Abstract
PURPOSE: To evaluate the clinical and implementation impact of "Alert System for New Prescriptions and Therapeutic Adherence Monitoring" (SANPAT), a real-time prescription alert system embedded in a structured pharmaceutical care model, aimed at optimizing antiretroviral therapy (ART) and improving medication adherence in people living with HIV (PLWH). PATIENTS AND METHODS: A quasi-experimental, before-and-after study was conducted in a hospital outpatient pharmaceutical care unit in Andalusia, Spain. Patients aged ≥50 years receiving ART were included if they had polypharmacy (≥6 concurrent medications) or demonstrated poor adherence. The pre-intervention period (Feb 2023-Jan 2024) relied on standard care without alerts. The post-intervention period (Feb 2024-Jan 2025) incorporated SANPAT, enabling pharmacists to receive real-time alerts for new prescriptions and adherence risks. Pharmaceutical interventions were classified using a validated Capacity-Motivation-Opportunity (CMO)-based taxonomy, and implementation was evaluated using the Reach, Effectiveness, Adoption, Implementation y Maintenance (RE-AIM) framework. RESULTS: A total of 153 patients were included (84 pre- and 69 post-intervention). The number of pharmacist interventions increased markedly post-intervention (from 84 to 877 events), especially in adherence support (0.0% to 47.2%) (p<0.001) and medication error prevention (0.0% to 34.7%) (p<0.001). The frequency of polypharmacy and major polypharmacy increased, while immunovirological risk markers improved (CD4 cell count<200 cells/μL decreased from 15.0% to 4.3%; detectable viral load from 20.3% to 3.6%) (p<0.001). The RE-AIM evaluation demonstrated broad reach, high adoption, improved implementation metrics, and early signs of long-term sustainability. CONCLUSION: SANPAT significantly enhanced the timely identification and resolution of pharmacotherapeutic risks in PLWH, supporting personalized interventions and optimizing ART management. Its integration within existing electronic prescribing populations.platforms and structured care models represents a scalable strategy to improve medication safety in aging and complex patients.