Telepharmacy


 

Telepharmacy

Telepharmacy

 

Introduction of Telepharmacy

  • During the 20th century, the use of information and telecommunication technologies has expanded at a rapid rate.
  • This expansion has strongly influenced healthcare delivery in many countries. The availability of the Internet has created more informed consumers who demand more of healthcare professionals.
  • However, a shortage of healthcare services and trained healthcare professionals.
  • Additionally, this shortage in the rural and regional areas, often hinders appropriate treatment and care for patients.
  • Rural communities have limited access to vital healthcare services, at least in part because of the closure of local pharmacies.
  • Losing the only retail pharmacy within a rural community can influence the access to prescription and over-the-counter medications.
  • In addition to, some cases, such as leave the community without proximate access to any clinical healthcare provider.
  • Pharmacies that currently operate in remote areas face the problem of service sustainability because of recruitment and retention of pharmacists.

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All this lead to difficulties in creating succession plans

  • As such, residents have to either drive to the nearest pharmacy or use mail order or online services to fill their prescription.
  • Moreover, it is a particular concern for frail individuals with limited mobility and limited support or without the connection/competence of information technology.
  • Technology has emerged as a potential mean to overcome some of these obstacles to patient care.
  • Telemedicine, particularly telepharmacy, appears to be an enabling technology that represents a unique and innovative way to deliver quality pharmacy services to rural and regional areas particularly.
  • Telepharmacy enables healthcare services such as medication review, patients counseling.
  • Importantly, the use in the prescription verification by a qualified pharmacist for the patients located at a distance from a remotely located hospital.

Telemedicine

  • The term “tele” originated from the Greek word “Telos” meaning “at a distance” and the term “medicine” derived from a Latin word “Meden” meaning “to heal”.
  • This technology devised to provide healthcare services to medically deprived population in geographically remote locations.
  • Additionally, it will help from long-distance medical centers.
  • Telemedicine has been defined by the World Health Organization as the delivery of healthcare services.
  • In addition, when the distance is a critical factor, by all healthcare professionals using information and communication technologies.
  • It is used for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation.
  • Additionally, used for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities.

 

Telemedicine involves a diverse range of technologies and applications.

  • The most commonly described telemedicine practice is those involving the use of telephones, videoconference, and the Internet.
  • Telemedical programs and consultations are gaining popularity each year since treatments via telemedical programs.
  • Additionally, it seems to achieve similar outputs as those obtained through face-to-face care.
  • Advancements in digital communication, data compression technologies.
  • In addition, the digitalisation processes have enabled the development of low-band width personal computer-based videoconference

Telepharmacy

  • Telepharmacy, analogous to telemedicine, is a more recent concept that refers to pharmaceutical service provision.
  • Additionally, the National Association of Boards of Pharmacy defines “telepharmacy” as “the provision of pharmaceutical care.
  • This is through the use of telecommunications and information technologies to patients at a distance”.
  • However, the telepharmacy delivers clinical pharmacy services and the dispensing of a prescription at a remote location without the physical presence of a pharmacist.
  • Typical telepharmacy involves services such as medication order review, dispensing and compounding.
  • Additionally, the drug information services, patient counseling, and therapeutic drug monitoring.
  • Hence, telepharmacy uses state-of-the-art technology that allows a qualified pharmacist situated at a central location.
  • This has been adopted by many healthcare institutions.
  • As an alternative strategy of extending pharmacy coverage in areas where 24-hours pharmacy services are not available.
  • The emerging electronic health information systems and related technologies, such as fax, and electronic health records.
  • These technologies are advancing telepharmacy services and enabling pharmacist to contribute efficiently in improving medication use.

Involvement of Pharmacists in Telepharmacy

  • In any telepharmacy model, pharmacist can play an active role in the delivery of pharmacy services.
  • The pharmacist involving in telepharmacy models ensures high quality care for the community particularly areas such as medication reviews and patient counseling.
  • A 2013 study of the impact of telepharmacy services has shown that the involvement of pharmacists in the remote review of medication orders.
  • Additionally, when the hospital pharmacy closed resulted in a decreased number of adverse drug events reported.
  • Adverse drug events and other medication error contribute to several thousand deaths each year.

The annual cost of preventable adverse drug events in the USA is estimated at US$2 billion.

  • Similarly, a 2012 US study has shown that adverse patient outcomes including prolonged hospitalisation.
  • Additionally, the cost of potential death may have been prevented using telepharmacy services.
  • For example, potential alternatives to around-the-clock on-site pharmacist medication review for rural hospitals.
  • With the growing population of patients with chronic medical conditions.
  • All around the world involvement of pharmacists in telepharmacy models to improve monitoring.
  • Additionally, it encourages medication compliance can decrease the risk of medication errors, adverse drug events.
  • Moreover, it decreased medication cost, and the chances for treatment failure.
  • This means that we need to be cautious of some of the telepharmacy models that often exclude active pharmacist involvement including Internet pharmacies.

Types of Telepharmacy Services & Solutions

To gain a better understanding of telepharmacy, it is worth taking a moment to identify the different types of telepharmacy services, of which there are many. In its statement on telepharmacy, ASHP highlights four applications. They are as follows:

  1. Medication selection, order review, and dispensing
  2. Intravenous (IV) admixture verification
  3. Patient counseling and monitoring
  4. Clinical services

Other telepharmacy services regularly referenced include drug review/monitoring, verification of oral and sterile compounding, patient assessment, and medication therapy management.

Advantages and Disadvantages of Telepharmacy Services

Advantages

Expanded access to pharmacy services

  • People with certain underlying medical conditions that place them at increased risk for severe illness from COVID-19.
  • Additionally, it limited interactions with other people as much as possible.
  • Telepharmacy is allowing many people in this situation to receive pharmacy services without increasing their risk of exposure by meeting with a pharmacist.

Increased medication adherence

  • The Agency for Healthcare Research and Quality  (AHRQ) published a chart identifying common barriers to medication adherence.
  • The approach it takes is to explain what patients may say as reasons they struggle with medication adherence and then share suggestions to address these reasons.
  • Additionally, there is some sound advice provided in the chart, it fails to mention telepharmacy.
  • For “My medicine makes me feel sick,” patients who know they can receive assistance via telepharmacy rather than needing to make a trip to a pharmacy may be more motivated to seek assistance faster.
  • That same logic can be applied to three other quotes:

1) “I can’t afford my medicine. I only take half a pill a day to save money;”

2) “I can’t understand these instructions;”

3) “There are so many pills. I can’t keep them straight! It’s too complicated.”

Telepharmacy Helps Knowing

  • Patient education by pharmacist counseling is just a phone call or video conference away.
  • It helps to improve adherence versus maintaining a regimen that’s not conducive to adherence.
  • Telepharmacy eliminates the need for an in-person discussion about a patient’s regimen.
  • Additionally, it is considering most pharmacies now deliver medications.
  • However, there is no need for patients to go to the pharmacy to pick up their prescriptions, which further addresses that challenge.
  • Two other benefits associated with telepharmacy can also help improve adherence: increased patient satisfaction and cost savings.
  • When patients can access and receive positive support and timely information from pharmacists, which can be delivered effectively via telepharmacy.

 

Extending pharmacy support

  • While many of telepharmacy’s benefits apply to patients, healthcare providers benefit as well.
  • One way is through the ability of organizations to leverage telepharmacy to extend pharmacy coverage and support.
  • For example, some hospitals do not offer 24-hour pharmacy services.
  • A 2012 national survey of hospitals conducted by the National Association of Boards of Pharmacy found that roughly one-third of hospital pharmacies lack such coverage.
  • As an Integrated Pharmacy Research and Practice article notes.
  • Telepharmacy acts as a potential alternative to around-the-clock on-site pharmacist medication review for remote hospitals.

 

Electronic health information systems and Telepharmacy

  • The emerging electronic health information systems and related technologies.
  • Such as fax, and electronic health records make information more readily available to pharmacist for review before a dose is available for administration to a patient.
  • Additionally, those technologies are advancing telepharmacy services and enabling pharmacist to contribute efficiently to improving medication use.
  • Other hospitals provide 24-hour coverage but with reduced staffing during slower hours (e.g., overnight).
  • Then there are those hospitals that maintain consistent 24-hour coverage but do so with a lean staff.
  • Telepharmacy can provide off-hours support to hospitals that take the former approach and can give surge support or fill in when short staffing.
  • As the American Society of Health-System Pharmacists (ASHP) notes, Telepharmacy provides a solution for order review.
  • Additionally, it verifies tertiary medical centres when staffing.
  • This is in speciality areas such as oncology and paediatrics, which are limited (e.g., due to attrition or staff turnover).
  • Moreover, it is creating a mechanism for health systems to provide enterprise-level pharmacy services.

 

High level of quality pharmacy services

  • Not only does telepharmacy provide the benefits described above and many others.
  • However, a multi-year study found that pharmacies rely on telepharmacy services.
  • Pharmacists were more likely to find medication dispensing errors during a final medication check than at standard community pharmacies.
  • This study performed several years back.
  • Since then, technology has dramatically improved.
  • This includes technology to help pharmacists identify errors and better support patients.
  • For example, medication counselling, adherence management, medication reconciliation, and drug therapy monitoring.
  • As well as technology used to communicate with patients.
  • Telepharmacists can leverage a wide range of audio and video solutions to interact with patients and clinicians.
  • Therefore, there is reason to believe that the quality of telepharmacy services has also improved.

Disadvantages of Telepharmacy

Qualifications:

  • Telepharmacy is complex and requires a team of technology-empowered, licensed and experienced pharmacy experts.
  • For this reason, partnering with a telepharmacy provider with the right level of expertise and background is critically important.

Location:

  • There might be a touch of irony to the fact that telepharmacy is best delivered by a pharmacy team in one place.
  • However, it makes a measurable difference having highly qualified pros in one place working together on your behalf.
  • Additionally, concentrate on your goals and objectives and serve the pharmacy needs of your patients.
  • However, most telepharmacy providers have a home-based workforce or work from other remote locations, creating barriers to effective team collaboration.

What Were Some of the Innovative Methods Used by Pharmacies to Implement Telepharmacy?

  • Innovative methods arose to enhance the implementation of telepharmacy during the COVID-19 pandemic and life thereafter.
  • The idea of a “digital health ecosystem”—where clients, providers, healthcare institutions and digital healthcare devices are interconnected in a digital health environment.
  • It has the goal to improve the well-being of individuals and families — developed.
  • Collectively, expert opinion and guideline articles mentioned that innovation of applications.
  • For example, the use of an Electronic Medical Record (EMR) system or APOmondo can serve as portals to ensure security and patient confidentiality.

 

SEHA Application of Telepharmacy

  • A similar application called SEHA created by the Kingdom of Saudi Arabia to provide visual medical consultations.
  • A case study from the U.S. reported developing patient resources to help set up and prepare the patient for a telepharmacy visit.
  • Resources also created by professional associations, regulatory bodies.
  • Additionally, its use in  the universities to assist healthcare professionals in conducting virtual consultations.
  • One article also reported the use of a geriatric-specific telemedicine consultation device known as GeriMedRisk.

 

Case studies in telepharmacy

  • Case studies and original research articles similarly mentioned innovation of applications.
  • For example, WeChat, one of the largest social communication mobile platforms in China, to provide relevant pharmaceutical care.
  • A case study from Spain reported the use of integrating geo-location for efficient delivery of medicines.
  • Research from Spain and the United Arab Emirates reported using a telephone survey to measure patient satisfaction.
  • Additionally, it evaluated the effectiveness of telepharmacy by examining the rate of dispensing errors and the number and nature of pharmacists’ interventions.

 

Another Netherlands Study of Telepharmacy

  • Another study from the Netherlands reported increased use of online patient education tools and online refill prescriptions.
  • Lastly, review articles focused on proper initiatives such as contacting legislation and policy makers to enhance policies to aid pharmacists to play an essential role in telepharmacy.
  • The use of telepharmacy can have an increased return on investment with improved productivity and efficiency.
  • Besides, it improved the patient compliance to telepharmacy visits and can advance the practice.
  • Additionally, increased use of telepharmacy can also increase the use of electronic prescriptions.
  • The online ordering of pharmaceutical products, thus eventually resulting in safe dispensing and distribution of medications.
  • In the long term, experts recommended educating federal and state policymakers on pharmacies’ fair.
  • Additionally, the equitable access to programs and opportunities to advance the profession and recognize pharmacists as healthcare providers

Impact of COVID-19 on Telepharmacy

  • One of the few silver linings from the pandemic is the increased adoption and embracing of telehealth, including telepharmacy.
  • The use of virtual care services was experiencing a gradual increase before the health crisis.
  • However, the lockdowns and stay-at-home orders, coupled with the rapid removal of regulatory hurdles, led to a surge in the number of telehealth visits.
  • A survey of 1,000 patients by software company Kyruus found that 72% of respondents experienced their first virtual care visit during the pandemic.
  • The broader concept of telehealth largely received the bulk of the attention during the initial weeks of the pandemic as healthcare providers.
  • Additionally, the insurance companies, employers, vendors, the federal government, state governments.
  • Now that the concept of telehealth is more widely known and appreciated, increased attention is being paid to specific types of telehealth, including telepharmacy.

Examples of Telepharmacy

  • For example, telepharmacy highlighted by the Centers for Disease Control (CDC) and Prevention in its guidance for pharmacists in community pharmacies during the COVID-19 response:
  • “Pharmacists who are providing patients with chronic disease management services, medication management services, and other services that do not require face-to-face encounters should make every effort to use telephone, telehealth, or telepharmacy strategies.”
  • In response to the pandemic, the Drug Enforcement Administration issued guidelines intended to make it easier for prescribers to gets patients controlled substances through telemedicine.
  • Many states loosened rules concerning the delivery of telehealth services, including those provided by pharmacists.
  • The American Pharmacists Association (APhA) noted, “Just like telemedicine, telepharmacy is essential during the COVID-19 crisis.
  • Telepharmacy is making a difference during the crisis.

Telepharmacy: A Potential Alternative Approach for Diabetic Patients During the COVID-19 Pandemic

  • Telepharmacy as an alternative healthcare method is becoming a new approach to providing pharmacist care.
  • For example, the support with drug management for chronic conditions.
  • The use of communication and information technology in pharmaceutical practice is not a new concept.
  • In fact, based on published evidence, this practice has been carried out for 20 years.
  • However, until now there have not been many articles discussing and summarising the evidence of the impact of providing pharmaceutical services via this technology.
  • Telepharmacy is effective in providing care for DM patients, especially during the COVID-19 pandemic when direct care is not possible.
  • The use of telepharmacy for the treatment of diabetic patients has been shown to be successful in positively improving clinical outcomes and patient adherence to therapy.
  • The use of telepharmacy has also succeeded in overcoming restrictions on routine visits for diabetic patients to healthcare facilities.

Innovations in practice: Telepharmacy’s time has arrived

  • The current COVID-19 pandemic crisis has presented pharmacists with many challenges as well as opportunities to enhance and expand their practice.
  • One of these areas is telepharmacy or the provision of pharmacy services using telephone or videoconferencing technology.
  • Some use the term telehealth, which is the broader umbrella term encompassing the transfer of any health care information via electronic communication.
  • Virtual consulting is one of the health service provisions under this umbrella.
  • In general, virtual consultations are appropriate for low-risk patients with access to technology and the ability to consent to this type of appointment.
  • As well, the patient should not have any overt memory or sensory impairment or anxiety about the technology or platform being used.

Video visit and counseling

  • Not every consult requires a video visit, particularly if the patient is comfortable receiving information by phone, and has no significant hearing impairments.
  • However, it will often be necessary to have visual contact with the patient, either to gauge their understanding.
  • Additionally, it demonstrated something, such as how to use a new inhaler; or to view their adherence packaging.
  • Performing complicated medication histories often requires visual contact.
  • As patients may have difficulty pronouncing drug names and it may be easier for them to show the vial or tablet via video, for example.
  • In a situation where the pharmacist needs to witness and document the ingestion of opioid agonist therapy such as methadone.
  • However, the patient is quarantined, a combination of medication delivery and video consult might support continued therapy.

Future for Telepharmacy

Remote Sterile Compounding

  • One of the newest expansions is using remote verification for sterile IV compounding at the University of North Carolina (UNC).
  • The Pyxis system uses gravimetric-based technology to weigh and verify compounded products.
  • The system images the compounding process, which is typically managed by a technician and reviewed by a local pharmacist.
  • Because the onsite pharmacist was using images generated by the system, there was no obvious difference between reviewing images in the next room or 25 miles away.
  • Results of the 90-day trial demonstrated no difference in accuracy or safety for remote versus local oversight, and resulted in an annualised cost savings of nearly $24,800.

Secure Medication Storage

  •  When Arizona approved telepharmacy in 2018, I provided a solution and 2 more problems.
  • One was security. Most telepharmacy operations he visited had a single technician handling the entire operation.
  •  The second problem was space.
  • State telepharmacy regulations required at least 300 square feet. The only available space at the Congress clinic was 125 square feet.
  •  His solution was RxSafe, a secure medication storage unit that can hold about 1300 medication vials.
  • The unit weighs every container coming out and going back into storage to verify the medication removed for each prescription.
  •  “Combining telepharmacy and RxSafe answered alot of questions.”
  • “We can stock just about everything our providers write in the limited space, and I know the location is safe for our tech. The technologies work well together.”

A Pharmacist in Every Room

  • Walgreens is investing $1 billion to support up to 700 new Village Medical primary care clinics at its locations by 2025. Other consults will likely come via telepharmacy.
  • We can utilize telepharmacy and telehealth technology by taking an iPad or tablet into any exam room.
  • Additionally, by having a conversation between the pharmacist, physician, and patient anywhere, anytime.”
  • The telepharmacy technology already exists and VillageMD already has a focus on pharmacy integration.
  • Patients with multiple chronic disease states or those who use multiple pharmacies have an elevated risk of therapy failure.
  • These patients already receive in-person or telephonic pharmacy consults, as do discharged and homebound patients.

Telepharmacy can further expand this reach.

  • Pharmacists in these settings have full access to patient electronic medical records, a common communication platform with clinicians, and collaborative practice agreements with delegated prescribing authority.
  • “We are taking full financial risk for many Medicare patients”.
  • “The physicians here understand that the best way, the only way, to successfully improve outcomes and reduce costs is by having pharmacists directly integrated into the care team.
  • Having a pharmacist on the care team is integral to our success and telepharmacy can help make that integration happen.”

ASHP statement of Telepharmacy

  • ASHP believes appropriately trained and equipped pharmacists can use telepharmacy to remotely oversee pharmacy operations.
  • Additionally, the telepharmacy provides distributive, clinical, analytical, and managerial services.
  • The ASHP advocates that telepharmacy be applied to suitable functions of pharmacy operations and patient care to improve patient outcomes.
  • Moreover, it expanded the access to healthcare, and enhance patient safety.
  • ASHP further advocates that boards of pharmacy adopt compatible regulations that enable the use of U.S.-based telepharmacy services.

Telepharmacy Infrastructure

  • The technology infrastructure required for the implementation and maintenance of telepharmacy services may be scalable and adjusted to fit the care setting.
  • Two intrasystem facilities may already share a network, a pharmacy information system, and possibly an order management system.
  • In contrast, the intersystem model provides telepharmacy services to a facility external to the health system.
  • Audiovisual equipment used to verify pharmaceutical products at the remote facility must include high-resolution cameras.
  • While most states do not require video rather than still imaging.
  • It is also suggested that equipment be mounted on a mobile cart to be used in the medication preparation area.
  • Additionally, another equipments at the automated dispensing cabinet, or at the patient’s bedside.
  • The ASHP supports the utilisation of  calibrated digital telemedicine devices within health systems.

Security of Information and Equipment

  • The security and integrity of patient data are of paramount importance when determining the information technology setup of a telepharmacy system.
  • Secure access to patient records at the remote site is required by the central site; however, patient records at the central site should be inaccessible from the remote site.
  • The remote site must restrict access to the telepharmacy so that only those employees directly involved in processing medication orders.
  • Moreover, no employees should be allowed access to the remote telepharmacy site when the pharmacy at the central site is closed.
  • Not all states allow pharmacists to work from sites that are not licensed as pharmacies, including home-based practices and corporate environments.
  • State regulations must be considered when developing a telepharmacy service or expanding the service across state lines.
  • Allow access to the electronic medical record, and workstation session per AH5 after periods of inactivity.

5 Reasons of Outpatient Telepharmacy

Help improve medication adherence

  • It’s been reported that only 50% – 70% of prescriptions are filled.
  • It’s also been reported that 95% of patients fill their initial prescriptions when offered the ability to do so at the point of care.
  • Furthermore, improving medication adherence can help prevent medication-related hospital readmissions.
  • Did you know that out of 100 prescriptions, on average only 70 arrive at the pharmacy and only 30 are taken properly.

Create opportunities to generate more revenue with minimal investment

  • Expanding your outpatient pharmacy business through telepharmacy — whether in hospitals, clinics or as standalone retail sites — can help generate more revenue and drive growth.
  • The collaborative staffing model allows healthcare organizations to share resources across the enterprise and serve more patients cost-effectively.
  • One of the main reasons outpatient telepharmacy makes sense is that it costs less to operate than a traditional pharmacy, and lower investment means lower risk.

Improve the patient experience

  • Outpatient tele-pharmacies are a convenient way for patients to fill their prescriptions when located inside hospitals or clinics.
  • TelePharm’s software requires that the pharmacist counsels the patient before any prescriptions are dispensed.
  • This gives pharmacists access to patients before they leave the point of care, and pharmacist-led patient education can help reduce medication-related readmissions and improve health outcomes.
  • Additionally, offering timely and efficient centralise refill services helps contribute to a better overall experience for patients.
  • Outpatient telepharmacy can also help healthcare organizations manage population health by integrating pharmacists into outpatient care teams.

Provide access to specialists

  • Participating in retail telepharmacy enables health systems to gain experience buying .
  • In addition, the billing for the outpatient drugs and managing complex chronic disease patients in the outpatient setting.
  • Health-system pharmacies can use live-and-interactive video counseling technology to connect their specialists to patients throughout the network.

Improve continuity of care

  • According to a Johns Hopkins University study, poor continuity of care results in the overuse of unnecessary procedures and diagnostics and costs the U.S. billions each year.
  • If the goal of integrating patient medical information across all providers and settings is better health outcomes, retail remote dispensing can help you get there.
  • Outpatient telepharmacy can start to close the patient-care loop by ensuring a smooth flow of information between providers and settings.
  • It enables specialists to provide remote discharge counseling at the bedside and delivering convenient pharmaceutical care remotely when necessary.
  • Including pharmacists as part of the patient-care team will reap dividends far beyond capturing more prescriptions.
  • Hospitals judged on adherence, readmissions and overall patient satisfaction.
  • Outpatient telepharmacy is a cost-effective tool health systems can use to improve the overall healthcare experience.

The Benefits of Telepharmacy in Clinics

  • With tele-pharmacies located on-site and in clinics.
  • Additionally, the delivery of pharmacy services became streamlined, making it more accessible and efficient for patients.
  • While allowing the providers to communicate clearly and thoroughly with patients and their caregivers on dosing regimens
  • As they are ensuring patients have a clear understanding of proper adherence before ever leaving the presence of their physician and pharmacy team.
  • Let’s examine in more depth just how tele-pharmacies in clinics help to solve issues and provide value for all parties involve.

Patient Benefits

Convenience (Enhanced level of attention and care from pharmacist and physician)

  • For patients, the convenience alone is a huge benefit, as patients no longer have to make the additional trips to their nearest pharmacy
  • Whether it be down the block, or 20 miles away.
  • Instead patients can get their needs met in one place at one time.
  • The benefits of course extend beyond the convenience factor.
  • When patients get their medications in a timely manner with proper education.
  • This is including instructions regarding adherence from both their physician and pharmacist.
  • Additionally, they are much more likely to actually be adherent.
  • When patients are adherent, they stay healthier and out of the hospital, helping them to feel better, live longer, and avoid unnecessary medical bills.

Pharmacist Benefits

Reach more patients (Cost-effectively expand pharmacy footprint)

  • When pharmacies partner with clinics to operate a telepharmacy on-site.
  • It allows the pharmacists to reach a new patient group and provide them with convenient access to their pharmacy services.
  • If patients are more adherent, there are more prescriptions being filled, which is a win-win for all pharmacies and patients involved.
  • The managing pharmacy can count on filling the majority of prescriptions for patients of that clinic.
  • Additionally, partnering with a clinic proves to be a very cost-effective way for pharmacies to expand their footprint and increase volume.
  • As with any retail telepharmacy setup, sharing the pharmacist between the host.
  • Pharmacy and the telepharmacy is an efficient way to maintain a low-volume pharmacy location.

Clinic/Physician Benefits

  • Provide maximum convenience for patients
  • Boost clinic Star ratings and benefit compensation rates
  • Enhance patient care and outcomes through collaboration with pharmacy team
  • When clinics provide this one-stop convenience for patients, it makes patients happy and (hopefully) loyal.
  • It’s fast, familiar, and easy.
  • That’s a winning formula for making customers happy and keeping them around for a long time.
  • When physicians are able to ensure patients are filling their prescriptions.
  • Additionally, patients are knowledgeable about their regimens, it will lead to better outcomes, which is great for the clinic.
  • For those clinics with value-based compensation rates, ensuring optimal outcomes is important also to the bottom line.
  • Lastly, by bridging the clinic-pharmacy gap, clinics improve their overall collaboration across the patient care team.

Developing a Telepharmacy program with home medication dispensing

  • A study aimed to describe the actions taken to implement a telepharmacy programme.
  • It also aimed to substantiate the applicability and benefits of the programme through analysing the findings and measuring patient satisfaction.
  • In Spain, telepharmacy has reduced the necessity for patients to travel to hospital centres during the COVID-19 pandemic.
  • As well as ensuring treatment continuity with hospital-dispensed medication.
  • In the study period, 24 incidents with the delivery service recorded, half of them occurred because the patient was not at home.
  • This highlights one of the limitations of the home delivery model.
  • In the same way, this analysis shows the potential benefit that telepharmacy with home medication dispensing.
  • Additionally, it ensures the delivery that present in terms of patient satisfaction.
  • It is a replicable method that is applicable in other pharmacy services with similar characteristics and requirements.

3 Reasons Why Your Next Pharmacy Should be a Telepharmacy

Reimbursements are still declining

  • As a pharmacy director/owner, you understand slim margins all too well.
  • Insurance plans and pharmacy benefit managers (PBMs) largely control margins on medications, and reimbursements continue to become obsolete.
  • In addition to slim margins, cost mandates at the federal, state and local level can result in halted growth and, in some cases, an independent pharmacy closure.
  •  In fact, it’s not unusual for a pharmacy to sell many prescriptions of which they actually take a net loss each day.
  • Telepharmacy is appealing because a remote-dispensing site, or retail telepharmacy, costs less to operate than a traditional pharmacy.
  • That leads us to our next point.

A cost-effective pharmacy solution

  • Beyond prescription reimbursements, operating costs play a major role in the profitability of your pharmacy business.
  • Whether you’re thinking about opening a new pharmacy in a rural community, inside or near a health system or clinic or in a medically underserved urban area.
  • Telepharmacy is more cost-effective than a traditional pharmacy.
  • A telepharmacy provides all the care services that a traditional pharmacy does, and can be operate in areas where a traditional pharmacy is not feasible.
  • A retail telepharmacy site costs less to operate than a traditional pharmacy because you are sharing a pharmacist across multiple locations.
  • Additionally, it maximize pharmacists’ time and maximize bottom line.

Patients demand convenience

  • In the age of consumer-driven healthcare, offering seamless, convenient pharmaceutical services can be a differentiator for patients and health outcomes.
  • Through remote telepharmacy sites, you bring pharmacy care.
  • Additionally, it raises the expertise of a pharmacist to patients instead of them traveling upwards of 30 minutes to their nearest pharmacy.
  • Convenient tele-pharmacies create a better patient experience which helps distinguish your pharmacy from that of a big chain.

Telepharmacy and quality of medication use

  • Pharmacy closures in rural areas is an increasingly common problem.
  • Closures disrupt medication access and decrease adherence to prescription medications.
  • Additionally, telepharmacy is a potential solution to this problem.
  • However, research on the relationship between telepharmacy and the quality of medication use is scarce.
  • They estimated the differences between tele-pharmacies serving rural areas and traditional pharmacies using generalised linear regression.
  • The study found that the quality of medication use at tele-pharmacies that serve rural areas was no worse than at traditional pharmacies.

Telepharmacy and medication adherence

There are four ways telepharmacy can help improve medication adherence.

(Convenience)

  • If your community has a provider but no pharmacy, you may have to travel 25+ minutes to the nearest city in order to fill your prescriptions.
  • That’s inconvenient and can lead to higher rates of patient non-adherence.
  • Telehealth services, like telepharmacy, offer us the ability to bring care to patients the same way that doctors used to make house calls.
  • The bottom line: patients are demanding that care comes to them.
  • Through tele-pharmacies, or remote-dispensing sites, we can make the pharmacist more accessible to patients in rural communities (as well as underserved urban areas).

(Hospital readmission rates)

  • Hospitals need to focus on curing the patient as a whole (value-based care) and not just treating their current symptom.
  • Additionally, health systems operating on-site tele-pharmacies can reduce readmission rates through convenient.
  • The point-of-care dispensing and increased patient education.
  • The bottom line: in 2015, 3 out of every 4 hospitals experienced a Medicare reimbursement penalty.
  • That cost, along with the cost of poor medication adherence, can be reduced through telepharmacy.

(Creating a relationship with pharmacy staff)

  • Imagine any setting where you could use the skills and expertise of a pharmacist. Telepharmacy allows that vision to become a reality.
  • Through telepharmacy, pharmacists are able to influence patient outcomes like never before.
  • The bottom line: by increasing access to pharmacy-care services through telepharmacy.
  • Additionally, we’re allowing patients to establish a relationship with a pharmacist.

(Focus on Clinical Activities)

  • Nearly ⅓ of patients report that the pharmacist looked too busy to speak with them about their personal medical concerns.
  • Through telepharmacy, pharmacists are able to shift their focus to more clinical activities.
  • By getting out from “behind the counter,” pharmacists can perform immunisations, CMRs, TIPs and various health-testing services.
  • The bottom line: telepharmacy frees up the pharmacist from behind-the-counter activities.
  • So they can utilise their expertise to impact health outcomes through clinical activities. 

Opportunities in Telepharmacy

  • Telepharmacy is more than just phoning it in.
  • It could expand the number of jobs for pharmacists and their access to patients who are otherwise out of reach.
  • Telepharmacy is gaining momentum as more pharmacies seek ways to extend their regular business hours.
  • Additionally, it grow their scope of services, or capture a greater share of the market.
  • This is true across the board-for pharmacies in rural communities, in specialty clinics, and in emergency departments.
  • For pharmacists, this growing interest in telepharmacy translates to more job opportunities.
  • However, a chance to further demonstrate the value pharmacists can have as an important member of the health-care team.
  • Telepharmacy has been touted as one strategy to preserve pharmacist jobs and expand access to patients, especially in rural areas.

Telepharmacy Value

  • However, experts say rural communities aren’t the only place where telepharmacy can have value.
  • Chain, health-system, and independent pharmacies can also use telepharmacy to extend their regular business hours.
  • Besides, it enters new areas of the market-such as HIV clinics.
  • Increasingly, there’s this idea that access is an issue.
  • Additionally, not only in remote locations but also in urban settings or places where it would be good to have pharmacy services available.
  • Additionally, it’s not really economically feasible to put a pharmacy practice.
  • More state boards of pharmacy are examining telepharmacy regulations.
  • Because of a growing demand for more telepharmacy service opportunities from pharmacies, health-care providers, and employer groups.

 

He has seen boards examine two different types of telepharmacy models:

  • The traditional telepharmacy models, where a brick and mortar pharmacy is staffed by a technician who is supervised remotely by a pharmacists.
  • Automated dispensing systems that are monitored or used remotely by a pharmacist.

How telepharmacy creates jobs and expands opportunities

Creating Jobs

  • Experts say telepharmacy solutions can be a win for pharmacies and pharmacists.
  • The telepharmacy actually creates more opportunities for pharmacists in areas that never would have been able to fully support a pharmacist before.
  • Every time we can add a telepharmacy to these towns, it creates part of a job for a pharmacist.
  • It allows them to have those scripts, it allows them to reach into those communities.
  • Every patient who improves adherence-improves  the number of prescriptions that are filled-each one improves the number of pharmacists who are needed.
  • The most common of these two models is using telepharmacy to support small hospitals, which either don’t have a pharmacist or don’t have round-the-clock coverage.
  • They go from having no pharmacist at times to having 24/7 pharmacist coverage, so certainly that’s added jobs.
  • Many hospitals hadn’t even heard of the concept of telepharmacy.

Expanded Opportunities

  • The potential of telepharmacy isn’t restricted to job creation. Experts say it also gives pharmacists more opportunities to practice at the top of their license.
  • By design, telepharmacies rely on technicians to fill prescriptions and for other non-clinical tasks.
  • Pharmacists can spend more time on counseling and other patient-focused responsibilities.
  • Every time a pharmacist can interact with a patient, there’s a better chance to have an intervention to improve drug therapy, to demonstrate the pharmacist’s value.
  • I definitely think it’s a tool to reach into communities that otherwise would not have access to pharmacist services. That’s really how we look at telepharmacy.
  • Finding time to counsel patients at both stores naturally weaves into her work flow.
  • She spends the same amount of time, if not more time, counseling those patients at the telepharmacy site compared to her traditional pharmacy.
  • I think now it’s very user-friendly and patients are pretty happy with it.

Expanded patient access

  • We can also utilise this technology to improve the efficiency that we can have with our pharmacist.
  • Additionally, we can free up our pharmacist’s time to focus on the clinical tasks.

Challenges face telepharmacy

  • Chains, health systems, and independents have seen advantages to the telepharmacy model, but experts acknowledge that there are still obstacles that prevent more widespread adoption of the strategy.
  • Some states are great. The way their laws are written, the board has the authority to allow pilot projects and other such things to test technology. 
  • Some don’t even have the statutory approval to operate a telepharmacy.
  • He said Cardinal Health is focusing on educating regulators and legislators to try to give more states the opportunity to use telepharmacy as a strategy within their state.
  • Another challenge is to ensure that high-caliber technicians are employed at these sites.
  • Since they will be operating at a separate location from the pharmacist who supervise them.
  •  You really have to go out on a limb and trust them and trust that they are doing everything in a way you would want it to be done.
  • We’ve gotten very lucky. We have great staff able to do that.
  • Barker said finding physical space to house telepharmacies can also be a challenge in some areas due to limited available retail space.

Some automated telepharmacies

  • Finally, some automated telepharmacies could  face challenges related to the distribution of controlled substances via automated technology.
  • This is less of a concern for brick and mortar telepharmacy buildings.
  • However, a challenge for those telepharmacies relying on automated dispensing systems.
  • It’s something that I think the DEA will eventually come around to, but they move slowly in terms of embracing technology.
  • Despite the challenges, those in the industry said they expect telepharmacy to continue to grow, further extending a pharmacist’s reach in patient care.

A Day in the Life of a Telepharmacist

  •  The majority of telepharmacy, is the time spent juggling patients at both sites. She shares what a typical day is like for her as a telepharmacist.
  • TelePharm software that connects her to the audio and visual system that supports the telepharmacy.
  • She does a test call with her technician to ensure the equipment is working properly.
  • When a prescription needs to be filled at the telepharmacy site, it notified by a sound that goes off to signal there’s a waiting prescription.
  • We first verify the prescription.
  • We check it for accuracy, just like we would at a typical pharmacy, and then all of their patient profile, medication history, allergies.
  • All of that comes across as part of their telepharmacy profile, so we check all of that.
  • If it’s a new prescription or she feels a consultation is necessary.

 

Telepharmacist presses a button to mark the exchange as a consult.

  • Additionally, she is able to provide the consult over a tablet that the technician provides to the patient.
  • It looks like you are Skyping with someone except I have the drug information pulled up on the right hand side as they are picking up the drug.
  • The patient is also able to request a consult at any time, and typically patients call from both of telepharmacies in Iowa.
  • They are placed into a pool that one of three pharmacists who monitor the system are able to answer.
  • If a problem or concern is identified with a prescription.
  • Additionally, there’s a chat option that allows the pharmacist to converse with the technician.
  • In addition, it notifies the technician and patient that the pharmacist plans to call the doctor.

Phone a pharmacist: Telepharmacy services at freestanding emergency departments

  • Emergency medicine (EM) pharmacists have demonstrated the ability to intercept and prevent medication errors in the emergency department (ED).
  • Additionally, it plays a critical role in the provision of safe and effective pharmacotherapy in this high-risk patient care environment.
  • Between 2011 and 2018, the number of institutions reporting dedicated EM pharmacists in hospital-based EDs increased from 10.9% to 32.4% as reported in an American Society of Health-System Pharmacists (ASHP) annual survey.
  • The expansion of EM pharmacy services in hospital-based EDs has been evident.
  • However, its inclusion of such services in freestanding emergency departments has not been routinely adopted.
  • Freestanding emergency departments (FSED) are defined as licensed facilities that provide emergency care but that are structurally separate and distinct from hospitals.

 

Financial Consideration of Telepharmacy

  • There are additional regulatory and financial considerations that have resulted in geographic clustering of telepharmacy in certain states (Texas, Ohio, and Colorado).
  • Strategic placement in communities with higher proportions of patients with commercial insurance.
  • Use of telehealth services, or telepharmacy, may increase the availability of select EM pharmacy services in FSEDs.
  • This is a retrospective chart review conducted in three FSEDs that are part of a large health system.
  • EM pharmacists provide remote clinical coverage for the FSEDs.
  • The clinical significance of a random sample of drug therapy recommendations rated using a validated scale.
  • Data analysed descriptively and a weighted Kappa statistic calculated to assess inter-rater reliability.
  • EM pharmacists provided clinically significant drug therapy recommendations through telepharmacy services which may represent a novel approach to optimise patient care.

Conclusion

  • During the 20th century, the use of information and telecommunication technologies has expanded at a rapid rate.
  • Pharmacies that currently operate in remote areas face the problem of service sustainability.
  • Telemedicine, particularly telepharmacy, appears to be an enabling technology that represents a unique and innovative way to deliver quality pharmacy services to rural and regional areas particularly.

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