic infrastructure. This includes evaluating the use of targeted SMS notifications sent automatically through the clinic's medical management system to eligible patients who have a pre-existing appointment scheduled at the practice. 6.3 Data collection: The HMR provides automated, backend aggregate level number of HMR referrals generated and completion rates.